Role of Citicoline in Patients With Mild Cognitive Impairment.

The term mild cognitive impairment (MCI) defines an intermediate state between normal aging and dementia. Vascular cognitive impairment refers to a decline in cognitive function that is caused by or associated with vascular disease and comprises all the spectrum of cognitive impairments, from MCI of vascular origin to vascular dementia. One of the available treatments for cognitive impairment is cytidine diphosphate-choline (CDP-Choline), or citicoline. The objective of the present manuscript is to provide complete evidence about the efficacy of citicoline for MCI, especially of vascular origin, but also due to other neurodegenerative disorders. Citicoline is a pharmaceutical product constituted by the combination of 2 natural molecules (cytidine and choline) and is marketed as a food supplement. It has been proposed to provide neuroprotective effects through diverse mechanisms of action. Taking into account the available literature, citicoline has shown a consistent improvement in cognitive function in patients with MCI, especially of vascular origin. Moreover, it provides beneficial effects on vascular, Alzheimer, and mixed dementias, stroke sequelae, intracerebral hemorrhages, traumatic brain injuries, and neurodegenerative diseases. Long-term treatment with citicoline has also been demonstrated to be well-tolerated and has not been associated with severe adverse events. Citicoline is a safe, well-tolerated, and promising agent with evidenced neuroprotective properties.

Antiepileptic drug treatment of generalized tonic-clonic seizures: An evaluation of regulatory data and five criteria for drug selection.

BACKGROUND: A generalized tonic-clonic seizure (GTCS) is the most severe form of common epileptic seizure and carries the greatest risk of harm. The aim of this review is to provide an evidence-based guide for the selection of antiepileptic drugs (AEDs) for patients with GTCSs. Eight AEDs are approved in Europe and the USA for the treatment of both primarily GTCSs (PGTCSs) and secondarily GTCSs (SGTCSs) and are considered in this paper. METHODS: Each AED is evaluated using five criteria: (1) efficacy, by seizure type (a: PGTCSs and b: SGTCSs); (2) adverse effects; (3) interactions; (4) adherence and dosing; and (5) mechanism of action (MOA). To ensure the inclusions of robust data, only efficacy data accepted by regulatory authorities were considered, and data related to adverse effects, interactions, adherence, and MOA were all extracted from UK Summaries of Product Characteristics (SPCs). RESULTS: (1a) There is class 1 evidence of the efficacy of only four AEDs in controlling PGTCSs (lamotrigine, levetiracetam, perampanel, and topiramate). (1b) There is no class 1 evidence of the efficacy of any AED in SGTCSs although some evidence from pooled/subgroup analyses or meta-analyses supports the use of the four AEDs (levetiracetam, perampanel, topiramate, and with less robust data for lamotrigine). (2) AEDs are associated with different, but to some extent overlapping, common adverse effect profiles but have differing idiosyncratic adverse effects. (3) Pharmacokinetic interactions are seen with most, but not all, AEDs and are most common with carbamazepine and phenytoin. (4) Good adherence is important for seizure control and is influenced by frequency of dosing, among other factors. (5) Mechanism of action is also a consideration in rationalising AED selection when switching or combining AEDs. CONCLUSION: Ultimately, the choice of AED depends on all these factors but particularly on efficacy and adverse effects. Different patients will weigh the various factors differently, and the role of the treating physician is to provide accurate information to allow patients to make informed choices.

Eslicarbacepina en pacientes con hipercolesterolemia asociada a carbamacepina y oxcarbacepina / Eslicarbazepine in patients with hipercholesterolemia associated to carbamazepine and oxcarbacepine

No disponible

Estimulación de nervios occipitales en el tratamiento de la migraña crónica refractaria / Occipital nerve stimulation for refractory chronic migraine

Introducción. La estimulación de nervios occipitales (ENO) es un tratamiento preventivo de la migraña crónica refractaria que está adquiriendo una importancia creciente en los últimos años. Objetivo. Evaluar el mecanismo de acción, estudios clínicos, técnica de implantación y criterios de inclusión de la ENO en el tratamiento preventivo de la migraña. Desarrollo. Se realiza una revisión no sistemática de la bibliografía sobre los aspectos anteriormente expuestos en la ENO como tratamiento para la migraña crónica. Esta patología afecta aproximadamente al 2% de la población y da lugar a una importante disminución de la calidad de vida e interferencia con las actividades laborales y sociales. La ENO es una terapia emergente y prometedora para el tratamiento de la migraña crónica que ha demostrado una disminución superior al 50% en el dolor en la mayoría de los estudios abiertos y ensayos clínicos publicados. Aunque el mecanismo de acción es desconocido, parece existir una neuromodulación de la información nociceptiva trigeminal en el núcleo caudal del trigémino explicada mediante la teoría de la puerta de entrada de Melzack y Wall. La ENO es un tratamiento seguro y bien tolerado, y los efectos secundarios son habitualmente locales, como desplazamiento de los electrodos o infecciones de la herida quirúrgica, que habitualmente no requieren su retirada. Conclusiones. La ENO es un tratamiento eficaz, bien tolerado y seguro en la prevención de la migraña crónica, y supone una opción útil para aquellos pacientes con migraña crónica refractaria a los tratamientos médicos convencionales (AU)

Introduction. Occipital nerve stimulation (ONS) is an emerging and promising preventive treatment for refractory chronic migraine. Aim. To evaluate the mechanisms of actions, clinical studies, implantation techniques and inclusion criteria of the ONS as a preventive treatment for migraine. Development. This work includes a non-systematic review of the literature on the above-mentioned aspects of ONS as a treatment for refractory chronic migraine. This disease affects approximately 2% of the population and results in a significant impairment in quality of life, economic burden and interference with labor and social activities. ONS is an emerging and promising therapy for the treatment of chronic migraine with greater than 50% pain reduction in most of open-label studies and published clinical trials. Although the mechanisms of action remain unknown, there seem to be a neuromodulation of the transmitted nociceptive trigeminal information in the trigeminal caudal nucleus, what could be explained by means of the Melzack and Wall pain gate theory. ONS is a safe and well tolerated treatment, and its most frequent side effects are usually local such as electrodes displacement or infections of the surgical incision. These complications do not usually require the electrodes withdrawal. Conclusions. ONS is an effective, well tolerated and safe treatment for the prevention of chronic migraine and could emerge as a useful option for those patients with medically refractory chronic migraine (AU)

[Occipital nerve stimulation for refractory chronic migraine]. / Estimulación de nervios occipitales en el tratamiento de la migraña crónica refractaria.

INTRODUCTION: Occipital nerve stimulation (ONS) is an emerging and promising preventive treatment for refractory chronic migraine. AIM: To evaluate the mechanisms of actions, clinical studies, implantation techniques and inclusion criteria of the ONS as a preventive treatment for migraine. DEVELOPMENT: This work includes a non-systematic review of the literature on the above-mentioned aspects of ONS as a treatment for refractory chronic migraine. This disease affects approximately 2% of the population and results in a significant impairment in quality of life, economic burden and interference with labor and social activities. ONS is an emerging and promising therapy for the treatment of chronic migraine with greater than 50% pain reduction in most of open-label studies and published clinical trials. Although the mechanisms of action remain unknown, there seem to be a neuromodulation of the transmitted nociceptive trigeminal information in the trigeminal caudal nucleus, what could be explained by means of the Melzack and Wall pain gate theory. ONS is a safe and well tolerated treatment, and its most frequent side effects are usually local such as electrodes displacement or infections of the surgical incision. These complications do not usually require the electrodes withdrawal. CONCLUSIONS: ONS is an effective, well tolerated and safe treatment for the prevention of chronic migraine and could emerge as a useful option for those patients with medically refractory chronic migraine.

TITLE: Estimulacion de nervios occipitales en el tratamiento de la migraña cronica refractaria.Introduccion. La estimulacion de nervios occipitales (ENO) es un tratamiento preventivo de la migraña cronica refractaria que esta adquiriendo una importancia creciente en los ultimos años. Objetivo. Evaluar el mecanismo de accion, estudios clinicos, tecnica de implantacion y criterios de inclusion de la ENO en el tratamiento preventivo de la migraña. Desarrollo. Se realiza una revision no sistematica de la bibliografia sobre los aspectos anteriormente expuestos en la ENO como tratamiento para la migraña cronica. Esta patologia afecta aproximadamente al 2% de la poblacion y da lugar a una importante disminucion de la calidad de vida e interferencia con las actividades laborales y sociales. La ENO es una terapia emergente y prometedora para el tratamiento de la migraña cronica que ha demostrado una disminucion superior al 50% en el dolor en la mayoria de los estudios abiertos y ensayos clinicos publicados. Aunque el mecanismo de accion es desconocido, parece existir una neuromodulacion de la informacion nociceptiva trigeminal en el nucleo caudal del trigemino explicada mediante la teoria de la puerta de entrada de Melzack y Wall. La ENO es un tratamiento seguro y bien tolerado, y los efectos secundarios son habitualmente locales, como desplazamiento de los electrodos o infecciones de la herida quirurgica, que habitualmente no requieren su retirada. Conclusiones. La ENO es un tratamiento eficaz, bien tolerado y seguro en la prevencion de la migraña cronica, y supone una opcion util para aquellos pacientes con migraña cronica refractaria a los tratamientos medicos convencionales.

Efectividad de la lacosamida en el tratamiento del dolor neuropático refractario: estudio observacional abierto / Effectiveness of lacosamide in the treatment of refractory neuropathic pain: an open observational trial

Introducción. Aunque se dispone de diferentes tratamientos para el dolor neuropático, en muchas ocasiones estos pacientes son refractarios, lo que hace necesario probar tratamientos que, por su utilidad en otras patologías, podrían ser eficaces en el dolor neuropático. Pacientes y métodos. Se recogieron las historias clínicas de pacientes que hubieran sido tratados con lacosamida para el dolor neuropático, en diferentes hospitales de la zona centro peninsular, y que cumplieran unas características similares en cuanto a refractariedad a otros tratamientos estándares, en un seguimiento de al menos seis meses, o que hubiesen tenido que suspender el tratamiento con dicho fármaco por cualquier motivo. Se obtuvo una muestra de 114 pacientes, 61 varones y 53 mujeres, con una edad media de 60,5 años. Resultados. Las causas de dolor neuropático más frecuentes fueron: polineuropatía diabética (31,6%), neuralgia postherpética (22,8%), neuralgia del trigémino (17,5%), neuralgia suboccipital y lumbociatalgia (un 12,3% en ambas). La eficacia fue buena/muy buena en la mayoría de los pacientes, con un descenso medio en la escala analógica visual tras seis meses de 7,7 a 4,8. No se registraron efectos secundarios graves en ningún paciente, pero en 12 y 10 pacientes no hubo registro más allá de seis meses, por ineficacia e intolerancia al tratamiento, respectivamente. Conclusiones. El tratamiento con lacosamida en el dolor neuropático de diferentes causas podría considerarse como una alternativa efectiva y bien tolerada para aquellos pacientes que no respondan a los tratamientos estándares (AU)

Introduction. Although different treatments are available for neuropathic pain, these patients are often refractory, which makes it necessary to test treatments that, as they have proven useful in other pathologies, could be effective in neuropathic pain. Patients and methods. The study made use of the medical records of patients who had been treated with lacosamide for neuropathic pain in different hospitals in the central area of the peninsula and who fulfilled similar characteristics in terms of refractoriness to other standard treatments, in a follow-up that lasted at least six months, or who had had to stop treatment with that drug for some reason or another. A sample of 114 patients (61 males and 53 females) with a mean age of 60.5 years was obtained from the data. Results. The most common causes of neuropathic pain were: diabetic polyneuropathy (31.6%), post-herpes neuralgia (22.8%), trigeminal neuralgia (17.5%), suboccipital and lumbar-radicular neuralgia (both 12.3%). Effectiveness was good/ very good in most patients, with the mean score on the visual analogue scale after six months dropping from 7.7 to 4.8. No serious side effects were reported in any of the patients, but in 12 and 10 patients no recordings were made beyond six months, due to ineffectiveness and intolerance to the treatment, respectively. Conclusions. Treatment with lacosamide in neuropathic pain due to different causes could be considered an effective and well-tolerated alternative for patients who fail to respond to standard treatments (AU)

[Effectiveness of lacosamide in the treatment of refractory neuropathic pain: an open observational trial]. / Efectividad de la lacosamida en el tratamiento del dolor neuropatico refractario: estudio observacional abierto.

INTRODUCTION: Although different treatments are available for neuropathic pain, these patients are often refractory, which makes it necessary to test treatments that, as they have proven useful in other pathologies, could be effective in neuropathic pain. PATIENTS AND METHODS: The study made use of the medical records of patients who had been treated with lacosamide for neuropathic pain in different hospitals in the central area of the peninsula and who fulfilled similar characteristics in terms of refractoriness to other standard treatments, in a follow-up that lasted at least six months, or who had had to stop treatment with that drug for some reason or another. A sample of 114 patients (61 males and 53 females) with a mean age of 60.5 years was obtained from the data. RESULTS: The most common causes of neuropathic pain were: diabetic polyneuropathy (31.6%), post-herpes neuralgia (22.8%), trigeminal neuralgia (17.5%), suboccipital and lumbar-radicular neuralgia (both 12.3%). Effectiveness was good/very good in most patients, with the mean score on the visual analogue scale after six months dropping from 7.7 to 4.8. No serious side effects were reported in any of the patients, but in 12 and 10 patients no recordings were made beyond six months, due to ineffectiveness and intolerance to the treatment, respectively. CONCLUSIONS: Treatment with lacosamide in neuropathic pain due to different causes could be considered an effective and well-tolerated alternative for patients who fail to respond to standard treatments.

TITLE: Efectividad de la lacosamida en el tratamiento del dolor neuropatico refractario: estudio observacional abierto.Introduccion. Aunque se dispone de diferentes tratamientos para el dolor neuropatico, en muchas ocasiones estos pacientes son refractarios, lo que hace necesario probar tratamientos que, por su utilidad en otras patologias, podrian ser eficaces en el dolor neuropatico. Pacientes y metodos. Se recogieron las historias clinicas de pacientes que hubieran sido tratados con lacosamida para el dolor neuropatico, en diferentes hospitales de la zona centro peninsular, y que cumplieran unas caracteristicas similares en cuanto a refractariedad a otros tratamientos estandares, en un seguimiento de al menos seis meses, o que hubiesen tenido que suspender el tratamiento con dicho farmaco por cualquier motivo. Se obtuvo una muestra de 114 pacientes, 61 varones y 53 mujeres, con una edad media de 60,5 años. Resultados. Las causas de dolor neuropatico mas frecuentes fueron: polineuropatia diabetica (31,6%), neuralgia postherpetica (22,8%), neuralgia del trigemino (17,5%), neuralgia suboccipital y lumbociatalgia (un 12,3% en ambas). La eficacia fue buena/muy buena en la mayoria de los pacientes, con un descenso medio en la escala analogica visual tras seis meses de 7,7 a 4,8. No se registraron efectos secundarios graves en ningun paciente, pero en 12 y 10 pacientes no hubo registro mas alla de seis meses, por ineficacia e intolerancia al tratamiento, respectivamente. Conclusiones. El tratamiento con lacosamida en el dolor neuropatico de diferentes causas podria considerarse como una alternativa efectiva y bien tolerada para aquellos pacientes que no respondan a los tratamientos estandares.

Eficacia de la lacosamida en el tratamiento del dolor neuropático / Efficacy of lacosamide in the treatment of neuropathic pain

No disponible

Eficacia de la lacosamida en el tratamiento del dolor neuropático / Efficacy of lacosamide in the treatment of neuropathic pain

No disponible

[Analyses of the patient knowledge about the medical report and its usefulness in neurology]. / Análisis del grado de conocimiento de los pacientes sobre el informe médico y su utilidad en neurología.

INTRODUCTION: The medical report is a legal, written document issued by the physician, exposing the clinical history and the diagnostic and therapeutic protocols applied to the patient. AIM: To evaluate the patient knowledge about the medical report and its usefulness. PATIENTS AND METHODS: We included consecutive first-visit patients attended in four general neurology offices. The descriptive analysis included: demographic data (age, sex, level of studies), degree of knowledge on the referring doctor (name, specialty, reason for referral), medical history (medical antecedents, treatment, dosage, reasons for its intake, reasons for not providing it) and the medical report (applications, reasons for not providing it and awarded usefulness). These data were compared between different sanitary areas and cultural levels. RESULTS: We included 378 patients (average age: 49.1 ± 20.6 years-old; 62.2% women; 40.2% with primary studies; 23.3% with secondary studies). 41.5% did not know the name of the referring doctor, 5.5% his specialty and 2.6% the reason for referral. 3.7% did not know their medical antecedents, 20.4% did not provide the treatment (49.3% did not know it was necessary), 4.8% did not know why they took it and 27.6% the dosage. 14.3% did not provide the medical report and 18.0% applied it (61.7% for bureaucratic reasons and 28.0% for information). Only 18.0% knew that the medical report included the medical information of the patient. CONCLUSION: The patient does not know the usefulness and importance of the medical report, despite being a legal document exposing the medical information of the patient disease.

[Pain in multiple sclerosis: prevalence, mechanisms, types and treatment]. / El dolor en la esclerosis multiple: prevalencia, mecanismos, tipos y tratamiento.

INTRODUCTION: Pain is a frequent symptom in multiple sclerosis (MS), although its prevalence and its importance vary from one study to another. AIM: To analyse the prevalence, types, mechanisms and treatments of the different painful syndromes that affect patients with MS. DEVELOPMENT: The work includes a non-systematic review of the literature on the above-mentioned aspects in patients with MS. The prevalence of pain in this disease is higher than what was initially supposed and some series estimate it to be up to 86%. It has important effects on patients' quality of life, limiting both their daily activities and their working life. It is associated with advanced age, duration of the disease, degree of disability, fatigue and depression. There are different types of pain in patients with MS and several different classifications have been proposed. Examples of such systems of classification include dysesthesias in the extremities, complex regional pain, L'Hermitte's sign, trigeminal neuralgia, pain associated to optic neuritis, painful tonic spasms, low back pain and headache. Treatments used are the same as those employed with patients who do not have MS, since few studies have been conducted in patients with this disease. CONCLUSIONS: Pain affects a high percentage of patients with MS, its pathophysiology is unknown and there are no specific treatments. We therefore recommend that further studies should be carried out to investigate the pain experienced by patients with MS.

Neuron numbers in the sensory trigeminal nuclei of the rat: A GABA- and glycine-immunocytochemical and stereological analysis.

The volume, total neuron number, and number of GABA- and glycine-expressing neurons in the sensory trigeminal nuclei of the adult rat were estimated by stereological methods. The mean volume is 1.38+/-0.13 mm3 (mean+/-SD) for the principal nucleus (Vp), 1.59+/-0.06 for the n. oralis (Vo), 2.63+/-0.34 for the n. interpolaris (Vip), and 3.73+/-0.11 for the n. caudalis (Vc). The total neuron numbers are 31,900+/-2,200 (Vp), 21,100+/-3,300 (Vo), 61,600+/-8,300 (Vip), and 159,100+/-25,300 (Vc). Immunoreactive (-ir) neurons were classified as strongly stained or weakly stained, depending on qualitative criteria, cross-checked by a densitometric analysis. GABA-ir cells are most abundant in Vc, in an increasing rostrocaudal gradient within the nucleus. Lower densities are found in Vip and Vp. The mean total number of strongly labeled GABA-ir neurons ranges between 1,800 in Vp to 7,800 in Vip and 22,900 in Vc, and varies notably between subjects. Glycine-ir neurons are more numerous and display more homogeneous densities in all nuclei. Strongly labeled Gly-ir cells predominate in all nuclei, their total number ranging between 9,400 in Vp to 24,300 in Vip and 34,200 in Vc. A substantial fraction of immunolabeled neurons in all nuclei coexpress GABA and glycine. In general, all neurons strongly immunoreactive for GABA are small, while weakly GABA-ir cells which coexpress Gly are larger. In Vc, one-third of all neurons are immunoreactive: 16.6% of them are single-labeled for GABA and 31.6% are single-labeled for glycine. The remaining 51.8% express GABA and glycine in different combinations, with those showing strong double labeling accounting for 22.6%.

Quantitative stereological evaluation of the gracile and cuneate nuclei and their projection neurons in the rat.

Stereological methods were employed to estimate the volume and neuron numbers of the rat dorsal column nuclei (DCN). These methods were applied to Nissl-stained sections from control animals and cases that received injections of horseradish peroxidase in the thalamus, the cerebellum, or the spinal cord. Additional cases received combinations of fluorescent tracers in the same structures, to examine whether some of the retrogradely labeled neurons sent collaterals to different targets. The mean volume of the DCN is 0.81 mm(3) (range 0.65-1.10 mm(3)), of which 3%, 39%, and 59% correspond, respectively, to the nucleus of Bischoff (Bi), the gracile (Gr), and the cuneate (Cu) nuclei. Within Cu, the middle division (CuM) is the largest (42%), followed by the rostral (CuR; 36%) and caudal (CuC; 22%) divisions. The mean total number of neurons in the DCN is 16,000 (range 12,400-19,500), of which 2.4%, 34.0% and 63.6% correspond, respectively, to Bi, Gr, and Cu. Within Cu, CuM contains 48% of all neurons, and 27% correspond to CuR and 25% to CuC. Interanimal variability is moderate for the whole DCN and Cu but increases when individual nuclei are considered. About 80% of DCN neurons project to the thalamus, 3% to the spinal cord, and 7% to the cerebellum. Thalamic-projecting cells are more numerous in CuM and Gr (83%), and relatively less common in Bi and CuC (72-74%). Most of the DCN neurons projecting to the spinal cord appear in CuC and CuM. Two-thirds of the neurons projecting to the cerebellum are located in CuR, 20% in CuM, and 15% in Gr. A small fraction of neurons projects simultaneously to spinal cord and thalamus.