Home-based transcranial direct current stimulation in mild neurocognitive disorder due to possible Alzheimer's disease. A randomised, single-blind, controlled-placebo study.

Introduction: Mild neurocognitive disorder (mNCD), a pre-dementia stage close to Mild Cognitive Impairment, shows a progressive and constant decline in the memory domain. Of the non-pharmacological therapeutic interventions that may help to decelerate the neurodegenerative progress, transcranial direct current stimulation (tDCS) shows beneficial effects on the learning curve, immediate recall, immediate verbal memory and executive functions. The purpose of this research was to study the effect of tDCS on general cognition, immediate and delayed memory and executive functions by comparing an active group with a placebo group of mNCD patients. Methods: Participants were 33 mNCD due to possible AD, randomly assigned to two groups: 17 active tDCS and 16 placebo tDCS. Ten sessions of tDCS were conducted over the left dorsolateral prefrontal cortex. Several neuropsychological scales were administered to assess the primary outcome measures of general cognitive function, immediate and delayed memory and learning ability, whereas the secondary outcome measures included executive function tests. All participants were evaluated at baseline and at the end of the intervention. Mixed ANOVAs were performed. Results: Significant effects were obtained on general cognitive function, immediate and delayed memory and learning ability, with increases in scores in the active tDCS group. However, there were no significant effects on executive function performance. Conclusion: The present study demonstrated the effectiveness of tDCS in an active tDCS group, compared to a placebo group, in improving general cognition and immediate and delayed memory, as previous studies found. Taken together, our data suggest that tDCS is a simple, painless, reproducible and easy technique that is useful for treating cognitive alterations found in neurodegenerative diseases.

'Apuntes en Neurología': una síntesis de la evidencia en trastornos neurológicos comunes paroxísticos y en trastornos neurodegenerativos / 'Apuntes en Neurología' (Notes in Neurology): a synthesis of the evidence on common paroxysmal neurological disorders and on neurodegenerative disorders

Apuntes en Neurología' es una iniciativa en la cual líderes de primera línea nacional e internacional, con amplio reconocimiento académico, se reunieron para sintetizar los aspectos clínicos más destacables dentro de su área de interés y acercar las novedades en una lengua más próxima. Entender los factores que afectan al inicio y progresión de cualquier enfermedad neurológica a través de una revisión es importante para el desarrollo de estrategias en pro de reducir la carga de estas enfermedades, y conocer los aspectos clínicos es esencial para poder resolver los problemas de la practica clínica diaria. Los datos aquí recogidos reflejan el peso de la evidencia y algunos de ellos anticipan un futuro prometedor en el tratamiento de estas enfermedades. Esta primera edición se centra en trastornos neurológicos comunes paroxísticos como la migraña, la epilepsia y las alteraciones del sueño, y en trastornos neurodegenerativos como la enfermedad de Parkinson y el deterioro cognitivo. Se trata de patologías claramente diferentes, si bien algunas de ellas, como la migraña y la epilepsia, pueden compartir sintomatología clínica. Los trastornos del sueño, por su parte, son manifestaciones importantes de enfermedades neurodegenerativas que, en ocasiones, son clínicamente evidentes mucho antes del inicio de otros síntomas neurológicos. Tras recordar la fisiopatología y el diagnostico, la revisión actual se centra en acercar los principales avances en cinco de las principales enfermedades neurológicas

Introduction. 'Apuntes en Neurologia' is an initiative in which prominent national and international leaders, with broad academic recognition, came together to synthesise the most outstanding clinical aspects within their area of interest and to discuss the latest developments in a more accessible language. Understanding the factors that affect the onset and progression of any neurological disease through a review is important to be able to develop strategies to reduce the burden of these diseases. Moreover, knowledge of the clinical aspects is essential to solve the problems of daily clinical practice. The data collected here reflect the weight of evidence and some of them anticipate a promising future in the treatment of these diseases. This first edition focuses on common paroxysmal neurological disorders such as migraine, epilepsy and sleep disorders, as well as neurodegenerative disorders such as Parkinson' disease and cognitive impairment. These are clearly different pathologies, although some of them such as migraine and epilepsy, may share clinical symptoms. Sleep disorders, however, are important manifestations of neurodegenerative diseases that are sometimes clinically apparent long before the onset of other neurological symptoms. After recalling pathophysiology and diagnosis, the current review focuses on bringing together the main advances in five of the major neurological diseases

[Spanish multi-centre observational study of the first attacks suggestive of multiple sclerosis: the PREM cohort]. / Estudio observacional multicentrico espanol de primeros episodios sugestivos de esclerosis multiple: cohorte PREM.

INTRODUCTION: Recent studies have shown the need to optimise the management of patients after a first attack suggestive of multiple sclerosis (MS). Our aim is to determine whether the results from follow-ups in these studies are reproducible within a Spanish multi-centre context. PATIENTS AND METHODS: The PREM study (observational prospective Spanish multi-centre study at 24 months) included patients in the first three months following a first event suggestive of MS with at least two typical lesions in a magnetic resonance scan. The Expanded Disability Status Scale (EDSS) was obtained and the presence of attacks was evaluated basally and at 3, 6, 9, 12, 18 and 24 months; a magnetic resonance scan was performed basally and at 6 and 24 months so as to be able to calculate the brain volume and the volumes of the lesions (T1, T2 and T1 after administering gadolinium). McDonald and Poser criteria were evaluated during the follow-up. A subgroup of patients was followed up for a total period of four years. RESULTS: Altogether 110 patients (67% females) with a mean age of 30.2 years were included in the study; 22 patients dropped out of the study before it finished. Poser criteria were met by 19% and 45% of patients at 6 months and 24 months, respectively; 63% and 71% satisfied McDonald criteria. The EDSS decreased significantly (-0.94; p < 0.001) and development of atrophy was observed (-1.2%; p < 0.001) at 24 months. CONCLUSIONS: Results of the follow-up of patients with first attacks suggestive of MS within a Spanish multi-centre context are wholly comparable with those from international clinical trials performed in these patients.

[Hospital processes and costs in neurology. A study of a referral hospital]. / Costes y procesos hospitalarios en neurologia. Estudio en un hospital de referencia.

INTRODUCTION: The steady growth of spending on healthcare and the limited availability of resources make it necessary to include cost analysis among the tools used for hospital management. AIMS. To obtain the hospitalisation operating statement of a neurology service and to analyse the differences with regard to costs per process. PATIENTS AND METHODS: The study involved an analysis of costs per process in the neurology service of a referral hospital in the Valencian Community (400,000 inhabitants). The data used were those concerning health care activity in 2008 according to the information registered by the Economic Information System of the Valencian Regional Ministry of Health; ABC and top-down methods were applied to calculate the cost per process. The results thus obtained were compared with the fees established for hospital production in the Valencian Regional Government's Law on Fees. RESULTS: For a production of 1092 hospital discharges, with a case-mix index of 0.96 and a mean length of stay of 9.2 days with a case mix of 1.91, hospitalisation costs came to 4,411,643.45 euros, with a mean cost per process of 2,111.46 euros. Taking into account the fees that were applied, the difference between income and expenditure was -12,770.39 euros. The diagnosis-related groups with the greatest difference were numbers 14 (-246,392.49 euros), 533 (-90,292.49 euros) and 15 (-55,139.66 euros). CONCLUSIONS: The hospitalisation profit and loss account obtained is negative due to the fact that the mean length of stay in the service is longer than expected, above all in diagnosis-related groups 14, 533 and 15, which are the most inefficient.