Efectividad y eficiencia de la dalbavancina en condiciones reales de uso / Effectiveness and efficiency of dalbavancin in real clinical practice use

Objetivos: El tratamiento de las infecciones por Gram positivos supone un reto asistencial, en un contexto en el que están aumentando las resistencias antibióticas. La dalbavancina, gracias a su alta vida media y alta actividad frente a Gram positivos, puede ser una buena opción terapéutica. Nuestros objetivos son conocer los usos, efectividad y eficiencia de la dalbavancina en pacientes del Hospital General Universitario de Valencia. Métodos: Se realiza un estudio descriptivo retrospectivo y un análisis de costes de los pacientes tratados con dalbavancina en el Hospital General Universitario de Valencia. Resultados: 15 pacientes (con 17 episodios de infección) fueron incluidos, con un Charlson medio de 3,7. Se trataron 4 infecciones de piel y partes blandas, 6 infecciones osteoarticulares y 7 infecciones intravasculares, aislándose en el 70,6% de los casos un Gram positivo. La tasa de curación fue del 59%, sin efectos adversos por la dalbavancina ni exitus en relación con la infección. Se evitaron 239 días de hospitalización, lo cual supone un ahorro de 6.556,02 € por paciente. Conclusiones: Series clínicas como la actual permiten analizar el papel de la dalbavancina en la práctica médica habitual y demuestran su importante función en el ahorro de recursos económicos. (AU)

Objectives: The treatment of Gram-positive infections it’s a medical challenge, in a context in which antibiotic resistances are increasing. Dalbavancin, due to its long half-life and high activity against Gram-positive bacteria, could be a good therapeutic option. Our objectives are to know the uses, effectiveness and efficiency of dalbavancin in patients of the General University Hospital of Valencia. Methods: A retrospective descriptive study and a cost analysis of patients treated with dalbavancin are carried out at the General University Hospital of Valencia. Results: 15 patients (with 17 episodes of infection) were included, with a mean Charlson index of 3.7. Were treated 4 skin and soft tissue infections, 6 osteoarticular infections and 7 intravascular infections. A Gram-positive bacteria was isolated in 70.6% of the patients. The cure rate was 59%, with no adverse effects due to dalbavancin or death in relation to infection. 239 days of hospitalization were saved with outpatient treatment, which means a saving of € 6,556.02 per patient. Conclusions: Clinical series like ours allow us to analyse the role of dalbavancin in routine medical practice and demonstrate its important function in saving economic resources. (AU)

Antimicrobial resistance in Gram-negative bacilli in Spain: an experts' view.

BACKGROUND: Antibiotic resistance in Gram-negative bacilli poses a serious problem for public health. In hospitals, in addition to high mortality rates, the emergence and spread of resistance to practically all antibiotics restricts therapeutic options against serious and frequent infections. OBJECTIVE: The aim of this work is to present the views of a group of experts on the following aspects regarding resistance to antimicrobial agents in Gram-negative bacilli: 1) the current epidemiology in Spain, 2) how it is related to local clinical practice and 3) new therapies in this area, based on currently available evidence. METHODS: After reviewing the most noteworthy evidence, the most relevant data on these three aspects were presented at a national meeting to 99 experts in infectious diseases, clinical microbiology, internal medicine, intensive care medicine, anaesthesiology and hospital pharmacy. RESULTS AND CONCLUSIONS: Subsequent local debates among these experts led to conclusions in this matter, including the opinion that the approval of new antibiotics makes it necessary to train the specialists involved in order to optimise how they use them and improve health outcomes; microbiology laboratories in hospitals must be available throughout a continuous timetable; all antibiotics must be available when needed and it is necessary to learn to use them correctly; and the Antimicrobial Stewardship Programs (ASP) play a key role in quickly allocating the new antibiotics within the guidelines and ensure appropriate use of them.

Tomar o no tomar "decisiones en caliente" respecto al tratamiento de la infección por SARS-CoV-2 / Whether to make decisions "on the fly" regarding treatment for SARS-CoV-2 infection

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Estudio LAM: conducta y calidad de vida en pacientes diagnosticados de epilepsia tratados con lacosamida / LAM study: Effects of lacosamide on behaviour and quality of life in patients with epilepsy

Introducción: La comorbilidad psiquiátrica es común en epilepsia, de ahí la importancia de considerar en qué medida los fármacos antiepilépticos pueden influir en el estado de ánimo. El objetivo de este trabajo es analizar el efecto de lacosamida en la calidad de vida y en la conducta del paciente epiléptico en la práctica clínica. Métodos: Estudio multicéntrico, observacional y prospectivo en pacientes diagnosticados de epilepsia, mal controlados que recibieron tratamiento adyuvante con lacosamida. Mediante 4 visitas durante 12 meses se valoró el impacto del fármaco en la calidad de vida y el estado de ánimo utilizando el cuestionario de calidad de vida QOLIE-10, la escala hospitalaria de ansiedad y depresión (HADS) y la escala de impulsividad de Barratt (BIS-11), además se determinó su eficacia y seguridad. Resultados: Se incluyeron 55 pacientes, edad media 47,1 ± 18,4 años; porcentaje inicial de comorbilidad psiquiátrica 34,5% y número medio de crisis/mes previo 3,6 ± 4,3. Las escalas QOLIE-10 y HADS reflejaron mejoras estadísticamente significativas en pacientes que partían de una situación basal desfavorable (ansiedad, depresión y/o baja calidad de vida). La escala BIS-11 no detectó la aparición de conductas impulsivas durante el seguimiento. Tras 12 meses de tratamiento el 51,9% de los pacientes estuvo sin crisis, y un 77,8% presentó una educción ≥ 50%. La mayoría de efectos adversos fueron leves, obligando a retirar el fármaco en 10 casos (18,2%). Conclusiones: Lacosamida ofrece un perfil de eficacia y seguridad favorable, y podría constituir una opción terapéutica útil en pacientes con epilepsia y comorbilidad psiquiátrica

Introduction: Psychiatric comorbidities are common in epileptic patients, and evaluating the impact of antiepileptic drugs on patients’ moods is therefore essential. The aim of this study is to assess the effects of lacosamide on behaviour and quality of life in people with epilepsy. Methods: We conducted a multicentre prospective observational study of poorly-controlled epileptic patients who received lacosamide as an adjuvant treatment. Patients were evaluated on 4 occasions during a 12-month period. The impact of lacosamide on patients’ mood and quality of life was assessed with the Quality of Life in Epilepsy Inventory-10 (QOLIE-10), the Hospital Anxiety and Depression Scale (HADS), and the Barratt Impulsiveness Scale (BIS-11). As a secondary objective, we evaluated the effectiveness and safety of lacosamide. Results: We included 55 patients with a mean age of 47.1 ± 18.4 years. At baseline, 34.5% of the patients had psychiatric comorbidities; the mean number of crises in the previous month was 3.6 ± 4.3. The QOLIE-10 and HADS scales revealed statistically significant improvements in patients with a poor baseline condition (anxiety, depression, and/or poor quality of life). The BIS-11 scale detected no impulsive behaviour during follow-up. After 12 months of treatment, 51.9% of the patients were seizure-free and 77.8% experienced a reduction of at least 50% in seizure frequency. Adverse effects were mild in most cases; lacosamide was discontinued in 10 patients (18.2%)

LAM study: Effects of lacosamide on behaviour and quality of life in patients with epilepsy. / Estudio LAM: conducta y calidad de vida en pacientes diagnosticados de epilepsia tratados con lacosamida.

INTRODUCTION: Psychiatric comorbidities are common in epileptic patients, and evaluating the impact of antiepileptic drugs on patients' moods is therefore essential. The aim of this study is to assess the effects of lacosamide on behaviour and quality of life in people with epilepsy. METHODS: We conducted a multicentre prospective observational study of poorly-controlled epileptic patients who received lacosamide as an adjuvant treatment. Patients were evaluated on 4 occasions during a 12-month period. The impact of lacosamide on patients' mood and quality of life was assessed with the Quality of Life in Epilepsy Inventory-10 (QOLIE-10), the Hospital Anxiety and Depression Scale (HADS), and the Barratt Impulsiveness Scale (BIS-11). As a secondary objective, we evaluated the effectiveness and safety of lacosamide. RESULTS: We included 55 patients with a mean age of 47.1±18.4 years. At baseline, 34.5% of the patients had psychiatric comorbidities; the mean number of crises in the previous month was 3.6±4.3. The QOLIE-10 and HADS scales revealed statistically significant improvements in patients with a poor baseline condition (anxiety, depression, and/or poor quality of life). The BIS-11 scale detected no impulsive behaviour during follow-up. After 12 months of treatment, 51.9% of the patients were seizure-free and 77.8% experienced a reduction of at least 50% in seizure frequency. Adverse effects were mild in most cases; lacosamide was discontinued in 10 patients (18.2%). CONCLUSIONS: Lacosamide is a safe and effective treatment option for patients with epilepsy and psychiatric comorbidities.

Design and development of low cost polyurethane biopolymer based on castor oil and glycerol for biomedical applications.

In the current study, we present the synthesis of novel low cost bio-polyurethane compositions with variable mechanical properties based on castor oil and glycerol for biomedical applications. A detailed investigation of the physicochemical properties of the polymer was carried out by using mechanical testing, ATR-FTIR, and X-ray photoelectron spectroscopy (XPS). Polymers were also tested in short term in-vitro cell culture with human mesenchymal stem cells to evaluate their biocompatibility for potential applications as biomaterial. FTIR analysis confirmed the synthesis of castor oil and glycerol based PU polymers. FTIR also showed that the addition of glycerol as co-polyol increases crosslinking within the polymer backbone hence enhancing the bulk mechanical properties of the polymer. XPS data showed that glycerol incorporation leads to an enrichment of oxidized organic species on the surface of the polymers. Preliminary investigation into in vitro biocompatibility showed that serum protein adsorption can be controlled by varying the glycerol content with polymer backbone. An alamar blue assay looking at the metabolic activity of the cells indicated that castor oil based PU and its variants containing glycerol are non-toxic to the cells. This study opens an avenue for using low cost bio-polyurethane based on castor oil and glycerol for biomedical applications.

OnabotulinumtoxinA in chronic migraine: predictors of response. A prospective multicentre descriptive study.

BACKGROUND AND PURPOSE: OnabotulinumtoxinA is a treatment specifically approved for the prophylaxis of chronic migraine in adults. The aim of this study was to assess the effectiveness of OnabotulinumtoxinA in chronic migraine after 1 year of treatment in a real-life setting and to identify clinical predictors of outcome. METHODS: We designed a prospective multicentre study performed in 13 hospitals in Spain. Patients underwent a complete medical history and examination. They were treated with OnabotulinumtoxinA every 12 weeks for 1 year. Data about outcome, adverse events, abortive medication use, emergency room use and disability were collected at 3 and 12 months. RESULTS: A total of 725 subjects completed the study. At 12 months, 79.3% showed >50% reduction in number of headaches per month and 94.9% reported no adverse events. Unilaterality of pain, fewer days of disability per month and milder headache at baseline were correlated with good outcome. Duration of disease <12 months increased the chances of response to treatment with OnabotulinumtoxinA (odds ratio, 1.470; 95% confidence interval, 1.123-2.174; P = 0.045). CONCLUSIONS: This study confirmed the effectiveness of treatment with OnabotulinumtoxinA after 1 year of treatment. The chances of a good outcome may be increased by starting treatment in the first 12 months after chronic migraine diagnosis.

Cefalea menstrual: subtipos, fenotipos clínicos y tratamiento / Menstrual headache: subtypes, clinical phenotypes and treatment

Introducción. Más del 60% de las mujeres refieren presentar cefalea relacionada con el ciclo menstrual. Se ha incluido la ‘migraña menstrual’ en la segunda edición de la Clasificación Internacional de las Cefaleas; sin embargo, la ‘cefaleatensional durante la menstruación’ es una entidad no reconocida por la Sociedad Internacional de Cefaleas.Objetivos. Evaluar la prevalencia de los diferentes subtipos de cefalea menstrual y analizar sus características clínicas y eltratamiento prescrito.Pacientes y métodos. Evaluamos de forma prospectiva a todas las mujeres atendidas en varias consultas de neurología,desde enero a noviembre de 2008, cuya cefalea aparecía durante el período menstrual. Resultados. Se incluyeron un total de 108 pacientes durante el período del estudio, con una edad media de 34,8 ± 8,9 años. El 29,3% presentaba migraña menstrual pura, el 58,7% migraña menstrual relacionada con la menstruación, el 4,5% cefalea tensional pura durante la menstruación y el 7,5% cefalea tensional relacionada con la menstruación. Conclusiones. Nuestros resultados sugieren que la cefalea tensional en el contexto de la menstruación existe, con unaprevalencia en torno al 12% en las pacientes valoradas en nuestras consultas (AU)

Introduction. Up to 60% of women relate their episodes of headache to menstrual cycle. Menstrual migraine has been included in the second edition of the International Classification of Headache disorders. Menstrual tension-type headache has not yet been recognised by the International Headache Society. Aims. To evaluate the prevalence of different subtypes of menstrual headache and to analyze their clinical features and the treatment prescribed. Patients and methods. We prospectively included women attending several neurology outpatient clinics, from January toNovember 2008 whose headache appeared during the menstrual period. Results. A total of 108 patients were included during the study period. Mean age was 34.8 ± 8.9 years-old. 29.3% sufferedfrom pure menstrual migraine, 58.7% from menstrual related migraine, 4.5% from pure menstrual tension-type headacheand 7.5% from menstrual related tension type headache.Conclusions. Our data suggest that menstrual related tension-type headaches exist with a prevalence found about 12%, inour neurology outpatient clinics

[Infection due to Rhodococcus equi in HIV infected patients: four cases]. / Infección por Rhodococcus equi en pacientes infectados por virus de la inmunodeficiencia humana: descripción de cuatro casos.

INTRODUCTION: Incidence of Rhodococcus equi (R. equi) infection is increasing parallel to a greater prevalence of immunosupressed patients. This study aims to describe clinico-epidemiological characteristics of R. equi infections in a single hospital. METHODS: Retrospective, observational study that includes any patient diagnosed of R. equi infection during the 1999-2007 period. Clinical and epidemiological characteristics were recorded. RESULTS: Four patients were diagnosed of R. equi infection, with a mean age of 37.75+/-9.94 years old. All of them were male, infected with human immunodeficiency virus, and showed severe immunosuppression (mean CD4+ lymphocyte count of 83+/-55.2 cells/microl). Respiratory symptoms and cavitary pulmonary lesions were constantly present. R. equi was always cultured in blood and respiratory secretions. CONCLUSIONS: R. equi infection is a rare disease that occurs predominantly in HIV infected patients, severely immunosuppressed patients and almost always causes cavitary pneumonia.

Infección por Rhodococcus equi en pacientes infectados por virus de la inmunodeficiencia humana: descripción de cuatro casos / Infection due to Rhodococcus equi in HIV infected patients: four cases

IntroducciónLa incidencia de la infección por Rhodococcus equi está incrementándose en paralelo con la mayor prevalencia de pacientes inmunodeprimidos. Este estudio se propone conocer las características clínico-epidemiológicas de las infecciones por R. equi en un único centro.MétodosEstudio retrospectivo, de observación, que incluye a todos los pacientes diagnosticados de infección por R. equi en el período 1999–2007. Se registraron características clínicas y epidemiológicas generales.ResultadosSe diagnosticó a cuatro pacientes de infección por R. equi, de 37,75±9,94 años de edad, todos ellos varones infectados por el virus de la inmunodeficiencia humana (VIH), con inmunosupresión importante (contaje medio de linfocitos CD4+: 83±55,2 células/μl). Todos los pacientes tenían sintomatología respiratoria y mostraban lesiones pulmonares radiológicas cavitadas. Se aisló R. equi tanto en sangre como en muestras respiratorias.ConclusionesLa infección por R. equi es poco frecuente, incide sobre todo en pacientes con infección por VIH muy inmunodeprimidos y cursa casi siempre como neumonía cavitada(AU)

IntroductionIncidence of Rhodococcus equi (R. equi) infection is increasing parallel to a greater prevalence of immunosupressed patients. This study aims to describe clinico-epidemiological characteristics of R. equi infections in a single hospital.MethodsRetrospective, observational study that includes any patient diagnosed of R. equi infection during the 1999–2007 period. Clinical and epidemiological characteristics were recorded.ResultsFour patients were diagnosed of R. equi infection, with a mean age of 37,75±9,94 years old. All of them were male, infected with human immunodeficiency virus, and showed severe immunosuppression (mean CD4+ lymphocyte count of 83±55,2 cells/μl). Respiratory symptoms and cavitary pulmonary lesions were constantly present. R. equi was always cultured in blood and respiratory secretions.ConclusionsR. equi infection is a rare disease that occurs predominantly in HIV infected patients, severely immunosuppressed patients and almost always causes cavitary pneumonia(AU)

Cefalea, ¿una sobrecarga asistencial en atención primaria? Consulta urbana frente a consulta rural / Headache, does it cause a health care overload in Primary Health Care? Urban area vs rural area medical visit

El dolor de cabeza supone una sobrecargay unun problema asistencial en cualquier consulta ambulatoriade neurología. Existen pocos estudios que cuantifiquen lasobrecarga que supone el dolor de cabeza en una consultade atención primaria. El objetivo del presente estudio esidentificar y cuantificar realmente la carga que esta patologíasupone en dos consultas de atención primaria, una localizadaen un ámbito rural y otra en un ámbito urbano.Material y métodos. Estudio observacional y descriptivode 6 meses de duración. Se registra el total de pacientesatendidos, el número de pacientes asistidos por dolor de cabezay su clasificación diagnóstica.Resultados. Se contabilizó un total de 6.014 consultas.Sólo 46 pacientes consultan por cefalea (0,76%). La cefaleatensional es el dolor de cabeza diagnosticado con más frecuencia(el 43,48%), seguido de la migraña (el 23,91%).Conclusiones. Nuestro estudio certifica lo publicadopor otros autores y determina que, contrariamente a lo quesucede en la neurología ambulatoria, la cefalea no suponeuna carga en el trabajo diario de un médico de familia. Elescaso número de consultas por cefalea, con los problemasde diagnóstico y manejo que rodea a esta patología, originanque un problema de atención multidisciplinar como lacefalea se afronte de diferente manera según el nivel asistencialdonde uno se encuentre (AU)

Objectives. Headache causes an overload and a problemto out-patient neurology. There are few studies that quantify the overload that the headache causes in a PrimaryHealth Care out-patient clinic visit. The aim of thepresent study is to identify and quantify the real loadthat this disease supposes in two Primary Health Careconsultations, one located in a rural area and another inan urban area.Material and methods. A 6 month long observationaland descritive study. The total number of patients seen,the number of patients seen for headache and theirdiagnostic classification were recorded.Results. A total of 6,014 visits were counted. Only46 patients consulted due to headache (0,76%). Tensionalheadache was the most frequently diagnosed headache(43.48%) followed by migraine (23.91%).Conclusions. Our study verifies that published byother authors and determines that, on the contrary tothat which occcurs in the neurology out-patient clinic,headache does not cause a daily work overload for thegeneral practitioner. The scarce number of consultationsfor headache, with the diagnosis and management involvedin this disease, makes it necessary to consider a multidisciplinaryhealth care problem such as headache differentlyaccording to the health care level involved (AU)

Enfermedad perianal de evolución tórpida / Perianal disease with slow evolution

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[Ambulatory neurological care in a prison population]. / Atencion neurologica ambulatoria a una poblacion penitenciaria.

AIMS: Some of the users attended in a Neurology service consist of the inmate population in a prison. The aim of this study is to analyse all the proposals referred from the Alicante II Prison Centre to a Neurology service. PATIENTS AND METHODS: We analyse and describe the clinical characteristics of patients referred from the Alicante II Prison Centre to the Neurology service at the Centro Sanitario Integrado in Villena between the years 2003 and 2006. This analysis involved the following variables: age, sex, personal history, reason for visiting and diagnosis. RESULTS: A total of 88 proposals were recorded. The mean age of the patients was 35 years (84 males/4 females). A total of 15 patients did not attend their appointment (17%). Positive serology for the human immunodeficiency virus was found in 18% of patients. The most frequent reason for visiting was headache (32%), followed by seizures (25%) and, thirdly, vascular pathologies (13%). In a group of 16 patients (18%) the main diagnosis was established as being some kind of psychiatric disorder (anxiety, depression, simulation). CONCLUSIONS: No studies have been published in the literature that analyse the clinical characteristics of patients from prisons referred to a Neurology service. The high percentage of patients who do not attend their appointment and the high percentage of psychiatric disorders that are diagnosed within this group of patients are especially noteworthy. However, and as can be observed in the general population, headache is still the most common reason for visiting. Nevertheless, the group of neurological diagnoses that are most frequently attended is epilepsy.

Atención neurológica ambulatoria a una población penitenciaria / Ambulatory neurological care in a prison population

La población recluida en un centro penitenciario forma parte de los usuarios atendidos en una consultade Neurología. El objetivo del presente estudio es analizar todas las propuestas derivadas desde el Centro Penitenciario Alicante II a una consulta de Neurología. Pacientes y métodos. Se analizan y describen las características clínicas de los pacientesderivados desde el Centro Penitenciario Alicante II a la consulta de Neurología del Centro Sanitario Integrado de Villena, entre los años 2003 y 2006. Se analizan las siguientes variables: edad, sexo, antecedentes personales, motivo de consulta ydiagnóstico. Resultados. Se contabiliza un total de 88 propuestas. La edad media de los pacientes fue de 35 años (84 varones y 4 mujeres). Un total de 15 pacientes no acudieron a la consulta (17%). El 18% de los pacientes presentan serología positivapara el virus de inmunodeficiencia humana. El motivo de consulta más frecuente fue el de cefalea (32%), seguido de crisis convulsivas (25%) y, en tercer lugar, de la patología vascular (13%). En un grupo de 16 pacientes (18%) se estableció como diagnóstico principal alguna alteración psiquiátrica (ansiedad, depresión, simulación). Conclusiones. No existen actualmenteen la bibliografía estudios que analicen las características clínicas de los pacientes penitenciarios derivados a una consulta de Neurología. Llama la atención el alto porcentaje de pacientes que no acuden a la consulta y el alto porcentaje de trastornospsiquiátricos diagnosticados en este grupo de pacientes. No obstante, y como se observa en la población general, la cefalea sigue siendo el motivo de consulta más frecuente. Sin embargo, el grupo diagnóstico neurológico más frecuentemente atendido es la epilepsia

Some of the users attended in a Neurology service consist of the inmate population in a prison. The aim ofthis study is to analyse all the proposals referred from the Alicante II Prison Centre to a Neurology service. Patients and methods. We analyse and describe the clinical characteristics of patients referred from the Alicante II Prison Centre to the Neurology service at the Centro Sanitario Integrado in Villena between the years 2003 and 2006. This analysis involved thefollowing variables: age, sex, personal history, reason for visiting and diagnosis. Results. A total of 88 proposals were recorded. The mean age of the patients was 35 years (84 males/4 females). A total of 15 patients did not attend their appointment (17%). Positive serology for the human immunodeficiency virus was found in 18% of patients. The most frequentreason for visiting was headache (32%), followed by seizures (25%) and, thirdly, vascular pathologies (13%). In a group of 16 patients (18%) the main diagnosis was established as being some kind of psychiatric disorder (anxiety, depression, simulation).Conclusions. No studies have been published in the literature that analyse the clinical characteristics of patients from prisons referred to a Neurology service. The high percentage of patients who do not attend their appointment and the high percentage of psychiatric disorders that are diagnosed within this group of patients are especially noteworthy. However, and as can be observed in the general population, headache is still the most common reason for visiting. Nevertheless, the group of neurological diagnoses that are most frequently attended is epilepsy

Síndrome de embolismo graso / Fat embolism syndrome

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El tratamiento preventivo con topiramato mejora la calidad de vida de los pacientes con migraña / Preventive treatment with topiramate enhances the quality of life of patients with migraine

Introducción. El topiramato ha demostrado recientementeser seguro y efectivo en la prevención de la migraña y en la actualidades el único fármaco neuromodulador con indicación parala prevención de la migraña en España. Objetivo. Evaluar la adherencia,la eficacia y la seguridad del tratamiento preventivo con topiramatoen pacientes diagnosticados de migraña. Pacientes y métodos.Se realizó un estudio multicéntrico prospectivo observacionalen las consultas de neurología general. Se incluyeron pacientescon migraña mayores de 14 años que requerían un tratamiento preventivo y en los que habían fallado otros tratamientos preventivos oen los que cuales se consideraba más adecuado el topiramato enfunción de su perfil de efectos adversos. Se evaluó la eficacia deltratamiento, la satisfacción del paciente, los efectos adversos y lareducción del peso corporal. La eficacia del tratamiento se valoró através de la reducción en la frecuencia de migrañas y en la puntuacióndel Headache Impact Test (HIT-6). Resultados. Se evaluaron79 pacientes. La dosis de topiramato osciló entre 25 y 200 mg/día,con una mediana de 100 mg/día. El 19% de los pacientes abandonóel estudio por efectos adversos. La causa más frecuente de abandonofueron las parestesias. No se observaron efectos adversos graves.El 14% de los pacientes experimentó una pérdida de peso superioral 5% del basal. El porcentaje de pacientes respondedores fuedel 58%. El grado de satisfacción de los pacientes que completaronel seguimiento fue buena (80%), regular (11%) y mala (9%). Conclusiones.El tratamiento preventivo con topiramato reduce significativamenteel impacto y la discapacidad de la migraña. El tratamientoes satisfactorio y mejora la calidad de vida en un porcentajeimportante de pacientes

Introduction. Topiramate has recently proved to be safe and effective in the prevention of migraine and is currentlythe only neuromodulatory drug indicated for the prevention of migraine in Spain. Aim. To evaluate the adherence, effectivenessand safety of preventive treatment with topiramate in patients diagnosed with migraine. Patients and methods. A prospective,observational, multi-centre study was conducted in general neurology departments. Patients eligible for the study were thosewith migraine, above 14 years of age, who needed preventive treatment and in whom other preventive treatments had failed orfor whom topiramate was believed to be the most suitable therapy as regards its profile of side effects. The effectiveness of thetreatment, patient satisfaction, side effects and loss of body weight were all evaluated. Effectiveness of the treatment wasevaluated by means of the reduction in the frequency of migraines and the score obtained on the Headache Impact Test (HIT-6).Results. A total of 79 patients were evaluated. The dosage of topiramate ranged between 25 and 200 mg/day, with an average of100 mg/day. 19% of the patients dropped out of the study due to side effects. Paresthesias were the most frequent reason fordropping out. No serious side effects were observed. 14% of the patients lost more than 5% of the base weight. The percentageof patients who responded was 58%. The degree of satisfaction of the patients who completed the follow-up was: good (80%),regular (11%) and poor (9%). Conclusions. Preventive treatment with topiramate significantly reduces the impact of migraineand the disability that results from it. Treatment is satisfactory and improves the quality of life in a large percentage of patients