RESUMO
OBJECTIVE: Although ocular side effects of topiramate are common, neuroophthalmologic manifestations such as blepharospasm, myokymia and oculogyric crisis are scarcely reported. METHODS: We present a serie of 8 patients with migraine who developed eyelid myokymia after treatment with topiramate. We reviewed all patients with migraine treated with topiramate attending the headache outpatient clinic of our hospital from January 2008 to December 2012. RESULTS: During the study period, a total of 140 patients with migraine were treated with topiramate in our headache clinic. Eight presented eyelid myokymia after beginning treatment with topiramate (5,7%). Topiramate was stopped and myokymia disappeared in all patients, it was prescribed again and eyelid myokymia reappeared with their previous characteristics in all patients. CONCLUSIONS: Eyelid myokymia is an underreported side-effect of topiramate in patients with migraine, of unknown cause, so that in future, further studies are need to examine whether patients with migraine are predisposed or not to this adverse effect.
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Pálpebras/efeitos dos fármacos , Frutose/análogos & derivados , Transtornos de Enxaqueca/tratamento farmacológico , Mioquimia/induzido quimicamente , Adolescente , Adulto , Feminino , Frutose/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , TopiramatoRESUMO
INTRODUCTION: Brochures are commonly used as educational tools in daily neurological practice. They are provided to increase the general population's knowledge of a specific disease and also to combat sources of erroneous information. Surveys are the most commonly used method of ascertaining user satisfaction with services received. OBJECTIVES: This study will assess patient-perceived satisfaction and provide feedback to measure the comprehensibility and overall utility of an educational brochure on migraine. MATERIAL AND METHODS: Open prospective multicentre study of a group of patients diagnosed with migraine in neurology clinics in Alicante province. During the initial visit, each patient received a migraine brochure prepared by the Valencian Society of Neurology's study group for headaches (CEFALIC). During a follow-up visit, they were then asked to fill out a personal survey on the overall quality of the information in the brochure. RESULTS: We included a total of 257 patients diagnosed with migraine (83% episodic migraine; 17% chronic migraine); mean age was 37.6 years. Two hundred seven patients confirmed having read the brochure (80.5%); 50 patients (19.5%) either forgot to read it or had no interest in doing so. The brochure seemed interesting and easy to understand according to 90% of the patients. Seventy-six per cent of the respondents stated that reading the brochure increased their overall knowledge of migraine, while 50% of the patients found the brochure useful for improving migraine control. CONCLUSIONS: Patients found the migraine educational brochure to be comprehensible, a means of increasing overall knowledge of the disease, and useful for increasing control over migraines. Evaluations of the educational brochures that we provide to our patients with migraine should be studied to discover the causes of dissatisfaction, determine the level of quality of service, and investigate potential areas for improvement.
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Transtornos de Enxaqueca/terapia , Folhetos , Educação de Pacientes como Assunto/métodos , Satisfação do Paciente , Adulto , Compreensão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Informal caregivers provide care to dementia patients, and this service prolongs their stay at home. OBJECTIVES: To describe characteristics of dementia patients in the province of Alicante, as well as the profiles and roles of caregivers who assist them. PATIENTS AND METHODS: Multi-centre prospective study carried out in 4 neurology departments in Alicante (June 2009 to January 2010). Dementia patients' relatives/caregivers were included in sequential order. The following variables were analysed: a) Demographic information pertaining to the patient and caregivers (age, sex, marital and employment status, educational level, relationship to patient); b) patient's family unit; c) motivating factor for primary caregiver (PC); d) secondary caregiver (SC) roles; e) country of citizenship of formal caregiver (FC) and source of remuneration (private/public); f) caregivers' knowledge of dementia. RESULTS: Most of our patients live at home (74.8%), and are female (69%) with Alzheimer's disease (78.4%) in a moderately severe stage (GDS level 4-5, 71.6%). PCs and SCs are mainly women (72.1% and 60.5% respectively), middle-aged and directly related to the patient (sons/daughters account for 64.3% of the PCs and 54.4% of the SCs); most are homemakers with a low educational level. Caregivers in the first category (PC) provide care due to moral obligation (75%), while those in the second (SC) involve patients in leisure or other stimulating activities (82.3%). Absent caregivers tend to be males (73.3%) residing long distances from the relative (52.4%). The FC tends to be female (91.7%), Spanish (81.8%) and privately remunerated. CONCLUSIONS: Women dominate the network of caregivers for dementia patients, whether as principal caregivers, supporting caregivers or formal caregivers (in all cases, they have only limited training in dementia management). Males are largely absent. Better knowledge of the care structure supporting dementia patients may be helpful in the overall management of these patients.
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Cuidadores/estatística & dados numéricos , Demência/terapia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/economia , Doença de Alzheimer/terapia , Cuidadores/economia , Efeitos Psicossociais da Doença , Demência/economia , Família , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Assistência Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Remuneração , Fatores Socioeconômicos , EspanhaAssuntos
Cuidadores/estatística & dados numéricos , Demência/terapia , Feminino , Humanos , MasculinoRESUMO
INTRODUCTION: Stroke is one of the main causes of morbidity and mortality in developed countries today. Smoking is a risk factor that is associated with arteriosclerotic disease. AIM: To evaluate the risk of having a stroke associated to both active and passive smoking in a case-control study. PATIENTS AND METHODS: A case-control study was conducted which included 151 stroke patients who were admitted to hospital in the Neurology Service at the Hospital General Universitario in Alicante over a 12-month period. The control group (302) was obtained from patients who visited the emergency department at the hospital with no history of strokes and who reported clinical signs and symptoms that were not compatible with a stroke. The cases and controls were paired according to age and sex, including two controls of the same sex and whose ages were within a year of that of each case which was obtained. RESULTS: The mean age of the patients was 70.6 years (range: 59-81 years). Males predominated in the sample (57.6%). Stroke patients had a significantly higher percentage of hypertension, peripheral arterial disease, heart disease and dyslipidemia than the control group. The most frequently affected vascular territory was the carotid (33.8%). The most frequent presenting symptom of the stroke was motor syndrome together with language disorders (39.4%). The risk of suffering a stroke associated to active smoking was 1.40 (CI 95% = 0.91-2.15) and in the case of passive smoking it was 1.45 (CI 95% = 0.82-2.58). CONCLUSIONS: The findings from this study suggest there is a relevant association between environmental exposure to tobacco smoke and increased vascular risk (which confirms other results that have been published in the literature) and stress how important it is for non-smokers to find smoke-free zones.
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Aterosclerose , Acidente Vascular Cerebral , Poluição por Fumaça de Tabaco , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/etiologia , Aterosclerose/patologia , Aterosclerose/fisiopatologia , Estudos de Casos e Controles , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologiaRESUMO
INTRODUCTION: The use of diagnostic criteria for mild cognitive impairment (MCI) that do not require the presence of amnesia enables patients to be classified into three types of MCI: pure amnestic MCI (aMCI), MCI with involvement of multiple cognitive functions and amnesia (mf-aMCI) and MCI with involvement of multiple cognitive functions without amnesia, or non-amnestic MCI (mf-nonaMCI). AIM: To determine whether patients with MCI with involvement of multiple functions (mfMCI) have a different profile of cognitive involvement depending on whether amnesia is present or not. PATIENTS AND METHODS: Out of a total sample of 175 patients with MCI, we studied 138 with mfMCI. Of these, 109 (79%) had memory disorders (mf-aMCI) and 29 (21%) did not (mf-nonaMCI). For each group of patients, we determined the percentage who scored below normal in each of the items on the abbreviated Barcelona test. RESULTS: Patients with mf-aMCI failed more frequently in temporal orientation, naming and semantic category evocation tests. Patients with mf-nonaMCI failed more often in motor praxis and abstraction tests. Differences were statistically significant. Additionally, it was noted that patients with mf-nonaMCI tended to make more mistakes in attention tests. CONCLUSIONS: The presence of amnesia allows us to identify an mf-aMCI group with a cognitive profile suggesting temporal involvement, unlike the mf-nonaMCI group, whose members have a cognitive profile that suggests subcortical compromise.
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Amnésia/fisiopatologia , Transtornos Cognitivos , Idoso , Transtornos Cognitivos/classificação , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/fisiopatologia , Feminino , Humanos , Transtornos da Memória/diagnóstico , Transtornos da Memória/fisiopatologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estudos RetrospectivosRESUMO
AIM: To describe the use of preadmission statins in patients with cerebrovascular accident and the possible predictive factors. PATIENTS AND METHODS: Cross-sectional observational study of 795 consecutive patients with acute cerebrovascular accident. We assessed the differences among patients who were on preadmission statins (161) and those who were not (634), regarding vascular risk factors and clinical and neurosonological atherothrombotic disease markers. For univariate analysis, we used squared chi test, and for multivariate analysis, logistic regression analysis. RESULTS: Preadmission statins were 20.3%. In high vascular risk patients defined based on National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), this reached 28% and it might be 72%. Predictive factors for preadmission statins use were, in a positive sense, the antecedent of hypercholesterolemia diagnosis (OR = 189; 95% CI = 58-615; p < or = 0.001) and stroke (OR = 2.1; 95% CI = 1.2-3.6; p < or = 0.01), and in a negative sense, smoking (OR = 0.38; 95% CI = 0.18-0.81; p = 0.012). CONCLUSIONS: In our population of patients with stroke, the predictive factors of preadmission statins did not adjust to the current therapeutic NCEP-ATP III recommendations; treatment with statins in high vascular risk population was way below the indications, it was 28% and it might be 72%.
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Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Adulto , Idoso , Estudos Transversais , Interpretação Estatística de Dados , Testes Diagnósticos de Rotina , Humanos , Masculino , Valor Preditivo dos Testes , Fatores de RiscoRESUMO
INTRODUCTION: Studies conducted in the American population have revealed the existence of differences in cerebral vascular pathologies and in the prevalence of vascular risk factors between races. The few studies carried out in Hispanic populations have found a higher prevalence of diabetes mellitus, as well as a lower frequency of cardioembolic strokes and extracranial carotid atheromatosis, in comparison with whites of Anglo-Saxon extraction. PATIENTS AND METHODS: We performed a case-control study in which one case was paired with two controls, according to age and sex. The cases were people from Central and Northern Europe and the controls were Spaniards. All of them had been admitted to hospital because of ischemic stroke or TIA. We compared the frequency of conventional risk factors (RF), the subtype of ischemic stroke and the results from carotid duplex scans. The odds ratio and confidence intervals (CI) at 95% were calculated for paired data. RESULTS: Arterial hypertension (AHT) was less frequent in the cases, with an OR of 0.45 (CI 0.24-0.83). No statistically significant differences were found in the prevalence of diabetes, hypercholesterolemia, heart disease and atrial fibrillation. Fast recovery stroke and TIA were observed more frequently in the cases than in the controls (OR: 3.73; CI: 1.72-8.07), which we interpreted as being due to a bias in admissions. Carotid duplex scanning revealed stenosis > 70% in 21.9% of the cases and in 13% of the controls. CONCLUSIONS: This study did not reveal any differences between Spaniards and Northern Europeans in conventional RF, except for a higher prevalence of AHT in Spaniards. Severe carotid pathology seems to be less frequent in Spaniards. Future research should take into account other RFs (such as cholesterol subfractions, homocysteine, etc.), which are possibly race-linked and may account for the differences described.
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Isquemia Encefálica/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/epidemiologia , Estenose das Carótidas/patologia , Estudos de Casos e Controles , Ecocardiografia , Europa (Continente)/epidemiologia , Feminino , Humanos , Hipertensão , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Acidente Vascular Cerebral/epidemiologia , População BrancaRESUMO
INTRODUCTION: Vascular dementia (VD) is the second most frequent cause of dementia after Alzheimer's disease in western societies. It includes a heterogeneous group of disorders in which vascular factors are believed to play a vital role in the development of cognitive impairment. Aims and development. Our aim was to determine what instruments can be used to diagnose VD and to what extent such a diagnosis is reliable. To this end, we review the diagnostic criteria that have been used up to now, the role played by neuropsychology, the value of neurosonology studies, and the growing development of neuroimaging techniques, especially magnetic resonance. CONCLUSIONS: Current diagnostic criteria for VD select a group that is clinically and aetiologically very heterogeneous. Such criteria need shifting towards new evidence-based criteria derived from analyses of population studies that focus on the early stages of the disease and that make a proper distinction between patients with mixed dementia. The subcortical subtype of vascular cognitive impairment (SVCI) is a form of vascular impairment that is more homogeneous and which selects more representative patients with a more predictable clinical pattern, natural history, response to treatment and prognosis. These characteristics make SVCI cases an ideal group for comparisons between clinical trials and studies.
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Demência Vascular/diagnóstico , Demência Vascular/classificação , Demência Vascular/patologia , Demência Vascular/fisiopatologia , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Testes Neuropsicológicos , NeuropsicologiaRESUMO
INTRODUCTION: Only a minority of patients with acute stroke are eligible for fibrinolysis, and the main reason for this is that time runs out and goes beyond the therapeutic window. The chief delay occurs prior to arrival at the hospital, but there is also a nosocomial delay, which has received far less attention. AIMS: The purpose of our study was to describe the data on delays occurring before and after arrival at the hospital in a sample of patients with acute stroke, and to analyse possible associated factors, including the overload on health care services in the Emergency department, an aspect that has not previously been evaluated. PATIENTS AND METHODS: Epidemiological data, times of delays before and after entering the hospital, means of transport used and the health care workload in the Emergency department of the day of admission were collected for all the stroke patients admitted to the Stroke Unit of the Hospital General Universitario de Alicante throughout the period under study. RESULTS: From an initial sample of 460 patients, 423 were finally included in the study, with a mean delay before and after admission to hospital of 3.99 and 2.36 hours, respectively. Use of an ambulance and the haemorrhagic and transient ischemic attack subtypes were linked to a shorter delay before reaching the hospital, and arrival during the night shift was the only factor associated to a longer delay once inside the hospital. CONCLUSIONS: In our environment, there is a need to establish strategies aimed at shortening the times stroke patients take to reach the hospital and the time that elapses before they are attended.
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Fibrinolíticos/uso terapêutico , Hospitais , Admissão do Paciente , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico , Transporte de Pacientes , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Dizziness is a common symptom at the outpatient clinic of family doctors. Its origin is usually multifactorial and its outcome is often benign. However, exists a tendency to relate the dizziness with a cerebrovascular disturbance. AIM. To determine if there are cerebrovascular disorders in patients with chronic dizziness using a non invasive technique. PATIENTS AND METHODS: A prospective study was conducted. It included 404 patients without limit of age. The patients were evaluated in a Neurology Outpatient Clinic, to select those patients with chronic instability. A neurosonographic exam was performed to all those selected patients. This exam included colour duplex of the cervical arteries and transcranial Doppler. RESULTS: Up to 54 % of the patients who were included in the study had a normal carotid study. For the rest of the patients, the thickness intima-media was the most prevalent finding. At the vertebrobasilar system the study of the vertebral arteries was completely normal in 81.7% followed by the presence of microangiopathy in 12.1%. The basilar system was also normal in a high figure (78%) followed by the microangiopathy (17.1%). CONCLUSIONS: The vascular disturbances in the vertebrobasilar system are an exceptional finding in patients with chronic instability.
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Transtornos Cerebrovasculares/fisiopatologia , Tontura/fisiopatologia , Ultrassonografia Doppler Transcraniana , Adulto , Idoso , Artérias Carótidas/metabolismo , Artérias Carótidas/patologia , Circulação Cerebrovascular/fisiologia , Transtornos Cerebrovasculares/patologia , Tontura/diagnóstico , Tontura/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fluxo Sanguíneo Regional , Fatores de RiscoRESUMO
OBJECTIVE: Although the use of calcium-channel blockers is strongly supported by experimental data, its clinical application is far less clear. In this paper we intend to review the actual guidelines for using a member of this family of drugs, nicardipine. MATERIAL AND METHODS: We have carried out an intensive search for any clinical assay published with nicardipine all over the last years in different clinical entities such as subarachnoid haemorrhage, migraine, cerebrovascular pathology, etc. In many of them no clinical assays have been done or either they have too many methodological problems so that appropriate conclusions can be drawn. However most of them offer results which should have prompted the design of wider works in number of patients and follow-up periods which could offer conclusive answers to an important number of questions which remain open about the use of this class of drugs. CONCLUSIONS: We have only found a clear indication for the use of nicardipine in migraine and subarachnoid haemorrhage. In the rest of clinical entities reviewed we have found some experimental evidences but no clinical data to justify this use. It is highly recommendable that well designed clinical assays with an adequate number of patients are started in this field.
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Bloqueadores dos Canais de Cálcio/uso terapêutico , Doenças do Sistema Nervoso/tratamento farmacológico , Nicardipino/uso terapêutico , Isquemia Encefálica/tratamento farmacológico , Demência/tratamento farmacológico , Epilepsia/tratamento farmacológico , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Doença de Moyamoya/tratamento farmacológico , Hemorragia Subaracnóidea/tratamento farmacológicoRESUMO
INTRODUCTION: Multiple sclerosis (MS) is a disease of controversial epidemiology, which has frequently been studied. The results of an epidemiological descriptive study in the Alcoi area led to a first case-control study to give information about the factors associated with the illness in this area. It was seen from this that migration, contact with dogs and with cloth might be related to it. OBJECTIVE: To carry out a second analytical study, maintaining the migration factor stable to avoid the possible confounding effect with other associated factors. MATERIAL AND METHODS: For this case-control study we grouped one case with four controls from the population according to age, sex and place of birth. All cases fulfilled criteria defined for MS and the controls were randomly selected from the census. We also classified the cases and controls into three groups, according to whether or not migration was involved (group A: Autochthonous; group B: Immigrants who arrived before the age of 13, and group C: Immigrants who arrived after the age of 13). RESULTS: We analyzed 40 patients and 160 controls. We obtained significant values for 'social group'. The cases belonged to the less favored social group both on overall analysis and in the autochthonous group. Pneumonia was the only infection with significant figures in patients over 15. Contact with dogs gave new statistically significant figures, together with cloth and cloth products. CONCLUSIONS: Persistence of positive correlation of MS with contact with dogs and cloth suggest the possible influence of these two factors in the increase in incidence of MS in this area.
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Esclerose Múltipla/epidemiologia , Adulto , Animais , Animais Domésticos , Estudos de Casos e Controles , Cães , Emigração e Imigração , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Masculino , Metalurgia , Metais/efeitos adversos , Exposição Ocupacional/efeitos adversos , Espanha/epidemiologia , Indústria TêxtilRESUMO
INTRODUCTION: Oat (small) cell carcinoma is the type of tumour most frequently associated to neurologic paraneoplastic syndromes. It is usually located in the lungs although it has been described in some other locations. Cerebellar symptoms may appear alone, associated to anti Yo antibodies ( Breast and gynaecologic carcinomas), or as manifestation of a more generalized paraneoplastic encephalopathy, associated to signs and symptoms of some other neurologic systems affected. CASE REPORT: A 52 year old patient consulted due to a pancerebellar clinical picture, which started about two months before, and later associated to polineuropathy. Abdominal CT showed a 4 cm mass in the head of the pancreas. Pathologic evaluation demonstrated a poorly differentiated small cell pancreatic tumour. Anti Hu antibodies in high titres were found both in serum and cerebrospinal fluid. DISCUSSION: The association of anti Hu immunity and paraneoplastic encephalomyelitis has been observed in patients with neuroblastoma, seminomas, colorectal, breast and prostate carcinomas and some types of sarcoma. Only about 1% of pancreatic malignancies correspond to small cell type. We have not found any previous report about the association between a paraneoplastic syndrome and pancreatic poorly differentiated small cell carcinoma.
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Carcinoma de Células Pequenas/patologia , Neoplasias Pancreáticas/patologia , Degeneração Paraneoplásica Cerebelar/patologia , Anticorpos/sangue , Carcinoma de Células Pequenas/complicações , Proteínas ELAV , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas do Tecido Nervoso/imunologia , Neoplasias Pancreáticas/complicações , Degeneração Paraneoplásica Cerebelar/etiologia , Degeneração Paraneoplásica Cerebelar/fisiopatologia , Proteínas de Ligação a RNA/imunologia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Carotid stenosis has been reported as being associated to lacunar infarcts (LI) with variable frequency, but the aetiopathogenic relation between them is still subject to some controversy. AIMS: Our aim was to describe the prevalence of carotid disorders in a neurosonological study of a sample of patients with LI. PATIENTS AND METHODS: We analysed the results of the neurosonological study conducted on patients with clinical-radiological criteria of LI who were admitted to our Stroke Unit during the period of study. RESULTS: We studied 140 patients, and results were normal in only 42% of the cases. Stenosis > 50% was found in 10% of the cases and plaque without stenosis in 40.3% of the patients. In patients without plaque there was an increase in the tunica intima-media thickness in 7.2% of the cases. CONCLUSION: In most of the patients with LI there were anomalies in the study of the carotid performed using ultrasound scanning.
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Infarto Encefálico/patologia , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/patologia , Idoso , Infarto Encefálico/etiologia , Doenças das Artérias Carótidas/complicações , Comorbidade , Feminino , Humanos , Ultrassonografia Doppler em CoresRESUMO
INTRODUCTION: Lamotrigine (LTG) is a new antiepileptic drug indicated in all kinds of partial and generalised clonic-tonic seizures, both in monotherapy and polytherapy. Between 20 and 30% of epileptic patients have poor control over their seizures despite adequate treatment. AIMS: We report on our experience regarding the long-term efficacy and tolerability of LTG in refractory seizures. PATIENTS AND METHODS: We conducted a consecutive 10-year study of patients who began LTG therapy following poor control of their seizures, in spite of being treated with two or more antiepileptic drugs in monotherapy or in combination. Both their epidemiological and clinical data were collected for study. We studied the efficacy of the treatment, differentiating between remission (absence of seizures), improvement (reduction>50% of the seizures), inefficacy (reduction<50%), exacerbation (increase in seizures) and its tolerability (side effects and dropout). RESULTS: In all, data was collected from 39 patients, 18 males (46.2%), mean age 30.9 +/- 13.7 years; mean follow up time: 27.6 +/- 23.4 months. 43.7% presented cryptogenic epilepsy, in 28.5% it was symptomatic and in the remaining 28.5% it was idiopathic. EEG readings and neuroimaging scans were pathological in 53.8% and 43.6%, respectively. After beginning therapy with LTG, 33% remained free of seizures, 43.6% improved, in 18.3% it was seen to be ineffective and 5.1% got worse. Dropout rate was 56.4%:23.1% due to insufficient control over the seizures, 17.9% owing to side effects and 15.4% because of non-compliance. CONCLUSION: Treatment with LTG offers a high degree of efficacy in the control of seizures in patients with refractory epilepsy, although it is limited by a high dropout rate.
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Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Triazinas/uso terapêutico , Adolescente , Adulto , Anticonvulsivantes/efeitos adversos , Criança , Quimioterapia Combinada , Epilepsia/patologia , Epilepsia/fisiopatologia , Humanos , Lamotrigina , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Triazinas/efeitos adversosRESUMO
INTRODUCTION: Meningiomas are primary tumours of the central nervous system. Usually they are sporadic. The occurrence in more than one member of a family is unusual. Up till now this coincidence had been related with type 2 neurofibromatosis. In this paper we comment on two siblings who did not fulfil neurofibromatosis diagnostic criteria as an example of sporadic familial meningiomas. CLINICAL CASES: Two siblings (a 79 years old female and a 77 years old male) were diagnosed of a meningioma in an interval of two years, with surprising clinical and neuroimaging similarities. In sporadic meningiomas, abnormalities in the long arm of chromosome 22 have been found. Type 2 neurofibromatosis causative gene has also been found in this chromosome. Meningiomas are quite often found in this entity, and therefore, this gene was implicated as a main factor in the genesis of an important number of meningiomas. However, several studies have not found an association between these tumours and the locus for neurofibromatosis, leading to think that there may be other genes that may influence on meningiomas development.
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Neoplasias Meníngeas/genética , Meningioma/genética , Idoso , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico , Meningioma/cirurgia , Neurofibromatose 2/diagnóstico , Neurofibromatose 2/genética , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION AND OBJECTIVE: Massive usage of new neuroimaging techniques has produced an increase in the number of patients with cerebral venous thrombosis. Our aim has been to evaluate this shift in our county through the clinico-radiologic characteristics of the patients admitted to our unit. MATERIAL AND METHODS: Over the last 7 years a total of 12 patients suffering from cerebral venous thrombosis were attended in our department. We have analyzed retrospectively their clinical records. RESULTS: There were 11 women 1 man with a range of ages from 13 to 60 years old. The main associated factor was oral contraceptives intake. Most of them presented with symptoms of benign intracranial hypertension. Magnetic resonance imaging was the most sensitive diagnostic tool. Outcome was good in general. Most of them were treated with intravenous heparin during the acute phase and received oral anticoagulation for 6 months. More than half were diagnosed all over the last three years. CONCLUSIONS: Our data seem to confirm this tendency towards a larger number of cases with the application of new diagnostic tools. In these cases, clinical course is more benign than reported in classical series.
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Embolia e Trombose Intracraniana/diagnóstico , Adolescente , Adulto , Veias Cerebrais/diagnóstico por imagem , Veias Cerebrais/patologia , Diagnóstico Diferencial , Feminino , Humanos , Embolia e Trombose Intracraniana/epidemiologia , Embolia e Trombose Intracraniana/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Febrile convulsions are the most frequent type of seizures in children under 6 years old. They usually have a good prognosis. Only a few of these children will later suffer from non-febrile seizures. The low risk of non-febrile seizures and important side-effects of antiepileptic drugs have limited the use of continuous prophylaxis in children with recurrent febrile seizures. OBJECTIVES: Our aim has been to identify the main factors that imply a higher risk for recurrent febrile convulsions and also to identify the frequency of antiepileptic prophylactic medication in our area. MATERIAL AND METHODS: We have carried out a protocoled study in children which were sent consecutively and with no previous selection to a reference electroencephalography (EEG) outpatient unit in Murcia with the clinical diagnosis of febrile convulsions. Data included have been: sex, actual age and age at the time of the first seizure, total number of seizures, family and personal history of either febrile seizures or epilepsy, EEG findings, treatment and side-effects. Data collection was accomplished between September 1991 and June 1993. A total of 509 patients have been included. RESULTS: A 34% of the children had suffered two or more seizures. Children with recurrent seizures were younger at onset (16.7 vs 21 months) and had more often family history of febrile seizures (40.6% vs 28%) and epilepsy (21.5% vs 12.5%). 60% of the children who had family history of febrile seizures of epilepsy and who suffered the first episode before the age of 16 months had recurrent febrile convulsions. CONCLUSIONS: An age under 16 months at the moment of the first convulsion and the existence of family history of febrile seizures or epilepsy increase the risk of recurrent febrile seizures.
Assuntos
Convulsões Febris/diagnóstico , Pré-Escolar , Eletroencefalografia , Feminino , Humanos , Lactente , Masculino , Recidiva , Estudos Retrospectivos , Fatores de Risco , População Rural , Convulsões Febris/tratamento farmacológico , População Urbana , Ácido Valproico/uso terapêuticoRESUMO
INTRODUCTION: Cerebrovascular disease is an important cause of morbi-mortality. Although its incidence is maximal in older groups, its incidence in young people cannot be forgotten, even more if we consider the socioeconomic and personal consequences derived from it. There are several works on this subject but few of them analyze the specific problem of stroke in women. There is some degree of controversy in this subject, specially about the role of several factors which are more prevalent or either exclusive for women. OBJECTIVES: We wanted to analyze the risk factors and clinical characteristics in a group of women under 45 who suffered a stroke and also to compare these risk factors between women under 35 and those from 35 to 45. MATERIAL AND METHODS: We have carried out a descriptive study, including 61 women under 45 admitted to our centre consecutively between January 1989 and October 1996. RESULTS: Among the most prevalent factors we have found hypertension (27.8%), tobacco consumption (24.5%) and the presence of cardiac abnormalities (22.9%), specially associated to valvular pathology, as well as a higher incidence of contraceptives consumption in women under 35 (80%). CONCLUSIONS: These factors are similar to those found in studies on the general population of young people. Our data indicate that the relevance of the main factors for stroke is common for both sexes and is also significant in young patients.