[Health care activity in a headache-specific clinic]. / Actividad asistencial en una consulta específica de cefalea.

INTRODUCTION: It is reckoned that headaches affect, at least once a year, around 90% of the population. The socioeconomic repercussion occasioned by this malady justifies the appearance in recent years of headache units. AIM: To conduct a descriptive epidemiological and health care study of the activity carried out in a headache-specific clinic. PATIENTS AND METHODS: All the relevant points from the histories of patients who visited our surgery over a period of two years were collected prospectively and consecutively. The different types of headaches were classified according to the 1988 IHS criteria. Both the symptomatic and the preventive treatment were analysed. RESULTS: In all, a total of 866 patients were found; 691 (79.8%) were females and the mean age was 39.8 +/- 15.9 years (range: 6-90 years); 208 (24%) had a history of migraine in the family; 399 (49.9%) were diagnosed as suffering from migraine: 256 (64.2%) had migraine without aura, 152 (19%) were diagnosed as having tension-type headache, and 218 (27.3%) presented chronic daily headache (CDH). The most frequently used symptomatic treatments were NSAI drugs (36.7%) and triptanes (28.4%). Amitriptyline (47.7%), beta-blockers (14.5%) and calcium antagonists (11.3%) were the main drugs used as preventive treatment. DISCUSSION: After several years' operation of our Headache Unit, we thought there was a need to analyse the population seen in the visits. The fact that the majority of our patients were middle-aged females matched our expectations. Although most of the patients were diagnosed as suffering from M, we also want to highlight the high proportion of cases of CDH, above all associated with the abuse of analgesics.

Actividad asistencial en una consulta específica de cefalea / Health care activity in a headache-specific clinic

Introducción. Se calcula que la cefalea afecta, al menos una vez al año, a cerca del 90 por ciento de la población. La repercusión socioeconómica que comporta justifica la aparición en los últimos años de unidades de cefalea. Objetivo. Realizar un estudio descriptivo epidemiológico y asistencial de la actividad realizada en una consulta específica de cefalea. Pacientes y métodos. Durante dos años, se recogieron de forma prospectiva y consecutiva todos los antecedentes de interés de los pacientes vistos en nuestra consulta. Se realizó una clasificación de los distintos tipos de cefalea según la de la IHS de 1988. Se analizó tanto el tratamiento sintomático como el preventivo. Resultados. Se recogieron 866 pacientes; 691 (79,8 por ciento) fueron mujeres y la edad media fue de 39,8 ñ 15,9 años (intervalo: 6-90 años); 208 (24 por ciento) tenían antecedentes familiares de migraña; 399 (49,9 por ciento) se diagnosticaron de migraña -256 (64,2 por ciento) migraña sin aura-, 152 (19 por ciento) se diagnosticaron de cefalea de tensión; 218 (27,3 por ciento) presentaron cefalea crónica diaria (CCD). Los tratamientos sintomáticos más usados fueron los AINE (36,7 por ciento) y los triptanes (28,4 por ciento). Como tratamiento preventivo se usó la amitriptilina (47,7 por ciento), betabloqueadores (14,5 por ciento) y calcioantagonistas (11,3 por ciento), principalmente. Discusión. Tras varios años de funcionamiento de nuestra Unidad de Cefalea, creímos necesario analizar a la población atendida en la consulta. La presencia de una mayoría de mujeres en edades medias de la vida se ajusta a lo esperado. A pesar de que la mayoría de los pacientes se diagnosticaron de migraña, se reseña la alta proporción de enfermos con CCD, sobre todo asociada al abuso de analgésicos (AU)

Introduction. It is reckoned that headaches affect, at least once a year, around 90% of the population. The socioeconomic repercussion occasioned by this malady justifies the appearance in recent years of headache units. Aim. To conduct a descriptive epidemiological and health care study of the activity carried out in a headache-specific clinic. Patients and methods. All the relevant points from the histories of patients who visited our surgery over a period of two years were collected prospectively and consecutively. The different types of headaches were classified according to the 1988 IHS criteria. Both the symptomatic and the preventive treatment were analysed. Results. In all, a total of 866 patients were found; 691 (79.8%) were females and the mean age was 39.8 ± 15.9 years (range: 6-90 years); 208 (24%) had a history of migraine in the family; 399 (49.9%) were diagnosed as suffering from migraine: 256 (64.2%) had migraine without aura, 152 (19%) were diagnosed as having tensiontype headache, and 218 (27.3%) presented chronic daily headache (CDH). The most frequently used symptomatic treatments were NSAI drugs (36.7%) and triptanes (28.4%). Amitriptyline (47.7%), beta-blockers (14.5%) and calcium antagonists (11.3%) were the main drugs used as preventive treatment. Discussion. After several years’operation of our Headache Unit, we thought there was a need to analyse the population seen in the visits. The fact that the majority of our patients were middle-aged females matched our expectations. Although most of the patients were diagnosed as suffering from M, we also want to highlight the high proportion of cases of CDH, above all associated with the abuse of analgesics (AU)

[Neurosonological studies in patients over 80 years old]. / Estudio neuroecográfico en mayores de 80 años.

INTRODUCTION: The link between cardiovascular risk factors and carotid atheromatosis has been shown to be more important in middle aged subjects than in the elderly. AIMS: Our aim was to study the frequency of carotid and intracranial atheromatosis in a population over the age of 80 and to compare the presence of neurosonological anomalies depending on whether the patients have suffered a stroke or not. We also wished to compare the findings according to the sex of the patient. PATIENTS AND METHODS: Patients over the age of 80 were studied at our Neurosonology laboratory using carotid and transcranial Doppler ultrasonography. The patients were analysed according to whether they had suffered an ischemic stroke or not. With regard to the carotid, a distinction was made between normal, non-significant atheromatosis and significant atheromatosis (stenosis > 50%). Intracranially, both the middle cerebral artery (normal, stenosis, microangiopathy and post-stenosis) and the basilar artery (normal, stenosis, microangiopathy and hyperdynamics) were studied. RESULTS: We recorded data concerning 832 patients: 342 males (44.1%), mean age 83.63 +/- 3.25 years, and 527 (63.3%) with stroke. The carotid study was pathological, with a higher frequency in stroke patients (32.1% compared with 41.9%; p = 0.002). The presence of atheromatosis was significantly linked to a higher risk of suffering a stroke and more intensely to its being more severe. Carotid studies were pathological with a higher frequency among males (28.7% compared with 40%; p < 0.001). No significant differences were found intracranially in any of the parameters analysed. CONCLUSIONS: There is a high frequency of carotid atheromatosis in patients over 80 years of age. Regardless of the age, carotid atheromatosis appears even more frequently in patients who have suffered a stroke and in males, and is significantly associated to the risk of suffering a stroke. Intracranially, no differences were found.

[Lamotrigine in refractory epilepsy]. / Lamotrigina en epilepsia refractaria.

INTRODUCTION: Lamotrigine (LTG) is a new antiepileptic drug indicated in all kinds of partial and generalised clonic-tonic seizures, both in monotherapy and polytherapy. Between 20 and 30% of epileptic patients have poor control over their seizures despite adequate treatment. AIMS: We report on our experience regarding the long-term efficacy and tolerability of LTG in refractory seizures. PATIENTS AND METHODS: We conducted a consecutive 10-year study of patients who began LTG therapy following poor control of their seizures, in spite of being treated with two or more antiepileptic drugs in monotherapy or in combination. Both their epidemiological and clinical data were collected for study. We studied the efficacy of the treatment, differentiating between remission (absence of seizures), improvement (reduction>50% of the seizures), inefficacy (reduction<50%), exacerbation (increase in seizures) and its tolerability (side effects and dropout). RESULTS: In all, data was collected from 39 patients, 18 males (46.2%), mean age 30.9 +/- 13.7 years; mean follow up time: 27.6 +/- 23.4 months. 43.7% presented cryptogenic epilepsy, in 28.5% it was symptomatic and in the remaining 28.5% it was idiopathic. EEG readings and neuroimaging scans were pathological in 53.8% and 43.6%, respectively. After beginning therapy with LTG, 33% remained free of seizures, 43.6% improved, in 18.3% it was seen to be ineffective and 5.1% got worse. Dropout rate was 56.4%:23.1% due to insufficient control over the seizures, 17.9% owing to side effects and 15.4% because of non-compliance. CONCLUSION: Treatment with LTG offers a high degree of efficacy in the control of seizures in patients with refractory epilepsy, although it is limited by a high dropout rate.

[Modification of clinical profile of stroke in atrial fibrillation patients. Effect of antithrombotic treatment]. / Modificacion del perfil clinico de los ictus en enfermos con fibrilacion auricular. Efecto del tratamiento antitrombotico.

BACKGROUND: Atrial fibrillation is present in 24% of the population over 60 and it increases the risk of stroke by 2,4% 3%/year. Antithrombotic treatment is considered as the treatment of choice for cardioembolic stroke prevention in this patients. As far as we know there are not relevant data about the influence of these treatments on the type of stroke that may develop in these patients. AIM: Analyze whether there are differences in the clinical profile and functional prognosis after stroke in patients with atrial fibrillation depending on the type of treatment they were on at the time of occurrence of the event. PATIENTS AND METHODS: We identified 67 patients who were admitted consecutively to our stroke unit with a stroke and atrial fibrillation over a period of 2 years. Patients were classified according to the type of antithrombotic treatment they were on. Functional prognosis was estimated by Rankin score at discharge. RESULTS: Treated patient showed a non significant tendency to suffer less severe strokes and present a better functional situation at discharge than those who were not on prophylactic treatment. Treated patients had a significant higher prevalence of previous TIA (44,2% vs 9,1%; p= 0,0042) and HBP (81,4% vs 52%; p= 0,041) than non treated patients. Embolic strokes were more frequent in non treated patients. CONCLUSION: Antithrombotic treatment not only prevents strokes but may also contribute to the development of less severe strokes with a better functional prognosis in patients with AF and does not contribute to increase complications in these group of patients.

Modificación del perfil clínico de los ictus en enfermos con fibrilación auricular. Efecto del tratamiento antitrombótico / Modification of clinical profile of stroke in atrial fibrillation patients. Effect of antithrombotic treatment

Background. Atrial fibrillation is present in 2-4% of the population over 60 and it increases the risk of stroke by 2,4-3% per year. Antithrombotic treatment is considered as the treatment of choice for cardioembolic stroke prevention in this patients. As far as we know there are not relevant data about the influence of these treatments on the type of stroke that may develop in these patients. Aim. Analyze whether there are differences in the clinical profile and functional prognosis after stroke in patients with atrial fibrillation depending on the type of treatment they were on at the time of occurrence of the event. Patients and methods. We identified 67 patients who were admitted consecutively to our stroke unit with a stroke and atrial fibrillation over a period of 2 years. Patients were classified according to the type of antithrombotic treatment they were on. The clinical picture was evaluated by the Canadian scale. Functional prognosis was estimated by Rankin score at discharge. Results. Treated patient showed a non-significant tendency to suffer less serious strokes and present a better functional situation at discharge than those who were not on prophylactic treatment. Treated patients had a significant higher prevalence of previous TIA (44,2% vs 9,1%; p = 0,0042) and HBP (81,4% vs 52%; p = 0,041) than non-treated patients. Embolic strokes were more frequent in non-treated patients. Conclusion. Antithrombotic treatment not only prevents strokes but may also contribute to the development of less serious strokes with a better functional prognosis in patients with AF and does not contribute to increase complications in these group of patients (AU)

Introducción. La fibrilación auricular (FA) aparece en el 2-4 por ciento de la población mayor de 60 años y hace aumentar el riego de ictus en un 2,4-3 por ciento por año. El tratamiento antitrombótico es el tratamiento de elección para prevenir los ictus de origen embólico. No existen datos relevantes sobre la influencia de estos tratamientos en el tipo de ictus que aparece en estos pacientes. Objetivo. Analizar si existen diferencias en la clínica y el pronóstico funcional entre pacientes con ictus y FA según se traten o no. Pacientes y métodos. Hemos incluido a 67 pacientes que ingresaron consecutivamente en nuestra Unidad de Ictus con FA asociada al ictus durante un período de 2 años. Hemos clasificado a los pacientes de acuerdo con el tipo de tratamiento profiláctico que recibían. Estimamos la clínica inicial mediante la escala canadiense, y la situación funcional al alta, mediante la escala de Rankin. Resultados. Encontramos una tendencia estadísticamente no significativa a una clínica menos grave al ingreso y un mejor estado funcional al alta a favor de los tratados respecto los no tratados. También encontramos diferencias significativas a favor de los tratados en cuanto a los antecedentes de accidente isquémico transitorio (44,2 por ciento frente a 9,1 por ciento; p = 0,0042) y a HTA (81,4 por ciento frente a 52 por ciento; p = 0,041), así como una mayor proporción de ictus embólicos en los no tratados. Conclusión. El tratamiento antitrombótico adecuado en un paciente con FA podría asociarse, en caso de aparecer un ictus, a una clínica inicial menos grave y un mejor estado funcional final respecto los no tratados sin aumentar el número de complicaciones (AU)

Lamotrigina en epilepsia refractaria / Lamotrigine in refractory epilepsy

Introducción. La lamotrigina (LTG) es un nuevo antiepiléptico indicado para todo tipo de crisis parciales y tonicoclónicas generalizadas, tanto en monoterapia como politerapia. El 20-30 por ciento de los pacientes epilépticos tienen un mal control de las crisis, pese a un tratamiento adecuado. Objetivo. Presentamos nuestra experiencia en cuanto a eficacia y tolerabilidad a largo plazo de la LTG en crisis refractarias. Pacientes y métodos. Estudiamos consecutivamente durante 10 años a los pacientes que iniciaron tratamiento con LTG tras un mal control de sus crisis, pese al tratamiento con dos o más fármacos antiepilépticos en monoterapia o en combinación. Recogimos sus datos epidemiológicos y clínicos. Estudiamos la eficacia del tratamiento, diferenciando entre remisión (ausencia de crisis), mejoría (reducción mayor o igual al 50 por ciento de las crisis), ineficacia (reducción menor del 50 por ciento), agravamiento (aumento de las crisis), y su tolerabilidad (efectos secundarios y abandono del tratamiento).Resultados. Se recogieron 39 pacientes -18 hombres (46,2 por ciento), edad media de 30,9 ñ 13,7 años-; el seguimiento medio fue de 27,6 ñ 23,4 meses. El 43,7 por ciento presentaba epilepsia criptogénica, el 28,5 por ciento, sintomática, y el 28,5 por ciento, idiopática. El EEG fue patológico en el 53,8 por ciento de los pacientes y la neuroimagen, en el 43,6 por ciento. Tras la introducción de la LTG, el 33 por ciento de los pacientes quedó libre de crisis, el 43,6 por ciento mejoró, en el 18,3 por ciento de ellos fue ineficaz y el 5,1 por ciento empeoró. El 56,4 por ciento abandonó el tratamiento: el 23,1 por ciento por control insuficiente de las crisis, el 17,9 por ciento por efectos secundarios y el 15,4 por ciento por incumplimiento terapéutico. Conclusión. El tratamiento con LTG logra una alta eficacia en el control de las crisis en los pacientes con epilepsia refractaria, si bien está limitado por una elevada tasa de abandonos terapéuticos (AU)

Introduction. Lamotrigine (LTG) is a new antiepileptic drug indicated in all kinds of partial and generalised clonic-tonic seizures, both in monotherapy and polytherapy. Between 20 and 30% of epileptic patients have poor control over their seizures despite adequate treatment. Aims. We report on our experience regarding the long-term efficacy and tolerability of LTG in refractory seizures. Patients and methods. We conducted a consecutive 10-year study of patients who began LTG therapy following poor control of their seizures, in spite of being treated with two or more antiepileptic drugs in monotherapy or in combination. Both their epidemiological and clinical data were collected for study. We studied the efficacy of the treatment, differentiating between remission (absence of seizures), improvement (reduction > 50% of the seizures), inefficacy (reduction < 50%), exacerbation (increase in seizures) and its tolerability (side effects and dropout). Results. In all, data was collected from 39 patients, 18 males (46.2%), mean age 30.9 ± 13.7 years; mean follow-up time: 27.6 ± 23.4 months. 43.7% presented cryptogenic epilepsy, in 28.5% it was symptomatic and in the remaining 28.5% it was idiopathic. EEG readings and neuroimaging scans were pathological in 53.8% and 43.6%, respectively. After beginning therapy with LTG, 33% remained free of seizures, 43.6% improved, in 18.3% it was seen to be ineffective and 5.1% got worse. Dropout rate was 56.4%: 23.1% due to insufficient control over the seizures, 17.9% owing to side effects and 15.4% because of non-compliance. Conclusion. Treatment with LTG offers a high degree of efficacy in the control of seizures in patients with refractory epilepsy, although it is limited by a high dropout rate (AU)