Eyelid myokymia in patients with migraine taking topiramate.

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.

[Ambulatory neurological care in a prison population]. / Atencion neurologica ambulatoria a una poblacion penitenciaria.

AIMS: Some of the users attended in a Neurology service consist of the inmate population in a prison. The aim of this study is to analyse all the proposals referred from the Alicante II Prison Centre to a Neurology service. PATIENTS AND METHODS: We analyse and describe the clinical characteristics of patients referred from the Alicante II Prison Centre to the Neurology service at the Centro Sanitario Integrado in Villena between the years 2003 and 2006. This analysis involved the following variables: age, sex, personal history, reason for visiting and diagnosis. RESULTS: A total of 88 proposals were recorded. The mean age of the patients was 35 years (84 males/4 females). A total of 15 patients did not attend their appointment (17%). Positive serology for the human immunodeficiency virus was found in 18% of patients. The most frequent reason for visiting was headache (32%), followed by seizures (25%) and, thirdly, vascular pathologies (13%). In a group of 16 patients (18%) the main diagnosis was established as being some kind of psychiatric disorder (anxiety, depression, simulation). CONCLUSIONS: No studies have been published in the literature that analyse the clinical characteristics of patients from prisons referred to a Neurology service. The high percentage of patients who do not attend their appointment and the high percentage of psychiatric disorders that are diagnosed within this group of patients are especially noteworthy. However, and as can be observed in the general population, headache is still the most common reason for visiting. Nevertheless, the group of neurological diagnoses that are most frequently attended is epilepsy.

[Retinopathy secondary to treatment with Interferon beta-1a in a patient with multiple sclerosis]. / Retinopatía secundaria a tratamiento con interferón beta 1a en paciente con esclerosis múltiple.

INTRODUCTION: Although visual symptoms of multiple sclerosis (MS) are very frequent, they are rarely related with treatment with interferon. This is the first case reported in the literature of retinopathy associated with subcutaneous interferon beta-1a, and the second related to interferons in MS. CASE REPORT: A 30-year-old female diagnosed with relapsing-remitting MS who, at 3 months after starting treatment with subcutaneous interferon beta-1a (44 microg/3 times a week), displayed visual disorders. Retinal lesions in the form of cotton wool spots were found as symptoms of microinfarctions in the retina. The lesions got better after stopping treatment and the patient was found to be asymptomatic. CONCLUSIONS: The existence of retinopathy secondary to interferon has been known in the treatment of hepatitis C and neoplasias with interferon alfa since 1990. Despite being a frequently occurring complication, it is usually a mild condition and disappears on withdrawing treatment, or even if it is continued. It is attributed to deposits of immunocomplexes and complement activation in the blood vessels of the retina. Only one other case associated to treatment of MS with interferon beta has been reported in the literature, more specifically related to subcutaneous interferon beta-1b. The clinical characteristics of both cases are identical to those associated to interferon alfa. Despite the fact that the frequency of appearance seems to be lower than in the case of interferon alfa, the physician must bear in mind the possibility encountering this complication.

[Ischemic stroke as a presentation of essential thrombocythemia. Four case reports]. / Ictus isquémico como forma de presentación de trombocitemia esencial. A propósito de cuatro casos.

INTRODUCTION: Essential thrombocythemia (ET) is a myelodysplastic syndrome that constitutes an infrequent cause of ischemic stroke. Few clinical reports have been published describing the clinical onset of ET in the form of a vascular accident. CASE REPORT: We describe four cases of patients with no known haematological pathology who began with an ischemic stroke and were later diagnosed as suffering from ET, following an aetiological investigation. The patients were all young, under 45 years of age, with no significant vascular risk factors, who presented a clinical picture of ischemic stroke and platelet counts above normal values, although in two cases they were below 600 x 10(9)/L. As they progressed, their platelet counts were constantly above this threshold and a diagnosis of ET was reached. CONCLUSIONS: Although ET is an infrequent cause of ischemic stroke, it must be taken into account even in young patients and when platelet counts do not exceed 600 x 10(9)/L. Antiplatelet drug therapy must be indicated in all cases and the clinician must evaluate the suitability of cytoreductive therapy in patients with a high risk of thrombotic event recurrence, especially if platelet counts are above 600 x 10(9)/L.

[The value of acetylcholinesterase inhibitor therapy in the serious phases of Alzheimer's disease]. / Relevancia del tratamiento con inhibidores de la acetilcolinesterasa en las fases graves de la enfermedad de Alzheimer.

INTRODUCTION: The effectiveness of these drugs in the serious stages of the disease has still to be determined. No studies have been published which evaluate the possible influence of pharmacological therapy in patients in the serious stages of Alzheimer type dementia. AIMS: The aim of this study is to compare the progress of deterioration between patients in serious stages of the disease submitted to treatment with anticholinesterase drugs (ACD) and those who, for some reason, are not currently taking them. PATIENTS AND METHODS: A prospective study involving the observation of 20 patients who were diagnosed as suffering from Alzheimer s disease (AD) and who presented serious and/or very serious deterioration. A basal evaluation and a five month follow up were conducted. Three scales, which the patients caregivers filled out by means of an interview, were employed: the Katz index, the Holden communication scale and the Clifton behaviour assessment scale. RESULTS: No statistically significant differences were found between the scores obtained by patients receiving ACD therapy and those who were not on any of the scales used which proved the value of these drugs in the most serious phases of the disease. CONCLUSIONS: Acetylcholinesterase blocking drugs have not proved to be effective in the serious phases of AD. The lack of data based on solid evidence means that we have little idea of the parameters involved in making a decision about whether to interrupt or to continue the treatment in these phases.

[Olfactory seizures and parasellar meningioma]. / Crisis olfatoria y meningioma paraselar.

INTRODUCTION: Partial olfactory seizures are infrequent. They are related to the presence of lesions in the uncinate area of the temporal lobe. Patients describe smells during the ictal phase that are generally unpleasant. We report the cases of two patients with olfactory disorders of a paroxysmal nature caused by a parasellar meningioma. CASE REPORTS: Case 1: a 43 year old male who presented paroxysmal episodes in which he perceived a bitter smell, with dysphoria, linked to the presence of a left side parasellar meningioma. Case 2: a 45 year old female who presented paroxysmal episodes during which she could smell formaldehyde and this was linked to the presence of a left side parasellar meningioma. DISCUSSION: Olfactory seizures are related to structural alterations to the amygdala. The most frequent causes are associated to the presence of mesial temporal sclerosis and, above all, to tumours situated in the temporomesial structures that have diverse aetiologies.

Síndrome del canal de Alcock secundario a infiltración por endometriosis / Alcock canal syndrome secondary to endometrial infiltration

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Atención neurológica ambulatoria a una población penitenciaria / Ambulatory neurological care in a prison population

La población recluida en un centro penitenciario forma parte de los usuarios atendidos en una consultade Neurología. El objetivo del presente estudio es analizar todas las propuestas derivadas desde el Centro Penitenciario Alicante II a una consulta de Neurología. Pacientes y métodos. Se analizan y describen las características clínicas de los pacientesderivados desde el Centro Penitenciario Alicante II a la consulta de Neurología del Centro Sanitario Integrado de Villena, entre los años 2003 y 2006. Se analizan las siguientes variables: edad, sexo, antecedentes personales, motivo de consulta ydiagnóstico. Resultados. Se contabiliza un total de 88 propuestas. La edad media de los pacientes fue de 35 años (84 varones y 4 mujeres). Un total de 15 pacientes no acudieron a la consulta (17%). El 18% de los pacientes presentan serología positivapara el virus de inmunodeficiencia humana. El motivo de consulta más frecuente fue el de cefalea (32%), seguido de crisis convulsivas (25%) y, en tercer lugar, de la patología vascular (13%). En un grupo de 16 pacientes (18%) se estableció como diagnóstico principal alguna alteración psiquiátrica (ansiedad, depresión, simulación). Conclusiones. No existen actualmenteen la bibliografía estudios que analicen las características clínicas de los pacientes penitenciarios derivados a una consulta de Neurología. Llama la atención el alto porcentaje de pacientes que no acuden a la consulta y el alto porcentaje de trastornospsiquiátricos diagnosticados en este grupo de pacientes. No obstante, y como se observa en la población general, la cefalea sigue siendo el motivo de consulta más frecuente. Sin embargo, el grupo diagnóstico neurológico más frecuentemente atendido es la epilepsia

Some of the users attended in a Neurology service consist of the inmate population in a prison. The aim ofthis study is to analyse all the proposals referred from the Alicante II Prison Centre to a Neurology service. Patients and methods. We analyse and describe the clinical characteristics of patients referred from the Alicante II Prison Centre to the Neurology service at the Centro Sanitario Integrado in Villena between the years 2003 and 2006. This analysis involved thefollowing variables: age, sex, personal history, reason for visiting and diagnosis. Results. A total of 88 proposals were recorded. The mean age of the patients was 35 years (84 males/4 females). A total of 15 patients did not attend their appointment (17%). Positive serology for the human immunodeficiency virus was found in 18% of patients. The most frequentreason for visiting was headache (32%), followed by seizures (25%) and, thirdly, vascular pathologies (13%). In a group of 16 patients (18%) the main diagnosis was established as being some kind of psychiatric disorder (anxiety, depression, simulation).Conclusions. No studies have been published in the literature that analyse the clinical characteristics of patients from prisons referred to a Neurology service. The high percentage of patients who do not attend their appointment and the high percentage of psychiatric disorders that are diagnosed within this group of patients are especially noteworthy. However, and as can be observed in the general population, headache is still the most common reason for visiting. Nevertheless, the group of neurological diagnoses that are most frequently attended is epilepsy

Síndrome de embolismo graso / Fat embolism syndrome

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Trombosis venosa cerebral y factor V de Leiden / Cerebral venous thrombosis and factor V Leiden

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Retinopatía secundaria a tratamiento con interferón beta 1a en paciente con esclerosis múltiple / Retinopathy secondary to treatment with interferon beta-1a in a patient with multiple sclerosis

Introducción. Aunque las manifestaciones visuales de la esclerosis múltiple (EM) son muy frecuentes, es excepcional que se relacionen con el tratamiento con interferón. Se presenta el primer caso de la bibliografía de retinopatía asociada a interferón beta 1a subcutáneo, y el segundo en relación con interferones en EM. Caso clínico. Mujer de 30 años, diagnosticada de EM remitente recidivante que, a los 3 meses de iniciar tratamiento con interferón beta 1a subcutáneo (44 μg/3 veces a la semana), presenta alteraciones visuales. Se comprobó la existencia de lesiones retinianas en forma de exudados algodonosos como manifestación de microinfartos en la retina. La lesiones mejoraron tras suspender el tratamiento, y la paciente quedó asintomática. Conclusiones. La retinopatía secundaria a interferón se conoce desde 1990 en los tratamientos con interferón alfa de hepatitis C y neoplasias. Se trata de una complicación frecuente, aunque suele ser leve y desaparece al suspender el tratamiento o incluso si se mantiene. Se atribuye a depósito de inmunocomplejos y activación del complemento en la vasculatura retiniana. En la bibliografía sólo se ha descrito un caso más asociado a interferón beta en el tratamiento de una EM, en concreto a interferón beta 1b subcutáneo. Las características clínicas de ambos casos son idénticas a las asociadas a interferón alfa. A pesar de que la frecuencia de aparición parece menor que con el interferón alfa, será necesario permanecer alerta sobre esta complicación.

Introduction. Although visual symptoms of multiple sclerosis (MS) are very frequent, they are rarely related with treatment with interferon. This is the first case reported in the literature of retinopathy associated with subcutaneous interferon beta-1a, and the second related to interferons in MS. Case report. A 30-year-old female diagnosed with relapsing-remitting MS who, at 3 months after starting treatment with subcutaneous interferon beta-1a (44 μg/3 times a week), displayed visual disorders. Retinal lesions in the form of cotton wool spots were found as symptoms of microinfarctions in the retina. The lesions got better after stopping treatment and the patient was found to be asymptomatic. Conclusions. The existence of retinopathy secondary to interferon has been known in the treatment of hepatitis C and neoplasias with interferon alfa since 1990. Despite being a frequently occurring complication, it is usually a mild condition and disappears on withdrawing treatment, or even if it is continued. It is attributed to deposits of immunocomplexes and complement activation in the blood vessels of the retina. Only one other case associated to treatment of MS with interferon beta has been reported in the literature, more specifically related to subcutaneous interferon beta-1b. The clinical characteristics of both cases are identical to those associated to interferon alfa. Despite the fact that the frequency of appearance seems to be lower than in the case of interferon alfa, the physician must bear in mind the possibility encountering this complication

Bostezos y epilepsia del lóbulo temporal / Yawning and temporal lobe epilepsy

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No disponible

Relevancia del tratamiento con inhibidores de la acetilcolinesterasa en las fases graves de la enfermedad de Alzheimer / The value of acetylcholinesterase inhibitor therapy in the serious phases of Alzheimer´s disease

Introducción. La eficacia de los inhibidores de la acetilcolinesterasa en estadios graves de la enfermedad de Alzheimer (EA) todavía debe clarificarse. No existen estudios publicados que evalúen la influencia del tratamiento farmacológico en los pacientes con demencia de tipo Alzheimer en fases graves. Objetivo. El objetivo de este estudio es comparar la evolución del deterioro entre los pacientes en estadios graves de la enfermedad, que mantienen el tratamiento con fármacos anticolin esterásicos (FAC) y aquellos que, por cualquier motivo, no los toman. Pacientes y métodos. Estudio prospectivo de observación sobre 20 pacientes diagnosticados de EA que presentan un deterioro grave o muy grave. Se realiza una evaluación basal y seguimiento durante cinco meses. Se emplearon tres escalas, que se cumplimentaron mediante entrevista por los cuidadores de los pacientes: índice de Katz, la escala de comunicación de Holden y la escala de valoración de la conducta de Clifton. Resultados. No se establecieron diferencias estadísticamente significativas en las puntuaciones obtenidas por los pacientes con y sin tratamiento con FAC, en ninguna de las escalas utilizadas, que determinara la utilidad de estos fármacos en las fases más graves de la enfermedad. Conclusiones. Los fármacos bloqueadores de la acetilcolinesterasa no han demostrado su eficacia en las fases graves de la EA. La escasez de datos basados en la evidencia provoca un extenso vacío acerca de los parámetros por los cuales tomamos la decisión de interrumpir o mantener el tratamiento en estas fases (AU)

Ictus isquémico como forma de presentación de trombocitemia esencial. A propósito de cuatro casos / Ischemic stroke as a presentation of essential thrombocythemia. Four case reports

Introducción. La trombocitemia esencial (TE) es un síndrome mielodisplásico que constituye una causa infrecuente de ictus isquémico. Hay escasas descripciones clínicas de debut clínico de una TE en forma de accidente vascular agudo. Casos clínicos. Se presentan cuatro casos de pacientes sin patología hematológica conocida que debutan con un accidente vascular cerebral isquémico y en los que la investigación etiológica llevó al diagnóstico de TE. Se trata de pacientes jóvenes, menores de 45 años todos ellos, sin factores de riesgo vascular significativos, que presentan clínica de ictus isquémico y cifras de plaquetas por encima de lo normal, aunque en dos casos por debajo de 600 × 10 elevado a 9/L. En la evolución de todos ellos, las cifras de plaquetas superaron ese umbral de forma mantenida y se llegó al diagnóstico de TE. Conclusiones. Aunque la TE es una causa infrecuente de accidente vascular cerebral isquémico, debe tenerse en cuenta incluso en pacientes jóvenes y cuando las cifras de plaquetas no superen las 600 × 10 elevado a 9/L. Se debe indicar el tratamiento antiagregante en todos los casos y valorar el tratamiento citorreductor en pacientes de alto riesgo de recidiva de fenómenos trombóticos, fundamentalmente, si las cifras de plaquetas superan las 600 × 10 elevado a 9/L (AU)

Introduction. Essential thrombocythemia (ET) is a myelodysplastic syndrome that constitutes an infrequent cause of ischemic stroke. Few clinical reports have been published describing the clinical onset of ET in the form of a vascular accident. Case reports. We describe four cases of patients with no known haematological pathology who began with an ischemic stroke and were later diagnosed as suffering from ET, following an aetiological investigation. The patients were all young, under 45 years of age, with no significant vascular risk factors, who presented a clinical picture of ischemic stroke and platelet counts above normal values, although in two cases they were below 600 × 109 /L. As they progressed, their platelet counts were constantly above this threshold and a diagnosis of ET was reached. Conclusions. Although ET is an infrequent cause of ischemic stroke, it must be taken into account even in young patients and when platelet counts do not exceed 600 × 109 /L. Antiplatelet drug therapy must be indicated in all cases and the clinician must evaluate the suitability of cytoreductive therapy in patients with a high risk of thrombotic event recurrence, especially if platelet counts are above 600 × 109 /L (AU)

Crisis olfatoria y meningioma paraselar / Olfactory seizures and parasellar meningioma

Introducción. Las crisis parciales olfatorias son infrecuentes. Se relacionan con la presencia de lesiones de la región temporouncinada. El paciente describe olores ictales, generalmente desagradables. Describimos dos pacientes con alteraciones olfatorias de carácter paroxístico por un meningioma paraselar. Casos clínicos. Caso 1: varón de 43 años, que presenta episodios paroxísticos de sensación a olor amargo, con disforia, en relación con la presencia de un meningioma paraselar izquierdo. Caso 2: mujer de 45 años, que presenta episodios paroxísticos de olor a formol en relación con la presencia de un meningioma paraselar izquierdo. Discusión. Las crisis olfatorias se relacionan con alteraciones estructurales de la amígdala. Las causas etiológicas más frecuentes se relacionan con la presencia de esclerosis mesial temporal y, sobre todo, con tumores de localización temporomesial de diversa etiología (AU)

Introduction. Partial olfactory seizures are infrequent. They are related to the presence of lesions in the uncinate area of the temporal lobe. Patients describe smells during the ictal phase that are generally unpleasant. We report the cases of two patients with olfactory disorders of a paroxysmal nature caused by a parasellar meningioma. Case reports. Case 1: a 43-year-old male who presented paroxysmal episodes in which he perceived a bitter smell, with dysphoria, linked to the presence of a left-side parasellar meningioma. Case 2: a 45-year-old female who presented paroxysmal episodes during which she could smell formaldehyde and this was linked to the presence of a left-side parasellar meningioma. Discussion. Olfactory seizures are related to structural alterations to the amygdala. The most frequent causes are associated to the presence of mesial temporal sclerosis and, above all, to tumours situated in the temporomesial structures that have diverse aetiologies (AU)