ABSTRACT
INTRODUCTION: The safety and effectiveness of natalizumab in patients with relapsing-remitting multiple sclerosis (RRMS) has been demonstrated in clinical trials. However, due to the limitations of these trials, it is important to know how the condition behaves under long-term clinical practice conditions. OBJECTIVE: To determine the long-term effectiveness of natalizumab in patients with RRMS by means of annual evaluation of the "no evidence of disease activity" (NEDA) parameter, which includes number of relapses, disability (measured with the Expanded Disability Status Scale), and brain MRI parameters. PATIENTS AND METHODS: We performed a retrospective study of patients with RRMS from 3 centres who were treated with one or more doses of natalizumab. Each year, we evaluated NEDA status and safety based on the percentage of patients who discontinued treatment with natalizumab and experienced adverse reactions. RESULTS: The study included 89 patients, most of whom received treatment for 2 to 4 years, with a follow-up period of up to 7 years. Natalizumab significantly reduces the radiological and clinical progression of the disease, as well as the annual rate of relapses. The NEDA parameter demonstrates the effectiveness of the drug, with values of 75.28% for year one and 66.67% for year 7. Twenty-five patients (28.1%) dropped out after a median of 4 years. Fourteen of these patients (56%) dropped out due to the appearance of anti-JC virus antibodies, either in isolation or associated with another cause. Four dropouts (16%) were due to treatment ineffectiveness, with one patient dying due to progressive multifocal leukoencephalopathy. CONCLUSIONS: Natalizumab is highly effective as measured by the NEDA long-term remission parameter.
Subject(s)
Multiple Sclerosis, Relapsing-Remitting , Multiple Sclerosis , Humans , Immunologic Factors/adverse effects , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Natalizumab/adverse effects , Retrospective StudiesABSTRACT
Introducción: La efectividad y seguridad de natalizumab en pacientes con esclerosis múltiple remitente recurrente (EMRR) se demostró en ensayos clínicos. Sin embargo, por las limitaciones de estos es importante saber cómo se comporta en condiciones de práctica clínica a largo plazo.ObjetivoConocer la eficacia a largo plazo de natalizumab en pacientes con EMRR mediante la evaluación anual del no evidence of disease activity (NEDA), que incluye número de brotes, discapacidad medida con EDSS y parámetros de RM cerebral.Pacientes y métodosEstudio retrospectivo y multicéntrico (n = 3) de pacientes con EMRR tratados con una o más dosis de natalizumab. Se evaluó el estado NEDA cada año y la seguridad a partir del porcentaje de pacientes que discontinuaron y que presentaron efectos adversos.ResultadosIncluimos 89 pacientes, la mayoría recibieron tratamiento durante 2 a 4 años, con una duración del seguimiento de hasta 7 años. Natalizumab reduce significativamente la progresión radiológica y clínica de la enfermedad, así como la tasa anual de brotes, demostrándose su eficacia con el parámetro NEDA, 75,28% al primer año y 66,67% al séptimo año. Veinticinco pacientes (28,1%) han abandonado el estudio en una mediana de tiempo de 4 años, 14 pacientes (56%) por aparición de anticuerpos contra el virus JC, como causa única o asociada a otro motivo, 4 abandonos (16%) fueron por ineficacia, un paciente falleció a causa de LMP.ConclusionesNatalizumab presenta una alta eficacia medida mediante el parámetro de remisión NEDA a largo plazo. (AU)
Introduction: The safety and effectiveness of natalizumab in patients with relapsing-remitting multiple sclerosis (RRMS) has been demonstrated in clinical trials. However, due to the limitations of these trials, it is important to know how the condition behaves under long-term clinical practice conditions.ObjectiveTo determine the long-term effectiveness of natalizumab in patients with RRMS by means of annual evaluation of the no evidence of disease activity (NEDA) parameter, which includes number of relapses, disability (measured with the Expanded Disability Status Scale), and brain MRI parameters.Patients and methodsWe performed a retrospective study of patients with RRMS from 3 centres who were treated with one or more doses of natalizumab. Each year, we evaluated NEDA status and safety based on the percentage of patients who discontinued treatment with natalizumab and experienced adverse reactions.ResultsThe study included 89 patients, most of whom received treatment for 2 to 4 years, with a follow-up period of up to 7 years. Natalizumab significantly reduces the radiological and clinical progression of the disease, as well as the annual rate of relapses. The NEDA parameter demonstrates the effectiveness of the drug, with values of 75.28% for year one and 66.67% for year 7. Twenty-five patients (28.1%) dropped out after a median of 4 years. Fourteen of these patients (56%) dropped out due to the appearance of antiJC virus antibodies, either in isolation or associated with another cause. Four dropouts (16%) were due to treatment ineffectiveness, with one patient dying due to progressive multifocal leukoencephalopathy.ConclusionsNatalizumab is highly effective as measured by the NEDA long-term remission parameter. (AU)
Subject(s)
Humans , Natalizumab , Multiple Sclerosis , Patients , Leukoencephalopathies , Immunosuppressive AgentsABSTRACT
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Humans , Male , Female , Ataxia/complications , Ataxia/diagnosis , Nystagmus, Pathologic/complications , Nystagmus, Pathologic/diagnosis , Ataxia/physiopathology , Ataxia , Nystagmus, Pathologic/physiopathology , Nystagmus, Pathologic , Peripheral Nervous System Diseases/physiopathology , Peripheral Nervous System DiseasesSubject(s)
Ataxia/etiology , Central Nervous System Diseases/diagnosis , Inflammation/diagnosis , Nystagmus, Pathologic/etiology , Aged , Ataxia/diagnosis , Ataxia/pathology , Central Nervous System Diseases/complications , Central Nervous System Diseases/physiopathology , Humans , Inflammation/complications , Inflammation/physiopathology , Male , Nystagmus, Pathologic/diagnosis , Nystagmus, Pathologic/pathologyABSTRACT
INTRODUCTION: A financial estimate has been made of the costs of epilepsy in adults. METHODS: A prospective, observational study, over a period of 6 months, on epileptic patients over 14 years-old. Patients with concomitant diseases that could influence the outcome of the epilepsy were excluded. The direct costs included: treatment received, number of visits to neurology, primary care, and emergencies, number of days admitted to hospital, number and type of diagnostic tests, use of transport to and from hospital, and psychopedagogic and social support due to the epilepsy. The indirect costs were analysed according to, loss of work productivity of the patients, taking into account families where the patient needed supervision due to epilepsy. The total costs were derived from the sum of the direct and indirect costs. The intangible costs were calculated according to QOLIE-10 questionnaire. RESULTS: The mean direct cost per patient was 1,055.2 . The mean indirect financial costs came to 1,528.8 per patient. The total cost associated to epilepsy was a mean of 2,584 for each patient, mainly arising from loss of work days (p<.05). For intangible costs according to the QOLIE-10 scale a mean of 77.8 was obtained. CONCLUSIONS: The greatest percentage of costs associated to epilepsy is due to the work productivity loss by the patients. The costs of psychological and social suffering in epilepsy lead to a deterioration in the quality of life.
Subject(s)
Cost of Illness , Epilepsy/economics , Adolescent , Adult , Aged , Aged, 80 and over , Epilepsy/psychology , Hospitalization/economics , Humans , Middle Aged , Prospective Studies , Quality of Life , Surveys and Questionnaires , Young AdultABSTRACT
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Humans , Leukoencephalopathies/diagnosis , Psychomotor Agitation/etiology , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: In Parkinson's disease there are patients with isolated and multiple cognitive impairment, and their cognitive performance ranges from normal to an advanced degree of dementia. Most patients present an executive deficit, either in isolation or combined with other cognitive disorders, which is considered to be the most characteristic aspect of the disease, and 30-40% of those affected will end up with a clinically-defined dementia. DEVELOPMENT: The presence of a mild cognitive disorder in patients with Parkinson means that the risk of dementia appearing at some time during the development of the disease is high. The dementia associated with Parkinson's disease is specifically related with neuropsychiatric signs and symptoms, which may have three possible explanations: disorders affecting the mesolimbic pathways, diffuse limbic and cortical compromise, or associated Alzheimer-type phenomenology. Psychotic episodes tend to present more often in patients with dopaminergic treatment and the clinical spectrum of Parkinson-related psychosis covers visual illusions, visual-audio-olfactory hallucinations, delirium and severe paranoid hallucinatory psychosis. All the antiparkinsonian drugs can give rise to hallucinations and psychosis, but the dopamine agonists are the ones with the greatest capacity to do so. CONCLUSIONS: In managing these problems, it is crucial for prevention as well as diagnosis and treatment to be carried out as soon as they are detected. Doses of antiparkinsonian drugs must be reduced, although this is not usually enough, and so it will be necessary to associate atypical antipsychotics, which act mainly on 5-HT receptors and, in most cases, do not produce D2 blockage.
Subject(s)
Cognition Disorders/etiology , Cognition Disorders/physiopathology , Mental Disorders/etiology , Mental Disorders/physiopathology , Parkinson Disease/complications , Parkinson Disease/physiopathology , Cognition Disorders/diagnosis , Cognition Disorders/drug therapy , Dementia/diagnosis , Dementia/drug therapy , Dementia/etiology , Dementia/physiopathology , Dopamine Agonists/therapeutic use , Hallucinations/chemically induced , Humans , Mental Disorders/diagnosis , Mental Disorders/drug therapy , Parkinson Disease/drug therapy , Psychotic Disorders/diagnosis , Psychotic Disorders/drug therapy , Psychotic Disorders/etiology , Psychotic Disorders/physiopathologyABSTRACT
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Adult , Humans , Young Adult , Leukoencephalopathies/genetics , Leukoencephalopathies/pathology , Nerve Fibers, Myelinated/pathology , Eukaryotic Initiation Factor-2B/genetics , Leukoencephalopathies/diagnosis , Leukoencephalopathies/physiopathology , Magnetic Resonance Imaging , Protein Isoforms/geneticsSubject(s)
Leukoencephalopathies/genetics , Leukoencephalopathies/pathology , Nerve Fibers, Myelinated/pathology , Adult , Eukaryotic Initiation Factor-2B/genetics , Humans , Leukoencephalopathies/diagnosis , Leukoencephalopathies/physiopathology , Magnetic Resonance Imaging , Mutation , Protein Isoforms/genetics , Young AdultSubject(s)
Basilar Artery/abnormalities , Headache Disorders/etiology , Vertebrobasilar Insufficiency/complications , Vertebrobasilar Insufficiency/pathology , Aged , Basilar Artery/pathology , Diagnosis, Differential , Headache Disorders/pathology , Headache Disorders/physiopathology , Humans , Male , SyndromeABSTRACT
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Male , Aged , Humans , Basilar Artery/abnormalities , Headache/etiology , Vertebrobasilar Insufficiency/complications , Vertebrobasilar Insufficiency/pathology , Basilar Artery/pathology , Diagnosis, Differential , Headache/pathology , Headache/physiopathology , SyndromeABSTRACT
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Adult , Humans , Anticonvulsants/therapeutic use , Carbamazepine/therapeutic use , Athetosis/complications , Athetosis/drug therapy , Athetosis/physiopathology , Chorea/complications , Chorea/drug therapy , Chorea/physiopathology , Carbamazepine/pharmacokineticsABSTRACT
Recently, candidiasis infection is on the increase and several factors have been associated, such us immunodepression, catheters, weakening diseases, prolonged antibiotherapy, HIV infection and IDU. Spondylodiskitis due to Candida sp. is a rare entity. Two cases of spondylodiskitis due to Candida albicans were diagnosed: a 29 year old man and a 35 year old woman. Both were IDUs with a previous history of HIV infection. The most prominent clinical features in both cases were pain, fever and constitutional syndrome. We describe the clinical, diagnostic, and therapeutic features of both cases.
Subject(s)
Candidiasis , Discitis/microbiology , Lumbar Vertebrae , Thoracic Vertebrae , Adult , Candidiasis/complications , Female , HIV Infections/complications , Humans , MaleABSTRACT
Recientemente hemos asistido a un incremento de la infección candidiásica. Los factores predisponentes son, la inmunodepresión, los catéteres, las enfermedades debilitantes, la antibioterapia prolongada, la infecciónpor VIH y los usuarios de drogas por vía parenteral (UDVP). La espondilodiscitis debido a Candida sp.es una entidad rara. Se aportan dos casos de espondilodiscitis por Candida albicans: un varón de 29 años de edad y una mujer de 35 años. Ambos tenían antecedentes de UDVP einfección por VIH. La clínica predominante en ambos casos fue dolor, fiebre y síndrome constitucional. Presentamos las características clínicas, diagnósticas y terapéuticas de ambos casos
Recently, candidiasis infection is on the increase and several factors have been associated, such us immunodepression, catheters, weakening diseases, prolonged antibiotherapy, HIV infection and IDU. Spondylodiskitis due to Candida sp. is a rare entity. Two cases of spondylodiskitis due to Candida albicans were diagnosed: a 29 year-old man and a 35 year-old woman. Both were IDUs with a previous history of HIV infection.The most prominent clinical features in both cases were pain, fever and constitutional syndrome. We describe the clinical, diagnostic, and therapeutic features of both cases
Subject(s)
Male , Female , Adult , Humans , Discitis/microbiology , Candidiasis/microbiology , Candida albicans/pathogenicity , Infusions, Parenteral/adverse effects , Infusions, Intravenous/adverse effects , AIDS-Related Opportunistic Infections/microbiology , HIV Infections/complications , Amphotericin B/administration & dosage , Fluconazole/administration & dosage , Candidiasis/drug therapySubject(s)
Psoas Abscess/diagnosis , Staphylococcal Infections/diagnosis , Aged , Bacteremia/complications , Bacteremia/drug therapy , Bacteremia/microbiology , Cloxacillin/therapeutic use , Combined Modality Therapy , Drainage , Drug Therapy, Combination/therapeutic use , Humans , Male , Palpation , Psoas Abscess/drug therapy , Psoas Abscess/microbiology , Psoas Abscess/surgery , Staphylococcal Infections/drug therapy , Staphylococcal Infections/surgery , Teicoplanin/therapeutic use , Tomography, X-Ray ComputedABSTRACT
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Subject(s)
Male , Aged , Humans , Tomography, X-Ray Computed , Teicoplanin , Staphylococcal Infections , Psoas Abscess , Palpation , Drainage , Combined Modality Therapy , Cloxacillin , Bacteremia , Drug Therapy, CombinationABSTRACT
Currently, miliary TB has a higher incidence among the elderly and immunodepressed patients, and exceptionally in young adults. A case of miliary tuberculosis was diagnosed in a young immunocompetent patient without using invasive techniques. The clinical and diagnostic implications will be discussed.
