Percepción de la validez del cuestionario Migraine Disability Assessment por una población de pacientes con migraña crónica / Perception of the validity of the Migraine Disability Assessment questionnaire in a population of patients with chronic migraine

Objetivos: El cuestionario Migraine Disability Assessment (MIDAS) es el instrumento más empleado para valorar el grado de discapacidad en los estudios de migraña. El objetivo del estudio es determinar el nivel de cumplimentación del cuestionario, valorar su facilidad de uso y conocer la percepción subjetiva del paciente sobre la capacidad del cuestionario para medir realmente su discapacidad.Material y métodosEstudio prospectivo sobre una población de 78 pacientes con migraña crónica. Se determina el nivel educativo y la situación laboral. En la visita basal se adiestra a los pacientes sobre la correcta cumplimentación del cuestionario. A los 3 meses se determina la puntuación total y el nivel de cumplimentación. Además los pacientes contestan una encuesta que mide: facilidad de uso y percepción del paciente sobre si la escala refleja su propia discapacidad.ResultadosSolo el 46% rellena completamente el cuestionario. El 69% de los pacientes indica que el cuestionario no les resulta fácil de cumplimentar (resultado no influido por el nivel educativo, pero sí por la situación laboral de los pacientes). El 62% de los encuestados opina que el cuestionario no refleja completamente su propia percepción de discapacidad.ConclusionesAunque está más que demostrada la validez y consistencia del cuestionario MIDAS, un porcentaje elevado de nuestra población reconoce que el cuestionario no es fácil de rellenar y además es percibido por muchos de nuestros pacientes como un cuestionario que no refleja adecuadamente su discapacidad. Conocer la opinión de los pacientes sobre la idoneidad de los cuestionarios administrados en las consultas es crucial para mejorar su cumplimentación. (AU)

Objectives: The Migraine Disability Assessment (MIDAS) questionnaire is the most frequently used instrument for assessing the level of disability in studies into migraine. This study aims to determine the level of completion of the questionnaire, assess the ease of use, and understand patients’ subjective perception of the questionnaire's actual ability to measure disability.Material and methodsWe performed a prospective study of a sample of 78 patients with chronic migraine, determining their level of education and employment status. In a baseline visit, patients were trained to properly complete the questionnaire. At 3 months, we determined the total score and level of completion. Patients also completed a survey measuring ease of use of the questionnaire and patients’ perception of whether the score accurately reflected their disability.ResultsOnly 46% of patients fully completed the questionnaire. Sixty-nine percent reported finding it difficult to complete (this was influenced by patient's employment status but not by educational level). Sixty-two percent of respondents believed that the questionnaire did not fully reflect their own perception of their disability.ConclusionsAlthough the validity and consistence of the MIDAS questionnaire are well documented, a high percentage of the study population reported finding it difficult to complete; many patients also considered that the questionnaire did not accurately reflect their disability. Understanding patients’ opinions of the suitability of questionnaires used in consultation is crucial to improving completion. (AU)

Perception of the validity of the Migraine Disability Assessment questionnaire in a population of patients with chronic migraine.

OBJECTIVES: The Migraine Disability Assessment (MIDAS) questionnaire is the most frequently used instrument for assessing the level of disability in studies into migraine. This study aims to determine the level of completion of the questionnaire, assess the ease of use, and understand patients' subjective perception of the questionnaire's actual ability to measure disability. MATERIAL AND METHODS: We performed a prospective study of a sample of 78 patients with chronic migraine, determining their level of education and employment status. In a baseline visit, patients were trained to properly complete the questionnaire. At 3 months, we determined the total score and level of completion. Patients also completed a survey measuring ease of use of the questionnaire and patients' perception of whether the score accurately reflected their disability. RESULTS: Only 46% of patients fully completed the questionnaire. Sixty-nine percent reported finding it difficult to complete (this was influenced by patient's employment status but not by educational level). Sixty-two percent of respondents believed that the questionnaire did not fully reflect their own perception of their disability. CONCLUSIONS: Although the validity and consistence of the MIDAS questionnaire are well documented, a high percentage of the study population reported finding it difficult to complete; many patients also considered that the questionnaire did not accurately reflect their disability. Understanding patients' opinions of the suitability of questionnaires used in consultation is crucial to improving completion.

Reversible Homonymous Inferior Quadrantanopia in a Nonketotic Hyperglycemic Patient.

Homonymous hemianopia is frequently associated with retrochiasmal lesions. Vascular etiology is the most common and usually evident on magnetic resonance imaging. When the results of neuroimaging are normal, there are other etiologies that we should consider, like nonketotic hyperglycemia (NKH). We report a 62-year-old female diabetic patient with headache, colour vision and sudden homonymous inferior quadrantanopia and elevated blood sugar levels with normal pH. The neuroimaging was normal and the visual lost improved after the correction of the hyperglycemia. NKH should be considered in patients with sudden and transient hemianopia and normal neuroimaging.

Perception of the validity of the Migraine Disability Assessment questionnaire in a population of patients with chronic migraine. / Percepción de la validez del cuestionario Migraine Disability Assessment por una población de pacientes con migraña crónica.

OBJECTIVES: The Migraine Disability Assessment (MIDAS) questionnaire is the most frequently used instrument for assessing the level of disability in studies into migraine. This study aims to determine the level of completion of the questionnaire, assess the ease of use, and understand patients' subjective perception of the questionnaire's actual ability to measure disability. MATERIAL AND METHODS: We performed a prospective study of a sample of 78 patients with chronic migraine, determining their level of education and employment status. In a baseline visit, patients were trained to properly complete the questionnaire. At 3 months, we determined the total score and level of completion. Patients also completed a survey measuring ease of use of the questionnaire and patients' perception of whether the score accurately reflected their disability. RESULTS: Only 46% of patients fully completed the questionnaire. Sixty-nine percent reported finding it difficult to complete (this was influenced by patient's employment status but not by educational level). Sixty-two percent of respondents believed that the questionnaire did not fully reflect their own perception of their disability. CONCLUSIONS: Although the validity and consistence of the MIDAS questionnaire are well documented, a high percentage of the study population reported finding it difficult to complete; many patients also considered that the questionnaire did not accurately reflect their disability. Understanding patients' opinions of the suitability of questionnaires used in consultation is crucial to improving completion.

Síndrome del canal de Alcock secundario a infiltración por endometriosis / Alcock canal syndrome secondary to endometrial infiltration

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Eyelid myokymia in patients with migraine taking topiramate.

OBJECTIVE: Although ocular side effects of topiramate are common, neuroophthalmologic manifestations such as blepharospasm, myokymia and oculogyric crisis are scarcely reported. METHODS: We present a serie of 8 patients with migraine who developed eyelid myokymia after treatment with topiramate. We reviewed all patients with migraine treated with topiramate attending the headache outpatient clinic of our hospital from January 2008 to December 2012. RESULTS: During the study period, a total of 140 patients with migraine were treated with topiramate in our headache clinic. Eight presented eyelid myokymia after beginning treatment with topiramate (5,7%). Topiramate was stopped and myokymia disappeared in all patients, it was prescribed again and eyelid myokymia reappeared with their previous characteristics in all patients. CONCLUSIONS: Eyelid myokymia is an underreported side-effect of topiramate in patients with migraine, of unknown cause, so that in future, further studies are need to examine whether patients with migraine are predisposed or not to this adverse effect.

[Prevention of migraine: a pharmacoepidemiological study]. / Prevención de la migraña: un estudio farmacoepidemiológico.

INTRODUCTION: This study aims to perform a descriptive analysis of the usage patterns of migraine prophylactic medications by various neurologists in our setting. MATERIAL AND METHODS: The first preventive treatment prescribed for migraine in patients not associated to other diagnoses of primary headache was recorded in three outpatient neurology clinics and one headache specific clinic. RESULTS: A total of 235 prophylactic treatments out of 669 patients were initiated. The patients were aged 37 +/- 12 years (mean +/- standard deviation) and 84.45% were women. Migraines with aura accounted for 18.9% of migraines. By order of frequency, the prophylactic treatments administered were topiramate (43%), beta-blockers (18%), flunaricine (17%), amitriptyline (14%), selective serotonin reputake inhibitors (6%) and others (2%). Beta-blockers and flunaricine were used much more frequently in men (29.7% and 27% versus 15.9% and 14.4%, respectively) and antidepressants were used more in women (21.87% versus 5.4%). The most frequently used antidepressant was amitriptyline, and its use increases with the age of the patient, it being the most frequently used treatment in over 60-year-old patient group. CONCLUSIONS: At present, topiramate has become the first preventive treatment option for migraine in our setting, especially in young women. There is greater variability in the choice of an alternative treatment. Amitriptyline is the first choice within the antidepressants and is almost exclusively prescribed in women with migraine and elderly age.

Prevención de la migraña: un estudio farmacoepidemiológico / Prevention of migraine: a pharamacoepidemiological study

Introducción. Se realiza un análisis descriptivo de los tratamientosprofilácticos empleados para el tratamiento de la migrañapor varios neurólogos de nuestro medio.Material y métodos. Se registró el primer tratamiento preventivopautado para migraña en pacientes que no asociaban otro diagnósticode cefalea primaria. Se reclutaron durante 1 año en tres consultasde neurología ambulatoria y una específica de cefalea de laprovincia de Alicante.Resultados. De 669 pacientes totales, se iniciaron 235 tratamientosprofilácticos, con una edad de los pacientes de 37±12años (media±desviación estándar) y un 84,45 % de mujeres. Un18,9% de migrañas eran con aura. Por orden de frecuencia, los profilácticosempleados fueron el topiramato (43 %), los betabloqueantes(18%), la flunaricina (17%), la amitriptilina (14 %), inhibidoresselectivos de la recaptación de serotonina (6 %) y otros(2 %). Los betabloqueantes y la flunaricina se emplearon muchomás en el hombre (29,7 y 27 % frente a 15,9 y 14,4%, respectivamente)y los antidepresivos en la mujer (21,87 frente a 5,4 %). Elantidepresivo más empleado fue la amitriptilina, y su empleo aumentacon la edad del paciente, siendo el tratamiento más frecuenteen el grupo de más de 60 años.Conclusiones. El topiramato en la actualidad y en nuestro medioes la primera opción en el tratamiento preventivo de la migraña,sobre todo en la mujer joven. La variabilidad es mayor en la eleccióndel tratamiento alternativo. La amitriptilina es la primera opcióndentro de los antidepresivos y se prescriben casi exclusivamente en lamujer con migraña y en edades avanzadas (AU)

Introduction. This study aims to perform a descriptiveanalysis of the usage patterns of migraine prophylactic medicationsby various neurologists in our setting.Material and methods. The first preventive treatment prescribedfor migraine in patients not associated to other diagnosesof primary headache was recorded in three outpatient neurologyclinics and one headache specific clinic.Results. A total of 235 prophylactic treatments out of 669patients were initiated. The patients were aged 37±12 years(mean±standard desviation) and 84.45% were women. Migraineswith aura accounted for 18.9% of migraines. By order of frequency,the prophylactic treatments administered were topiramate(43%), beta-blockers (18%), flunaricine (17%), amitriptyline(14%), selective serotonin reputake inhibitors (6 %) and others(2 %). Beta-blockers and flunaricine were used much more frequentlyin men (29.7% and 27% versus 15.9% and 14.4%, respectively)and antidepressants were used more in women(21.87% versus 5.4%). The most frequently used antidepressantwas amitriptyline, and its use increases with the age of the patient,it being the most frequently used treatment in over 60 yearold patient group.Conclusions. At present, topiramate has become the firstpreventive treatment option for migraine in our setting, especiallyin young women. There is greater variability in the choiceof an alternative treatment. Amitriptyline is the first choice withinthe antidepressants and is almost exclusively prescribed inwomen with migraine and elderly age (AU)

SIP30-AI: reflexiones / SIP30-AI: reflections

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[Ambulatory neurological care in a prison population]. / Atencion neurologica ambulatoria a una poblacion penitenciaria.

AIMS: Some of the users attended in a Neurology service consist of the inmate population in a prison. The aim of this study is to analyse all the proposals referred from the Alicante II Prison Centre to a Neurology service. PATIENTS AND METHODS: We analyse and describe the clinical characteristics of patients referred from the Alicante II Prison Centre to the Neurology service at the Centro Sanitario Integrado in Villena between the years 2003 and 2006. This analysis involved the following variables: age, sex, personal history, reason for visiting and diagnosis. RESULTS: A total of 88 proposals were recorded. The mean age of the patients was 35 years (84 males/4 females). A total of 15 patients did not attend their appointment (17%). Positive serology for the human immunodeficiency virus was found in 18% of patients. The most frequent reason for visiting was headache (32%), followed by seizures (25%) and, thirdly, vascular pathologies (13%). In a group of 16 patients (18%) the main diagnosis was established as being some kind of psychiatric disorder (anxiety, depression, simulation). CONCLUSIONS: No studies have been published in the literature that analyse the clinical characteristics of patients from prisons referred to a Neurology service. The high percentage of patients who do not attend their appointment and the high percentage of psychiatric disorders that are diagnosed within this group of patients are especially noteworthy. However, and as can be observed in the general population, headache is still the most common reason for visiting. Nevertheless, the group of neurological diagnoses that are most frequently attended is epilepsy.

Atención neurológica ambulatoria a una población penitenciaria / Ambulatory neurological care in a prison population

La población recluida en un centro penitenciario forma parte de los usuarios atendidos en una consultade Neurología. El objetivo del presente estudio es analizar todas las propuestas derivadas desde el Centro Penitenciario Alicante II a una consulta de Neurología. Pacientes y métodos. Se analizan y describen las características clínicas de los pacientesderivados desde el Centro Penitenciario Alicante II a la consulta de Neurología del Centro Sanitario Integrado de Villena, entre los años 2003 y 2006. Se analizan las siguientes variables: edad, sexo, antecedentes personales, motivo de consulta ydiagnóstico. Resultados. Se contabiliza un total de 88 propuestas. La edad media de los pacientes fue de 35 años (84 varones y 4 mujeres). Un total de 15 pacientes no acudieron a la consulta (17%). El 18% de los pacientes presentan serología positivapara el virus de inmunodeficiencia humana. El motivo de consulta más frecuente fue el de cefalea (32%), seguido de crisis convulsivas (25%) y, en tercer lugar, de la patología vascular (13%). En un grupo de 16 pacientes (18%) se estableció como diagnóstico principal alguna alteración psiquiátrica (ansiedad, depresión, simulación). Conclusiones. No existen actualmenteen la bibliografía estudios que analicen las características clínicas de los pacientes penitenciarios derivados a una consulta de Neurología. Llama la atención el alto porcentaje de pacientes que no acuden a la consulta y el alto porcentaje de trastornospsiquiátricos diagnosticados en este grupo de pacientes. No obstante, y como se observa en la población general, la cefalea sigue siendo el motivo de consulta más frecuente. Sin embargo, el grupo diagnóstico neurológico más frecuentemente atendido es la epilepsia

Some of the users attended in a Neurology service consist of the inmate population in a prison. The aim ofthis study is to analyse all the proposals referred from the Alicante II Prison Centre to a Neurology service. Patients and methods. We analyse and describe the clinical characteristics of patients referred from the Alicante II Prison Centre to the Neurology service at the Centro Sanitario Integrado in Villena between the years 2003 and 2006. This analysis involved thefollowing variables: age, sex, personal history, reason for visiting and diagnosis. Results. A total of 88 proposals were recorded. The mean age of the patients was 35 years (84 males/4 females). A total of 15 patients did not attend their appointment (17%). Positive serology for the human immunodeficiency virus was found in 18% of patients. The most frequentreason for visiting was headache (32%), followed by seizures (25%) and, thirdly, vascular pathologies (13%). In a group of 16 patients (18%) the main diagnosis was established as being some kind of psychiatric disorder (anxiety, depression, simulation).Conclusions. No studies have been published in the literature that analyse the clinical characteristics of patients from prisons referred to a Neurology service. The high percentage of patients who do not attend their appointment and the high percentage of psychiatric disorders that are diagnosed within this group of patients are especially noteworthy. However, and as can be observed in the general population, headache is still the most common reason for visiting. Nevertheless, the group of neurological diagnoses that are most frequently attended is epilepsy

El tratamiento preventivo con topiramato mejora la calidad de vida de los pacientes con migraña / Preventive treatment with topiramate enhances the quality of life of patients with migraine

Introducción. El topiramato ha demostrado recientementeser seguro y efectivo en la prevención de la migraña y en la actualidades el único fármaco neuromodulador con indicación parala prevención de la migraña en España. Objetivo. Evaluar la adherencia,la eficacia y la seguridad del tratamiento preventivo con topiramatoen pacientes diagnosticados de migraña. Pacientes y métodos.Se realizó un estudio multicéntrico prospectivo observacionalen las consultas de neurología general. Se incluyeron pacientescon migraña mayores de 14 años que requerían un tratamiento preventivo y en los que habían fallado otros tratamientos preventivos oen los que cuales se consideraba más adecuado el topiramato enfunción de su perfil de efectos adversos. Se evaluó la eficacia deltratamiento, la satisfacción del paciente, los efectos adversos y lareducción del peso corporal. La eficacia del tratamiento se valoró através de la reducción en la frecuencia de migrañas y en la puntuacióndel Headache Impact Test (HIT-6). Resultados. Se evaluaron79 pacientes. La dosis de topiramato osciló entre 25 y 200 mg/día,con una mediana de 100 mg/día. El 19% de los pacientes abandonóel estudio por efectos adversos. La causa más frecuente de abandonofueron las parestesias. No se observaron efectos adversos graves.El 14% de los pacientes experimentó una pérdida de peso superioral 5% del basal. El porcentaje de pacientes respondedores fuedel 58%. El grado de satisfacción de los pacientes que completaronel seguimiento fue buena (80%), regular (11%) y mala (9%). Conclusiones.El tratamiento preventivo con topiramato reduce significativamenteel impacto y la discapacidad de la migraña. El tratamientoes satisfactorio y mejora la calidad de vida en un porcentajeimportante de pacientes

Introduction. Topiramate has recently proved to be safe and effective in the prevention of migraine and is currentlythe only neuromodulatory drug indicated for the prevention of migraine in Spain. Aim. To evaluate the adherence, effectivenessand safety of preventive treatment with topiramate in patients diagnosed with migraine. Patients and methods. A prospective,observational, multi-centre study was conducted in general neurology departments. Patients eligible for the study were thosewith migraine, above 14 years of age, who needed preventive treatment and in whom other preventive treatments had failed orfor whom topiramate was believed to be the most suitable therapy as regards its profile of side effects. The effectiveness of thetreatment, patient satisfaction, side effects and loss of body weight were all evaluated. Effectiveness of the treatment wasevaluated by means of the reduction in the frequency of migraines and the score obtained on the Headache Impact Test (HIT-6).Results. A total of 79 patients were evaluated. The dosage of topiramate ranged between 25 and 200 mg/day, with an average of100 mg/day. 19% of the patients dropped out of the study due to side effects. Paresthesias were the most frequent reason fordropping out. No serious side effects were observed. 14% of the patients lost more than 5% of the base weight. The percentageof patients who responded was 58%. The degree of satisfaction of the patients who completed the follow-up was: good (80%),regular (11%) and poor (9%). Conclusions. Preventive treatment with topiramate significantly reduces the impact of migraineand the disability that results from it. Treatment is satisfactory and improves the quality of life in a large percentage of patients

[Preventive treatment with topiramate enhances the quality of life of patients with migraine]. / El tratamiento preventivo con topiramato mejora la calidad de vida de los pacientes con migrana.

INTRODUCTION: Topiramate has recently proved to be safe and effective in the prevention of migraine and is currently the only neuromodulatory drug indicated for the prevention of migraine in Spain. AIM: To evaluate the adherence, effectiveness and safety of preventive treatment with topiramate in patients diagnosed with migraine. PATIENTS AND METHODS: A prospective, observational, multi-centre study was conducted in general neurology departments. Patients eligible for the study were those with migraine, above 14 years of age, who needed preventive treatment and in whom other preventive treatments had failed or for whom topiramate was believed to be the most suitable therapy as regards its profile of side effects. The effectiveness of the treatment, patient satisfaction, side effects and loss of body weight were all evaluated. Effectiveness of the treatment was evaluated by means of the reduction in the frequency of migraines and the score obtained on the Headache Impact Test (HIT-6). RESULTS: A total of 79 patients were evaluated. The dosage of topiramate ranged between 25 and 200 mg/day, with an average of 100 mg/day. 19% of the patients dropped out of the study due to side effects. Paresthesias were the most frequent reason for dropping out. No serious side effects were observed. 14% of the patients lost more than 5% of the base weight. The percentage of patients who responded was 58%. The degree of satisfaction of the patients who completed the follow-up was: good (80%), regular (11%) and poor (9%). CONCLUSIONS: Preventive treatment with topiramate significantly reduces the impact of migraine and the disability that results from it. Treatment is satisfactory and improves the quality of life in a large percentage of patients.

Trombosis venosa cerebral y factor V de Leiden / Cerebral venous thrombosis and factor V Leiden

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Bostezos y epilepsia del lóbulo temporal / Yawning and temporal lobe epilepsy

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[Retinopathy secondary to treatment with Interferon beta-1a in a patient with multiple sclerosis]. / Retinopatía secundaria a tratamiento con interferón beta 1a en paciente con esclerosis múltiple.

INTRODUCTION: Although visual symptoms of multiple sclerosis (MS) are very frequent, they are rarely related with treatment with interferon. This is the first case reported in the literature of retinopathy associated with subcutaneous interferon beta-1a, and the second related to interferons in MS. CASE REPORT: A 30-year-old female diagnosed with relapsing-remitting MS who, at 3 months after starting treatment with subcutaneous interferon beta-1a (44 microg/3 times a week), displayed visual disorders. Retinal lesions in the form of cotton wool spots were found as symptoms of microinfarctions in the retina. The lesions got better after stopping treatment and the patient was found to be asymptomatic. CONCLUSIONS: The existence of retinopathy secondary to interferon has been known in the treatment of hepatitis C and neoplasias with interferon alfa since 1990. Despite being a frequently occurring complication, it is usually a mild condition and disappears on withdrawing treatment, or even if it is continued. It is attributed to deposits of immunocomplexes and complement activation in the blood vessels of the retina. Only one other case associated to treatment of MS with interferon beta has been reported in the literature, more specifically related to subcutaneous interferon beta-1b. The clinical characteristics of both cases are identical to those associated to interferon alfa. Despite the fact that the frequency of appearance seems to be lower than in the case of interferon alfa, the physician must bear in mind the possibility encountering this complication.