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Asociación entre el déficit de vitamina D y los potenciales evocados visuales en la esclerosis múltiple / Relationship between vitamin D deficiency and visually evoked potentials in multiple sclerosis

OBJETIVO: Evaluar la posible relación entre los niveles séricos de 25-OH-vitamina D y los potenciales evocados visuales (PEV) de los pacientes con esclerosis múltiple (EM) residentes en la zona sur de Gran Canaria. MATERIAL Y MÉTODOS: Se incluyó a 49 pacientes con EM. Se les realizó determinación de 25-OH-vitamina D, PEV, exploración neurológica para determinar la discapacidad y se recogieron variables clínicas tales como el antecedente de neuritis óptica. RESULTADOS: El valor medio de 25-OH-vitamina D de los pacientes fue de 28,1 ± 9,5 ng/ml, la latencia de los PEV fue de 119,1 ± 23,2 ms y la amplitud de 8,5 ± 4,4 μV. Los pacientes con niveles normales de 25-OH-vitamina D tuvieron mayor número de brotes en el año previo al estudio (p = 0,049) y aquellos con déficit de vitamina D y neuritis óptica previa no presentaron reducción de la amplitud de los PEV (p = 0,006). CONCLUSIÓN: Los pacientes con déficit de vitamina D tienen menor actividad clínica de la EM y no presentan afectación axonal en PEV tras haber sufrido neuritis óptica. Estas asociaciones, aunque estadísticamente significativas, no parecen clínicamente plausibles, por lo que sería preciso realizar nuevos estudios que intentasen confirmar esta posible asociación

OBJECTIVE: To evaluate the possible relationship between serum 25-OH vitamin D levels and visually evoked potentials (VEP) in patients with multiple sclerosis (MS), residents in the south zone of Gran Canaria. MATERIAL AND METHODS: The study included 49 patients with MS, on whom 25-OH-vitamin D was determined, along with VEP, and a neurological examination to determine incapacity. Clinical variables, such as a history of optic neuritis were recorded. RESULTS: The mean value of 25-OH-vitamin D of the patients was 28.1 ± 9.5 ng/ml. The VEP latency was 119.1 ± 23.2 ms and the amplitude, 8.5 ± 4.4 μV. Patients with a higher 25-OH-vitamin D had a greater number of outbreaks in the year prior to the study (P=.049), and those with vitamin D deficiency and previous optic neuritis showed no reduction in the amplitude of the VEP (P=.006). CONCLUSION: Patients with vitamin D deficiency have lower clinical activity of the MS and show no axonal involvement in VEP after having suffered optic neuritis. These relationships, although statistically significant, do not seem clinically plausible, thus new studies are needed to try and confirm this possible relationship

Relationship between vitamin D deficiency and visually evoked potentials in multiple sclerosis. / Asociación entre el déficit de vitamina D y los potenciales evocados visuales en la esclerosis múltiple.

OBJECTIVE: To evaluate the possible relationship between serum 25-OH vitamin D levels and visually evoked potentials (VEP) in patients with multiple sclerosis (MS), residents in the south zone of Gran Canaria. MATERIAL AND METHODS: The study included 49 patients with MS, on whom 25-OH-vitamin D was determined, along with VEP, and a neurological examination to determine incapacity. Clinical variables, such as a history of optic neuritis were recorded. RESULTS: The mean value of 25-OH-vitamin D of the patients was 28.1±9.5ng/ml. The VEP latency was 119.1±23.2ms and the amplitude, 8.5±4.4 µV. Patients with a higher 25-OH-vitamin D had a greater number of outbreaks in the year prior to the study (P=.049), and those with vitamin D deficiency and previous optic neuritis showed no reduction in the amplitude of the VEP (P=.006). CONCLUSION: Patients with vitamin D deficiency have lower clinical activity of the MS and show no axonal involvement in VEP after having suffered optic neuritis. These relationships, although statistically significant, do not seem clinically plausible, thus new studies are needed to try and confirm this possible relationship.

Midriasis benigna episódica. Experiencia en una consulta monográfica de neuro-oftalmología de un hospital terciario / Benign episodic mydriasis. Experience in a specialist neuro-ophthalmology clinic of a tertiary hospital

Introducción: Las anisocorias son un motivo de consulta relativamente frecuente en unidades de neuro-oftalmología (UNO). Suponen un reto diagnóstico por la variedad de procesos que pueden ocasionarla. En ausencia de síntomas acompañantes, suelen estar ocasionadas por procesos benignos. La midriasis benigna episódica (MBE) es una causa aislada de asimetría pupilar intermitente, de fisiopatología no esclarecida y predominio en mujeres jóvenes migrañosas. Sujetos, material y métodos: Describimos las características epidemiológicas y clínicas de los pacientes con MBE valorados en una UNO de un hospital terciario. Resultados: Un total de 7 pacientes fueron diagnosticadas de MBE. Todas eran mujeres, con edad media de 33 ± 10 años. Los motivos de consulta fueron asimetría pupilar (n = 5) y visión borrosa (n = 2) de presentación fundamentalmente unilateral (n = 6). La duración fue variable, desde minutos hasta 48 h. Cuatro pacientes (57%) presentaban como antecedente migraña sin aura. En estas, los episodios eran recidivantes (75%), de minutos de duración (75%) y asociaban visión borrosa (50%). Los estudios de neuroimagen (resonancia magnética cerebral) fueron normales. Discusión: La midriasis benigna episódica se presenta predominantemente en mujeres jóvenes. Se asocia al antecedente de migraña y hace plantear si se trata de un síntoma acompañante de la migraña, un aura migrañosa o de migraña oftalmopléjica. De predominio unilateral, puede sin embargo existir alternancia del ojo afectado o ser bilateral de forma simultánea, lo que nos hace cuestionarnos la idoneidad del término. En ausencia de síntomas acompañantes y en episodios de corta duración, no consideramos necesaria la realización de pruebas de imagen

Introduction: Anisocorias are a relatively frequent reason for consultation in neuro-ophthalmology units. They remain a diagnostic challenge for specialists as they may be due to several etiological factors. In the absence of other accompanying symptoms, anisocorias are usually due to benign processes. Benign episodic mydriasis (BEM) is an isolated cause of intermittent pupil asymmetry, in which the pathophysiology is still not fully understood, and is predominant in young women with migraine. Subjects, material and methods: We describe the epidemiological and clinical characteristics of patients with BEM, assessed in a neuro-ophthalmology unit in a tertiary hospital. Results: A total of 7 patients were diagnosed with BEM, all of them females, with a mean age of 33 ± 10 yrs. The patients presented with pupil asymmetry (n = 5) and blurred vision (n = 2), and 6 of the 7 patients had unilateral involvement. The duration of impairment varied from a few minutes to 48 hrs. Four patients (57%) had a clinical history of migraine without aura. The episodes in these 4 patients were recurrent (75%), often lasted for a few minutes (75%), and had associated blurred vision (50%). The neuroimaging studies were normal. Discussion: BEM appears predominantly in young women. It is frequently related to a previous history of migraine, and the specialist must consider if it is a concomitant symptom of common migraine, migraine with aura, or ophthalmoplegic migraine. Although BEM has unilateral predominance, there may be alternation of the affected eye or even bilateral impairment during the same episode, which makes us question the adequacy of the term to describe the process. Imaging tests are not recommended in the absence of other accompanying symptoms, or in short-term episodes

Vitamina D y esclerosis múltiple. Prevalencia de hipovitaminosis D / Vitamin D and multiple sclerosis. Prevalence of hypovitaminosis D

La esclerosis múltiple (EM) es una enfermedad crónica, inflamatoria y autoinmune del sistema nervioso central de etiología desconocida. Determinados factores ambientales, como la vitamina D, pueden influir en su patogénesis, aunque no está claro cuál es el umbral óptimo de vitamina D necesario para maximizar sus beneficios extraóseos. En el presente artículo se revisan de forma no sistemática los estudios que relacionan vitamina D y EM a lo largo del mundo. De forma global, no existen diferencias significativas entre casos de EM y controles. En las series de casos, se aprecia hipovitaminosis D en pacientes con EM respecto a los valores que se consideran normales, observación que también se puede dar en individuos sanos. Para poder precisar el alcance de la asociación entre vitamina D y EM serán necesarios nuevos estudios prospectivos (AU)

Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system whose etiology is unknown. Certain environmental factors, such as vitamin D, may have an influence on its pathogenesis, although the optimum threshold for vitamin D necessary to maximise its extraosseous benefits is not known. This article reviews, non-systematically, studies world-wide which relate vitamin D with MS. Overall, there are no significant differences between cases of MS and controls. In the case series, hypovitaminosis D with respect to values considered to be normal is seen in patients with MS, an observation which may also apply to healthy individuals. To be able to clarify the extent of the relationship between vitamin D and MS, further prospective studies are needed (AU)

Benign episodic mydriasis. Experience in a specialist neuro-ophthalmology clinic of a tertiary hospital.

INTRODUCTION: Anisocorias are a relatively frequent reason for consultation in neuro-ophthalmology units. They remain a diagnostic challenge for specialists as they may be due to several etiological factors. In the absence of other accompanying symptoms, anisocorias are usually due to benign processes. Benign episodic mydriasis (BEM) is an isolated cause of intermittent pupil asymmetry, in which the pathophysiology is still not fully understood, and is predominant in young women with migraine. SUBJECTS, MATERIAL AND METHODS: We describe the epidemiological and clinical characteristics of patients with BEM, assessed in a neuro-ophthalmology unit in a tertiary hospital. RESULTS: A total of 7 patients were diagnosed with BEM, all of them females, with a mean age of 33 ± 10 yrs. The patients presented with pupil asymmetry (n = 5) and blurred vision (n = 2), and 6 of the 7 patients had unilateral involvement. The duration of impairment varied from a few minutes to 48 hrs. Four patients (57%) had a clinical history of migraine without aura. The episodes in these 4 patients were recurrent (75%), often lasted for a few minutes (75%), and had associated blurred vision (50%). The neuroimaging studies were normal. DISCUSSION: BEM appears predominantly in young women. It is frequently related to a previous history of migraine, and the specialist must consider if it is a concomitant symptom of common migraine, migraine with aura, or ophthalmoplegic migraine. Although BEM has unilateral predominance, there may be alternation of the affected eye or even bilateral impairment during the same episode, which makes us question the adequacy of the term to describe the process. Imaging tests are not recommended in the absence of other accompanying symptoms, or in short-term episodes.