Cortico-juxtacortical involvement increases risk of epileptic seizures in multiple sclerosis.

OBJECTIVES: Previous studies have reported an increased risk for epileptic seizures in multiple sclerosis (MS) patients. However, data on the pathogenesis of seizures remain inconclusive. The aim of our study is to evaluate prevalence, clinical and paraclinical features of epileptic attacks in our MS cohort and to search MS-specific risk factors for epileptic seizures. MATERIALS AND METHODS: In this cohort of 428 MS patients, 13 patients were identified with epileptic seizures occurring at any point during the course of MS including at MS onset. As a control group, we selected 26 MS patients without seizures and matched for gender, age and date of MS onset. We compared demographic features and clinic-radiological findings between the both groups. RESULTS: Thirteen patients (3%) were identified as having epileptic attacks. Ten patients (77%) experienced focal seizures, half of whom had confirmed secondary generalization. We did not find an association between seizures and disease course. Most patients had a single or few (2-5) seizures. MS patients with seizures had a significantly higher number of cortical and juxtacortical lesions on T2-weighted/fluid attenuation inversion recovery magnetic resonance imaging than control group [OR = 2.6 CI95% (1.0-6.5); P = 0.047]. CONCLUSIONS: Our findings support a credible role of cortical and juxtacortical involvement in the development of epileptic seizures in MS.

Epigenetic changes in headache.

INTRODUCTION: Multiple factors, including both genetic and environmental mechanisms, appear to play a role in the aetiology of headache. An interesting area of study is the possible involvement of epigenetic mechanisms in headache development and the transformation to chronic headache, and the potential role of these factors as a therapeutic target. METHODS: We performed a literature review of the involvement of different epigenetic mechanisms in headache, mainly using the Medline/PubMed database. To this end, we used the following English search terms: headache, migraine, epigenetics, DNA methylation, histones, non-coding RNA, and miRNA. RESULTS: A total of 15 English-language publications related to the above terms were obtained. CONCLUSION: There is limited but consistent evidence of the relationship between epigenetics and headache; it is therefore essential to continue research of epigenetic changes in headache. This may help to understand the pathophysiology of headache and even to identify candidate biomarkers and new, more effective, therapeutic targets.

Non-responder migraine patients to a first anti-CGRP monoclonal antibody benefit from a switch to a second one. / Efecto beneficioso del cambio a un segundo anticuerpo monoclonal anti-CGRP en pacientes con migraña no respondedores a un primero.

TITLE: Efecto beneficioso del cambio a un segundo anticuerpo monoclonal anti-CGRP en pacientes con migraña no respondedores a un primero.

[ADAL-1(R): a new synthetic adhesive for use in strabismus surgery]. / ADAL-1(R): Nuevo adhesivo sintético de uso en cirugía del estrabismo.

PURPOSE: To evaluate the efficacy and tolerance of ADAL-1(R), a new adhesive in strabismus surgery. METHODS: Three groups of 10 eyes each of 30 albino rabbits underwent superior rectus muscle recession 4 mm, 1(st) group of 10 eyes using the new adhesive, sacrified after one week, 2(nd) group of 10 eyes also with ADAL-1(R), sacrificed after one month and the 3(rd) group (control) of 10 eyes using Dexon 6/0 suture, sacrificed after one month. Clinical evaluation was done at the 1(st) postoperative day, at one week and at one month. The presence of residue of the adhesive, its hardness and the condition of the muscle were all studied after sacrificing the animal. Descriptive study was done for the 1(st) and the 2(nd) group, within the 2(nd) group significant changes along the follow up period were studied using the Friedman test and also differences between the 2(nd) and the suture group were examined using the Fisher's Exact Test. RESULTS: The inflammatory reaction was evaluated between absent and mild in 80% of the cases, both in the 2(nd) and the control group. In the ADAL-1(R) group there were significant statistical differences between 1(st) and 4(th) week (p=0.0002). In the 2(nd) group, 80% of the muscles were attached to the planed position and 20% were slightly displaced, while in the control group 90% of the muscles were attached to the planed position, and 10% were slightly displaced, however there is no significant difference between the two groups p=0.5 (Fisher's Exact Test). CONCLUSION: ADAL-1(R), a new adhesive, could replace sutures in strabismus surgery, giving rise to a rapid and efficient adhesion between muscles and sclera and well tolerated by the ocular tissues.

[Comparative study between different conjunctival tissue adhesives]. / Estudio comparativo entre diferentes adhesivos conjuntivales.

PURPOSE: To evaluate efficacy and clinical and histopathological tolerance of a new acrylic tissue adhesive (ADAL-2) compared to sutures (Vicryl) and other available tissue adhesives (Tisuacryl) for their use in conjunctival surgery. METHODS: This was an experimental study performed in New Zealand albino rabbits with conjunctival dissection and closure by ADAL-2. Groups treated with Vicryl and Tisuacryl were compared regarding efficacy, clinical, and histological tolerance at 7, 28 and 42 days. RESULTS: Efficacy was similar in the three methods of conjunctival repositioning evaluated. Tolerance to ADAL-2 was similar to that of Vicryl suture and tolerance to ADAL-2 was superior to that to Tisuacryl. Histopathological results with ADAL-2 and Tisuacryl are similar. CONCLUSIONS: ADAL-2 tissue adhesive is an efficient and very well tolerated alternative for conjunctival closure in ophthalmic surgery.

[Proposals to improve adherence to immunomodulatory therapies in patients with multiple sclerosis]. / Herramientas para mejorar la adherencia al tratamiento con inmunomoduladores en pacientes con esclerosis múltiple.

INTRODUCTION: The objective of this work was to assess the factors identified in the Global Adherence Project (GAP) in disease-modifying therapy (DMT) in patients with multiple sclerosis (MS) and to propose measures directed at improving adherence. It was proposed to prepare questionnaires to detect patients at risk of non-adherence before and during the follow-up. METHODS: Two meetings were held by Spanish researchers involved in the GAP project. Factors associated with non-adherence were grouped in therapy-, patient-, disease- and health care professional-related factors. Four working groups were created. Each group studied one individual,factor, taking into account the stages of diagnosis, management and administering treatment, follow-up and discontinuation or change of treatment. A draft of proposals and tools (questionnaires) was agreed. RESULTS: Patients should be provided with summaries of treatments, in a positive and simple way, and have time to discuss any doubts. Questionnaires should be given to patients at the start of treatment and during follow-up, so that individual characteristics can be assessed in order to monitor their adherence and act accordingly. Patients should be instructed in the management of the most common adverse reactions. CONCLUSION: Therapeutic education to improve adherence to treatments and identification of non-adherent patients is recommended. We propose 2 questionnaires, initial and follow up, to stratify patients depending on their adherence.

[Topographic diagnosis of lesions of the acoustico-facial nerve complex using the winking reflex]. / Diagnostic topographique des lésions du complexe acoustico-facial au moyen des réflexes de clignements.

An electrophysiological study in close to 1,500 cases of various lesions of the trigeminal nerve, the acoustico-facial complex and the brain stem was presented. It was concluded that following a detailed clinical examination which, most often, allows precise topographical diagnosis, the study of the trigemino-facial and facial reflexes appears to be an essential diagnostic tool to determine the topography of a lesion. Moreover, this method may give prognostic evaluation as well as facilitate the choice of surgical approach to the lesions of the acoustico-facial complex.