Early beginning of alemtuzumab: Changing the multiple sclerosis treatment paradigm. Interim analysis of the LEMVIDA study.

INTRODUCTION: LEMVIDA is a real-world prospective study of 3-year follow-up on quality of life of patients with multiple sclerosis (MS) receiving alemtuzumab in Spain. METHODS: This is an interim analysis evaluating the baseline characteristics of patients who started alemtuzumab between October 2016-September 2018. For 3 additional subanalysis patients were categorised by baseline EDSS score; time of alemtuzumab initiation during the recruitment period (cohort 1: October 2016-March 2017, cohort 2: April-September 2017, cohort 3: October 2017-March 2018 and cohort 4: April-September 2018); and the presence of highly active MS criteria. RESULTS: 161 patients were analysed: 67.1% female, age 38.7 ± 9.4 years, MS duration 8.5 ± 6.0 years, EDSS 3.3 ± 1.7 and number of relapses in the previous 2 years 1.8 ± 1.3. 48.3% of patients presented gadolinium-enhanced (Gd+) lesions (mean: 5.2 ± 6.9) and 63.1% had received prior treatment with fingolimod or natalizumab. Baseline EDSS scores and number of Gd+ lesions were higher in cohort 1 than in cohort 4 (4.1 ± 1.8 vs 3.2 ± 1.7; P = .040 and 10.9 ± 11.9 vs 4.5 ± 5.7; P = .020). The frequency of prior treatment with fingolimod and natalizumab was lower in cohort 4 (60.6%) than in cohort 1 (70.6%) (comparison between groups not analysed). CONCLUSIONS: Unlike phase 3 studies of alemtuzumab, the patients included in LEMVIDA are older, have a longer duration of MS, higher disability and have received previous immunosuppressants. However, throughout the recruitment period, there is a tendency towards an early beginning of treatment with alemtuzumab, probably due to the evidence of higher effectiveness in the early stages of MS.

Incidence and prevalence of multiple sclerosis in China and other Asian countries.

The prevalence of multiple sclerosis (MS) in Asian countries is thought to be lower than in Western countries, with Asian populations presenting 80% less risk of MS than white populations. Incidence and prevalence rates in Asian countries are therefore not well defined and their association with rates in neighboring countries, as well as with ethnic, environmental, and socioeconomic factors, are not well understood. We performed a comprehensive literature review of epidemiological data from China and neighbouring countries to study the frequency of the disease, focusing on prevalence, and the progression over time and the influence of sex-related, environmental, dietary, and sociocultural factors. Prevalence rates in China range between 0.88 cases/100,000 population in 1986 and 5.2 cases/100,000 population in 2013, with a non-significant upwards trend (p = .08). The increase observed in Japan, where figures ranged between 8.1 and 18.6 cases/100,000 population was highly significant (p < .001). Prevalence rates in countries with predominantly white populations are considerably higher and have increased over time, reaching 115 cases/100,000 population in 2015 (r2 = 0.79, p < .0001). In conclusion, the prevalence of MS in China appears to have risen in recent years, although Asian populations (including Chinese and Japanese populations, among others) appear to present less risk than other populations. Within Asia, geographical latitude appears not to be a determining factor for developing MS.

Incidencia y prevalencia de la esclerosis múltiple en China y países asiáticos / Incidence and prevalence of multiple sclerosis in China and other Asian countries

La prevalencia de la esclerosis múltiple (EM) en los países asiáticos se considera que es más baja que en los países occidentales, las poblaciones asiáticas tienen un 80% menos de riesgo de EM que las caucásicas. No se conocen bien las cifras de incidencia, prevalencia y su relación con otros países de su entorno y su relación con factores étnicos, ambientales y socioeconómicos.Hemos realizado una revisión bibliográfica exhaustiva de los datos epidemiológicos existentes en China y países limítrofes, para estudiar la frecuencia de la enfermedad, centrándonos en la prevalencia, sus cambios evolutivos a lo largo del tiempo y su relación con factores de género, ambientales, alimenticios y socioculturales.La prevalencia en China oscila en cifras que van desde 0,88 en 1986 a 5,2 en 2013 por 100.000 habitantes con una tendencia a aumentar que no es estadísticamente significativa (p = 0,08), mientras que en Japón este incremento es muy significativo, con cifras que oscilan entre 8,1 y 18,6 (p < 0,001). La prevalencia en los países donde predomina la raza caucásica son mucho más elevadas y aumentan con el tiempo, llegando a 115 por 100.000 habitantes en 2015 (r2 = 0,79, p = 0,0001).En conclusión, la prevalencia de la EM en China parece está aumentando en los últimos años, aunque la raza amarilla (chinos y japoneses, entre otros) tienen menor riesgo de padecerla que el resto de las poblaciones. La latitud no parece ser un factor muy determinante en Asia para presentar un mayor riesgo de padecer EM. (AU)

The prevalence of multiple sclerosis (MS) in Asian countries is thought to be lower than in Western countries, with Asian populations presenting 80% less risk of MS than white populations. Incidence and prevalence rates in Asian countries are therefore not well defined and their association with rates in neighboring countries, as well as with ethnic, environmental, and socioeconomic factors, are not well understood.We performed a comprehensive literature review of epidemiological data from China and neighbouring countries to study the frequency of the disease, focusing on prevalence, and the progression over time and the influence of sex-related, environmental, dietary, and sociocultural factors.Prevalence rates in China range between 0.88 cases/100,000 population in 1986 and 5.2 cases/100,000 population in 2013, with a non-significant upwards trend (p = .08). The increase observed in Japan, where figures ranged between 8.1 and 18.6 cases/100,000 population was highly significant (p < .001). Prevalence rates in countries with predominantly white populations are considerably higher and have increased over time, reaching 115 cases/100,000 population in 2015 (r2 = 0.79, p < .0001).In conclusion, the prevalence of MS in China appears to have risen in recent years, although Asian populations (including Chinese and Japanese populations, among others) appear to present less risk than other populations. Within Asia, geographical latitude appears not to be a determining factor for developing MS. (AU)

Redes neurales atencionales en enfermedades neurodegenerativas: evidencias anatómico-funcionales empleando el Attention Network Test / Attentional networks in neurodegenerative diseases: anatomical and functional evidence from the Attention Network Test

Introducción: Comprender las alteraciones en la anatomía y función del cerebro en los procesos cognitivos para las enfermedades neurodegenerativas es aún un desafío para la neurociencia actual. Desde la neurociencia experimental algunos test computarizados han sido desarrollados para mejorar nuestro conocimiento de las redes neurales involucradas en la cognición. El Attention Network Test (ANT) permite medir la activad de las 3 redes atencionales (alerta, orientación y función ejecutiva).ObjetivosEl principal objetivo de esta revisión fue describir todas las alteraciones anatómicas y funcionales encontradas en diversas enfermedades neurológicas usando el ANT.Material y métodosUn protocolo de revisión fue aplicado seleccionando estudios desde 2010 en la base de datos PubMed, que involucraban al ATN en diferentes enfermedades neurológicas. Se obtuvieron 32 artículos para esclerosis múltiple, epilepsia o Parkinson entre otras enfermedades.ConclusionesSe confirman algunas de las estructuras anatómicas propuestas para el modelo de 3 grandes redes atencionales. Las estructuras más relevantes para la red de alerta son la corteza prefrontal, las regiones parietales, el tálamo y el cerebelo. El tálamo es también relevante para la red de orientación, junto a regiones parietales posteriores. Respecto a la red ejecutiva no depende exclusivamente de la corteza prefrontal y corteza cingulada anterior, sino también de estructuras subcorticales como los ganglios basales y el cerebelo y sus proyecciones hacia toda la corteza. (AU)

Introduction: Understanding alterations to brain anatomy and cognitive function associated with neurodegenerative diseases remains a challenge for neuroscience today. In experimental neuroscience, several computerised tests have been developed to contribute to our understanding of neural networks involved in cognition. The Attention Network Test (ANT) enables us to measure the activity of 3 attentional networks (alertness, orienting, and executive function).ObjectivesThe main aim of this review is to describe all the anatomical and functional alterations found in diverse neurological diseases using the ANT.Material and methodsWe collected studies published since 2010 in the PubMed database that employed the ANT in different neurological diseases. Thirty-two articles were obtained, addressing multiple sclerosis, epilepsy, and Parkinson's disease, among other disorders.ConclusionsSome of the anatomical structures proposed in the 3 attentional networks model were confirmed. The most relevant structures in the alertness network are the prefrontal cortex, parietal region, thalamus, and cerebellum. The thalamus is also relevant in the orienting network, together with posterior parietal regions. The executive network does not depend exclusively on the prefrontal cortex and anterior cingulate cortex, but also involves such subcortical structures as the basal ganglia and cerebellum and their projections towards the entire cortex. (AU)

Attentional networks in neurodegenerative diseases: anatomical and functional evidence from the Attention Network Test.

INTRODUCTION: Understanding alterations to brain anatomy and cognitive function associated with neurodegenerative diseases remains a challenge for neuroscience today. In experimental neuroscience, several computerised tests have been developed to contribute to our understanding of neural networks involved in cognition. The Attention Network Test (ANT) enables us to measure the activity of 3 attentional networks (alertness, orienting, and executive function). OBJECTIVES: The main aim of this review is to describe all the anatomical and functional alterations found in diverse neurological diseases using the ANT. MATERIAL AND METHODS: We collected studies published since 2010 in the PubMed database that employed the ANT in different neurological diseases. Thirty-two articles were obtained, addressing multiple sclerosis, epilepsy, and Parkinson's disease, among other disorders. CONCLUSIONS: Some of the anatomical structures proposed in the 3 attentional networks model were confirmed. The most relevant structures in the alertness network are the prefrontal cortex, parietal region, thalamus, and cerebellum. The thalamus is also relevant in the orienting network, together with posterior parietal regions. The executive network does not depend exclusively on the prefrontal cortex and anterior cingulate cortex, but also involves such subcortical structures as the basal ganglia and cerebellum and their projections towards the entire cortex.

Consensus statement on the use of alemtuzumab in daily clinical practice in Spain.

INTRODUCTION: Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis. OBJECTIVE: A consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain. DEVELOPMENT: A group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group. CONCLUSION: The present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice.

Consenso de expertos sobre el uso de alemtuzumab en la práctica clínica diaria en España / Consensus statement on the use of alemtuzumab in daily clinical practice in Spain

Introducción: Alemtuzumab es un fármaco de alta eficacia aprobado por la Agencia Europea de Medicamentos como tratamiento modificador de la enfermedad en pacientes con esclerosis múltiple remitente recurrente.ObjetivoElaborar un documento de consenso sobre el manejo de alemtuzumab en la práctica clínica habitual, que sea de aplicación en el ámbito español.DesarrolloUn grupo de expertos en esclerosis múltiple revisó las publicaciones disponibles hasta diciembre de 2017, de tratamiento con alemtuzumab y esclerosis múltiple. Se incluyeron trabajos sobre eficacia, efectividad y seguridad, despistaje de infecciones y vacunación, administración y monitorización. La propuesta inicial de recomendaciones fue desarrollada por un grupo coordinador con base en la evidencia disponible y en su experiencia clínica. El proceso de consenso se llevó a cabo en 2 etapas; se estableció como porcentaje inicial de acuerdo grupal el 80%. El documento final con todas las recomendaciones acordadas por el grupo de trabajo se sometió a revisión externa y los comentarios recibidos fueron considerados por el grupo coordinador.ConclusionesEl documento aportado pretende ser una herramienta útil para facilitar el manejo del fármaco en condiciones de práctica clínica habitual. (AU)

Introduction: Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis.ObjectiveA consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain.DevelopmentA group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group.ConclusionThe present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice. (AU)

Consensus statement on the use of alemtuzumab in daily clinical practice in Spain. / Consenso de expertos sobre el uso de alemtuzumab en la práctica clínica diaria en España.

INTRODUCTION: Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis. OBJECTIVE: A consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain. DEVELOPMENT: A group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group. CONCLUSION: The present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice.

Eficacia de la terapia con señales electromagnéticas pulsadas y transmitidas de manera dieléctrica monopolar en procesos dolorosos asociados a esclerosis múltiple. Estudio piloto / Effectiveness of monopolar dielectric transmission of pulsed electromagnetic fields for multiple sclerosis–related pain: A pilot study

Introducción: El dolor presenta elevadas tasas de prevalencia en la población con esclerosis múltiple (EM), siendo el 50% de carácter crónico y clasificándose en tipo nociceptivo, neuropático o mixto. Afecta a la calidad de vida, al sueño y a las actividades de la vida diaria. La electroterapia se presenta como una interesante alternativa o complemento en el abordaje del dolor en EM, presentando constantes innovaciones.Material y métodosEste estudio valora la eficacia de la terapia por señales electromagnéticas pulsadas y transmitidas de manera dieléctrica monopolar (SEDM) en procesos dolorosos asociados a EM mediante un ensayo clínico aleatorizado sobre 24 pacientes a los que se les medirá el dolor mediante Brief Pain Inventory, la calidad de vida con MusiQoL, la depresión con Beck y la fatiga mediante Modified Fatigue Impact Scale.ResultadosSe hallaron mejoras estadísticamente significativas en puntuaciones máximas y medias de dolor, así como en interferencia del dolor a nivel laboral, a nivel de relaciones personales, del sueño y el descanso. Las diferencias entre grupo de intervención y placebo no fueron significativas.ConclusionesEl tratamiento con SEDM podría ser efectivo para reducir el dolor en pacientes con EM, siendo necesarios más estudios para mostrar su efectividad respecto al placebo y diferenciar en qué tipología de dolor puede ser más eficaz. (AU)

Introduction: Pain is highly prevalent in patients with multiple sclerosis (MS); it is chronic in 50% of cases and is classified as nociceptive, neuropathic, or mixed-type. Pain affects quality of life, sleep, and the activities of daily living. Electrotherapy is an interesting alternative or complementary treatment in the management of pain in MS, with new innovations constantly appearing.Material and methodsThis study evaluates the effectiveness of treatment with monopolar dielectric transmission of pulsed electromagnetic fields (PEMF) for pain associated with MS. We performed a randomised, placebo-controlled clinical trial including 24 patients, who were assessed with the Brief Pain Inventory, the Multiple Sclerosis International Quality of Life questionnaire, the Beck Depression Inventory, and the Modified Fatigue Impact Scale.ResultsStatistically significant improvements were observed in maximum and mean pain scores, as well as in the impact of pain on work, personal relationships, and sleep and rest. Not significant differences were found between the treatment and placebo groups.ConclusionsTreatment with PEMF may be effective in reducing pain in patients with MS, although further research is necessary to confirm its effectiveness over placebo and to differentiate which type of pain may be more susceptible to this treatment. (AU)

Effectiveness of monopolar dielectric transmission of pulsed electromagnetic fields for multiple sclerosis-related pain: a pilot study.

INTRODUCTION: Pain is highly prevalent in patients with multiple sclerosis (MS); it is chronic in 50% of cases and is classified as nociceptive, neuropathic, or mixed-type. Pain affects quality of life, sleep, and the activities of daily living. Electrotherapy is an interesting alternative or complementary treatment in the management of pain in MS, with new innovations constantly appearing. MATERIAL AND METHODS: This study evaluates the effectiveness of treatment with monopolar dielectric transmission of pulsed electromagnetic fields (PEMF) for pain associated with MS. We performed a randomised, placebo-controlled clinical trial including 24 patients, who were assessed with the Brief Pain Inventory, the Multiple Sclerosis International Quality of Life questionnaire, the Beck Depression Inventory, and the Modified Fatigue Impact Scale. RESULTS: Statistically significant improvements were observed in maximum and mean pain scores, as well as in the impact of pain on work, personal relationships, and sleep and rest. Not significant differences were found between the treatment and placebo groups. CONCLUSIONS: Treatment with PEMF may be effective in reducing pain in patients with MS, although further research is necessary to confirm its effectiveness over placebo and to differentiate which type of pain may be more susceptible to this treatment.

Incidence and prevalence of multiple sclerosis in China and other Asian countries. / Incidencia y prevalencia de la esclerosis múltiple en China y países asiáticos.

The prevalence of multiple sclerosis (MS) in Asian countries is thought to be lower than in Western countries, with Asian populations presenting 80% less risk of MS than white populations. Incidence and prevalence rates in Asian countries are therefore not well defined and their association with rates in neighboring countries, as well as with ethnic, environmental, and socioeconomic factors, are not well understood. We performed a comprehensive literature review of epidemiological data from China and neighbouring countries to study the frequency of the disease, focusing on prevalence, and the progression over time and the influence of sex-related, environmental, dietary, and sociocultural factors. Prevalence rates in China range between 0.88 cases/100,000 population in 1986 and 5.2 cases/100,000 population in 2013, with a non-significant upwards trend (p = .08). The increase observed in Japan, where figures ranged between 8.1 and 18.6 cases/100,000 population was highly significant (p < .001). Prevalence rates in countries with predominantly white populations are considerably higher and have increased over time, reaching 115 cases/100,000 population in 2015 (r2 = 0.79, p < .0001). In conclusion, the prevalence of MS in China appears to have risen in recent years, although Asian populations (including Chinese and Japanese populations, among others) appear to present less risk than other populations. Within Asia, geographical latitude appears not to be a determining factor for developing MS.

Attentional networks in neurodegenerative diseases: anatomical and functional evidence from the Attention Network Test. / Redes neurales atencionales en enfermedades neurodegenerativas: evidencias anatómico-funcionales empleando el Attention Network Test.

INTRODUCTION: Understanding alterations to brain anatomy and cognitive function associated with neurodegenerative diseases remains a challenge for neuroscience today. In experimental neuroscience, several computerised tests have been developed to contribute to our understanding of neural networks involved in cognition. The Attention Network Test (ANT) enables us to measure the activity of 3 attentional networks (alertness, orienting, and executive function). OBJECTIVES: The main aim of this review is to describe all the anatomical and functional alterations found in diverse neurological diseases using the ANT. MATERIAL AND METHODS: We collected studies published since 2010 in the PubMed database that employed the ANT in different neurological diseases. Thirty-two articles were obtained, addressing multiple sclerosis, epilepsy, and Parkinson's disease, among other disorders. CONCLUSIONS: Some of the anatomical structures proposed in the 3 attentional networks model were confirmed. The most relevant structures in the alertness network are the prefrontal cortex, parietal region, thalamus, and cerebellum. The thalamus is also relevant in the orienting network, together with posterior parietal regions. The executive network does not depend exclusively on the prefrontal cortex and anterior cingulate cortex, but also involves such subcortical structures as the basal ganglia and cerebellum and their projections towards the entire cortex.

Free kappa light chains in cerebrospinal fluid as a biomarker to assess risk conversion to multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) initiates with a first attack or clinically isolated syndrome (CIS). The importance of an early treatment in MS leads to the search, as soon as possible, for novel biomarkers which can predict conversion from CIS to MS. OBJECTIVE: The purpose of this study was to assess the predictive value of the kappa index ([Formula: see text] index), using kappa free light light chains ([Formula: see text]FLCs) in cerebrospinal fluid (CSF), for the conversion of CIS patients to MS, and compare its accuracy with other parameters used in clinical practice. METHODS: FLC levels were analysed in CSF from 176 patients: 70 as control group, 77 CIS, and 29 relapsing-remitting MS. FLC levels were quantified by nephelometry. RESULTS: [Formula: see text] Index sensitivity and specificity (93.1%; 95.7%) was higher than those from the immunoglobulin G (IgG) index (75.9%; 94.3%), and lower than those from oligoclonal IgG bands (OCGBs) (96.5%; 98.6%). The optimal cut-off for [Formula: see text] index was 10.62. Most of the CIS patients with [Formula: see text] index >10.62 presented OCGBs, IgG index >0.56 and fulfilled magnetic resonance imaging (MRI) criteria. CONCLUSION: CIS patients above [Formula: see text] index cut-off of 10.62 present 7.34-fold risk of conversion to MS than CIS below this value. The [Formula: see text] index correlated with positive OCGBs, IgG index above 0.56 and MRI criteria.

El diagnóstico precoz de esclerosis múltiple en urgencias: una necesidad con importantes implicaciones terapéuticas / Early diagnosis of multiple sclerosis in the emergency department: necessary for its important therapeutic implications

Numerosos estudios internacionales han concluido que los pacientes que inician el tratamiento para la esclerosis múltiple (EM) en las fases tempranas de la enfermedad experimentan una notable reducción en el número e intensidad de los brotes y, como consecuencia, tienen mayor probabilidad de permanecer durante más tiempo activos e independientes. Así pues, podemos afirmar que la detección precoz de la EM puede resultar el método más efectivo para combatir esta enfermedad degenerativa, que actualmente afecta en España a unas 40.000 personas. La primera fuente de diagnóstico de estos pacientes es el servicio de urgencias de los hospitales y representa casi un tercio de los diagnosticados de EM. En este contexto, los urgenciólogos cobran especial relevancia y deben ser capaces de sospechar que un paciente sin clínica previa neurológica puede presentar un primer brote de EM. En esta revisión se muestran las claves para poder detectar a estos enfermos lo antes posible, para evitar así demoras que puedan causar una pérdida de los efectos beneficiosos de los tratamientos actualmente disponibles (AU)

Numerous international studies have shown that patients who start treatment for multiple sclerosis (MS) early havemarkedly fewer outbreaks and the episodes are less intense. Consequently, they are likely to stay active and independentlonger. We might say that early detection of MS is the most effective way to fight this degenerative disease, which presently affects some 40 000 persons in Spain. Hospital emergency departments are often the first place MS is recognized, and nearly a third of all MS diagnoses are made there. Emergency physicians therefore play an importantrole and should be able to suspect the debut of this disease in patients without a prior history of neurological symptoms. This review discusses the keys for identifying MS as early as possible to avoid delays that may diminish the effectiveness of currently available treatments (AU)

Ictus isquémico talámico: una etiología infrecuente del síndrome de sobresalto / Thalamic ischaemic stroke: an uncommon aetiology of “startle syndrome”

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[Spinal metastatic tumor in a patient with tuberous sclerosis complex]. / Tumoración intrarraquídea metastásica en paciente con esclerosis tuberosa.

Most of the cauda equina tumors are primary tumors and metastases (especially from some tumors like renal carcinoma [RC]) are very unusual. We report a 28-yearold- man with tuberous sclerosis complex (TSC) who had undergone a left nephrectomy one year before for the treatment of RC. He presented with a 2-3 month history of lower back pain that radiated to both legs and weakness in lower limbs. He denied bowel and bladder symptoms. A magnetic resonance scan of the dorsolumbar spine revealed an intradural extramedullary cauda equina mass that demonstrated uniform homogeneous enhancement, which was a metastasis. Therapeutical and diagnostic aspects are discussed. We review the previous literature on this topic.

[Cost-utility analisys of multiple sclerosis treatment with glatiramer acetate or interferon beta in Spain]. / Análisis coste utilidad del tratamiento de la esclerosis múltiple remitente-recidivante con acetato de glatiramero o interferón beta en España.

OBJECTIVE: To carry out a cost-utility analysis of the treatment of relapsing-remitting multiple sclerosis (RRMS) with glatiramer acetate (copaxone) or interferon beta (all, avonex, rebif and betaferon). METHODS: A pharmacoeconomic Markov model was used to compare treatment options by simulating the life of a hypothetical cohort of women aged 30, from the societal perspective. The transition probabilities, utilities, resource utilisation and costs (direct and indirect) were obtained from Spanish sources and from bibliography. Univariant sensitivity analyses of the base case were performed. RESULTS: In the base case analysis, the average cost per patient (euro in 2001) for a lifetime treatment, considering a life expectancy of 53 years, would be 1,243,906 euros (euro), 1,818,149 euros, 1,763,263 euros, 1,987,153 euros and 1,704,031 euros with copaxone, all interferons, avonex, rebif and betaferon, respectively. Therefore, the saving with copaxone would range between 460,000 and 737,000 euros approximately. The quality-adjusted life years (QALY) obtained with copaxone or interferons would be 10.977 and 6.917, respectively, with an average gain of 4.060 QALY patient with copaxone. The sensitivity analyses confirmed the robustness of the base case. The interferons would only be superior to copaxone in the unlikely hypothetical case that they delay the progression of the illness by 20% more than that actually observed in clinical trials. CONCLUSIONS: For a typical patient with RRMS, treatment with copaxone would be more efficient than interferons and would dominate (would be more efficacious with lower costs) interferon beta.

Tumoración intrarraquídea metastásica en paciente con esclerosis tuberosa / Spinal metastatic tumor in a patient with tuberous sclerosis complex

La mayoría de los tumores de la cola de caballo son primarios, siendo excepcionales las metástasis, especialmente de algunos tumores como el carcinoma renal. Se presenta el caso de un varón de 28 años diagnosticado de esclerosis tuberosa, al que 1 año antes se le practica nefrectomía izquierda por carcinoma renal. Consulta por cuadro de dolor lumbar irradiado a miembros inferiores junto con debilidad en dichos miembros sin alteraciones esfinterianas, de 2-3 meses de evolución. Se realiza una resonancia magnética de columna dorsolumbar que detecta tumoración intradural extramedular en la cola de caballo con captación homogénea de contraste, que resultó ser metastásica. Se discuten aspectos diagnósticos y terapeúticos, y se realiza una revisión de la literatura (AU)

Análisis coste-utilidad del tratamiento de la esclerosis múltiple remitente-recidivante con acetato de glatiramero o interferón beta en España / Cost-utility analysis of multiple sclerosis treatment with glatiramer acetate or interferon beta in Spain

Objetivo: Realizar un análisis coste-utilidad del tratamiento de la esclerosis múltiple remitente-recidivante (EMRR) con acetato de glatiramero (copaxone) o los interferones beta (todos en conjunto, avonex, rebif y betaferón).Métodos: Modelo farmacoeconómico de Markov que comparó los tratamientos mediante la simulación de la vida de una cohorte hipotética de mujeres de 30 años de edad, desde la perspectiva de la sociedad. Las probabilidades de transición, las utilidades, la utilización de recursos y los costes (directos e indirectos), se estimaron a partir de fuentes españolas y de la bibliografía. Se hicieron análisis de sensibilidad simples univariantes del caso básico.Resultados: En el caso básico del análisis, el coste medio por paciente ( de 2001) de un tratamiento de por vida, considerando una esperanza vida de 53 años, sería de 1.243.906 euros €, 1.818.149 € , 1.763.263 €, 1.987.153 € y 1.704.031€ con copaxone, todos los interferones, avonex, rebif y betaferón, respectivamente. Por tanto, el ahorro con copaxone oscilaría entre 460.000 y 737.000 € aproximadamente. Los años de vida ajustados por calidad (AVAC) que se obtendrían con copaxone o los interferones serían 10,977 y 6,917, respectivamente, con una ganancia media de 4,060 AVAC/paciente con copaxone. Los análisis de sensibilidad confirmaron la robustez del caso básico.Los interferones serían superiores a copaxone únicamente en el caso hipotético e improbable de que éstos produjeran retrasos en la progresión de la enfermedad un 20 por ciento mayores que los realmente observados en los ensayos clínicos.Conclusiones: Para un paciente tipo con EMRR, el tratamiento con copaxone sería más eficiente que los interferones, a los que dominaría (copaxone sería más eficaz con costes inferiores a los de éstos) (AU)