Holter STAT-ON™ against other tools for detecting MF in advanced Parkinson's disease: an observational study.

Background: Different screening tools to identify advanced Parkinson's disease (APD) have emerged in recent years. Among them, wearable medical devices, such as STAT-ON™, have been proposed to help to objectively detect APD. Objectives: To analyze the correlation between STAT-ON™ reports and other assessment tools to identify APD and to assess the accuracy of screening tools in APD patients, using the STAT-ON™ as the gold standard. Methods: In this retrospective, observational study, data from the University Hospital Complex of Pontevedra database on 44 patients with potential APD who wore STAT-ON™ were extracted. Data were collected according to different sources of tools for identifying APD: (1) STAT-ON™, (2) information provided by the patient, (3) questionnaire for advanced Parkinson's disease (CDEPA), (4) 5-2-1 Criteria, and (5) Making Informed Decisions to Aid Timely Management of Parkinson's Disease (MANAGE-PD). Considering STAT-ON™ recordings as a reference, the sensitivity, specificity, and positive and negative predictive values for each tool were calculated. The kappa index assessed the degree of agreement between the gold standard and the other instruments. Results: Although no statistically significant association was found between STAT-ON™ recordings and any screening methods evaluated, the CDEPA questionnaire demonstrated the highest sensitivity and VPN values to detect patients with APD candidates for second-line therapy (SLT). According to the correlation analyses, MANAGE-PD demonstrated the highest degree of concordance with STAT-ON™ recordings to identify the SLT indication and to predict the SLT decision. Conclusion: STAT-ON™ device may be a helpful tool to detect APD and to guide treatment decisions.

Ulises en la literatura médica / Ulysses in the medical literatura

INTRODUCCIÓN: Es frecuente el empleo de manifestaciones culturales como origen de descriptores en el campo de las ciencias de la salud. La historia de Odiseo (Ulises) es una de las obras más antiguas e influyentes de la literatura universal y ha dado lugar a múltiples creaciones posteriores, con un fuerte arraigo en la cultura popular. OBJETIVO: Ponderar el uso del relato de Odiseo en la literatura médica, describir los términos en los que se emplea y discutir la pertinencia de estos. DESARROLLO: Tras una revisión en PubMed, se hallaron 112 publicaciones de carácter médico con referencias al mito de Odiseo, de un total de 343 resultados. Se recogen hasta cinco entidades diferentes directamente nombradas a partir de Ulises (tres síndromes de Ulises, el contrato de Ulises y el conflicto de Ulises), y dos más sobre otros personajes que forman parte de su ciclo (síndrome de Elpenor y síndrome de Penélope), las cuales analizamos de forma crítica respecto al material original del que se parte. CONCLUSIONES: La historia de Odiseo constituye una de las fuentes de inspiración más frecuentes en la medicina, tanto para la elaboración de descriptores como para el empleo de símiles, metáforas u otras figuras retóricas, particularmente en el área de las neurociencias

INTRODUCTION: Cultural manifestations are frequently used as a source of descriptors in the field of the health sciences. The story of Odysseus (Ulysses) is one of the oldest and most influential works of world literature and has given rise to many subsequent creations, with strong roots in popular culture. AIMS: To consider the use of the story of Odysseus in the medical literature, to describe the terms in which it is used, and to discuss its relevance. DEVELOPMENT: From a review performed in PubMed, 112 medical publications with references to the myth of Odysseus were found, out of a total of 343 results. Five different conditions named directly after Ulysses were found (three Ulysses syndromes, the Ulysses contract and the Ulysses conflict), together with two others that have been given the names of other characters who are part of the same cycle (Elpenor syndrome and Penelope syndrome), which we analyse in a critical manner referring to the original material from which they have been taken. CONCLUSIONS: The story of Odysseus constitutes one of the most frequent sources of inspiration in medicine, both for the creation of descriptors and for the use of similes, metaphors or other rhetorical figures, particularly in the area of neuroscience

Epilepsia y lactancia materna: del mito a la realidad / Epilepsy and breastfeeding: from myth to reality

Introducción. En la práctica clínica es habitual encontrar el caso de una mujer epiléptica en tratamiento con fármacos antiepilépticos (FAE) a la que deberemos asesorar sobre la compatibilidad de esos FAE con la lactancia materna. Objetivo. Para realizar un asesoramiento correcto deberemos estar bien informados sobre las características farmacocinéticas de los diferentes FAE, así como estar al tanto de la experiencia clínica al respecto. La intención de esta revisión nace de la escasez de información a este respecto. Desarrollo. La Organización Mundial de la Salud recomienda que la lactancia materna debe ser la norma en todas las mujeres, incluso en las madres epilépticas que toman FAE, a las cuales debe prestarse siempre especial atención para vigilar la aparición de efectos adversos en el lactante, eludiendo siempre el destete brusco para evitar el síndrome de abstinencia. Conclusiones. Son muy pocos los FAE incompatibles con la lactancia materna. La decisión de amamantar debe tener en cuenta no sólo el FAE, sino su número, la dosis, los niveles séricos, los porcentajes de transmisión y eliminación en el lactante, y las condiciones del neonato. La etosuximida y el felbamato presentan un riesgo probablemente alto y son incompatibles con la lactancia materna. La lamotrigina, el fenobarbital, la pregabalina, la primidona, la tiagabina, la eslicarbacepina, el brivaracetam, el perampanel, la zonisamida, la lacosamida o el uso puntual y en bajas dosis de benzodiacepinas se consideran bastante seguros, con riesgo bajo para la lactancia. El resto de FAE presenta muy bajo riesgo para la lactancia materna

Introduction. In clinical practice, it is common to find cases of epileptic women being treated with antiepileptic drugs (AEDs) whom we have to advise on the compatibility of these AEDs with breastfeeding. Aims. In order to offer correct guidance, we must be well informed about the pharmacokinetic characteristics of the different AEDs, in addition to being aware of the clinical experience in this regard. This review stems from the paucity of information on this topic. Development. The World Health Organisation recommends that breastfeeding should be the norm for all women, even in epileptic mothers that are taking AEDs, who must always be given special attention in order to watch for the appearance of adverse effects in the infant, and always avoiding sudden weaning in order to avoid withdrawal symptoms. Conclusions. Very few AEDs are incompatible with breastfeeding. The decision to breastfeed should take into account not only the AED, but also its number, dose, serum levels, transmission and elimination rates in the infant, and the conditions of the newborn infant. Ethosuximide and felbamate are probably high risk and incompatible with breastfeeding. Lamotrigine, phenobarbital, pregabalin, primidone, tiagabine, eslicarbazepine, brivaracetam, perampanel, zonisamide, lacosamide or the sporadic use of benzodiazepines in low doses are considered quite safe, with a low risk for breastfeeding. The other AEDs present a very low risk for breastfeeding

Miastenia grave y tratamiento con inmunoglobulinas por vía intravenosa. Réplica / Myasthenia gravis and treatment with intravenous immunoglobulins. Reply

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Meningitis aséptica como complicación del tratamiento con inmunoglobulinas en la miastenia grave / Aseptic meningitis as a complication of immunoglobulin treatment in myasthenia gravis

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Fingolimod: efectividad y seguridad en la práctica clínica habitual. Estudio observacional, retrospectivo y multicéntrico en Galicia / Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in Galicia

INTRODUCCIÓN: La efectividad y seguridad del fingolimod en pacientes con esclerosis múltiple remitente recurrente (EMRR) se demostró en ensayos clínicos. Sin embargo, por las limitaciones de éstos, es importante saber cómo se comporta en condiciones de práctica clínica habitual. Así, el objetivo de este estudio es evaluar la efectividad y seguridad del fingolimod después de 12 meses de uso en la práctica clínica en Galicia. PACIENTES Y MÉTODOS: Estudio retrospectivo y multicéntrico (n = 8) de pacientes con EMRR y tratados con una o más dosis de fingolimod, 0,5 mg/día. Se evaluó la efectividad -tasa anualizada de brotes (TAB), cambio en la puntuación de la escala expandida del estado de discapacidad (EDSS), porcentaje de pacientes libres de brotes, libres de progresión de discapacidad y libres de actividad en resonancia- para el total de pacientes y según tratamiento previo. Se evaluó la seguridad a partir del porcentaje de pacientes que discontinuaron y que presentaron efectos adversos. RESULTADOS: Después de 12 meses de uso, el fingolimod redujo un 87% la TAB (de 1,7 a 0,23; p < 0,0001) y, en consecuencia, un 81% de pacientes estuvo libre de brotes. La puntuación de la EDSS disminuyó un 9%. Un 91% de pacientes estuvo libre de progresión de discapacidad y un 72%, libre de actividad en resonancia. En el 43% de los pacientes no se evidenciaron signos de la actividad de la enfermedad. La mayoría de los beneficios del fingolimod difirieron según el tratamiento previo. Alrededor de un tercio de los pacientes comunicaron efectos adversos, pero sólo el 2% discontinuó debido a ellos. CONCLUSIONES: La mayoría de los resultados de efectividad de los ensayos clínicos del fingolimod se observa durante los 12 primeros meses de tratamiento en la práctica clínica. Se observó un mejor perfil de seguridad al comunicado en los ensayos clínicos

INTRODUCTION: The effectiveness and safety of fingolimod in patients with relapsing-remitting multiple sclerosis (RRMS) have been proven in clinical trials. Yet, due to their limitations, it is important to know how it behaves under everyday clinical practice conditions. Hence, the aim of this study is to evaluate the effectiveness and safety of fingolimod after 12 months' usage in clinical practice in Galicia. PATIENTS AND METHODS: We conducted a retrospective, multi-centre study (n = 8) of patients with RRMS who were treated with one or more doses of fingolimod, 0.5 mg/day. Effectiveness was assessed -annualised relapse rate (ARR), changes in the score on the Expanded Disability Status Scale (EDSS), percentage of patients free from relapses, free from progression of disability and free from activity in resonance- for the total number of patients and according to previous treatment. Safety was assessed based on the percentage of patients who withdrew and presented adverse side effects. RESULTS: After 12 months' use, fingolimod reduced the ARR by 87% (1.7 to 0.23; p < 0.0001) and, consequently, 81% of patients were free from relapses. The score was reduced by 9%. In all, 91% of patients were free from progression of disability and 72% were free from resonance activity. No signs of disease activity were found in 43% of the PATIENTS: Most of the benefits of fingolimod differed depending on previous treatment. About a third of the patients reported adverse side effects, but only 2% of them withdrew for this reason. CONCLUSIONS: In clinical practice, most of the results on the effectiveness of the clinical trials conducted with fingolimod were observed during the first 12 months of treatment. A better safety profile was observed than that reported in the clinical trials (AU)

Neurosarcoidosis en el área sanitaria de Pontevedra-Salnés / Neurosarcoidosis in the Pontevedra-Salnés health district

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[Acute cranial multineuritis caused by a fungus]. / Multineuritis craneal aguda de causa fúngica.

TITLE: Multineuritis craneal aguda de causa fungica.

Multineuritis craneal aguda de causa fúngica / Acute cranial multineuritis caused by a fungus

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Relevance of basilar artery study in patients with subclavian steal phenomenon.

A 72-year-old male presented to the emergency department with gait instability and unclear speech. Computed tomography of the brain showed old lacunar infarcts in basal ganglia. Transcranial Doppler (TCD) sonography was normal. Extracranial Duplex sonography showed indirect hemodynamic signs of bilateral subclavian artery stenosis and both vertebral arteries also showed delayed systolic flow increase. A bilateral subclavian steal phenomenon was suspected, and arm compression tests was performed. The tests promoted reverse flow in the right VA, loss of diastolic flow in the left VA and interestingly, the normal anterograde BA flow became retrograde. Although subclavian steal is likely to be an innocuous phenomenon for the majority of our patients, it is probable that the presence of a hemodynamic effect on the basilar artery may identify those who are at special risk of neurologic symptoms. So, we recommend TCD study in all patients suffering SSP to rule out the possibility of a BA steal phenomenon.