Epilepsy in elderly patients: does age of onset make a difference?

INTRODUCTION: Epilepsy is most frequent in children and elderly people. Today's population is ageing and epilepsy prevalence is increasing. The type of epilepsy and its management change with age. METHODS: We performed a retrospective, observational study comparing patients aged ≥ 65 years with epilepsy diagnosed before and after the age of 65, and describing epilepsy characteristics and comorbidities in each group. RESULTS: The sample included 123 patients, of whom 61 were diagnosed at < 65 years of age (group A), 62 at ≥ 65 of age (group B). Sex distribution was similar in both groups, with 39 men (62.9%) in group A and 37 (60.7%) in group B. Mean age was 69.97 ±â€¯5.6 years in group A and 77.29 ±â€¯6.73 in group B. The most common aetiology was cryptogenic in group A (44.3%, n = 27) and vascular in group B (74.2%, n = 46). History of stroke was present in 12 patients from group A (19.7%) and 32 (51.6%) in group B. Antiepileptic drugs were prescribed at lower doses in group A. Statistically significant differences were found between groups for history of ischaemic stroke, cognitive impairment, psychiatric disorders, and diabetes mellitus; degree of dependence; and number of antiepileptic drugs. CONCLUSION: Age of onset ≥ 65 years is closely related to cardiovascular risk factors; these patients require fewer antiepileptic drugs and respond to lower doses. Some cases initially present as status epilepticus.

Cefalea post-stent carotídeo / Headache after carotid artery stenting

Introducción y objetivos: La cefalea post-stent carotídeo es aquella cefalea de aparición durante el procedimiento o en las horas posteriores, sin que haya datos de la existencia de una complicación del mismo. El objetivo de este estudio es definir las características de esta cefalea a partir de nuestra experiencia clínica. Pacientes y método: Estudio transversal prospectivo observacional de una muestra de pacientes sometidos a stenting carotídeo en el Hospital Clínico Universitario Lozano Blesa. Se estudiaron variables sociodemográficas, factores de riesgo cardiovascular, afectación carotídea y antecedentes de cefalea primaria. Se realizó una entrevista estructurada antes del procedimiento y en las siguientes 24h. Resultados: Se incluyeron un total de 56 pacientes con una media de edad de 67 ± 9,52 años; un 84% eran hombres. La cefalea apareció en 12 pacientes (21,4%), siendo el 83,3% hombres con una media de edad de 60,58 ± 9,31 años. En el 58,4% (n = 7) comenzó en las primeras 6h y en el 33,3% (n = 4) durante el procedimiento. En el 33,3% (n = 4) la duración fue menor de 10min, y en el 41,7% (n = 5) osciló entre 10-120 min. Localizaron el dolor en la región frontotemporal el 58,3% (n = 7); el 58,3% (n = 7) lo describe como unilateral. Es opresivo en un 66,7% (n = 8), de intensidad moderada en un 50% (n = 6) y el 75% de los pacientes no precisó analgesia. No se observó ninguna relación estadísticamente significativa con las variables estudiadas, excepto la edad (p = 0,007). Conclusiones: En nuestra serie, la cefalea post-stent carotídeo es de intensidad leve-moderada, unilateral, opresiva y de breve duración. Si bien son necesarios más estudios para poder definir mejor sus características y factores de riesgo

Introduction and objectives: Headache after carotid artery stenting is a headache with onset during the procedure or in the first few hours after it, and where there is no evidence to suggest a complication of that procedure. The purpose of this study is to describe the main features of these headaches based on our clinical experience. Patients and methods: Observational prospective study of a sample of patients undergoing carotid artery stenting at Hospital Clínico Universitario Lozano Blesa, in Zaragoza, Spain. We recorded sociodemographic characteristics, cardiovascular risk factors, carotid artery disease, and history of primary headache; data were gathered using structured interviews completed before and 24 hours after the procedure. Results: We included 56 patients (mean age 67 ± 9.52 years); 84% were men. Twelve patients (21.4%) experienced headache, 83.3% of whom were men; mean age was 60.58 ± 9.31 years. Headache appeared within the first 6hours in 7 patients (58.4%) and during the procedure in 4 (33.3%). Pain lasted less than 10 minutes in 4 patients (33.3%) and between 10 and 120 minutes in 5 (41.7%). Headache affected the frontotemporal area in 7 patients (58.3%); 7 patients (58.3%) described pain as unilateral. It was oppressive in 8 patients (66.7%) and of moderate intensity in 6 (50%). Nine patients (75%) required no analgesics. We found no statistically significant associations with any of the variables except for age (p = .007; t test). Conclusions: In our sample, headache after carotid artery stenting was mild to moderate in intensity, unilateral, oppressive, and short-lasting. Further studies are necessary to gain a deeper knowledge of its characteristics and associated risk factors

Epilepsy in elderly patients: does age of onset make a difference? / Epilepsia en el anciano: ¿la edad de inicio marca la diferencia?

INTRODUCTION: Epilepsy is most frequent in children and elderly people. Today's population is ageing and epilepsy prevalence is increasing. The type of epilepsy and its management change with age. METHODS: We performed a retrospective, observational study comparing patients aged ≥ 65 years with epilepsy diagnosed before and after the age of 65, and describing epilepsy characteristics and comorbidities in each group. RESULTS: The sample included 123 patients, of whom 61 were diagnosed at <65 years of age (group A), 62 at ≥ 65 of age (group B). Sex distribution was similar in both groups, with 39 men (62.9%) in group A and 37 (60.7%) in group B. Mean age was 69.97±5.6 years in group A and 77.29±6.73 in group B. The most common aetiology was unknown in group A (44.3%, n=27) and vascular in group B (74.2%, n=46). History of stroke was present in 12 patients from group A (19.7%) and 32 (51.6%) in group B. Antiepileptic drugs were prescribed at lower doses in group A. Statistically significant differences were found between groups for history of ischaemic stroke, cognitive impairment, psychiatric disorders, and diabetes mellitus; degree of dependence; and number of antiepileptic drugs. CONCLUSION: Age of onset ≥ 65 years is closely related to cardiovascular risk factors; these patients require fewer antiepileptic drugs and respond to lower doses. Some cases initially present as status epilepticus.

Headache after carotid artery stenting. / Cefalea post-stent carotídeo.

INTRODUCTION AND OBJECTIVES: Headache after carotid artery stenting is a headache with onset during the procedure or in the first few hours after it, and where there is no evidence to suggest a complication of that procedure. The purpose of this study is to describe the main features of these headaches based on our clinical experience. PATIENTS AND METHODS: Observational prospective study of a sample of patients undergoing carotid artery stenting at Hospital Clínico Universitario Lozano Blesa, in Zaragoza, Spain. We recorded sociodemographic characteristics, cardiovascular risk factors, carotid artery disease, and history of primary headache; data were gathered using structured interviews completed before and 24hours after the procedure. RESULTS: We included 56 patients (mean age 67±9.52 years); 84% were men. Twelve patients (21.4%) experienced headache, 83.3% of whom were men; mean age was 60.58±9.31 years. Headache appeared within the first 6hours in 7 patients (58.4%) and during the procedure in 4 (33.3%). Pain lasted less than 10minutes in 4 patients (33.3%) and between 10 and 120minutes in 5 (41.7%). Headache affected the frontotemporal area in 7 patients (58.3%); 7 patients (58.3%) described pain as unilateral. It was oppressive in 8 patients (66.7%) and of moderate intensity in 6 (50%). Nine patients (75%) required no analgesics. We found no statistically significant associations with any of the variables except for age (P=.007; t test). CONCLUSIONS: In our sample, headache after carotid artery stenting was mild to moderate in intensity, unilateral, oppressive, and short-lasting. Further studies are necessary to gain a deeper knowledge of its characteristics and associated risk factors.

El día de la semana en la exploración de la orientación en el tiempo / Day of the week for the assessment of orientation in time

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Epilepsia y síndrome de Brugada / Epilepsy and Brugada syndrome

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[Knowledge of cerebrovascular disease in the population of Zaragoza]. / Conocimiento de la enfermedad vascular cerebral en la poblacion de Zaragoza.

INTRODUCTION: Acute cerebrovascular disease is a major cause of disability and mortality, with important socio-economic and health impacts. Early stroke care can reduce mortality and improve prognosis. Right now, we can apply treatments in the acute phase, with capacity to reverse the symptoms, but few patients who benefit not reach the hospital soon. One reason for this delay is the lack of recognition of symptoms and poor perception of gravity. AIM: To find out the knowledge of the public about the stroke. SUBJECTS AND METHODS: The sample analyzed was the population of Sector III of Zaragoza, with random selection. The tool used was a telephone survey structured. We analyzed 583 surveys. RESULTS: 63.5% of respondents did not know any symptoms of stroke. 48% do not know any vascular risk factor. Only 9% recognized at least two symptoms and two risk factors. Regarding the attitude, 56% act properly against 44% who do not. Multivariate analysis showed that the factors more related to knowledge are the cultural level and young age. Living in town, and female, they are associated with the best attitude. CONCLUSIONS: Knowledge about stroke is poor, with a low sense of urgency. The factors most associated with the best knowledge are young age and cultural level.

TITLE: Conocimiento de la enfermedad vascular cerebral en la poblacion de Zaragoza.Introduccion. El ictus es una de las principales causas de invalidez y mortalidad en nuestra sociedad, con importantes repercusiones socioeconomicas y sanitarias. La asistencia precoz puede mejorar el pronostico de los pacientes. Actualmente, existen tratamientos en fase aguda, que consiguen reperfundir el tejido isquemico en riesgo y revertir la sintomatologia, pero son pocos los pacientes que se benefician, por el retraso en su atencion, debido a la falta de reconocimiento de los sintomas y la escasa percepcion de gravedad. Objetivo. Analizar el conocimiento de la poblacion de nuestra area de salud sobre el ictus. Sujetos y metodos. La muestra analizada ha sido la poblacion del sector III de la provincia de Zaragoza, con seleccion aleatoria. La herramienta utilizada ha sido una encuesta telefonica estructurada (total de 583). Resultados. Un 63,5% de los encuestados desconoce los sintomas del ictus, y un 48%, los factores de riesgo vascular. Solo un 9% reconoce al menos dos sintomas y dos factores de riesgo. En cuanto a la actitud, un 56% actuaria correctamente frente a un 44% que no. El analisis multivariante mostro que los factores mas relacionados con el conocimiento fueron el nivel cultural y la edad joven. Vivir en un pueblo y sexo femenino se relacionaron con la mejor actitud. Conclusiones. El conocimiento del ictus es escaso, con una baja percepcion de urgencia. Los factores que implican un mejor conocimiento son la edad joven y el nivel cultural alto.

[Study of the diagnostic agreement on headaches between neurology and primary care]. / Estudio de concordancia diagnostica en cefalea entre neurologia y atencion primaria.

INTRODUCTION: Headache as a symptom is a very common disease and one of the main reasons for consultation in primary care. AIM: To analyze the characteristics of patients referred from primary care to general neurology whose chief complaint was headache and/or neuralgia and diagnostic agreement. PATIENTS AND METHODS: Cross-sectional study of all patients referred from primary care; demographic/clinical variables were collected and diagnostic hypothesis by primary care and general neurology were compared by determining their agreement. RESULTS: 2,514 were referred from primary care patients (588 of them on a preferential basis); in 378 cases the reason for consultation was headache and/or neuralgia (average 42.46 years; 77.8% female). In 139 patients it was established only a semiological diagnostic and other episodic migraine predominated (49.79%), chronic tension headache (18.41%) and trigeminal neuralgia (12.13%). Since general neurology, the most common diagnoses were, respectively, 33.86%, 24.05% and 18.67%. A compatible kappa coefficient of 0.543 (p < 0.05) with a moderate agreement when considering only those patients referred from primary care to a specific diagnosis was obtained. CONCLUSIONS: Headaches are a very common reason for consultation in primary care (15%). The diagnostic agreement is moderate in our health sector so it is necessary to design training programs to help outline the criteria for referral to specialists and improve care for our patients.

TITLE: Estudio de concordancia diagnostica en cefalea entre neurologia y atencion primaria.Introduccion. La cefalea como sintoma es una patologia frecuente y uno de los principales motivos de consulta por parte de atencion primaria. Objetivo. Analizar las caracteristicas de los pacientes derivados desde atencion primaria a la consulta de neurologia general con cefalea o neuralgia como motivo de consulta, y la concordancia diagnostica. Pacientes y metodos. Estudio descriptivo transversal de todos los pacientes remitidos desde atencion primaria; se recogieron variables demograficas/clinicas y se compararon las hipotesis diagnosticas de atencion primaria y neurologia, determinando su concordancia. Resultados. Se remitieron desde atencion primaria 2.514 pacientes (588 de ellos con caracter preferente); en 378 casos el motivo de la consulta fue cefalea o neuralgia (42,46 años de media; el 77,8%, mujeres). En 139 pacientes se establecio tan solo un diagnostico semiologico y en el resto predominaron la migraña episodica (49,79%), la cefalea tensional cronica (18,41%) y la neuralgia del trigemino (12,13%). Desde neurologia, los diagnosticos mas frecuentes fueron, respectivamente, 33,86%, 24,05% y 18,67%. Se obtuvo un coeficiente kappa de 0,543 (p < 0,05), compatible con una concordancia moderada al considerar solo los pacientes remitidos desde atencion primaria con un diagnostico concreto. Conclusiones. Las cefaleas constituyen un motivo de consulta desde atencion primaria muy frecuente (15%). La concordancia diagnostica es moderada en nuestro sector sanitario, por lo que es necesario diseñar programas de formacion que ayuden a perfilar los criterios de derivacion al especialista y mejorar la atencion a nuestros pacientes.

Estudio de la función sexual en la migraña y la cefalea en racimos / A study of sexual function in migraine and cluster headache

Introducción. La disfunción eréctil y sexual son síntomas comunes a muchas enfermedades crónicas cuyo diagnóstico va a condicionar el manejo terapéutico de los pacientes. Objetivo. Valorar la función sexual en varones con migraña o cefalea en racimos (CR) comparándola con un grupo control. Sujetos y métodos. Estudio descriptivo transversal de 34 pacientes con migraña, 31 pacientes con CR y 60 sujetos control de edad inferior a 46 años. La disfunción eréctil se valoró con el índice internacional de disfunción eréctil (IIEF), y el estado emocional, mediante el inventario de depresión de Beck. Resultados. La puntuación media en el IIEF fue de 68,41 ± 10,09, 64,26 ± 5,73 y 59,33 ± 15,89 en los grupos control, con migraña y con CR, respectivamente (p = 0,041), y la diferencia es significativa entre controles y con CR (p = 0,036). En el grupo de pacientes migrañosos, tres pacientes tenían disfunción eréctil leve, y uno, moderada. En el grupo de pacientes con CR, 12 puntuaron en rango de disfunción eréctil leve y dos cumplieron criterios de disfunción eréctil grave (p < 0,05). Al analizar las diferencias en los diferentes dominios del IIEF, éstas fueron significativas en el dominio de satisfacción global (p = 0,015) entre el grupo control y los pacientes con CR (p = 0,012). Conclusiones. Hemos encontrado una mayor frecuencia de disfunción eréctil y afectación de la función sexual en términos de satisfacción global en los pacientes con migraña y con CR. Creemos que la valoración de la función sexual en este tipo de cefaleas debe integrarse en nuestra práctica clínica habitual (AU)

Introduction. The sexual erectile dysfunction are common symptoms and many chronic diseases whose diagnosis will determine the therapeutic management of patients. Aim. To assess sexual function in men with migraine or cluster headache (CH) compared with a control group. Subjects and methods. Cross-sectional study of 34 patients with migraine, 31 patients with CH and 60 control subjects less than 46 years old. Erectile dysfunction was assessed using the International Index of Erectile Dysfunction (IIEF). Emotional state was evaluated using the Beck Depression Inventory. Results. The average score on the IIEF was 68.41 ± 10.09, 64.26 ± 5.73 and 59.33 ± 15.89 in the control group, migraine and CH respectively (p = 0.041) being the significant difference between controls and CH (p = 0.036). In the group of migraine patients, three patients had mild and one moderate erectile dysfunction. In the group of patients with CH, twelve scored in rank of mild erectile dysfunction, and two met the criteria for severe erectile dysfunction (p < 0.05). By analyzing differences in the different domains of IIEF, they were significant in the domain of overall satisfaction (p = 0.015) between the control group and patients with CH (p = 0.012). Conclusions. In our study we found a higher frequency of and involvement in sexual function in terms of overall satisfaction in patients with migraine and CH. We believe that the evaluation of sexual function in this type of headache should be integrated into our clinical practice (AU)

[A study of sexual function in migraine and cluster headache]. / Estudio de la funcion sexual en la migrana y la cefalea en racimos.

INTRODUCTION: The sexual erectile dysfunction are common symptoms and many chronic diseases whose diagnosis will determine the therapeutic management of patients. AIM: To assess sexual function in men with migraine or cluster headache (CH) compared with a control group. SUBJECTS AND METHODS: Cross-sectional study of 34 patients with migraine, 31 patients with CH and 60 control subjects less than 46 years old. Erectile dysfunction was assessed using the International Index of Erectile Dysfunction (IIEF). Emotional state was evaluated using the Beck Depression Inventory. RESULTS: The average score on the IIEF was 68.41 ± 10.09, 64.26 ± 5.73 and 59.33 ± 15.89 in the control group, migraine and CH respectively (p = 0.041) being the significant difference between controls and CH (p = 0.036). In the group of migraine patients, three patients had mild and one moderate erectile dysfunction. In the group of patients with CH, twelve scored in rank of mild erectile dysfunction, and two met the criteria for severe erectile dysfunction (p < 0.05). By analyzing differences in the different domains of IIEF, they were significant in the domain of overall satisfaction (p = 0.015) between the control group and patients with CH (p = 0.012). CONCLUSIONS: In our study we found a higher frequency of and involvement in sexual function in terms of overall satisfaction in patients with migraine and CH. We believe that the evaluation of sexual function in this type of headache should be integrated into our clinical practice.

TITLE: Estudio de la funcion sexual en la migrana y la cefalea en racimos.Introduccion. La disfuncion erectil y sexual son sintomas comunes a muchas enfermedades cronicas cuyo diagnostico va a condicionar el manejo terapeutico de los pacientes. Objetivo. Valorar la funcion sexual en varones con migrana o cefalea en racimos (CR) comparandola con un grupo control. Sujetos y metodos. Estudio descriptivo transversal de 34 pacientes con migrana, 31 pacientes con CR y 60 sujetos control de edad inferior a 46 anos. La disfuncion erectil se valoro con el indice internacional de disfuncion erectil (IIEF), y el estado emocional, mediante el inventario de depresion de Beck. Resultados. La puntuacion media en el IIEF fue de 68,41 ± 10,09, 64,26 ± 5,73 y 59,33 ± 15,89 en los grupos control, con migrana y con CR, respectivamente (p = 0,041), y la diferencia es significativa entre controles y con CR (p = 0,036). En el grupo de pacientes migranosos, tres pacientes tenian disfuncion erectil leve, y uno, moderada. En el grupo de pacientes con CR, 12 puntuaron en rango de disfuncion erectil leve y dos cumplieron criterios de disfuncion erectil grave (p < 0,05). Al analizar las diferencias en los diferentes dominios del IIEF, estas fueron significativas en el dominio de satisfaccion global (p = 0,015) entre el grupo control y los pacientes con CR (p = 0,012). Conclusiones. Hemos encontrado una mayor frecuencia de disfuncion erectil y afectacion de la funcion sexual en terminos de satisfaccion global en los pacientes con migrana y con CR. Creemos que la valoracion de la funcion sexual en este tipo de cefaleas debe integrarse en nuestra practica clinica habitual.

Absceso cerebral por Rhodococcus equi con comportamiento seudotumoral en paciente inmunocompetente / Cerebral abscess due to Rhodococcus equi with pseudotumour presentation in an immunocompetent patient

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[Mnemonic complaints and chronic migraine]. / Quejas mnesicas y migraña cronica.

INTRODUCTION. Patients with chronic migraine often report lower cognitive performance, which affects their quality of life. AIMS. To analyse whether the mnemonic capacity of patients with chronic migraine is altered or not. SUBJECTS AND METHODS. A cross-sectional study was conducted in patients with chronic migraine evaluated consecutively in our unit, and paired by age (18-60 years) and gender with a control group consisting of cognitively healthy volunteers. The following cognitive instruments were administered: Folstein Minimental State Examination (MMSE), Memory Alteration Test (M@T), Montreal Cognitive Assessment (MoCA) and working memory. RESULTS. A total of 30 patients with chronic migraine were included (mean age: 49.33 ± 10.05 years) paired with a control group of 30 healthy volunteers (mean age: 44.83 ± 10.91 years). The mean elapsed time since onset of the patients with chronic migraine was 4.47 ± 2.74 years. On performing a comparative analysis between the two groups, significant differences were found with overall lower scores in the group of patients with chronic migraine in the MoCA (24.16 versus 29), M@T (43.76 versus 48.8) and working memory tests (17.5 versus 24.26). Performance in the MMSE was similar in both groups. CONCLUSIONS. Patients with chronic migraine can have lower cognitive performance regardless of distracting elements, such as pharmacological factors or psychiatric comorbidity, since chronic migraine can be understood as yet another element within the spectrum of chronic pain.

TITLE: Quejas mnesicas y migraña cronica.Introduccion. Los pacientes con migraña cronica refieren frecuentemente un menor rendimiento cognitivo, lo que interfiere en su calidad de vida. Objetivo. Analizar si existe alteracion en la capacidad mnesica de los pacientes con migraña cronica. Sujetos y metodos. Estudio transversal en pacientes con migraña cronica valorados de forma consecutiva en nuestra unidad, pareados en edad (18-60 años) y sexo con un grupo control constituido por voluntarios cognitivamente sanos. Se administraron los siguientes instrumentos cognitivos: test minimental de Folstein (MMSE), test de alteracion de memoria (T@M), evaluacion cognitiva de Montreal (MoCA) y memoria de trabajo. Resultados. Se incluyo un total de 30 pacientes con migraña cronica (edad media: 49,33 ± 10,05 años) pareados con un grupo control de 30 voluntarios sanos (edad media: 44,83 ± 10,91 años). El tiempo medio de evolucion de los pacientes con migraña cronica fue de 4,47 ± 2,74 años. Al realizar el analisis comparativo entre ambos grupos, se encontraron diferencias significativas con puntuaciones mas bajas de forma global en el grupo de pacientes con migraña cronica en el test de MoCA (24,16 frente a 29), T@M (43,76 frente a 48,8) y memoria de trabajo (17,5 frente a 24,26). El rendimiento en el MMSE fue similar en ambos grupos. Conclusiones. Los pacientes con migraña cronica pueden tener un menor rendimiento cognitivo independientemente de elementos distractores, como el farmacologico o la comorbilidad psiquiatrica, dado que la migraña cronica puede entenderse como un elemento mas dentro del espectro del dolor cronico.

Macropsia, micropsia, alestesia y discromatopsia tras hemorragia intraparenquimatosa occipital / Macropsia, micropsia, allesthesia and dyschromatopsia after occipital intraparenchymal haemorrhage

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