Influencia de la estimulación cerebral profunda en la carga de cuidadores de pacientes con enfermedad de Parkinson / Deep brain stimulation for patients with Parkinson's disease: Effect on caregiver burden

INTRODUCCIÓN: Nuestro objetivo es determinar el grado de carga de cuidadores de pacientes con enfermedad de Parkinson en tratamiento con estimulación cerebral profunda (ECP) con respecto a aquellos en estadios avanzados con otros tratamientos y las variables asociadas a la presencia de sobrecarga. MATERIAL Y MÉTODOS: Se incluyeron de forma consecutiva pacientes con enfermedad de Parkinson en tratamiento con ECP, utilizando como grupo control a otros con enfermedad de Parkinson en estadio avanzado sin ECP. Los pacientes fueron sometidos a una valoración mediante las escalas UPDRS-II, UPDRS-III, UPDRS-IV, Hoehn y Yahr, Schawb & England, Barthel, PDQ-39, MoCA, Apathy Scale, HADS y la QUIP abreviada. A los cuidadores se les estudió mediante el inventario de sobrecarga de Zarit y de valoración afectiva HADS. RESULTADOS: Se incluyeron 11 pacientes en tratamiento con ECP y 11 con otros tratamientos. En aquellos con ECP se observó una mejor calidad de vida según la escala PDQ-39 (p = 0,028), y una menor puntuación en la subescala HADS para la ansiedad (p = 0,010). Se observó sobrecarga en un 54,5% de los cuidadores de pacientes de ambos grupos (p = 1,000), con una puntuación similar en la escala Zarit (p = 0,835). La presencia de sobrecarga se asoció a una mayor puntuación en la escala de apatía (p = 0,048) y en la subescala HADS de ansiedad en el cuidador (p = 0,006). CONCLUSIÓN: Según los resultados de nuestro estudio el tratamiento con ECP no se relaciona con una menor carga del cuidador, siendo la apatía del paciente y la ansiedad del cuidador factores asociados a su desarrollo

INTRODUCTION: Our aim is to assess the burden on caregivers of patients with Parkinson's disease treated with deep brain stimulation (DBS) compared to those caring for patients at advanced stages and undergoing other treatments. We have also assessed the variables associated with presence of caregiver overload. MATERIAL AND METHODS: We included consecutive patients with Parkinson's disease treated with DBS. Our control group included patients in advanced stages of Parkinson's disease undergoing other treatments. Patients were assessed with the following scales: UPDRS-II, UPDRS-III, UPDRS-IV, Hoehn and Yahr, Schwab & England, Barthel, PDQ-39, MoCA, Apathy Evaluation Scale, HADS, and the abbreviated QUIP. Caregiver burden was evaluated with the Zarit caregiver burden interview and their moods were assessed with the HADS scale. RESULTS: We included 11 patients treated with DBS and 11 with other treatments. For patients treated with DBS, we observed a better quality of life according to the PDQ-39 questionnaire (P = .028), and a lower score on the HADS anxiety subscale (P = .010). Caregiver overload was observed in 54.5% of the caregivers of patients in both groups (P = 1.000); Zarit scores were similar (P = .835). Caregiver overload was associated with higher scores on the caregiver's Apathy Evaluation Scale (P = .048) and on the HADS anxiety subscale (P = .006). CONCLUSION: According to our results, treatment with DBS is not associated with lower caregiver burden. Apathy in patients and anxiety in caregivers are factors associated with the appearance of overload

Deep brain stimulation for patients with Parkinson's disease: Effect on caregiver burden. / Influencia de la estimulación cerebral profunda en la carga de cuidadores de pacientes con enfermedad de Parkinson.

INTRODUCTION: Our aim is to assess the burden on caregivers of patients with Parkinson's disease treated with deep brain stimulation (DBS) compared to those caring for patients at advanced stages and undergoing other treatments. We have also assessed the variables associated with presence of caregiver overload. MATERIAL AND METHODS: We included consecutive patients with Parkinson's disease treated with DBS. Our control group included patients in advanced stages of Parkinson's disease undergoing other treatments. Patients were assessed with the following scales: UPDRS-II, UPDRS-III, UPDRS-IV, Hoehn and Yahr, Schwab & England, Barthel, PDQ-39, MoCA, Apathy Evaluation Scale, HADS, and the abbreviated QUIP. Caregiver burden was evaluated with the Zarit caregiver burden interview and their moods were assessed with the HADS scale. RESULTS: We included 11 patients treated with DBS and 11 with other treatments. For patients treated with DBS, we observed a better quality of life according to the PDQ-39 questionnaire (P=.028), and a lower score on the HADS anxiety subscale (P=.010). Caregiver overload was observed in 54.5% of the caregivers of patients in both groups (P=1.000); Zarit scores were similar (P=.835). Caregiver overload was associated with higher scores on the caregiver's Apathy Evaluation Scale (P=.048) and on the HADS anxiety subscale (P=.006). CONCLUSION: According to our results, treatment with DBS is not associated with lower caregiver burden. Apathy in patients and anxiety in caregivers are factors associated with the appearance of overload.

[Relationship between homocysteinaemia and sympathetic skin response in Parkinson's disease]. / Relacion entre homocisteinemia y respuesta simpaticocutanea en la enfermedad de Parkinson.

INTRODUCTION: High levels of homocysteine linked to treatment with levodopa have been observed in patients with Parkinsons disease (PD). Our aim was to assess the influence of serum homocysteine levels and other PD-related on the sympathetic skin response. PATIENTS AND METHODS: An observational, cross-sectional study was conducted that consecutively included patients with PD. We unilaterally assessed the sympathetic skin response in the upper limbs. We measured the influence of PD severity (measured by the Hoehn and Yahr and the Schwab and England scales, and the Unified Parkinson Disease Rating Scale) and blood homocysteine, vitamin B12 and folic acid levels on the latency and amplitude of the sympathetic skin response. RESULTS: A total of 78 patients were enrolled, and all achieved a sympathetic skin response. In the bivariate analysis, latency was significantly correlated with age, age at PD onset and homocysteinaemia levels. The presence of hyper-homocysteinemia was associated with a longer latency. The amplitude was only correlated with the score on the Schwab and England scale. In the multivariate analysis, age was the only variable that showed a significant association with the latency duration and homocysteine levels. CONCLUSION: A direct association could not be established between the increase in homocysteinaemia levels and sympathetic skin response dysfunction in PD. The results of the multivariate analysis suggest that latency prolongation in elderly patients could be due to the fact that these patients have higher blood levels of homocysteinaemia.

TITLE: Relacion entre homocisteinemia y respuesta simpaticocutanea en la enfermedad de Parkinson.Introduccion. En la enfermedad de Parkinson (EP) se han observado niveles elevados de homocisteina en relacion con el tratamiento con levodopa. Nuestro objetivo ha sido valorar su influencia y la de otras variables relacionadas con la propia EP sobre la respuesta simpaticocutanea. Pacientes y metodos. Estudio observacional, transversal, en el que se incluyo de forma consecutiva a pacientes con EP. Se valoro la respuesta simpaticocutanea de forma unilateral en los miembros superiores, y se determino la influencia de la gravedad de la EP segun la Unified Parkinson Disease Rating Scale, y las escalas de Hoehn y Yahr y de Schwab y England, y de los niveles sanguineos de homocisteina, vitamina B12 y acido folico sobre la latencia y amplitud de la respuesta simpaticocutanea. Resultados. Se incluyo a 78 pacientes. La respuesta simpaticocutanea se obtuvo en todos ellos. En el analisis bivariante, la latencia se correlaciono significativamente con la edad, con la edad de inicio de la EP y con los niveles de homocisteina. La presencia de hiperhomocisteinemia se relaciono con una latencia mas prolongada. La amplitud solo se correlaciono con la puntuacion en la escala de Schwab y England. En el analisis multivariante, la edad fue la unica variable que demostro una asociacion significativa tanto con la duracion de la latencia como con los niveles de homocisteina. Conclusion. No pudo establecerse una asociacion directa entre el aumento de homocisteinemia y la disfuncion de la respuesta simpaticocutanea. Los resultados del analisis multivariante sugieren que la prolongacion de la latencia en los pacientes de una mayor edad podria deberse a que estos presentan unos mayores niveles sanguineos de homocisteina.

Síndrome de vena cava superior como complicación del tratamiento con inmunoglobulinas intravenosas / Superior vena cava syndrome as a complication of intravenous immunoglobulin treatment

No disponible

Manejo de la disfunción autonómica en la enfermedad de Parkinson / Management of autonomic dysfunction in Parkinson’s disease

La disfunción autonómica es una manifestación frecuente en los pacientes con enfermedad de Parkinson que, en ocasiones, puede preceder a la afectación motora. Se manifiesta en forma de hipotensión ortostática y posprandial, hipertensión supina, sialorrea, estreñimiento, retraso del vaciamiento gástrico, dishidrosis y disfunción vesical y sexual. Repercute significativamente en la calidad de vida de los pacientes, complicando el manejo de los síntomas motores. La evidencia disponible para el tratamiento de la mayoría de las complicaciones es escasa. Nuestro objetivo es revisar las características fisiopatológicas y clínicas de la disfunción autonómica en la enfermedad de Parkinson y aportar un enfoque práctico en su manejo según la evidencia disponible (AU)

Autonomic dysfunction is a common manifestation in patients with in Parkinson’s disease, which can sometimes precede motor impairment. It can be expressed as orthostatic and postprandial hypotension, supine hypertension, hypersalivation, constipation, delayed gastric emptying, dyshidrosis, bladder and sexual dysfunction. It impairs the quality of life of patients and complicates the management of motor symptoms. Evidence available to treat complications is low. Our aim is to review the pathophysiology and clinical features of autonomic dysfunction in Parkinson’s disease and provide a practical approach to handling the available evidence (AU)

[Clinical and therapeutic differences in neuro-ophthalmological involvement secondary to syphilis]. / Diferencias clinicas y terapeuticas de la afectacion neurooftalmologica secundaria a sifilis.

INTRODUCTION. There are many forms of neuro-ophthalmological involvement secondary to syphilis, and not all of them are well known. Our aim is to determine the clinical and therapeutic differences in these patients. CASE REPORTS. Our sample included eight patients diagnosed with an ocular and neuro-ophthalmological disorder due to syphilis over the years 2012 and 2013. Five of them presented uveitis, pan-eveitis being the most frequent, with three cases. Two cases presented papilloedema and another displayed retrobulbar optic neuropathy. A total of 62.5% were diagnosed with neurosyphilis, the presence of which was related with compromise of the optic nerve (p = 0.035). None of them gave positive for VDRL in cerebrospinal fluid and they were diagnosed by the presence of FTA antibodies together with high protein levels in cerebrospinal fluid, lymphocytic pleocytosis or intrathecal synthesis of antibodies. In the absence of uveitis, diagnosis was delayed by a mean time of 2.6 months (p = 0.047). All the patients, except one who required a vitrectomy, progressed favourably with intravenous antibiotic therapy. CONCLUSIONS. In cases of neuro-ophthalmological compromise, whether inflammatory or non-inflammatory, the physician must bear syphilis in mind as a potential causation in order to avoid delays in the diagnosis, since early well-tailored treatment can prevent permanent loss of sight.

TITLE: Diferencias clinicas y terapeuticas de la afectacion neurooftalmologica secundaria a sifilis.Introduccion. Existen multiples formas de afectacion neurooftalmologica secundaria a sifilis, no siempre bien conocidas. Nuestro objetivo es conocer las diferencias clinicas y de tratamiento en estos pacientes. Casos clinicos. Se incluyeron ocho pacientes diagnosticados de afectacion ocular y neurooftalmologica por sifilis durante los años 2012 y 2013. Cinco presentaron uveitis, siendo la panuveitis la forma mas frecuente, con tres casos. Dos casos presentaron papiledema, y otro, neuropatia optica retrobulbar. Un 62,5% fue diagnosticado de neurosifilis, cuya presencia se relaciono con la afectacion del nervio optico (p = 0,035). Ninguno de ellos presento positividad para VDRL en el liquido cefalorraquideo, y se diagnosticaron por la presencia de anticuerpos FTA junto con hiperproteinorraquia, pleocitosis linfocitaria o sintesis intratecal de anticuerpos. En ausencia de uveitis, se produjo un retraso diagnostico medio de 2,6 meses (p = 0,047). Todos los pacientes, salvo uno que preciso vitrectomia, evolucionaron favorablemente con antibioterapia intravenosa. Conclusiones. En casos de afectacion neurooftalmologica, inflamatoria y no inflamatoria, el clinico debe tener en cuenta la sifilis como potencial etiologia para evitar un retraso diagnostico, puesto que un adecuado tratamiento precoz puede evitar una perdida de vision permanente.

[The importance of chronic migraine in a general neurology service]. / Importancia de la migraña crónica en una consulta general de neurología.

INTRODUCTION: Chronic migraine is a primary headache that is difficult to treat and has an important impact on the patient's quality of life. The international headache classification recently modified the criteria for chronic migraine and therefore few studies have been conducted that analyse groups according to these new criteria. AIM. To analyse a group of patients with chronic migraine who were referred to a general neurology service. PATIENTS AND METHODS: The first 100 patients with migraine were selected. Researchers established and analysed a number of subgroups of patients with episodic, chronic or chronic migraine with probable headache due to medication abuse, in accordance with the International Headache Society (IHS) headache classification and its revised version from 2006. RESULTS: Of the total sample of 738 new patients, 100 (13.5%) suffered from migraines and of these 100 new patients with migraine 42 (5.6% of the total series) satisfied criteria for chronic migraine and 15 patients with chronic migraine met the criteria for probable headache due to medication abuse. Before visiting the neurology service, only 41% had been diagnosed as suffering from migraine, 38% had received no information about this condition, only 17% took triptans for symptomatic relief and 23% had followed some kind of preventive treatment. CONCLUSIONS: One notable finding was the importance of episodic and chronic migraine in a general neurology service, on applying the recent IHS criteria. A high percentage of patients with chronic migraine who were referred to the neurology service have not been diagnosed or given any information or proper treatment; an elevated degree of self-medication and medication abuse also exists. Preventive treatment and triptans in cases of intense migraines are still not commonly used in primary care.

Importancia de la migraña crónica en una consulta general de neurología / The importance of chronic migraine in a general neurology service

La migraña crónica es una cefalea primaria difícil de tratar que produce gran afectación de la calidadde vida del paciente. La clasificación internacional de cefaleas modificó los criterios de migraña crónica recientemente, por lo que existen pocos trabajos que analicen grupos con estos nuevos criterios. Objetivo. Analizar un grupo de pacientes con migrañacrónica remitidos a una consulta de neurología general. Pacientes y métodos. Se seleccionaron los primeros 100 pacientes con migraña. Se establecieron y analizaron subgrupos de pacientes con migraña episódica, crónica o crónica con probable cefalea por abuso de fármacos según la clasificación de cefaleas de la Sociedad Internacional de Cefaleas (IHS) y su revisión delaño 2006. Resultados. Del total de 738 nuevos pacientes, 100 (13,5%) sufrieron migrañas. De estos 100 nuevos pacientes con migraña, 42 (el 5,6% de la serie total) cumplieron los criterios de migraña crónica, y 15 pacientes con migraña crónica, los criteriosde probable cefalea por abuso de fármacos. Antes de acudir a la consulta de neurología, sólo al 41% se le había diagnosticado migraña, un 38% no había recibido información sobre esta entidad, sólo el 17% tomaba triptanes como tratamiento sintomático,y un 23% había seguido tratamiento preventivo. Conclusiones. Destacamos la importancia de la migraña episódica y crónica en una consulta general de neurología, aplicando los criterios recientes de la IHS. Los pacientes con migraña crónica enviados a la consulta de neurología siguen, en un alto porcentaje, sin haber sido diagnosticados, ni informados, ni tratados correctamente, con un alto grado de automedicación y abuso frecuente de fármacos. Los tratamientos preventivos y triptanes en migrañasintensas se siguen utilizando poco en atención primaria (AU)

Chronic migraine is a primary headache that is difficult to treat and has an important impact on the patient’s quality of life. The international headache classification recently modified the criteria for chronic migraine and therefore few studies have been conducted that analyse groups according to these new criteria. Aim. To analyse a group of patients with chronic migraine who were referred to a general neurology service. Patients and methods. The first 100 patients with migraine were selected. Researchers established and analysed a number of subgroups of patients with episodic, chronic or chronic migraine with probable headache due to medication abuse, in accordance with the International Headache Society (IHS) headache classification and its revised version from 2006. Results. Of the total sample of 738 new patients, 100 (13.5%) suffered from migraines and of these 100 new patients with migraine 42 (5.6% of the total series) satisfied criteria for chronic migraine and 15 patients with chronic migraine met the criteria for probable headache due to medication abuse. Before visiting the neurology service, only 41% had been diagnosed as suffering from migraine, 38% had received no information about this condition, only 17% took triptans for symptomatic relief and 23% had followed some kind of preventive treatment.Conclusions. One notable finding was the importance of episodic and chronic migraine in a general neurology service, on applying the recent IHS criteria. A high percentage of patients with chronic migraine who were referred to the neurology service have not been diagnosed or given any information or proper treatment; an elevated degree of self-medication and medication abuse also exists. Preventive treatment and triptans in cases of intense migraines are still not commonly used in primary care (AU)

Angioedema orolingual secundario al tratamiento con alteplasa en el ictus / Orolingual angiooedema secondary to alteplase treatment in cases of stroke

No disponible

[Application of a clinical pathway for the treatment of transient ischaemic attacks: implementation strategies and appraisal at two years]. / Aplicación de una vía clínica para el tratamiento del accidente isquémico transitorio: estrategias de implantación y evaluación a los dos años.

INTRODUCTION: Management of cerebral vascular pathologies by means of clinical pathways allows us to make cost effective use of resources, to enhance health care quality and to obtain a greater degree of satisfaction in patients. AIMS: To assess the efficiency of applying a clinical pathway designed for the treatment of transient ischemic attacks (TIA) by monitoring a series of indicators that enable us to detect existing problems, to introduce any corrections that are needed and to draw conclusions that can be useful in the future. PATIENTS AND METHODS: To this end, a clinical pathway was drawn up with the general agreement of the members of our service and the different professionals involved in caring for these patients. Analyses were performed to study the data from 1998 to 2001, prior to implementation of the pathway, and from 2002 and 2003, which were the first years in which it was being applied. Altogether 1,433 patients with a diagnosis of TIA were hospitalised during this period, 554 of whom were admitted during the years 2002 and 2003. RESULTS: Of this group, the pathway was initially applied in 123 cases and 62 completed it. The mean stay in hospital was reduced from 9.2 days in 2000 to 5.7 days in 2003. The mean stay of patients who fulfilled all the requirements of the pathway was only 2.9 days. As far as the survey on satisfaction is concerned, 97% of patients said they were satisfied or very satisfied with the care they had received. CONCLUSIONS: The application of a clinical pathway in the treatment of TIA resulted in a high degree of satisfaction among the patients who were treated and a notable reduction in the mean stay in hospital.

Aplicación de una vía clínica para el tratamiento del accidente isquémico transitorio: estrategias de implantación y evaluación a los dos años / Application of a clinical pathway for the treatment of transient ischaemic attacks: implementation strategies and appraisal at two years

Introducción. El manejo de la patología vascular cerebral a través de vías clínicas permite rentabilizar los recursos, potenciar la calidad asistencial y obtener una mayor satisfacción del paciente. Objetivo. Valorar la eficacia de la aplicación de una vía clínica diseñada para la atención de los accidentes isquémicos transitorios (AIT), mediante la monitorización de una serie de indicadores que permitieran detectar los problemas existentes, introducir las oportunas correcciones y extraer conclusiones válidas para el futuro. Pacientes y métodos. A tal efecto, se confeccionó una vía clínica de forma consensuada entre los miembros de nuestro servicio y los diversos profesionales implicados en la atención a dichos pacientes. Se analizaron los datos de 1998 a 2001, previos a la implantación de la vía, y de los años 2002 y 2003, primeros del funcionamiento de ésta. Resultados. Un total de 1.433 pacientes ingresaron con el diagnóstico de AIT en este período, de los cuales, 554 lo hicieron en los años 2002 y 2003. De este grupo, en 123 casos se aplicó inicialmente la vía y la completaron 62. La estancia media se redujo de 9,2 días en 2000 a 5,7 días en 2003. La estancia media de los pacientes que cumplieron todos los requisitos de la vía fue de tan sólo 2,9 días. En cuanto a la encuesta de satisfacción, el 97% de los pacientes se mostraron satisfechos o muy satisfechos con la atención recibida. Conclusión. La aplicación de una vía clínica en el tratamiento de los AIT implicó un alto grado de satisfacción en los pacientes atendidos y un notable descenso de la estancia media

Introduction. Management of cerebral vascular pathologies by means of clinical pathways allows us to make cost effective use of resources, to enhance health care quality and to obtain a greater degree of satisfaction in patients. Aims. To assess the efficiency of applying a clinical pathway designed for the treatment of transient ischemic attacks (TIA) by monitoring a series of indicators that enable us to detect existing problems, to introduce any corrections that are needed and to draw conclusions that can be useful in the future. Patients and methods. To this end, a clinical pathway was drawn up with the general agreement of the members of our service and the different professionals involved in caring for these patients. Analyses were performed to study the data from 1998 to 2001, prior to implementation of the pathway, and from 2002 and 2003, which were the first years in which it was being applied. Altogether 1,433 patients with a diagnosis of TIA were hospitalised during this period, 554 of whom were admitted during the years 2002 and 2003. Results. Of this group, the pathway was initially applied in 123 cases and 62 completed it. The mean stay in hospital was reduced from 9.2 days in 2000 to 5.7 days in 2003. The mean stay of patients who fulfilled all the requirements of the pathway was only 2.9 days. As far as the survey on satisfaction is concerned, 97% of patients said they were satisfied or very satisfied with the care they had received. Conclusions. The application of a clinical pathway in the treatment of TIA resulted in a high degree of satisfaction among the patients who were treated and a notable reduction in the mean stay in hospital

[Sexual dysfunction management in multiple sclerosis]. / Abordaje de la disfunción sexual en la esclerosis múltiple.

INTRODUCTION: Sexual dysfunction is a frequent disorder associated to multiple sclerosis, that contributes to the worsening of life quality of these patients. AIM: To ascertain how it is managed in a demyelinating disease unit. PATIENTS AND METHODS: It was done an anonymous poll to multiple sclerosis patients in a demyelinating disease unit. The following variables were analysed: age, sex, marital status, education degree, sexual dysfunction, vesical dysfunction, gait disturbances and duration of illness. RESULTS: 67 of 97 patients answered. 74.6% females. Average age was 43.7 years. Average developing time was 11.3 years. 58% of the patients had vesical dysfunction. 43% had sexual dysfunction. There was relation with statistical significance between sexual and vesical dysfunction but not among the rest of variables. 63% of the patients with sexual dysfunction had never talked about this problem with their doctors. That the patient talked about sexual dysfunction was related with the fact that the neurologist asked for or not, and if sexual dysfunction was an important problem for the patient. The neurologist had asked for dysfunction sexual symptoms to 30% of the patients, and this was more frequent if the patient was male and if he or she had gait disturbances. CONCLUSIONS: Sexual dysfunction is a frequent and important problem for patients with multiple sclerosis. According to our results, this problem is raised up in an insufficient manner as much for patients as for neurologists.

Abordaje de la disfunción sexual en la esclerosis múltiple / Sexual dysfunction management in multiple sclerosis

Introducción. La disfunción sexual es un trastorno frecuente asociado a la esclerosis múltiple (EM) y contribuye al empeoramiento de la calidad de vida de estos pacientes. Objetivo. Valorar cómo se aborda este tema en una unidad de enfermedades desmielinizantes. Pacientes y métodos. Encuesta de respuesta anónima a pacientes con EM de una unidad de enfermedades desmielinizantes. Variables analizadas: edad, sexo, estado civil, nivel de escolarización, disfunción sexual, disfunción vesical, trastornos de la marcha y tiempo de evolución. Análisis bivariante y regresión logística. Resultados. Respondieron 67 de 97 pacientes. El 74,6% eran mujeres. Edad media: 43,7 años. Tiempo medio de evolución: 11,3 años. El 58% tenía disfunción vesical. La disfunción sexual estaba presente en el 43% de los pacientes. Observamos relación estadísticamente significativa entre la disfunción sexual y la disfunción vesical, pero no con el resto de las variables analizadas. El 63% de los pacientes con disfunción sexual no había comentado nunca este problema con el neurólogo. Las variables que se relacionan de forma independiente con que el paciente hable con el especialista de disfunción sexual son que se le interrogue a este respecto y que sea un problema importante en relación con su enfermedad. El neurólogo había preguntado por síntomas de disfunción sexual al 30% de los pacientes y el hecho de preguntar se relacionó con que el paciente fuera varón y con que tuviera trastornos en la marcha. Conclusión. La disfunción sexual es un problema frecuente e importante para los pacientes con EM. Según nuestros resultados, se aborda de manera insuficiente

Introduction. Sexual dysfunction is a frequent disorder associated to multiple sclerosis, that contributes to the worsening of life quality of these patients. Aim. To ascertain how it is managed in a demyelinating disease unit. Patients and methods. It was done an anonymous poll to multiple sclerosis patients in a demyelinating disease unit. The following variables were analysed: age, sex, marital status, education degree, sexual dysfunction, vesical dysfunction, gait disturbances and duration of illness. Results. 67 of 97 patients answered. 74.6% females. Average age was 43.7 years. Average developing time was 11.3 years. 58% of the patients had vesical dysfunction. 43% had sexual dysfunction. There was relation with statistical significance between sexual and vesical dysfunction but not among the rest of variables. 63% of the patients with sexual dysfunction had never talked about this problem with their doctors. That the patient talked about sexual dysfunction was related with the fact that the neurologist asked for or not, and if sexual dysfunction was an important problem for the patient. The neurologist had asked for dysfunction sexual symptoms to 30% of the patients, and this was more frequent if the patient was male and if he or she had gait disturbances. Conclusions. Sexual dysfunction is a frequent and important problem for patients with multiple sclerosis. According to our results, this problem is raised up in an insufficient manner as much for patients as for neurologists