Discontinuación y adherencia a largo plazo en la terapia con interferón beta en pacientes con esclerosis múltiple / Discontinuation and long-term adherence to beta interferon therapy in patients with multiple sclerosis

Objetivo Estudiar la frecuencia de discontinuación y el grado de adherencia en la primera línea de tratamiento con interferón beta (INFβ) en pacientes con esclerosis múltiple (EM), identificando sus causas y factores asociados. Método Estudio observacional retrospectivo que incluyó pacientes con EM clínicamente definida en tratamiento con INFβ durante el año 2001 en el área de pacientes externos de un servicio de farmacia hospitalaria. Se realizó un seguimiento desde el inicio del tratamiento hasta finales del año 2006. Las fuentes de datos utilizadas fueron la base de datos informatizada del área de pacientes externos, la historia clínica y los protocolos de solicitud de inicio y seguimiento de tratamiento para la EM. Se recopiló información sobre las características basales del paciente, tratamiento y continuidad del mismo. Resultados Se incluyeron 131 pacientes, a los que se les realizó un seguimiento medio de 7,4±2,6 años. El 64,1% fueron tratados con un solo fármaco durante todo el estudio. A los 2 años del inicio de la terapia con INFβ habían discontinuado la terapia el 9,9%, a los 5 años el 41,2% y a los 8 años y medio el 58,7%. Se mantenían más tiempo en tratamiento los hombres, pacientes con EM recurrente-remitente y tratados con INFβ1a-im, si bien solo fue significativo en los pacientes con 10 años o menos de evolución de la enfermedad al inicio del tratamiento. Las causas mayoritarias de discontinuación fueron la falta de efectividad (38,8%) y la aparición de efectos adversos (32,8%). Los pacientes adherentes discontinuaron menos el tratamiento (55,8 vs 75%).Conclusiones La continuidad a largo plazo en el tratamiento de la EM se ve reducida principalmente por la falta de efectividad y los efectos adversos. Una aproximación a la perspectiva del paciente puede ayudar a identificar aquellos con mayor riesgo de falta de adherencia para ayudar a optimizar la terapia(AU)

Objective To determine discontinuation rate and degree of adherence to first-line treatment with interferon-beta (INFβ) in patients with multiple sclerosis (MS), identifying causes and associated factors. Material and Method A retrospective observational study that included patients with MS treated with INFβ during 2001. The patients were followed-up from the beginning of treatment until the end of 2006. The data sources used were a computer database compiled in the outpatients’ area, medical records and application protocols for beginning and monitoring treatment for MS. Patient characteristics at baseline, treatment and continuity were included in the information collected. Results The study included 131 patients. Mean follow-up was 74±26 years. 641% of the patients were treated with only one drug during the study. At 2 years follow-up 99% of patients had discontinued INFβ therapy and at 5 years 412% had done so. Men, patients with relapsing-remitting MS and those treated with INFβ1a i.m. continued treatment for a longer period, but this was statistically significant only in patients with 10 years or less of disease progression at the beginning of therapy. Main causes of discontinuation were lack of efficacy (388%) and adverse effects (328%). Compliant patients presented lower discontinuation rates (558% vs. 75%).Conclusions treatment of MS patients with IFNβ is discontinued mainly due to lack of efficacy and adverse effects. Greater understanding of patients’ views can help to identify those at greatest risk of lack of adherence, thereby helping to improve treatment (AU)

[Discontinuation and long-term adherence to beta interferon therapy in patients with multiple sclerosis]. / Discontinuación y adherencia a largo plazo en la terapia con interferón beta en pacientes con esclerosis múltiple.

OBJECTIVE: To determine discontinuation rate and degree of adherence to first-line treatment with interferon-beta (INFß) in patients with multiple sclerosis (MS), identifying causes and associated factors. MATERIAL AND METHOD: A retrospective observational study that included patients with MS treated with INFß during 2001. The patients were followed-up from the beginning of treatment until the end of 2006. The data sources used were a computer database compiled in the outpatients' area, medical records and application protocols for beginning and monitoring treatment for MS. Patient characteristics at baseline, treatment and continuity were included in the information collected. RESULTS: The study included 131 patients. Mean follow-up was 74 ± 26 years. 641% of the patients were treated with only one drug during the study. At 2 years follow-up 99% of patients had discontinued INFß therapy and at 5 years 412% had done so. Men, patients with relapsing-remitting MS and those treated with INFß1a i.m. continued treatment for a longer period, but this was statistically significant only in patients with 10 years or less of disease progression at the beginning of therapy. Main causes of discontinuation were lack of efficacy (388%) and adverse effects (328%). Compliant patients presented lower discontinuation rates (558% vs. 75%). CONCLUSIONS: treatment of MS patients with IFNß is discontinued mainly due to lack of efficacy and adverse effects. Greater understanding of patients' views can help to identify those at greatest risk of lack of adherence, thereby helping to improve treatment.

[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

Importancia y factores relacionados con la fatiga crónica en la esclerosis múltiple / Importance and factors related to chronic fatigue in multiple sclerosis

Introducción. La importancia de la fatiga en la esclerosis múltiple (EM) viene determinada por la elevada frecuencia con la que aparece y por ser una causa importante de incapacidad. Objetivo. Conocer los factores relacionados con la presencia de fatiga crónica en una serie hospitalaria de pacientes con EM. Pacientes y métodos. Se incluyeron pacientes con EM atendidos de forma consecutiva en la unidad de enfermedades desmielinizantes de un hospital terciario que cumplían los siguientes criterios: EM clínicamente definida (RR o SP), duración de la EM superior a 2 años y ausencia de recaídas en el último mes. Se analizaron las siguientes variables: fatiga crónica, datos demográficos generales, sistemas funcionales, EDSS, ISS, ESS, actividad de la enfermedad, escala de depresión de Hamilton, GHQ-28, índice de calidad de sueño de Pittsburg y tratamiento con interferón. Se llevó a cabo estudio estadístico utilizando análisis bivariante y multivariante mediante regresión logística. Resultados. La serie comprende 100 pacientes (72 mujeres y 28 varones). La edad media fue 39,27 años. Un 88 % de los casos tenían una EM RR y un 12 % EM SP. El tiempo medio de evolución fue 11,2 años. El EDSS medio fue de 2,54. Un 53 % de los casos presentó fatiga crónica. Las únicas variables que se asociaron de forma estadísticamente significativa con la presencia de fatiga crónica fueron la depresión y la disfunción del sueño diurna, de forma que la presencia de depresión multiplica por 3,6 la probabilidad de fatiga crónica y cada punto de más en el PSQI-7 la multiplica por 3,5. Conclusión. La depresión y la disfunción del sueño diurna son las únicas variables que se relacionan de forma independiente con la fatiga crónica entre los pacientes con EM

Introduction. The importance of fatigue in multiple sclerosis (MS) is determined by its high frequency and it is an important cause of disability. Objective. To determine factors that are related to the presence of chronic fatigue in patients with MS. Patients and methods. The series comprises patients with MS, consecutively attended in the demyelinizating diseases unit, who met the following criteria: clinically definite MS (RR or SP), MS duration of more than two years, and no relapses during the previous month. Analyzed variables were as follows: chronic fatigue, demographic data, functional systems, EDSS, ISS, ESS, disease activity, Hamilton, depression scale GHQ-28, PSQI, and interferon. Statistical study: bivariate and multivariate analysis by logistic regression. Results. A hundred patients were inclued, 72 female and 28 male. Mean age was 39.27 years. Of the 100 patients 88 had RR disease and 12 SP disease. MS mean duration was 11.2 years. Mean EDSS 2.54. Chronic fatigue was 53 %. The presence of depression increased the probability of chronic fatigue 3.6 fold, and every point in PSQI-7 increases it 3.5 fold. Conclusion. Depression and the PSQI-7 subscale (day sleep dysfunction) are the only variables independently related to chronic fatigue in patients with MS

[Leukocytes and primary intracerebral hemorrhage]. / Leucocitos y hemorragia intracerebral primaria.

INTRODUCTION AND OBJECTIVE: The association between the leucocyte count and prognosis observed in ischemic cerebrovascular disease and subarachnoid hemorrhage has rarely been reported in primary intracerebral hemorrhage. The objective of our study is to assess the importance of the number of leukocytes in the peripheral blood during the first 24 hours for prognosis of mortality. PATIENTS AND METHODS: We made a prospective analysis of supratentorial primary intracerebral hemorrhages seen during the first 24 hours during the period 1987-1994. We evaluated the relationship between age, sex, size of hematoma, blood found in the ventricles, level of consciousness on admission, survival and prognosis after 30 days, level of glucaemia, arterial hypertension and leucocyte count. RESULTS: We considered 186 primary intracerebral hemorrhages (64% men and 36% women); the average age was 64 years (Standard Deviation: 10 years). There were 63% deep and 37% lobar hemorrhages. Thirty five percent of the patients died. Leucocytosis was associated with survival (p = 0.003), prognosis (p = 0.0005) and intraventricular bleeding (p = 0.03). We found a significant relationship between the size of the hematoma (r = 0.256; df = 186; p < 0.0001), level of glycaemia on admission (r = 0.282; df = 186; p < 0.0001), level of consciousness (r = -0.263; df = 186, p < 0.0001) and leukocyte count. CONCLUSIONS: The peripheral blood leucocyte count was significantly associated with prognosis and increased mortality. It may therefore be considered to be another parameter of bad prognosis in primary intracerebral hemorrhage.

[Ischemic stroke and auricular septal aneurysm: six cases]. / Ictus isquémico y aneurisma del septo auricular: estudio de seis casos.

INTRODUCTION: Aneurysms of the atrial septum (AAS) are uncommon. They have been considered to be related to embolic phenomena. They are usually associated with other cardiac anomalies, especially persistence of the formen ovale. PATIENTS AND METHODS: We studied six patients diagnosed during a period of 24 months as having ischemic ictus and AAS. They were investigated for vascular risk factors and possible causes of cardiac embolism by means of ECG, transthoracic and transoesophagic echography (ETE). Cases with the clinical characteristics of embolism were anticoagulated. RESULTS: Five patients were men with an average age of 47.6 years. Three had the clinical features of established ictus, one of RIND and two of AIT. Three patients had vascular risk factors. The TSA study showed pathology of the carotid arteries to be present in three patients. In all six cases the AAS was identified on ETE. There were no thrombi in the atria in any case, and in two there was left-right communication. In four patients the condition was considered to have a cardio-embolic origin. No patient has had further episodes of cerebral ischaemia. DISCUSSION: It seems there is a certain risk of cerebral embolus associated with AAS. The simultaneous presence of alterations in cardiac rhythm together with other structural cardiac pathology seems to have a synergic effect on this. Paradoxical embolism, arrhythmias and intra-aneurysmal thrombi appear to be the mechanisms involved in the appearance of emboli. The best therapeutic approach is still unknown. New studies are therefore necessary to establish whether or not it is necessary to anticoagulate these patients.

[Drug-induced parkinsonism. Clinical aspects compared with Parkinson disease]. / Parkinsonismo inducido por fármacos. Aspectos clínicos comparativos con la enfermedad de Parkinson.

INTRODUCTION: Drug-induced Parkinsonism (DIP) is the second commonest cause of Parkinson syndrome, after Parkinson disease (PD) and represents between 10% and 30% of all patients with Parkinsonism. OBJECTIVES: To study the frequency and drugs responsible for DIP and to compare some of the clinical characteristics of these patients and those with PD. PATIENTS AND METHODS: A retrospective community based study in Bajo Aragon district to determine the frequency of PD and other Parkinsonism, including DIP. PD was diagnosed on the criteria proposed by the United Kingdom Parkinson's Disease Society Brain Bank and DIP on the criteria of Jiménez et al. RESULTS: Calcium antagonists were the cause of 73% of the DIP, followed by neuroleptic drugs (11.5%). There were 73% women (19/26). The patients with DIP were older than those with PD when their symptoms started (p = 0.02). In patients with DIP, 48% presented with bilateral symptoms as compared with 7% in PD (p < 0.0001). CONCLUSIONS: 1. Cinarizine is the main drug responsible for DIP (58%) 2. As compared with patients with PD, patients with DIP are mainly women, older, more frequently have bilateral onset of symptoms and consult the doctor sooner.

[Comparative clinical study of patients with Parkinson disease and essential tremor]. / Estudio clínico comparativo entre pacientes con enfermedad de Parkinson y temblor esencial.

INTRODUCTION AND OBJECTIVE: Some studies have shown that essential tremor (ET) occurs more frequently in Parkinson disease (PD) patients and opposite, suggesting these disorders are pathogenically related. To evaluate this relationship, we have compared some clinical features between patients with ET and with PD. PATIENTS AND METHODS: PD patients (N = 134) and patients with ET (N = 46), were collected from Bajo Aragon district. A diagnosis of PD was taken according to the United Kingdom Parkinson's Disease Society Brain Bank criteria. A diagnosis of ET was confirmed on the basis of Rajput et al criteria. RESULTS: A statistically significant higher number of females with ET were founded (p < 0.05). An earlier mean age at tremor onset was observed in ET patients (p < 0.0001). More than half ET patients had a positive had a positive family history of ET (p < 0.0001). Interval period between tremor onset and first medical consulting was higher in ET patients (p < 0.01). Depression was more common in PD patients (p < 0.05). CONCLUSIONS: A statistically significant differences about mean age at tremor onset, duration of illness, positive family history of ET, one side or bilateral tremor onset and frequency of depression were observed between these two disorders. The differences found in clinical features and others described previously about necropsy findings and TEP with 18F-Dopa studies, don't support the possibility that PD and ET are pathogenically related.

[Thromboangiitis obliterans with cerebral involvement]. / Tromboangeítis obliterante con isquemia cerebral.

We report the case of a male with Buerger's disease and neurologic involvement. Cerebral arteriography showed multiple distal arterial obliterans with left-sided Moya-moya phenomena. Thromboangiitis obliterans is a chronic segmental occlusive disease affecting medium-sized and small arteries and veins throughout the body. Neurologic signs are rare, occurring in fewer than 2 % of cases, and most often found on the cortical surface and adjacent territories. We review the most common signs of this entity and its main diagnostic difficulties.