Estudio de concordancia diagnóstica en cefalea entre neurología y atención primaria / Study of the diagnostic agreement on headaches between neurology and primary care

Introducción. La cefalea como síntoma es una patología frecuente y uno de los principales motivos de consulta por parte de atención primaria. Objetivo. Analizar las características de los pacientes derivados desde atención primaria a la consulta de neurología general con cefalea o neuralgia como motivo de consulta, y la concordancia diagnóstica. Pacientes y métodos. Estudio descriptivo transversal de todos los pacientes remitidos desde atención primaria; se recogieron variables demográficas/clínicas y se compararon las hipótesis diagnósticas de atención primaria y neurología, determinando su concordancia. Resultados. Se remitieron desde atención primaria 2.514 pacientes (588 de ellos con carácter preferente); en 378 casos el motivo de la consulta fue cefalea o neuralgia (42,46 años de media; el 77,8%, mujeres). En 139 pacientes se estableció tan sólo un diagnóstico semiológico y en el resto predominaron la migraña episódica (49,79%), la cefalea tensional crónica (18,41%) y la neuralgia del trigémino (12,13%). Desde neurología, los diagnósticos más frecuentes fueron, respectivamente, 33,86%, 24,05% y 18,67%. Se obtuvo un coeficiente kappa de 0,543 (p < 0,05), compatible con una concordancia moderada al considerar sólo los pacientes remitidos desde atención primaria con un diagnóstico concreto. Conclusiones. Las cefaleas constituyen un motivo de consulta desde atención primaria muy frecuente (15%). La concordancia diagnóstica es moderada en nuestro sector sanitario, por lo que es necesario diseñar programas de formación que ayuden a perfilar los criterios de derivación al especialista y mejorar la atención a nuestros pacientes (AU)

Introduction. Headache as a symptom is a very common disease and one of the main reasons for consultation in primary care. Aim. To analyze the characteristics of patients referred from primary care to general neurology whose chief complaint was headache and/or neuralgia and diagnostic agreement. Patients and methods. Cross-sectional study of all patients referred from primary care; demographic/clinical variables were collected and diagnostic hypothesis by primary care and general neurology were compared by determining their agreement. Results. 2,514 were referred from primary care patients (588 of them on a preferential basis); in 378 cases the reason for consultation was headache and/or neuralgia (average 42.46 years; 77.8% female). In 139 patients it was established only a semiological diagnostic and other episodic migraine predominated (49.79%), chronic tension headache (18.41%) and trigeminal neuralgia (12.13%). Since general neurology, the most common diagnoses were, respectively, 33.86%, 24.05% and 18.67%. A compatible kappa coefficient of 0.543 (p < 0.05) with a moderate agreement when considering only those patients referred from primary care to a specific diagnosis was obtained. Conclusions. Headaches are a very common reason for consultation in primary care (15%). The diagnostic agreement is moderate in our health sector so it is necessary to design training programs to help outline the criteria for referral to specialists and improve care for our patients (AU)

Rhombencephalitis due to Listeria monocytogenes: A Clinicopathologic Study of a Case.

INTRODUCTION: Central nervous system infections caused by Listeria monocytogenes usually manifest in the form of meningitis or meningoencephalitis, and are more common among immunosuppressed patients. Brainstem encephalitis (rhombencephalitis) is less common and fatal if not recognized and treated early. CASE REPORT: We describe the case of a 40-year-old, immunocompetent male patient, who presented with initial symptoms of high fever and productive cough. Signs of brainstem involvement appeared later. A magnetic resonance imaging of the brain revealed a lesion of inflammatory appearance in the right medulla oblongata, and the cerebrospinal fluid test showed mononuclear pleocytosis. Blood and cerebrospinal fluid cultures were negative. He presented with a significant improvement with the start of ceftriaxone and subsequent association of corticosteroids, until he developed respiratory failure and died. The third blood cultures grew after his death and they were positive for L. monocytogenes. An autopsy was carried out, which showed necrotizing inflammation, with gram-positive bacilli in the brainstem and the cerebellum. CONCLUSIONS: A fatal delay in the diagnosis occurred, mainly because of the favorable clinical response to ceftriaxone and corticosteroids. This case reminds us that a febrile clinical presentation with brainstem involvement must generate the suspicion of a Listeria infection, and therefore ampicillin must be a part of the empirical treatment.

¿El abuso de fármacos en pacientes con migraña crónica influye en la efectividad del tratamiento preventivo con topiramato? / Does medication abuse in patients with chronic migraine influence the effectiveness of preventive treatment with topiramate?

Introducción. Los pacientes con migraña crónica (MC) y abuso de medicación son difíciles de tratar y tienen peor calidad de vida que otros pacientes con migrañas. Objetivo. Valorar si la presencia de abuso de fármacos disminuye la efectividad del topiramato. Pacientes y métodos. Una serie de pacientes con MC fueron agrupados según presentasen criterios de abuso o no abuso de fármacos. Se les aconsejo la supresión del fármaco del cual abusaban. Se ajustó el tratamiento de sus crisis y se inició tratamiento preventivo desde el principio con topiramato. Se valoró el número días con cefalea y migrañas intensas en el mes previo y al cuarto mes de tratamiento. Resultados. Fueron seleccionados 262 pacientes con criterios de MC, y de ellos 167 (63,7%) cumplieron criterios de abuso. En ambos grupos hubo una reducción significativa del número de días con cefalea/mes y numero de crisis de migraña/mes al cuarto mes de tratamiento con topiramato. Porcentaje de reducción de días con cefalea/mes en MC sin abuso, 59,3} 36,1%; y con abuso, 48,7} 41,7% (p = 0,0574). Porcentaje de reducción de migrañas intensas/mes en MC sin abuso, 61,2%; y con abuso, 50% (p = 0,0224). Tasa de respondedores según numero de días con cefalea/mes en MC sin abuso, 69%; y con abuso, 57%. Tasa de respondedores según numero de migrañas intensas/mes en MC sin abuso, 76,8%; y en MC con abuso, 61% (p = 0,0097). Conclusiones. El topiramato fue efectivo en pacientes con MC sin y con abuso de fármacos, aunque con menor efectividad en estos últimos (AU)

Introduction: Patients with chronic migraine (CM) and medication abuse are difficult to treat, and have a greater tendency towards chronification and a poorer quality of life than those with other types of headache. Aim: To evaluate whether the presence of medication abuse lowers the effectiveness of topiramate. Patients and methods: A series of patients with CM were grouped according to whether they met abuse criteria or not. They were advised to stop taking the drug that they were abusing. Treatment was adjusted to match their crises and preventive treatment with topiramate was established from the beginning. The number of days with headache and intense migraine in the previous month and at four months of treatment was evaluated. Results. In all, 262 patients with CM criteria were selected and 167 (63.7%) of them fulfilled abuse criteria. In both groups there was a significant reduction in the number of days with headache/month and number of migraine attacks/month at the fourth month of treatment with topiramate. The percentage of reduction in the number of days with headache/ month in CM without abuse was 59.3} 36.1%, and with abuse, 48.7} 41.7% (p = 0.0574). The percentage of reduction in the number of days with intense migraine/month in CM without abuse was 61.2%, and with abuse, 50% (p = 0.0224). Response rate according to the number of days with headache/month in CM without abuse was 69%, and with abuse, 57%. Response rate according to the number of intense migraines/month in CM without abuse was 76.8%, and in CM with abuse, 61% (p = 0.0097). Conclusions. Topiramate was effective in patients with CM with and without medication abuse, although effectiveness is lower in the latter case (AU)

[A comparative study of the effectiveness of topiramate and flunarizine in independent series of chronic migraine patients without medication abuse]. / Estudio comparativo de la efectividad del topiramato y la flunaricina en series independientes de pacientes con migraña cronica sin abuso de medicacion.

INTRODUCTION: Topiramate and onabotulinumtoxin A have proven to be effective in chronic migraine with or without medication abuse according to recent criteria of the International Headache Society's Headache Classification. AIMS: To show that flunarizine is as effective as topiramate in cases of chronic migraine without medication abuse. PATIENTS AND METHODS: We conducted a prospective, non-randomised, comparative study of two groups of patients paired by age and sex, with chronic migraine without abuse, who had been treated preventively for the first time with topiramate or flunarizine. RESULTS: Forty patients treated with flunarizine were assigned a patient of their same sex and age who was being treated with topiramate. The mean rate of reduction in intense migraines in the topiramate group was 59% and in the flunarizine group, 58.5% (p = 0.9444); the responder rate at four months of treatment did not show any significant differences either, the figures being 75% for topiramate and 70% for flunarizine (p = 0.6236). The mean reduction of other headaches in the topiramate group was 57% and in the flunarizine group, 64% (p = 0.4261); the responder rate at four months of treatment was similar in the two groups: 76%. The percentage of dropouts from treatment was higher with topiramate (19.5%) than with flunarizine (10%) (p = 0.3493). No serious side effects occurred in either of the groups. In all, 78.9% of the patients who took topiramate said they were satisfied with the drug versus 75% of those in the flunarizine group (p = 0.7903). CONCLUSIONS: Flunarizine proved to be as effective as topiramate in the treatment of chronic migraine without medication abuse.

TITLE: Estudio comparativo de la efectividad del topiramato y la flunaricina en series independientes de pacientes con migraña cronica sin abuso de medicacion.Introduccion. El topiramato y la onabotulinumtoxina A han mostrado ser eficaces en la migraña cronica con o sin abuso de farmacos segun los criterios recientes de la Clasificacion de Cefaleas de la Sociedad Internacional de Cefaleas. Objetivo. Demostrar que la flunaricina es tan efectiva como el topiramato en la migraña cronica sin abuso de farmacos. Pacientes y metodos. Estudio prospectivo, no aleatorizado, comparativo de dos grupos de pacientes con similar edad y sexo, con migraña cronica sin abuso, tratados preventivamente por primera vez con topiramato o flunaricina. Resultados. A 40 pacientes tratados con flunaricina se les asigno un paciente del mismo sexo y edad tratado con topiramato. La media de reduccion de las migrañas intensas en el grupo del topiramato fue del 59% y en el grupo de la flunaricina, del 58,5% (p = 0,9444); la tasa de respondedores al cuarto mes de tratamiento tampoco mostro diferencias significativas, ya que fue del 75% para el topiramato y del 70% para la flunaricina (p = 0,6236). La media de reduccion de otras cefaleas en el grupo del topiramato fue del 57%, y en el grupo de la flunaricina, del 64% (p = 0,4261); la tasa de respondedores al cuarto mes de tratamiento fue del 76%, similar en ambos grupos. El porcentaje de abandonos del tratamiento fue mayor con el topiramato (19,5%) que con la flunaricina (10%) (p = 0,3493). En ninguno de los dos grupos hubo efectos adversos graves. Un 78,9% de los pacientes que tomo topiramato presento satisfaccion con el farmaco frente al 75% del grupo de la flunaricina (p = 0,7903). Conclusion. La flunaricina mostro ser tan efectiva como el topiramato en el tratamiento de la migraña cronica sin abuso de farmacos.

Estudio comparativo de la efectividad del topiramato y la flunaricina en series independientes de pacientes con migraña crónica sin abuso de medicación / A comparative study of the effectiveness of topiramate and flunarizine in independent series of chronic migraine patients without medication abuse

Introducción. El topiramato y la onabotulinumtoxina A han mostrado ser eficaces en la migraña crónica con o sin abuso de fármacos según los criterios recientes de la Clasificación de Cefaleas de la Sociedad Internacional de Cefaleas. Objetivo. Demostrar que la flunaricina es tan efectiva como el topiramato en la migraña crónica sin abuso de fármacos.Pacientes y métodos. Estudio prospectivo, no aleatorizado, comparativo de dos grupos de pacientes con similar edad ysexo, con migraña crónica sin abuso, tratados preventivamente por primera vez con topiramato o flunaricina. Resultados. A 40 pacientes tratados con flunaricina se les asignó un paciente del mismo sexo y edad tratado con topiramato. La media de reducción de las migrañas intensas en el grupo del topiramato fue del 59% y en el grupo de la flunaricina, del 58,5% (p = 0,9444); la tasa de respondedores al cuarto mes de tratamiento tampoco mostró diferencias significativas, ya que fue del 75% para el topiramato y del 70% para la flunaricina (p = 0,6236). La media de reducción de otras cefaleas en el grupo del topiramato fue del 57%, y en el grupo de la flunaricina, del 64% (p = 0,4261); la tasa de respondedores al cuarto mes de tratamiento fue del 76%, similar en ambos grupos. El porcentaje de abandonos del tratamiento fue mayor con el topiramato (19,5%) que con la flunaricina (10%) (p = 0,3493). En ninguno de los dos grupos hubo efectos adversos graves. Un 78,9% de los pacientes que tomó topiramato presentó satisfacción con el fármaco frente al 75% del grupo de la flunaricina (p = 0,7903). Conclusión. La flunaricina mostró ser tan efectiva como el topiramato en el tratamiento de la migraña crónica sin abuso de fármacos (AU)

Introduction. Topiramate and onabotulinumtoxin A have proven to be effective in chronic migraine with or without medication abuse according to recent criteria of the International Headache Society’s Headache Classification. Aims. To show that flunarizine is as effective as topiramate in cases of chronic migraine without medication abuse. Patients and methods. We conducted a prospective, non-randomised, comparative study of two groups of patients paired by age and sex, with chronic migraine without abuse, who had been treated preventively for the first time with topiramate or flunarizine. Results. Forty patients treated with flunarizine were assigned a patient of their same sex and age who was being treated with topiramate. The mean rate of reduction in intense migraines in the topiramate group was 59% and in the flunarizine group, 58.5% (p = 0.9444); the responder rate at four months of treatment did not show any significant differences either, the figures being 75% for topiramate and 70% for flunarizine (p = 0.6236). The mean reduction of other headaches in the topiramate group was 57% and in the flunarizine group, 64% (p = 0.4261); the responder rate at four months of treatment was similar in the two groups: 76%. The percentage of dropouts from treatment was higher with topiramate (19.5%) than with flunarizine (10%) (p = 0.3493). No serious side effects occurred in either of the groups. In all, 78.9% of the patients who took topiramate said they were satisfied with the drug versus 75% of those in the flunarizine group (p = 0.7903). Conclusions. Flunarizine proved to be as effective as topiramate in the treatment of chronic migraine without medication abuse (AU)

Coincidencia temporal de miastenia grave y síndrome de Guillain-Barré: primer caso publicado en España / Simultaneous myasthenia gravis and Guillain-Barré syndrome: the first case reported in Spain

No disponible

Coincidencia temporal de miastenia grave y síndrome de Guillain-Barré: primer caso publicado en España / Simultaneous myasthenia gravis and Guillain-Barre syndrome: the first case reported in Spain

No disponible

Estudio comparativo de grupos independientes de pacientes con migraña episódica tratados preventivamente con flunaricina o nadolol / A study to compare independent groups of patients with episodic migraine who were treated preventively with flunarizine or nadolol

Introducción. La flunaricina, con nivel de evidencia A, y el nadolol, con nivel de evidencia C, estarían indicados como tratamiento preventivo de la migraña. No existen estudios previos que comparen la efectividad de ambos fármacos. Objetivo. Comparar parámetros de efectividad en grupos independientes de pacientes tratados preventivamente con uno de los fármacos del estudio a los que se aplicó el mismo protocolo. Pacientes y métodos. Se seleccionó a pacientes con migraña episódica (criterios de la Sociedad Internacional de Cefaleas del 2004) que se habían sometido a tratamiento preventivo por primera vez, con flunaricina (5 mg/día) o nadolol (20-40 mg/día). Se analizaron las variables principales de efectividad (reducción del número de crisis al cuarto mes de tratamiento y tasa de respondedores). Resultados. Se incluyó a 227 pacientes con intención de recibir tratamiento: 155 con flunaricina (80,5% mujeres; edad media: 38,3 ± 12,1 años) y 72 con nadolol (63,8% mujeres; edad media: 37,1 ± 12,0 años). La media de crisis en el mes previo al tratamiento fue de 6,09 ± 2,6 en el grupo de la flunaricina y de 5,1 ± 1,7 en el grupo del nadolol (p = 0,0079); la media de crisis al cuarto mes de tratamiento fue de 2,61 ± 2,4 en el grupo de la flunaricina y de 2,77 ± 2,4 en el grupo del nadolol (p = NS). Porcentaje de reducción de migrañas: 55,2% con flunaricina y 50,4% con nadolol (p = NS). La tasa de respondedores fue del 69% con flunaricina y del 67% con nadolol (p = NS). La tasa de respuesta excelente (reducción mayor o igual al 75% de las crisis) fue del 52,2% con flunaricina y del 36,1% con nadolol (p = 0,0077). Porcentaje de efectos adversos: 48,3% con flunaricina frente a 25% con nadolol (p = 0,0009). La tasa de satisfacción fue del 68%, similar en ambos grupos. Conclusión. Tanto la flunaricina como el nadolol mostraron ser efectivos en el tratamiento preventivo de la migraña episódica. La flunaricina se utilizó con mayor frecuencia en nuestro medio y fue peor tolerada (AU)

Introduction. Flunarizine, with level of evidence A, and nadolol, with evidence level C, would be indicated as preventive treatment of migraine. Yet, no previous studies have been conducted to compare the effectiveness of the two drugs. Aim. To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study, the same protocol being applied in both cases. Patients and methods. The subjects selected for the study were patients with episodic migraine (according to 2004 International Headache Society criteria) who had undergone preventive treatment for the first time, with flunarizine (5 mg/day) or nadolol (20-40 mg/day). The main effectiveness variables (reduction in the number of seizures at four months of treatment and responder rates) were analysed. Results. The study included 227 patients who intended to receive treatment: 155 with flunarizine (80.5% females; mean age: 38.3 ± 12.1 years) and 72 with nadolol (63.8% females; mean age: 37.1 ± 12.0 years). The mean number of seizures prior to treatment was 6.09 ± 2.6 in the flunarizine group and 5.1 ± 1.7 in the nadolol group (p = 0.0079); at four months of treatment it was 2.61 ± 2.4 in the flunarizine group and 2.77 ± 2.4 in the nadolol group (p = NS). Percentage of reduction of migraines: 55.2% with flunarizine and 50.4% with nadolol (p = NS). The responder rate was 69% with flunarizine and 67% with nadolol (p = NS). The excellent response rate (reduction in the number of seizures by 75% or more) was 52.2% with flunarizine and 36.1% with nadolol (p = 0.0077). Percentage of adverse side effects: 48.3% with flunarizine and 25% with nadolol (p = 0.0009). The satisfaction rate was similar in both groups, 68%. Conclusions. Both flunarizine and nadolol proved to be effective in the preventive treatment of episodic migraine. Flunarizine is used more often in our milieu and was less well tolerated (AU)

Factores predisponentes al abandono del tratamiento preventivo en una serie de pacientes con migraña / Predisposing factors affecting drop-out rates in preventive treatment in a series of patients with migraine

Introducción. Más de un 30% de pacientes abandona el tratamiento preventivo de la migraña. Esta situación es poco conocida y los factores de riesgo que llevan al abandono del tratamiento tampoco están identificados. Objetivo. Valorar alguno de los factores que pueden predisponer al abandono de un tratamiento preventivo. Pacientes y métodos. Es un estudio prospectivo de pacientes con migraña que precisaron tratamiento preventivo por primera vez con uno de tres fármacos considerados de primera línea: un betabloqueante (nadolol), un neuromodulador (topiramato) o un antagonista del calcio (flunaricina). Se establecieron dos grupos según se produjese abandono o no del tratamiento. Se analizaron y compararon diferentes variables demográficas y clínicas en ambos grupos. Resultados. En un total de 800 pacientes con migraña que precisaron tratamiento preventivo por primera vez, hubo un 19,7% de abandonos. En el grupo que abandonó, las variables ‘edad’, ‘número de crisis previas al tratamiento preventivo’ y ‘efectos adversos’ mostraron diferencias significativas con las del grupo de pacientes que no suspendieron el tratamiento preventivo. Conclusiones. El fármaco utilizado como tratamiento preventivo, los efectos adversos, la edad más joven y el menor número de crisis antes de iniciar el tratamiento preventivo favorecieron su abandono. El tipo de migraña episódica o crónica, la presencia de abuso de fármacos y los fármacos utilizados para el tratamiento de las crisis no guardaron relación con la suspensión del tratamiento preventivo (AU)

Introduction. The drop-out rate among patients receiving preventive treatment for migraine is higher than 30%. This situation is not very widely known and the risk factors that lead patients to drop out from treatment have yet to be identified. Aim. To evaluate some of the factors that can predispose patients to drop out of preventive treatment. Patients and methods. We conducted a prospective study of patients suffering from migraine who required preventive treatment for the first time with one of what are considered the top three first-choice drugs, i.e. a beta-blocker (nadolol a neuromodulator (topiramate) or a calcium antagonist (flunarizine). Two groups were established according to whether patients dropped out of treatment or not. Different demographic and clinical variables were analysed and compared in the two groups. esults. Of 800 patients with migraine who required preventive treatment for the first time, the drop-out rate was 19.7%. In the drop-out group, the variables ‘age’, ‘number of seizures’, ‘number of seizures prior to preventive treatment’ and ‘side effects’ showed significant differences with those from the group of patients who did not drop out of preventive treatment. Conclusions. The drug used as preventive treatment, the side effects, a younger age and a lower number of seizures before starting the preventive treatment favoured higher drop-out rates. Whether the migraine was episodic or chronic, the presence of medication abuse and the drugs used to treat the seizures were not related with dropping out of preventive treatmen (AU)

[Predisposing factors affecting drop-out rates in preventive treatment in a series of patients with migraine]. / Factores predisponentes al abandono del tratamiento preventivo en una serie de pacientes con migraña.

INTRODUCTION: The drop-out rate among patients receiving preventive treatment for migraine is higher than 30%. This situation is not very widely known and the risk factors that lead patients to drop out from treatment have yet to be identified. AIM: To evaluate some of the factors that can predispose patients to drop out of preventive treatment. PATIENTS AND METHODS: We conducted a prospective study of patients suffering from migraine who required preventive treatment for the first time with one of what are considered the top three first-choice drugs, i.e. a beta-blocker (nadolol), a neuromodulator (topiramate) or a calcium antagonist (flunarizine). Two groups were established according to whether patients dropped out of treatment or not. Different demographic and clinical variables were analysed and compared in the two groups. RESULTS: Of 800 patients with migraine who required preventive treatment for the first time, the drop-out rate was 19.7%. In the drop-out group, the variables 'age', 'number of seizures', 'number of seizures prior to preventive treatment' and 'side effects' showed significant differences with those from the group of patients who did not drop out of preventive treatment. CONCLUSIONS: The drug used as preventive treatment, the side effects, a younger age and a lower number of seizures before starting the preventive treatment favoured higher drop-out rates. Whether the migraine was episodic or chronic, the presence of medication abuse and the drugs used to treat the seizures were not related with dropping out of preventive treatment.

Insuficiencia respiratoria aguda en el postoperatorio de cirugía abdominal, una forma infrecuente de presentación de la esclerosis lateral amiotrófica / Acute respiratory failure in the post-operative period following abdominal surgery, an infrequent presenting symptom of amyotrophic lateral sclerosis

No disponible

[Comparative study of the effectiveness of topiramate and nadolol in the preventive treatment of episodic migraine in independent series of patients]. / Estudio comparativo de la efectividad del topiramato y del nadolol en el tratamiento preventivo de la migraña episodica en series independientes de pacientes.

INTRODUCTION: Topiramate and nadolol with levels A and C of scientific evidence, respectively, would be indicated as preventive treatments of migraine. To date only one study of satisfaction has been carried out to compare the two pharmaceuticals. AIM: To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study. PATIENTS AND METHODS: From a database of 700 patients with migraine, those with episodic migraine and who had followed a course of preventive treatment, for the first time, with topiramate or nadolol were selected for the study. The effectiveness variables (reduction in the number of crises at four months of preventive treatment and responder rates) were analysed. RESULTS: Altogether 208 patients with were included for treatment: 140 with topiramate (77.8% females; mean age, 37.9) and 68 with nadolol (69% females; mean age, 36.9). The mean number of crises in the month prior to treatment was: topiramate group, 6.3 +/- 2.6; nadolol group 5.3 +/- 2.0 (p = 0.0066). At four months after starting treatment: topiramate group, 2.69 +/- 2.6; nadolol group 2.6 +/- 2.2 (NS). The percentage of reduction in the number of migraines was 56.6% with topiramate and 51.6% with nadolol (NS). The responder rate (reduction in the frequency of crises by at least 50%) was 71.3% with topiramate versus 69% with nadolol (NS). The excellent response rate (reduction in crises by at least 75%) was 53.3% with topiramate versus 32.2% with nadolol (p = 0.0077). Adverse side effects were reported by 54% of patients treated with topiramate versus 30.8% of those treated with nadolol (p = 0.0015). The rate of satisfaction was 61% for the topiramate group and 71% for the group with nadolol (NS). CONCLUSIONS: Both topiramate and nadolol proved to be effective in the preventive treatment of episodic migraine. Topiramate was found to be more effective than nadolol, although it was used in patients with a higher frequency of crises, and was not tolerated so well.

Estudio comparativo de la efectividad del topiramato y del nadolol en el tratamiento preventivo de la migraña episódica en series independientes de pacientes / Comparative study of the effectiveness of topiramate and nadolol in the preventive treatment of episodic migraine in independent series of patients

Introducción. El topiramato con nivel A y el nadolol con nivel C de evidencia científica estarían indicados como tratamientos preventivos de la migraña. Sólo existe un estudio de satisfacción que compare ambos fármacos. Objetivo. Comparar los parámetros de efectividad en grupos independientes de pacientes tratados preventivamente con uno de los fármacos del estudio. Pacientes y métodos. De una base de datos de 700 pacientes con migraña, se seleccionaron aquéllos con migraña episódica y que habían llevado tratamiento preventivo, por primera vez, con topiramato o nadolol. Se analizaron las variables de efectividad (reducción del número de crisis al cuarto mes de tratamiento preventivo y tasa de respondedores). Resultados. Fueron incluidos 208 pacientes con intención de tratar; 140 con topiramato (77,8% mujeres; edad media: 37,9 años) y 68 con nadolol (69% mujeres; edad media: 36,9 años). La media de crisis en el mes previo al tratamiento fue: grupo con topiramato, 6,3 ± 2,6; grupo con nadolol, 5,3 ± 2,0 (p = 0,0066). Al cuarto mes de tratamiento: grupo con topiramato, 2,69 ± 2,6; grupo con nadolol, 2,6 ± 2,2 (NS). El porcentaje de reducción de migrañas fue del 56,6% con topiramato y del 51,6% con nadolol (NS). La tasa de respondedores (reducción en la frecuencia de crisis al menos del 50%) fue del 71,3% con topiramato y del 69% con nadolol (NS). La tasa de respuesta excelente (reducción de las crisis al menos un 75%) fue del 53,3% con topiramato y del 32,2% con nadolol (p = 0,0077). El 54% de los pacientes tratados con topiramato y el 30,8% de los pacientes tratados con nadolol presentaron efectos adversos (p = 0,0015). La tasa de satisfacción fue del 61% en el grupo de topiramato y del 71% en el grupo de nadolol (NS). Conclusión. El topiramato y el nadolol mostraron ser efectivos en el tratamiento preventivo de la migraña episódica. El topiramato mostró mayor efectividad y se utilizó en pacientes con mayor frecuencia de crisis, pero se toleró peor que el nadolol (AU)

Introduction. Topiramate and nadolol with levels A and C of scientific evidence, respectively, would be indicated as preventive treatments of migraine. To date only one study of satisfaction has been carried out to compare the two pharmaceuticals. Aim. To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study. Patients and methods. From a database of 700 patients with migraine, those with episodic migraine and who had followed a course of preventive treatment, for the first time, with topiramate or nadolol were selected for the study. The effectiveness variables (reduction in the number of crises at four months of preventive treatment and responder rates) were analysed. Results. Altogether 208 patients with were included for treatment: 140 with topiramate (77.8% females; mean age, 37.9) and 68 with nadolol (69% females; mean age, 36.9). The mean number of crises in the month prior to treatment was: topiramate group, 6.3 ± 2.6; nadolol group 5.3 ± 2.0 (p = 0.0066). At four months after starting treatment: topiramate group, 2.69 ± 2.6; nadolol group 2.6 ± 2.2 (NS). The percentage of reduction in the number of migraines was 56.6% with topiramate and 51.6% with nadolol (NS). The responder rate (reduction in the frequency of crises by at least 50%) was 71.3% with topiramate versus 69% with nadolol (NS). The excellent response rate (reduction in crises by at least 75%) was 53.3% with topiramate versus 32.2% with nadolol (p = 0.0077). Adverse side effects were reported by 54% of patients treated with topiramate versus 30.8% of those treated with nadolol (p = 0.0015). The rate of satisfaction was 61% for the topiramate group and 71% for the group with nadolol (NS). Conclusions. Both topiramate and nadolol proved to be effective in the preventive treatment of episodic migraine. Topiramate was found to be more effective than nadolol, although it was used in patients with a higher frequency of crises, and was not tolerated so well (AU)