Concordance of the ACR TI-RADS.

BACKGROUND: Ultrasonography (US) is the method of choice for evaluating thyroid nodules. In 2017, the American College of Radiology (ACR) created a classification system based on US characteristics. For the system to be adopted, it must be reproducible. OBJECTIVES: To determine the intraobserver and interobserver variability of the ACR TI-RADS. METHODS: Cross-sectional study; three radiologists with different levels of experience used the ACR TI-RADS to classify 100 nodules on two occasions one month apart, and we calculated the intraobserver and interobserver variability. RESULTS: Regarding intraobserver variability, the first radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci; the second radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci, and the third radiologist had nearly perfect concordance for composition, echogenicity, and shape and substantial concordance for margins and echogenic foci. The interobserver concordance was calculated for the two readings; the concordance was substantial except for shape in the first reading and for echogenicity and margins in the second reading, which had moderate concordance. CONCLUSIONS: The ACR TI-RADS classification system is reproducible.

Concordance of the ACR TI-RADS. / Concordancia del TIRADS-ACR.

BACKGROUND: Ultrasonography (US) is the method of choice for evaluating thyroid nodules. In 2017, the American College of Radiology (ACR) created a classification system based on US characteristics. For the system to be adopted, it must be reproducible. OBJECTIVES: To determine the intraobserver and interobserver variability of the ACR TI-RADS. METHODS: Cross-sectional study; three radiologists with different levels of experience used the ACR TI-RADS to classify 100 nodules on two occasions one month apart, and we calculated the intraobserver and interobserver variability. RESULTS: Regarding intraobserver variability, the first radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci; the second radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci, and the third radiologist had nearly perfect concordance for composition, echogenicity, and shape and substantial concordance for margins and echogenic foci. The interobserver concordance was calculated for the two readings; the concordance was substantial except for shape in the first reading and for echogenicity and margins in the second reading, which had moderate concordance. CONCLUSIONS: The ACR TI-RADS classification system is reproducible.

Current management of breakthrough cancer pain according to physicians from pain units in Spain.

PURPOSE: Current evidence suggests the need to improve the management of breakthrough cancer pain (BTcP). For this reason, we aimed to assess the opinion of a panel of experts composed exclusively of physicians from pain units, who play a major role in BTcP diagnosis and treatment, regarding the key aspects of BTcP management. METHODS: An ad hoc questionnaire was developed to collect real-world data on the management of BTcP. The questionnaire had 5 parts: (a) organizational aspects of pain units (n = 12), (b) definition and diagnosis (n = 3), (c) screening (n = 3), (d) treatment (n = 8), and (e) follow-up (n = 7). RESULTS: A total of 89 pain-unit physicians from 13 different Spanish regions were polled. Most of them agreed on the traditional definition of BTcP (78.9%) and the key features of BTcP (92.1%). However, only 30.3% of participants used the Davies' algorithm for BTcP diagnosis. Respondents preferred to prescribe rapid-onset opioids [mean 77.0% (SD 26.7%)], and most recommended transmucosal fentanyl formulations as the first option for BTcP. There was also considerable agreement (77.5%) on the need for early follow-up (48-72 h) after treatment initiation. Finally, 65.2% of participants believed that more than 10% of their patients underused rapid-onset opioids. CONCLUSIONS: There was broad agreement among pain experts on many important areas of BTcP management, except for the diagnostic method. Pain-unit physicians suggest that rapid-onset opioids may be underused by BTcP patients in Spain, an important issue that need to be evaluated in future studies.

Maxillary sinus balloon lifting and deferred implantation of 50 osseointegrated implants: a prospective, observational, non-controlled study.

The aim of this study was to assess the effectiveness of minimally invasive antral membrane balloon elevation (MIAMBE). Twenty-seven patients with severe resorption of the posterior maxilla were treated by balloon catheter-assisted sinus lift procedure with deferred implant placement. Panoramic radiographs and computed tomography scans were obtained prior to surgery and at 6 months after surgery, before implantation. Data collected following surgery included inflammation, pain, bleeding, infection, and haematoma. Pain and inflammation were recorded using a six-point verbal rating scale (VRS). The patients were followed up for an average of 15 months. The initial sinus floor height was measured for each planned implant and compared with the height at 6 months post-surgery. The average bone height gain was 8.10±3.45mm (range 0.5-13.95mm). Inflammation on the VRS ranged from 0 to 3 (mean 0.97±0.85), while pain ranged from 0 to 4 (mean 0.87±1.19). There was a perforation of the Schneiderian membrane smaller than 2mm in one case. In another case, the balloon lift procedure had to be aborted and changed to the conventional Tatum technique due to breakage of the balloon inside the sinus. The results of this study show the balloon sinus lift technique to be an easy procedure to perform, with apparently low rates of inflammation and pain, and to provide sufficient quantity and quality of bone for the placement of osseointegrated implants.

Early spermatogenesis changes in traumatic complete spinal cord-injured adult patients.

STUDY DESIGN: Prospective longitudinal study. OBJECTIVES: To assess the impact of spinal cord injury (SCI) on the spermatogenesis of patients studied in the early subacute stage and ensuing months. SETTING: National hospital for SCI patients. METHODS: A prospective follow-up study was conducted on 28 male patients with complete SCI who were evaluated in the early subacute phase (~1 month), and 3 and 6 months after the injury. At each time point, fine needle aspiration biopsy samples were taken from the testes for cytological assessment, and serum levels of relevant hormones were measured. At the end of the study period, ejaculation was attempted for standard semen analyses. RESULTS: Cytological patterns indicative of defective spermatogenesis were found in 61%, 52% and 20% of the patients at 1, 3 and 6 months after SCI, respectively, suggesting an improvement over time. Serum hormone analyses showed a steady elevation of estradiol levels above the reference range, and increasing levels of testosterone, inhibin B and prolactin throughout the study period. Prolactin levels were above the reference range at all time points. Only 2 out of the 10 patients who were able to ejaculate at 6 months post injury showed normal sperm parameters. CONCLUSION: A majority of the patients showed impaired spermatogenesis soon after the injury, which in most cases recovered over time. That was accompanied by parallel increases in serum levels of inhibin B, testosterone and prolactin, possibly driving or reflecting the spermatogenesis recovery. Further studies are needed to elucidate the biological mechanisms underlying these changes.

Tear proteome and protein network analyses reveal a novel pentamarker panel for tear film characterization in dry eye and meibomian gland dysfunction.

Dry eye and meibomian gland dysfunction are common ocular surface disorders. Discrimination of both conditions often may be difficult given the overlapping of signs and symptoms, and the lack of correlation with clinical parameters. A total of 144 individuals were included in this study. To search for proteome differences, tear proteins were collected by Merocel sponge and analyzed using 2D-PAGE. Comparative tear protein profile analysis indicated changes in the expression levels of fifteen proteins. Subsequent to MALDI-TOF/TOF protein identification, network analysis revealed expression/interaction connections with other proteins, thereby identifying additional putative markers. A screening validation assay demonstrated the discriminative power of six candidate biomarkers. A further validation study using multiplexed-like ELISA assays in tear samples collected with both sponge and capillary confirmed the high discriminatory power of five biomarkers: S100A6, annexin A1 (ANXA1), annexin A11 (ANXA11), cystatin-S (CST4), and phospholipase A2-activating protein (PLAA) with an area under ROC curve (AUC)≥ 97.9% (sensitivity ≥ 94.3%; specificity ≥ 97.6%) when comparing dry eye and control individuals. This panel also discriminated between dry eye, meibomian gland dysfunction and control individuals, with a global correct assignment (CA) of 73.2% between all groups. Correct assignment was not found to be significantly dependent on the tear collection method.

Changes in tear protein profile in keratoconus disease.

PURPOSE: To analyze tear protein profile variations in patients with keratoconus (KC) and to compare them with those of control subjects. SUBJECTS AND METHODS: Tears from 12 normal subjects and 12 patients with KC were analyzed by two-dimensional gel electrophoresis (2-DE) and liquid chromatography-mass spectrometry (LC-MS). Analysis of the 2-DE gels was performed using Progenesis SameSpots software (Nonlinear Dynamics). Proteins exhibiting high variation in expression levels (P-value <0.05) were identified using matrix-assisted laser desorption/ionization-TOF spectrometry. For LC-MS analysis, a label-free quantification approach was used. Tears were digested with trypsin, subjected to data-independent acquisition (MS(E)) analysis, and identified proteins were relatively quantified using ProteinLynx Global Server software (Waters). RESULTS: The 2-DE and LC-MS analyses revealed a significant decrease in the levels of members of the cystatin family and an increase in lipocalin-1 in KC patients. A 1.43-fold decrease was observed for cystatin-S by 2-DE, and 1.69- and 1.56-fold for cystatin-SN and cystatin-SA by LC-MS, respectively. The increase in lipocalin-1 was observed by both methods with fold changes of 1.26 in the 2-DE approach and 1.31 according to LC-MS. Significant protein upregulation was also observed for Ig-κ chain C and Ig J chain proteins by 2-DE. Levels of lipophilin-C, lipophilin-A, and phospholipase A2 were decreased in tears from KC patients according to LC-MS. Serum albumin was found to be increased in KC patients according to LC-MS. CONCLUSION: The results show differences in the tear protein profile of KC and control subjects. These changes are indicative of alterations in tear film stability and in interactions with the corneal surface in KC patients.

Subclinical keratoconus and inflammatory molecules from tears.

BACKGROUND/AIMS: Tissue degradation in corneal thinning disorders, such as keratoconus (KC), involves the expression of inflammatory mediators. The purpose of this study was to determine the levels of proinflammatory cytokines and matrix metalloproteinase 9 (MMP-9) in tears from both eyes of unilateral keratoconus (KC) patients. METHODS: Thirty patients diagnosed as having asymmetrical KC (30 KC eyes, and 30 subclinical KC eyes) and 20 normal control subjects (one eye) were studied in a prospective, cross-sectional study. Keratoconus screening programmes were performed on these participants. Ten microlitres of tears was collected from each eye. The concentrations of cytokines (interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-alpha)) and MMP-9 were measured by ELISA. RESULTS: Mean values for IL-6 levels were similar in KC and subclinical KC samples (5.5 (4.9 to 6.9) vs 5.7 (4.5 to 6.2) pg/ml, p = 0.131), but significantly higher in relation to the control group (2.2 (1.0 to 4.1) pg/ml, p<0.0001). Significant differences were found in TNF-alpha levels between KC and subclinical KC eyes (5.4 (4.1 to 6.8) vs 4.8 (4.2 to 6.0) pg/ml, p = 0.032) and control group (1.8 (1.5 to 2.3) pg/ml, p<0.0001). Increased values of MMP-9 were found in KC (59.4 (50.6 to 66.1) ng/ml) vs subclinical KC eye (7.0 (4.8 to 8.6) ng/ml) (p<0.0001). MMP-9 levels in the control group (6.1 (3.9 to 8.3) ng/ml) and subclinical KC were similar (p = 0.203). CONCLUSIONS: IL-6 and TNF-alpha are overexpressed in the tears of subclinical and KC eyes. Increased MMP-9 levels were found only in the KC eye. These results indicate that the pathogenesis of KC may involve chronic inflammatory events.

[An analysis of the causes, characteristics, and consequences of reexposure to a drug or compound responsible for a hepatotoxicity event]. / Análisis de las causas, características y consecuencias de la reexposición al fármaco o compuesto responsable de un episodio de hepatotoxidad.

INTRODUCTION: reexposure to a causal agent represents a potentially serious event in hepatotoxicity. OBJECTIVES: to assess the characteristics and outcome of cases with positive reexposure. MATERIAL AND METHODS: a retrospective study of cases with evidence of positive reexposure included in Registro Español de Hepatopatías Asociadas a Medicamentos, and an analysis of their relation to demographic and clinical variables, causality, course, and consequences. RESULTS: of a total of 520 cases 31 (6%) met reexposure criteria. Fatal outcomes, needs for admission, and mean recovery time were all higher for hepatocellular-type toxic injury. The most commonly identified drug class was antibiotics. On most occasions (73%) reexposure to the causal compound escaped notice because of: absence of index case diagnosis, lack of information to patients and their physicians, and (12%) development of cross reactions between structurally similar drugs. CONCLUSIONS: accidental reexposure to a drug or a structurally-related compound after an initial hepatotoxicity event is common and may have serious consequences, particularly in hepatocellular-type toxicity. Careful history taking and reflecting diagnostic suspicion in the initial episode s record may reduce the incidence of this iatrogenic event.

Análisis de las causas, características y consecuencias de la reexposición al fármaco o compuesto responsable de un episodio de hepatotoxicidad / No disponible

Introducción: la reexposición al agente causal constituye unincidente potencialmente grave en hepatotoxicidad.Objetivos: evaluar las características y la evolución de los casoscon reexposición positiva.Material y métodos: estudio retrospectivo de una serie decasos con evidencia de reexposición positiva incluidos en el RegistroEspañol de Hepatopatías Asociadas a Medicamentos, analizandosu relación con variables demográficas y clínicas, causalidad,evolución y consecuencias.Resultados: de un total de 520 casos, 31 (6%) cumplían loscriterios de reexposición. La evolución fatal, la necesidad de hospitalizacióny el tiempo medio de recuperación fueron mayores enla lesión tóxica de tipo hepatocelular. El grupo farmacológicoidentificado con mayor frecuencia fue el de los antibióticos. En lamayoría de los casos la reexposición con el compuesto responsablefue inadvertida (73%) debido a: la ausencia de diagnóstico delcaso índice, la carencia de información al paciente o a su médicoy también (12%) por el desarrollo de una reacción cruzada entrefármacos estructuralmente similares.Conclusiones: la reexposición accidental a un mismo fármacoo a otro estructuralmente relacionado tras un primer episodiode hepatotoxicidad no es infrecuente y sus consecuencias puedenser graves, especialmente en el tipo de lesión hepatocelular. Unaminuciosa historia clínica y la sospecha diagnóstica reflejada en elinforme del primer episodio podrían disminuir la incidencia deeste evento iatrogénico

Introduction: reexposure to a causal agent represents a potentiallyserious event in hepatotoxicity.Objectives: to assess the characteristics and outcome of caseswith positive reexposure.Material and methods: a retrospective study of cases withevidence of positive reexposure included in Registro Español deHepatopatías Asociadas a Medicamentos, and an analysis of theirrelation to demographic and clinical variables, causality, course,and consequences.Results: of a total of 520 cases 31 (6%) met reexposure criteria.Fatal outcomes, needs for admission, and mean recovery timewere all higher for hepatocellular-type toxic injury. The most commonlyidentified drug class was antibiotics. On most occasions(73%) reexposure to the causal compound escaped notice becauseof: absence of index case diagnosis, lack of information topatients and their physicians, and (12%) development of cross reactionsbetween structurally similar drugs.Conclusions: accidental reexposure to a drug or a structurally-related compound after an initial hepatotoxicity event is commonand may have serious consequences, particularly in hepatocellular-type toxicity. Careful history taking and reflectingdiagnostic suspicion in the initial episode’s record may reduce the incidence of this iatrogenic event (AU)

[Protected penetrating keratoplasty: surgical technique and endothelial response]. / Queratoplastia penetrante protegida: técnica quirúrgica y respuesta del endotelio.

PURPOSE: To describe the technique and to evaluate the safety of protected penetrating keratoplasty (PPK). METHODS: A technique for penetrating keratoplasty is described. The postoperative endothelial cell counts of 17 eyes in which this operative technique was used were compared with those in 24 eyes in whom the standard operative technique for penetrating keratoplasty (PK) was used. The post-operative time periods were grouped as follows: 3-6 months, 7-12 months and >12 months. For statistical analysis, the Mann-Whitney U non-parametric test was employed. RESULTS: There was no case where tissue extrusion occurred during the procedure. The endothelial cell count was similar in both groups for the 3-6 month period (PK = 2,086, DS 566; PPK = 1,858, DS 671; p = 0.2702) and >12 months period (PK = 1,574, DS 745; PPK = 1,419, DS 810; p = 0.2882). There was a significant difference in the 7-12 month period (PK = 2,255, DS 831; PPK = 1,569, DS 623; p = 0.0397). CONCLUSIONS: The described technique of PPK may reduce the risk of per-operative complications. Damage to the endothelium is not increased compared with that seen following the standard PK procedure.

Effects of baclofen on temperature perception in humans.

The aim of this study was to evaluate the effect of chronic consumption of the GABAB agonist baclofen on temperature perception in humans. We investigated temperature perception thresholds to detect warm and cold stimuli in a group of 21 patients with spinal cord injury, who were chronically consuming oral baclofen at different daily doses to treat spasticity. Temperature perception thresholds were assessed above the level of the lesion, using a psychophysical approach based on the ability of the subjects to perceive precisely quantified sensory stimuli (quantitative sensory testing, QST). The data were compared with a control group of healthy subjects, not receiving baclofen. We found that chronic baclofen consumption increased temperature perception thresholds for both cold and warm stimuli in a dose-dependent manner. Temperature perception thresholds did not depend on the level of the lesion nor on the duration of baclofen treatment, suggesting that our finding represent normal GABAB-mediated modulation in spared nervous structures. We conclude that GABAB therefore plays a role in temperature perception in humans.

Intermenstrual bleeding from interaction of ebastine with combined oral contraceptives

No disponible

No disponible

[Subclinical keratoconus diagnosis by elevation topography]. / Diagnóstico del queratocono subclínico por topografía de elevación.

PURPOSE: To evaluate the most effective parameters of Orbscan Corneal Topography System for subclinical keratoconus screening. METHODS: The study includes corneas from patients with clinical diagnosis of keratoconus (group 1, n=35), patients with subclinical keratoconus (group 2, n=14) and a control group of myopic subjects paired in gender, age and refractive spherical equivalent (group 3, n=35). Placement of the apex, anterior and posterior corneal elevation, minimal corneal thickness, anterior chamber depth and corneal diameter were evaluated. RESULTS: The most frequent location of the apex was at the inferotemporal sector (53%). Mean anterior elevation was 56.73 S.D. 25.95 mm in group 1 and 20.35 S.D. 8.04 mm in group 2; results that are statistically significant different from the control group (p<0.001). Mean posterior elevation was 126.23 S.D. 57.7 mm in group 1 and 54.28 S.D. 19.55 mm in group 2, both showing a statistically significant difference from the control group (p<0.001). Minimal corneal thickness and anterior chamber depth also showed statistically significant differences between the three groups. No differences were found in corneal diameter values. CONCLUSIONS: Statistically significant differences were found in anterior and posterior elevation, minimal corneal thickness and anterior chamber depth parameters, as measured by the Orbscan system, between normal myopic subjects and those with clinical and sub-clinical keratoconus. These parameters should be considered in the detection of patients with increased risk for developing secondary keratectasia following corneal refractive surgery.

[Iris-claw phakic intraocular lens for high myopia correction. Visual and refractive results]. / Corrección de la alta miopía con lentes de fijación en iris. Resultados visuales y refractivos.

PURPOSE: To determine predictability, efficacy, complications and patient's satisfaction to phakic intraocular lens (Artisan) in highly myopic patients. METHOD: Retrospective study of 65 eyes (36 patients), with preoperative spherical equivalent (SE) between -9,75 and -25,0 diopters (D) operated on by a single surgeon (JAD) between January 1999 and August 2001. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, postoperative complications, and patient's subjective response were evaluated. RESULTS: UCVA evaluated 3 months postoperatively was 0.47 and BSCVA was 0.62. An average gain of 2.3 lines was observed with respect to the preoperative BSCVA. Refraction between +/-0.50 D from emmetropia ocurred in 49.23% of the eyes, and between +/- 1.0 D in 78.46% of the eyes. The difference between intended SE (preoperative SE minus IOL diopter) and achieved postoperative SE, showed a 0.55 D mean undercorrection. An intraocular pressure (IOP) over 30 mmHg was seen in 10% of the eyes in the immediate postoperative period. Night halos/glare perception was <> in 20% of the eyes, and in 90.77% of the cases the patient showed satisfaction with the results of the procedure. CONCLUSION: Artisan iris-claw phakic lens implantation in highly myopic eyes is a safe procedure that increases BSCVA. It was observed a tendency towards undercorrection in the postoperative refractive outcome.

[Retinal ganglion cell neuroprotection in culture]. / Neuroprotección de las células ganglionares de la retina.

PURPOSE: To study the pig retinal ganglion cell (RGC) survival in culture, analysing the possible neuroprotective effect of retinal Müller glia (RMG) and brain-derived neurotrophic factor (BDNF). METHODS: Adult pig retina were dissociated and cultured under different conditions: 1) on laminin/poly-D-lysine-coated coverslips in chemically defined medium (CDM); 2) on laminin/poly-D-lysine-coated coverslips in CMD supplemented with BDNF; 3) on confluent monolayer cultures of RMG in CDM; 4) on laminin/poly-D-lysine substrate in conditioned medium obtained from RMG. RGCs were identified by immunocytochemistry using antibody against 68 kDa neurofilament and observed under an fluorescent microscope. RGCs were classified on the basis of the size, number and length of neurites, and their survival was assayed for each treatment. RESULTS: Confluent RMG substrates and RMG conditioned medium significantly increased the survival of cultured pig RGC. Moreover these two conditions increased the mean area of RGCs and enhanced neurite growth and elongation. Addition of BDNF to culture medium did not modify survival but increased RGC size, neurite number and neurite length. CONCLUSIONS: These findings demonstrate that factor(s) secreted by RMG exert beneficial effects on adult RGC survival and neurite regeneration in vitro, and might constitute important agent(s) for RGC neuroprotection. BDNF also increases the mean area of RGCs and enhances neurite growth but it does not increase the survival of RGCs.

[Usefulness of olanzapine in the levodopa-induced psychosis in patients with Parkinson's disease]. / Utilidad de la olanzapina en la psicosis inducida por levodopa en pacientes parkinsonianos.

BACKGROUND: To evaluate the antipsychotic efficacy of olanzapine (OLZ) in patients with Parkinson's disease (PD) and drug-induced psychosis (DIP) and its repercussion on the motor function. METHODS: Ten patients (5 women and 5 men) diagnosed of PD and DIP, aged 67 years (range: 50-81), with PD duration of 11.1 years (range: 6-23), treated chronically with levodopa per day, received a dose of 2.5 or 5.0 mg OLZ daily. Data concerning improvement of psychosis and worsening of motor function was based on Positive And Negative Symptoms Scale (PANSS) and Unified Parkinsons Disease Rating Scale (UPDRS) motor. RESULTS: Psychotic symptoms were improved in all patients. In most of them the improvement was almost total. Seven patients increased levodopa dose on OLZ, but significant worsening of motor function was reported just in one patient. None of the patients had agranulocytosis in the blood monitoring. Two patients presented weight gain. Seven patients improved their cognitive status. CONCLUSIONS: We conclude that OLZ at the doses studied may have efficacy for DIP which appears in PD and does not induce worsening of motor function in most of the patients.

Utilidad de la olanzapina en la psicosis inducida por levodopa en pacientes parkinsonianos / Usefulness of olanzapine in the levodopainduced psychosis in patients with Parkinson's disease

FUNDAMENTO: Valorar la eficacia antipsicótica de la olanzapina (OLZ) en pacientes con enfermedad de Parkinson (EP) con psicosis inducida por fármacos (PIF) y su repercusión sobre la función motora. MÉTODOS: Diez pacientes (5 mujeres y 5 varones) diagnosticados de EP y PIF, con una media de edad de 67 años (límites: 50-81), con una evolución media de la EP de 11,1 años (límites: 6-23), tratados crónicamente con levodopa, recibieron una dosis de 2,5 o 5,0 mg/día de OLZ. Para la valoración de la mejoría de la psicosis o del empeoramiento de la función motora se utilizaron las escalas Positive and Negative Symptoms Scale (PANSS) y Unified Parkinson's Disease Rating Scale (UPDRS) motora, respectivamente. RESULTADOS: Los síntomas psicóticos mejoran en todos los pacientes, obteniendo todos los casos una puntuación > 80 por ciento en comparación con la anterior al tratamiento. Siete pacientes necesitaron incrementar la dosis de levodopa al incorporar la OLZ, aunque sólo en uno de ellos se produjo un empeoramiento motor. Ningún enfermo presentó agranulocitosis y dos ganaron peso. La mayoría de los pacientes mejoraron claramente su estado cognitivo. CONCLUSIONES: La OLZ, a las dosis utilizadas en este trabajo, puede ser eficaz en la PIF que aparece en la EP y en la mayoría de los pacientes no parece deteriorar la función motora. (AU)