1st Post-European Headache Federation Meeting: a review of the latest developments presented at the 2020 European Headache Federation Congress. / I Reunión Post-European Headache Federation: revisión de las novedades presentadas en el Congreso de la European Headache Federation de 2020.

INTRODUCTION: After the European Headache Federation (EHF) Congress, renowned Spanish neurologists specialised in migraine presented the most significant latest developments in research in this field at the Post-EHF Meeting. DEVELOPMENT: The main data presented concerning the treatment of chronic and episodic migraine were addressed, with attention paid more specifically to those related to preventive treatments and real-life experience in the management of the disease. An important review was carried out of the new therapeutic targets and the possibilities they offer in terms of understanding the pathophysiology of migraine and its treatment. An update was also presented of the latest developments in the treatment of migraine with fremanezumab, a monoclonal antibody recently authorised by the European Medicines Agency. Participants were also given an update on the latest developments in basic research on the pathology, as well as an overview of the symptoms of migraine and COVID-19. Finally, the repercussions of migraine in terms of its burden on the care and economic resources of the health system were addressed, along with its impact on society. CONCLUSIONS: The meeting summarised the content presented at the 14th EHF Congress, which took place in late June/early July 2020.

TITLE: I Reunión Post-European Headache Federation: revisión de las novedades presentadas en el Congreso de la European Headache Federation de 2020.Introducción. Tras la celebración del congreso de la European Headache Federation (EHF), reconocidos neurólogos españoles expertos en el tratamiento de la migraña expusieron en la Reunión Post-EHF las principales novedades presentadas en el congreso y relacionadas con ese ámbito. Desarrollo. Se abordan los principales datos presentados relacionados con el tratamiento de la migraña crónica y episódica; concretamente, los relacionados con los tratamientos preventivos y la experiencia en vida real en el manejo de la enfermedad. Se hizo una importante revisión de las nuevas dianas terapéuticas y las posibilidades que ofrecen en cuanto al conocimiento de la fisiopatología de la migraña y su tratamiento. Asimismo, se hizo una actualización de las novedades presentadas en el tratamiento de la migraña con fremanezumab, anticuerpo monoclonal recientemente autorizado por la Agencia Europea de Medicamentos. Se hizo una actualización de las novedades en investigación básica en la patología, así como una relación de los síntomas de migraña y COVID-19. Finalmente, se abordaron las implicaciones de la migraña en la carga sanitaria asistencial y económica, y su impacto en la sociedad. Conclusiones. En la reunión se hizo un resumen del contenido presentado en el 14 Congreso de la EHF, que tuvo lugar a finales de junio y principios de julio de 2020.

Guía consenso sobre técnicas de infiltración anestésica de nervios pericraneales / Consensus recommendations for anaesthetic peripheral nerve block

Introducción: Los bloqueos anestésicos constituyen un recurso terapéutico para el manejo de distintos dolores de cabeza, de forma aislada o combinado con otros tratamientos. Sin embargo, existe una importante heterogeneidad en los patrones de uso entre los distintos profesionales. Desarrollo: A partir de una exhaustiva revisión y análisis de la bibliografía existente y de nuestra experiencia clínica se ha elaborado este documento de consenso cuyo objetivo es servir como guía para aquellos profesionales que quieran aplicar estas técnicas. Se establecen recomendaciones basadas en los niveles de evidencia que ofrecen los estudios revisados en migraña, cefaleas trigémino-autonómicas, cefalea cervicogénica y neuralgias pericraneales. Se describen los principales aspectos técnicos y formales de los diferentes procedimientos, así como las posibles reacciones adversas que pueden surgir y la actitud recomendada. Conclusiones: El tratamiento con bloqueos anestésicos del paciente con cefalea debe ser siempre individualizado y basarse en una correcta anamnesis, exploración neurológica y ejecución técnica (AU)

Introduction: Anaesthetic block, alone or in combination with other treatments, represents a therapeutic resource for treating different types of headaches. However, there is significant heterogeneity in patterns of use among different professionals. Development: This consensus document has been drafted after a thorough review and analysis of the existing literature and our own clinical experience. The aim of this document is to serve as guidelines for professionals applying anaesthetic blocks. Recommendations are based on the levels of evidence of published studies on migraine, trigeminal autonomic cephalalgias, cervicogenic headache, and pericranial neuralgias. We describe the main technical and formal considerations of the different procedures, the potential adverse reactions, and the recommended approach. Conclusion: Anaesthetic block in patients with headache should always be individualised and based on a thorough medical history, a complete neurological examination, and expert technical execution (AU)

Consensus recommendations for anaesthetic peripheral nerve block. / Guía consenso sobre técnicas de infiltración anestésica de nervios pericraneales.

INTRODUCTION: Anaesthetic block, alone or in combination with other treatments, represents a therapeutic resource for treating different types of headaches. However, there is significant heterogeneity in patterns of use among different professionals. DEVELOPMENT: This consensus document has been drafted after a thorough review and analysis of the existing literature and our own clinical experience. The aim of this document is to serve as guidelines for professionals applying anaesthetic blocks. Recommendations are based on the levels of evidence of published studies on migraine, trigeminal autonomic cephalalgias, cervicogenic headache, and pericranial neuralgias. We describe the main technical and formal considerations of the different procedures, the potential adverse reactions, and the recommended approach. CONCLUSION: Anaesthetic block in patients with headache should always be individualised and based on a thorough medical history, a complete neurological examination, and expert technical execution.

[Triptans in clinical practice: effectiveness, tolerance and patient's satisfaction with medication (TRIPRACLI study)]. / Los triptanes en la practica clinica: eficacia, tolerancia y satisfaccion del paciente con los farmacos (estudio TRIPRACLI).

INTRODUCTION AND AIMS: This study was aimed determining the effectiveness, tolerance and satisfaction of patients with migraine as regards different triptans, according to the characteristics of their attacks. At the same time it sought to establish a predictive model that can be used to recommend one or another, depending on those characteristics. PATIENTS AND METHODS: Retrospective observation-based study conducted in headache units in a number of different centres. Patients included in the study were those with migraine who used the same triptan to treat their attacks. Data concerning preference, effectiveness, speed and tolerance were analysed. RESULTS: The analysis included 160 patients (88 females), with a mean age of 42.92 years. The most commonly used triptans were eletriptan, almotriptan and rizatriptan. Both patients and doctors reported a high degree of satisfaction (88% and 65%) with the triptan that was used. In the surveys on preference, patients preferred their current triptan to the previous one (83%) or to non-specific drugs. The overall score on a visual analogue scale was above 7 for all the triptans, without any differences from one to another. On analysing the use of a particular triptan depending on the characteristics of the attacks, no statistically significant differences were found. CONCLUSIONS: In this selected group of patients, triptans are a treatment that patients claim to be very satisfied with. Although there are no overall differences in the scores among different triptans, the fact that certain triptans are used more by patients after previous experiences with others suggests that they are more effective. We did not find any parameter that predicts the use of a particular triptan.

[A study to compare independent groups of patients with episodic migraine who were treated preventively with flunarizine or nadolol]. / Estudio comparativo de grupos independientes de pacientes con migrana episodica tratados preventivamente con flunaricina o nadolol.

INTRODUCTION. Flunarizine, with level of evidence A, and nadolol, with evidence level C, would be indicated as preventive treatment of migraine. Yet, no previous studies have been conducted to compare the effectiveness of the two drugs. AIM. To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study, the same protocol being applied in both cases. PATIENTS AND METHODS. The subjects selected for the study were patients with episodic migraine (according to 2004 International Headache Society criteria) who had undergone preventive treatment for the first time, with flunarizine (5 mg/day) or nadolol (20-40 mg/day). The main effectiveness variables (reduction in the number of seizures at four months of treatment and responder rates) were analysed. RESULTS. The study included 227 patients who intended to receive treatment: 155 with flunarizine (80.5% females; mean age: 38.3 ± 12.1 years) and 72 with nadolol (63.8% females; mean age: 37.1 ± 12.0 years). The mean number of seizures prior to treatment was 6.09 ± 2.6 in the flunarizine group and 5.1 ± 1.7 in the nadolol group (p = 0.0079); at four months of treatment it was 2.61 ± 2.4 in the flunarizine group and 2.77 ± 2.4 in the nadolol group (p = NS). Percentage of reduction of migraines: 55.2% with flunarizine and 50.4% with nadolol (p = NS). The responder rate was 69% with flunarizine and 67% with nadolol (p = NS). The excellent response rate (reduction in the number of seizures by 75% or more) was 52.2% with flunarizine and 36.1% with nadolol (p = 0.0077). Percentage of adverse side effects: 48.3% with flunarizine and 25% with nadolol (p = 0.0009). The satisfaction rate was similar in both groups, 68%. CONCLUSIONS. Both flunarizine and nadolol proved to be effective in the preventive treatment of episodic migraine. Flunarizine is used more often in our milieu and was less well tolerated.

Estudio de la demanda de electromiografía en un hospital general básico / A study of the demand for electromyography in a general hospital

No disponible

No disponible

[Evolution of the demand for ambulatory neurological care and pathologies attended in neurology clinics in the health care district of Tortosa, Tarragona]. / Evolución de la demanda de asistencia neurológica ambulatoria y patología atendida en la consulta de neurología de la región sanitaria de Tortosa, Tarragona.

AIMS: An analysis was conducted to determine whether there were any changes in the demand for health care, demography and pathologies attended in outpatient departments within the health care district of Tortosa between 1997 and 2003. PATIENTS AND METHODS: Data about the demand for and attendance at first neurology visits over the period 1997 and from March 2003 to February 2004 was collected prospectively. Information concerning age, sex, groups of pathologies, diagnoses, rates of requests for first visits, source of the demand and destination after the visit were compared. RESULTS: Mean age rose from 49 to 56 years (p < 0.001). Patients above 70 years of age increased from 23.7% to 35.9% (p < 0.001), while in the population within the area the figure only rose from 15.8 to 17.1%. The proportion of females went up from 52 to 62% (p < 0.001). Demand (that is, the rate of requests for first visits per 1000 inhabitants per year among those over the age of 15) rose from 8.5 to 9.3, 9.8% (p = 0.03). Demand from primary care increased from 52 to 69% (p < 0.001). Cognitive disorders (6.5% and 15.9%) grew by 144.6% (p < 0.001). Headaches (23.9% and 24.1%), the largest diagnostic group, and non-neurological diagnoses (18% and 18.5%) remained unchanged (p = NS). No changes were observed in the number of discharges in the first visit: 22.8% and 21.1% (p = NS). CONCLUSIONS: The most striking results are the increase in demand (mainly from primary care), the increased age of the population attended and the notable growth in the number of cognitive disorders. These quantitative and qualitative changes in the demand increase the need for resources.

Evolución de la demanda de asistencia neurológica ambulatoria y patología atendida en la consulta de neurología de la región sanitaria de Tortosa, Tarragona / Evolution of the demand for ambulatory neurological care and pathologies attended in neurology clinics in the health care district of Tortosa, Tarragona

Objetivos. Se analiza si existen cambios en la demanda de asistencia, demografía y patología atendida en las consultas externas de neurología de la región sanitaria de Tortosa entre 1997 y 2003. Pacientes y métodos. Se recogieron prospectivamente los datos de la demanda y asistencia de las primeras visitas de neurología los períodos de 1997 y marzo del 2003 a febrero de 2004. Se compararon edad, sexo, grupos de patologías, diagnósticos, índices de solicitud de primera visita, origen de la demanda y destino tras la visita. Resultados. La edad media creció de 49 a 56 años (p < 0,001). Los pacientes mayores de 70 años aumentaron del 23,7% al 35,9% (p < 0,001), mientras en la población del área sólo del 15,8 al 17,1%. La proporción de mujeres pasó del 52 al 62% (p < 0,001). La demanda (índice de solicitudes de primeras visitas/1.000 habitantes y año mayores de 15 años) creció del 8,5 al 9,3, un 9,8% (p = 0,03). La demanda desde atención primaria creció del 52 al 69% (p < 0,001). Los trastornos cognitivos (6,5% y 15,9%) crecieron un 144,6% (p < 0,001). Las cefaleas (23,9% y 24,1%), el mayor grupo diagnóstico, y los diagnósticos no neurológicos (18% y 18,5%) se mantienen (p = NS). Las altas en primera visita no cambian, 22,8% y 21,1% (p = NS). Conclusiones. Destaca el aumento de la demanda, fundamentalmente desde atención primaria, el aumento de edad de la población atendida y el marcado incremento de los trastornos cognitivos. Estos cambios cuantitativos y cualitativos de la demanda incrementan las necesidades de recursos (AU)

Aims. An analysis was conducted to determine whether there were any changes in the demand for health care, demography and pathologies attended in outpatient departments within the health care district of Tortosa between 1997 and 2003. Patients and methods. Data about the demand for and attendance at first neurology visits over the period 1997 and from March 2003 to February 2004 was collected prospectively. Information concerning age, sex, groups of pathologies, diagnoses, rates of requests for first visits, source of the demand and destination after the visit were compared. Results. Mean age rose from 49 to 56 years (p < 0.001). Patients above 70 years of age increased from 23.7% to 35.9% (p < 0.001), while in the population within the area the figure only rose from 15.8 to 17.1%. The proportion of females went up from 52 to 62% (p < 0.001). Demand (that is, the rate of requests for first visits per 1000 inhabitants per year among those over the age of 15) rose from 8.5 to 9.3, 9.8% (p = 0,03). Demand from primary care increased from 52 to 69% (p < 0.001). Cognitive disorders (6.5% and 15.9%) grew by 144.6% (p < 0.001). Headaches (23.9% and 24.1%), the largest diagnostic group, and non-neurological diagnoses (18% and 18.5%) remained unchanged (p = NS). No changes were observed in the number of discharges in the first visit: 22.8% and 21.1% (p = NS). Conclusions. The most striking results are the increase in demand (mainly from primary care), the increased age of the population attended and the notable growth in the number of cognitive disorders. These quantitative and qualitative changes in the demand increase the need for resources (AU)

Carcinomatosis meníngea / Meningeal carcinomatosis

Introducción. La carcinomatosis meníngea es una complicación grave de los tumores sólidos, en particular de los adenocarcinomas de mama, pulmón y melanoma. Objetivo. En este trabajo presentamos una revisión bibliográfica de esta enfermedad, con especial atención a los aspectos etiopatogénicos, clínicos -sobre todo otoneuroftalmológicos-, diagnósticos y terapéuticos. Desarrollo. La carcinomatosis meníngea se presenta en fases avanzadas del cáncer y tiene un pronóstico ominoso con una supervivencia media sin tratamiento de cuatro a seis semanas. Su frecuencia ha aumentado en los últimos años debido a la mayor longevidad de los pacientes con cáncer sistémico. La característica de la enfermedad es la afectación de diversos niveles del sistema nervioso, con síntomas encefálicos, de nervios craneales o espinales y medulares.Una pérdida de visión o audición de instauración brusca o rápidamente progresiva puede ser la manifestación inicial de la enfermedad. Estudios de neuroimagen (tomografía axial computarizada, resonancia magnética y estudios isotópicos de flujo del líquido cefalorraquídeo) son necesarios para valorar metástasis asociadas y detectar obstrucción del flujo licuoral. La obtención de citología licuoral positiva confirma el diagnóstico. El tratamiento debe ser individualizado según el estado clínico y la naturaleza tumoral y debe combinar quimioterapia intratecal y radioterapia local, aunque estudios recientes obtienen buenos resultados con quimioterapia sistémica. Conclusión. Se requiere un alto índice de sospecha clínica para el diagnóstico de esta infrecuente enfermedad, con la demostración de signos neurológicos en distintos niveles y la obtención de células malignas en líquido cefalorraquídeo para su confirmación diagnóstica (AU)

[Meningeal carcinomatosis]. / Carcinomatosis meníngea.

INTRODUCTION: Meningeal carcinomatosis is a serious complication of solid tumors, particularly adenocarcinomas of breast, lung and melanoma. OBJECTIVE: In this paper we present a review of the bibliography on this disease, with particular emphasis on etiopathogenic, clinical--especially otoneurophthalmological--diagnostic and therapeutic aspects. DEVELOPMENT: Meningeal carcinomatosis presents in advanced stages of cancer and has an ominous prognosis with average untreated survival of from four to six weeks. Its frequency has increased in recent years since patients with systemic cancer now live longer. The characteristic of the disease is involvement of various levels of the nervous system, including encephalic, cranial or spinal nerve and spinal symptoms. Sudden loss of vision or hearing which may progress rapidly may be the initial sign of the disease. Neuroimaging studies (computerized axial tomography, magnetic resonance and isotope studies of cerebrospinal fluid flow) are necessary to evaluate associated metastases and detect obstruction of cerebrospinal fluid flow. Positive cerebrospinal fluid cytological findings confirm the diagnosis. Treatment should be tailored to the individual according to the clinical condition and nature of the tumour and should combine intrathecal chemotherapy and local radiotherapy, although recent studies have shown good results with systemic chemotherapy. CONCLUSION: A high degree of clinical suspicion is necessary for diagnosis of this uncommon disease, with neurological signs show to be present at different levels and the finding of malignant cells in the cerebrospinal fluid for confirmation of the diagnosis.

[Treatment of Guillain-barre syndrome: immunoglobulins or plasmapheresis?]. / Tratamiento del síndrome de Guillain-Barré: inmunoglobulinas o plasmaféresis?

The aim of this study was to compare the efficacy of IgIV versus plasmapheresis in the treatment of Guillain-Barré syndrome. Twenty-four Guillain-Barré patients were treated either with IgIV (n = 17), or plasmapheresis (n = 7). Evolution during the first year after onset were assessed using the motor functional scale of Hughes and nerve conduction studies. IgIV treated patients had better functional recovery than the plasmapheresis group (p < 0.05) and shorter hospital stays (p < 0.05). These differences were significant from day 30 after treatment. Complications occurred in 14 patients: 9 (58%) in the IgIV group, and 5 (71%) in the patients treated with plasmapheresis. IgIV treated patients had better functional recovery scores and shorter hospital stays. There were no differences in the complication rates. Therefore we believe that IgIV is the treatment of choice for Guillain-Barré syndrome in our clinical setting.