Response to methylphenidate by adult and pediatric patients with attention-deficit/hyperactivity disorder: the Spanish multicenter DIHANA study.

BACKGROUND: The purpose of this multicenter Spanish study was to evaluate the response to immediate-release methylphenidate by children and adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), as well as to obtain information on current therapy patterns and safety characteristics. METHODS: This multicenter, observational, retrospective, noninterventional study included 730 patients aged 4-65 years with a diagnosis of ADHD. Information was obtained based on a review of medical records for the years 2002-2006 in sequential order. RESULTS: The ADHD predominantly inattentive subtype affected 29.7% of patients, ADHD predominantly hyperactive-impulsive was found in 5.2%, and the combined subtype in 65.1%. Overall, a significant lower Clinical Global Impression (CGI) score and mean number of DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision) symptoms by subtype were found after one year of treatment with immediate-release methylphenidate; CGI decreased from 4.51 to 1.69, symptoms of inattention from 7.90 to 4.34, symptoms of hyperactivity from 6.73 to 3.39, and combined subtype symptoms from 14.62 to 7.7. Satisfaction with immediate-release methylphenidate after one year was evaluated as "very satisfied" or "satisfied" by 86.90% of the sample; 25.75% of all patients reported at least one adverse effect. At the end of the study, 41.47% of all the patients treated with immediate-release methylphenidate were still receiving it, with a mean time of 3.80 years on therapy. CONCLUSION: Good efficacy and safety results were found for immediate-release methylphenidate in patients with ADHD.

Enfermedad cerebrovascular en la infancia. Análisis retrospectivo de los ingresos hospitalarios en los últimos diez años en un hospital terciario de la Comunidad Valenciana / Cerebrovascular disease in childhood: a retrospective analysis of hospital admissions in a tertiary hospital in the community of Valencia in the last ten years

Introducción: En los últimos años ha aumentado el interés por el ictus en la infancia. La revisión de la literatura aporta poca información sobre factores de riesgo y otros aspectos de interés clínico. El objetivo es describir las características del ictus en niños con el objetivo de identificar factores de riesgo, presentación clínica y el pronóstico. Pacientes y métodos: Se llevó a cabo un estudio retrospectivo entre los pacientes ingresados en el hospital La Fe entre enero de 2000 y septiembre de 2010 con los diagnósticos de ictus, isquémicos o hemorrágicos. Resultados: Un total de 76 pacientes cumplían los criterios de inclusión, 44,7% presentaron un ictus isquémico y 55,3% fue hemorrágico. La edad media de presentación fue de 6,8 años, 8,4 años para los hemorrágicos y 4,7 años para los isquémicos. La cefalea fue el síntoma de presentación más frecuente. El principal factor de riesgo fue la malformación vascular en los ictus hemorrágicos y las vasculopatías y cardiopatías en los isquémicos. En 34 pacientes se llevó a cabo un estudio de trombofilia y en un 64,7%, de estos, el estudio fue positivo. Respecto al pronóstico, el 17% de los pacientes falleció, solamente tres pacientes presentaron una epilepsia secundaria y el 31 y 60% de los infartos hemorrágicos e isquémicos, respectivamente, desarrollaron una hemiparesia. Conclusiones: En este estudio hemos identificado los principales factores de riesgo, así como edad de presentación, sintomatología y pronóstico. Queremos destacar la edad de presentación más precoz en los ictus isquémicos frente a los hemorrágicos(AU)

Introduction: There has been increasing interest in stroke in children in the last few years. A literature review produced little information on risk factors and other clinical questions. The aim of this study is to describe the characteristics of stroke in children, mainly in order to identify the risk factors, clinical presentation and outcomes. Patients and methods: A retrospective study was conducted on patients admitted to the Hospital La Fe in Valencia between January 2000 to September 2010 with the diagnosis of ischaemic or haemorrhagic stroke. Results: A total of 76 patients were identified, of whom 44.7% had an ischaemic stroke and 55.3% had a haemorrhagic one. The average age of presentation was 6.8 years; 8.4 years for haemorrhagic strokes and 4.7 years for ischaemic strokes. Headache was the most frequent symptom of presentation. The most frequent risk factor was vascular malformations in haemorrhagic cerebral stroke, and vascular and cardiac disorders in ischaemic stroke. A study of prothrombotic factors was conducted on 34 patients, which was positive in 64.7% of them. As regards outcome, 17% of the patients died; only 3 patients had a secondary epilepsy, and 31% and 60% of the haemorrhagic and ischaemic stokes, respectively, had a hemiparesis. Conclusions: In this study we identified the principal risk factors as well as, the age of presentation, symptomatology and outcome. We would like to emphasise that the age of presentation was earlier in ischaemic strokes than in haemorrhagic ones(AU)

[Cerebrovascular disease in childhood: a retrospective analysis of hospital admissions in a tertiary hospital in the community of Valencia in the last ten years]. / Enfermedad cerebrovascular en la infancia. Análisis retrospectivo de los ingresos hospitalarios en los últimos diez años en un hospital terciario de la Comunidad Valenciana.

INTRODUCTION: There has been increasing interest in stroke in children in the last few years. A literature review produced little information on risk factors and other clinical questions. The aim of this study is to describe the characteristics of stroke in children, mainly in order to identify the risk factors, clinical presentation and outcomes. PATIENTS AND METHODS: A retrospective study was conducted on patients admitted to the Hospital La Fe in Valencia between January 2000 to September 2010 with the diagnosis of ischaemic or haemorrhagic stroke. RESULTS: A total of 76 patients were identified, of whom 44.7% had an ischaemic stroke and 55.3% had a haemorrhagic one. The average age of presentation was 6.8 years; 8.4 years for haemorrhagic strokes and 4.7 years for ischaemic strokes. Headache was the most frequent symptom of presentation. The most frequent risk factor was vascular malformations in haemorrhagic cerebral stroke, and vascular and cardiac disorders in ischaemic stroke. A study of prothrombotic factors was conducted on 34 patients, which was positive in 64.7% of them. As regards outcome, 17% of the patients died; only 3 patients had a secondary epilepsy, and 31% and 60% of the haemorrhagic and ischaemic stokes, respectively, had a hemiparesis. CONCLUSIONS: In this study we identified the principal risk factors as well as, the age of presentation, symptomatology and outcome. We would like to emphasise that the age of presentation was earlier in ischaemic strokes than in haemorrhagic ones.

[Phonological processing in children with attention deficit hyperactivity disorder: is methylphenidate effective?]. / Procesamiento fonológico en niños con trastorno por déficit de atencion e hiperactividad: es eficaz el metilfenidato?

INTRODUCTION: Although attention deficit hyperactivity disorder (ADHD) is usually associated with language disorders, there are few studies of phonological processing and the efficacy of psychostimulants (methylphenidate) on this. OBJECTIVE: 1. To find whether there are differences in the development of phonological processing, evaluated using linguistic segmentation tests and tests of lexical fluency with a phonetic mediator, between children with ADHD and normal children; and 2. To analyze the effects of methylphenidate on the phonological processing of children with ADHD. PATIENTS AND METHODS: For the first objective, 37 children with ADHD and 37 normal children aged between 5 and 12 years were studied. Twenty were boys and 16 girls of lower middle class. Of these children, 18 of the ADHD and 18 of the normal group were studied for the second objective, 15 boys and 3 girls. Three different tests were used to evaluate aspects of phonological processing: induced phonological register, linguistic follow up and lexical fluency with phonetic mediation. RESULTS: Significant differences were found between the experimental and control groups when carrying out all types of phonological processing tasks. In the experimental group, with or without methylphenidate, improvement was seen in lexical fluency tasks whereas linguistic segmentation test improvement was limited. CONCLUSIONS: These results show the importance of evaluating phonological processing in children with ADHD since this affects learning to read and write.

[Present and future of neurology in Spain]. / Presente y futuro de la neurología española.

This is a document prepared by the Spanish Society of Neurology (SEN), which was given to the President of Spain (Mr. José María Aznar) last September with the main aim of examining the current situation of Neurology in our country. It analyses the present and future of Neurology in clinical assistance, teaching and research. To prepare this document the criteria of patients' associations has been considered, including the Declaration of Madrid which has been subscribed by thirty of these associations. In spite of its relevant development in the previous decades, the current situation of Neurology in Spain is far from the ideal. To reach the recommendable menber of 3 or 4 neurologists per 100,000 inhabitants it is necessary to duplicate the present number of neurologists which has been estimated around 2/100,000; this situation is especially urgent in some Autonomous Communities. The most important problems in neurological assistance are: inadequate follow-up of the chronic outpatients, low numbers of neurological beds and of duties of Neurology, as well as of neurological case of patients with urgent neurological disorders. It is also necessary to increase the number of professors of Neurology to adequately cover pregraduate teaching; again there are important differences in teaching positions among Autonomous Communities. Neurology residence should be prolonged from 4 to 5 years. Finally, it is necessary to support the appearance of superespecialised units and to promote a coordinated research with other close specialities including basic neuroscience.

Secuelas psicológicas en los supervivientes a largo plazo de cáncer / Psychological sequelae in longterm cancer survivors

OBJETIVO: Analizar las secuelas psicológicas de los supervivientes a largo plazo de cáncer pediátrico. Relacionar los cambios producidos tanto en aspectos cognitivos (cociente intelectual) como emocionales (ansiedad y depresión) con las variables diagnósticas, terapéuticas y las secuelas sensoriales (visuales y auditivas). MÉTODOS: Se evaluaron un total de 138 supervivientes, 73 pacientes de leucemia aguda y 65 pacientes de tumor sólido (nefroblastoma y tumores del sistema nervioso simpático) diagnosticados antes de los 15 años, cuyo tiempo transcurrido después del diagnóstico fue al menos de 10 años y el tiempo fuera de tratamiento superior a 2 años. Los datos de filiación y sociales de los supervivientes, progenitores y hermanos, el diagnóstico, el número de recaídas y el tratamiento administrado se registraron a partir de la historia clínica y entrevista personal en el momento de la evaluación. Los aspectos cognitivos y emocionales estudiados y los instrumentos de medición utilizados fueron el cociente intelectual (escala de inteligencia de Wechsler para niños [WISC] y adultos [WAIS]), ansiedad estado-riesgo (State-Trait Anxiety Inventory para adultos [STAI] y State-TraitAnxiety Inventory for children [STAIC]) y sintomatología depresiva (subescala de depresión del Minnesota Multiphasic Personality Inventory [MMPI-D]). La evaluación oftalmológica incluyó la agudeza visual, biomicroscopia en lámpara de hendidura, medición de la presión intraocular y examen del fondo de ojo. La evaluación auditiva consistió en audiograma tonal liminal explorando las frecuencias de 125 a 8.000 Hz. RESULTADOS: Los cocientes intelectuales total, verbal y manipulativo para el total de supervivientes fueron, respectivamente, 102, 106 y 105. El 5 por ciento obtuvo una puntuación inferior a 70 (deficiente mental) y el 6,5 por ciento superior a 129 (superdo-tado). La puntuación de los supervivientes de tumor sólido fue superior a la de los supervivientes de leucemia craneoirradiados en dosis 4Gy (108 frente a 98; p 50,03) y similar a la de los supervivientes de leucemia craneoirradiados en dosis más bajas (102 casos) o no irradiados (109). El cociente intelectual se relacionó de forma positiva con la edad al diagnóstico y de manera negativa con la dosis acumulada de metotrexato intratecal y la dosis de irradiación craneal. Los supervivientes de leucemia que presentaron al menos una recaída obtuvieron un cociente intelectual 14 puntos inferior al de los supervivientes de leucemia en primera remisión completa. Las áreas cognitivas más afectadas fueron la comprensión, la aritmética, la capacidad de atención, la memoria auditiva y visual, el razonamiento causal y la coordinación visuomotora. No encontramos una relación significativa entre las secuelas visuales y auditivas y el desarrollo cognitivo, posiblemente por la escasa gravedad de las mismas. La prevalencia de depresión fue superior a la de la población general y la de ansiedad inferior. CONCLUSIÓN: El cociente intelectual (CI) se encontró dentro de los límites de normalidad, y su deterioro se relacionó con la irradiación craneal, la edad en el momento del diagnóstico y la presencia de recaídas. En el plano emocional, afrontaron el cáncer de manera adecuada, siendo la sintomatología depresiva más prevalente y prácticamente ausente la ansiedad (AU)

[Sturge-Weber syndrome: experience with 14 cases]. / Síndrome de Sturge-Weber: Experiencia en 14 casos.

OBJECTIVE: The objective of this study was to review the cases of Sturge-Weber syndrome (SWS) diagnosed and followed-up in our center over the last 25 year period in order to evaluate their clinical characteristics, evolution and therapeutical response. PATIENTS AND METHODS: A retrospective review of the records of patients diagnosed of SSW (facial nevus flammeus at least over the first branch of the trigeminal nerve and ipsilateral leptomeningeal angioma) was performed. RESULTS: Fifteen patients were found in our records, with one of them being excluded from the study due to the lack of follow-up. From the remaining 14, 11 had been diagnosed before the age of 18 months. Nevus flammeus was located on the right side in 8 cases, bilaterally in 3 and on the left side in the other 3 patients. Four cases had glaucoma, 3 of which had good evolution after trabeculotomy. Thirteen of the 14 patients had seizures, usually contralateral to the nevus flammeus. The main drugs used were phenytoin, phenobarbital, valproic acid and carbamazepine. Ten of the 13 patients treated had a good therapeutical response. The EEG was abnormal in 12 patients, two of them occurring during the follow-up period. The main abnormality found was an interhemispherical asymmetry. Nine patients developed hemiparesis. In reference to the neuroimaging. MR was better than CT in evaluating parenchymatous atrophy, which was present in all patients, and the abnormalities of the white and grey matters (9 and 8 patients, respectively). CONCLUSIONS: Early evaluation of newborns with nevus flammeus affecting the first branch of the trigeminal nerve must be done, including an MR with contrast and an ophthalmological exam.