Intravenous lacosamide (LCM) in status epilepticus (SE): Weight-adjusted dose and efficacy.

BACKGROUND: Some studies suggest higher efficacy of lacosamide (LCM) in status epilepticus (SE) with higher loading doses; however, this weight-adjusted dose has not been evaluated. OBJECTIVE: The objective was to evaluate the relationship between loading weight-adjusted dose and efficacy of LCM in SE. METHODS: A group of patients with SE treated with LCM from Spanish hospitals was examined retrospectively. Demographic data, type of SE, etiology, response rate, last antiepileptic drug (AED) used, treatment line in which LCM was used, total loading dose, and weight-adjusted dose were collected. RESULTS: One hundred sixty-five cases of SE were collected; 87 (52.7%) patients had nonconvulsive SE. Mean age was 64.2 ±â€¯17.2 and 60.6% (n = 100) were men. Regarding etiology, SE was considered as acute symptomatic in 85 (51.5%), remote symptomatic in 51 (30.9%), progressive symptomatic in 10 (6.1%), and cryptogenic in 19 (11.5%). Lacosamide was used as the third drug in 46.1%, and as a second option in 28%. In 115 patients, clonazepam had been used as the first option, and no benzodiazepines had been administered in the remaining 50. The median loading dose was 400 mg (100-600 mg), and the weight-adjusted dose was 5 mg/kg (3-6 mg/kg). The response rate was 63.3%, and 55.1% responded within the first 12 h. Efficacy was significantly higher in patients who had taken benzodiazepines at LCM loading doses >5.3 mg/kg (p = 0.006). This relationship was maintained independent of using other concomitant AEDs. However, if benzodiazepines were not taken, this relationship was not found. CONCLUSIONS: In adults with benzodiazepine-resistant SE, the response rate to LCM was higher, with weight-adjusted doses above 5.3 mg/kg.

Efficacy and safety of eslicarbazepine-acetate in elderly patients with focal epilepsy: Case series.

PURPOSE: Eslicarbazepine-acetate (ESL) is a third generation antiepileptic drug licensed as adjunctive therapy in adults with focal seizures. Efficacy and safety of ESL have been established in real-life setting. However, data about outcomes in elderly patients are scarce. Primary endpoint was to evaluate outcomes of ESL in elderly patients. METHOD: This was a retrospective survey that included patients >65years with focal seizures who started ESL between January 2010 and July 2012 at 12 Spanish Hospitals. ESL was prescribed individually according to real-life practice. Efficacy and safety were evaluated over 1year. These patients were included within the bigger study ESLIBASE. RESULTS: We included 29 patients, most of them males (18). Mean age was 71.2 year-old and epilepsy evolution was 20 years. Eighteen were pharmacorresistant at baseline. At 12 months, the mean dose was 850mg/day, the retention rate 69%, the responder rate 62% and 24.1% were seizure-free. At 12 months, 16 patients (55.2%) had ≥1 adverse effect (AE), that led to discontinuation in 7 patients. Dizziness, nausea and ataxia were the most common AEs. The tolerability profile improved in 4/5 patients who switched from carbamazepine (CBZ) or oxcarbazepine (OXC) to ESL due to AEs. CONCLUSIONS: ESL was well-tolerated and effective in elderly patients in a real-life setting over 1year, with a dose around 800mg/day. AE effects improved in most of who switched from CBZ or OXC to ESL.

EARLY-ESLI study: Long-term experience with eslicarbazepine acetate after first monotherapy failure.

PURPOSE: Evaluate real-life experience with eslicarbazepine acetate (ESL) after first monotherapy failure in a large series of patients with focal epilepsy. METHOD: Multicentre, retrospective, 1-year, observational study in patients older than 18 years, with focal epilepsy, who had failed first antiepileptic drug monotherapy and who received ESL. Data from clinical records were analysed at baseline, 3, 6 and 12 months to assess effectiveness and tolerability. RESULTS: Eslicarbazepine acetate was initiated in 253 patients. The 1-year retention rate was 92.9%, and the final median dose of ESL was 800 mg. At 12 months, 62.3% of patients had been seizure free for 6 months; 37.3% had been seizure free for 1 year. During follow-up, 31.6% of the patients reported ESL-related adverse events (AEs), most commonly somnolence (8.7%) and dizziness (5.1%), and 3.6% discontinued due to AEs. Hyponatraemia was observed in seven patients (2.8%). After starting ESL, 137 patients (54.2%) withdrew the prior monotherapy and converted to ESL monotherapy; 75.9% were seizure free, 87.6% were responders, 4.4% worsened, and 23.4% reported ESL-related AEs. CONCLUSION: Use of ESL after first monotherapy failure was associated with an optimal seizure control and tolerability profile. Over half of patients were converted to ESL monotherapy during follow-up.

Safety, efficacy and outcome-related factors of perampanel over 12 months in a real-world setting: The FYDATA study.

BACKGROUND: Real-world data of current antiepileptic drugs (AEDs) used to treat focal seizures is of importance to understand the efficacy and safety outside of the clinical trial setting. Here we report real-world data from a large series of patients treated with perampanel for 1year. METHODS: FYDATA was a multicentre, retrospective, 1-year observational study assessing the efficacy and safety of adjuvant perampanel in patients ≥12 years of age with focal epilepsy in a real-world setting. At 12 months, the proportion of patients who were seizure free, median percentage seizure reduction, proportion of responders, retention rate and proportion of patients with adverse events (AEs) were assessed. Analyses were also performed to identify any patient-, medication- and disease-related factors associated with a large clinical response or carry a risk for AEs. RESULTS: A total of 464 patients were included in the study with a retention rate of 60.6% at 1year. The mean number of prior AEDs was 7.8. The median percentage reduction in overall seizures was 33.3% (75% for secondary generalised seizures) after 1year, with 7.2% of patients achieving seizure freedom. Furthermore, patients on non-enzyme-inducing AEDs were more likely to achieve seizure freedom, and logistic regression revealed that patients aged ≥65 years, those with epilepsy due to a vascular aetiology and those who had received fewer prior AEDs showed a better clinical response to perampanel. A total of 62.9% of the patients experienced AEs at 12 months; dizziness, somnolence and irritability were the most frequent AEs. Patients with prior psychiatric comorbidities (hyperactivity and personality disorder) were more likely to experience psychiatric AEs with perampanel, and slower titration schedules were associated with less AEs overall. CONCLUSION: Perampanel, for the treatment of focal epilepsy in a real-world setting in a refractory population, over 1year, demonstrates a similar efficacy and safety profile to that observed in clinical trials. Our results have implications for the optimisation of perampanel use in a clinical setting.

Long-term safety and efficacy of eslicarbazepine acetate in patients with focal seizures: results of the 1-year ESLIBASE retrospective study.

BACKGROUND: Eslicarbazepine acetate (ESL) is a new antiepileptic drug (AED) licensed as adjunctive therapy in adults with partial-onset or focal seizures. OBJECTIVE: To evaluate in a clinical practice setting the long-term efficacy and safety of ESL in patients with focal seizures. METHODS: ESLIBASE was a retrospective study that included all patients with focal seizures who started ESL between January 2010 and July 2012 at 12 hospitals. ESL was prescribed individually according to real-life practice. Efficacy and safety were evaluated over 1 year. Switching from carbamazepine (CBZ) and oxcarbazepine (OXC) was assessed. RESULTS: Three hundred and twenty-seven patients were included; 78% of patients were taking ≥2 other AEDs at baseline. Most (87%) began ESL because of poor seizure control and 13% because of adverse events (AEs) with CBZ or OXC. After 1 year, 237 patients (72.4%) remained on ESL. At 3, 6 and 12 months, the responder rate was 46.3%, 57.9%, and 52.5%, and 21.0%, 28.0%, and 25.3% of patients were seizure free. The responder rate significantly increased when ESL was combined with a non-sodium channel-targeting drug (non-SC drug) (66.7%) versus an SC drug (47.7%; p<0.001). At 12 months, 40.7% of patients had ≥1 AE; AEs led to treatment discontinuation in 16.2%. Dizziness, nausea, and somnolence were the most common AEs. The tolerability profile improved in >50% of the patients who switched from CBZ or OXC to ESL because of AEs. CONCLUSIONS: ESL was well tolerated and effective in a real-world setting over 1 year. Side-effect profile improved when OXC and CBZ recipients were switched to ESL.

Clinical implications of the angiosome model in peripheral vascular disease.

Vascular surgery has seen a revolutionary transformation in its approach to peripheral vascular disease over the last 2 decades, fueled by technological innovation and a willingness by the field to adopt these changes. However, the underlying pathology behind critical limb ischemia and the significant rate of unhealed wounds and secondary amputations despite apparently successful revascularization needs to be addressed. In seeking to improve outcomes, it may be beneficial to examine our approach to vascular disease at the fundamental level of anatomy, the angiosome, to better dictate reperfusion strategies beyond a simple determination of open vs endovascular procedure. We performed a systematic review of the current literature concerning the significance of the angiosome concept in the realm of vascular surgery. The dearth of convincing evidence in the form of prospective trials and large patient populations, and the lack of a consistent, comparable vocabulary to contrast study findings, prevent recommendation of the conceptual model at a wider level for guidance of revascularization attempts. Further well-structured, prospective studies are required as well as emerging imaging strategies, such as indocyanine green dye-based fluorescent angiography or hyperspectral imaging, to allow wider adoption of the angiosome model in vascular operations.

Lower extremity bypass vs endovascular therapy for young patients with symptomatic peripheral arterial disease.

The uncertainty continues over the best approach to patients with symptomatic peripheral arterial disease. Medical therapy and risk factor modification is part of any treatment regimen; with this there is little disagreement. However, with the introduction of lesser invasive percutaneous technologies, the discussion regarding surgical and endovascular therapies has become more and more complicated. Unfortunately, there is a relative shortage of robust outcomes data to support many of our specific treatment recommendations. Younger patients are an especially troublesome patient cohort. They have consistently shown poorer outcomes after any intervention compared with older patients and may represent a subset of more aggressive atherosclerotic disease. Our debaters will discuss their preferred approaches to these difficult patients in the context of the currently available supporting literature.

Acceptability and tolerability of levetiracetam oral solution for the treatment of partial-onset seizures: the SOLUCIÓN study.

This cross-sectional, observational study evaluated the use of levetiracetam oral solution in usual clinical practice. Patients ≥ 16 years with partial-onset seizures (had received levetiracetam oral solution for ≥ 28 days) completed a study questionnaire assessing overall acceptability of levetiracetam oral solution, specific organoleptic characteristics (taste, taste intensity, aftertaste), ease of use and convenience. Tolerability was assessed by evaluating adverse events. Of 389 patients, 92.8% (361/389) were evaluable for acceptability, all (389) for tolerability; 65.3% (236/361) rated levetiracetam oral solution very acceptable or acceptable, 41.5% (150/361) pleasant or very pleasant, 54.3% (196/361) neither strong nor mild taste intensity and indicated the drug left an aftertaste (most stated aftertaste did not bother them), 75.3% very easy or easy to use and 61.8% very convenient or convenient to use. There was a positive relationship between overall acceptability of levetiracetam oral solution and favorable responses for organoleptic characteristics, ease of use, convenience and patients' evaluation of treatment compliance (P < 0.0001 for each). Of the 176/353 who previously received another antiepileptic drug and reported preference for a medication, 72.2% (127/176) preferred levetiracetam oral solution and 39/389 (10%) reported adverse events. Levetiracetam oral solution demonstrated a high degree of patient acceptability in adult patients with partial-onset seizures and was well tolerated.

[Topiramate in chronic daily headache due to migraine]. / Topiramato en cefalea crónica diaria por migraña.

INTRODUCTION: Chronic daily headache (CDH) includes primary headaches that last more than four hours with a frequency equal or superior to 15 days a month over the last three months. It has a prevalence of 4-5% in the general population and is a frequent reason for visiting the physician in headache units. AIM: To evaluate the effectiveness of topiramate, as the primary drug, in CDH due to probable chronic migraine with or without medication abuse. PATIENTS AND METHODS: From the 447 patients with migraine in our database, we selected those: a) satisfying Silberstein criteria for CDH; b) that had not followed prior prophylactic treatment; and c) who were treated with topiramate as the primary drug. The mean number of days with headache and bouts of severe migraine in the fourth month of treatment using topiramate as compared to the month preceding treatment, as well as the percentage of responses and the rate of respondents in the fourth month were all analysed. RESULTS: Eighty-three patients (88% females) with a mean age of 38.0 +/- 14.13 years were selected. Medication abuse was reported in 44% of cases. At the fourth month of treatment, the mean number of days with headache dropped significantly from 20.8 to 7.9 (p < 0.0001) and the mean number of bouts of severe migraine diminished from 4.4 to 1.7 (p < 0.0001). The rate of respondents was 72%. Medication abuse continued in 14% of cases. Side effects were produced in 58% of patients and the dropout rate was 24%. CONCLUSIONS: Topiramate proved to be effective in the treatment of CDH due to probable chronic migraine and with probable medication abuse in de novo migraine patients.

Topiramato en cefalea crónica diaria por migraña / Topiramate in chronic daily headache due to migraine

La cefalea crónica diaria (CCD) incluye aquellas cefaleas primarias de más de cuatro horas de duracióny frecuencia igual o superior a 15 días al mes en los últimos tres meses. Presenta una prevalencia del 4-5% entre la población general y es un motivo frecuente de consulta en las unidades de cefaleas. Objetivo. Valorar la efectividad de topiramato, como primer fármaco, en la CCD por probable migraña crónica con o sin abuso de fármacos. Pacientes y métodos. De nuestra base de datos de 447 pacientes con migraña se seleccionaron aquellos: a) con criterios de Silberstein de CCD, b) queno habían llevado un tratamiento profiláctico previo, y c) tratados con topiramato como primer fármaco. Se analizaron la media de días con cefalea y crisis de migraña intensa en el cuarto mes de tratamiento con topiramato en relación con el mes previoal tratamiento, los porcentajes de respuesta y la tasa de respondedores en el cuarto mes. Resultados. Se seleccionaron 83 pacientes (88% de mujeres) con una edad media de 38,0 ± 14,13 años. El 44% abusaba de fármacos. Al cuarto mes de tratamiento, la media de días con cefalea disminuyó significativamente de 20,8 a 7,9 (p < 0,0001) y la medía de crisis de migrañaintensa, de 4,4 a 1,7 (p < 0,0001). La tasa de respondedores fue del 72%. Un 14% continuó abusando de los fármacos. Se produjeron efectos adversos en el 58% de pacientes y hubo un 24% de abandonos. Conclusión. El topiramato se mostró efectivo en el tratamiento de la CCD por probable migraña crónica y con probable abuso de fármacos en pacientes migrañosos de novo

Chronic daily headache (CDH) includes primary headaches that last more than four hours with afrequency equal or superior to 15 days a month over the last three months. It has a prevalence of 4-5% in the general population and is a frequent reason for visiting the physician in headache units. Aim. To evaluate the effectiveness of topiramate, as theprimary drug, in CDH due to probable chronic migraine with or without medication abuse. Patients and methods. From the 447 patients with migraine in our database, we selected those: a) satisfying Silberstein criteria for CDH; b) that had not followed prior prophylactic treatment; and c) who were treated with topiramate as the primary drug. The mean number of days with headache and bouts of severe migraine in the fourth month of treatment using topiramate as compared to the monthpreceding treatment, as well as the percentage of responses and the rate of respondents in the fourth month were all analysed.Results. Eighty-three patients (88% females) with a mean age of 38.0 ± 14.13 years were selected. Medication abuse was reported in 44% of cases. At the fourth month of treatment, the mean number of days with headache dropped significantly from20.8 to 7.9 (p < 0.0001) and the mean number of bouts of severe migraine diminished from 4.4 to 1.7 (p < 0.0001). The rate of respondents was 72%. Medication abuse continued in 14% of cases. Side effects were produced in 58% of patients and thedropout rate was 24%. Conclusions. Topiramate proved to be effective in the treatment of CDH due to probable chronic migraine and with probable medication abuse in de novo migraine patients

Protective effect of melatonin and pinoline on nitric oxide-induced lipid and protein peroxidation in rat brain homogenates.

Nitric oxide (NO) is a physiological neurotransmitter, a mediator of the excitatory neurotransmitter glutamate pathways that regulates several neuroendocrine functions, but excessive NO is toxic by itself and it interacts with superoxide radical (O(2)(-)) to form the peroxynitrite anion (ONOO(-)). Using rat brain homogenates, we investigated the effects of melatonin and pinoline in preventing the level of lipid peroxidation (LPO) and carbonyl contents in proteins induced by nitric oxide (NO) which was released by the addition of sodium nitroprusside (SNP). Lipid and protein peroxidation were estimated by quantifying malondialdehyde (MDA) and 4-hydroxyalkenal (4-HDA) concentrations and carbonyl contents, respectively. SNP increased MDA+4-HDA and carbonyl contents production in brain homogenates in a time and concentration dependent manner. Both, melatonin and pinoline reduced NO-induced LPO and carbonyl contents in a dose-dependent manner in concentrations from 0.03 to 3 mM and 1 to 300 microM, respectively. Under the in vitro conditions of this experiment, both antioxidants were more efficient in limiting SNP protein oxidation than lipid damage.

["Household items" : an alternative task to "animals" in the assessment of semantic verbal fluency: a validation study]. / "Cosas en una casa", una tarea alternativa a "animales" en la exploración de la fluidez verbal semántica: estudio de validación.

INTRODUCTION: The semantic verbal fluency (SVF) is usually evaluated with the task animals in 1 minute . This is a test widely applied in the screening of cognitive impairment. In our best knowledge there are not other alternatives categories for this task validated in our environment (Spanish as mother tongue, Spain). OBJECTIVE: To validate the category households items as an alternative parallel task to animals in the assessment of SVF. PATIENTS AND METHODS: Prospective assessment of two categories (animals and household items) in two groups: normal controls and patients with Alzheimer s disease (AD). CONTROL GROUP: n= 22 (13 M, 9 W); age: 73 5 years, education: 12 5 years; MMSE MEC 35: 30 4; Animals : 15 4. Percentile distribution 10th: 11; 50th: 15; 90th: 20; household items : 17 4. Percentile distribution: 10th: 12; 50th: 17; 90th: 22. AD group: n= 24 (9 M, 15 W); age: 74 5 years; education: 11 5 years; MMSE MEC 35: 17 8; Animals : 6 3. Percentile distribution: 10th: 2; 50th: 6; 90th: 9; household items : 6 4. Percentile distribution: 10th: 1; 50th: 6; 90th: 11. It is observed a positive correlation between the two categories (Spearman s Rho: 0.83, p< 0.0001). CONCLUSIONS: Both SVF categories had a similar distribution and a high correlation. This findings demonstrated the validity of the household items as an alternative and parallel form to animals in the assessment of SVF in patients with cognitive impairment or dementia.

[Steroid treatment of acute psychosis associated with multiple sclerosis]]. / Tratamiento con esteroides de la psicosis aguda relacionada con esclerosis múltiple.

INTRODUCTION: Psychiatric disorders are common in patients suffering from multiple sclerosis (MS). Psychosis is a rare complication in this condition. We present two patients with MS and psychosis. CLINICAL CASES: Case 1. A 45-year-old man was admitted to the hospital because an acute psychosis. The diagnosis of clinical definitive MS was made two years before. Cranial magnetic resonance imaging (MRI) and single positron emission computerized tomography (SPECT) showed lesions in the left temporal lobe. He was treated with a 3-day course of high-dose corticosteroid and neuroleptic. The patient's status gradually improved within the following weeks. Case 2. A 41-year-old man with MS was hospitalized in a Psychiatric Department for acute psychosis. He was treated with high-dose of neuroleptic. Thereafter two remissions and relapses of MS have occurred. In 1998, the patient was evaluated in the Service of Psychiatric for new paranoid acute psychosis. CONCLUSIONS: Psychosis is not a prominent feature of the disease, occurring in 5% of cases. The relationship between lesions of the central nervous system and psychiatric illness has not been established although some reports have implicated the temporal lobe. The propensity of steroids to exacerbate psychosis usually argues against this option, but steroids could theoretically improve psychosis related to acute demyelination.

Tratamiento con esteroides de la psicosis agudarelacionada con esclerosis múltiple / Treatment with steroids for acute psychosis associated with multiple sclerosis

Introducción. La esclerosis múltiple (EM) puede cursar con gran variedad de síntomas psiquiátricos, sin embargo, la psicosis asociada a esta enfermedad es poco frecuente. Presentamos los casos de dos pacientes diagnosticados de EM clínicamente definida que desarrollaron brotes psicóticos agudos. Casos clínicos. Caso 1. Varón de 45 años diagnosticado de EM en 1996. Dos años después, ingresó en la Unidad de Psiquiatría por presentar psicosis aguda. La resonancia magnética craneal (RM) y la tomografía computarizada por emisión de fotón simple (SPECT) mostraron lesiones temporales izquierdas. El paciente fue tratado con neurolépticos y Metilprednisolona, con mejoría parcial.Caso 2. Varón de 41 años diagnosticado de EM en 1988. Al año del diagnóstico ingresó en la Unidad de Psiquiatría por padecer un delirio celotípico agudo; este paciente precisaba dosis altas de neurolépticos. Posteriormente ha tenido dos brotes, seguido en 1998 por una reagudización de la psicosis, motivo por el cual reingresó en la Unidad de Psiquiatría. Conclusiones. La psicosis no es un síntoma prominente de la EM, aunque puede aparecer hasta en un 5 por ciento de los casos. La localización de la desmielinización responsable de la psicosis no está claramente establecida; se ha implicado sobre todo al lóbulo temporal, y en el primer caso la RMN/SPECT mostraron lesiones a ese nivel. La posibilidad de que los esteroides exacerben la psicosis frena su uso, pero si se sospecha que este cuadro está relacionado con la desmielinización aguda se cree que teóricamente los síntomas mejorarían con la administración de esteroides (AU)

[Acute transverse myelitis secondary to hepatitis B vaccination]. / Mielitis transversa aguda secundaria a la vacunación de la hepatitis B.

INTRODUCTION: Acute transverse myelitis is an inflammatory disorder. The pathogenesis is unclear, but the probable mechanism involves an autoimmune phenomenon. Possible causes included multiple sclerosis and parainfectious and postvaccinal events. Myelitis has rarely been reported secondary to vaccinations including hepatitis B. We present a case of acute myelitis, which seems secondary to the administration of the hepatitis B vaccine. CLINICAL CASE: A 15-years-old female presented with progressive numbness of the right arm and leg, with right leg weakness. Symptom began one week after receiving the first dose of the hepatitis B vaccine. Spinal cord magnetic resonance (MR) revealed a diffuse increased signal extending from C6 to D2. Cerebral MR and cerebrospinal fluid were normal. She was treated with high doses of methylprednisolone with a complete recovery of neurological functional. Repeat medullar cord MR was normal. There was no relapse during a four years follow up. CONCLUSIONS: Potential causal relationship between vaccination against hepatitis B and multiple sclerosis was brought to the attention and to public debate. However, no conclusive association could be made between vaccination and demyelination. In the clinical setting, the distinction between a first episode of multiple sclerosis or postvaccinal myelitis depends upon subsequent course.

Neurotoxicidad en el sistema nervioso periférico secundaria a tratamiento con quimioterapia / Perypheral nervous system toxicity due to chemotherapy

La toxicidad sobre el sistema nervioso periférico (SNP) secundaria a la utilización de fármacos quimioterápicos es uno de los principales efectos adversos de estos tratamientos. Es una de las pocas complicaciones de la quimioterapia que no tiene tratamiento preventivo y en ocasiones es el efecto secundario que obliga a suspender el tratamiento o al menos a reducir las dosis del quimioterápico. Las complicaciones neurológicas de la quimioterapia están aumentando en frecuencia, debido sobre todo a que, como la mayor parte de las complicaciones extraneurológicas de estos fármacos tienen tratamiento, se están utilizando dosis cada vez más altas de quimioterápicos. Por otro lado, la terapia combinada, que se considera uno de los avances más importantes en el tratamiento del cáncer, busca el efecto sinérgico de los quimioterápicos sobre la célula tumoral, planteándose entonces un posible aumento de la neurotoxicidad si este mismo efecto sinérgico se ejerce sobre el SNP. El objeto de esta revisión es evaluar el estado actual de los conocimientos sobre neurotoxicidad, incluyendo los nuevos fármacos que se están utilizando, así como revisar las investigaciones que se están realizando sobre el tratamiento preventivo de la neurotoxicidad (AU)

Mielitis transversa aguda secundaria a la vacunación de la hepatitis B / Acute transverse myelitis secondary to hepatitis B vaccination

Introducción. La mielitis transversa aguda es un proceso inflamatorio de patogenia desconocida, aunque se sospecha una base autoinmune. La mayor parte de los casos aparecen en el contexto de la esclerosis múltiple o tras infecciones o vacunaciones. El desarrollo de una mielitis transversa aguda asociada a la vacunación de la hepatitis B es poco frecuente. Presentamos un caso de mielitis transversa aguda desencadenada tras la primera dosis de la vacuna de la hepatitis B. Después de cuatro años de seguimiento no ha aparecido ningún otro síntoma neurológico. Caso clínico. Mujer de 15 años de edad, que a la semana de recibir la primera dosis de la vacuna de la hepatitis B comenzó con parestesias en el hemicuerpo derecho y posteriormente paresia en miembro inferior derecho. En la RMN medular se objetivó una lesión hiperintensa entre C6 y D2.Tanto la RMN craneal como los estudios inmunológicos en suero y líquido cefalorraquídeo fueron negativos. Se trató con megadosis de corticosteroides. A los 6 meses la paciente estaba asintomática y la RMN cervical de control fue normal. Conclusiones. La relación entre la administración de la vacuna de la hepatitis B y el primer brote de esclerosis múltiple ha sido objeto de debate y de estudios epidemiológicos. Aunque no hay suficientes datos para relacionar ambos efectos, en la práctica la distinción entre un primer brote de esclerosis múltiple o una mielitis transversa aguda posvacunal sólo puede realizarse con el seguimiento en el tiempo (AU)

Patients with acenocoumarol treatment and migraine.

OBJECTIVE: The aim of our study was to investigate the possible effect of acenocoumarol, which is indicated for nonneurological disease, on headache. BACKGROUND: It has been suggested that anticoagulation can have beneficial effects in the control of migraine attacks. METHODS: Four hundred randomized patients on oral anticoagulant therapy were asked to complete a questionnaire regarding their headaches. RESULTS: Headache was present before or during oral anticoagulation in 166 (66 migraineurs and 100 nonmigraineurs) of 326 respondents. The major finding was that oral anticoagulation produced improvement in 63% of patients with migraine versus 38% of patients with nonmigranous headache. Improvement was related to the severity of migraine but not to age. CONCLUSIONS: Oral anticoagulant therapy can improve migraine. The way in which anticoagulant therapy acts on migraine is unknown, but potential mechanisms include its effect on platelet aggregability and pharmacological effects such as suppression of enhanced nitric oxide.