[Spasticity in neurological pathologies. An update on the pathophysiological mechanisms, advances in diagnosis and treatment]. / Espasticidad en la patología neurológica. Actualización sobre mecanismos fisiopatológicos, avances en el diagnóstico y tratamiento.

INTRODUCTION: Spasticity is a frequent clinical sign in people with neurological diseases that affects mobility and causes serious complications: pain, joint limitation, muscular contractions and bed sores, which have a significant effect on the individual's functionality and quality of life. AIM: To review the integration, description and critical interpretation of the most recent scientific evidence on the clinical variability of spasticity and associated symptoms, the different pathophysiological mechanisms and their relevance in the diagnostic and therapeutic approach. DEVELOPMENT: A search was conducted in the scientific publications on the different aspects of spasticity grouped into two main categories: cerebral and spinal cord pathologies. The epidemiological, clinical and pathophysiological aspects, clinical and instrumental diagnoses, and the physiotherapeutic, pharmacological and surgical approach to spasticity in each group of pathologies were all reviewed. CONCLUSION: Spasticity is related to structural lesions and maladaptive neuroplastic changes that determine an important variability in its clinical expression. Although its diagnosis presents important limitations, the use of clinical and neurophysiological diagnostic tools aimed at achieving different approaches in cases of neurological pathologies originating in the brain and in the spinal cord could optimise the effectiveness of spasticity therapies.

TITLE: Espasticidad en la patología neurológica. Actualización sobre mecanismos fisiopatológicos, avances en el diagnóstico y tratamiento.Introducción. La espasticidad es un signo clínico frecuente en personas con enfermedades neurológicas que afecta a la movilidad y causa graves complicaciones: dolor, limitación articular, contracturas y úlceras por presión, que conllevan una afectación significativa de la funcionalidad del individuo y de su calidad de vida. Objetivo. Revisar la integración, la descripción y la interpretación crítica de la evidencia científica más reciente sobre la variabilidad clínica de la espasticidad y los síntomas asociados, los distintos mecanismos fisiopatológicos y su relevancia en el abordaje diagnóstico y terapéutico. Desarrollo. Se realizó una búsqueda de las publicaciones científicas sobre los distintos aspectos de la espasticidad agrupados en dos categorías magistrales: patologías cerebral y medular; y se revisaron aspectos epidemiológicos, clínicos y fisiopatológicos, el diagnóstico clínico e instrumental, y el abordaje fisioterapéutico, farmacológico y quirúrgico de la espasticidad en cada grupo de patologías. Conclusión. La espasticidad se relaciona con lesiones estructurales y cambios neuroplásticos maladaptativos que determinan una importante variabilidad en su expresión clínica. Aunque su diagnóstico presenta importantes limitaciones, el uso de herramientas de diagnóstico clínico y neurofisiológico encaminadas al abordaje diferencial en las patologías neurológicas de origen cerebral y medular podría optimizar la eficacia de las terapias de la espasticidad.

Hemorragias intracerebrales en pacientes anticoagulados, ¿qué hacemos después? / Intracerebral hemorrhage in anticoagulated patients: What do we do afterwards?

Introducción: El manejo del tratamiento antitrombótico tras una hemorragia intracerebral (HIC) en pacientes anticoagulados no está bien definido. Analizamos los riesgos y beneficios de la antiagregación (AG) frente al reinicio de la anticoagulación con antagonistas de la vitamina K (AVK) en una serie de pacientes. Material-métodos: Estudio retrospectivo de HIC en pacientes anticoagulados. Se registraron datos demográficos, antecedentes de hipertensión arterial, tiempo de seguimiento y nuevo evento vascular cerebral (HIC, infarto cerebral [IC]).Resultados: Se evaluó a 88 pacientes, de edad media 69±9 años, 50% varones, 73% hipertensos. Durante la fase aguda fallecieron 18 pacientes y el seguimiento se perdió en 31. De los restantes (n=39), se reinició AVK en 25 y se cambió a AG en 14. Comparando las características de ambos grupos, el grupo anticoagulado era de menor edad (p=0,005) y las fuentes cardioembólicas eran con mayor frecuencia de alto riesgo (p=0,003). Tras un seguimiento promedio de 54±31 meses, la distribución de eventos fue: IC (grupo AVK 8%, grupo AG 14,3%, p=0,6); HIC (AVK 24%, AG 7.1%, p=0,38); IC o HIC (AVK 32%, AG 21,4%, p=0,48); muerte (AVK 29%, AG 7,1%, p=0,21). Esta tendencia de mayor riesgo de nuevos eventos en pacientes con AVK se confirmó mediante curvas de Kaplan-Meier, aunque sin significación estadística.Conclusiones: El reinicio del tratamiento con AVK tras una HIC en pacientes anticoagulados podría aumentar el riesgo de nuevos eventos hemorrágicos y la mortalidad. Son necesarios estudios prospectivos, para definir mejor el tratamiento antitrombótico idóneo tras una HIC relacionada con la anticoagulación (AU)

Introduction: The management of antithrombotic therapy after intracerebral hemorrhage (ICH) in anticoagulated patients is not well defined. We analyzed the risks and benefits of antiplatelet therapy (AG) against the resumption of anticoagulation with vitamin K antagonists (AVK) in a series of patients. Material and methods: Retrospective study of ICH in anticoagulated patients. We registered demographic data, history of hypertension (HT), time of follow-up and new cerebral vascular events (ICH, stroke [IC]).Results: We evaluated 88 patients, mean age 69±9 years, 50% men, 73% hypertensive. During the acute phase 18 patients died and the follow-up was lost in 31. Of the remaining (n=39), AVKs were resumed in 25 and changed to AG in 14. Comparing the characteristics of both groups, the anticoagulated group was younger (P=.005) and the embolic sources were more often of higher risk (P=.003). After an average follow-up of 54±31 months, the distribution of events was: IC (AVKs 8%, AG 14.3%, P=.6), ICH (AVKs 24%, AG 7.1%, P=.38), IC or ICH (AVKs 32%, AG 21.4%, P=.48) and death (AVKs 29%, AG 7.1%, P=.21). This trend of increased risk of new events in patients with AVKs was confirmed by Kaplan-Meier curves, although without statistical differences.Conclusions: Restarting AVK treatment after ICH in anticoagulated patients could increase the risk of new bleeding events and mortality. Prospective studies are needed to define a better and appropriate antithrombotic therapy after ICH related with anticoagulation (AU)

[Intracerebral hemorrhage in anticoagulated patients: what do we do afterwards?]. / Hemorragias intracerebrales en pacientes anticoagulados, ¿qué hacemos después?

INTRODUCTION: The management of antithrombotic therapy after intracerebral hemorrhage (ICH) in anticoagulated patients is not well defined. We analyzed the risks and benefits of antiplatelet therapy (AG) against the resumption of anticoagulation with vitamin K antagonists (AVK) in a series of patients. MATERIAL AND METHODS: Retrospective study of ICH in anticoagulated patients. We registered demographic data, history of hypertension (HT), time of follow-up and new cerebral vascular events (ICH, stroke [IC]). RESULTS: We evaluated 88 patients, mean age 69±9 years, 50% men, 73% hypertensive. During the acute phase 18 patients died and the follow-up was lost in 31. Of the remaining (n=39), AVKs were resumed in 25 and changed to AG in 14. Comparing the characteristics of both groups, the anticoagulated group was younger (P=.005) and the embolic sources were more often of higher risk (P=.003). After an average follow-up of 54±31 months, the distribution of events was: IC (AVKs 8%, AG 14.3%, P=.6), ICH (AVKs 24%, AG 7.1%, P=.38), IC or ICH (AVKs 32%, AG 21.4%, P=.48) and death (AVKs 29%, AG 7.1%, P=.21). This trend of increased risk of new events in patients with AVKs was confirmed by Kaplan-Meier curves, although without statistical differences. CONCLUSIONS: Restarting AVK treatment after ICH in anticoagulated patients could increase the risk of new bleeding events and mortality. Prospective studies are needed to define a better and appropriate antithrombotic therapy after ICH related with anticoagulation.

Cefalea e inmigración. Estudio en la consulta externa del Hospital de la Santa Creu i Sant Pau de Barcelona / Headache and immigration. A study in the outpatient department of the Hospital de la Santa Creu i Sant Pau in Barcelona

Introducción. La población inmigrante es cada vez más numerosa en la consulta neurológica. No está bien establecido si existen diferencias geográficas en la prevalencia de las cefaleas primarias y la posible influencia de la emigración. Pacientes y métodos. Estudio retrospectivo (12 meses) y prospectivo (18 meses) de las primeras visitas en la Unidad de Cefaleas del Hospital de la Santa Creu i Sant Pau. Identificamos el país de origen, parámetros temporales de la cefalea y de la inmigración, diagnósticos según criterios de la Sociedad Internacional de Cefaleas y tratamientos realizados. Se considera cefalea relacionada la que se inicia en el período de un año tras la inmigración. Resultados. La población inmigrante representa el 13,6% (n = 142) del total de las primeras visitas por cefalea (n = 1.044). Proceden principalmente de Latinoamérica (83,9%). La cefalea comenzó posteriormente a la inmigración en el 40,1% de los casos, sin existir relación temporal con la inmigración. La distribución de los diagnósticos de la cefalea son semejantes a los de la población autóctona; los más frecuentes son migraña (57,7%) y cefalea tensional (15,5%). Al comparar los tratamientos anteriores y posteriores a la inmigración, encontramos diferencias en el uso de triptanes (2,1% frente a 46,2%), ergotamina (9,8% frente a 2,1%) y utilización de tratamientos preventivos (2% frente a 45%). Conclusiones. La población inmigrante representa el 13% de las primeras visitas de cefalea y sus diagnósticos son similares a los de la población autóctona. El hecho de la emigración no es desencadenante ni agravante de la cefalea en nuestra serie. El tratamiento sintomático y preventivo difiere significativamente entre el período anterior a la inmigración y el posterior(AU)

Introduction. The immigrant population (IP) is visiting neurology departments on an increasingly more frequent basis. Research has still not made it clear whether there are geographical differences in the prevalence of primary headaches and the possible influence of emigration. Patients and methods. We conducted a retrospective (12 months) and prospective study (18 months) of the first visits to the Headache Unit at the Hospital de la Santa Creu i Sant Pau. Data collected included the country of birth, time parameters of the headache and of the immigration, diagnoses according to the criteria of the IHS and treatments that had been used. Related headaches were considered to be those that began within one year of having immigrated. Results. The IP represents 13.6% (n = 142) of the total number of first visits because of headaches (n = 1044). Immigrants came mostly from Latin America (83.9%). Headaches began after immigration in 40.1% of cases without the existence of any temporal relation with immigration. The distribution of the diagnoses of headache is similar to those of the local population, the most frequent being migraine (57.7%) and tension-type headache (15.5%). On comparing treatments prior to and following immigration, we find differences in the use of triptans (2.1% versus 46.2%), ergotamine (9.8% versus 2.1%) and in the use of preventive treatments (2% versus 45%). Conclusions. The IP accounts for 13% of all first visits due to headaches and their diagnoses are similar to those of the local population. Emigration is neither a precipitating nor an aggravating factor for headaches in our series. There is a significant difference in symptomatic and preventive treatment between the period prior to immigration and afterwards (AU)

[Headache and immigration. A study in the outpatient department of the Hospital de la Santa Creu i Sant Pau in Barcelona]. / Cefalea e inmigracion. Estudio en la consulta externa del Hospital de la Santa Creu i Sant Pau de Barcelona.

INTRODUCTION: The immigrant population (IP) is visiting neurology departments on an increasingly more frequent basis. Research has still not made it clear whether there are geographical differences in the prevalence of primary headaches and the possible influence of emigration. PATIENTS AND METHODS: We conducted a retrospective (12 months) and prospective study (18 months) of the first visits to the Headache Unit at the Hospital de la Santa Creu i Sant Pau. Data collected included the country of birth, time parameters of the headache and of the immigration, diagnoses according to the criteria of the IHS and treatments that had been used. Related headaches were considered to be those that began within one year of having immigrated. RESULTS: The IP represents 13.6% (n = 142) of the total number of first visits because of headaches (n = 1044). Immigrants came mostly from Latin America (83.9%). Headaches began after immigration in 40.1% of cases without the existence of any temporal relation with immigration. The distribution of the diagnoses of headache is similar to those of the local population, the most frequent being migraine (57.7%) and tension-type headache (15.5%). On comparing treatments prior to and following immigration, we find differences in the use of triptans (2.1% versus 46.2%), ergotamine (9.8% versus 2.1%) and in the use of preventive treatments (2% versus 45%). CONCLUSIONS: The IP accounts for 13% of all first visits due to headaches and their diagnoses are similar to those of the local population. Emigration is neither a precipitating nor an aggravating factor for headaches in our series. There is a significant difference in symptomatic and preventive treatment between the period prior to immigration and afterwards.