[Clinical experience in the treatment of motor fluctuations in Parkinson's disease. Delphi consensus of a group of experts in movement disorders]. / Experiencia clínica en el tratamiento de las fluctuaciones motoras en la enfermedad de Parkinson. Consenso Delphi de un grupo de expertos en trastornos del movimiento.

INTRODUCTION: Motor fluctuations are one of the most common complications of Parkinson's disease and their treatment is still a complex matter. Therefore, from the Neurology Movement Disorders Group we present our clinical experience in the treatment of these complications, with the intention of it being useful in decision-making in daily clinical practice. DEVELOPMENT: Nineteen questions were developed based on a literature review and an open survey answered by members of this group. These issues were discussed in two phases, using the Delphi methodology. Considering the results of the survey, levodopa dose adjustment and dopamine agonists are the option with the best efficacy/tolerability ratio in the treatment of motor fluctuations. Rotigotine is useful in the motor fluctuations associated with gastroparesis, and intermittent subcutaneous apomorphine has positive effects in patients with unpredictable off periods. The most relevant adverse effect associated with dopamine agonists is impulse control disorder. Catechol-O-methyltransferase inhibitors are useful in the initial stages of motor fluctuations, especially in wearing off. Monoamine oxidase inhibitors are generally drugs that are well-tolerated and useful in motor fluctuations. If these measures are not effective, second-line treatments should be indicated on a case-by-case basis. CONCLUSION: The clinical profile of patients with Parkinson's disease is paramount in deciding the most appropriate therapy for the treatment of motor fluctuations.

TITLE: Experiencia clínica en el tratamiento de las fluctuaciones motoras en la enfermedad de Parkinson. Consenso Delphi de un grupo de expertos en trastornos del movimiento.Introducción. Las fluctuaciones motoras son una de las complicaciones más frecuentes en la enfermedad de Parkinson y su tratamiento sigue siendo complejo. Por ello, desde el Grupo de Trastornos del Movimiento de la Asociación Madrileña de Neurología presentamos nuestra experiencia clínica en el tratamiento de estas complicaciones, con la intención de que sea de utilidad en la toma de decisiones en la práctica clínica diaria. Desarrollo. Se elaboraron 19 preguntas a partir de una revisión bibliográfica y una encuesta abierta respondida por los miembros de dicho grupo. Dichas cuestiones se debatieron en dos fases, utilizando la metodología Delphi. Considerando los resultados de la encuesta, el ajuste de la dosis de levodopa y los agonistas dopaminérgicos son la opción con mejor relación eficacia/tolerabilidad en el tratamiento de las fluctuaciones motoras. La rotigotina es útil en las fluctuaciones motoras asociadas a gastroparesia, y la apomorfina subcutánea intermitente, en pacientes con off impredecible. El efecto adverso más relevante asociado a los agonistas dopaminérgicos es el trastorno del control de impulsos. Los inhibidores de la catecol-O-metiltransferasa son útiles en las fluctuaciones motoras de inicio, especialmente en el wearing off. Los inhibidores de la monoaminooxidasa son fármacos, en general, bien tolerados y útiles en las fluctuaciones motoras. En caso de que estas medidas no resulten eficaces, se deben indicar terapias de segunda línea de manera individualizada. Conclusión. El perfil clínico del paciente con enfermedad de Parkinson es primordial para decidir la terapia más adecuada en el tratamiento de las fluctuaciones motoras.

Antidepresivos en la enfermedad de Parkinson. Recomendaciones del grupo de trastornos del movimiento de la Asociación Madrileña de Neurología / Antidepressants in Parkinson's disease. Recommendations by the movement disorder study group of the Neurological Association of Madrid

INTRODUCCIÓN: El uso de antidepresivos está muy extendido en la enfermedad de Parkinson (EP), aunque existen pocos estudios de calidad que aclaren su eficacia. DESARROLLO: La metodología para esta guía clínica se ha basado en la revisión de la literatura y en la opinión de consenso del grupo de trastornos del movimiento de la AMN, recogida mediante una encuesta. CONCLUSIONES: Según la evidencia científica, nortriptilina, venlafaxina, paroxetina o citalopram podrían ser utilizados en el tratamiento de la depresión en la EP, aunque paroxetina y citalopram con resultados contradictorios. Sin embargo, en la práctica clínica, los inhibidores selectivos de la recaptación de serotonina suelen ser los fármacos de primera elección. Por otro lado, aunque con menor evidencia, duloxetina podría ser una alternativa a venlafaxina y la asociación de venlafaxina con mirtazapina podría ser útil en casos refractarios. Además, podemos considerar el uso de citalopram para la ansiedad, atomoxetina para el tratamiento de la hipersomnia diurna, trazodona y mirtazapina para el tratamiento del insomnio y la psicosis, y bupropión para el tratamiento de la apatía. En general, los antidepresivos son fármacos bien tolerados en la EP. No obstante, es necesario considerar el efecto anticolinérgico de los tricíclicos, el efecto sobre la presión arterial de los inhibidores de la recaptación de serotonina y noradrenalina, la capacidad de los antidepresivos para desarrollar síntomas extrapiramidales y tener precaución con la asociación de inhibidores de la monoaminooxidasa B

INTRODUCTION: Although antidepressants are widely used in Parkinson's disease (PD), few well-designed studies to support their efficacy have been conducted. DEVELOPMENT: These clinical guidelines are based on a review of the literature and the results of an AMN movement disorder study group survey. CONCLUSIONS: Evidence suggests that nortriptyline, venlafaxine, paroxetine, and citalopram may be useful in treating depression in PD, although studies on paroxetine and citalopram yield conflicting results. In clinical practice, however, selective serotonin reuptake inhibitors are usually considered the treatment of choice. Duloxetine may be an alternative to venlafaxine, although the evidence for this is less, and venlafaxine plus mirtazapine may be useful in drug-resistant cases. Furthermore, citalopram may be indicated for the treatment of anxiety, atomoxetine for hypersomnia, trazodone and mirtazapine for insomnia and psychosis, and bupropion for apathy. In general, antidepressants are well tolerated in PD. However, clinicians should consider the anticholinergic effect of tricyclic antidepressants, the impact of serotonin-norepinephrine reuptake inhibitors on blood pressure, the extrapyramidal effects of antidepressants, and any potential interactions between monoamine oxidase B inhibitors and other antidepressants

The high prevalence of impulse control behaviors in patients with early-onset Parkinson's disease: A cross-sectional multicenter study.

INTRODUCTION: In Parkinson's disease patients, impulse control disorders (ICDs) have been associated with younger age and early disease onset, yet the prevalence of ICDs in early-onset Parkinson's disease (EOPD) patients has yet to be studied. Thus, we set out to compare the prevalence of impulse control behaviors (ICBs) in a cohort of EOPD patients with that in age and gender matched healthy controls (HCs), as well as to analyze the association of these symptoms with the use of dopaminergic drugs and other clinical or demographic factors. METHODS: A cross-sectional, multicenter study was carried out on patients recruited from outpatient Movement Disorder Clinics, assessing ICBs using the short form of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP). In addition, depression and quality of life (QoL) were measured, along with other demographic and clinical variables. RESULTS: Of the 87 EOPD patients, 49 (58.3%) displayed an ICB, as did 28 of the 87 HCs (32.9%; p=0.001). Most of the EOPD patients that displayed an ICB (91.8%) were medicated with a dopamine agonist (DA) and accordingly, DA treatment was associated with a 7-fold increased risk of developing an ICB. Patients with ICBs had a higher depression score and a worse QoL. CONCLUSIONS: ICBs are much more prevalent in EOPD patients than in HCs and they are associated with DA intake, depression and a worse QoL.

Antidepressants in Parkinson's disease. Recommendations by the movement disorder study group of the Neurological Association of Madrid. / Antidepresivos en la enfermedad de Parkinson. Recomendaciones del grupo de trastornos del movimiento de la Asociación Madrileña de Neurología.

INTRODUCTION: Although antidepressants are widely used in Parkinson's disease (PD), few well-designed studies to support their efficacy have been conducted. DEVELOPMENT: These clinical guidelines are based on a review of the literature and the results of an AMN movement disorder study group survey. CONCLUSIONS: Evidence suggests that nortriptyline, venlafaxine, paroxetine, and citalopram may be useful in treating depression in PD, although studies on paroxetine and citalopram yield conflicting results. In clinical practice, however, selective serotonin reuptake inhibitors are usually considered the treatment of choice. Duloxetine may be an alternative to venlafaxine, although the evidence for this is less, and venlafaxine plus mirtazapine may be useful in drug-resistant cases. Furthermore, citalopram may be indicated for the treatment of anxiety, atomoxetine for hypersomnia, trazodone and mirtazapine for insomnia and psychosis, and bupropion for apathy. In general, antidepressants are well tolerated in PD. However, clinicians should consider the anticholinergic effect of tricyclic antidepressants, the impact of serotonin-norepinephrine reuptake inhibitors on blood pressure, the extrapyramidal effects of antidepressants, and any potential interactions between monoamine oxidase B inhibitors and other antidepressants.

[Botulinum toxin type A in the treatment of neuropathic pain in a case of postherpetic neuralgia]. / Toxina botulínica tipo A en el tratamiento del dolor neuropático en un caso de neuralgia postherpética.

INTRODUCTION: Botulinum toxin type A has been used in a wide range of neurological diseases such as migraine, cervical dystonia, spasticity or tics. However, the use of this drug in the treatment of neuropathic pain is still uncommon despite the fact that more and more cases supporting its role as an alternative treatment are emerging in the literature. CASE REPORT: Herein, we report a case of an 83 year old woman who suffered from severe pain with neuropathic characteristics due to postherpetic neuralgia which was refractory to different conventional therapies. The neuropathic pain was dramatically improved by multiple botulinum toxin type A injections and the analgesia lasted 2 months. Treatment was well tolerated and there were no side effects. CONCLUSIONS: Using botulinum toxin has been effective and well tolerated in the treatment of postherpetic neuralgia in our patient. Despite the fact that its action mechanisms is still unknown, we consider that botulinum neurotoxin may be an alternative treatment in relieving refractory neuropathic pain and that controlled studies are needed to study this possibility.

[Rotigotine in the treatment of Parkinson's disease. A study on a sample of 150 patients]. / Rotigotina en el tratamiento de la enfermedad de Parkinson. Experiencia sobre una muestra de 150 pacientes.

INTRODUCTION: Rotigotine is a non-ergot dopamine agonist that has become the first treatment for Parkinson's disease formulated as a transdermal release system. Its side effects are very similar to those of other dopamine agonists, as well as those deriving from the site of application, while its advantages include a once-daily administration, the absence of interactions with foods and steady levels in plasma. AIM: To determine the frequency of and reasons for withdrawing rotigotine in 150 consecutive patients diagnosed with Parkinson's disease. PATIENTS AND METHODS: A retrospective analysis was carried out using the database at our Movement Disorders Unit in order to identify the first 150 patients who were treated with rotigotine. Only patients with Parkinson's disease who were free of intracranial lesions, psychiatric pathologies or dementia were eligible for inclusion in the sample. Patients were evaluated before and at two, four and six months after beginning treatment with rotigotine. RESULTS: In all, 85 males and 65 females were identified. A total of 110 of them had previously been treated with dopamine agonists. Although 12% of the patients dropped out, 88% of them continued the treatment. The reasons for withdrawing were worsening of the clinical condition (12 patients), lack of effectiveness (three patients), drowsiness (two patients) and dyskinesias (one patient). CONCLUSIONS: Rotigotine is safe and effective as medication in the treatment of Parkinson's disease. The fact that most of the drop-outs were due to a worsening of the clinical signs and symptoms after changing from another dopamine agonist suggests the need for an equivalence between other agonists and rotigotine.

Rotigotina en el tratamiento de la enfermedad de Parkinson. Experiencia sobre una muestra de 150 pacientes / Rotigotine in the treatment of parkinson’s disease a study on a sample 150 patients

La rotigotina es un agonista dopaminérgico no ergótico que se ha convertido en el primer tratamientode liberación transdérmica utilizado en la enfermedad de Parkinson. Su perfil de efectos secundarios es muy similar al de otros agonistas dopaminérgicos, además de los derivados del sitio de aplicación, mientras que entre sus ventajas se encuentran una sola administración diaria, ausencia de interacciones con alimentos y niveles plasmáticos estables. Objetivo. Determinarla frecuencia y razones de la retirada de rotigotina en 150 pacientes consecutivos diagnosticados de enfermedad de Parkinson. Pacientes y métodos. Se realizó un análisis retrospectivo de la base de datos de nuestra Unidad de Trastornos del Movimiento para identificar a los 150 primeros pacientes tratados con rotigotina. Sólo se incluyeron pacientes con enfermedadde Parkinson sin lesiones intracraneales, patología psiquiátrica ni demencia. Los pacientes fueron evaluados antes y tras dos, cuatro y seis meses de iniciar el tratamiento con rotigotina. Resultados. Se identificó a 85 hombres y 65 mujeres. 110 de ellos habían tomado previamente agonistas dopaminérgicos. El 88% de los pacientes continuó con el tratamiento, mientras que el 12% lo abandonó. Las razones fueron empeoramiento clínico (12 pacientes), falta de eficacia (tres pacientes), somnolencia (dos pacientes) y discinesias (un paciente). Conclusiones. La rotigotina es un fármaco eficaz y bien tolerado en el tratamiento de la enfermedad de Parkinson. El hecho de que la mayoría de los abandonos se debiese a empeoramiento clínico tras el cambio desde otro agonista dopaminérgico sugiere la necesidad de una equivalencia entre otros agonistas y la rotigotina

Rotigotine is a non-ergot dopamine agonist that has become the first treatment for Parkinson’s diseaseformulated as a transdermal release system. Its side effects are very similar to those of other dopamine agonists, as well as those deriving from the site of application, while its advantages include a once-daily administration, the absence of interactions with foods and steady levels in plasma. Aim. To determine the frequency of and reasons for withdrawing rotigotine in 150 consecutive patients diagnosed with Parkinson’s disease. Patients and methods. A retrospective analysis was carried out using the database at our Movement Disorders Unit in order to identify the first 150 patients who were treated with rotigotine. Only patients with Parkinson’s disease who were free of intracranial lesions, psychiatric pathologies or dementia were eligible for inclusion in the sample. Patients were evaluated before and at two, four and six months after beginning treatment with rotigotine. Results. In all, 85 males and 65 females were identified. A total of 110 of them had previously been treated with dopamine agonists. Although 12% of the patients dropped out, 88% of them continued the treatment. The reasons for withdrawing were worsening of the clinical condition (12 patients), lack of effectiveness (three patients), drowsiness (two patients) and dyskinesias (one patient). Conclusions. Rotigotine is safe and effective as medication in the treatment of Parkinson’s disease. The fact that most of the drop-outs were due to a worsening of the clinical signs and symptoms after changing from another dopamine agonist suggests the need for an equivalence between other agonists and rotigotine

[Zonisamide in refractory essential tremor]. / Zonisamida en el temblor esencial refractario.

INTRODUCTION: Essential tremor is one of the most frequent movement disorders. It is characterized by postural and action tremor that may affect different regions of the body. Among current treatments propranolol and primidone are included. However, these two drugs have demonstrated a limited efficacy and several adverse events. Additionally, they are contraindicated in patients with cardiac insufficiency and several respiratory diseases. New antiepileptic drugs are revealing as a possibility in the treatment of this disease. AIM. To evaluate efficacy and tolerability of zonisamide in the treatment of essential tremor. PATIENTS AND METHODS: We perform a retrospective study about 13 patients with essential tremor refractory to an average of 2.8 drugs. Age, sex, zonisamide dosage, adverse events, duration and response to the treatment before and after the treatment were collected and analysed. Average zonisamide dosage was 215 mg/day and average duration of the treatment was 121 days. RESULTS: Nine of 13 patients included in our study experienced a good response. A positive response was understood as a decrease on the limitation of daily activities and an improvement on neurological examination. Zonisamide was well tolerated and no patient abandoned the study for this reason. CONCLUSIONS: Our data suggest that zonisamide is effective and well tolerated in the treatment of essential tremor. Placebo-controlled and bigger studies are warranted to confirm these results.

Zonisamida en el temblor esencial refractario / Zonisamide in refractory essential tremor

El temblor esencial es uno de los trastornos del movimiento más frecuentes, que se caracteriza portemblor postural y de acción, y que puede afectar a distintas regiones del cuerpo. Entre los tratamientos actualmente utilizados se incluyen el propranolol y la primidona. Sin embargo, estos dos fármacos han demostrado una utilidad limitada y marcados efectos secundarios. Además, están contraindicados en pacientes con insuficiencia cardíaca y algunos problemas pulmonares. Los nuevos fármacos antiepilépticos se están revelando como una posibilidad en el tratamiento de esta enfermedad. Objetivo. Evaluar la eficacia y la tolerabilidad de la zonisamida en el tratamiento del temblor esencial. Pacientes y métodos.Se evalúan trece pacientes con temblor esencial refractarios a una media de 2,8 tratamientos de un modo retrospectivo. Se recogierony evaluaron la edad, el sexo, la dosis de zonisamida, los efectos secundarios, la duración y la respuesta al tratamiento. La dosis media utilizada fue de 215 mg/día, y la duración media de seguimiento, de 121 días. Resultados. Nueve de los 13 pacientes experimentaron una buena respuesta clínica, entendida como una menor limitación para llevar a cabo sus actividadesdiarias y/o una mejoría objetiva en la exploración física. Los efectos secundarios fueron leves y ningún paciente abandonó el estudio por este motivo. Conclusiones. Los datos obtenidos sugieren que la zonisamida es eficaz y bien tolerada en eltratamiento del temblor esencial. Son necesarios estudios controlados con placebo y con mayor número de pacientes para confirmar estos resultados

Essential tremor is one of the most frequent movement disorders. It is characterized by postural andaction tremor that may affect different regions of the body. Among current treatments propranolol and primidone are included. However, these two drugs have demonstrated a limited efficacy and several adverse events. Additionally, they are contraindicatedin patients with cardiac insufficiency and several respiratory diseases. New antiepileptic drugs are revealing as a possibility in the treatment of this disease. Aim. To evaluate efficacy and tolerability of zonisamide in the treatment of essentialtremor. Patients and methods. We perform a retrospective study about 13 patients with essential tremor refractory to an average of 2.8 drugs. Age, sex, zonisamide dosage, adverse events, duration and response to the treatment before and after the treatment were collected and analysed. Average zonisamide dosage was 215 mg/day and average duration of the treatmentwas 121 days. Results. Nine of 13 patients included in our study experienced a good response. A positive response was understood as a decrease on the limitation of daily activities and an improvement on neurological examination. Zonisamide was well tolerated and no patient abandoned the study for this reason. Conclusions. Our data suggest that zonisamide iseffective and well tolerated in the treatment of essential tremor. Placebo-controlled and bigger studies are warranted to confirm these results

[Relationship between essential tremor, Parkinson's disease and dementia with Lewy bodies]. / Relación entre temblor esencial, enfermedad de Parkinson y demencia con cuerpos de Lewy.

INTRODUCTION: Although essential tremor (ET), Parkinson's disease (PD) and dementia with Lewy bodies (DLB) are considered to be distinct illnesses, there is a certain overlap between some of their clinical, pathological and genetic features. AIM: To conduct a critical examination of the evidence for and against the association between these three pathological conditions. DEVELOPMENT: The body of evidence supporting the notion of a relation between ET and PD is growing all the time; the same can be said of the fact that a postural tremor may appear years before the onset of other extrapyramidal symptoms, the involvement of common genes in the development of both conditions or the presence of common pathological findings. In addition, it has also been suggested that there are several aspects linking PD and DLB, and it has even been claimed that that they might be part of the clinical spectrum of the same disease. The concept of ET as a benign single-symptom disease has changed in recent years and, since it has been related to cognitive disorders and Lewy bodies in the central nervous system, it is now considered to be a neurodegenerative pathology. CONCLUSIONS. ET, PD and DLB could represent different points on the same clinical spectrum.

Relación entre temblor esencial, enfermedad de Parkinson y demencia con cuerpos de Lewy / Relationship between essential tremor parkinson’s disease and dementia with lewy bodies

Aunque el temblor esencial (TE), la enfermedad de Parkinson (EP) y la demencia con cuerpos deLewy (DCL) se consideran enfermedades distintas, existe un solapamiento entre algunas de sus características clínicas, anatomopatológicas y genéticas. Objetivo. Examinar de forma crítica la evidencia a favor y en contra de la asociación entre estastres patologías. Desarrollo. Las evidencias que apoyan una relación entre el TE y la EP son cada vez mayores, como lo son el hecho de que un temblor postural pueda preceder en años al inicio de otros síntomas extrapiramidales, la implicación de genes comunes en el desarrollo de ambas patologías o la presencia de hallazgos anatomopatológicos comunes. Por otro lado,la EP y la DCL también se han relacionado en varios aspectos, y se ha sugerido incluso que puedan ser parte del espectro clínico de la misma enfermedad. El concepto del TE como enfermedad monosintomática benigna ha cambiado en los últimos años y, al relacionarse con alteraciones cognitivas y cuerpos de Lewy en el sistema nervioso central, se ha llegado a consideraruna patología neurodegenerativa. Conclusiones. El TE, la EP y la DCL podrían ser extremos del mismo espectro clínico

Introduction. Although essential tremor (ET), Parkinson’s disease (PD) and dementia with Lewy bodies (DLB) are considered to be distinct illnesses, there is a certain overlap between some of their clinical, pathological and genetic features.Aim. To conduct a critical examination of the evidence for and against the association between these three pathological conditions. Development. The body of evidence supporting the notion of a relation between ET and PD is growing all the time; the same can be said of the fact that a postural tremor may appear years before the onset of other extrapyramidal symptoms,the involvement of common genes in the development of both conditions or the presence of common pathological findings. In addition, it has also been suggested that there are several aspects linking PD and DLB, and it has even been claimed that that they might be part of the clinical spectrum of the same disease. The concept of ET as a benign single-symptom disease haschanged in recent years and, since it has been related to cognitive disorders and Lewy bodies in the central nervous system, it is now considered to be a neurodegenerative pathology. Conclusions. ET, PD and DLB could represent different points on thesame clinical spectrum

Síndrome de Korsakoff secundario a hemorragia talámica izquierda / Korsakoff's syndrome secondary to left thalamic bleeding

El síndrome de Korsakoff se caracteriza por una importante afectación de la memoria en comparación con otras funciones cognitivas. Es frecuente la presencia de confabulaciones, aunque no son características de este síndrome. Si bien el alcoholismo es la principal causa de este cuadro, se ha descrito asociado a otras causas, desde malnutrición hasta lesiones estructurales. A pesar de ser conocida la importante participación del tálamo en el proceso de la memoria, la presencia de confabulaciones por lesión talámica está poco descrita en la bibliografía. Presentamos un paciente varón de 61 años, hipertenso, que tras sufrir un hematoma talámico izquierdo presenta una alteración importante de la memoria anterógrada, con cierto componente retrógrado, confabulaciones y acalculia. Salvo cierta desorientación temporal, el resto de las funciones cognitivas fueron respetadas. La demencia talámica se produce generalmente por lesiones talámicas bilaterales y suele cursar con afectación de todas las funciones cognitivas. Dada la participación del tálamo en el circuito de Papez, resulta lógico pensar que lesiones en esta estructura o bien en regiones que afecten las conexiones talámicas pueden cursar con afectación de la memoria. Sin embargo, y a pesar de que se ha establecido una relación entre la presencia de confabulaciones y la lesión de las conexiones entre el tálamo y el lóbulo frontal, prácticamente no existe evidencia en la literatura (AU)

Korsakoff's syndrome is characterised by an important impairment in memory in comparison to other cognitive functions. Presence of confabulations is frequent but they are not characteristic of this syndrome. Alcohol abuse is the main cause of this syndrome but it also has been associated to other causes, like malnutrition or structural lesions. Although the role of thalamus in memory processing is well established, the development of confabulations in the setting of a thalamic lesion is poorly described in the literature. We present a 61 year-old hypertensive man, with an important impairment in anterograde memory, confabulations and acalculia after a left thalamic haemorrhage. Other cognitive functions were intact except a partial temporal disorientation. Thalamic dementia is generally caused by bilateral thalamic damage. Usually, all cognitive functions are impaired. As thalamus takes part in Papez's circuit, either thalamic nuclei or their connections lesions may originate memory impairment. However, although a relation between the presence of confabulations and connections from thalamus to frontal lobe lesions has been described, there is almost no evidence in the literatura (AU)

[Korsakoff's syndrome secondary to left thalamic bleeding]. / Síndrome de Korsakoff secundario a hemorragia talámica izquierda.

Korsakoff's syndrome is characterised by an important impairment in memory in comparison to other cognitive functions. Presence of confabulations is frequent but they are not characteristic of this syndrome. Alcohol abuse is the main cause of this syndrome but it also has been associated to other causes, like malnutrition or structural lesions. Although the role of thalamus in memory processing is well established, the development of confabulations in the setting of a thalamic lesion is poorly described in the literature. We present a 61 year-old hypertensive man, with an important impairment in anterograde memory, confabulations and acalculia after a left thalamic haemorrhage. Other cognitive functions were intact except a partial temporal disorientation. Thalamic dementia is generally caused by bilateral thalamic damage. Usually, all cognitive functions are impaired. As thalamus takes part in Papez's circuit, either thalamic nuclei or their connections lesions may originate memory impairment. However, although a relation between the presence of confabulations and connections from thalamus to frontal lobe lesions has been described, there is almost no evidence in the literature.