Epidemiología de la miastenia gravis en la provincia de Ourense (Galicia, noroeste de España) / Epidemiology of myasthenia gravis in the province of Ourense (Galicia, Spain)

Introducción: La miastenia gravis (MG) es un enfermedad autoinmune que afecta a la transmisión nerviosa a nivel de la unión neuromuscular causando debilidad muscular típicamente fluctuante. Los estudios epidemiológicos constatan un aumento de las tasas de prevalencia de la MG y es especialmente evidente en la población anciana.ObjetivoRealizar un estudio epidemiológico retrospectivo para conocer las tasas de incidencia y prevalencia en la provincia de Ourense (Galicia) caracterizada por el envejecimiento poblacional.Material y métodosLos pacientes fueron reclutados de nuestra base de datos clínica de enfermedades neuromusculares y a través de la búsqueda de pacientes con prescripción activa de bromuro de piridostigmina. La tasa de incidencia se estimó entre los años 2009-2018. Se estableció la fecha de prevalencia al 31/12/2018. El censo de la provincia de Ourense al 1/1/2019 era de 307.651 habitantes, de los que 96.544 (31,4%) tenían una edad ≥ de 65 años.ResultadosSe identificaron 80 casos de MG. La prevalencia fue de 260 casos/1.000.000 habitantes (IC95%: 202,7-316,4), y en la población ≥ 65 años de 517,9/1.000.000 habitantes (IC95%: 363,2-672,9). La incidencia acumulada en el periodo de estudio fue de 15,4 casos/1.000.000 habitantes-año. El inicio precoz (≤ 50 años) ocurrió en el 29,1% de los casos.ConclusiónLa prevalencia de la MG en nuestra área sanitaria es de las más altas entre las cifras previamente reportadas, y es una enfermedad muy prevalente en la población anciana. (AU)

Introduction: Myasthenia gravis (MG) is an autoimmune disease affecting nerve transmission at the level of the neuromuscular junction, and typically causes fluctuating muscle weakness. Epidemiological studies show an increase in MG prevalence, particularly among the older population.ObjectiveWe performed a retrospective epidemiological study to determine the incidence and prevalence of MG in the province of Ourense (Galicia, Spain), characterised by population ageing.Material and methodsPatients were selected from our clinical neuromuscular diseases database by searching for patients with an active prescription for pyridostigmine bromide. Incidence was estimated for the period 2009-2018. We calculated prevalence at 31/12/2018. According to census data for the province of Ourense, the population on 1/1/2019 was 307,651, of whom 96,544 (31.4%) were aged ≥ 65 years.ResultsWe identified 80 cases of MG, with a prevalence rate of 260 cases/1 000 000 population (95% CI, 202.7-316.4), rising to 517.9/1 000 000 population in those aged ≥ 65 (95% CI, 363.2-672.9). Cumulative incidence in the study period was 15.4 cases per 1 000 000 person-years. Early onset (≤ 50 years) was recorded in 29.1% of cases.ConclusionThe prevalence of MG in our health district is one of the highest published figures, and the disease is highly prevalent in the older population. (AU)

Epidemiology of myasthenia gravis in the province of Ourense (Galicia, Spain).

INTRODUCTION: Myasthenia gravis (MG) is an autoimmune disease affecting nerve transmission at the level of the neuromuscular junction, and typically causes fluctuating muscle weakness. Epidemiological studies show an increase in MG prevalence, particularly among the older population. OBJECTIVE: We performed a retrospective epidemiological study to determine the incidence and prevalence of MG in the province of Ourense (Galicia, Spain), characterised by population ageing. MATERIAL AND METHODS: Patients were selected from our clinical neuromuscular diseases database by searching for patients with an active prescription for pyridostigmine bromide. Incidence was estimated for the period 2009-2018. We calculated prevalence at 31/12/2018. According to census data for the province of Ourense, the population on 1/1/2019 was 307 651, of whom 96 544 (31.4%) were aged ≥ 65 years. RESULTS: We identified 80 cases of MG, with a prevalence rate of 260 cases/1 000 000 population (95% CI, 202.7-316.4), rising to 517.9/1 000 000 population in those aged ≥ 65 (95% CI, 363.2-672.9). Cumulative incidence in the study period was 15.4 cases per 1 000 000 person-years. Early onset (≤ 50 years) was recorded in 29.1% of cases. CONCLUSION: The prevalence of MG in our health district is one of the highest published figures, and the disease is highly prevalent in the older population.

Epidemiology of myasthenia gravis in the province of Ourense (Galicia, Spain). / Epidemiología de la miastenia gravis en la provincia de Ourense (Galicia, noroeste de España).

INTRODUCTION: Myasthenia gravis (MG) is an autoimmune disease affecting nerve transmission at the level of the neuromuscular junction, and typically causes fluctuating muscle weakness. Epidemiological studies show an increase in MG prevalence, particularly among the older population. OBJECTIVE: We performed a retrospective epidemiological study to determine the incidence and prevalence of MG in the province of Ourense (Galicia, Spain), characterised by population ageing. MATERIAL AND METHODS: Patients were selected from our clinical neuromuscular diseases database by searching for patients with an active prescription for pyridostigmine bromide. Incidence was estimated for the period 2009-2018. We calculated prevalence at 31/12/2018. According to census data for the province of Ourense, the population on 1/1/2019 was 307,651, of whom 96,544 (31.4%) were aged ≥ 65 years. RESULTS: We identified 80 cases of MG, with a prevalence rate of 260 cases/1 000 000 population (95% CI, 202.7-316.4), rising to 517.9/1 000 000 population in those aged ≥ 65 (95% CI, 363.2-672.9). Cumulative incidence in the study period was 15.4 cases per 1 000 000 person-years. Early onset (≤ 50 years) was recorded in 29.1% of cases. CONCLUSION: The prevalence of MG in our health district is one of the highest published figures, and the disease is highly prevalent in the older population.

[The prevalence of multiple sclerosis in the city of Ourense, Galicia, in the north-west of the Iberian Peninsula]. / Prevalencia de la esclerosis múltiple en la ciudad de Ourense, Galicia, noroeste de la Península Ibérica.

INTRODUCTION: Multiple sclerosis is an inflammatory neurodegenerative disease of the central nervous system, which mainly affects young people of working and reproductive age, and represents the first cause of non-traumatic disability in this age group of the population. A north-south latitude gradient is recognised, with prevalence rates increasing as we move away from the equator. This gradient probably represents the genetic predisposition transmitted from the Scandinavian regions through the Viking invasions and could presuppose an influence of the vitamin D deficit related to a lower number of hours of sunshine per year. AIMS: To determine the prevalence and incidence of multiple sclerosis in the city of Ourense, Galicia. PATIENTS AND METHODS: The latitude coordinate of the city of Ourense is 42° 34' N. A retrospective epidemiological study covering the period from 2002 to 2016 was conducted. The prevalence date was 31 December 2016. According to the latest census, the population of the city of Ourense was 105,892 on 1 January 2016. RESULTS: Altogether, 195 cases were recorded, representing a prevalence of 184.1 cases/100,000 inhabitants. In the period 2002-2016, 127 cases of multiple sclerosis were diagnosed, representing an average incidence of 7.86 cases/100,000 inhabitants/year. CONCLUSION: The city of Ourense has the highest prevalence rate of multiple sclerosis of those studied to date in the Iberian Peninsula, with a figure that brings it closer to the data reported in more northern areas under Nordic and Anglo-American influence.

TITLE: Prevalencia de la esclerosis múltiple en la ciudad de Ourense, Galicia, noroeste de la Península Ibérica.Introducción. La esclerosis múltiple es una enfermedad inflamatoria y neurodegenerativa del sistema nervioso central, que afecta fundamentalmente a personas jóvenes en edad laboral y reproductiva, y que representa la primera causa de discapacidad no traumática en este rango etario de la población. Se reconoce un gradiente de latitud norte-sur, con un aumento de las tasas de prevalencia a medida que nos alejamos del ecuador. Este gradiente probablemente representa la predisposición genética transmitida desde las regiones escandinavas a través de las invasiones vikingas y podría presuponer una influencia del déficit de vitamina D en relación con un menor número de horas de sol anuales. Objetivo. Determinar la prevalencia e incidencia de la esclerosis múltiple en la ciudad de Ourense, Galicia. Pacientes y métodos. La ciudad de Ourense tiene una coordenada de latitud de 42° 34' N. Se ha realizado un estudio epidemiológico retrospectivo que abarca desde 2002 a 2016. La fecha de prevalencia fue el 31 de diciembre de 2016. El censo de la población de la ciudad de Ourense a 1 de enero de 2016 era de 105.892 habitantes. Resultados. Se registraron 195 casos, lo que representa una prevalencia de 184,1 casos/100.000 habitantes. En el período 2002-2016 se diagnosticaron 127 casos de esclerosis múltiple, lo que supone una incidencia media de 7,86 casos/ 100.000 habitantes/año. Conclusión. La ciudad de Ourense presenta la tasa de prevalencia de esclerosis múltiple más alta de las estudiadas hasta la actualidad en la Península Ibérica, con una cifra que la aproxima a los datos comunicados en áreas más septentrionales de influencia nórdica y anglosajona.

[Isolated dysarthria and dysphagia as the presenting symptoms of simultaneous bilateral acute lagunar ischaemic stroke]. / Disartria y disfagia aisladas como forma de presentacion de un ictus isquemico agudo lacunar bilateral y simultaneo.

TITLE: Disartria y disfagia aisladas como forma de presentacion de un ictus isquemico agudo lacunar bilateral y simultaneo.

[Trigeminal-autonomic cephalgia secondary to a spontaneous intra-orbital haematoma]. / Cefalea trigeminoautonomica secundaria a un hematoma intraorbitario espontaneo.

TITLE: Cefalea trigeminoautonomica secundaria a un hematoma intraorbitario espontaneo.

[Frequent episodic migraine and calcitonin gene-related peptide. Influence of treatment with topiramate and zonisamide on levels of the peptide]. / Migraña episodica frecuente y peptido relacionado con el gen de la calcitonina. Influencia del tratamiento con topiramato y zonisamida en los niveles del peptido.

INTRODUCTION: The pathophysiology of pain in migraine is related to the activation of the trigeminovascular system by releasing vasoactive neuropeptides, the most important of which is calcitonin gene-related peptide (CGRP), which causes a neurogenic inflammation in the leptomeningeal vessels. AIM: To study whether CGRP is increased in frequent episodic migraine and whether preventive treatment with topiramate or zonisamide modifies its levels. SUBJECTS AND METHODS: We studied 28 patients with episodic migraine with or without aura, in accordance with the International Headache Society criteria, with a frequency of 4-14 days/month. Plasma levels of CGRP were determined in all the patients during an interictal period (> 72 hours without pain). Patients were divided at random into two treatment groups, one with 50 mg/day of topiramate and the other with 50 mg/day of zonisamide, for three months. At the end of the active period the CGRP level was analysed again. The control group consisted of nine healthy subjects. RESULTS: CGRP was significantly higher in the episodic migraine group than in the control group (50.61 ± 22.5 pg/mL versus 34.96 ± 17.03 pg/mL; p = 0.037). After treatment with neuromodulators no significant differences were found in the level of CGRP (46.11 ± 24.2 pg/mL basal versus 47.5 ± 24.88 pg/mL post-treatment). Neither were any differences found on analysing the topiramate and zonisamide groups individually. CONCLUSIONS: The plasma level of CGRP is increased in episodic migraine, and its levels are not modified by treatment with low doses of topiramate or zonisamide.

TITLE: Migraña episodica frecuente y peptido relacionado con el gen de la calcitonina. Influencia del tratamiento con topiramato y zonisamida en los niveles del peptido.Introduccion. La fisiopatologia del dolor en la migraña se relaciona con la activacion del sistema trigeminovascular por medio de la liberacion de neuropeptidos vasoactivos, y el mas importante es el peptido relacionado con el gen de la calcitonina (CGRP), que causa una inflamacion neurogena en los vasos leptomeningeos. Objetivo. Investigar si el CGRP esta incrementado en la migraña episodica frecuente y si el tratamiento preventivo con topiramato o zonisamida modifica sus niveles. Sujetos y metodos. Se estudiaron 28 pacientes con migraña episodica con o sin aura, cumpliendo los criterios de la Sociedad Internacional de Cefaleas, con una frecuencia de 4-14 dias/mes. En todos los pacientes se determinaron los niveles plasmaticos del CGRP durante un periodo intercritico (> 72 h sin dolor). Los pacientes se aleatorizaron en dos grupos de tratamiento, uno con 50 mg/dia de topiramato y otro con 50 mg/dia de zonisamida, durante tres meses. Al finalizar el periodo activo se analizo nuevamente el nivel del CGRP. El grupo control lo constituyeron nueve sujetos sanos. Resultados. El CGRP fue significativamente superior en el grupo de migraña episodica comparado con el grupo control (50,61 ± 22,5 pg/mL frente a 34,96 ± 17,03 pg/mL; p = 0,037). Despues del tratamiento con neuromoduladores no se hallaron diferencias significativas en el nivel de CGRP (46,11 ± 24,2 pg/mL basal frente a 47,5 ± 24,88 pg/mL postratamiento). Tampoco se hallaron diferencias al analizar los grupos de topiramato y zonisamida de forma individualizada. Conclusiones. El nivel plasmatico del CGRP esta incrementado en la migraña episodica y sus niveles no son modificados por el tratamiento con dosis bajas de topiramato o zonisamida.