Multiple sclerosis following SARS-CoV-2 infection.

SARS-CoV-2 infection can produce neurological features. The most common are headache, anosmia and dysgeusia but patients may also develop other central nervous system (CNS) injuries. We present a patient affected by Covid-19 who initially consulted for decreased visual acuity. The MRI showed inflammation in the right optic nerve and demyelinating lesions in the CNS. We speculate that an immune mechanism induced by SARS-CoV-2, which can activate lymphocytes and an inflammatory response, plays a role in the clinical onset of the disease. This pathogen may be associated with either the triggering or the exacerbation of inflammatory/demyelinating disease.

¿Se ha producido un cambio en la etiología del ictus isquémico en las últimas décadas? Análisis y comparación de una base de datos de ictus actual frente a las históricas / Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases

OBJETIVOS: Comprobar si han existido variaciones en la etiología del ictus isquémico en los últimos años e investigar las posibles causas que lo justifiquen. PACIENTES Y MÉTODOS: Análisis de los antecedentes epidemiológicos y factores de riesgo vascular de los pacientes diagnosticados de ictus isquémico en el Complejo Hospitalario Universitario de Albacete (CHUA) entre 2009 y 2014. La clasificación etiológica del ictus isquémico se realizó según los criterios TOAST. Se compararon los resultados con los de la clásica Stroke Data Bank (SDB) y se contrastaron ambas series con otros registros hospitalarios publicados en el periodo que las separa. RESULTADOS: Se analiza a 1.664 pacientes, 58% varones, mediana de edad 74 años. Según la clasificación etiológica los resultados obtenidos son (CHUA/SDB): aterotrombóticos (12%/9%), lacunares (13%/25%), cardioembólicos (32%/19%), causa infrecuente (3%/4%) e indeterminados (40%/44%). El 63% de los pacientes del CHUA era mayor de 70 años, en la SDB solo el 42% superaba esa edad. En ambos registros el subtipo cardioembólico era más prevalente en mayores de 70 años. La HTA no tratada era más frecuente en la SDB (SDB = 31% vs. CHUA = 10%). El análisis de otras bases de datos muestra una tendencia progresiva a escala mundial al aumento en la prevalencia del ictus cardioembólico. CONCLUSIONES: Nuestro estudio muestra tanto en nuestro centro como a escala mundial una disminución del porcentaje de ictus lacunares y un aumento del de cardioembólicos respecto a la SDB. Estas diferencias pudieran justificarse por el envejecimiento de los pacientes, el mejor control de la HTA actualmente y mayor capacidad para detectar arritmias cardioembólicas en las Unidades de Ictus

OBJECTIVES: We aimed to determine whether the aetiology of ischaemic stroke has changed in recent years and, if so, to ascertain the possible reasons for these changes. PATIENTS AND METHODS: We analysed the epidemiological history and vascular risk factors of all patients diagnosed with ischaemic stroke at Complejo Hospitalario Universitario de Albacete (CHUA) from 2009 to 2014. Ischaemic stroke subtypes were established using the TOAST criteria. Our results were compared to data from the classic Stroke Data Bank (SDB); in addition, both series were compared to those of other hospital databases covering the period between the two. RESULTS: We analysed 1664 patients (58% were men) with a mean age of 74 years. Stroke aetiology in both series (CHUA, SDB) was as follows: atherosclerosis (12%, 9%), small-vessel occlusion (13%, 25%), cardioembolism (32%, 19%), stroke of other determined aetiology (3%, 4%), and stroke of undetermined aetiology (40%, 44%). Sixty-three percent of the patients from the CHUA and 42% of the patients from the SDB were older than 70 years. Cardioembolic strokes were more prevalent in patients older than 70 years in both series. Untreated hypertension was more frequent in the SDB (SDB = 31% vs CHUA = 10%). The analysis of other databases shows that the prevalence of cardioembolic stroke is increasing worldwide. CONCLUSIONS: Our data show that the prevalence of lacunar strokes is decreasing worldwide whereas cardioembolic strokes are increasingly more frequent in both our hospital and other series compared to the SDB. These differences may be explained by population ageing and the improvements in management of hypertension and detection of cardioembolic arrhythmias in stroke units

The UCP2-866G/A Polymorphism Could be Considered as a Genetic Marker of Different Functional Prognosis in Ischemic Stroke After Recanalization.

Recent studies based on experimental animal models of stroke have suggested that uncoupling protein 2 (UCP2), an inner mitochondrial membrane protein that is thought to regulate energy metabolism and reduce reactive oxygen species generation, provides protection against reperfusion damage. We aimed to investigate whether -866G/A polymorphism in the promoter of the UCP2 gene, which enhances its transcriptional activity, is associated with functional prognosis in patients with embolic ischemic stroke after early recanalization. We investigate a hospital-based prospective cohort of patients with acute ischemic stroke due to occlusion of the middle cerebral artery diagnosed by transcranial Doppler who obtained a partial/complete recanalization 24 h after administration of intravenous thrombolysis. The main end point of the study was functional independence defined as modified Rankin Scale 0-2 on day 90. A total of 80 patients were enrolled. The UCP2-866G/A polymorphism was determined by polymerase chain reaction-restriction fragment length polymorphism technique (14 genotype A/A (18%), 45 genotype A/G (56%) and 21 genotype G/G (26%). The percentage of patients with good functional outcome at 3 months was significantly higher in patients harboring the A/A genotype than in those with A/G or G/G genotypes (85 vs 41%, p = 0.01). The A/A genotype was found to be an independent marker of good prognosis after adjustment for secondary variables (age, sex, glucose level, NIHSS score at baseline, complete recanalization and early neurological improvement) in a logistic regression analysis (OR 0.05, 95% CI 0.01-0.48, p = 0.01). Our results suggest that the AA genotype of UCP2-866 may predict a better functional outcome in ischemic stroke after recanalization of proximal MCA occlusion.

Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases. / ¿Se ha producido un cambio en la etiología del ictus isquémico en las últimas décadas? Análisis y comparación de una base de datos de ictus actual frente a las históricas.

OBJECTIVES: We aimed to determine whether the aetiology of ischaemic stroke has changed in recent years and, if so, to ascertain the possible reasons for these changes. PATIENTS AND METHODS: We analysed the epidemiological history and vascular risk factors of all patients diagnosed with ischaemic stroke at Complejo Hospitalario Universitario de Albacete (CHUA) from 2009 to 2014. Ischaemic stroke subtypes were established using the TOAST criteria. Our results were compared to data from the classic Stroke Data Bank (SDB); in addition, both series were compared to those of other hospital databases covering the period between the two. RESULTS: We analysed 1664 patients (58% were men) with a mean age of 74 years. Stroke aetiology in both series (CHUA, SDB) was as follows: atherosclerosis (12%, 9%), small-vessel occlusion (13%, 25%), cardioembolism (32%, 19%), stroke of other determined aetiology (3%, 4%), and stroke of undetermined aetiology (40%, 44%). Sixty-three percent of the patients from the CHUA and 42% of the patients from the SDB were older than 70 years. Cardioembolic strokes were more prevalent in patients older than 70 years in both series. Untreated hypertension was more frequent in the SDB (SDB = 31% vs CHUA = 10%). The analysis of other databases shows that the prevalence of cardioembolic stroke is increasing worldwide. CONCLUSIONS: Our data show that the prevalence of lacunar strokes is decreasing worldwide whereas cardioembolic strokes are increasingly more frequent in both our hospital and other series compared to the SDB. These differences may be explained by population ageing and the improvements in management of hypertension and detection of cardioembolic arrhythmias in stroke units.

Estimulación cerebral profunda en la enfermedad de Parkinson / Deep brain stimulation in Parkinson's disease

Introducción. Desde su aparición en la década de los noventa, la estimulación cerebral profunda se ha impuesto como una alternativa terapéutica segura y eficaz en la enfermedad de Parkinson, estando indicada cuando aparecen complicaciones motoras incontrolables con el tratamiento farmacológico. Objetivo. Realizar una revisión actualizada de la literatura médica sobre los aspectos más importantes de esta cirugía funcional. Desarrollo. Aunque su mecanismo de acción a día de hoy continúa siendo desconocido, se ha postulado que ejerce una acción inhibitoria sobre la actividad de los núcleos subtalámico y globo pálido interno, que se encuentra exaltada en enfermos parkinsonianos. La técnica quirúrgica de elección es la estimulación del núcleo subtalámico. Ha demostrado tener unos resultados favorables tanto desde el punto de vista motor, con una mejoría significativa de los síntomas cardinales de la enfermedad, como en la calidad de vida de estos pacientes. El éxito de la cirugía depende de tres pasos fundamentales: 1) La adecuada selección del candidato quirúrgico, teniendo en cuenta las recomendaciones de los principales grupos de estudio sobre factores pronóstico como son la edad, el tiempo de evolución y la presencia de síntomas resistentes a la levodopa. 2) La correcta posición del electrodo en la diana quirúrgica. 3) La programación del sistema de estimulación. Conclusión. La estimulación cerebral profunda del núcleo subtalámico es una opción terapéutica claramente establecida en la enfermedad de Parkinson avanzada, cuyo desarrollo en los últimos años, ha favorecido la obtención de unos resultados clínicos favorables cuando el tratamiento farmacológico fracasa (AU)

Introduction. Since its appearance in the nineties, deep brain stimulation has proved itself to be a safe, effective therapeutic alternative in Parkinson's disease, and is indicated when there are motor complications that pharmacological treatment fails to control. Aims. The purpose of this work is to conduct an updated review of the medical literature on the most important aspects of this functional surgery. Development. Although today its mechanism of action remains unknown, it has been suggested that it exerts an inhibitory action on the activity of the subthalamic nuclei and internal globus pallidus, which is found to be overexcited in patients with parkinsonism. The preferred surgical technique is subthalamic nucleus stimulation. This procedure has proved to yield favourable results both from the motor point of view, with a significant improvement in the cardinal symptoms of the disease, and as regards these patients’ quality of life. The success of the surgical procedure depends on three fundamental steps: 1) Selection of a suitable candidate for surgery, taking into account the recommendations of the main study groups on prognostic factors, such as age, time to progression and the presence of symptoms that are resistant to levodopa; 2) The correct position of the electrode on the surgical target; 3) The programming of the stimulation system. Conclusions. Deep brain stimulation of the subthalamic nucleus is a clearly established therapeutic option in advanced Parkinson's disease. Recent developments allow favourable clinical outcomes to be obtained when pharmacological treatment fails (AU)

Miscelánea: parkinsonismo en otras enfermedades degenerativas / Miscellany: Parkinsonism in other degenerative diseases

Introducción. El parkinsonismo en otras enfermedades neurodegenerativas es un tema amplio y variado. Describiremos las características diferenciadoras de algunas entidades bien definidas (enfermedad de Huntington, enfermedad de Wilson), así como de otras más raras. Desarrollo. Existen gran cantidad de trastornos neurodegenerativos que cursan con parkinsonismo en algún momento de su evolución. Es necesario reconocer marcadores clínicos diferenciadores (edad de inicio, corea, hepatopatía, parálisis supranuclear de la mirada, respuesta a levodopa...), así como patrones de herencia y de neuroimagen que nos permitan reconocer cuadros clínicos definidos. Conclusiones. Todo cuadro de parkinsonismo debe estudiarse cuidadosamente. Debemos identificar aquellos cuadros con especial importancia por su frecuencia (enfermedad de Huntington) o por ser potencialmente curables (enfermedad de Wilson), en especial en todos los pacientes con un inicio juvenil. Otras entidades infrecuentes (hemiatrofia-hemiparkinson, síndrome pálido-piramidal, enfermedades por depósito, neuroacantocitosis, etc), también deben ser consideradas en el diagnóstico diferencial (AU)

Introduction. Parkinsonism in other neurodegenerative diseases is a broad and varied topic. We report the differentiating features of some well-defined conditions (Huntington's disease, Wilson's disease), as well as some other rarer ones. Development. There are many neurodegenerative disorders that are accompanied by parkinsonism at some point in their development. It is necessary to recognise differentiating clinical markers (age at onset, chorea, liver disease, supranuclear gaze palsy, response to levodopa, and so on) as well as inheritance and neuroimaging patterns that enable us to recognise defined clinical pictures. Conclusions. very clinical picture suggestive of parkinsonism must be studied carefully. We must identify those clinical patterns that are especially important due to their frequency (Huntington's disease) or because they are potentially curable (Wilson's disease), particularly in all patients with onset prior to adulthood. Other infrequent conditions (hemiatrophyhemiparkinsonism, pallidal-pyramidal syndrome, diseases due to deposits, neuroacanthocytosis, etc.) should also be taken into account in the differential diagnosis (AU)

Prevalencia y coste farmacológico de la enfermedad de Parkinson en España / The prevalence and pharmacological cost of Parkinson’s disease in Spain

Introducción. La enfermedad de Parkinson es la segundaenfermedad neurodegenerativa más frecuente. Objetivo. Analizar la dispensación de fármacos antiparkinsonianos en las diferentes comunidades autónomas españolas y estimar la prevalencia de la enfermedad en las mismas. Materiales y métodos. Se han estudiado las dispensaciones de antiparkinsonianos en España durante dos años (de octubre 1998 a septiembre de 2000), calculando lasdosis diarias definidas por mil habitantes y día (DHD). La DHD de levodopa ha permitido estimar la prevalencia de la enfermedad. El gasto se ha expresado en coste por mil habitantes y día (CHD) y en coste por tratamiento y día. Resultados. El fármaco más utilizado es levodopa, seguido de biperideno y selegilina. El coste total durante el período de estudio fue de 116.346.589,30 euros. El CHDse cifró en 4,14 euros. En el coste por tratamiento y día de los diferentes fármacos destaca el elevado coste de pramipexol y entacapona. La prevalencia de enfermedad de Parkinson en España se estima en 1,7‰; se observa una variabilidad geográfica importante, con cifras de prevalencia más altas en Castilla-León, Galicia y LaRioja, y cifras inferiores en Andalucía y Murcia. En cifras absolutas, el número de enfermos en España se puede estimar en 69.571 personas. Conclusión. Se encuentran diferencias en la utilización de fármacos antiparkinsonianos en las diferentes comunidades autónomas

Introduction. Parkinson’s disease is the second most frequent neurodegenerative disease. Aim. To analyze thedispensation of antiparkinsonian agents in Spain and to estimate the Parkinson’s disease prevalence. Materials and methods. Dispensation of antiparkinsonian agents were studied in Spain during two years (October 1998 to September 2000). Results were expressed in defined daily dosages per 1,000 inhabitants per day (DID). Levodopa’s DID was used to estimate the prevalence of the disease. The cost per 1,000 inhabitants per day (CID) and the daily treatment cost was also valued. Results. The most frequently used drugs are levodopa, biperiden and selegiline. The total cost reached values of 116,346,589.30 euros during the study period. The CID was 4,14 euros. It was very high the daily treatment cost of pramipexol and entacapone. The prevalence of Parkinson’s disease is considered in 1.7 per 1,000 inhabitants in Spain. There is an important geographical variability; regions as Castilla-Leon, Galicia and La Rioja have a higher prevalence than Andalucia or Murcia. The numberof patients in Spain can be considered in 69,571 people. Conclusion. There are some differences between the autonomous communities in the antiparkinsonian drugs’ utilization

[The prevalence and pharmacological cost of Parkinson's disease in Spain]. / Prevalencia y coste farmacológico de la enfermedad de Parkinson en España.

INTRODUCTION: Parkinson's disease is the second most frequent neurodegenerative disease. AIM: To analyze the dispensation of antiparkinsonian agents in Spain and to estimate the Parkinson's disease prevalence. MATERIALS AND METHODS: Dispensation of antiparkinsonian agents were studied in Spain during two years (October 1998 to September 2000). Results were expressed in defined daily dosages per 1,000 inhabitants per day (DID). Levodopa's DID was used to estimate the prevalence of the disease. The cost per 1,000 inhabitants per day (CID) and the daily treatment cost was also valued. RESULTS: The most frequently used drugs are levodopa, biperiden and selegiline. The total cost reached values of 116,346,589.30 euros during the study period. The CID was 4,14 euros. It was very high the daily treatment cost of pramipexol and entacapone. The prevalence of Parkinson's disease is considered in 1.7 per 1,000 inhabitants in Spain. There is an important geographical variability; regions as Castilla-Leon, Galicia and La Rioja have a higher prevalence than Andalucia or Murcia. The number of patients in Spain can be considered in 69,571 people. CONCLUSION: There are some differences between the autonomous communities in the antiparkinsonian drugs' utilization.