Cumplimiento de las guías de la Sociedad Española de Neurología en el tratamiento de los pacientes con esclerosis múltiple / Compliance of the guidelines of the Spanish Neurology Society in the treatment of patients with multiple sclerosis

Introducción. El tratamiento de la esclerosis múltiple se basa en la administración de fármacos modificadores de la enfermedad (FAME), utilizados para frenar el curso natural de la enfermedad. Objetivo. Evaluar el grado de cumplimiento de las guías terapéuticas de la Sociedad Española de Neurología (SEN) de 2010 por parte de los neurólogos. Pacientes y métodos. Estudio observacional, retrospectivo y multicéntrico de 218 pacientes adultos con esclerosis múltiple de al menos cinco años de evolución y en tratamiento con FAME. Los datos se obtuvieron de la historia clínica y se compararon con las recomendaciones de la SEN. Resultados. Según las guías de la SEN de 2010, el 82% de los pacientes presentaba respuesta clínica adecuada, y el 18%, respuesta clínica inadecuada al FAME actual; el 94% y 92%, respectivamente, mantuvieron ese tratamiento. Los pacientes en los que la respuesta clínica inadecuada no originó un cambio del FAME actual llevaban en tratamiento más tiempo y experimentaron con mayor frecuencia progresión de su discapacidad e incremento del número de brotes. El 48% de los pacientes inició tratamiento de primera línea con interferón beta-1a, administrado por vía subcutánea (29%) o intramuscular (19%), seguido de interferón beta-1b y acetato de glatiramero. Algunos pacientes recibieron tratamientos de segunda línea como segunda/tercera opción (15% y 28%, respectivamente), pero el uso de estos tratamientos (especialmente natalizumab) sólo se generalizó a partir de la cuarta línea de tratamiento. Conclusiones. De acuerdo con las guías de la SEN de 2010, la mayoría de los pacientes tuvo una respuesta clínica adecuada. Un elevado porcentaje de pacientes con respuesta clínica inadecuada continuó con el tratamiento actual (AU)

Introduction. Treatment of multiple sclerosis is based on the administration of the disease modifying drugs (DMD), used to slow the natural course of the disease. Aim. To assess the degree of compliance of Spanish neurologists with 2010 Spanish Neurology Society (SEN) treatment guidelines. Patients and methods. Observational, retrospective and multicenter study of 218 adult patients with at least five years of disease evolution and under treatment with DMD. Data on their past/current management was obtained from their medical records and descriptively compared to SEN recommendations. Results. According to SEN 2010 guidelines, 82% of patients had an adequate clinical response and 18% had an inadequate clinical response to their current DMD; 94% and 92%, respectively, maintained that treatment. Patients in which inadequate clinical response did not motivate a change in the current DMD more frequently had higher disability decline and higher number of relapses during previous treatments, and longer treatment duration with their current DMD. Regarding the sequence of DMDs used, 48% of patients initiated first-line treatment with interferon beta-1a administered through subcutaneous (29%) or intramuscular injections (19%), followed by interferon beta-1b, and glatiramer acetate. Some patients received second-line treatments as second/third option (15% and 28% respectively), but these treatments (mostly natalizumab) were only widespread from fourth treatment onwards. Conclusions. In accordance with SEN 2010 guidelines, the majority of patients from the study had an adequate clinical response. A high percentage of patients with an inadequate clinical response remained with their current treatment. An explanation to this phenomenon could be found in the chronic, complex and variable nature of multiple sclerosis (AU)

[Compliance of the guidelines of the Spanish Neurology Society in the treatment of patients with multiple sclerosis]. / Cumplimiento de las guías de la Sociedad Española de Neurología en el tratamiento de los pacientes con esclerosis multiple.

INTRODUCTION: Treatment of multiple sclerosis is based on the administration of the disease modifying drugs (DMD), used to slow the natural course of the disease. AIM: To assess the degree of compliance of Spanish neurologists with 2010 Spanish Neurology Society (SEN) treatment guidelines. PATIENTS AND METHODS: Observational, retrospective and multicenter study of 218 adult patients with at least five years of disease evolution and under treatment with DMD. Data on their past/current management was obtained from their medical records and descriptively compared to SEN recommendations. RESULTS: According to SEN 2010 guidelines, 82% of patients had an adequate clinical response and 18% had an inadequate clinical response to their current DMD; 94% and 92%, respectively, maintained that treatment. Patients in which inadequate clinical response did not motivate a change in the current DMD more frequently had higher disability decline and higher number of relapses during previous treatments, and longer treatment duration with their current DMD. Regarding the sequence of DMDs used, 48% of patients initiated first-line treatment with interferon beta-1a administered through subcutaneous (29%) or intramuscular injections (19%), followed by interferon beta-1b, and glatiramer acetate. Some patients received second-line treatments as second/third option (15% and 28% respectively), but these treatments (mostly natalizumab) were only widespread from fourth treatment onwards. CONCLUSIONS: In accordance with SEN 2010 guidelines, the majority of patients from the study had an adequate clinical response. A high percentage of patients with an inadequate clinical response remained with their current treatment. An explanation to this phenomenon could be found in the chronic, complex and variable nature of multiple sclerosis.

TITLE: Cumplimiento de las guias de la Sociedad Española de Neurologia en el tratamiento de los pacientes con esclerosis multiple.Introduccion. El tratamiento de la esclerosis multiple se basa en la administracion de farmacos modificadores de la enfermedad (FAME), utilizados para frenar el curso natural de la enfermedad. Objetivo. Evaluar el grado de cumplimiento de las guias terapeuticas de la Sociedad Española de Neurologia (SEN) de 2010 por parte de los neurologos. Pacientes y metodos. Estudio observacional, retrospectivo y multicentrico de 218 pacientes adultos con esclerosis multiple de al menos cinco años de evolucion y en tratamiento con FAME. Los datos se obtuvieron de la historia clinica y se compararon con las recomendaciones de la SEN. Resultados. Segun las guias de la SEN de 2010, el 82% de los pacientes presentaba respuesta clinica adecuada, y el 18%, respuesta clinica inadecuada al FAME actual; el 94% y 92%, respectivamente, mantuvieron ese tratamiento. Los pacientes en los que la respuesta clinica inadecuada no origino un cambio del FAME actual llevaban en tratamiento mas tiempo y experimentaron con mayor frecuencia progresion de su discapacidad e incremento del numero de brotes. El 48% de los pacientes inicio tratamiento de primera linea con interferon beta-1a, administrado por via subcutanea (29%) o intramuscular (19%), seguido de interferon beta-1b y acetato de glatiramero. Algunos pacientes recibieron tratamientos de segunda linea como segunda/tercera opcion (15% y 28%, respectivamente), pero el uso de estos tratamientos (especialmente natalizumab) solo se generalizo a partir de la cuarta linea de tratamiento. Conclusiones. De acuerdo con las guias de la SEN de 2010, la mayoria de los pacientes tuvo una respuesta clinica adecuada. Un elevado porcentaje de pacientes con respuesta clinica inadecuada continuo con el tratamiento actual.

Behavioural symptoms in patients with Alzheimer's disease and their association with cognitive impairment.

BACKGROUND: Behavioural and psychological symptoms of dementia (BPSD) are non-cognitive symptoms commonly associated to Alzheimer's disease (AD). The characterization of the clinical profile of AD patients might help to better understand disease evolution and to improve diagnosis and treatment. Thus, the aim of the present study is to describe the clinical profile of AD patients, and to correlate the presence of BPSD with the severity of the disease. METHODS: A cross-sectional, observational and multicenter study was conducted at 115 centres in Spain. Patients suffering from AD with higher and lower BPSD scores (ADAS-Noncog score 26-50 and ≤25, respectively) were included. Demographic and clinical data were collected, and dementia severity was assessed by the Mini Mental State Examination (MMSE) [mild 27-21, moderate 20-11, severe ≤10]. The use of ADAS-Noncog in clinical practice was also explored. RESULTS: A total of 1014 patients (463 with higher and 551 with lower BPSD scores) were included (mean age 77 ± 7 years, 65% women). Almost all patients (90%) had BPSD at inclusion, 17% of which reported psychotic outbreaks. The most prevalent symptoms were lack of concentration (56%), tremors (56%), depression (44%), lack of cooperation (36%), and delusions (32%). Patients with higher BPSD scores showed a significantly higher prevalence of psychotic symptoms (delusions, hallucinations, and delirium) and tremors, while emotional symptoms (tearfulness and apathy) predominated in patients with lower BPSD scores. MMSE and ADAS-Noncog scores were negatively associated (p = 0.0284), suggesting a correlation between cognitive impairment and BPSD. Lack of concentration and appetite change significantly correlated with MMSE (p = 0.0472 and p = 0.0346, respectively). Rivastigmine and donepezil were the first choice therapies in mild to moderate dementia. ADAS-Noncog was generally considered better or similar to other scales (82%), and 68% of the investigators were willing to use it in the future. CONCLUSIONS: Our study shows that patients with AD have a high prevalence of noncognitive symptoms, and that cognitive impairment and BPSD are correlated. Therefore, ADAS-Noncog is a useful evaluation tool.