RESUMO
BACKGROUND AND PURPOSE: Spain has been one of the countries more heavily stricken by SARS-CoV-2, which has had huge implications for stroke care. The aim was to analyse the impact of the COVID-19 epidemic outbreak on reperfusion therapies for acute ischaemic stroke in the northwest of Spain. METHODS: This was a Spanish multicentre retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. All patients receiving reperfusion therapy for ischaemic stroke between 30 December 2019 and 3 May 2020 were recorded, and their baseline, clinical and radiological characteristics, extra- and intra-hospital times of action, Code Stroke activation pathway, COVID-19 status, reperfusion rate, and short-term outcome before and after the setting of the emergency state were analysed. RESULTS: A total of 796 patients received reperfusion therapies for ischaemic stroke. There was a decrease in the number of patients treated per week (46.5 patients per week vs. 39.0 patients per week, P = 0.043) and a delay in out-of-hospital (95.0 vs. 110.0 min, P = 0.001) and door-to-needle times (51.0 vs. 55.0, P = 0.038). Patients receiving endovascular therapy obtained less successful reperfusion rates (92.9% vs. 86.6%, P = 0.016). COVID-19 patients had more in-hospital mortality. CONCLUSION: A decrease in the number of patients benefiting from reperfusion therapies was found, with a delay in out-of-hospital and door-to-needle times and worse reperfusion rates in northwest Spain. COVID-19 patients had more in-hospital mortality.
Assuntos
COVID-19 , AVC Isquêmico/terapia , Pandemias , Reperfusão , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência/estatística & dados numéricos , Procedimentos Endovasculares/estatística & dados numéricos , Feminino , Humanos , AVC Isquêmico/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Sistema de Registros , Estudos Retrospectivos , Espanha/epidemiologia , Terapia Trombolítica/estatística & dados numéricos , Resultado do TratamentoAssuntos
Encefalomielite Aguda Disseminada/etiologia , Lúpus Eritematoso Sistêmico/complicações , Adulto , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Humanos , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Imageamento por Ressonância Magnética , MasculinoAssuntos
Encéfalo/irrigação sanguínea , Artérias Cerebrais/virologia , Hepatite C/complicações , Hemorragias Intracranianas/virologia , Vasculite do Sistema Nervoso Central/complicações , Vasculite do Sistema Nervoso Central/virologia , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/patologia , Doença Crônica , Transtornos da Consciência/etiologia , Transtornos da Consciência/patologia , Transtornos da Consciência/fisiopatologia , Crioglobulinemia/fisiopatologia , Crioglobulinemia/virologia , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/patologia , Microcirculação/diagnóstico por imagem , Microcirculação/patologia , Microcirculação/virologia , Polineuropatias/fisiopatologia , Polineuropatias/virologia , Convulsões/etiologia , Convulsões/patologia , Convulsões/fisiopatologia , Tomografia Computadorizada por Raios X , Vasculite do Sistema Nervoso Central/patologiaRESUMO
INTRODUCTION: Eight new antiepileptic drugs (AED) have been marketed in Spain since 1990 and others will soon follow. OBJECTIVE: To review the concepts underlying the development of the new drugs, as well as their indications, efficacy and safety. DEVELOPMENT: Pharmacologic antiepileptic intervention is no longer solely directed towards an anticonvulsant effect, but also to epileptogenic prevention, disease modification and reversal of pharmacoresistance. The development of new AED, initially based on the screening of putative products in animal models, changed during the last half of the century to a rational design based on known facts about excitatory /inhibitory neuronal mechanisms. More recently, attention has focussed on pharmacogenetics. The new AED were initially indicated for partial epilepsies, but some have been shown to have a broader clinical spectrum. Some show the ideal pharmacokinetic mechanisms, avoiding hepatic metabolism and protein binding. Drug interactions and adverse effects, especially severe idiosyncratic adverse effects, are rare, although there are some exceptions. In most cases, however, seizure control does not seem to be better than with the classic AED. Because of the specific characteristics of childhood epilepsy and pharmacokinetics, as well as the regulations governing the development of clinical trials, the use of new products in children is circumspect, which in turn delays the access of such patients to a possible therapeutic benefit.
Assuntos
Anticonvulsivantes/uso terapêutico , Anticonvulsivantes/farmacocinética , Anticonvulsivantes/farmacologia , Criança , Interações Medicamentosas , Resistência a Medicamentos , HumanosRESUMO
Introducción: Desde 1990 se han comercializado en nuestro país ocho nuevos fármacos antiepilépticos (FAE), y otros más lo serán en un futuro próximo. Objetivo Revisar los conceptos que guían el desarrollo de los nuevos fármacos, indicaciones, mecanismo de acción, eficacia y tolerabilidad. Desarrollo La intervención farmacológica antiepiléptica no es ya puramente anticonvulsionante, sino que se dirige hoy en día a la prevención de la epileptogénesis, a la modificación del pronóstico de la enfermedad y a revertir la farmacorresistencia. El desarrollo de nuevos fármacos pasó desde la experimentación animal con diferentes productos, hacia el "diseño racional" de fármacos basado en los mecanismos conocidos de excitación/inhibición neuronal durante la segunda mitad de siglo, para encaminarse actualmente hacia la denominada farmacogenética. Los nuevos FAE estaban indicados inicialmente para las epilepsias focales, aunque algunos han demostrado poseer un espectro de acción más amplio. La farmacocinética de muchos de ellos posee las características ideales, eludiendo el metabolismo hepático y la unión a proteínas. Las interacciones medicamentosas y los efectos secundarios son menores, sobre todo en lo referido a reacciones idiosincrásicas graves, existiendo alguna excepción que conviene reseñar. La eficacia terapéutica, sin embargo, no es mayor que la de los fármacos clásicos en la mayoría de los casos. Las características específicas de la epilepsia y de la farmacocinética durante la infancia, además de las normas oficiales para el desarrollo de los ensayos clínicos, condicionan una utilización precavida de los nuevos FAE en la infancia, lo que simultáneamente retrasa la accesibilidad de los niños al posible beneficio terapéutico (AU)