Perampanel effectiveness and safety as early add-on treatment for focal-onset seizures: PEREAGAL study.

BACKGROUND: Perampanel (PER) is an effective adjunctive therapy for controlling focal-onset seizures (FOS), but few studies have examined its effects as an early add-on for the treatment of FOS in daily clinical practice. METHODS: Our retrospective, multicenter, observational study evaluated the effectiveness and safety of PER as an early add-on in 77 patients with FOS, with and without focal to bilateral tonic-clonic seizures (FBTCS) after 3, 6 and 12 months in a real-world setting. RESULTS: After 12 months of treatment (median dose 6 [4,8] mg/day), the retention rate was 79.2 % and 60 % of patients (39/65) experienced a ≥50 % reduction in seizure frequency relative to baseline. The seizure-free rate was 38.5 % for all seizures (25/65) and 60 % for FBTCS (12/20). The responder rate at 12 months was significantly higher when PER was given with one concomitant AED (72.2 %) compared to when PER was given with two concomitant AEDs (44.8 %). Drug-related adverse events (AEs) were reported in 40.3 % of patients, most of them being mild (64.2 %). Twelve patients (15.6 %) discontinued treatment because of AEs. CONCLUSIONS: PER is an effective and safe early add-on for patients with refractory FOS, especially for those with FBTCS.

Estudios neurofisiológicos en los parkinsonismos / Neurophysiological studies in parkinsonism

Introducción. El estudio del sistema motor y de sus trastornos ha sido un tema importante para la neurofisiología, siendo uno de sus objetivos intentar comprender los mecanismos fisiopatológicos que subyacen a las disfunciones del mismo. Desarrollo: Se revisa lo más relevante acerca de: (1) Técnicas neurofisiológicas utilizadas en el diagnóstico de la EP y otros parkinsonismos; (2) Utilidad de la estimulación magnética transcraneal (EMT); (3) Estudios neurofisiológicos de los trastornos del sueño en la EP; (4) Aspectos neurofisiológicos de la estimulación cerebral profunda (ECP). Conclusiones: Las pruebas neurofisiológicas puede ayudar en el diagnóstico diferencial del parkinsonismo además de profundizar en la fisiopatología de los síntomas y signos parkinsonianos. Diferentes técnicas pueden emplearse en el estudio de los trastornos del sueño en la EP. La EMT resulta útil tanto desde el punto de vista diagnóstico como probablemente también terapéutico en la EP. Actualmente, los registros con microelectrodos constituyen la forma más precisa de poder identificar la diana seleccionada en la cirugía de la EP (AU)

Introduction. The study of motor system and its diseases has been an interesting topic for neurophysiology, being one of the objectives of this to know the physiopathology mechanisms. Development. We review the most relevant about: (1) Neurophysiological techniques used in the diagnosis of Parkinson's disease (PD) and other parkinsonisms; (2) Utility of transcranial magnetic stimulation (TMS); (3) Neurophysiological techniques used in the diagnosis of sleep disorders in PD patients; (4) Neurophysiological aspects of deep brain stimulation (DBS). Conclusions. Different neurophysiological techniques can be used for differential diagnosis of PD and others parkinsonisms besides to investigate in the physiopathology mechanisms. We can use different techniques for study sleep disorders in PD patients. TMS results to be utility for diagnosis and probably such as therapy in PD patients. Actually, microelectrode recording could be the best method for target identification in DBS surgery (AU)

[Sensory symptoms in Parkinson's disease]. / Síntomas sensoriales en la enfermedad de Parkinson.

INTRODUCTION: In addition to the motor disturbances experienced by the patients suffering from Parkinson's disease (PD), several non-motor symptoms also affect the PD patients: neurobehavior symptoms (dementia, depression, anxiety, psychosis), autonomic (postural hypotension, urinary symptoms, gastro intestinal symptoms, diaphoresis), sleep disorders (insomnia, somnolence, REM sleep behavior disorder, apnea), sensitive-motor (fatigue, diplopia, restless legs syndrome), and sensory symptoms. DEVELOPMENT: We review the most relevant about sensory symptoms in PD: visual dysfunction, olfactory dysfunction, taste, hearing loss, and pain and other sensitive associate symptoms. CONCLUSIONS: Pain is frequently observed in patients with PD, being its prevalence high and probably infra diagnosed. Its identification and classification is very important for a correct treatment. Hyposmia is a common symptom in PD and could be a predictor of future PD. Visual dysfunction and hearing dysfunction among others must be considered in patients with PD.

[Restless legs syndrome]. / Síndrome de las piernas inquietas.

INTRODUCTION: Restless legs syndrome (RLS) is a movement disorder with a neurological origin that manifests in the form of sensory-motor symptoms which are located mainly in the lower limbs. DEVELOPMENT: We review the epidemiological, pathophysiological, clinical and therapeutic characteristics of this disease, with special emphasis on the diagnostic criteria. CONCLUSIONS: Diagnosis of RLS is mainly clinical and is based on the criteria established by the National Institutes of Health consensus development conference in 2002. There are specific criteria for special groups (the elderly with cognitive impairment and children) in which it is not possible to determine whether RLS exists or not using the usual diagnostic criteria.

Síndrome de las piernas inquietas / Restless legs syndrome

Resumen. Introducción. El síndrome de piernas inquietas (SPI) es un trastorno del movimiento de origen neurológico, que se manifiesta por clínica sensitivomotora localizada principalmente en las extremidades inferiores. Desarrollo. Se revisan las características epidemiológicas, fisiopatológicas clínicas y terapéuticas de esta enfermedad, y se hace un especial énfasis en los criterios diagnósticos. Conclusiones. El diagnóstico del SPI es eminentemente clínico y se basa en los criterios de la conferencia de consenso de los National Institutes of Health de 2002. Existen criterios específicos para grupos especiales (ancianos con deterioro cognitivo y niños) en los cuales no es posible determinar si existe SPI mediante los criterios diagnósticos habituales (AU)

Summary. Introduction. Restless legs syndrome (RLS) is a movement disorder with a neurological origin that manifests in the form of sensory-motor symptoms which are located mainly in the lower limbs. Development. We review the epidemiological, pathophysiological, clinical and therapeutic characteristics of this disease, with special emphasis on the diagnostic criteria. Conclusions. Diagnosis of RLS is mainly clinical and is based on the criteria established by the National Institutes of Health consensus development conference in 2002. There are specific criteria for special groups (the elderly with cognitive impairment and children) in which it is not possible to determine whether RLS exists or not using the usual diagnostic criteria (AU)

Oxcarbacepina en el tratamiento de la coreoatetosis paroxística cinesigénica / Oxcarbacepine in the treatment of kinesigenic paroxysmal choreoathetosis

No disponible

No disponible

[Seasonal variations in the outbreaks in patients with multiple sclerosis]. / Variaciones estacionales de los brotes en pacientes con esclerosis múltiple.

INTRODUCTION: It has been suggested that there is an environmental factor at play in the aetiology and pathogenesis of multiple sclerosis (MS) that acts as an essential component of the disease process, and a number of studies also point to a relationship between the seasons of the year and the appearance of outbreaks. AIMS: Our aim was to study the possible relation between seasonal variations and the appearance of outbreaks in patients with relapsing-remitting forms of MS. PATIENTS AND METHODS: We studied 31 patients over the period between 1997 and 2002 and calculated the monthly and quarterly rate of incidence of outbreaks. The statistical evaluation of the results was performed by applying the Chi-squared test. RESULTS: We observed a higher incidence of outbreaks in the summer months (more in June) and a lower incidence in winter (less in December), with statistically significant differences. CONCLUSIONS: In our patients, outbreaks of MS are related to seasonal variations, with a higher number in the warmer months and fewer in the colder months.

Variaciones estacionales de los brotes en pacientes con esclerosis múltiple / Seasonal variations in the outbreaks in patients with multiple sclerosis

Introducción. En la etiología y la patogenia de la esclerosis múltiple (EM) se ha sugerido un factor ambiental como componente esencial del proceso de la enfermedad, y diversos estudios sugieren además una relación entre las estaciones del año y la aparición de brotes. Objetivo. Estudiar la posible relación entre las variaciones estacionales y la aparición de brotes en pacientes con formas remitentes-recurrentes de EM. Pacientes y métodos. Estudiamos 31 pacientes durante el período comprendido entre 1997 y 2002 y calculamos la tasa de incidencia mensual y trimestral de los brotes. La evaluación estadística de los resultados se realizó aplicando el test de Chi-cuadrado . Resultados. Observamos una mayor incidencia de brotes en los meses de verano (más en junio) y una menor incidencia en invierno (menos en diciembre), con diferencias estadísticamente significativas. Conclusiones. En nuestros pacientes existe una relación estacional de los brotes de la EM, con un número mayor en los meses cálidos y menor en los meses fríos

Introduction. It has been suggested that there is an environmental factor at play in the aetiology and pathogenesis of multiple sclerosis (MS) that acts as an essential component of the disease process, and a number of studies also point to a relationship between the seasons of the year and the appearance of outbreaks. Aims. Our aim was to study the possible relation between seasonal variations and the appearance of outbreaks in patients with relapsing-remitting forms of MS. Patients and methods. We studied 31 patients over the period between 1997 and 2002 and calculated the monthly and quarterly rate of incidence of outbreaks. The statistical evaluation of the results was performed by applying the Chi-squared test. Results. We observed a higher incidence of outbreaks in the summer months (more in June) and a lower incidence in winter (less in December), with statistically significant differences. Conclusions. In our patients, outbreaks of MS are related to seasonal variations, with a higher number in the warmer months and fewer in the colder months

[Cerebral atrophy in multiple sclerosis patients treated periodically with boluses of methylprednisolone]. / Atrofia cerebral en pacientes con esclerosis múltiple tratados con bolos periódicos de metilprednisolona.

INTRODUCTION: In the last years advances in the treatment of the remittant and secondary progressive forms of the multiple sclerosis (MS) have taken place. In the primary progressive forms (PP) the side effects of potentially useful drugs prevent their use; in some studies an improvement of the evolution with the intravenous administration of periodic pulses of methylprednisolone (MP) has been observed. OBJECTIVE: To evaluate if periodic pulses of intravenous MP injected every 4-6 weeks increase the degree of cerebral atrophy of the patients with PP MS. PATIENTS AND METHODS: We studied 11 patients with PP MS treated during 33 months with periodic pulses of intravenous MP. The degree of cerebral atrophy was evaluated in axial cuts of 10 mm of studies of magnetic resonance with the indices of Evans, bicaudate, bifrontal, frontal spears and bithalamic. The statistical evaluation of the results was made applying the test of Wilcoxon-Mann-Whitney. RESULTS: There are not statistically significant differences in the degree of cerebral atrophy with any of the used indices. CONCLUSIONS: Periodic pulses of intravenous MP do not accelerate the cerebral atrophy in patients with progressive forms of multiple sclerosis.

Atrofia cerebral en pacientes con esclerosis múltiple tratados con bolos periódicos de metilprednisolona / Cerebral strophy in multiple sclerosis patients treated periodically with boluses of methylprednisolone

Introducción. En los últimos años se han producido avances en el tratamiento de las formas remitentes y secundariamente progresivas de la esclerosis múltiple (EM). En las formas primariamente progresivas (PP) los fármacos potencialmente útiles causan efectos secundarios que impiden su utilización; en algunos estudios se ha observado una mejoría de la evolución con la administración intravenosa de pulsos periódicos de metilprednisolona (MP). Objetivos. Ave riguar si los bolos periódicos intravenosos de MP administrados cada 4-6 semanas aumentan el grado de atrofia cerebral de los pacientes con formas PP de la EM. Pacientes y métodos. Estudiamos 11 pacientes con EM clínicamente definida como PP, tratados durante 33 meses con bolos periódicos intravenosos de MP. El grado de atrofia cerebral se evaluó en cortes axiales de 10 mm de estudios de resonancia magnética con los índices de Evans, bicaudado, bifrontal, de astas frontales y bitalámico. La evaluación estadística de los resultados se realizó con el test de Wilcoxon-Mann-Whitney. Resultados. No observamos diferencias estadísticamente significativas en el grado de atrofia cerebral con ninguno de los índices empleados. Conclusiones. Los bolos periódicos intravenosos de MP no aceleran la atrofia cerebral en pacientes con formas progresivas de EM (AU)

Introduction. In the last years advances in the treatment of the remitent and secondary progressive forms of the multiple sclerosis (MS) have taken place. In the primary progressive forms (PP) the side effects of potentially useful drugs prevent their use; in some studies an improvement of the evolution with the intravenous administration of periodic pulses of methylprednisolone (MP) has been observed. Objective. To evaluate if periodic pulses of intravenous MP injected every 4-6 weeks increase the degree of cerebral atrophy of the patients with PP MS. Patients and methods. We studied 11 patients with PP MS treated during 33 months with periodic pulses of intravenous MP. The degree of cerebral atrophy was evaluated in axial cuts of 10 mm of studies of magnetic resonance with the indices of Evans, bicaudate, bifrontal, frontal spears and bithalamic. The statistical evaluation of the results was made applying the test of Wilcoxon-Mann-Whitney. Results. There are not statistically significant differences in the degree of cerebral atrophy with any of the used indices. Conclusions. Periodic pulses of intravenous MP do not accelerate the cerebral atrophy in patients with progressive forms of multiple sclerosis (AU)