Relationship between sleep quality and cognitive performance in patients with epilepsy.

PURPOSE: To investigate the relationship between self-reported sleep quality and cognitive function in patients with epilepsy (PWE), as well as anxiety and depressive symptoms and patient quality of life (QoL). METHODS: This multicenter cross-sectional study included PWE aged ≥12 years who were receiving ≥1 anti-seizure medication (ASM) and had not been diagnosed with a sleep disorder. Patients completed the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Montreal Cognitive Assessment test (MoCA), the Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy Inventory-10 (QOLIE-10). RESULTS: The study enrolled 150 patients aged 16-83 years, mean age (standard deviation [SD]) 40.6 (15.2) years; 58.7% were female and 75.3% had focal epilepsy. Mean (SD) PSQI score was 4.71 (3.08), 44.4% of patients had impaired sleep quality (PSQI score ≥5), 19.9% had pathologic excessive daytime sleepiness (ESS score >12), and 32.7% had mild cognitive impairment (MoCA score <26). Within the PSQI, sleep disturbance (P = 0.036) and use of sleep medication (P = 0.006) scores were significantly higher in patients with mild cognitive impairment. Multiple regression analysis showed older age (regression coefficient [B], -0.086; 95% confidence interval [CI], -0.127, -0.045; P < 0.001) and the use of sleep medication component of the PSQI [B, -1.157; 95% CI, -2.064, -0.220; P = 0.013) were independently associated with lower MoCA score. Poor sleep quality was associated with probable anxiety and depression symptoms, and directly correlated with reduced QoL. CONCLUSIONS: In PWE, sleep quality was not significantly independently associated with mild cognitive impairment, although poor sleep quality had a negative effect on mood and QoL.

Palinacusia secundaria a daño cerebral por metotrexato / Palinacousis secondary to brain damage from methotrexate

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Hemicránea continua: características y experiencia terapéutica en una serie de 36 pacientes / Hemicrania continua: characteristics and therapeutic experience in a series of 36 patients

Introducción. La hemicránea continua se caracteriza por un dolor unilateral, continuo, con exacerbaciones frecuentementeasociadas a síntomas autonómicos. Es probablemente poco conocida e infradiagnosticada. Su diagnóstico requiere respuesta a la indometacina, no siempre bien tolerada. Objetivo. Se presenta una serie de 36 casos de hemicránea continua atendidos en la consulta de cefaleas de un hospitalterciario. Analizamos sus características demográficas y clínicas y las alternativas terapéuticas a la indometacina.Pacientes y métodos. Entre enero de 2008 y abril de 2012, 36 pacientes (28 mujeres, ocho varones) fueron diagnosticadosde hemicránea continua entre 1.800 (2%) atendidos en dicha consulta.Resultados. La edad al inicio fue de 46,3 ± 18,4 años. En cuatro pacientes (11,1%) existían remisiones del dolor superioresa tres meses. El dolor basal era principalmente opresivo o quemante, y su intensidad era de 5,2 ± 1,4 en la escala analógicaverbal. Las exacerbaciones tenían una duración de 32,3 ± 26,1 minutos, carácter predominantemente punzante,intensidad de 8,3 ± 1,4, y en el 69,4% de casos se acompañaban de síntomas autonómicos. El 16,7% de los pacientes no toleró la indometacina más allá de un indotest, y un 50% lo hizo con efectos adversos. En 13 casos se llevó a cabo al menos un bloqueo anestésico en el nervio supraorbitario o el occipital mayor, o una inyección de corticoides en la tróclea con respuesta completa en el 53,8% y parcial en el 38,5%.Conclusiones. La hemicránea continua no es un diagnóstico infrecuente en una consulta de cefaleas, y es necesario aumentarsu conocimiento al tratarse de una entidad tratable. Los bloqueos anestésicos del nervio supraorbotario o del occipital mayor o la inyección de corticoides en la tróclea son una opción terapéutica que se debe considerar cuando la indometacina no se tolera bien (AU)

Introduction. Hemicrania continua is characterised by a continuous unilateral pain, which frequently gets worse in association with autonomic symptoms. It is probably little known and underdiagnosed. Its diagnosis requires a responseto indomethacin, which is not always well tolerated. Aims. We report a series of 36 cases of hemicrania continua that were treated in the headache service of a tertiary hospital. We analyse their demographic and clinical features and the therapeutic alternatives to indomethacin. Patients and methods. Between January 2008 and April 2012, 36 patients (28 females, eight males) were diagnosed with hemicrania continua from among 1800 (2%) who were treated in that service Results. The age of onset was 46.3 ± 18.4 years. In four patients (11.1%) there were pain remissions that lasted overthree months. The baseline pain was chiefly oppressive or burning with an intensity of 5.2 ± 1.4 on the verbal analogue scale. Exacerbations lasted 32.3 ± 26.1 minutes, were of a predominantly stabbing nature with an intensity of 8.3 ± 1.4, and in 69.4% of cases were accompanied by autonomic symptoms. Altogether 16.7% of the patients did not tolerate indomethacin beyond an indotest and 50% did so with side effects. In 13 cases at least one anaesthetic blockade was performed in the supraorbital or the greater occipital nerve or a trochlear injection of corticoids was carried out with a fullresponse in 53.8% and a partial response in 38.5%. Conclusions. Hemicrania continua is not an infrequent diagnosis in a headache clinic and, because it is a treatablecondition, further knowledge on the subject is needed. Anaesthetic blockades of the supraorbital or greater occipital nerves or a trochlear injection of corticoids are the therapeutic options that must be taken into consideration whenindomethacin is not well tolerated (AU)

[Hemicrania continua: characteristics and therapeutic experience in a series of 36 patients]. / Hemicránea continua: características y experiencia terapéutica en una serie de 36 pacientes.

INTRODUCTION: Hemicrania continua is characterised by a continuous unilateral pain, which frequently gets worse in association with autonomic symptoms. It is probably little known and underdiagnosed. Its diagnosis requires a response to indomethacin, which is not always well tolerated. AIMS: We report a series of 36 cases of hemicrania continua that were treated in the headache service of a tertiary hospital. We analyse their demographic and clinical features and the therapeutic alternatives to indomethacin. PATIENTS AND METHODS: Between January 2008 and April 2012, 36 patients (28 females, eight males) were diagnosed with hemicrania continua from among 1800 (2%) who were treated in that service. RESULTS: The age of onset was 46.3 ± 18.4 years. In four patients (11.1%) there were pain remissions that lasted over three months. The baseline pain was chiefly oppressive or burning with an intensity of 5.2 ± 1.4 on the verbal analogue scale. Exacerbations lasted 32.3 ± 26.1 minutes, were of a predominantly stabbing nature with an intensity of 8.3 ± 1.4, and in 69.4% of cases were accompanied by autonomic symptoms. Altogether 16.7% of the patients did not tolerate indomethacin beyond an indotest and 50% did so with side effects. In 13 cases at least one anaesthetic blockade was performed in the supraorbital or the greater occipital nerve or a trochlear injection of corticoids was carried out with a full response in 53.8% and a partial response in 38.5%. CONCLUSIONS: Hemicrania continua is not an infrequent diagnosis in a headache clinic and, because it is a treatable condition, further knowledge on the subject is needed. Anaesthetic blockades of the supraorbital or greater occipital nerves or a trochlear injection of corticoids are the therapeutic options that must be taken into consideration when indomethacin is not well tolerated.

La tomografía computarizada de perfusión permite superar importantes criterios de exclusión SITS-MOST para la trombólisis endovenosa del infarto cerebral / Perfusion computed tomography makes it possible to overcome important SITS-MOST exclusion criteria for the endovenous thrombolysis of cerebral infarction

Objetivo. Estudiar la frecuencia, seguridad y eficacia de la trombólisis intravenosa guiada por tomografía computarizadade perfusión (TCP) mediante la identificación de tejido cerebral rescatable en ictus isquémicos a priori excluidos por criteriostradicionales (SITS-MOST y ECASS-3). Pacientes y métodos. Incluimos ictus isquémicos no lacunares consecutivos. Tras tomografía convencional, se realizó TCP en los siguientes supuestos: inicio 4,5-6 h, desconocido o al despertar, signos precoces de infarto extenso, ictus menoro grave, e inicio con crisis epiléptica o pérdida de conciencia. Se indicó alteplasa intravenosa 0,9 mg/kg si: ausencia de infarto establecido en tomografía simple, core en mapa de volumen sanguíneo cerebral menor de un tercio del territorio de la arteria cerebral media, mismatch > 20% entre mapas de tiempo de tránsito medio y volumen sanguíneo cerebral, y consentimiento informado. Las variables pronósticas fueron parámetros de seguridad-eficacia del SIST-MOST.Resultados. De mayo de 2009 a abril de 2010, 66 pacientes con ictus isquémico a priori no candidatos para trombólisis intravenosa fueron estudiados con TCP. Las indicaciones fueron: > 4,5 h en 18 pacientes, ictus del despertar o inicio desconocido en 25, signos precoces extensos en 6, inicio con crisis epilépticas en 11, e ictus menor (escala del ictus del NationalInstitute of Health < 4) en seis. Veintinueve (44%) recibieron trombólisis intravenosa de acuerdo con los hallazgos de la TCP. De ellos, 2 (6,9%) sufrieron transformación hemorrágica sintomática y 18 (62,1%) alcanzaron un Rankin igual o menor a 2 al tercer mes. Conclusión. Una alta proporción de pacientes con ictus isquémico, excluibles a priori según criterios tradicionales, podríarecibir trombólisis intravenosa de manera eficaz-segura utilizando protocolo de TCP. No obstante, estos hallazgos necesitaríanconfirmación en ensayos clínicos aleatorizados (AU)

Aim. To study the frequency, safety and efficacy of perfusion computed tomography (PCT), through identification of brain tissue-at-risk, to guide intravenous thrombolysis in stroke patients with regulatory exclusion criteria (SITS-MOST andECASS-3). Patients and methods. We studied consecutive acute non-lacunar ischemic stroke patients. After conventional CT wasconsidered eligible, PCT was performed in the following circumstances: 4.5 to 6 h window, wake-up stroke or unknowntime of onset; extent early infarct signs on CT; minor or severe stroke; seizures or loss of consciousness. Intravenous 0.9 mg/kg alteplase was indicated if: cerebral blood volume lesion covered < 1/3 of middle cerebral artery territory;mismatch > 20% between mean transit time and cerebral blood volume maps existed; and informed consent. SITS-MOST safety-efficacy parameters were used as endpoint variables. Results. Between May 2009-April 2010, 66 hyperacute ischemic stroke patients a priori not eligible for intravenous thrombolysis underwent PCT. Indications were: > 4.5 h in 18 patients, wake up stroke or unknown onset in 25, extentinfarct signs in 6, seizures at onset in 11, and minor stroke (NIHSS < 4) in 6. Twenty-nine (44%) of them finally received intravenous thrombolysis. Symptomatic hemorrhagic transformation occurred in 2 (6.9%) patient and 18 (62.1%) achieved a modified Rankin scale score equal or less than 2 on day 90. Conclusion. A high proportion of acute stroke patients with SITS-MOST and ECASS-3 exclusion criteria can be safely andefficaciously treated with intravenous thrombolysis using a PCT selection protocol. However randomized control trials willbe needed to confirm our results (AU)

Efficacy of long-term continuous subcutaneous apomorphine infusion in advanced Parkinson's disease with motor fluctuations: a multicenter study.

Continuous subcutaneous apomorphine infusion (CSAI) is, at present, an alternative option for advanced Parkinson's disease (PD) with motor fluctuations. We studied the evolution of patients with PD and severe motor fluctuations long-term treated with CSAI. We reviewed data from 82 patients with PD (mean age, 67 +/- 11.07; disease duration, 14.39 +/- 5.7 years) and severe motor fluctuations referred to 35 tertiary hospitals in Spain. These patients were long-term treated (for at least 3 months) with CSAI and tolerated the procedure without serious side effects. We compared the baseline data of these 82 patients (before CSAI) with those obtained from the last follow-up visit of each patient. The mean follow-up of CSAI was 19.93 +/- 16.3 months. Mean daily dose of CSAI was 72.00 +/- 21.38 mg run over 14.05 +/- 1.81 hours. We found a statistically significant reduction in off-hours, according to self-scoring diaries (6.64 +/- 3.09 vs. 1.36 +/- 1.42 hours/day, P < 0.0001), total and motor UPDRS scores (P < 0.0001), dyskinesia severity (P < 0.0006), and equivalent dose of antiparkinsonian therapy (1,405 +/- 536.7 vs. 800.1 +/- 472.9 mg of levodopa equivalent units P < 0.0001). CSAI is an effective option for patients with PD and severe fluctuations, poorly controlled by conventional oral drug treatment.