[Epidemiology of multiple sclerosis in Spain]. / Epidemiologia de la esclerosis multiple en España.

INTRODUCTION: Multiple sclerosis is a chronic autoimmune, inflammatory and neurodegenerative disease of the central nervous system and the most common non-traumatic disabling neurological disease in young adults. In the latest decades, multiple sclerosis is increasing worldwide, especially in women. The latitudinal distribution has been progressively attenuated. AIM: To review the epidemiological studies of multiple sclerosis in Spain to verify if this worldwide trend also occurs in Spain. DEVELOPMENT: We searched PubMed and Teseo databases using the search terms «epidemiology¼, «prevalence¼, «incidence¼, «multiple sclerosis¼ and «Spain¼. We selected articles published in Spanish and English between 1968 and 2018. CONCLUSIONS: Recent epidemiological studies confirm that Spain is a medium-high risk area for MS. The prevalence of MS has increased significantly throughout Spain in the latest years, especially in women, and recent studies show prevalence as high as 80-180 cases per 100,000.

TITLE: Epidemiologia de la esclerosis multiple en España.Introduccion. La esclerosis multiple es una enfermedad cronica autoinmune, inflamatoria y degenerativa del sistema nervioso central, y es el trastorno neurologico discapacitante no traumatico mas comun en adultos jovenes. Los estudios de prevalencia mas recientes indican que la frecuencia de la enfermedad ha aumentado en el mundo en las ultimas decadas, que dicho incremento de la prevalencia ocurre fundamentalmente a expensas de un mayor numero de casos de mujeres con formas remitentes, y que el gradiente latitudinal de la incidencia de la enfermedad se viene atenuando. Objetivo. Revisar los estudios sobre epidemiologia de esclerosis multiple en España para verificar si las tendencias mundiales se confirman en nuestro pais. Desarrollo. Busqueda bibliografica en las bases de datos PubMed y Teseo usando como palabras clave «epidemiology¼, «prevalence¼ e «incidence¼, cruzandolas con los terminos «multiple sclerosis¼ y «Spain¼; se realiza una seleccion inicial por titulo y resumen, en castellano e ingles, entre los años 1968 y 2018. Conclusiones. Un buen numero de estudios epidemiologicos recientes en España confirman que es una region de prevalencia media-alta de la enfermedad a lo largo de su geografia. Las cifras de prevalencia aumentan progresivamente a lo largo de las ultimas decadas hasta alcanzar en la actualidad 80-180 casos por 100.000 habitantes, y ello ha ocurrido a expensas de una mayor frecuencia de la enfermedad en las mujeres.

[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.

Folletos de información educativa en migraña: satisfacción percibida en un grupo de pacientes / Migraine education brochures and patient-perceived satisfaction

Introducción: Los folletos informativos son una herramienta educativa habitual en la práctica neurológica diaria; mediante este mecanismo se pretende incrementar de primera mano los conocimientos que la población tiene sobre una enfermedad concreta, además de evitar fuentes de información erróneas. Las encuestas son el medio más empleado para conocer la satisfacción de los usuarios con los servicios recibidos. Objetivos: Evaluar la satisfacción percibida y establecer una retroalimentación informativa que valore la comprensión y la utilidad global de un folleto educativo sobre migraña. Material y métodos: Estudio abierto, prospectivo y multicéntrico sobre una población de pacientes diagnosticados de migraña en diversas consultas de neurología de la provincia de Alicante. En la visita basal se les entrega un folleto informativo de migraña confeccionado por el grupo de estudio para la cefalea de la Sociedad Valenciana de Neurología (CEFALIC). En la visita control se les solicita la cumplimentación de una encuesta personal y por escrito sobre la calidad global de la información incluida en el folleto. Resultados: Se incluye a un total de 257 pacientes diagnosticados de migraña (83% migraña episódica; 17% migraña crónica), con una edad media de 37,6 años. Confirmaron la lectura del folleto 207 paciente (80,5%) y no lo habían leído 50 pacientes (19,5%), bien por olvido bien por desinterés. Al 90% de los pacientes la lectura del folleto les pareció interesante y comprensible. El 76% de los encuestados opina que la lectura del folleto incrementa sus conocimientos sobre migraña. El 50% de los pacientes opina que el folleto resultó de utilidad para mejorar el control de su migraña. Conclusiones: La utilización de un folleto educativo sobre migraña resultó comprensible, además incrementó el conocimiento global de la enfermedad y en opinión de los pacientes resultó útil para mejorar el control de su migraña. La evaluación de la información educativa que prestamos a nuestros pacientes con migraña debe ser medida para descubrir las causas de descontento, determinar el nivel de calidad del servicio e investigar las posibilidades de mejora de calidad

Introduction: Brochures are commonly used as educational tools in daily neurological practice. They are provided to increase the general population's knowledge of a specific disease and also to combat sources of erroneous information. Surveys are the most commonly used method of ascertaining user satisfaction with services received. Objectives: This study will assess patient-perceived satisfaction and provide feedback to measure the comprehensibility and overall utility of an educational brochure on migraine. Material and methods: Open prospective multicentre study of a group of patients diagnosed with migraine in neurology clinics in Alicante province. During the initial visit, each patient received a migraine brochure prepared by the Valencian Society of Neurology's study group for headaches (CEFALIC). During a follow-up visit, they were then asked to fill out a personal survey on the overall quality of the information in the brochure. Results: We included a total of 257 patients diagnosed with migraine (83% episodic migraine; 17% chronic migraine); mean age was 37.6 years. Two hundred seven patients confirmed having read the brochure (80.5%); 50 patients (19.5%) either forgot to read it or had no interest in doing so. The brochure seemed interesting and easy to understand according to 90% of the patients. Seventy-six per cent of the respondents stated that reading the brochure increased their overall knowledge of migraine, while 50% of the patients found the brochure useful for improving migraine control. Conclusions: Patients found the migraine educational brochure to be comprehensible, a means of increasing overall knowledge of the disease, and useful for increasing control over migraines. Evaluations of the educational brochures that we provide to our patients with migraine should be studied to discover the causes of dissatisfaction, determine the level of quality of service, and investigate potential areas for improvement

Migraine education brochures and patient-perceived satisfaction.

INTRODUCTION: Brochures are commonly used as educational tools in daily neurological practice. They are provided to increase the general population's knowledge of a specific disease and also to combat sources of erroneous information. Surveys are the most commonly used method of ascertaining user satisfaction with services received. OBJECTIVES: This study will assess patient-perceived satisfaction and provide feedback to measure the comprehensibility and overall utility of an educational brochure on migraine. MATERIAL AND METHODS: Open prospective multicentre study of a group of patients diagnosed with migraine in neurology clinics in Alicante province. During the initial visit, each patient received a migraine brochure prepared by the Valencian Society of Neurology's study group for headaches (CEFALIC). During a follow-up visit, they were then asked to fill out a personal survey on the overall quality of the information in the brochure. RESULTS: We included a total of 257 patients diagnosed with migraine (83% episodic migraine; 17% chronic migraine); mean age was 37.6 years. Two hundred seven patients confirmed having read the brochure (80.5%); 50 patients (19.5%) either forgot to read it or had no interest in doing so. The brochure seemed interesting and easy to understand according to 90% of the patients. Seventy-six per cent of the respondents stated that reading the brochure increased their overall knowledge of migraine, while 50% of the patients found the brochure useful for improving migraine control. CONCLUSIONS: Patients found the migraine educational brochure to be comprehensible, a means of increasing overall knowledge of the disease, and useful for increasing control over migraines. Evaluations of the educational brochures that we provide to our patients with migraine should be studied to discover the causes of dissatisfaction, determine the level of quality of service, and investigate potential areas for improvement.

Switching from natalizumab to fingolimod: an observational study.

BACKGROUND: Multiple sclerosis patients who discontinue using natalizumab are at risk of a rebound in disease activity. However, the optimal alternative therapy is not currently known. AIMS OF THE STUDY: We report on clinical and MRI data and patient safety in a group of relapsing-remitting multiple sclerosis patients who tested seropositive for the JC virus and who have switched from natalizumab to fingolimod because of concerns regarding PML risks. METHODS: The test for JC virus antibodies was performed in 18 relapsing-remitting multiple sclerosis patients who were being treated with natalizumab for more than 1 year. Eight seropositive patients switched to fingolimod while the seronegative patients continued with natalizumab. RESULTS: After switching to fingolimod, five of eight patients (63%) experienced clinical relapses, and MRI activity was detected in six of eight patients (75%). Neither clinical relapses nor MRI activity was observed in the patients who continued with natalizumab. No serious adverse effects were detected. CONCLUSIONS: Natalizumab is an effective treatment for relapsing-remitting multiple sclerosis, but its discontinuation continues to be a complex problem. All of the therapies tried thus far, including fingolimod, have been unable to control the reactivation of the disease. Further studies addressing alternative therapies after natalizumab discontinuation are necessary.

El fenómeno de la inmigración en la Europa comunitaria y su impacto en la asistencia neurológica en el área de la Marina Baixa, Alicante / The phenomenon of immigration within the european community and its impact on neurological care in the Marina Baixa Area, Alicante

Introducción. La inmigración configura un nuevo modelo de sociedad, con nuevas necesidades y demandas, cuya caracterización debe orientar las políticas de salud. Objetivo. Conocer la repercusión del fenómeno de la inmigración sobre la asistencia neurológica extrahospitalaria llevada a cabo en el Departamento 16 de la Agencia Valenciana de Salud y cómo influye en la consulta la dificultad idiomática. Pacientes y métodos. Estudio prospectivo durante 26 consultas ambulatorias consecutivas en el primer trimestre de 2006. Resultados. El 9,5% de los pacientes atendidos era extranjero. El 77,7% pertenecía a países comunitarios. De los extracomunitarios, el 13% provenía de países latinoamericanos, el 5% de países europeos no comunitarios y el 5% de África. Las edades medias fueron 61,5 años para el grupo de europeos comunitarios y 42,6 años para el resto de nacionalidades. Los motivos de consulta principales fueron la cefalea y el deterioro cognitivo. A menor calidad de comunicación, mayor era la duración de la consulta. Conclusiones. La alta prevalencia de población inmigrante comunitaria, mayoritariamente de edad avanzada y con patología neurológica crónica, contribuye, junto con el envejecimiento de la población autóctona, al progresivo crecimiento de la demanda asistencial en nuestra área. La barrera idiomática complica la práctica clínica y conlleva un aumento del tiempo necesario por paciente. Estos hechos han de tenerse en cuenta a la hora de planificar tanto los recursos sanitarios de nuestra área como los tiempos de consulta por paciente (AU)

Introduction. Immigration is shaping a new model of society, with new needs and demands, whose characteristics must guide health-care policies. Aim. To determine the repercussions of the phenomenon of immigration on the extra-hospital neurological care carried out in Department 16 of the Agencia Valenciana de Salud (Valencian Health Service) and how language problems affect visits. Patients and methods. We conducted a prospective study during 26 consecutive outpatientvisits in the first three months of 2006. Results. Of all the patients who were attended, 9.5% were foreigners. Of these, 77.7% came from EU countries. And of those from outside the Community, 13% were from Latin American countries, 5% came from European countries that do not belong to the EU and 5% were from Africa. Mean ages were 61.5 years for the EU group and 42.6 years for the other nationalities. The main reasons for visiting were headache and cognitive impairment. The poorer the quality of communication was, the longer the visit lasted. Conclusions. The high prevalence of immigrants from the EU, mostly elderly persons and with chronic neurological pathologies, together with the ageing of the autochthonous population, have led to a progressive growth in the demand for health care in our area. The language barrier makes clinical practice more complicated and results in an increase in the time needed for each patient. These facts must be taken into account when planning both the health care resources in our area and visiting times per patient (AU)

[The phenomenon of immigration within the European Community and its impact on neurological care in the Marina Baixa area, Alicante]. / El fenómeno de la inmigración en la Europa comunitaria y su impacto en la asistencia neurológica en el área de la Marina Baixa, Alicante.

INTRODUCTION: Immigration is shaping a new model of society, with new needs and demands, whose characteristics must guide health-care policies. AIM. To determine the repercussions of the phenomenon of immigration on the extra-hospital neurological care carried out in Department 16 of the Agencia Valenciana de Salud (Valencian Health Service) and how language problems affect visits. PATIENTS AND METHODS: We conducted a prospective study during 26 consecutive outpatient visits in the first three months of 2006. RESULTS: Of all the patients who were attended, 9.5% were foreigners. Of these, 77.7% came from EU countries. And of those from outside the Community, 13% were from Latin American countries, 5% came from European countries that do not belong to the EU and 5% were from Africa. Mean ages were 61.5 years for the EU group and 42.6 years for the other nationalities. The main reasons for visiting were headache and cognitive impairment. The poorer the quality of communication was, the longer the visit lasted. CONCLUSIONS: The high prevalence of immigrants from the EU, mostly elderly persons and with chronic neurological pathologies, together with the ageing of the autochthonous population, have led to a progressive growth in the demand for health care in our area. The language barrier makes clinical practice more complicated and results in an increase in the time needed for each patient. These facts must be taken into account when planning both the health care resources in our area and visiting times per patient.

Mononeuropatía múltiple asociada a tratamiento con pravastatina / Multiple mononeuropathy associated to treatment with pravastatin

Introducción. La neuropatía secundaria al tratamiento con estatinas se conoce desde 1994. aunque es una complicación poco frecuente. Habitualmente se trata de una polineuropatía axonal, predominantemente sensitiva, distal y simétrica, subaguda o crónica. Presentamos el segundo caso que se recoge en la bibliografía de mononeuritis múltiple asociada al uso de estatinas. Caso clínico. Mujer de 51 años que, tras iniciar tratamiento con pravastatina, presentó parestesias progresivas distales en miembros, de distribución asimétrica, con inestabilidad en la marcha. El estudio electromiográfico fue compatible con mononeuritis múltiple. Las pruebas complementarias realizadas para descartar otras causas de mononeuropatía múltiple fueron normales. La enferma mejoró al abandonar el tratamiento y empeoró de nuevo tras retomarlo. Con la suspensión definitiva de la pravastatina volvió a mejorar de forma progresiva hasta quedar prácticamente asintomática. Conclusiones. La relación entre el tratamiento con estatinas y la aparición de polineuropatía ha quedado establecida en distintos estudios epidemiológicos de casos y controles. No sólo se puede presentar como la clásica polineuropatía distal y simétrica, sino que se han descrito formas clínicas atípicas, incluido algún caso como el nuestro de mononeuropatía múltiple. El riesgo de desarrollar esta complicación es pequeño y se ve compensado por los beneficios cardiovasculares de las estatinas, aunque posiblemente en un futuro se verá con más frecuencia, dado el uso creciente de estos fármacos. Es importante tener en cuenta esta causa de neuropatía, dada su reversibilidad potencial

Introduction. The first reports of neuropathy due to treatment with statins appeared in 1994, although it is an infrequent complication. It usually consists of an axonal polyneuropathy, which is predominantly sensory, distal and symmetric, and may be subacute or chronic. We present here the second case reported in the literature of multiple mononeuropathy associated to the use of statins. Case report. A 51-year-old female patient who, after beginning therapy with pravastatin, presented with progressive, asymmetrically distributed, distal paresthesias in the limbs and an unstable gait. An electromyographic study was compatible with multiple mononeuritis. Results of complementary tests that were carried out to preclude other causes of multiple mononeuropathy were normal. The patient’s condition improved on withdrawing treatment with the drug and it became worse again when therapy was restarted. When pravastatin therapy was stopped for good, the patient's condition progressively improved until she was practically free of symptoms. Conclusions. The relationship between treatment with statins and the appearance of polyneuropathy has been proved in different epidemiological case-control studies. It does not only appear as the classical distal symmetrical olyneuropathy, but has also been reported as taking on atypical clinical forms including a few cases, like ours, of multiple mononeuropathy. The risk of developing this complication is low and is offset by the cardiovascular benefits offered by statins, although it may become more common in the future due to the increasing rate of use of these agents. It is important to bear this cause of neuropathy in mind, given the fact that it is potentially reversible

[Multiple mononeuropathy associated to treatment with pravastatin]. / Mononeuropatía múltiple asociada a tratamiento con pravastatina.

INTRODUCTION: The first reports of neuropathy due to treatment with statins appeared in 1994, although it is an infrequent complication. It usually consists of an axonal polyneuropathy, which is predominantly sensory, distal and symmetric, and may be subacute or chronic. We present here the second case reported in the literature of multiple mononeuropathy associated to the use of statins. CASE REPORT: A 51-year-old female patient who, after beginning therapy with pravastatin, presented with progressive, asymmetrically distributed, distal paresthesias in the limbs and an unstable gait. An electromyographic study was compatible with multiple mononeuritis. Results of complementary tests that were carried out to preclude other causes of multiple mononeuropathy were normal. The patient's condition improved on withdrawing treatment with the drug and it became worse again when therapy was restarted. When pravastatin therapy was stopped for good, the patient's condition progressively improved until she was practically free of symptoms. CONCLUSIONS: The relationship between treatment with statins and the appearance of polyneuropathy has been proved in different epidemiological case-control studies. It does not only appear as the classical distal symmetrical polyneuropathy, but has also been reported as taking on atypical clinical forms including a few cases, like ours, of multiple mononeuropathy. The risk of developing this complication is low and is offset by the cardiovascular benefits offered by statins, although it may become more common in the future due to the increasing rate of use of these agents. It is important to bear this cause of neuropathy in mind, given the fact that it is potentially reversible.

[Ambulatory neurological care in the Marina Baixa area, Alicante]. / Asistencia neurológica ambulatoria en el área de la Marina Baixa, Alicante.

INTRODUCTION: The demand for neurological care depends on the type of population to be attended, among other variables. The Marina Baixa area, which includes towns such as Altea and Benidorm, has its own peculiar characteristics due to its being one of the places that is often chosen by pensioners from northern and central Spain and Europe to set up residence. AIM: The aim of this study was to determine the characteristics of the ambulatory neurological care in our health area. PATIENTS AND METHODS: Data on 1,000 patients attended in the Neurological Clinic at the Specialty Centre in Benidorm (age, sex, reason for visit, tests requested and destination on discharge) were recorded prospectively and consecutively. RESULTS: The mean age was 58.04 years (range 14-94) and 56.4% were females. 25% of the patients attended were over 75 years old. The main reasons for visiting were headache (28.2%) and cognitive impairment (21%). 26.5% were first-time visits, with a mean age of 55.02 years, which is significantly lower than that of the review patients (59.12 years; p = 0.003). 15.6% of the patients were discharged from hospital. A prolonged follow-up was foreseen for over 50% of them. The demand for care in 2003 was 27.5 per 1,000 inhabitants/year in the population above the age of 14 years. CONCLUSIONS: The higher the mean age of the population is, the greater the prevalence of neurodegenerative diseases will become and the more demand there will be for ambulatory care. Resources must be adjusted to this new situation and there is also a need to adopt the most suitable model of health care for chronic neurological patients.

[Serous otitis media. Comparative study of carbinoxamine- pseudoephedrine vs astemizole-pseudoephedrine]. / Otitis media serosa. Estudio comparativo de carbinoxamina-pseudoefedrina vs astemizol-pseudoefedrina.

They were studied 48 children of 3 to 8 years old, of two sex (30 male and 18 female), that attended the external service of otolaryngology of the Hospital of the ISSSTE of Nuevo Laredo, Tamaulipas (Mexico) and the private practice of the Allergy Clinic and Otolaringol in Nuevo Laredo, Tamaulipas, of the month of November of 1995 to April of 1996. Some of the side effects observed in the patients treated in the group A (carbinoxamine-P) were: mild sedation and in some instances hyperexcitability and irritability. However, it was not necessary to discontinue the medication or to modify the dose. In the group B (astemizole-P) was observed only excitement and irritability in some instances by hypersensitivity to the pseudoephedrine. It is very important to consider that the adequate and timely treatment in a patient with otitis serous media will permit to avoid sequels that they can cause, in the long run, a meaningful impact in the language and intellectual development of the child.

[Hyperinsulinism probably caused by diffuse pancreatic hyperplasia]. / Hiperinsulinismo por probable hiperplasia difusa pancreática.

A case history of a two years seven months old boy with hyperinsulinism and marked psychomotor retardation is presented. In this patient, biochemical analysis revealed persistent hypoglycemia. Basal insulin levels (RIA) were consistently superior to 10 mU/ml. and were higher than would be expected from the child's glycemias. Angiographic study of the celiac trunk revealed diffuse pancreatic enlargement. Therapy was initiated with oral diazoxide normalizing and stabilizing the patient's glycemia. The importance of an early diagnosis of this condition and the necessary biochemical analyses involved are discussed as well as the use of diazoxide in the medical treatment of hypoglycemia.