[Multiple sclerosis incidence in the Alcoi Health district. 12-year-long study (1986-1997)]. / Incidencia de la esclerosis múltiple en el área sanitaria de Alcoi. Estudio de 12 años (1986-1997).

INTRODUCTION: To date, epidemiological studies on multiple sclerosis in Spain have been basically prevalence studies, and the data on incidence recorded have been the result of different methodologies, with no definition of the criteria for inclusion. OBJECTIVE: To carry out a study of incidence with prospective collection/review of cases over a prolonged period of time. PATIENTS AND METHODS: Over 12 years, between 1 March 1986 and 31 December 1997, we collected data prospectively for patients with a definite diagnosis of multiple sclerosis. The year of incidence was considered to be when the patient fulfilled clinical criteria for diagnosis of the disease. RESULTS: On 31 December 1997 in the Alcoi Health District there were 54 patients with clinically defined multiple sclerosis (a prevalence of 41.28 cases per 100,000 inhabitants). Of these, 45 patients were diagnosed during the period studied, with an average incidence of 2.82 cases per 100,000 inhabitants per year. Only 15 patients were confirmed before 1986. CONCLUSIONS: This is the most prolonged study of the incidence of multiple sclerosis carried out in Spain. The figures found for incidence are in contrast to those found in previous years for prevalence and incidence. Analysis of the data suggests that the incidence of multiple sclerosis in the Alcoi district has changed and has increased since the second half of the 1980s.

[The prevalence of multiple sclerosis in the Alcoi Health district]. / Prevalencia de la esclerosis múltiple en el área sanitaria de Alcoi.

INTRODUCTION: The epidemiological studies done in Spain in recent years show higher figures for the prevalence of multiple sclerosis than before. Spain is therefore now in the area with a high risk of contracting the disease. OBJECTIVE: We have made a new study to confirm the current prevalence of the disorder in the Alcoi Health District. PATIENTS AND METHODS: Between 1 March 1986 and the prevalence day, 31 December 1997 we recorded the patients with definite or probable multiple sclerosis, as defined on Poser's criteria, after intensive fieldwork and reevaluation of all possible patients by a neurologist from the Neurology Unit. On the prevalence day there were 130,786 inhabitants in the district. RESULTS: On the prevalence day we found 54 patients with definite multiple sclerosis and no patient with probable multiple sclerosis. The rate of prevalence was 41.28 cases per 100,000 inhabitants (95% CI: 31-53.6). During the study we counted an incidence of 45 cases with an average rate of 2.82 cases per 100,000 inhabitants per year. We also describe the clinical characteristics of the patients. CONCLUSIONS: The rate of prevalence found is much higher than that described for the district in studies using similar methodology. This increase, together with the discrepancy between the incidence found and the prevalence, makes us consider that possibly the prevalence has increased in recent years.

Incidencia de la esclerosis múltiple en el área sanitaria de Alcoi. Estudio de 12 años (1986-1997) / The incidence of multiple sclerosis in the Alcoi health district. A 12 year study (1986-1997)

Introducción. Los estudios epidemiológicos sobre esclerosis múltiple en España han sido hasta la fecha estudios fundamentalmente de prevalencia, y los datos de incidencia descritos se han recogido con metodología dispar, sin precisar los criterios de inclusión.Objetivo. Realizar un estudio de incidencia con recogida prospectiva de los casos a lo largo de un período prolongado de tiempo. Pacientes y métodos. A lo largo de 12 años, desde el 1 de marzo de 1986 al 31 de diciembre de 1997, se han recogido de forma prospectiva aquellos enfermos con diagnóstico de esclerosis múltiple definida. Se ha considerado como año de incidencia aquel en el que los pacientes cumplían criterios clínicos de la enfermedad. Resultados. El 31 de diciembre de 1997 había en el área de Alcoi 54 pacientes con esclerosis múltiple clínicamente definida (prevalencia de 41,28 casos por 100.000 habitantes). De ellos, 45 pacientes fueron incidentes a lo largo del período del estudio, con una tasa media de incidencia de 2,82 casos por 100.000 habitantes y año. Únicamente 15 pacientes fueron incidentes con anterioridad a 1986. Conclusiones. Este estudio es el más prolongado de los realizados sobre la incidencia de la esclerosis múltiple en España. Las cifras de incidencia halladas contrastan con los datos de prevalencia y la incidencia de los años anteriores. El análisis de los datos sugiere que la incidencia de la esclerosis múltiple en el área de Alcoi ha variado, incrementándose desde la segunda mitad de los años 80 (AU)

Prevalencia de la esclerosis múltiple en el área sanitaria de Alcoi / The prevalence of multiple sclerosis in the Alcoi health district

Introducción. Los estudios epidemiológicos llevados a cabo los últimos años en España muestran cifras de prevalencia de la esclerosis múltiple superiores a las anteriormente descritas, y sitúan a nuestro país dentro de un área de riesgo elevado de padecer la enfermedad. Objetivo. Se ha realizado un nuevo estudio en el área sanitaria de Alcoi para comprobar la prevalencia actual de la enfermedad. Pacientes y métodos. Desde el 1 de marzo de 1986 hasta el día de prevalencia, el 31 de diciembre de 1997, se han recogido aquellos pacientes con diagnóstico de esclerosis múltiple definida o probable según los criterios de Poser, tras realizar un intensivo trabajo de campo y reevaluar a todos los posibles pacientes por un neurólogo de la Unidad de Neurología. El día de prevalencia el número de habitantes del área era 130.786. Resultados. El día de prevalencia se encontraron 54 pacientes con esclerosis múltiple definida y ningún paciente con esclerosis múltiple probable. La tasa de prevalencia fue de 41,28 casos por 100.000 habitantes (IC del 95 por ciento: 31-53,6). A lo largo del estudio se contabilizaron 45 casos incidentes con una tasa media de 2,82 casos por 100.000 habitantes y año. Se describen asimismo las características clínicas de los pacientes. Conclusiones. La tasa de prevalencia hallada es muy superior a la descrita previamente en la zona con estudios de similar metodología. Este incremento, junto a la discrepancia entre la incidencia encontrada y la prevalencia, hacen pensar en la posibilidad de un aumento de la prevalencia en los últimos años (AU)

[Clinical features of migraine according to the questionnaire 'Alcoi-92' in the Comtat area]. / Características clínicas de la migraña según el cuestionario 'Alcoi-92' en el Area del Comtat.

INTRODUCTION: Headache is one of the commonest reasons for consultation and it might be useful to know its characteristics in order to determine which patients may need medical attention. OBJECTIVES: To carry out a randomized transverse study in a rural population using the validated questionnaire 'Alcoi-92', and to determine the clinical characteristics of the headaches detected. PATIENTS AND METHODS: A door to door survey was done by randomized selection of 790 persons aged over 18 and living in the Comarca del Comtat. A validated self-questionnaire was sent and this was followed by an interview with a doctor. RESULTS: Five hundred and forty-eight persons were interviewed. The standard prevalence of migraine is 19.6% with a sex incidence of 1:2.4 and an average age of 46.1 years. The average age of onset was 20.64 years. There were family histories of cerebrovascular accidents in 26.4% and of migraine in 57.1%. There were no differences in the use of toxic substances, of socio-economic status or of marital status. The commonest pre-existing pathology was arterial hypertension. The number of episodes of headache was one to seven per year in 50% of those with migraine, with an average duration of 4-24 hours, predominantly bilateral presentation and pulsatile in character with moderate repercussion in everyday activities. The commonest associated symptoms were photophobia and sonophobia. There were prodromal symptoms in 36.9%, most commonly confusion and photopsy. CONCLUSION: The questionnaire 'Alcoi-92' has been shown to be a useful tool for definition of the clinical characteristics of migraine.

[A descriptive study of migraine in a rural population of Area del Comtat]. / Estudio descriptivo de migraña en una población rural del àrea del comtat.

INTRODUCTION: Headache is one of the commonest causes of consultation in neurology. There are many studies of the prevalence of migraine showing considerable variation in the results obtained. OBJECTIVES: To find the prevalence of migraine, with and without an aura, by means of a randomized transverse study carried out in a previously selected rural population, using the validated questionnaire 'Alcoi-92'. To find the overall prevalence of migraine, specifically regarding age and sex and adjusted for the European population. PATIENTS AND METHODS: A door-to-door study was made by random selection of 790 persons aged over 18, in three towns in the comarca del Comtat, Alacant, Spain. A self-questionnaire was sent to all persons studies and subsequently they were seen by a medical interviewer. RESULTS: We interviewed 548 persons (overall response rate 78%). The average age was 52.5 +/- 19.3 years. Sex distribution of the population interviewed showed a predominance of females (52.9%) as compared to males (47.1%). According to the type of headache: other types of headache 62.32%, persons with no previous history of headache 20.07%, amplified migraine 16.6%, typical migraine 12.6%, cluster type migraine 0.18%. CONCLUSIONS: The overall prevalence of amplified migraine was 16.6%. According to diagnostic groups the frequency of migraine with aura was 2.9%, migraine without aura 9.7% and typical migraine 12.6%. A predominance of women was seen in all types of migraine. The frequency of migraine, adjusted for the European population was 19.6%. Prevalence during the past year, as a measure of activity of the disorder was 15.7%.

[Daily defined doses of parkinsonian drugs in Alcoi]. / Dosis diarias definidas de fármacos antiparkinsonianos en Alcoi.

BACKGROUND: Some authors have suggested that the use of DDD (defined daily doses) of L-dopa may be useful as an indicator of the frequency of Parkinson's disease. AIM: To determine the measurement for L-dopa and selegiline in Alcoi. MATERIAL AND METHODS: We have obtained the intakes for L-dopa and selegiline between January and December, 1990 and we have calculated the DDD/1,000 inhab/day. RESULTS: During the study period, we have found that the mean intakes were 18,000.969 mg and 53,800 mg for L-dopa and selegiline, respectively. And so, the L-dopa intake in Alcoi was 0.60 DDD/ 1,000 inh, and the selegiline intake was 0.21 DDD/1,000 inh. DISCUSSION: Comparing the other data of the literature, specially in scandinavian countries, the obtained intake for L-dopa was low, and that could indicate that the frequency of the disease in Alcoi was lower.

[Hormonal markers of stress in acute cerebrovascular pathology]. / Marcadores hormonales de estrés en la patología vascular cerebral aguda.

Various studies carried out over the last decade have shown that high glucose levels in the blood foster ischaemic brain damage associated with a worse evolution of such pathologies. The aim of the study we performed was to try to shed some light on whether stress in these patients raised their glucose levels adding to a worsening of the patient's clinical picture. We studied 318 consecutive patients suffering from stroke. We determined fasting glucose levels, prolactin and cortisol within the first few hours of hospitalization and afterwards at seven to ten days and again at one month after the stroke. Clinical severity was evaluated using Toronto and Mathew neurological scales and the degree of incapacity was measured using the Barthel functional scale on the three aforementioned occasions and Rankin's modified scale six and twelve months after the stroke. Clinical severity the first hours after stroke was significantly related to glucose levels, such relationship not being observed with prolactin and cortisol. Nor did we observe any significant association between glucose and these hormones. Likewise the anxiety scale had no relationship with any hormone. Studying medium and long term functional incapacity, glucose significantly correlated with the Rankin scale although with low dependence, such a relationship not being found either with prolactin or cortisol. Our work would seem to indicate that blood glucose behaviour is independent of prolactin and cortisol levels since we found no such relationship between them.

[Profile of the migrainous patients according to drug intakes]. / Perfil de los pacientes migrañosos según el consumo de fármacos habituales.

Migraine headache is a common, recurrent and often incapacitating disorder resulting in a substantial loss of work days and productivity, significant consumption of medicines, and considerable economic cost. We performed this study in order to determine the characteristic features of migrainous patients with regular or frequent intake of ergotamine preparations and non steroidal anti-inflammatory drugs (NSAIDs) and the existence of significant differences between both groups. 186 patients were included in the study, 36.6% suffering from migraine without aura and 63.4% from migraine with aura. 24.7% were males and 75.3% females. Mean age of the sample was 35.6 +/- 12.9 years. With regard to medication used for immediate relief of headache, 74.7% patients reported an intake of analgesics and 25.3% ergotamine preparations. In patients with analgesic intake the mean age was significantly lower than in patients with ergotamine for treatment of migraine. When clinic features of these two headache groups were examined, the duration of migraine attacks in the analgesic group was significantly higher (p = 0.0014) than in the ergotamine group, and the severity of migraine was lower (p < 0.05) than in this group. Among associated symptoms, nausea and vomiting were significantly less frequent (p = 0.024) in the analgesic group than in the group of patients with ergotamine intake.

[Epidemiology of migraine]. / Epidemiología de la migraña.

Knowing the epidemiology of migraine is important for a host of reasons. Migraine is one of the most prevalent types of headache. In addition, it constitutes a pathology which due to its cyclic, recurring and highly incapacitating characteristics has enormous repercussions on the quality of life of those affected; it is responsible for the loss of an important number of working days and of production; responsible too for the vast consumption of medicaments and consequently represents a considerable economic cost. An epidemiological study, however, of its pathology poses countless difficulties owing to its characteristics and its association with risk factors. In this present work we review the obstacles to carrying out migraine epidemiological studies and we also comment upon many such studies found in the literature. In each section we present the data obtained in such studies as were performed by our working group.

[Factors brought on by migraine]. / Los factores precipitantes de la migraña.

Migraine is a paroxysmic abnormality in which asymtomatic periods alternate with the appearance of attacks. Such attacks are the end result of a chain of events leading on to the acute clinical syndrome. Amongst those phenomena which occur in the days prior to the attack starting, the factors which bring such attacks on have been widely studied by a great number of researchers. Identifying these initiating factors is a fundamental preventive element and looking into the behavioural mechanisms of such factors could prove useful in clarifying the pathogenic mechanisms of migraine. In the present study we review most of the works which have sought to identify these factors concerning the development of attacks and to work out their behavioural patterns.

[Stress as a precipitating factor in migraine]. / El estrés como factor precipitante de la migraña.

Stress is the precipitating factor in migraine which is most commonly recognized by patients. There are many affected who describe headaches brought on by stressful situations and events, although they also speak of the onset of their attacks during the period of calm immediately after such moments of stress. There are however few objective works in the literature which study the relationship between stress and migraine. In the present work we review that literature which does exist concerning such a relationship.

[A comparative study of mortality and infectious complications in patients admitted to neurological and general wards]. / Estudio comparativo de mortalidad y complicaciones infecciosas entre pacientes ingresados en Neurología y periféricos.

We analyse the outcome of patients with cerebral infarction depending the admission in neurological department or in general wards. We find an improvement of the changes in Toronto, Mathew and Barthel scales and a reduction in the mortality in patients admitted in Neurological department. The improvement is related with a reduction in infectious complications observed in the Neurological ward. Our data suggest that the place of the patient admission in the hospital may influence the prognosis of stroke patients and should be consider in patients with cerebrovascular disease.

[Descriptive epidemiology of transitory ischemic attack: a study in Muro d'Alcoi]. / Epidemiología descriptiva del accidente isquémico transitorio: estudio en Muro d'Alcoi.

A door-to-door survey of transient ischemic attack was conducted in Muro de Alcoi using a randomized sample. We randomly choose 646 people of the 4.525 included in the census. The prevalence ratio found for TIA and stroke were 12.3 per 1,000 people (95% CI 3.9-20.7). The age-specific prevalence rates for male and for women were 12.4 per 1,000 (95% CI 0.3-24.5) and 12.3 per 1,000 (95% CI 0.4-24.2) respectively. The work suggests that methodology of ascertainment strongly influences in the obtained rates, and reinforces the data of our previous whole population work in the same area.

[Descriptive epidemiology of risk factors in cerebrovascular disorders:a study in Muro d'Alcoi]. / Epidemiología descriptiva de los factores de riesgo cerebrovasculares: el estudio en Muro d'Alcoi.

We evaluated cerebrovascular risk factors and the values of cholesterol and triglicerides in the survey in Muro d'Alcoi using a door-to-door randomised interview. We found 14.9% hypertensives, 5.5% persons with diabetes, 1.2% with heart diseases and 42.1 persons with tabaccoism into the 646 persons evaluated. The Serum Cholesterol levels were high and we observed that 62% of males and 63.8% of females had values higher than 200 mg/dl. Our study showed that 24.8% of males and 12% of females presented values of triglicerides higher than 150 mg/dl. The data of risk factors were comparable with the findings described in Beniarres, Lorcha and Planes, located in the same healthy area.

[Comparative study of nicardipine versus placebo in the prevention of cognitive deterioration in patients with transient ischemic attack]. / Estudio comparativo de nicardipina frente a placebo en la prevención del deterioro cognitivo en los pacientes con accidentes isquémicos transitorios.

The neuropsychological follow up of transient ischemic attacks can provide a model for evaluating the efficiency of a drug in vascular dementia. A double blind study has been conducted using nicardipine, a calcium-antagonist, as opposed to a placebo in 40 patients with transient ischemic attacks, over a six month period. The patients were evaluated according to a Wechsler's intelligence scale, and their memory was also tested before and after this period. Although no alterations were registered on either scale, some differences did appear in certain sub-tests, especially as regards the verbal coefficient. This pilot study has provided information concerning the possible beneficial effect of the drug, which should be proven by means of a larger-scale study.

Occurrence of transient ischemic attacks in Alcoi: descriptive epidemiology.

A door-to-door survey of transient ischemic attack (TIA) and stroke was conducted in 3 towns of the Alcoi health area. The prevalence ratios found for TIA and stroke were 13/1,000 people (95% CI 8.8-17.9) and 21.5/1,000 (95% CI 15.8-27.2), respectively. The crude incidence rates for both TIA and stroke were 2.8/1,000 (95% CI 0.7-4.9). Methodological differences in the ascertainment of the cases may explain the variations in the rates between the present work and other studies in the literature.