RESUMO
INTRODUCTION: The need for safe health care, in which the care and treatment of the patient does not cause any injuries in addition to those already arising from their baseline disease, has led to the present study. Our objective has been to determine the frequency and describe the neurological syndromes attributable to drugs, their preventability and the levels of medical care involved. METHODS: Observational study. Cohort of subjects referred from Primary and Specialized Care between December 2008 and January 2010 due to neurological symptoms attributable to drugs, and previously known neurology patients who began to have symptoms other than those of the baseline disease, also caused by drugs. The notifications were recorded in a questionnaire. Frequency distributions, central tendency measurements, X(2) or Fisher tests and non-parametric tests were performed. RESULTS: The prevalence of adverse neurological events was 0.586% of the total sample. Of the 105 patients selected, the most frequent adverse events were: 25.7%, akinetic-rigid syndrome, 18.1%, dyskinetic syndrome, 11.4% neuro-psychiatric symptoms, and 10.5% confusional syndrome. The most commonly recorded pharmacological groups were, in decreasing order: anti-epileptic, dopaminergic, antidepressant, neuroleptic, antivertiginous and prokinetic drugs. We describe the most susceptible population and the statistically significant relationships between the presence of certain pharmacological groups and neurological syndromes. CONCLUSIONS: The low prevalence detected may be due to the study design, although adverse neurological events accounted for 2.84% of the admissions to a Neurology Unit. Understanding the epidemiology should help to identify the safest approaches, apply them correctly to the population at a higher risk, and reduce healthcare needs and consumption of medical resources.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Doenças do Sistema Nervoso/induzido quimicamente , Doenças do Sistema Nervoso/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Tratamento Farmacológico/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/psicologia , Estudos Prospectivos , Fatores Sexuais , Espanha/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Freezing of gait unresponsive to dopaminergic stimulation in patients with severe Parkinsonism. The freezing of gait episodes (FOG) normally appear during the off period and generally improve with dopaminergic stimulus, at the same time as improving other Parkinsonian symptoms. PATIENTS AND METHODS: We report a group of 10 patients with severe Parkinson's disease. All patients suffered motor fluctuations, dyskinesias and episodes of FOG during the on and off state. The patients received a subcutaneous apomorphine bolus, without other dopaminergic medication; an effective dose of apomorphine was considered as one that induced a reduction of at least a 60% in the UPDRS motor scale. RESULTS: The baseline motor UPDRS was 61.3 +/- 4.7, which dropped to 21 +/- 4.3 after the apomorphine injection. The mean dose of apomorphine was 5.5 mg (3-7 mg). The bolus of apomorphine improved the parameters of the gait related to bradykinesia and the tapping tests of the limbs, but the episodes of FOG did not vary significantly between the off and on state. CONCLUSIONS: We present a group of 10 patients with freezing of gait episodes that did not improve with treatment and persisted during the on period induced by dopaminergic stimulus with apomorphine.
Assuntos
Apomorfina/uso terapêutico , Dopamina/uso terapêutico , Discinesias , Marcha , Doença de Parkinson , Idoso , Antiparkinsonianos/uso terapêutico , Dopaminérgicos/uso terapêutico , Discinesias/tratamento farmacológico , Discinesias/etiologia , Discinesias/fisiopatologia , Humanos , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/fisiopatologia , Resultado do TratamentoRESUMO
INTRODUCTION: Current neuro-radiological techniques have led to a more frequent diagnosis of cerebral vein thrombosis (CVT), and revealed its greater clinical heterogeneity. AIM: To analize the characteristics of the cases with the diagnosis of CVT in our unit between 1996 and 2008. PATIENTS AND METHODS: We describe 20 cases of CVT (14 women and 6 men), with ages of 22 to 75 years. RESULTS: Headache was the most frequent symptom, followed by intracranial hypertension, disorders of consciousness and focal deficits. Unusual presentations included transitory ischemia and progressive optical neuropathy. Subacute and chronic courses were more frequent than acute. The etiology was diverse including puerperium, contraception, hyperthyroidism, meningitis, Leiden V factor mutation, multiple myeloma, Crohn, ulcerative colitis, meningioma and epidural anesthesia. No cause was found in 8 cases. Magnetic resonance imaging was always diagnostic. Patients were anticoagulated during the acute phase. In subacute or chronic presentations, a more conservative treatment was considered on individual basis. Only 6 patients had mild sequelae. CONCLUSIONS: We report a great variety of etiologies and patterns of presentation of CVT. CVT should be suspected in patients with subacute headache, even in outpatients. Nonacute presentation with isolated headache or intracranial hypertension could have better prognosis, requiring a less aggressive therapy.