[Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in the province of Alicante]. / Fingolimod: efectividad y seguridad en la practica clinica habitual. Estudio observacional, retrospectivo y multicentrico en la provincia de Alicante.

INTRODUCTION: Post-authorisation studies are important to confirm whether the outcomes of clinical trials are reproduced in usual clinical practice. AIMS: To evaluate the effectiveness and safety of fingolimod in clinical practice in the province of Alicante. PATIENTS AND METHODS: A retrospective multi-centre study was conducted with remitting multiple sclerosis patients treated with fingolimod. Demographic, clinical and pharmacological data were collected. We report on the effectiveness of the drug -annualised relapse rate (ARR) and percentage of patients free from attacks- at one and at two years after treatment in relation to the previous year, and data concerning side effects are also provided. RESULTS: The sample consisted of 89 patients. Previous treatment was with immunomodulators (interferon beta or glatiramer acetate) in 54 patients and natalizumab in 32. Fifty patients changed due to failure with the immunomodulator and 31 owing to positive serology for JC virus (JCV+). Overall ARR decreased by 67.3% the first year (p < 0.0001) and by 84.1% the second (p = 0.0078). It diminished in patients with immunomodulator failure (85.6% the first year, p < 0.0001; 88.9% the second year, p = 0.0039) and increased in a non-significant manner in JCV+ patients in the first year. The percentage of patients free from relapses in the overall population increased from 32.6% to 68.1% in the first year (p < 0.0019) and to 82.6% in the second (p = 0.0215). This increase was not observed in JCV+ patients. Side effects were reported by 13 patients, which led to the drug being withdrawn in two of them. CONCLUSION: In clinical practice in the province of Alicante, levels of effectiveness and safety of fingolimod proved to be slightly higher than those found in clinical trials.

TITLE: Fingolimod: efectividad y seguridad en la practica clinica habitual. Estudio observacional, retrospectivo y multicentrico en la provincia de Alicante.Introduccion. Los estudios postautorizacion son importantes para confirmar si los resultados de los ensayos clinicos se reproducen en la practica clinica habitual. Objetivo. Evaluar la efectividad y seguridad del fingolimod en la practica clinica en la provincia de Alicante. Pacientes y metodos. Estudio multicentrico retrospectivo de pacientes con esclerosis multiple remitente tratados con fingolimod. Se recogen las caracteristicas demograficas, clinicas y farmacologicas. Se describe la efectividad del farmaco ­tasa anualizada de brotes (TAB) y porcentaje de pacientes libres de brotes­ al año y a los dos años de tratamiento en relacion con el año previo y datos de efectos secundarios. Resultados. Se incluyo a 89 pacientes. El tratamiento previo fue inmunomodulador (interferon beta o acetato de glatiramero) en 54 pacientes y natalizumab en 32. Cincuenta pacientes cambiaron por fracaso con el inmunomodulador y 31 por serologia positiva del virus JC (VJC+). La TAB global disminuyo el 67,3% el primer año (p < 0,0001) y el 84,1% el segundo (p = 0,0078). Disminuyo en los pacientes con fracaso del inmunomodulador (el 85,6% el primer año, p < 0,0001; el 88,9% el segundo año, p = 0,0039) y aumento de forma no significativa en los pacientes VJC+ en el primer año. El porcentaje de pacientes libres de brotes en la poblacion global aumento del 32,6 al 68,1% en el primer año (p < 0,0019) y al 82,6% en el segundo (p = 0,0215). Este aumento no se observo en los pacientes VJC+. Trece pacientes tuvieron efectos secundarios, que obligaron a la retirada del farmaco en dos de ellos. Conclusion. En la practica clinica de la provincia de Alicante, el fingolimod mostro una efectividad y una seguridad ligeramente superiores a las de los ensayos clinicos.

Alteraciones genéticas en el trastorno por déficit de atención con hiperactividad: relación con variables neuropsicológicas / Genetic variations in attention deficit hyperactivity disorder: relationship with neuropsychological variables

El Trastorno por Déficit de Atención con Hiperactividad (TDAH) es una patología frecuente de la infancia con una fuerte contribución genética. Tras unos años dedicados al estudio de los genes específicos que explicaban la sintomatología nuclear del trastorno (inatención, hiperactividad e impulsividad), en la actualidad el interés de los investigadores se ha ampliado, considerando la repercusión neuropsicológica que estas alteraciones genéticas tienen en los sujetos afectos de esta patología. En este trabajo revisamos la literatura existente sobre los correlatos genéticos de los déficits cognitivos del TDAH. Estas nuevas estrategias de investigación, necesariamente multidisciplinares, pretenden conseguir, además del incremento en la caracterización neurobiológica de esta patología, líneas de tratamiento alternativas a las existentes que respondan a la relación comentada entre genes y cognición en el TDAH

Attention Deficit/Hyperactivity Disorder (ADHD) is a frequent disorder in childhood with a strong genetic contribution. After a few years studying the specific genes that could explain the nuclear symptomatology of the disorder (inattention, hyperactivity, and impulsivity), actual research has been extended considering the neuropsychological repercussion that these genetic alterations have in subjects with ADHD. In this work we review the existing literature on the genetic basis of the cognitive deficits in ADHD. These new research strategies, necessarily multidisciplinary, try to explain a better neurobiological characterization of this pathology, plus alternative new lines of treatment based on the relationship between genes and cognition in ADHD

[Key informers. When and How?]. / Informadores clave. ¿Cuándo? ¿Cómo?

INTRODUCTION: When information obtained through duly designed and developed studies is not available, the solution to certain problems that affect the population or that respond to certain questions may be approached by using the information and experience provided by the so-called key informer. DEVELOPMENT: The key informer is defined as a person who is in contact with the community or with the problem to be studied, who is considered to have good knowledge of the situation and therefore who is considered an expert. The search for consensus is the basis to obtain information through the key informers. The techniques used have different characteristics based on whether the experts chosen meet together or not, whether they are guided or not, whether they interact with each other or not. These techniques include the survey, the Delphi technique, the nominal group technique, brainwriting, brainstorming, the Phillips 66 technique, the 6-3-5 technique, the community forum and the community impressions technique. CONCLUSION: Information provided by key informers through the search for consensus is relevant when this is not available or cannot be obtained by other methods. It has permitted the analysis of the existing neurological care model, elaboration of recommendations on visit times for the out-patient neurological care, and the elaboration of guidelines and recommendations for the management of prevalent neurological problems.

Informadores clave. ¿Cuándo? ¿Cómo? / Key informers. When and How?

Introducción. Cuando no se dispone de información obtenida a travésde estudios debidamente diseñados y desarrollados, es posible abordarla solución de determinados problemas que afectan a la poblacióno responder a determinadas preguntas aprovechando la información yexperiencia aportada por los denominados informadores clave.Desarrollo. El informador clave se define como una persona encontacto con la comunidad o con el problema a estudiar, a quien sereconoce un buen conocimiento de la situación y, por lo tanto, esconsiderado experto. La búsqueda del consenso es la base para la obtenciónde información a través de informadores clave. Las técnicasutilizadas tienen características diferentes en función de que los expertoselegidos se reúnan o no, sean conducidos o no, interaccionenentre sí o no. Estas técnicas incluyen la encuesta, la técnica Delphi, latécnica del grupo nominal, el brainwriting, el brainstorming, la técnicaPhillips 66, la técnica del 6-3-5, el forum comunitario y la técnicade impresiones de la comunidad.Conclusiones. La información aportada por informadores clavea través de la búsqueda del consenso es relevante cuando ésta noestá disponible o no es posible su obtención por otros métodos. Hapermitido el análisis del modelo de asistencia neurológica existente,la elaboración de recomendaciones sobre tiempos de visita para laasistencia neurológica ambulatoria y la elaboración de guías y recomendacionespara el manejo de problemas neurológicos prevalentes (AU)

Introduction. When information obtained through duly designedand developed studies is not available, the solution to certainproblems that affect the population or that respond to certainquestions may be approached by using the information and experienceprovided by the so-called key informer.Development. The key informer is defined as a person whois in contact with the community or with the problem to be studied,who is considered to have good knowledge of the situationand therefore who is considered an expert. The search for consensusis the basis to obtain information through the key informers.The techniques used have different characteristics based onwhether the experts chosen meet together or not, whether theyare guided or not, whether they interact with each other or not.These techniques include the survey, the Delphi technique, thenominal group technique, brainwriting, brainstorming, the Phillips66 technique, the 6-3-5 technique, the community forumand the community impressions technique.Conclusion. Information provided by key informers throughthe search for consensus is relevant when this is not available orcannot be obtained by other methods. It has permitted the analysisof the existing neurological care model, elaboration of recommendationson visit times for the out-patient neurological care,and the elaboration of guidelines and recommendations for themanagement of prevalent neurological problems (AU)

[Neuropsychological assessment of memory in attention deficit hyperactivity disorder: the role of executive functions]. / Evaluación neuropsicológica de la memoria en el trastorno pordéficit de atención/hiperactividad: papel de las funciones ejecutivas.

INTRODUCTION: There is an important agreement on the consideration of attention deficit hyperactivity disorder (ADHD) as a condition characterized by neurodevelopmental dysfunction of fronto-striatal dopaminergic and noradrenergic circuits with resultant executive deficits in cognitive functioning. AIM: To assess the existence of memory deficits in children with ADHD associated with a poor performance executive. SUBJECTS AND METHODS: We assess 14 children diagnosed with ADHD combined type and 14 controls matched on intellectual coefficient, age and level of schooling, in a neuropsychological evaluation protocol designed to assess executive functions and memory skills using Auditory Verbal Learning Test, Memory for Stories Test -Test of Memory and Learning (TOMAL)-, Complex Figure Text, Visual Selective Reminding Test (TOMAL), Tower of Hanoi, Memory Phrases Test (Siegel and Ryan), Digit Span (Wechsler Intelligence Scale for Children-Revised) and Tapping Test (Wechsler Memory Scale III). RESULTS: The ADHD group showed deficits in the learning and free recall of verbal material, in procedural and working memory. No group differences were observed in the visual memory tasks. CONCLUSIONS: The results are analyzed in terms of difficulty in coding strategies, storage and search of information previously stored in the group with ADHD, at least for the kind of verbal information. These difficulties are associated with deficits in executive functioning.

Evaluación neuropsicológica de la memoria en el trastorno por déficit de atención/hiperactividad: papel de las funciones ejecutivas / Neuropsycological assessment of memory in attention deficit hyperactivity disorder: The role of executive functions

Introducción. Existe un acuerdo importante en la consideración del trastorno por déficit de atención/hiperactividad (TDAH) como una patología del neurodesarrollo caracterizada por déficit dopaminérgicos y noradrenérgicos de los circuitos frontoestriados que afectan al funcionamiento ejecutivo en el rendimiento cognitivo. Objetivo. Evaluar la existencia de déficit en memoria en niños con TDAH asociados a un deficiente rendimiento ejecutivo. Sujetos y métodos. Administramos a 14 niños diagnosticados de TDAH tipo combinado y a 14 controles equiparados en cociente intelectual, edad y nivel de escolarización, un protocolo de evaluación neuropsicológica destinado a evaluar funciones ejecutivas y habilidades de memoria, mediante las pruebas Auditory Verbal Learning Test, test de memoria de historias –test de memoria y aprendizaje (TOMAL)–,figura compleja de Rey, recuerdo selectivo visual (TOMAL), torre de Hanoi, test de memoria de frases (Siegel y Ryan), test de dígitos (escala de inteligencia para niños de Wechsler revisada) y test de tapping visual (escala de memoria de Wechsler III).Resultados. Se encontró que los niños con TDAH presentan déficit en el aprendizaje y en el recuerdo libre del material verbal descontextualizado y contextualizado, en la memoria de trabajo y en la memoria procedimental. Por el contrario, no se encontraron diferencias significativas entre los grupos en las pruebas de memoria de naturaleza visuoespacial y visuoperceptiva.Conclusiones. Los resultados obtenidos se analizan en términos de dificultades en las estrategias de codificación, almacenamiento y búsqueda de la información previamente almacenada en el grupo con TDAH, al menos para la información de naturaleza verbal. Estas dificultades están asociadas a déficit en el funcionamiento ejecutivo

Introduction. There is an important agreement on the consideration of attention deficit hyperactivity disorder(ADHD) as a condition characterized by neurodevelopmental dysfunction of fronto-striatal dopaminergic and noradrenergic circuits with resultant executive deficits in cognitive functioning. Aim. To assess the existence of memory deficits in children with ADHD associated with a poor performance executive. Subjects and methods. We assess 14 children diagnosed with ADHD combined type and 14 controls matched on intellectual coefficient, age and level of schooling, in a neuropsychological evaluation protocol designed to assess executive functions and memory skills using Auditory Verbal Learning Test, Memoryfor Stories Test –Test of Memory and Learning (TOMAL)–, Complex Figure Text, Visual Selective Reminding Test (TOMAL), Tower of Hanoi, Memory Phrases Test (Siegel and Ryan), Digit Span (Wechsler Intelligence Scale for Children-Revised) and Tapping Test (Wechsler Memory Scale III). Results. The ADHD group showed deficits in the learning and free recall of verbal material, in procedural and working memory. No group differences were observed in the visual memory tasks. Conclusions. The results are analyzed in terms of difficulty in coding strategies, storage and search of information previously stored in the group with ADHD, at least for the kind of verbal information. These difficulties are associated with deficits in executivefunctioning

[Neuropsychological assessment of the effectiveness of OROS-methylphenidate in attention deficit hyperactivity disorder]. / Evaluación neuropsicológica de la eficacia del metilfenidato-OROS en el trastorno por deficit de atención/hiperactividad.

INTRODUCTION: There is wide evidence about dopaminergic and noradrenergic mechanisms in fronto-striatal circuits which are thought to be related with attention deficit hyperactivity disorder (ADHD) neurobiology. That dysfunction may explain core symptoms and part of executive deficits in cognitive functioning. Methylphenidate is effective in alleviating core symptoms, enhancing dopaminergic and noradrenergic biodisponibility. Less evidence in improving executive functions, specially working memory is found. AIMS: To assess if methylphenidate-OROS has a potential effect increasing working memory and attention parameters in ADHD children, and to determine if initial working memory and attention differences between ADHD and control group disappear after one month of daily methylphenidate-OROS treatment. SUBJECTS AND METHODS: Eleven children with ADHD were selected and as control group was chosen eleven children compared in age, intelligence quotient, school grade, and social-demographic status. Neuropsychological battery was administered in naive ADHD patients at three times, before treatment, after the first methylphenidate-OROS dose, and after one month of daily treatment. Simultaneously neuropsychological battery was administered to control group. RESULTS. Statistically significant differences were found in neuropsychological variables of working memory after one month daily treatment with methylphenidate-OROS and attention parameters after only one dose in ADHD group. Differences between naive ADHD and control group in terms of working memory were statistically significant before treatment but not after one month daily treatment. CONCLUSION: Methylphenidate-OROS improves attention achievement after the first dose and working memory after one month of daily treatment.

Evaluación neuropsicológica de la eficacia del metilfenidato-OROS en el trastorno por déficit de atención/hiperactividad / Neuropsychological assessment of the effectiveness of oros-methylphenidate in attention deficit hyperactivity disorder

El déficit dopaminérgico y noradrenérgico en los circuitos frontoestriatales es considerado como labase bioquímica del trastorno por déficit de atención/hiperactividad (TDAH). Estas alteraciones parecen explicar parte de sus déficit cognitivos, entre los cuales están las funciones ejecutivas. El metilfenidato incrementa la biodisponibilidad dopaminérgica y noradrenérgica en la corteza prefrontal y los ganglios basales. Este hecho supone beneficios inmediatos en el incremento de la atención y un descenso de la impulsividad. Menos documentado está el efecto del metilfenidato sobre las funciones ejecutivas y, en concreto, sobre la memoria de trabajo. Objetivos. Evaluar si el metilfenidato-OROS incrementa el rendimiento de los TDAH en diversos parámetros atencionales y en tareas de memoria de trabajo, y estudiar si las diferencias entre el grupo con TDAH y el grupo control desaparecen tras un mes de tratamiento con metilfenidato-OROS. Sujetos y métodos.Se seleccionaron 11 pacientes con TDAH y 11 sujetos control equiparados en edad, cociente intelectual, años de escolaridad y nivel socioeconómico. Se administró un protocolo neuropsicológico en tres momentos: antes del tratamiento, tras una sola dosis y tras un mes de tratamiento con metilfenidato-OROS. Se administró el mismo protocolo neuropsicológico al grupocontrol. Resultados. Se encontraron diferencias en memoria de trabajo tras un mes de tratamiento y en parámetros atencionales tras una sola toma en el grupo con TDAH. Las diferencias iniciales entre el grupo con TDAH y el grupo control en memoria de trabajo dejaron de ser significativas tras un mes de tratamiento. Conclusión. El metilfenidato-OROS mejora elrendimiento atencional desde la primera dosis y la memoria de trabajo verbal tras un mes de administración diaria

There is wide evidence about dopaminergic and noradrenergic mechanisms in fronto-striatal circuitswhich are thought to be related with attention deficit hyperactivity disorder (ADHD) neurobiology. That dysfunction may explain core symptoms and part of executive deficits in cognitive functioning. Methylphenidate is effective in alleviating coresymptoms, enhancing dopaminergic and noradrenergic biodisponibility. Less evidence in improving executive functions, specially working memory is found. Aims. To assess if methylphenidate-OROS has a potential effect increasing working memory and attention parameters in ADHD children, and to determine if initial working memory and attention differences between ADHD and control group disappear after one month of daily methylphenidate-OROS treatment. Subjects andmethods. Eleven children with ADHD were selected and as control group was chosen eleven children compared in age,intelligence quotient, school grade, and social-demographic status. Neuropsychological battery was administered in naive ADHD patients at three times, before treatment, after the first methylphenidate-OROS dose, and after one month of daily treatment. Simultaneously neuropsychological battery was administered to control group. Results. Statistically significant differences were found in neuropsychological variables of working memory after one month daily treatment with methylphenidate-OROS and attention parameters after only one dose in ADHD group. Differences between naive ADHD and controlgroup in terms of working memory were statistically significant before treatment but not after one month daily treatment. Conclusion. Methylphenidate-OROS improves attention achievement after the first dose and working memory after one month of daily treatment

[The neurologist when faced with stroke]. / El neurólogo ante el ictus.

The role of the neurologist during the entire care process involving patients who suffer a stroke is stressed. His/her intervention in this process is of fundamental importance given the existence of widely verified scientific evidence that this significantly improves the survival expectancies and the independence of these patients and that it is profitable for the health care system. An improvement in the quality of life of both the patients and their family is obtained from this intervention.

El neurólogo ante el ictus / The neurologist when faced with stroke

Se destaca el papel del neurólogo a largo todo el proceso asistencial y sanitario en el que se ven implicados los pacientes que sufren un ictus. Su intervención en dicho proceso es de primordial importancia dado que existen evidencias científicas ampliamente constatadas de que la misma mejora de forma significativa las expectativas de supervivencia e independencia de estos pacientes y es rentable para el sistema sanitario. De esta intervención se puede derivar una mejora en la calidad de vida tanto de los pacientes como de sus familiares

The role of the neurologist during the entire care process involving patients who suffer a stroke is stressed. His/her intervention in this process is of fundamental importance given the existence of widely verified scientific evidence that this significantly improves the survival expectancies and the independence of these patients and that it is profitable for the health care system. An improvement in the quality of life of both the patients and their family is obtained from this intervention

[Evaluation of autonomic cardiovascular functioning in patients with syncope]. / Valoracion de la funcion autonomica cardiovascular en pacientes con sincope.

INTRODUCTION: According to the current literature on the subject, patients with syncope suffer a dysfunction of the autonomic nervous system (ANS). Yet few studies offer a clear explanation of this dysfunction. Moreover, the evaluation of cardiovascular reflexes is a simple, useful method of studying the functional status of the ANS. This work was designed to evaluate the existence of dysautonomia in syncope patients by means of the autonomic cardiovascular stimulation tests; it has been the most comprehensive of those published to date. SUBJECTS AND METHODS: We studied 170 healthy volunteers and 188 patients with syncopes in the previous months, paired by age and sex. Cardiovascular stimulation tests were conducted, in accordance with Ewing and Clark's methodology, together with the cold test. A rating scale was included to evaluate the symptoms related to ANS involvement. RESULTS: Syncope patients display lower reactivity in tests involving cardiovascular stimulation of the ANS, regardless of whether they are taken individually or as a whole (67% in patients and 39% in controls) (p = 0.0001), except in the cold test. They also show an increase in the clinical symptoms of an autonomic origin (2.82 +/- 0.17) with respect to control subjects (0.78 +/- 0.09) (p = 0.0001). CONCLUSIONS: Our syncope patients have a dysautonomia that appears as a sympathetic and parasympathetic hypofunction. These findings confirm the value of autonomic cardiovascular stimulation tests in the study of these patients. Moreover, the search for other symptoms of autonomic involvement can be a great aid in evaluating this pathology.

Valoración de la función autonómica cardiovascular en pacientes con síncope / Evaluation of autonomic cardiovascular functioning in patients with syncope

Introducción. La bibliografía actual considera que en lospacientes con síncope existe una disfunción del sistema nerviosoautónomo (SNA). Sin embargo, existen pocos estudios que objetivendicha disfunción. Por otra parte, la valoración de los reflejoscardiovasculares constituye un método de estudio sencillo y útil delestado funcional del SNA. Este trabajo se diseñó para valorar laexistencia de disautonomía en pacientes con síncope mediante lostests de estimulación autonómica cardiovascular; ha sido el másnumeroso de los publicados hasta ahora. Sujetos y métodos. Estudiamosa 170 voluntarios sanos y 188 pacientes con síncopes en los meses previos, pareados por edad y sexo. Se realizaron los testsde estimulación cardiovascular, según la metodología de Ewing yClark, y el test del frío. Se incluyó una escala de valoración de lossíntomas relacionados con la afectación del SNA. Resultados. Lospacientes con síncope presentan una menor reactividad en los testsde estimulación cardiovascular del SNA, tomados de forma aisladao en su conjunto (67% en los pacientes y 39% en los controles)(p = 0,0001), si exceptuamos el test del frío. También refieren unaumento de la sintomatología de origen autonómico (2,82 ± 0,17)con respecto a los controles (0,78 ± 0,09) (p = 0,0001). Conclusión.Nuestros pacientes con síncope presentan una disautonomíaque se muestra como una hipofunción simpática y parasimpática.Estos resultados confirman la utilidad de los tests de estimulaciónautonómica cardiovascular en el estudio de dichos pacientes. Porsu parte, la búsqueda de otros síntomas de afectación autonómicapuede ser de gran ayuda para la valoración de esta patología

Introduction. According to the current literature on the subject, patients with syncope suffer a dysfunction of theautonomic nervous system (ANS). Yet few studies offer a clear explanation of this dysfunction. Moreover, the evaluation ofcardiovascular reflexes is a simple, useful method of studying the functional status of the ANS. This work was designed toevaluate the existence of dysautonomia in syncope patients by means of the autonomic cardiovascular stimulation tests; it hasbeen the most comprehensive of those published to date. Subjects and methods. We studied 170 healthy volunteers and 188patients with syncopes in the previous months, paired by age and sex. Cardiovascular stimulation tests were conducted, inaccordance with Ewing and Clark’s methodology, together with the cold test. A rating scale was included to evaluate thesymptoms related to ANS involvement. Results. Syncope patients display lower reactivity in tests involving cardiovascularstimulation of the ANS, regardless of whether they are taken individually or as a whole (67% in patients and 39% in controls)(p = 0.0001), except in the cold test. They also show an increase in the clinical symptoms of an autonomic origin (2.82 ± 0.17)with respect to control subjects (0.78 ± 0.09) (p = 0.0001). Conclusions. Our syncope patients have a dysautonomia thatappears as a sympathetic and parasympathetic hypofunction. These findings confirm the value of autonomic cardiovascularstimulation tests in the study of these patients. Moreover, the search for other symptoms of autonomic involvement can be agreat aid in evaluating this pathology

[Neurologist regarding the dependence law]. / El neurólogo ante la ley de dependencia.

INTRODUCTION: The approval of the "project of promotion of personal autonomy and care to people on dependence" situation law now opens the parliamentary process to the approval of the mentioned law around October- November 2006. Should the neurologist know its content and express his/her opinion about it? DEVELOPMENT: We analyze the role of neurological disorders as a cause of dependence, the law principles, the involvement of the neurologist in the social-health care coordination, the health administrations involved in the law development and the role of Spanish Neurological Society and regional societies as mediators with the different health administration, the involvement of the neurologist in accreditation, education, research and development, independence promotion, and dependence evaluation. CONCLUSION: Given that the project will be modified in the course of its parliamentary process, and the relevance of its reglamentary development, the door has been left open for the role of the neurologist to be accepted at the moment when the law is developed and applied. In any case, the well-being and quality of life of our patients should not be overlooked. We think that the Spanish Neurological Society will have an important role in this process.

El neurólogo ante la ley de dependencia / Neurologist regarding the dependence law

Introducción. La aprobación el 21 de abril de 2006 del "proyecto de ley de promoción de autonomía personal y atención a las personas en situación de dependencia" abre el proceso parlamentario que supondrá la aprobación de la citada ley hacia octubre noviembre de 2006. Debemos los neurólogos conocer su contenido y expresar nuestra opinión al respecto. Desarrollo. Se analizan el papel de las enfermedades neurológicas como causa de dependencia, los principios de la ley, la implicación del neurólogo en la coordinación sociosanitaria, las administraciones implicadas en el desarrollo de ley y el papel de la Sociedad Española de Neurología y de las sociedades autonómicas como interlocutoras con las distintas administraciones, la implicación de neurólogo en temas de acreditación, formación, investigación y desarrollo, promoción de la autonomía personal, atención y cuidado y en la valoración de la dependencia. Conclusiones. Dada la posibilidad de que el proyecto sufra modificaciones más o menos relevantes durante el proceso parlamentario y la importancia del desarrollo reglamentario, queda abierta una puerta a la esperanza, en el sentido de que el papel del neurólogo sea reconocido de forma explícita a la hora de aplicar y desarrollar la ley, siempre sin perder de vista el bienestar y la calidad de vida del ciudadano. A este respecto será importante el papel que las sociedades científicas, en nuestro caso la Sociedad Española de Neurología y las sociedades neurológicas autonómicas (AU)

Introduction: The approval of the "project of promotion of personal autonomy and care to people on dependence" situation law now opens the parliamentary process to the approval of the mentioned law around October- November 2006. Should the neurologist know its content and express his/her opinion about it? Development: We analyze the role of neurological disorders as a cause of dependence, the law principles, the involvement of the neurologist in the social-health care coordination, the health administrations involved in the law development and the role of Spanish Neurological Society and regional societies as mediators with the different health administration, the involvement of the neurologist in accreditation, education, research and development, independence promotion, and dependence evaluation. Conclusion: Given that the project will be modified in the course of its parliamentary process, and the relevance of its reglamentary development, the door has been left open for the role of the neurologist to be accepted at the moment when the law is developed and applied. In any case, the well-being and quality of life of our patients should not be overlooked. We think that the Spanish Neurological Society will have an important role in this process (AU)

[Evaluation of the quality of inter-clinic documents. Does their proper filling out by the family doctor affect the reply obtained from the specialist?]. / Evaluación de la calidad del documento de interconsulta. 'Influye la adecuada cumplimentación del médico de familia en la respuesta que obtiene del especialista?

OBJECTIVE: To analyse the filling out of the inter-clinic form (IF) at a centre with special fields of care (CS) and to assess whether its proper filling out in primary care (PC) affects the reply from specialist care. DESIGN: Cross-sectional, descriptive study. SETTING: Primary health care area in the Community of Valencia. PARTICIPANTS: Randomised sample of IFs of patients referred for the first time from PC to specialists. MAIN MEASUREMENTS: Evaluation criteria were grouped in two: those IFs were considered acceptable (IFCA) in which the family doctor included the reason for consultation or his/her diagnostic impression, as well at least one of the following: anamnesis, personal background, physical examination, further tests or current medication. The remaining IFs were considered inadequately filled out (IFCI). RESULTS: The sample analysed for the IF audit of the CS was 392 people. The result of the audit in the specialist clinics was that 243 IFs were blank (62.0%); the specialist doctor was identified in 19% of cases; the diagnosis was given in 23.5%; treatment, in 21%, and the follow-up plan, in 20%. In the PC evaluation, there were no blank IFs; anamnesis was recorded in 41.8%; reason for consultation in 73%; suspected diagnosis in 58.2%, and treatment in 11.5%. The sample to analyse the differences in the filling of the form in specialist care according to the quality of the PC filling out was 529 IFs. 56.3% of the IFs were considered acceptable. No statistically significant differences were found in the filling of any of the criteria of evaluation by the specialist doctor between the IFs from PC of acceptable and inadequate quality, except on the question of specifying treatment. CONCLUSIONS: We found no relationship between the quality of the IF from PC and the reply from specialist care. Currently, the filling out of IFs continues to be deficient.

[Hyperuricemia as a risk factor for cerebrovascular accident: a case-control study]. / La hiperuricemia como factor de riesgo del accidente vascular cerebral: estudio caso-control.

INTRODUCTION: Although several collateral studies have been made of the relationship between hyperuricemia and cerebral vascular accidents (CVA), no definite conclusion has been reached. OBJECTIVE: To analyze the possible relationship between hyperuricemia and CVA. PATIENTS AND METHODS: We studied the cases and controls paired for age, sex and hospital. They included patients with CVA (125) and controls (250 ophthalmological patients). Both groups contained 50.4% men and 49.6% women with an average age of 70 +/- 11 years. Data regarding vascular risk factors, a known personal history of hyperuricemia were recorded and serum uric acid levels determined in both groups. The relative risks were calculated using the Odds Ratio (OR) with a confidence interval of 95% (CI 95) and a conditional logistic regression study made. RESULTS: A statistically significant relationship was found between CVA and: arterial hypertension (OR: 6.32; CI 95: 3.43, 11.65); smoking (OR: 3.79; CI 95: 1.36, 10.58); alcoholism (OR: 2.54; CI 95: 1.11, 5.41); ischemic cardiopathy (OR: 2.37; CI 95: 1.2, 4.70) and previous CVA (OR: 5.93; CI 95: 3.17, 11.09). No relation was found with: a history of hyperuricemia (OR: 1.53; CI 95: 0.63, 3.73), serum uric acid levels (OR: 0.86, CI 95: 0.36, 2.00 when the uricemia was between 5 and 5.99 mg/dl and OR: 0.46, CI 95: 0.21, 1.02, when the uricemia was over 6 mg/dl). CONCLUSION: Our results suggest that hyperuricemia is not an independent risk factor for CVA.

[Life events, quality of life and social support prior to acute cerebral vascular disease, as predictive factors of the quality of life and functional state following stroke]. / Acontecimientos vitales, calidad de vida y apoyo social previos a la enfermedad vascular cerebral aguda, como factores predictores de la calidad de vida y situación funcional posteriores al ictus.

INTRODUCTION: The repercussion of stroke on quality of life has been evaluated but not the possible relation between the quality of life before and months after an acute stroke. OBJECTIVE: To study the possible relation between quality of life, social support, stressful life events prior to the stroke and quality of life, social support and functional state months after. PATIENTS AND METHODS: A prospective study was made of 34 patients (71.7 +/- 8 years; 19 (56%) men; 15 (44%) women with stroke, by means of two evaluations: personal interview within the first 36 hours (quality of life--Nothingham health profile (NHP)-, perception of social support and stressful life events--Holmes and Rake inventory-) and an interview over the phone 16.5 +/- 5.3 months after the stroke (NHP, perception of social support and functional state--Rankin scale-). RESULTS: Following the stroke there was deterioration in perception of social support (19.8 +/- 3 vs 12.5 +/- 8; p = 0.000) and in the degree of social isolation of the NHP (9.4 +/- 20 vs 21.1 +/- 30; p = 0.03). The only relation found was between the following variables: pain at the first evaluation and pain (r = 0.45; p = 0.007) at the second evaluation; mobility at the first evaluation and emotional state (r = 0.39; p = 0.029) and social support (r = 0.37; p = 0.027) at the second evaluation; sleepiness at the first evaluation and energy (r = 0.55; p = 0.0006), pain (r = 0.39; p = 0.022), emotional state (r = 0.35; p = 0.038), mobility (r = 0.34, p = 0.048) and sleepiness (r = 0.51; p = 0.001) at the second evaluation. CONCLUSION: Our results indicate that there is little relationship between the previous state and that following stroke, and that the deterioration in perception of support and social isolation is due to the stroke itself.

La hiperuricemia como factor de riesgo del accidente vascular cerebral: estudio caso-control / Hyperuricemia as a risk factor for cerebral vascular accident: a case-control study

Introducción. Aunque diversos trabajos han estudiado colateralmente la relación entre la hiperuricemia y el accidente vascular cerebral (AVC), no ha podido llegarse a una conclusión definitiva al respecto. Objetivo. Analizar la posible asociación entre la hiperuricemia y el AVC. Pacientes y métodos. Estudio de casos y controles apareado por dos según edad, sexo y hospital, que incluye pacientes incidentes con AVC (125) y controles (250; pacientes oftalmológicos). En ambos grupos el 50,4 por ciento son varones y el 49,6 por ciento mujeres, con edad media de 70ñ11 años. En ambos grupos se recogieron datos relativos a los factores de riesgo vascular y antecedentes conocidos de hiperuricemia, y se determinaron los niveles séricos de ácido úrico. Se estimaron los riesgos relativos mediante el cálculo de las odd ratio (OR) y sus intervalos de confianza del 95 por ciento (IC95), realizándose un estudio de regresión logística condicional. Resultados. Se encontró una asociación estadísticamente significativa con el AVC para la hipertensión arterial (OR: 6,32; IC95: 3,43, 11,65), el tabaquismo (OR: 3,79; IC95: 1,36, 10,58), el alcoholismo (OR: 2,54; IC95: 1,11, 5,41), la cardiopatía isquémica (OR: 2,37; IC95: 1,2, 4,70) y el AVC previo (OR: 5,93; IC95: 3,17, 11,09). No se encontró relación con los antecedentes de hiperuricemia (OR: 1,53; IC95: 0,63, 3,73), ni con los niveles séricos de ácido úrico (OR: 0,86, IC95: 0,36, 2,00 para uricemia entre 5 y 5,99 mg/dl y OR: 0,46, IC95: 0,21, 1,02, para uricemia mayor de 6 mg/dl). Conclusión. Nuestros resultados sugieren que la hiperuricemia no es un factor de riesgo independiente para el AVC (AU)

Acontecimientos vitales, calidad de vida y apoyo social previos a la enfermedad vascular cerebral aguda, como factores predictores de la calidad de vida y situación funcional posteriores al ictus / Live events quality of life and social support prior to acute cerebral vascular disease, as predictive factors of the quality of life and functional state following stroke

Introducción. Se ha valorado la repercusión del ictus en la calidad de vida pero no la posible relación entre la calidad de vida previa y la que tienen los pacientes meses después del episodio agudo. Objetivo. Estudiar la posible relación entre calidad de vida, apoyo social y acontecimientos vitales estresantes previos al ictus y calidad de vida, apoyo social y situación funcional meses después del mismo. Pacientes y métodos. Estudio prospectivo de 34 pacientes (71,7 ± 8 años; 19 (56%) varones; 15 (44%) mujeres) con ictus mediante dos valoraciones: entrevista personal en las primeras 36 horas (calidad de vida –perfil de salud de Nottingham (PSN)–, percepción de apoyo social y acontecimientos vitales estresantes –inventario de Holmes y Rake–) y entrevista telefónica 16,5 ± 5,3 meses después del ictus (PSN, percepción de apoyo social y situación funcional –escala de Rankin–). Resultados. Después del ictus se produce un deterioro en la percepción del apoyo social (19,8 ± 3 frente a 12,5 ± 8; p= 0,000) y en la dimensión de aislamiento social del PSN (9,4 ± 20 frente a 21,1 ± 30; p= 0,03). Sólo se encontró relación entre las siguientes variables: dolor en la primera evaluación y dolor (r= 0,45; p= 0,007) en la segunda evaluación; movilidad en la primera evaluación y estado emocional (r= 0,39; p= 0,029) y apoyo social (r= 0,37; p= 0,027) en la segunda evaluación; sueño en la primera evaluación y energía (r= 0,55; p= 0,0006), dolor (r= 0,39; p= 0,022), estado emocional (r= 0,35; p= 0,038), movilidad (r= 0,34; p= 0,048) y sueño (r= 0,51; p= 0,001) en la segunda evaluación. Conclusión. Nuestros resultados sugieren que la relación existente entre la situación previa y la posterior al ictus es escasa, y que el deterioro en la percepción del apoyo y el aislamiento social se deben al ictus en sí mismo (AU)

Introduction. The repercussion of stroke on quality of life has been evaluated but not the possible relation between the quality of life before and months after an acute stroke. Objective. To study the possible relation between quality of life, social support, stressful life events prior to the stroke and quality of life, social support and functional state months after. Patients and methods. A prospective study was made of 34 patients (71.7 ± 8 years; 19 (56%) men; 15 (44%) women with stroke, by means of two evaluations: personal interview within the first 36 hours (quality of life –Nothingham health profile (NHP)–, perception of social support and stressful life events –Holmes and Rake inventory–) and an interview over the phone 16.5 ± 5.3 months after the stroke (NHP, perception of social support and functional state –Rankin scale–). Results. Following the stroke there was deterioration in perception of social support (19.8 ± 3 vs 12.5 ± 8; p= 0.000) and in the degree of social isolation of the NHP (9.4 ± 20 vs 21.1 ± 30; p= 0.03). The only relation found was between the following variables: pain at the first evaluation and pain (r= 0.45; p= 0.007) at the second evaluation; mobility at the first evaluation and emotional state (r= 0.39; p= 0.029) and social support (r= 0.37; p= 0.027) at the second evaluation; sleepiness at the first evaluation and energy (r= 0.55; p= 0.0006), pain (r= 0.39; p= 0.022), emotional state (r= 0.35; p= 0.038), mobility (r= 0.34, p= 0.048) and sleepiness (r= 0.51; p= 0.001) at the second evaluation. Conclusion. Our results indicate that there is little relationship between the previous state and that following stroke, and that the deterioration in perception of support and social isolation is due to the stroke itself (AU)

[Vertebrobasilar ischemia of thrombotic and embolic origin]. / Isquemia vertebrobasilar de origen trombótico y embólico.

OBJECTIVE: To analyze the mechanisms involved in the appearance of ischemia in vertebro-basilar territory, especially those of embolic or thrombotic characteristics. DEVELOPMENT: The mechanism of vertebro-basilar ischemia had not been adequately studied until a few years ago. This had led to the belief that most were due to a haemodynamic mechanism. However, in recent years studies of large numbers of patients, in whom cardiological and neurovascular evaluation had been systematically carried out, has shown that this is not so. In general, the commonest mechanism is embolism, both of arterial and of cardiac origin. Local thrombosis and a haemodynamic mechanism are less common. The arterial lesions most often associated with intra-arterial embolism have their origins in the intracranial segment of the vertebral artery. The most frequent sites of blockage by emboli are the distal segments of the basilar artery, the superior cerebellar artery, the posterior cerebral artery and the intracranial region of the vertebral artery-posteriorinferior cerebellar artery. CONCLUSIONS: The mechanism of vertebro-basilar ischemia is not homogeneous and can not be taken for granted in any patient in particular. For this reason it is necessary to carry out a full clinical study of patients with these symptoms, similar to that done for patients with carotid ischemia. This permits not only individualized, correct treatment of each patient but also a more complete knowledge of the mechanisms of ischemia in this territory.