[Epidemiology of multiple sclerosis in Spain]. / Epidemiologia de la esclerosis multiple en España.

INTRODUCTION: Multiple sclerosis is a chronic autoimmune, inflammatory and neurodegenerative disease of the central nervous system and the most common non-traumatic disabling neurological disease in young adults. In the latest decades, multiple sclerosis is increasing worldwide, especially in women. The latitudinal distribution has been progressively attenuated. AIM: To review the epidemiological studies of multiple sclerosis in Spain to verify if this worldwide trend also occurs in Spain. DEVELOPMENT: We searched PubMed and Teseo databases using the search terms «epidemiology¼, «prevalence¼, «incidence¼, «multiple sclerosis¼ and «Spain¼. We selected articles published in Spanish and English between 1968 and 2018. CONCLUSIONS: Recent epidemiological studies confirm that Spain is a medium-high risk area for MS. The prevalence of MS has increased significantly throughout Spain in the latest years, especially in women, and recent studies show prevalence as high as 80-180 cases per 100,000.

TITLE: Epidemiologia de la esclerosis multiple en España.Introduccion. La esclerosis multiple es una enfermedad cronica autoinmune, inflamatoria y degenerativa del sistema nervioso central, y es el trastorno neurologico discapacitante no traumatico mas comun en adultos jovenes. Los estudios de prevalencia mas recientes indican que la frecuencia de la enfermedad ha aumentado en el mundo en las ultimas decadas, que dicho incremento de la prevalencia ocurre fundamentalmente a expensas de un mayor numero de casos de mujeres con formas remitentes, y que el gradiente latitudinal de la incidencia de la enfermedad se viene atenuando. Objetivo. Revisar los estudios sobre epidemiologia de esclerosis multiple en España para verificar si las tendencias mundiales se confirman en nuestro pais. Desarrollo. Busqueda bibliografica en las bases de datos PubMed y Teseo usando como palabras clave «epidemiology¼, «prevalence¼ e «incidence¼, cruzandolas con los terminos «multiple sclerosis¼ y «Spain¼; se realiza una seleccion inicial por titulo y resumen, en castellano e ingles, entre los años 1968 y 2018. Conclusiones. Un buen numero de estudios epidemiologicos recientes en España confirman que es una region de prevalencia media-alta de la enfermedad a lo largo de su geografia. Las cifras de prevalencia aumentan progresivamente a lo largo de las ultimas decadas hasta alcanzar en la actualidad 80-180 casos por 100.000 habitantes, y ello ha ocurrido a expensas de una mayor frecuencia de la enfermedad en las mujeres.

[Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in the province of Alicante]. / Fingolimod: efectividad y seguridad en la practica clinica habitual. Estudio observacional, retrospectivo y multicentrico en la provincia de Alicante.

INTRODUCTION: Post-authorisation studies are important to confirm whether the outcomes of clinical trials are reproduced in usual clinical practice. AIMS: To evaluate the effectiveness and safety of fingolimod in clinical practice in the province of Alicante. PATIENTS AND METHODS: A retrospective multi-centre study was conducted with remitting multiple sclerosis patients treated with fingolimod. Demographic, clinical and pharmacological data were collected. We report on the effectiveness of the drug -annualised relapse rate (ARR) and percentage of patients free from attacks- at one and at two years after treatment in relation to the previous year, and data concerning side effects are also provided. RESULTS: The sample consisted of 89 patients. Previous treatment was with immunomodulators (interferon beta or glatiramer acetate) in 54 patients and natalizumab in 32. Fifty patients changed due to failure with the immunomodulator and 31 owing to positive serology for JC virus (JCV+). Overall ARR decreased by 67.3% the first year (p < 0.0001) and by 84.1% the second (p = 0.0078). It diminished in patients with immunomodulator failure (85.6% the first year, p < 0.0001; 88.9% the second year, p = 0.0039) and increased in a non-significant manner in JCV+ patients in the first year. The percentage of patients free from relapses in the overall population increased from 32.6% to 68.1% in the first year (p < 0.0019) and to 82.6% in the second (p = 0.0215). This increase was not observed in JCV+ patients. Side effects were reported by 13 patients, which led to the drug being withdrawn in two of them. CONCLUSION: In clinical practice in the province of Alicante, levels of effectiveness and safety of fingolimod proved to be slightly higher than those found in clinical trials.

TITLE: Fingolimod: efectividad y seguridad en la practica clinica habitual. Estudio observacional, retrospectivo y multicentrico en la provincia de Alicante.Introduccion. Los estudios postautorizacion son importantes para confirmar si los resultados de los ensayos clinicos se reproducen en la practica clinica habitual. Objetivo. Evaluar la efectividad y seguridad del fingolimod en la practica clinica en la provincia de Alicante. Pacientes y metodos. Estudio multicentrico retrospectivo de pacientes con esclerosis multiple remitente tratados con fingolimod. Se recogen las caracteristicas demograficas, clinicas y farmacologicas. Se describe la efectividad del farmaco ­tasa anualizada de brotes (TAB) y porcentaje de pacientes libres de brotes­ al año y a los dos años de tratamiento en relacion con el año previo y datos de efectos secundarios. Resultados. Se incluyo a 89 pacientes. El tratamiento previo fue inmunomodulador (interferon beta o acetato de glatiramero) en 54 pacientes y natalizumab en 32. Cincuenta pacientes cambiaron por fracaso con el inmunomodulador y 31 por serologia positiva del virus JC (VJC+). La TAB global disminuyo el 67,3% el primer año (p < 0,0001) y el 84,1% el segundo (p = 0,0078). Disminuyo en los pacientes con fracaso del inmunomodulador (el 85,6% el primer año, p < 0,0001; el 88,9% el segundo año, p = 0,0039) y aumento de forma no significativa en los pacientes VJC+ en el primer año. El porcentaje de pacientes libres de brotes en la poblacion global aumento del 32,6 al 68,1% en el primer año (p < 0,0019) y al 82,6% en el segundo (p = 0,0215). Este aumento no se observo en los pacientes VJC+. Trece pacientes tuvieron efectos secundarios, que obligaron a la retirada del farmaco en dos de ellos. Conclusion. En la practica clinica de la provincia de Alicante, el fingolimod mostro una efectividad y una seguridad ligeramente superiores a las de los ensayos clinicos.

[Co-authorship and collaboration networks in Spanish research into multiple sclerosis (1996-2010)]. / Coautoria y redes de colaboracion en la investigacion española sobre esclerosis multiple (1996-2010).

INTRODUCTION. Scientific collaboration is vital for to the advance of knowledge and is especially important in health sciences. The aim of this study is to identify scientific collaboration indicators and co-authorship networks of researchers and Spanish institutions that publish on multiple sclerosis (MS) during the period 1996-2010. MATERIALS AND METHODS. The analyzed papers were obtained from Web of Science and Scopus international databases, and IBECS and IME national databases, applying specific search profiles in each one of them. In order to identify collaboration networks all signed papers were quantified and co-authored measures were obtained, as the different indexes, degree, intermediation and closeness. RESULTS. 1,613 articles were published in the period 1996-2010, 92% of them in collaboration. With 10 or more works signed in collaboration, 20 Spanish research groups in MS were identified. 64.23% of the papers were published in collaboration between Spanish institutions, and 33.85% were in collaboration with foreign institutions. The institutional participation analysis has identified a large network of institutional partnerships that integrates 27 institutions, with the Hospital Vall d'Hebron in a central position. International collaboration is headed by the U.S. and European countries, most notably the UK and Italy. CONCLUSION. The most collaborative authors, institutions, and work groups in Spanish research in MS have been identified. Despite these indicators that characterize the collaboration in this area, it is necessary to enhance cooperation between them, since this collaboration is positively related to the quality and impact of research and publications.

TITLE: Coautoria y redes de colaboracion en la investigacion española sobre esclerosis multiple (1996-2010).Introduccion. La colaboracion cientifica es fundamental para el avance del conocimiento y es especialmente importante en ciencias de la salud. El objetivo de este trabajo es identificar los indicadores de colaboracion cientifica y las redes de coautoria de los investigadores e instituciones españolas que publican sobre esclerosis multiple (EM) durante el periodo 1996-2010. Materiales y metodos. Los trabajos objeto de estudio se han obtenido de las bases de datos internacionales Web of Science y Scopus, y nacionales IME e IBECS, aplicando perfiles de busqueda especificos en cada una de ellas. Se cuantificaron todos los trabajos firmados en coautoria y se obtuvieron como medidas del analisis estructural el grado, indice de intermediacion e indice de cercania. Resultados. Durante el periodo 1996-2010 se publicaron 1.613 articulos, de los que el 92% se realizo en colaboracion. Aplicando un umbral de 10 o mas trabajos firmados en colaboracion, se han identificado 20 grupos de investigacion españoles en EM. La mayor parte de los trabajos (64,23%) se ha publicado en colaboracion entre instituciones españolas, y el 33,85%, en colaboracion con extranjeras. El analisis de la participacion institucional ha permitido identificar un gran nucleo o red de relaciones de colaboracion institucional que integra 27 instituciones, en la que ocupa un lugar central el Hospital Vall d'Hebron. La colaboracion internacional esta encabezada por Estados Unidos y paises europeos como Reino Unido e Italia. Conclusion. A pesar de la bonanza de los indicadores de colaboracion que los caracterizan, es necesario potenciar la colaboracion entre autores, instituciones y grupos de trabajo, ya que esta se relaciona positivamente con la calidad e impacto de la investigacion y de las publicaciones medidos a traves de las citas.

Switching from natalizumab to fingolimod: an observational study.

BACKGROUND: Multiple sclerosis patients who discontinue using natalizumab are at risk of a rebound in disease activity. However, the optimal alternative therapy is not currently known. AIMS OF THE STUDY: We report on clinical and MRI data and patient safety in a group of relapsing-remitting multiple sclerosis patients who tested seropositive for the JC virus and who have switched from natalizumab to fingolimod because of concerns regarding PML risks. METHODS: The test for JC virus antibodies was performed in 18 relapsing-remitting multiple sclerosis patients who were being treated with natalizumab for more than 1 year. Eight seropositive patients switched to fingolimod while the seronegative patients continued with natalizumab. RESULTS: After switching to fingolimod, five of eight patients (63%) experienced clinical relapses, and MRI activity was detected in six of eight patients (75%). Neither clinical relapses nor MRI activity was observed in the patients who continued with natalizumab. No serious adverse effects were detected. CONCLUSIONS: Natalizumab is an effective treatment for relapsing-remitting multiple sclerosis, but its discontinuation continues to be a complex problem. All of the therapies tried thus far, including fingolimod, have been unable to control the reactivation of the disease. Further studies addressing alternative therapies after natalizumab discontinuation are necessary.

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

[The role of platybasia in trigeminal neuralgia]. / Influencia de la platibasia en la neuralgia del trigémino.

INTRODUCTION: The vascular compression of a nerve is known to be the most important cause of idiopathic trigeminal neuralgia (ITN) by most authors. However, several cases of skull base deformities in patients with ITN have been reported in our bibliographic review. AIM. To compare the existence of platybasia between a group of patients with ITN and a randomized control group. SUBJECTS AND METHODS: Twenty-five patients with ITN and twenty-five control subjects were X-rayed and their basal angles were measured and compared. RESULTS: The basal angle measured to investigate the existence of platybasia is significantly greater in the ITN group than in the control group. Platybasia was found in 10 patients with ITN. However, only two cases of platybasia were reported in the control group. Therefore in our study we have found that the incidence of platybasia in patients with ITN is significantly increased. CONCLUSION: Our data demonstrated that platybasia has an important role in the pathogenesis of the ITN by altering the normal anatomy of the nerves and vessels within the posterior fossa.

Síndrome radiológico aislado / Radiologically isolated syndrome

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Influencia de la platibasia en la neuralgia del trigémino / The role of platybasia in trigeminal neuralgia

Resumen. Introducción. La gran mayoría de autores considera que la neuralgia del trigémino idiopática (NTI) está causada por la compresión de un vaso sobre el nervio. Sin embargo, en la bibliografía se recogen algunos casos de neuralgia del trigémino asociados a deformidades de la base del cráneo, entre las cuales se encuentra la platibasia. Objetivo. Investigar la influencia de un tipo de deformidad de la base del cráneo, la platibasia, en la etiopatogenia de la compresión vascular que se considera causante de la NTI. Sujetos y métodos. Se realizan radiografías laterales de cráneo a 25 pacientes con diagnóstico de NTI, así como a 25 controles sanos para medir el ángulo basal y compararlos. Resultados. El ángulo basal medido para investigar la existencia de platibasia fue significativamente mayor en el grupo con NTI, aunque la platibasia estaba presente en sólo 10 pacientes. Sólo dos controles mostraban dicha deformidad. Por tanto, la diferencia de incidencia en platibasia entre ambos grupos de pacientes fue estadísticamente significativa. Conclusión. Los datos obtenidos en nuestro trabajo apoyan la teoría de que la platibasia influye en la etiopatogenia de la NTI, probablemente al alterar la disposición habitual de las estructuras vasculonerviosas alojadas en la fosa posterior (AU)

Summary. Introduction. The vascular compression of a nerve is known to be the most important cause of idiopathic trigeminal neuralgia (ITN) by most authors. However, several cases of skull base deformities in patients with ITN have been reported in our bibliographic review. Aim. To compare the existence of platybasia between a group of patients with ITN and a randomized control group. Subjects and methods. Twenty-five patients with ITN and twenty-five control subjects were X-rayed and their basal angles were measured and compared. Results. The basal angle measured to investigate the existence of platybasia is significantly greater in the ITN group than in the control group. Platybasia was found in 10 patients with ITN. However, only two cases of platybasia were reported in the control group. Therefore in our study we have found that the incidence of platybasia in patients with ITN is significantly increased. Conclusion. Our data demonstrated that platybasia has an important role in the pathogenesis of the ITN by altering the normal anatomy of the nerves and vessels within the posterior fossa (AU)

Utilización de levetiracetam intravenoso en un hospital general / The Use of intravenous levetiracetam in a general hospital

Introducción y objetivos. Aunque la vía oral es la forma habitual de administración de los fármacos antiepilépticos, en ciertas ocasiones se requiere la vía parenteral. El levetiracetam es el único de los nuevos fármacos antiepilépticos con posibilidad de administración por vía intravenosa. Se presenta un estudio de utilización de levetiracetam intravenoso en un hospital general, con evaluación de su eficacia y seguridad. Pacientes y métodos. Se analizaron de forma retrospectiva las historias clínicas de todos los pacientes ingresados en el hospital que fueron tratados con levetiracetam intravenoso durante el período de tiempo comprendido entre julio de 2007 y mayo de 2008. Resultados. Un total de 53 pacientes fue tratado con levetiracetam intravenoso. Aproximadamente la mitad de los pacientes (47%) había estado ingresada a cargo del servicio de neurología, seguido del servicio de neurocirugía (21%) y oncología (9%). La edad media fue de 52,2 años (rango: 9-87 años) y el 40% eran mujeres. Las crisis fueron sintomáticas en el 81%, y las etiologías más frecuentes fueron los ictus (40%) y los tumores cerebrales (33%). La presentación clínica más frecuente fueron las crisis epilépticas repetidas (47,2%) y el estado epiléptico (26,4%). Globalmente, el control de las crisis se consiguió en el 87% de los pacientes. No se detectaron efectos adversos graves atribuibles al tratamiento con levetiracetam. Conclusiones. El levetiracetam intravenoso parece ser un fármaco antiepiléptico eficaz y seguro en pacientes hospitalizados, especialmente en aquéllos que presentan comorbilidad asociada y/o plurimedicación (AU)

Introduction and aims. Although antiepileptic drugs are usually administered orally, sometimes they must be given intravenously. Levetiracetam is the only one of the new antiepileptic drugs that can be administered intravenously. In this study we report on the use of intravenous levetiracetam in a general hospital, while also evaluating its effectiveness and safety. Patients and methods. A retrospective analysis was conducted of the medical records of all hospital admissions that were treated with intravenous levetiracetam between July 2007 and May 2008. Results. A total of 53 patients were treated with intravenous levetiracetam. Approximately half the patients (47%) had been admitted to neurology, followed by neurosurgery (21%) and oncology (9%). The mean age was 52.2 years (range: 9-87 years) and 40% were females. Seizures were symptomatic in 81% of cases and the most common aetiologies were strokes (40%) and brain tumours (33%). The most frequent presenting symptoms were repeated epileptic seizures (47.2%) and epileptic status (26.4%). Overall, control of seizures was achieved in 87% of patients. No severe side-effects that could be attributed to levetiracetam therapy were detected. Conclusions. Intravenous levetiracetam seems to be an effective, safe antiepileptic drug in hospitalised patients, and especially so in those who present an associated comorbidity and/or who are on multiple drug therapy (AU)

[The use of intravenous levetiracetam in a general hospital]. / Utilización de levetiracetam intravenoso en un hospital general.

INTRODUCTION AND AIMS: Although antiepileptic drugs are usually administered orally, sometimes they must be given intravenously. Levetiracetam is the only one of the new antiepileptic drugs that can be administered intravenously. In this study we report on the use of intravenous levetiracetam in a general hospital, while also evaluating its effectiveness and safety. PATIENTS AND METHODS: A retrospective analysis was conducted of the medical records of all hospital admissions that were treated with intravenous levetiracetam between July 2007 and May 2008. RESULTS: A total of 53 patients were treated with intravenous levetiracetam. Approximately half the patients (47%) had been admitted to neurology, followed by neurosurgery (21%) and oncology (9%). The mean age was 52.2 years (range: 9-87 years) and 40% were females. Seizures were symptomatic in 81% of cases and the most common aetiologies were strokes (40%) and brain tumours (33%). The most frequent presenting symptoms were repeated epileptic seizures (47.2%) and epileptic status (26.4%). Overall, control of seizures was achieved in 87% of patients. No severe side-effects that could be attributed to levetiracetam therapy were detected. CONCLUSIONS: Intravenous levetiracetam seems to be an effective, safe antiepileptic drug in hospitalised patients, and especially so in those who present an associated comorbidity and/or who are on multiple drug therapy.

[Approximation to the impact of biomedical journals in neurological sciences: study of bibliometric indicators in the Journal Citation Reports-Science Citation Index 2006]. / Aproximacion al 'impacto' de las revistas biomedicas en ciencias neurologicas: estudio de los indicadores bibliometricos en el Journal Citation Reports-Science Citation Index 2006.

INTRODUCTION: Neurological sciences form a multidisciplinary field that produces a wide range of scientific journals. The aim of this study was to perform a scientometric analysis of neurological science journals in the 2006 Journal Citation Reports-Science Citation Index (JCR-SCI) edition. MATERIALS AND METHODS: We study the three areas dedicated to neurological sciences (Neurosciences, Clinical Neurology and Neuroimaging) in the 2006 JCR-SCI edition. Bibliometric indicators used are: journals, articles, citations, impact factor (IF), immediacy index, half life and journals with the greatest IF in each specialty. We also perform a special analysis of Spanish neurological journals in JCR-SCI. RESULTS: In the area of Neurosciences we find a total of 200 journals, 27.157 articles, 1.109.784 citations and an average IF of 2,446, the greatest IF belonging to Annu Rev Neurosci (28,533) and Nat Rev Neurosci (23,054); Spanish journals: Neurocirugia and Acta Esp Psiquiatr. The area of Clinical Neurology contains 147 journals, 18.114 articles, 540.364 citations and an average IF of 1,848, the greatest IF belonging to Lancet Neurol (9,479) and Ann Neurol (8,051); Spanish journals: Neurologia and Rev Neurol. The area of Neuroimaging contains 13 journals, 1.747 articles, 49.210 citations and an average IF of 1,298, the greatest IF belonging to Neuroimage (5,559) and Hum Brain Mapp (4,888). CONCLUSIONS: We found out a broad representation of neurological journals from the 6,166 journals included in the 2006 JCR-SCI edition. Bibliometric characteristics differ in accordance to the clinical (Clinical Neurology) or experimental (Neurosciences) nature of the area. Even though bibliometric indicators for the four Spanish neurological journals have gradually improve over the previous 5 years, they are still proportionally ranked low in JCR-SCI. Due to significant limitations observed in the IF, we suggest conducting its analysis from a multidimensional bibliometric perspective, and always within its contextual research area.

Trastorno del sueño asociado al tratamiento con rimonabant / Sleep disorders associated with treatment with rimonabant

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[Coauthorship networks and institutional collaboration in Revista de Neurología]. / Redes de coautoría y colaboración institucional en Revista de Neurología.

INTRODUCTION: Scientific cooperation is essential for the advance of science. Bibliometrics and social network analysis offer evaluation indicators to analyse collaboration in scientific papers. The aim of this study is to characterize scientific collaboration patterns in Revista de Neurología between 2002 and 2006. MATERIALS AND METHODS: Coauthorships and institutional relationships of papers published in Revista de Neurología have been identified. Collaboration Index, the most productive authors' and institutional collaboration patterns and the types of institutional collaborations have been quantified. Also, it has been constructed the coauthorship networks and the institutional collaboration network. Networks have been identified and represented using Access and Pajek software tools. RESULTS: The Collaboration Index was 4.01. 56.54% of papers involved institutional collaboration. The collaboration between institutions of the same country prevails (52.7%), followed by collaborations between departments, services or units of the same institution (40.47%) and international collaboration (6.83%). 45 coauthorship networks involving 149 investigators with a high intensity of collaboration and a large institutional network involved 80 centres were observed. CONCLUSIONS: Revista de Neurología covers scientific production of a high number of research groups. It has been observed a positive evolution in the collaboration patterns over the time. Nevertheless, it is essential to encourage inter-regional and international collaboration.

[Lumbar puncture: its indications, contraindications, complications and technique]. / Punción lumbar: indicaciones, contraindicaciones, complicaciones y técnica de realización.

INTRODUCTION: Although first described over 100 years ago, lumbar puncture is still an important tool in the diagnosis of neurological diseases. In this article we review its indications, contraindications, the technique for carrying it out, the analysis of the cerebrospinal fluid and possible complications. DEVELOPMENT: The lumbar puncture has diagnostic and therapeutic indications. The chief diagnostic indications include infectious, inflammatory and neoplastic diseases affecting the central nervous system. Complications are infrequent, except for headaches and low back pain, but can be severe. Analysis of the cerebrospinal fluid must include a cell count and determination of the glucose and protein concentrations. The other analytical studies of cerebrospinal fluid must be conducted according to the diagnostic suspicion. CONCLUSION: The lumbar puncture in expert hands is a safe test. The health professional should be suitably familiar with its contraindications, the regional anatomy and the technique used to perform it.

Punción lumbar: indicaciones, contraindicaciones, complicaciones y técnica de realización / Lumbar puncture: Its indications, conraindications, complications and technique

Aunque se describió hace más de 100 años, la punción lumbar continúa siendo una importante herramientadiagnóstica en las enfermedades neurológicas. En este artículo se revisan sus indicaciones, contraindicaciones, técnica de realización, análisis del líquido cefalorraquídeo y posibles complicaciones. Desarrollo. La punción lumbar tiene indicacionesdiagnósticas y terapéuticas. Las principales indicaciones diagnósticas incluyen enfermedades infecciosas, inflamatorias y neoplásicas que afectan al sistema nervioso central. Las complicaciones, con la excepción de la cefalea y la lumbalgia, son infrecuentespero pueden ser graves. El análisis del líquido cefalorraquídeo debe incluir un conteo celular y la determinación de la concentración de glucosa y proteínas. El resto de los estudios analíticos en el líquido cefalorraquídeo debe realizarse en funciónde la sospecha diagnóstica. Conclusión. La punción lumbar en manos expertas es una prueba segura. Es necesario conocer adecuadamente sus contraindicaciones, la anatomía regional y su técnica de realización

Although first described over 100 years ago, lumbar puncture is still an important tool in thediagnosis of neurological diseases. In this article we review its indications, contraindications, the technique for carrying it out, the analysis of the cerebrospinal fluid and possible complications. Development. The lumbar puncture has diagnostic andtherapeutic indications. The chief diagnostic indications include infectious, inflammatory and neoplastic diseases affecting the central nervous system. Complications are infrequent, except for headaches and low back pain, but can be severe. Analysisof the cerebrospinal fluid must include a cell count and determination of the glucose and protein concentrations. The other analytical studies of cerebrospinal fluid must be conducted according to the diagnostic suspicion. Conclusion. The lumbar puncture in expert hands is a safe test. The health professional should be suitably familiar with its contraindications, the regional anatomy and the technique used to perform it

[Gender analysis of papers published in Revista de Neurología (2002-2006)]. / Análisis de género de los artículos publicados en Revista de Neurología durante el quinquenio 2002-2006.

INTRODUCTION: There is an ongoing interest in the society in promoting gender equality and in women integration in research activities. The purpose of this work is to identify from a gender perspective the bibliometric characteristics of articles published in Revista de Neurología journal during the 2002-2006 period. MATERIALS AND METHODS: Records were obtained from Science Citation Index database of ISI-Thomson platform. The following indicators were determined, disaggregated by gender: year of publication, type of document, number and order of signatures, number of collaborators, signature/papers index and in the institutional and geographical level. RESULTS: 4527 authors were identified, 2614 (57.74%) men and 1913 (42.,26%) women. The highest women's participation took place in original articles (39.01% of signatures). 44.5% of authors with one published article were women, while 'big women producers' (those with more than 9 articles) only were 16.67%. A greater productivity in men and a greater rate of collaboration in women has been detected. CONCLUSIONS: Scientific activity studies disaggregated by gender give an essential information in order to establish the basis of a scientific policy for promoting the woman as researcher. The evolution in the number of female authors in Revista de Neurología journal does not present an aiming growth to reach the parity in the next years. A low presence of women in positions of high productivity has been detected, whose causes should be identified.