Alteraciones inmunológicas en pacientes epilépticos asociadas a la localización del foco epileptogénico / Immunological disorders in epileptic patients linked to the localisation of the epileptogenic focus

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[Evolution of the demand for ambulatory neurological care and pathologies attended in neurology clinics in the health care district of Tortosa, Tarragona]. / Evolución de la demanda de asistencia neurológica ambulatoria y patología atendida en la consulta de neurología de la región sanitaria de Tortosa, Tarragona.

AIMS: An analysis was conducted to determine whether there were any changes in the demand for health care, demography and pathologies attended in outpatient departments within the health care district of Tortosa between 1997 and 2003. PATIENTS AND METHODS: Data about the demand for and attendance at first neurology visits over the period 1997 and from March 2003 to February 2004 was collected prospectively. Information concerning age, sex, groups of pathologies, diagnoses, rates of requests for first visits, source of the demand and destination after the visit were compared. RESULTS: Mean age rose from 49 to 56 years (p < 0.001). Patients above 70 years of age increased from 23.7% to 35.9% (p < 0.001), while in the population within the area the figure only rose from 15.8 to 17.1%. The proportion of females went up from 52 to 62% (p < 0.001). Demand (that is, the rate of requests for first visits per 1000 inhabitants per year among those over the age of 15) rose from 8.5 to 9.3, 9.8% (p = 0.03). Demand from primary care increased from 52 to 69% (p < 0.001). Cognitive disorders (6.5% and 15.9%) grew by 144.6% (p < 0.001). Headaches (23.9% and 24.1%), the largest diagnostic group, and non-neurological diagnoses (18% and 18.5%) remained unchanged (p = NS). No changes were observed in the number of discharges in the first visit: 22.8% and 21.1% (p = NS). CONCLUSIONS: The most striking results are the increase in demand (mainly from primary care), the increased age of the population attended and the notable growth in the number of cognitive disorders. These quantitative and qualitative changes in the demand increase the need for resources.

Evolución de la demanda de asistencia neurológica ambulatoria y patología atendida en la consulta de neurología de la región sanitaria de Tortosa, Tarragona / Evolution of the demand for ambulatory neurological care and pathologies attended in neurology clinics in the health care district of Tortosa, Tarragona

Objetivos. Se analiza si existen cambios en la demanda de asistencia, demografía y patología atendida en las consultas externas de neurología de la región sanitaria de Tortosa entre 1997 y 2003. Pacientes y métodos. Se recogieron prospectivamente los datos de la demanda y asistencia de las primeras visitas de neurología los períodos de 1997 y marzo del 2003 a febrero de 2004. Se compararon edad, sexo, grupos de patologías, diagnósticos, índices de solicitud de primera visita, origen de la demanda y destino tras la visita. Resultados. La edad media creció de 49 a 56 años (p < 0,001). Los pacientes mayores de 70 años aumentaron del 23,7% al 35,9% (p < 0,001), mientras en la población del área sólo del 15,8 al 17,1%. La proporción de mujeres pasó del 52 al 62% (p < 0,001). La demanda (índice de solicitudes de primeras visitas/1.000 habitantes y año mayores de 15 años) creció del 8,5 al 9,3, un 9,8% (p = 0,03). La demanda desde atención primaria creció del 52 al 69% (p < 0,001). Los trastornos cognitivos (6,5% y 15,9%) crecieron un 144,6% (p < 0,001). Las cefaleas (23,9% y 24,1%), el mayor grupo diagnóstico, y los diagnósticos no neurológicos (18% y 18,5%) se mantienen (p = NS). Las altas en primera visita no cambian, 22,8% y 21,1% (p = NS). Conclusiones. Destaca el aumento de la demanda, fundamentalmente desde atención primaria, el aumento de edad de la población atendida y el marcado incremento de los trastornos cognitivos. Estos cambios cuantitativos y cualitativos de la demanda incrementan las necesidades de recursos (AU)

Aims. An analysis was conducted to determine whether there were any changes in the demand for health care, demography and pathologies attended in outpatient departments within the health care district of Tortosa between 1997 and 2003. Patients and methods. Data about the demand for and attendance at first neurology visits over the period 1997 and from March 2003 to February 2004 was collected prospectively. Information concerning age, sex, groups of pathologies, diagnoses, rates of requests for first visits, source of the demand and destination after the visit were compared. Results. Mean age rose from 49 to 56 years (p < 0.001). Patients above 70 years of age increased from 23.7% to 35.9% (p < 0.001), while in the population within the area the figure only rose from 15.8 to 17.1%. The proportion of females went up from 52 to 62% (p < 0.001). Demand (that is, the rate of requests for first visits per 1000 inhabitants per year among those over the age of 15) rose from 8.5 to 9.3, 9.8% (p = 0,03). Demand from primary care increased from 52 to 69% (p < 0.001). Cognitive disorders (6.5% and 15.9%) grew by 144.6% (p < 0.001). Headaches (23.9% and 24.1%), the largest diagnostic group, and non-neurological diagnoses (18% and 18.5%) remained unchanged (p = NS). No changes were observed in the number of discharges in the first visit: 22.8% and 21.1% (p = NS). Conclusions. The most striking results are the increase in demand (mainly from primary care), the increased age of the population attended and the notable growth in the number of cognitive disorders. These quantitative and qualitative changes in the demand increase the need for resources (AU)

[Meningeal carcinomatosis]. / Carcinomatosis meníngea.

INTRODUCTION: Meningeal carcinomatosis is a serious complication of solid tumors, particularly adenocarcinomas of breast, lung and melanoma. OBJECTIVE: In this paper we present a review of the bibliography on this disease, with particular emphasis on etiopathogenic, clinical--especially otoneurophthalmological--diagnostic and therapeutic aspects. DEVELOPMENT: Meningeal carcinomatosis presents in advanced stages of cancer and has an ominous prognosis with average untreated survival of from four to six weeks. Its frequency has increased in recent years since patients with systemic cancer now live longer. The characteristic of the disease is involvement of various levels of the nervous system, including encephalic, cranial or spinal nerve and spinal symptoms. Sudden loss of vision or hearing which may progress rapidly may be the initial sign of the disease. Neuroimaging studies (computerized axial tomography, magnetic resonance and isotope studies of cerebrospinal fluid flow) are necessary to evaluate associated metastases and detect obstruction of cerebrospinal fluid flow. Positive cerebrospinal fluid cytological findings confirm the diagnosis. Treatment should be tailored to the individual according to the clinical condition and nature of the tumour and should combine intrathecal chemotherapy and local radiotherapy, although recent studies have shown good results with systemic chemotherapy. CONCLUSION: A high degree of clinical suspicion is necessary for diagnosis of this uncommon disease, with neurological signs show to be present at different levels and the finding of malignant cells in the cerebrospinal fluid for confirmation of the diagnosis.