Tratamiento de la cefalea tensional con toxina botulínica tipo A / Botulinum toxin type A for the treatment of tension-type headache

Objetivos: Determinar el tiempo de inicio de la analgesia, la eficacia y la seguridad de la aplicación de la toxina botulínica tipo A (TB-A) en pacientes con cefalea tensional (CT). Material y métodos: Criterios de inclusión: Edad de 18-70 años, diagnóstico de CT de acuerdo a la International Headache Society, dos o más episodios de CT por mes durante por lo menos 3 meses, CT no controlado con el tratamiento estándar, examen neurológico normal y firma de un consentimiento informado. Variables: Intensidad de la cefalea (IC), frecuencia de presentación de la cefalea (FC), duración de cefalea (DC), sensibilidad a la digitopresión (SDP) de la musculatura pericraneal, número de puntos dolorosos (NPD) de la musculatura pericraneal, tiempo de inicio de la analgesia (TIA), tiempo hasta el efecto máximo de la analgesia (TMA) y disminución de la utilización de analgésicos (DUA). Evaluaciones en los días 0, 15 y 30. Se aplicaron 50 U TB-A en la musculatura pericraneal. Los pacientes pudieron continuar con su terapia analgésica previa de acuerdo a la evolución de la cefalea. Resultados: Se reclutaron 20 pacientes, todos de sexo femenino, con una edad promedio de 47 años. La IC de 2,15 en la primera evaluación disminuyó a 1,05 y 0,9 en la segunda y tercera evaluaciones (p=0,009 y 0,008). La FC de 10,25 días disminuyó a 3,6 y 2,75 días (p=0,008 y 0,012). La DC de 2,3 horas diarias disminuyó a 1,3 y 1,1 (p=0,009 en las dos). La SDP de 1,55 disminuyó a 0,5 y 0,55 (p=0,008 en las dos). El NPD de 2,65 disminuyó a 0,8 y 0,6 (p=0,010 y 0,006). El TIA fue de 8 días y el TMA fue de 25 días. La DUA de 5 disminuyó a 1,9 y 1,5. El 35% de los pacientes presentaron un evento adverso probable, y de una intensidad leve a moderada. Conclusiones: La TB-A es un tratamiento simple, efectivo y seguro para el control de la CT La técnica de aplicación estandarizada es un método fácil de reproducir. Se requieren estudios para valorar el número de punciones y el área total de aplicación, como probables factores en la respuesta analgésica (AU)

Objectives: To determine the time of onset of the analgesia, the < ficacy and the security of the application of the botulinu toxin A (BTA) in patient with tension-type headache (TH). Material and methods: Inclusion criteria: patients between 18 and 70 yeai diagnosis of TH according to the International Headache S ciety, two or more episodes of TH per month during at lea 3 months, non controlled TH with the standard treatmei normal neurological examination and signed inform consei Variables analyzed: Intensity of headache (IH), frequency presentation of headache (FH), duration of headache (DH sensibility to digit pressure (SDP) of the cranial musculatur number of painful points (NPD) of the cranial musculatur time of onset of the analgesia (TBA), time until the ma: mum effect of analgesia (TMA) and decrease of use of an.gesics (DUA). Evaluations in the days 0, 15 and 30. Fifty units of BT were applied to cranial musculature. The patients could continue with their previous analgesic therapy according to the evolution of the headache. Results: Twenty female patients were included with a median age of 47 years. IH 2.15 in the first evaluation diminished at 1.05 and 0.9 in the second and third evaluations (p=0.009 and 0.008). FH of 10.25 days diminished to 3.6 and 2.75 days (p=0.008 and 0.012). DH of 2.3 daily hours it diminished at 1.3 and 1.1 (p=0.009 in both). SDP 1.55 diminished at 0.5 and 0.55 (p=0.008 in both). NPD 2.65 diminished at 0.8 and 0.6 (p=0.010 and 0.006). TBA was 8 days and TMA was 25 days. DUA 5 diminished at 1.9 and 1.5. Around of 35% of the patients presented a probable adverse event of mild or moderate severity. Conclusion: TB-TO it is a simple, effective treatment and provides control of the TH. The technique is easy to reproduce. More studies are needed to value the number of applications and the total area of application, as probable factors in the analgesic response (AU)

Neurologic complications of autologous and allogeneic bone marrow transplantation in patients with leukemia: a comparative study.

We retrospectively evaluated the neurologic complications in 425 patients who underwent bone marrow transplant (BMT) (310 allogeneic, 115 autologous) for leukemia. Forty-six patients (11%) developed 47 central and three peripheral neurologic complications. The most common complications were cerebral hemorrhage (3.8%), metabolic encephalopathy (3%), and CNS infections (2%). All CNS infections occurred with allogeneic BMT. Eleven of 16 hemorrhages were subdural hematomas (69%), which were more frequent in autologous (8%) than in allogeneic (0.6%) BMT (p < 0.0001), and in patients with acute myelogenous leukemia (AML) (5%) than in the remaining leukemia patients (0.8%) (p = 0.013). Eight of 11 subdural hematomas occurred in AML patients receiving autologous BMT. When we compared patient-, disease-, and transplant-related characteristics of these patients with those without subdural hematoma, only platelet refractoriness correlated with an increased risk of subdural hematoma. The actuarial probability of developing subdural hematoma was 44% in patients with platelet-refractory disease and only 2.5% in the other patients (p < 0.0001). Ten patients with subdural hematoma did not have surgery and eight had significant clinical improvement associated with reduction or resolution of the hematoma, confirmed by CT scan in six patients. The subdural hematoma was the cause of death in only one patient. This study shows that the frequency of the different neurologic complications varies among types of BMT. Patients undergoing autologous BMT for AML with platelet refractoriness have an increased risk of subdural hematoma that may be treated with conservative measures.

Epilepsia en tumores cerebrales primarios / Epilepsy in primary intracranial tumors

Se trata de un estudio retrospectivo de 246 pacientes con diagnóstico de tumor intracraneal primario en los que se estudió epilépsia como manifestación inicial, resultando que 59 pacientes (24 por ciento) constituyeron el grupo con epilépsia. Hubo 130 pacientes con tumores hemisféricos de los que el 41 por ciento presentó epilépsia, la mayor frecuencia se presentó en los portadores de oligodendrogliomas (80 por ciento). Los pacientes del grupo con epilépsia tuvieron una edad menor, un tiempo de enfermedad más prolongado, un examen clínico normal más frecuente y una sobrevida mayor, cuando se compararon con los pacientes que no presentaron epilépsia como primera manifestación clínica. Como método de estudio el electroencefalograma fue útil en los tumores hemisféricos, especialmente los que tuvieron epilépsia.

[Surgical treatment combined with radiotherapy and chemotherapy in an unselected population of patients with malignant glioma]. / Tratamiento quirúrgico combinado con radioterapia y quimioterapia en una población no seleccionada de pacientes con glioma maligno.

BACKGROUND: Malignant gliomas are tumors of bad prognosis with a mean survival of 12 months. In the present report 74 patients diagnosed of malignant glioma were studied with the following aims: 1) evaluate how many could receive combined radiotherapy (RT) and chemotherapy (BCNU) treatment following surgery and 2) analyze whether the patients treated presented a survival similar to that described in the literature. METHODS: The records of 74 patients operated on for malignant glioma between 1987-1990 and consecutively included in a protocol of treatment with RT and BCNU were reviewed. RESULTS: Out of the total of 74 patients, 29 (39%) were considered evaluable. The medians of progression free interval and survival were of 10 and 16 months, respectively in these patients. Forty-five (61%) patients could not fulfill the protocol mainly because of tumoral progression prior to completion of RT and severe post surgical complications. The evaluable patients were significantly younger (p = 0.004) and tumoral exeresis wider (p = 0.0003) than in those who were not evaluable. CONCLUSIONS: Most of the patients operated on for malignant glioma may not receive treatment considered as standard, principally due to tumor progression in the first weeks following surgery and the presence of severe post surgical complications.

[Primary cerebral lymphoma in 10 patients with AIDS. Comparative clinico-radiologic study with cerebral toxoplasmosis, cerebral tuberculoma and primary cerebral lymphoma in non-immunodepressed patients]. / Linfoma cerebral primario en 10 pacientes con SIDA. Estudio clínico-radiológico comparativo con toxoplasmosis cerebral, tuberculoma cerebral y linfoma cerebral primario en pacientes no inmunodeprimidos.

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is the second cause of cerebral masses in patients with the acquired immunodeficiency syndrome (AIDS). The present study evaluated the possible presence of clinical or radiologic signs permitting differentiation of AIDS patients and PCNSL from those with cerebral masses of other etiologies. METHODS: Clinical history and cranial computerized tomography (CT) of patients with PCNSL and AIDS from the Hospital Clinic i Provincial in Barcelona were reviewed. Results were compared with those of patients with PCNSL without evidence of immunosuppression and with those with AIDS and cerebral toxoplasmosis or tuberculoma diagnosed during the same period. RESULTS: Of 685 patients with AIDS, 10 were identified with PCNSL. The clinical picture was not different to that observed in patients with AIDS and cerebral toxoplasmosis or tuberculomas. In contrast to PCNSL in non immunodepressed patients, the cerebral CT in patients with PCNSL and AIDS demonstrated hyperdense lesions in only 44% and contrast enhancement was not homogeneous in any case. These characteristics were similar to those observed in the CT of patients with cerebral toxoplasmosis or tuberculoma with the exception that only 8% of the lesions by toxoplasmosis were spontaneously hyperdense. CONCLUSIONS: The clinical-radiological data of primary central nervous system lymphoma in patients with the acquired immunodeficiency syndrome are similar to those observed in other etiologies. However, the presence of a sole spontaneously hyperdense region in cranial computerized tomography is more suggestive of primary central nervous system lymphoma than cerebral toxoplasmosis.

Plasmapheresis and antineoplastic treatment in CNS paraneoplastic syndromes with antineuronal autoantibodies.

We retrospectively evaluated the effect of plasmapheresis (PE) in seven patients with paraneoplastic encephalomyelitis (PEM), small-cell lung carcinoma, and anti-Hu antibodies, and four patients with paraneoplastic cerebellar degeneration (PCD), ovarian or breast cancer, and anti-Yo antibodies. In addition to PE, patients received prednisone (nine), cyclophosphamide (eight), or treatment of the tumor (five). All but one patient were severely disabled by the time PE began. The clinical outcome was compared with that of five patients (PEM, four; PCD, one) who only had treatment of the tumor. Only one of these five patients had a severe neurologic deficit at the onset of the antineoplastic treatment. No patient improved. Two patients treated with PE and antineoplastic therapy and three who only received treatment of the tumor remained stable for at least 6 months. Four of the five patients with a stable course started the treatment when the neurologic deficit was not severe. We conclude that the efficacy of PE with other immunosuppressive therapies in the stabilization of the neurologic deficit is uncertain.

[Non tumor intracranial expansive processes: clinico-topographical correlation]. / Procesos expansivos intracraneanos no tumorales. Correlato clínico-tomográfico.

Presentation of clinical-tomographic correlation in 111 cases of non tumoral intracranial expansive processes seen between 1984-1988 in the Hospital Cayetano Heredia (Lima, Peru). Emphasis is given fundamentally to: (1) the importance of establishing the organicity of partial and late epilepsy; (2) the high incidence rate of inflammatory infectious processes with CNS compromise in underdeveloping countries; (3) the necessity of making public the importance of two parasitic diseases in the differential diagnosis of non tumoral intracranial expansive processes: free living amebiasis, and toxoplasmosis (especially in association with AIDS).

Procesos expansivos intracraneanos no tumorales: correlato clínico-tomográfico / Non tumor intracranial expansive processes: clinico-topographical correlation

Se presentan 159 casos de procesos expansivos de los cuales se revisan 111 catalogados como no neoplásicos vistos durante los años 1984-1988 en el HGBCH, lhamando la atención fundamentalmente sobre 3 aspectos: (1) la importancia de establecer organicidad en la epilepsia parcial y la epilepsia tardía; (2) la incidencia cada vez mayor de procesos infecciosos e inflamatorios intracraneanos en países en desarrollo; (3) la existencia de dos procesos parasitarios que deben encontrarse en el diagnóstico diferencial de procesos expansivos no tumorales: amebiasis de vida libre, y toxoplasmosis (especialmente en pacientes con SIDA)