Percepción de la validez del cuestionario Migraine Disability Assessment por una población de pacientes con migraña crónica / Perception of the validity of the Migraine Disability Assessment questionnaire in a population of patients with chronic migraine

Objetivos: El cuestionario Migraine Disability Assessment (MIDAS) es el instrumento más empleado para valorar el grado de discapacidad en los estudios de migraña. El objetivo del estudio es determinar el nivel de cumplimentación del cuestionario, valorar su facilidad de uso y conocer la percepción subjetiva del paciente sobre la capacidad del cuestionario para medir realmente su discapacidad.Material y métodosEstudio prospectivo sobre una población de 78 pacientes con migraña crónica. Se determina el nivel educativo y la situación laboral. En la visita basal se adiestra a los pacientes sobre la correcta cumplimentación del cuestionario. A los 3 meses se determina la puntuación total y el nivel de cumplimentación. Además los pacientes contestan una encuesta que mide: facilidad de uso y percepción del paciente sobre si la escala refleja su propia discapacidad.ResultadosSolo el 46% rellena completamente el cuestionario. El 69% de los pacientes indica que el cuestionario no les resulta fácil de cumplimentar (resultado no influido por el nivel educativo, pero sí por la situación laboral de los pacientes). El 62% de los encuestados opina que el cuestionario no refleja completamente su propia percepción de discapacidad.ConclusionesAunque está más que demostrada la validez y consistencia del cuestionario MIDAS, un porcentaje elevado de nuestra población reconoce que el cuestionario no es fácil de rellenar y además es percibido por muchos de nuestros pacientes como un cuestionario que no refleja adecuadamente su discapacidad. Conocer la opinión de los pacientes sobre la idoneidad de los cuestionarios administrados en las consultas es crucial para mejorar su cumplimentación. (AU)

Objectives: The Migraine Disability Assessment (MIDAS) questionnaire is the most frequently used instrument for assessing the level of disability in studies into migraine. This study aims to determine the level of completion of the questionnaire, assess the ease of use, and understand patients’ subjective perception of the questionnaire's actual ability to measure disability.Material and methodsWe performed a prospective study of a sample of 78 patients with chronic migraine, determining their level of education and employment status. In a baseline visit, patients were trained to properly complete the questionnaire. At 3 months, we determined the total score and level of completion. Patients also completed a survey measuring ease of use of the questionnaire and patients’ perception of whether the score accurately reflected their disability.ResultsOnly 46% of patients fully completed the questionnaire. Sixty-nine percent reported finding it difficult to complete (this was influenced by patient's employment status but not by educational level). Sixty-two percent of respondents believed that the questionnaire did not fully reflect their own perception of their disability.ConclusionsAlthough the validity and consistence of the MIDAS questionnaire are well documented, a high percentage of the study population reported finding it difficult to complete; many patients also considered that the questionnaire did not accurately reflect their disability. Understanding patients’ opinions of the suitability of questionnaires used in consultation is crucial to improving completion. (AU)

Perception of the validity of the Migraine Disability Assessment questionnaire in a population of patients with chronic migraine.

OBJECTIVES: The Migraine Disability Assessment (MIDAS) questionnaire is the most frequently used instrument for assessing the level of disability in studies into migraine. This study aims to determine the level of completion of the questionnaire, assess the ease of use, and understand patients' subjective perception of the questionnaire's actual ability to measure disability. MATERIAL AND METHODS: We performed a prospective study of a sample of 78 patients with chronic migraine, determining their level of education and employment status. In a baseline visit, patients were trained to properly complete the questionnaire. At 3 months, we determined the total score and level of completion. Patients also completed a survey measuring ease of use of the questionnaire and patients' perception of whether the score accurately reflected their disability. RESULTS: Only 46% of patients fully completed the questionnaire. Sixty-nine percent reported finding it difficult to complete (this was influenced by patient's employment status but not by educational level). Sixty-two percent of respondents believed that the questionnaire did not fully reflect their own perception of their disability. CONCLUSIONS: Although the validity and consistence of the MIDAS questionnaire are well documented, a high percentage of the study population reported finding it difficult to complete; many patients also considered that the questionnaire did not accurately reflect their disability. Understanding patients' opinions of the suitability of questionnaires used in consultation is crucial to improving completion.

Reversible Homonymous Inferior Quadrantanopia in a Nonketotic Hyperglycemic Patient.

Homonymous hemianopia is frequently associated with retrochiasmal lesions. Vascular etiology is the most common and usually evident on magnetic resonance imaging. When the results of neuroimaging are normal, there are other etiologies that we should consider, like nonketotic hyperglycemia (NKH). We report a 62-year-old female diabetic patient with headache, colour vision and sudden homonymous inferior quadrantanopia and elevated blood sugar levels with normal pH. The neuroimaging was normal and the visual lost improved after the correction of the hyperglycemia. NKH should be considered in patients with sudden and transient hemianopia and normal neuroimaging.

Perception of the validity of the Migraine Disability Assessment questionnaire in a population of patients with chronic migraine. / Percepción de la validez del cuestionario Migraine Disability Assessment por una población de pacientes con migraña crónica.

OBJECTIVES: The Migraine Disability Assessment (MIDAS) questionnaire is the most frequently used instrument for assessing the level of disability in studies into migraine. This study aims to determine the level of completion of the questionnaire, assess the ease of use, and understand patients' subjective perception of the questionnaire's actual ability to measure disability. MATERIAL AND METHODS: We performed a prospective study of a sample of 78 patients with chronic migraine, determining their level of education and employment status. In a baseline visit, patients were trained to properly complete the questionnaire. At 3 months, we determined the total score and level of completion. Patients also completed a survey measuring ease of use of the questionnaire and patients' perception of whether the score accurately reflected their disability. RESULTS: Only 46% of patients fully completed the questionnaire. Sixty-nine percent reported finding it difficult to complete (this was influenced by patient's employment status but not by educational level). Sixty-two percent of respondents believed that the questionnaire did not fully reflect their own perception of their disability. CONCLUSIONS: Although the validity and consistence of the MIDAS questionnaire are well documented, a high percentage of the study population reported finding it difficult to complete; many patients also considered that the questionnaire did not accurately reflect their disability. Understanding patients' opinions of the suitability of questionnaires used in consultation is crucial to improving completion.

[Efficacy and safety of fingolimod in routine clinical practice in patients with relapsing-remitting multiple sclerosis in Spain: an intermediate analysis of the MS NEXT study]. / Efectividad y seguridad del fingolimod en la practica clinica habitual en pacientes con esclerosis multiple remitente recurrente en España: analisis intermedio del estudio MS NEXT.

INTRODUCTION: Fingolimod is a disease modifying therapies, which has showed clinical efficacy and an acceptable safety profile in clinical trials with relapsing-remitting multiple sclerosis (RRMS) patients. AIM: To assess fingolimod effectiveness and safety in patients with RRMS in clinical practice. PATIENTS AND METHODS: We present an interim analysis (July 2015) of MS NEXT, an observational, retrospective and multicenter study. 442 patients were included (mean age: 41 ± 9 years; median baseline EDSS: 3.0; 70% female; 284 previously treated with first-line disease modifying therapies, 139 with natalizumab and 19 without a previous treatment; mean fingolimod treatment duration: 25 ± 9 months) treated with fingolimod from November 2011 and with at least 12 months follow-up. 56 neurology-unit Spanish hospitals enrolled patients. Basal clinical and demographic data were recorded. Relapses, EDSS scores and radiological activity were recorded at baseline and annually. Adverse events were also recorded during the follow-up period. RESULTS: After two years of follow-up: annual relapse rates decreased by 76%, the proportion of relapse-free patients was 67%, of disability progression-free patients confirmed at 3 months was 91%, of relapse and disability progression-free patients was 63%, of radiological activity-free patients was 50%, and the proportion of relapse, disability progression and radiological activity-free patients was 35%. Only 3.9% of patients discontinued fingolimod permanently during the first year of treatment. CONCLUSIONS: In this interim analysis, most of patients treated with fingolimod in clinical practice had a controlled clinical disease activity, stable disability progression and high persistency.

TITLE: Efectividad y seguridad del fingolimod en la practica clinica habitual en pacientes con esclerosis multiple remitente recurrente en España: analisis intermedio del estudio MS NEXT.Introduccion. El fingolimod es un tratamiento modificador de la enfermedad que ha demostrado eficacia y seguridad en ensayos clinicos en pacientes con esclerosis multiple remitente recurrente (EMRR). Objetivo. Evaluar la efectividad y la seguridad del fingolimod en pacientes con EMRR en la practica clinica. Pacientes y metodos. Se presentan los resultados del analisis intermedio (julio de 2015) del MS NEXT, un estudio observacional, multicentrico y retrospectivo. Se incluyo a 442 pacientes (edad media: 41 ± 9 años; escala expandida del estado de discapacidad basal, mediana: 3; 70% mujeres; 284 previamente tratados con tratamientos modificadores de la enfermedad de primera linea, 139 con natalizumab y 19 naive; media de tratamiento con fingolimod: 25 ± 9 meses) tratados con fingolimod a partir de noviembre de 2011 y con al menos 12 meses de seguimiento. Participaron 56 hospitales españoles. Se recogieron datos demograficos y clinicos (basal y anualmente, numero de brotes, puntuacion en la escala expandida del estado de discapacidad y actividad radiologica). Tambien se registraron los efectos adversos durante el seguimiento. Resultados. Tras dos años de tratamiento, la tasa anualizada de brotes se redujo un 76%; el 67% de los pacientes estaba libre de brotes; el 91%, libre de progresion de la discapacidad confirmada a los tres meses; el 63%, libre de brotes y progresion de discapacidad; el 50%, libre de actividad radiologica, y el 35%, libre de brotes, progresion de discapacidad y actividad radiologica. Un 3,9% abandono el fingolimod permanentemente. Conclusiones. En este analisis intermedio, la mayoria de los pacientes tratados con fingolimod en la practica clinica presenta una actividad clinica controlada y una elevada persistencia al tratamiento.

Síndrome del canal de Alcock secundario a infiltración por endometriosis / Alcock canal syndrome secondary to endometrial infiltration

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Eyelid myokymia in patients with migraine taking topiramate.

OBJECTIVE: Although ocular side effects of topiramate are common, neuroophthalmologic manifestations such as blepharospasm, myokymia and oculogyric crisis are scarcely reported. METHODS: We present a serie of 8 patients with migraine who developed eyelid myokymia after treatment with topiramate. We reviewed all patients with migraine treated with topiramate attending the headache outpatient clinic of our hospital from January 2008 to December 2012. RESULTS: During the study period, a total of 140 patients with migraine were treated with topiramate in our headache clinic. Eight presented eyelid myokymia after beginning treatment with topiramate (5,7%). Topiramate was stopped and myokymia disappeared in all patients, it was prescribed again and eyelid myokymia reappeared with their previous characteristics in all patients. CONCLUSIONS: Eyelid myokymia is an underreported side-effect of topiramate in patients with migraine, of unknown cause, so that in future, further studies are need to examine whether patients with migraine are predisposed or not to this adverse effect.

[Ambulatory neurological care in a prison population]. / Atencion neurologica ambulatoria a una poblacion penitenciaria.

AIMS: Some of the users attended in a Neurology service consist of the inmate population in a prison. The aim of this study is to analyse all the proposals referred from the Alicante II Prison Centre to a Neurology service. PATIENTS AND METHODS: We analyse and describe the clinical characteristics of patients referred from the Alicante II Prison Centre to the Neurology service at the Centro Sanitario Integrado in Villena between the years 2003 and 2006. This analysis involved the following variables: age, sex, personal history, reason for visiting and diagnosis. RESULTS: A total of 88 proposals were recorded. The mean age of the patients was 35 years (84 males/4 females). A total of 15 patients did not attend their appointment (17%). Positive serology for the human immunodeficiency virus was found in 18% of patients. The most frequent reason for visiting was headache (32%), followed by seizures (25%) and, thirdly, vascular pathologies (13%). In a group of 16 patients (18%) the main diagnosis was established as being some kind of psychiatric disorder (anxiety, depression, simulation). CONCLUSIONS: No studies have been published in the literature that analyse the clinical characteristics of patients from prisons referred to a Neurology service. The high percentage of patients who do not attend their appointment and the high percentage of psychiatric disorders that are diagnosed within this group of patients are especially noteworthy. However, and as can be observed in the general population, headache is still the most common reason for visiting. Nevertheless, the group of neurological diagnoses that are most frequently attended is epilepsy.

Atención neurológica ambulatoria a una población penitenciaria / Ambulatory neurological care in a prison population

La población recluida en un centro penitenciario forma parte de los usuarios atendidos en una consultade Neurología. El objetivo del presente estudio es analizar todas las propuestas derivadas desde el Centro Penitenciario Alicante II a una consulta de Neurología. Pacientes y métodos. Se analizan y describen las características clínicas de los pacientesderivados desde el Centro Penitenciario Alicante II a la consulta de Neurología del Centro Sanitario Integrado de Villena, entre los años 2003 y 2006. Se analizan las siguientes variables: edad, sexo, antecedentes personales, motivo de consulta ydiagnóstico. Resultados. Se contabiliza un total de 88 propuestas. La edad media de los pacientes fue de 35 años (84 varones y 4 mujeres). Un total de 15 pacientes no acudieron a la consulta (17%). El 18% de los pacientes presentan serología positivapara el virus de inmunodeficiencia humana. El motivo de consulta más frecuente fue el de cefalea (32%), seguido de crisis convulsivas (25%) y, en tercer lugar, de la patología vascular (13%). En un grupo de 16 pacientes (18%) se estableció como diagnóstico principal alguna alteración psiquiátrica (ansiedad, depresión, simulación). Conclusiones. No existen actualmenteen la bibliografía estudios que analicen las características clínicas de los pacientes penitenciarios derivados a una consulta de Neurología. Llama la atención el alto porcentaje de pacientes que no acuden a la consulta y el alto porcentaje de trastornospsiquiátricos diagnosticados en este grupo de pacientes. No obstante, y como se observa en la población general, la cefalea sigue siendo el motivo de consulta más frecuente. Sin embargo, el grupo diagnóstico neurológico más frecuentemente atendido es la epilepsia

Some of the users attended in a Neurology service consist of the inmate population in a prison. The aim ofthis study is to analyse all the proposals referred from the Alicante II Prison Centre to a Neurology service. Patients and methods. We analyse and describe the clinical characteristics of patients referred from the Alicante II Prison Centre to the Neurology service at the Centro Sanitario Integrado in Villena between the years 2003 and 2006. This analysis involved thefollowing variables: age, sex, personal history, reason for visiting and diagnosis. Results. A total of 88 proposals were recorded. The mean age of the patients was 35 years (84 males/4 females). A total of 15 patients did not attend their appointment (17%). Positive serology for the human immunodeficiency virus was found in 18% of patients. The most frequentreason for visiting was headache (32%), followed by seizures (25%) and, thirdly, vascular pathologies (13%). In a group of 16 patients (18%) the main diagnosis was established as being some kind of psychiatric disorder (anxiety, depression, simulation).Conclusions. No studies have been published in the literature that analyse the clinical characteristics of patients from prisons referred to a Neurology service. The high percentage of patients who do not attend their appointment and the high percentage of psychiatric disorders that are diagnosed within this group of patients are especially noteworthy. However, and as can be observed in the general population, headache is still the most common reason for visiting. Nevertheless, the group of neurological diagnoses that are most frequently attended is epilepsy

Síndrome de embolismo graso / Fat embolism syndrome

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Angeítis aislada del sistema nervioso central / Isolated cerebral angiitis

Introducción. La angeítis granulomatosa aislada del sistema nervioso central se define histológicamente por la presencia de una inflamación granulomatosa que se distribuye desde los vasos meníngeos y se extiende hacia el parénquima a lo largo de venas y de arterias de calibre variable. Las alteraciones clínicas más frecuentes en estos pacientes son la cefalea y cuadros de encefalopatía. Caso clínico. Presentamos el caso clínico de una paciente que inicia crisis convulsivas de inicio parcial con generalización secundaria, diagnosticado mediante biopsia cerebral, con buena respuesta clínica al tratamiento inmunosupresor (corticoides y ciclofosfamida). Realizamos una actualización bibliográfica sobre esta patología. Conclusiones. La sintomatología tan heterogénea que presentan los pacientes con esta patología provoca en numerosas ocasiones confusión y retraso en el diagnóstico. La confirmación histológica mediante la realización de una biopsia cerebral y meníngea es el parámetro determinante para el diagnóstico de la angeítis granulomatosa del sistema nervioso central (AU)

Introduction: Isolated cerebral angiitis of the central nervous system is defined histologically by presence of granulomatous inflammation in the meningeal vessels, and parenchyma throughout veins and arteries of variable size. The most common clinical manifestations are headache and encephalopathy. Case Report: We present the clinical case of a patient with epileptic seizures of focal onset, secondary generalized, diagnosed by cerebral biopsy. Clinical response to immunosuppressive treatment (corticosteroid and cyclophosphamyde) was excellent. We make a bibliographic review and update. Conclusion: The heterogeneous clinical symptomatology of this disease leads to confusion and delay in diagnosis. Histological confirmation by cerebral and meningeal biopsy is the best parameter for diagnosis of isolated cerebral angiitis of the central nervous system (AU)

Mononeuropatía múltiple asociada a tratamiento con pravastatina / Multiple mononeuropathy associated to treatment with pravastatin

Introducción. La neuropatía secundaria al tratamiento con estatinas se conoce desde 1994. aunque es una complicación poco frecuente. Habitualmente se trata de una polineuropatía axonal, predominantemente sensitiva, distal y simétrica, subaguda o crónica. Presentamos el segundo caso que se recoge en la bibliografía de mononeuritis múltiple asociada al uso de estatinas. Caso clínico. Mujer de 51 años que, tras iniciar tratamiento con pravastatina, presentó parestesias progresivas distales en miembros, de distribución asimétrica, con inestabilidad en la marcha. El estudio electromiográfico fue compatible con mononeuritis múltiple. Las pruebas complementarias realizadas para descartar otras causas de mononeuropatía múltiple fueron normales. La enferma mejoró al abandonar el tratamiento y empeoró de nuevo tras retomarlo. Con la suspensión definitiva de la pravastatina volvió a mejorar de forma progresiva hasta quedar prácticamente asintomática. Conclusiones. La relación entre el tratamiento con estatinas y la aparición de polineuropatía ha quedado establecida en distintos estudios epidemiológicos de casos y controles. No sólo se puede presentar como la clásica polineuropatía distal y simétrica, sino que se han descrito formas clínicas atípicas, incluido algún caso como el nuestro de mononeuropatía múltiple. El riesgo de desarrollar esta complicación es pequeño y se ve compensado por los beneficios cardiovasculares de las estatinas, aunque posiblemente en un futuro se verá con más frecuencia, dado el uso creciente de estos fármacos. Es importante tener en cuenta esta causa de neuropatía, dada su reversibilidad potencial

Introduction. The first reports of neuropathy due to treatment with statins appeared in 1994, although it is an infrequent complication. It usually consists of an axonal polyneuropathy, which is predominantly sensory, distal and symmetric, and may be subacute or chronic. We present here the second case reported in the literature of multiple mononeuropathy associated to the use of statins. Case report. A 51-year-old female patient who, after beginning therapy with pravastatin, presented with progressive, asymmetrically distributed, distal paresthesias in the limbs and an unstable gait. An electromyographic study was compatible with multiple mononeuritis. Results of complementary tests that were carried out to preclude other causes of multiple mononeuropathy were normal. The patient’s condition improved on withdrawing treatment with the drug and it became worse again when therapy was restarted. When pravastatin therapy was stopped for good, the patient's condition progressively improved until she was practically free of symptoms. Conclusions. The relationship between treatment with statins and the appearance of polyneuropathy has been proved in different epidemiological case-control studies. It does not only appear as the classical distal symmetrical olyneuropathy, but has also been reported as taking on atypical clinical forms including a few cases, like ours, of multiple mononeuropathy. The risk of developing this complication is low and is offset by the cardiovascular benefits offered by statins, although it may become more common in the future due to the increasing rate of use of these agents. It is important to bear this cause of neuropathy in mind, given the fact that it is potentially reversible

[Isolated cerebral angiitis]. / Angeítis aislada del sistema nervioso central.

INTRODUCTION: Isolated cerebral angiitis of the central nervous system is defined histologically by presence of granulomatous inflammation in the meningeal vessels, and parenchyma throughout veins and arteries of variable size. The most common clinical manifestations are headache and encephalopathy. CASE REPORT: We present the clinical case of a patient with epileptic seizures of focal onset, secondary generalized, diagnosed by cerebral biopsy. Clinical response to immunosuppressive treatment (corticosteroid and cyclophosphamyde) was excellent. We make a bibliographic review and update. CONCLUSION: The heterogeneous clinical symptomatology of this disease leads to confusion and delay in diagnosis. Histological confirmation by cerebral and meningeal biopsy is the best parameter for diagnosis of isolated cerebral angiitis of the central nervous system.

[Multiple mononeuropathy associated to treatment with pravastatin]. / Mononeuropatía múltiple asociada a tratamiento con pravastatina.

INTRODUCTION: The first reports of neuropathy due to treatment with statins appeared in 1994, although it is an infrequent complication. It usually consists of an axonal polyneuropathy, which is predominantly sensory, distal and symmetric, and may be subacute or chronic. We present here the second case reported in the literature of multiple mononeuropathy associated to the use of statins. CASE REPORT: A 51-year-old female patient who, after beginning therapy with pravastatin, presented with progressive, asymmetrically distributed, distal paresthesias in the limbs and an unstable gait. An electromyographic study was compatible with multiple mononeuritis. Results of complementary tests that were carried out to preclude other causes of multiple mononeuropathy were normal. The patient's condition improved on withdrawing treatment with the drug and it became worse again when therapy was restarted. When pravastatin therapy was stopped for good, the patient's condition progressively improved until she was practically free of symptoms. CONCLUSIONS: The relationship between treatment with statins and the appearance of polyneuropathy has been proved in different epidemiological case-control studies. It does not only appear as the classical distal symmetrical polyneuropathy, but has also been reported as taking on atypical clinical forms including a few cases, like ours, of multiple mononeuropathy. The risk of developing this complication is low and is offset by the cardiovascular benefits offered by statins, although it may become more common in the future due to the increasing rate of use of these agents. It is important to bear this cause of neuropathy in mind, given the fact that it is potentially reversible.

Bostezos y epilepsia del lóbulo temporal / Yawning and temporal lobe epilepsy

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[Retinopathy secondary to treatment with Interferon beta-1a in a patient with multiple sclerosis]. / Retinopatía secundaria a tratamiento con interferón beta 1a en paciente con esclerosis múltiple.

INTRODUCTION: Although visual symptoms of multiple sclerosis (MS) are very frequent, they are rarely related with treatment with interferon. This is the first case reported in the literature of retinopathy associated with subcutaneous interferon beta-1a, and the second related to interferons in MS. CASE REPORT: A 30-year-old female diagnosed with relapsing-remitting MS who, at 3 months after starting treatment with subcutaneous interferon beta-1a (44 microg/3 times a week), displayed visual disorders. Retinal lesions in the form of cotton wool spots were found as symptoms of microinfarctions in the retina. The lesions got better after stopping treatment and the patient was found to be asymptomatic. CONCLUSIONS: The existence of retinopathy secondary to interferon has been known in the treatment of hepatitis C and neoplasias with interferon alfa since 1990. Despite being a frequently occurring complication, it is usually a mild condition and disappears on withdrawing treatment, or even if it is continued. It is attributed to deposits of immunocomplexes and complement activation in the blood vessels of the retina. Only one other case associated to treatment of MS with interferon beta has been reported in the literature, more specifically related to subcutaneous interferon beta-1b. The clinical characteristics of both cases are identical to those associated to interferon alfa. Despite the fact that the frequency of appearance seems to be lower than in the case of interferon alfa, the physician must bear in mind the possibility encountering this complication.