Sleep Problems Are Related to a Worse Quality of Life and a Greater Non-Motor Symptoms Burden in Parkinson's Disease.

INTRODUCTION: The aim of the present study was to examine the frequency of self-reported sleep problems and their associated factors in a large cohort of PD patients. METHODS: PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort were included in this cross-sectional study. Sleep problems were assessed by the Spanish version of the Parkinson's disease Sleep Scale version 1 (PDSS-1). An overall score below 82 or a score below 5 on at least 1 item was defined as sleep problems. RESULTS: The frequency of sleep problems was nearly double in PD patients compared to controls: 65.8% (448/681) vs 33.5% (65/206) (p < 0.0001). Mean total PDSS score was lower in PD patients than controls: 114.9 ± 28.8 vs 132.8 ± 16.3 (p < 0.0001). Quality of life (QoL) was worse in PD patients with sleep problems compared to those without: PDQ-39SI, 19.3 ± 14 vs 13 ± 11.6 (p < 0.0001); EUROHIS-QoL8, 3.7 ± 0.5 vs 3.9 ± 0.5 (p < 0.0001). Non-motor symptoms burden (NMSS; OR = 1.029; 95%CI 1.015-1.043; p < 0.0001) and impulse control behaviors (QUIP-RS; OR = 1.054; 95%CI 1.009-1.101; p = 0.018) were associated with sleep problems after adjustment for age, gender, disease duration, daily equivalent levodopa dose, H&Y, UPDRS-III, UPDRS-IV, PD-CRS, BDI-II, NPI, VAS-Pain, VAFS, FOGQ, and total number of non-antiparkinsonian treatments. CONCLUSION: Sleep problems were frequent in PD patients and were related to both a worse QoL and a greater non-motor symptoms burden in PD. These findings call for increased awareness of sleep problems in PD patients.

COPPADIS-2015 (COhort of Patients with PArkinson's DIsease in Spain, 2015): an ongoing global Parkinson's disease project about disease progression with more than 1000 subjects included. Results from the baseline evaluation.

BACKGROUND AND PURPOSE: In Parkinson's disease (PD), the course of the disorder is highly variable between patients. Well-designed, prospective studies for identifying PD progression biomarkers are necessary. Our aim was to show the results of baseline evaluations of an ongoing global PD project, COPPADIS-2015 (Cohort of Patients with PArkinson's DIsease in Spain, 2015). METHODS: This was an observational, descriptive, nationwide study (Spain). The recruitment period ended in October 2017. Baseline evaluation included more than 15 validated scales and complementary studies in a subgroup of participants. RESULTS: In total, 1174 subjects from 35 centres were considered valid for baseline analysis: 694 patients (62.6 ± 8.9 years old, 60.3% males), 273 caregivers (58.5 ± 11.9 years old, 31.8% males) and 207 controls (61 ± 8.3 years old, 49.5% males). The mean disease duration was 5.5 ± 4.4 years. Hoehn and Yahr stage was 1 or 2 in 90.7% of the patients whilst 33.9% and 18.1% of them presented motor fluctuations and dyskinesias, respectively. The mean Non-Motor Symptoms Scale total score was 45.4 ± 38.1, and 30.4% of the patients presented cognitive impairment, 16.1% major depression, 12.7% impulse control disorder, 7.2% compulsive behaviour, 57.2% pain and 13.2% falls. Compared to the control group, PD patients presented a significantly higher burden of non-motor symptoms and a worse quality of life. More than 300 subjects conducted complementary studies (serum biomarkers, genetic and neuroimaging). CONCLUSIONS: Parkinson's disease is a complex disorder and different non-motor symptoms are frequently present and are more prevalent than in controls. In real clinical practice it is important to ask for them.

Dopaminergic agonists in Parkinson's disease.

BACKGROUND: Non-ergoline dopamine agonists (DA) are effective treatments for Parkinson's disease (PD). This review presents the pharmacology, evidence of efficacy and safety profile of pramipexole, ropinirole, and rotigotine, and practical recommendations are given regarding their use in clinical practice. RESULTS: Extended-release formulations of pramipexole and ropinirole and transdermal continuous delivery rotigotine patches are currently available; these may contribute to stabilising of plasma levels. In early PD, the three drugs significantly improve disability scales, delay time to dyskinesia and allow a later introduction of levodopa. In late PD they reduced total 'off'-time, improved Unified Parkinson's Disease Rating Scale (UPDRS) in both 'on' and 'off' state and allowed a reduction in total levodopa dosage. A significant improvement in quality of life scales has also been demonstrated. Extended-release formulations have proved to be non-inferior to the immediate release formulations and are better tolerated (ropinirole). Despite a generally good safety profile, serious adverse events, such as impulse control disorder and sleep attacks, need to be routinely monitored. Although combination therapy has not been addressed in scientific literature, certain combinations, such as apomorphine and another DA, may be helpful. Switching from one DA to another is feasible and safe, although in the first days an overlap of dopaminergic side effects may occur. When treatment with DA is stopped abruptly, dopamine withdrawal syndrome may present. Suspending any DA, especially pramipexole, has been linked to onset of apathy, which may be severe. CONCLUSIONS: New non-ergotine DAs are a valuable option for the treatment of both early and late PD. Despite their good safety profile, serious adverse effects may appear; these effects may have a pathoplastic effect on the course of PD and need to be monitored.

The impact of Parkinson's disease severity on performance of activities of daily living: an observational study. / El impacto de la gravedad de la enfermedad de Parkinson en el desempeño de las actividades de la vida diaria: un estudio observacional.

INTRODUCTION: Parkinson's disease (PD) affects the ability to perform activities of daily living (ADL), increasing with disease progression. The study of the association between PD severity and occupational performance skills may improve the understanding of the functional impairment associated with this pathology. OBJECTIVE: To study the relationship between PD severity and the loss of functional performance. PATIENTS AND METHODS: 49 non-demented PD patients were assessed with The Assessment of Motor and Process Skills (AMPS) scale, the Hoehn and Yahr scale (HY), the section III of the Unified Parkinson Disease Rating Scale (UPDRS), and the Schwab and England scale. RESULTS: PD severity was related to the AMPS scale (p < 0.001). There was a strong correlation between the AMPS motor skills and the HY scale (p < 0.001) and UPDRS III (p < 0.001), as well as between process skills and the Schwab and England E scale (p < 0.001). A moderate correlation was found between Schwab and England scale and AMPS motor skills, while a strong correlation was found with the process skills. Finally, a weak correlation was found between the AMPS scale and disease duration, yet only in the motor section. CONCLUSIONS: The severity of PD is closely related to the impairment of functional skills measured with the AMPS scale in non-demented PD patients. A strong correlation was found with the motor skills. A strong correlation was found between the AMPS process skills scale and Schwab and England ADL scale. A weak correlation was found between the AMPS motor scale and disease duration. The AMPS scale might be a useful tool to monitoring the PD progression through the observation of ADL performance.

TITLE: El impacto de la gravedad de la enfermedad de Parkinson en el desempeño de las actividades de la vida diaria: un estudio observacional.Introducción. La enfermedad de Parkinson (EP) afecta a la capacidad para realizar actividades de la vida diaria (AVD), lo que se incrementa con la progresión de la enfermedad. El estudio de la asociación entre la gravedad de la EP y las habilidades de desempeño ocupacional puede mejorar la comprensión del deterioro funcional asociado a esta patología. Objetivo. Estudiar la relación entre la gravedad de la EP y la pérdida de rendimiento funcional. Pacientes y métodos. Se evaluó a 49 pacientes con EP con la escala Assessment of Motor and Process Skills (AMPS), la escala Hoehn and Yahr (HY), la sección III de la Unified Parkinson Disease Rating Scale (UPDRS) y la escala Schwab and England. Resultados. La gravedad de la EP se observó correlacionada con la escala AMPS (p < 0,001). Hubo una fuerte correlación entre las destrezas motoras de la AMPS y las escalas HY (p < 0,001) y UPDRS III (p < 0,001), así como entre las destrezas de procesamiento y la escala Schwab and England (p < 0,001). Se encontró una correlación moderada entre la escala Schwab and England y las habilidades motoras de la AMPS, mientras que se encontró una correlación fuerte con las habilidades de procesamiento. Por último, se encontró una correlación débil entre la escala AMPS y los años de evolución de la EP, aunque sólo en el apartado motor. Conclusiones. La gravedad de la EP está estrechamente relacionada con el deterioro de las habilidades funcionales medidas con la escala AMPS en pacientes con EP no dementes. Se encontró una fuerte correlación con las habilidades motoras. Se encontró una fuerte correlación entre la escala AMPS de habilidades de procesamiento y la escala Schwab and England. Se encontró una correlación débil entre la escala motora AMPS y la duración de la enfermedad. La escala AMPS podría ser una herramienta útil para monitorizar la progresión de la EP a través de la observación del desempeño de las AVD.

[What do medical students think about functional neurological disorders?] / ¿Qué piensan los estudiantes de Medicina sobre los trastornos neurológicos funcionales?

INTRODUCTION: Functional neurological disorders (FND) are a frequent reason for visits in neurology. However, specific training on these disorders during undergraduate and residency training is limited. This study assesses the knowledge, attitude and exposure of medical students to FNDs before completing their medical degree. PATIENTS AND METHODS: We conducted a 15-item survey to explore understanding, exposure and attitudes towards FNDs among sixth-year medical students at four Spanish universities. RESULTS: A total of 118 students (mean age 23.6 ± 1.2 years; 71.2% female) returned the survey. Of these, 88 (74.6%) were aware of the concept of FNDs and 78 (66.1%) had studied them in psychiatry classes. The term 'psychosomatic' was chosen by 54.1% of the students as the most appropriate term to refer to these disorders, and 111 (94.1%) believed that a history of sexual or physical abuse was common among FND patients. Fifty-seven students (48.3%) assumed that the diagnosis of FND was mostly a clinical diagnosis of exclusion and 63 (53.4%) indicated that it is managed only by psychiatry. One hundred and one students (85.6%) considered that adequate training on FNDs is an important aspect of their medical training. CONCLUSIONS: Medical students are aware of the existence of FNDs, but their preferred terminology, as well as the perceived aetiological factors, reflect that the historical view of these disorders is still deeply rooted. Medical students feel that they should receive adequate education on FNDs from specialists in neurology and psychiatry as part of their training.

TITLE: ¿Qué piensan los estudiantes de Medicina sobre los trastornos neurológicos funcionales?Introducción. Los trastornos neurológicos funcionales (TNF) son un motivo de consulta frecuente en neurología. Sin embargo, la formación específica sobre estos trastornos durante la formación universitaria y el período de residencia es limitada. En este estudio se evalúan los conocimientos, la actitud y la exposición de los estudiantes de Medicina a los TNF antes de terminar el grado de Medicina. Sujetos y métodos. Realizamos una encuesta de 15 ítems para explorar la comprensión, la exposición y las actitudes hacia los TNF entre los estudiantes de Medicina de sexto año en cuatro universidades españolas. Resultados. Devolvieron la encuesta 118 estudiantes (edad media 23,6 ± 1,2 años; 71,2%, mujeres). De ellos, 88 (74,6%) conocían el concepto de TNF y 78 (66,1%) los habían estudiado en las clases de psiquiatría. El 54,1% de los estudiantes eligió el término 'psicosomático' como el más adecuado para referirse a estos trastornos, y 111 (94,1%) creían que una historia de abuso sexual o físico era común entre los pacientes con TNF. Cincuenta y siete estudiantes (48,3%) asumieron que el diagnóstico de TNF era mayoritariamente un diagnóstico clínico de exclusión y 63 (53,4%) señalaron que el manejo se realiza únicamente desde psiquiatría. Ciento un estudiantes (85,6%) consideraron que una formación adecuada sobre los TNF es un aspecto importante de su formación médica. Conclusiones. Los estudiantes de Medicina son conscientes de la existencia de los TNF, pero la terminología preferida por ellos, así como los factores etiológicos percibidos, reflejan que la visión histórica acerca de estos trastornos está aún arraigada. Los estudiantes de Medicina consideran que deberían recibir una educación adecuada sobre los TNF como parte de su formación por parte de los especialistas en neurología y psiquiatría.

[Perioperative management of Parkinson's disease]. / Manejo perioperatorio de la enfermedad de Parkinson.

One of the particular characteristics of Parkinson's disease (PD) is the wide clinical variation as regards the treatment that can be found in the same patient. This occurs with specific treatment for PD, as well as with other drug groups that can make motor function worse. For this reason, the perioperative management of PD requires experience and above all appropriate planning. In this article, the peculiarities of PD and its treatment are reviewed, and a strategy is set out for the perioperative management of these patients.

Visual impairment induced by prosthetic cobaltism.

The case of a 68-year-old patient with visual loss secondary to prosthetic cobaltism is reported. The degeneration of the metallic hip prosthesis can produce a systemic absorption of cobalt with cardiac, neurological, endocrine, auditory, and visual manifestations. The diagnostic suspicion is confirmed by serum cobalt measurements. Treatment with early surgery and chelating agents can lead to improvement of the visual, and the other disorders.

Staging Parkinson's Disease Combining Motor and Nonmotor Symptoms Correlates with Disability and Quality of Life.

INTRODUCTION: In a degenerative disorder such as Parkinson's disease (PD), it is important to establish clinical stages that allow to know the course of the disease. Our aim was to analyze whether a scale combining Hoehn and Yahr's motor stage (H&Y) and the nonmotor symptoms burden (NMSB) (assessed by the nonmotor symptoms scale (NMSS)) provides information about the disability and the patient's quality of life (QoL) with regard to a defined clinical stage. MATERIALS AND METHODS: Cross-sectional study in which 603 PD patients from the COPPADIS cohort were classified according to H&Y (1, stage I; 2, stage II; 3, stage III; 4, stage IV/V) and NMSB (A: NMSS = 0-20; B: NMSS = 21-40; C: NMSS = 41-70; D: NMSS ≥ 71) in 16 stages (HY.NMSB, from 1A to 4D). QoL was assessed with the PDQ-39SI, PQ-10, and EUROHIS-QOL8 and disability with the Schwab&England ADL (Activities of Daily Living) scale. RESULTS: A worse QoL and greater disability were observed at a higher stage of H&Y and NMSB (p < 0.0001). Combining both (HY.NMSB), patients in stages 1C and 1D and 2C and 2D had significantly worse QoL and/or less autonomy for ADL than those in stages 2A and 2B and 3A and 3B, respectively (p < 0.005; e.g., PDQ-39SI in 1D [n = 15] vs 2A [n = 101]: 28.6 ± 17.1 vs 7.9 ± 5.8; p < 0.0001). CONCLUSION: The HY.NMSB scale is simple and reflects the degree of patient involvement more accurately than the H&Y. Patients with a lower H&Y stage may be more affected if they have a greater NMS burden.

[Efficacy of Tranexamic Acid to decrease perioperative bleeding in primary total reverse arthroplasty]. / Eficacia del ácido tranexámico para disminuir el sangrado perioperatorio en artroplastía total reversa primaria.

INTRODUCTION: Reverse shoulder arthroplasty improves function and pain in patients with glenohumeral osteoarthritis and rotator cuff deficiency. However, it is associated with significant blood loss and postoperative hematoma (PO) formation. OBJECTIVE: To determine the efficacy of tranexamic acid (ATXM) to decrease perioperative bleeding in patients undergoing primary reverse shoulder arthroplasty. MATERIAL AND METHODS: Cohort of 31 patients undergoing reverse primary arthroplasty, in two groups: group A (17 patients) were given 1 g IV of preoperative tranexamic acid and group B (14 patients) to whom it was not administered. Preoperative hemoglobin and hematocrit were recorded and then after 24 hours of surgery, and quantified bleeding in drainage at 24 hours, as well as blood transfusion needs. The changes presented were statistically compared. RESULTS: Demographic data did not show significant differences between the two groups. There is a tendency to reduce bleeding in surgical drainage in patients with ATXM (115.6 ml vs. 162.65 ml p = 0.0768), in the decrease of hemoglobin (2.16 g/dl vs. 2.79 g/dl p = 0.1257) and hematocrit (6.67% vs. 7.95% p = 0.3431). There was a significant reduction in the use of blood products in patients with ATXM (p = 0.0441). CONCLUSION: There is a tendency to have less PO bleeding in patients undergoing primary reverse arthroplasty with the use of ATXM and a lower PO blood transfusion requirement.

INTRODUCCIÓN: La artroplastía reversa de hombro mejora la función y el dolor en pacientes con artrosis glenohumeral y deficiencia del manguito de los rotadores. Sin embargo, se asocia con pérdida sanguínea significativa y formación de hematoma en el postoperatorio (PO). OBJETIVO: Determinar la eficacia del ácido tranexámico (ATXM) para disminuir el sangrado perioperatorio en pacientes sometidos a artroplastía reversa primaria de hombro. MATERIAL Y MÉTODOS: Cohorte de 31 pacientes sometidos a artroplastía primaria reversa, dos grupos: grupo A (17 pacientes) se les aplicó 1 g intravenoso de ácido tranexámico preoperatorio y el grupo B (14 pacientes) a quienes no se les administró. Se registraron la hemoglobina y el hematocrito preoperatorio y a las 24 horas de la cirugía y el sangrado cuantificado en el drenaje a las 24 horas, así como las necesidades de transfusión sanguínea. Se compararon estadísticamente los cambios presentados. RESULTADOS: Los datos demográficos no demostraron diferencias significativas entre ambos grupos. Hay tendencia a menor sangrado en el drenaje quirúrgico en los pacientes con ATXM (115.6 vs 162.65 ml, p = 0.0768), en la disminución de hemoglobina (2.16 vs 2.79 g/dl, p = 0.1257) y del hematocrito (6.67% vs 7.95% p = 0.3431). Existió una significativa reducción en el uso de hemoderivados en los pacientes con ATXM (p = 0.0441). CONCLUSIONES: Existe una tendencia a presentar menor sangrado PO en pacientes sometidos a artroplastía reversa primaria con el uso del ATXM y un menor requerimiento de transfusión sanguínea PO.

[Supraspinatus tendon ruptures: correlation between MRI and surgical findings]. / Rupturas del tendón del supraespinoso: correlación entre RMN y hallazgos quirúrgicos.

INTRODUCTION: In rotator cuff rupture, the supraspinatus tendon ranks first in frequency. MRI is the study of choice for preoperative diagnosis and planning. The objective of this study was to assess the concordance between findings observed with MRI and transoperative in patients with supraspinatus tendon rupture. MATERIAL AND METHODS: A retrospective analysis was conducted from January 2014 to January 2020. Including patients over the age of 18, with MRI and supraspinatus tendon rupture report. A 2 analysis was performed for sensitivity, specificity, predictive values and diagnostic certainty using surgical findings as a reference. The kappa index was used to show the concordance between MRI and transoperative findings. RESULTS: A total of 79 patients were included in the study, 45 male and 34 female. The average age was 52.14 years. MRI correctly diagnosed 60.76% of supraspinatus ruptures, showing 74% sensitivity and 96% specificity for complete ruptures. For partial ruptures I show a sensitivity of 96%, a specificity of 33%. The kappa index showed a match of 0.90 for total ruptures and 0.53 for partial. CONCLUSIONS: MRI demonstrated good sensitivity and specificity for diagnosing complete ruptures, with good match to surgical findings. MRI proved to be a non-specific study for the identification of partial ruptures, which causes these lesions to be overdiagnosed.

INTRODUCCIÓN: En la ruptura del manguito de los rotadores, el tendón del supraespinoso ocupa el primer lugar en frecuencia. La resonancia magnética es el estudio de elección para el diagnóstico y planificación preoperatoria. El objetivo de este estudio fue evaluar la concordancia entre los hallazgos observados con la IRM y los hallazgos transoperatorios en pacientes con ruptura del tendón del supraespinoso. MATERIAL Y MÉTODOS: Se realizó un análisis retrospectivo de Enero de 2014 a Enero de 2020. Se incluyeron pacientes mayores de 18 años, con IRM y reporte de ruptura del tendón del supraespinoso. Se realizó un análisis de 2 para la sensibilidad, especificidad, valores predictivos y certeza diagnóstica utilizando los hallazgos quirúrgicos como referencia. Se utilizó el índice de Kappa para mostrar la concordancia entre IRM y hallazgos transoperatorios. RESULTADOS: Un total de 79 pacientes se incluyeron en el estudio, 45 masculinos y 34 femeninos. La edad promedio fue de 52.14 años. La IRM diagnosticó correctamente 60.76% de las rupturas del supraespinoso, mostró una sensibilidad de 74% y especificidad de 96% para rupturas completas. Para rupturas parciales mostró una sensibilidad de 96% y una especificidad de 33%. El índice de Kappa mostró una concordancia de 0.90 para rupturas totales y de 0.53 para rupturas parciales. CONCLUSIONES: La resonancia magnética demostró una buena sensibilidad y especificidad para el diagnóstico de rupturas completas, con una buena concordancia con los hallazgos quirúrgicos. La IRM demostró ser un estudio poco específico para la identificación de rupturas parciales, lo cual genera que estas lesiones estén sobrediagnosticadas.

Quality of life and non-motor symptoms in Parkinson's disease patients with subthreshold depression.

BACKGROUND: The role of subthreshold depression (subD) in Parkinson's Disease (PD) is not clear. The present study aimed to compare the quality of life (QoL) in PD patients with subD vs patients with no depressive disorder (nonD). Factors related to subD were identified. MATERIAL AND METHODS: PD patients and controls recruited from the COPPADIS cohort were included. SubD was defined as Judd criteria. The 39-item Parkinson's disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8) were used to assess QoL. RESULTS: The frequency of depressive symptoms was higher in PD patients (n = 694) than in controls (n = 207) (p < 0.0001): major depression, 16.1% vs 7.8%; minor depression, 16.7% vs 7.3%; subD, 17.4% vs 5.8%. Both health-related QoL (PDQ-39; 18.1 ±â€¯12.8 vs 11.6 ±â€¯10; p < 0.0001) and global QoL (EUROHIS-QOL8; 3.7 ±â€¯0.5 vs 4 ±â€¯0.5; p < 0.0001) were significantly worse in subD (n = 120) than nonD (n = 348) PD patients. Non-motor Symptoms Scale (NMSS) total score was higher in subD patients (45.9 ±â€¯32 vs 29.1 ±â€¯25.8;p < 0.0001). Non-motor symptoms burden (NMSS;OR = 1.019;95%CI 1.011-1.028; p < 0.0001), neuropsychiatric symptoms (NPI; OR = 1.091; 95%CI 1.045-1.139; p < 0.0001), impulse control behaviors (QUIP-RS; OR = 1.035; 95%CI 1.007-1063; p = 0.013), quality of sleep (PDSS; OR = 0.991; 95%CI 0.983-0.999; p = 0.042), and fatigue (VAFS-physical; OR = 1.185; 95%CI 1.086-1.293; p < 0.0001; VAFS-mental; OR = 1.164; 95%CI 1.058-1.280; p = 0.0001) were related to subD after adjustment to age, disease duration, daily equivalent levodopa dose, motor status (UPDRS-III), and living alone. CONCLUSIONS: SubD is a frequent problem in patients with PD and is more prevalent in these patients than in controls. QoL is worse and non-motor symptoms burden is greater in subD PD patients.

Non-motor symptoms burden, mood, and gait problems are the most significant factors contributing to a poor quality of life in non-demented Parkinson's disease patients: Results from the COPPADIS Study Cohort.

OBJECTIVE: To identify factors related to a poor health-related and global quality of life (QoL) in a cohort of non-demented Parkinson's disease (PD) patients and compare to a control group. METHODS: The data correspond to the baseline evaluation of the COPPADIS-2015 Study, an observational, 5-year follow-up, multicenter, evaluation study. Three instruments were used to assess QoL: (1) the 39-item Parkinson's disease Questionnaire (PDQ-39), (2) a subjective rating of global QoL (PQ-10), and (3) the EUROHIS-QOL 8-item index (EUROHIS-QOL8). Multiple linear regression methods were used to evaluate the direct impact of different variables on these QoL measures. RESULTS: QoL was worse in PD patients (n = 692; 62.6 ±â€¯8.9 years old, 60.3% males) than controls (n = 206; 61 ±â€¯8.3 years old, 49.5% males): PDQ-39, 17.1 ±â€¯13.5 vs 4.4 ±â€¯6.3 (p < 0.0001); PQ-10, 7.3 ±â€¯1.6 vs 8.1 ±â€¯1.2 (p < 0.0001); EUROHIS-QOL8, 3.8 ±â€¯0.6 vs 4.2 ±â€¯0.5 (p < 0.0001). A high correlation was observed between PDQ-39 and Non-Motor Symptoms Scale (NMSS) (r = 0.72; p < 0.0001), and PDQ-39 and Beck Depression Inventory-II (BDI-II) (r = 0.65; p < 0.0001). For health-related QoL (PDQ-39), non-motor symptoms burden (NMSS), mood (BDI-II), and gait problems (Freezing Of Gait Questionnaire [FOGQ]) provided the highest contribution to the model (ß = 0.32, 0.28, and 0.27, respectively; p < 0.0001); whereas mood and gait problems contributed the most to global QoL (PQ-10, ß = -0.46 and -0.21, respectively; EUROHIS-QOL8, ß = -0.44 and -0.23, respectively). CONCLUSIONS: QoL is worse in PD patients than in controls. Mood, non-motor symptoms burden, and gait problems seem to be the most relevant factors affecting health-related and global perceived QoL in non-demented PD patients.

Exploring the interaction of microcystin-LR with proteins and DNA.

The physiological role of microcystin-LR is still under discussion, and since binding of microcystin-LR to proteins different from their main cellular targets was described, we have performed experiments in order to explore this interaction. A non-specific interaction of microcystin-LR with a variety of soluble proteins in vitro is disrupted when using organic solvents such as methanol. The isoelectric point of proteins is not affected by their interaction with microcystin-LR, even though the presence of microcystin-LR alters the pool of peptides obtained by tryptic digestions. Under the conditions tested, microcystin-LR does not exhibit affinity for DNA. Although it is unlikely that the non-specific binding of microcystin-LR to proteins has a physiological meaning, one must be aware of the fact that determinations of the toxin extracted from any biological sample may be affected by the presence of proteins in the extracts. Consequently, we strongly recommend use organic solvents and to lyophilise the tissue samples to guarantee the accessibility of these organic solvents to microcystin-LR when performing experiments with tissue or cell extracts.

El impacto de la gravedad de la enfermedad de Parkinson en el desempeño de las actividades de la vida diaria: un estudio observacional / The impact of Parkinson’s disease severity on performance of activities of daily living: an observational study

Introducción: La enfermedad de Parkinson (EP) afecta a la capacidad para realizar actividades de la vida diaria (AVD), lo que se incrementa con la progresión de la enfermedad. El estudio de la asociación entre la gravedad de la EP y las habilidades de desempeño ocupacional puede mejorar la comprensión del deterioro funcional asociado a esta patología. Objetivo: Estudiar la relación entre la gravedad de la EP y la pérdida de rendimiento funcional. Pacientes y métodos: Se evaluó a 49 pacientes con EP con la escala Assessment of Motor and Process Skills (AMPS), la escala Hoehn & Yahr (HY), la sección III de la Unified Parkinson Disease Rating Scale (UPDRS) y la escala Schwab & England. Resultados: La gravedad de la EP se observó correlacionada con la escala AMPS (p < 0,001). Hubo una fuerte correlación entre las destrezas motoras de la AMPS y las escalas HY (p < 0,001) y UPDRS III (p < 0,001), así como entre las destrezas de procesamiento y la escala Schwab & England (p < 0,001). Se encontró una correlación moderada entre la escala Schwab & England y las habilidades motoras de la AMPS, mientras que se encontró una correlación fuerte con las habilidades de procesamiento. Por último, se encontró una correlación débil entre la escala AMPS y los años de evolución de la EP, aunque sólo en el apartado motor. Conclusiones: La gravedad de la EP está estrechamente relacionada con el deterioro de las habilidades funcionales medidas con la escala AMPS en pacientes con EP no dementes. Se encontró una fuerte correlación con las habilidades motoras. Se encontró una fuerte correlación entre la escala AMPS de habilidades de procesamiento y la escala Schwab & England. Se encontró una correlación débil entre la escala motora AMPS y la duración de la enfermedad. La escala AMPS podría ser una herramienta útil para monitorizar la progresión de la EP a través de la observación del desempeño de las AVD.(AU)

Introduction: Parkinson’s disease (PD) affects the ability to perform activities of daily living (ADL), increasing with disease progression. The study of the association between PD severity and occupational performance skills may improve the understanding of the functional impairment associated with this pathology. Objective: To study the relationship between PD severity and the loss of functional performance. Patients and methods: 49 non-demented PD patients were assessed with The Assessment of Motor and Process Skills (AMPS) scale, the Hoehn & Yahr scale (HY), the section III of the Unified Parkinson Disease Rating Scale (UPDRS), and the Schwab & England scale. Results: PD severity was related to the AMPS scale (p < 0.001). There was a strong correlation between the AMPS motor skills and the HY scale (p < 0.001) and UPDRS III (p < 0.001), as well as between process skills and the Schwab & England E scale (p < 0.001). A moderate correlation was found between Schwab & England scale and AMPS motor skills, while a strong correlation was found with the process skills. Finally, a weak correlation was found between the AMPS scale and disease duration, yet only in the motor section. Conclusions: The severity of PD is closely related to the impairment of functional skills measured with the AMPS scale in non-demented PD patients. A strong correlation was found with the motor skills. A strong correlation was found between the AMPS process skills scale and Schwab & England ADL scale. A weak correlation was found between the AMPS motor scale and disease duration. The AMPS scale might be a useful tool to monitoring the PD progression through the observation of ADL performance.(AU)

¿Qué piensan los estudiantes de Medicina sobre los trastornos neurológicos funcionales? / What do medical students think about functional neurological disorders?

Introducción: Los trastornos neurológicos funcionales (TNF) son un motivo de consulta frecuente en neurología. Sin embargo, la formación específica sobre estos trastornos durante la formación universitaria y el período de residencia es limitada. En este estudio se evalúan los conocimientos, la actitud y la exposición de los estudiantes de Medicina a los TNF antes de terminar el grado de Medicina. Sujetos y métodos: Realizamos una encuesta de 15 ítems para explorar la comprensión, la exposición y las actitudes hacia los TNF entre los estudiantes de Medicina de sexto año en cuatro universidades españolas. Resultados: Devolvieron la encuesta 118 estudiantes (edad media 23,6 ± 1,2 años; 71,2%, mujeres). De ellos, 88 (74,6%) conocían el concepto de TNF y 78 (66,1%) los habían estudiado en las clases de psiquiatría. El 54,1% de los estudiantes eligió el término ‘psicosomático’ como el más adecuado para referirse a estos trastornos, y 111 (94,1%) creían que una historia de abuso sexual o físico era común entre los pacientes con TNF. Cincuenta y siete estudiantes (48,3%) asumieron que el diagnóstico de TNF era mayoritariamente un diagnóstico clínico de exclusión y 63 (53,4%) señalaron que el manejo se realiza únicamente desde psiquiatría. Ciento un estudiantes (85,6%) consideraron que una formación adecuada sobre los TNF es un aspecto importante de su formación médica. Conclusiones: Los estudiantes de Medicina son conscientes de la existencia de los TNF, pero la terminología preferida por ellos, así como los factores etiológicos percibidos, reflejan que la visión histórica acerca de estos trastornos está aún arraigada. Los estudiantes de Medicina consideran que deberían recibir una educación adecuada sobre los TNF como parte de su formación por parte de los especialistas en neurología y psiquiatría.(AU)

Introduction: Functional neurological disorders (FND) are a frequent reason for visits in neurology. However, specific training on these disorders during undergraduate and residency training is limited. This study assesses the knowledge, attitude and exposure of medical students to FNDs before completing their medical degree. Patients and methods: We conducted a 15-item survey to explore understanding, exposure and attitudes towards FNDs among sixth-year medical students at four Spanish universities. Results: A total of 118 students (mean age 23.6 ± 1.2 years; 71.2% female) returned the survey. Of these, 88 (74.6%) were aware of the concept of FNDs and 78 (66.1%) had studied them in psychiatry classes. The term ‘psychosomatic’ was chosen by 54.1% of the students as the most appropriate term to refer to these disorders, and 111 (94.1%) believed that a history of sexual or physical abuse was common among FND patients. Fifty-seven students (48.3%) assumed that the diagnosis of FND was mostly a clinical diagnosis of exclusion and 63 (53.4%) indicated that it is managed only by psychiatry. One hundred and one students (85.6%) considered that adequate training on FNDs is an important aspect of their medical training. Conclusions: Medical students are aware of the existence of FNDs, but their preferred terminology, as well as the perceived aetiological factors, reflect that the historical view of these disorders is still deeply rooted. Medical students feel that they should receive adequate education on FNDs from specialists in neurology and psychiatry as part of their training.(AU)

[Myths and evidence on the use of botulinum toxin: neuropharmacology and dystonia]. / Mitos y evidencias en el empleo de la toxina botulinica: neurofarmacologia y distonias.

INTRODUCTION: Botulinum toxin type A (BTA) is a bacterial endotoxin, whose therapeutic use has had a dramatic impact on different neurological disorders, such as dystonia and spasticity. AIM: To analyze and summarize different questions about the use of BTA in our clinical practice. DEVELOPMENT: A group of experts in neurology developed a list of topics related with the use of BTA. Two groups were considered: neuropharmacology and dystonia. A literature search at PubMed, mainly for English language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of neuropharmacology, such as mechanism of action, bioequivalence of the different preparations, immunogenicity, etc. were included. Regarding dystonia, the document included questions about methods of evaluation, cervical dystonia, blepharospasm, etc. CONCLUSION: This review does not pretend to be a guide, but rather a tool for continuous training of residents and specialists in neurology, about different specific areas of the management of BTA.

TITLE: Mitos y evidencias en el empleo de la toxina botulinica: neurofarmacologia y distonias.Introduccion. La toxina botulinica de tipo A (TBA) ha supuesto una verdadera revolucion terapeutica en neurologia, y en la actualidad es el tratamiento rutinario en las distonias focales y la espasticidad. Objetivo. Plantear, revisar y responder cuestiones controvertidas en relacion con la neurofarmacologia de la TBA y su uso en las distonias en la practica clinica habitual. Desarrollo. Un grupo de expertos en trastornos del movimiento reviso una lista de temas controvertidos relacionados con la farmacologia de la TBA y su uso en las distonias. Revisamos la bibliografia e incluimos articulos relevantes especialmente en ingles, pero tambien, si su importancia lo merece, en castellano y en frances, hasta junio de 2016. El documento se estructuro como un cuestionario que incluyo las preguntas que podrian generar mayor controversia o duda. El borrador inicial del documento fue revisado por los miembros del panel y se realizaron las modificaciones necesarias hasta alcanzar el mayor grado de consenso. Incluimos preguntas sobre diferentes aspectos de la neurofarmacologia, especialmente el mecanismo de accion, la bioequivalencia de los diferentes preparados y la inmunogenicidad. En relacion con el subapartado de las distonias, se incluyeron aspectos sobre la evaluacion y el tratamiento de las distonias focales. Conclusiones. Esta revision no pretende ser una guia, sino una herramienta practica destinada a neurologos y medicos internos residentes interesados en esta area, dentro de diferentes ambitos especificos del manejo de la TBA.

[Management and improvement of the process of outpatient treatment of transient ischemic attacks in Neurology departments]. / Gestión y mejora del proceso de tratamiento ambulatorio del accidente isquémico transitorio en consultas de Neurología.

AIMS: To describe our experience in the ambulatory treatment of transient ischemic attacks (TIA) in a second-level hospital with the implementation of an example of process management within the different services involved in attending such conditions. PATIENTS AND METHODS: The following aspects of the process--mission, limits, flowchart, eligibility criteria and performance indicators (process, sentinel and effectiveness)--were defined by multidisciplinary consensus (Emergency, Vascular Surgery, Cardiology, Neurology and Radiology departments). This process was implemented from April 2002 to May 2004, and monthly assessments were carried out to check for problems and to introduce corrective measures. After ending the process, patients with TIA were admitted as inpatients for a hospital study. RESULTS: Definition of the process: medical care (diagnosis and treatment) of TIA patients who are eligible for a complete outpatient study within seven days. Patients evaluated: 254. Indicator 1 (percentage of suitable referrals): 2002: 53%, 2003: 75%, 2004: 73%. Indicator 2 (percentage of complete studies in less than one week): 2002: 35%, 2003: 57%, 2004: 50%; hospitalised: 90%. Indicator 3 (infarcts during the study): 2002: 4.3%, 2003: 0%, 2004: 0%; hospitalised: 0%. Indicator 4 (percentage of adjustments made to treatment): 2002: 39%, 2003: 31%, 2004: 62%; hospitalised: 72%. Mean delay before visit: in February 2002: 90 days, in April 2002: 7.67 days and in April 2003: 5.37. Problems detected: delays in referrals, failure to fit hospitalisation criteria, delays in carrying out examinations not included in the protocol, unsuitable indicator design. Steps taken: redefinition of indicators, modification of the referral system, adjustments made to the circuits involved in carrying out tests, review of hospitalisation criteria. CONCLUSIONS: Process management is an ideal tool for achieving ongoing improvements in clinical praxis. Early monitoring makes it possible to detect problems and to implement corrective measures. In our area, the study of TIA must be performed in a hospital inpatient regimen in order to comply with the guidelines for clinical practice.

[Modificated plication technique of the tunica albuginea in penis curvature correction]. / Técnica de plicatura modificada de túnica albugínea para la corrección de la incurvación peneana.

We present our penile curvature treatment experience in Peyronie's disease and cogenital curvature, using a modificated plication technique of the tunica albuginea with Prolene inverted sutures covered with Vicryl ones. The first suture gives security to the plication and the second one hides the first dots avoiding the nonabsorbable sutures bother.

[Tadalafil vs sildenafil patient preference in Spanish men with erectile dysfunction: results from an International Multicentric Study]. / Preferencia de tadalafilo vs sildenafilo en pacientes españoles con disfunción eréctil: resultados procedentes de un estudio multicéntrico internacional.

OBJECTIVE: To compare patient preference for sildenafil citrate (sildenafil) vs. tadalafil and for their respective dosing instructions in a cohort of Spanish patients with erectile dysfunction (ED). MATERIAL AND METHODS: Sixty four Spanish patients from a multicenter, two period, cross-over, double-blind study (265 patients enrolled in total) were randomized to receive on-demand sildenafil 50 mg or tadalafil 20 mg for 12 weeks and afterwards were crossed over to the alternate regimen for another 12 weeks to assess drug preference in an extension period of the study. Similarly, to evaluate preference for their respective dosing instructions, 30 patients were randomized to one of the 2 arms treated with tadalafil: one with sildenafil (S) dosing instructions and the other with tadalafil (T) dosing instructions. RESULTS: Seventy percent of 56 patients completing the study chose to receive tadalafil treatment versus sildenafil treatment (30%) in the extension period (p<0.01). Correspondingly, 73% of 13 evaluating each drug dosing instructions preferred T dosing instructions (p>0.05). Preference did not vary with age, concomitant diseases and previous use of sildenafil. CONCLUSIONS: In this study, 7 out of 10 patients preferred tadalafil and its dosing instructions to sildenafil, for the treatment of their ED.