Impact of a specific consultation for patients with progressive forms of multiple sclerosis on the response to their unmet care needs: a cross-sectional study.

BACKGROUND: As their disease evolves, most patients with progressive forms of multiple sclerosis (MS) develop particular healthcare needs that are not always addressed with usual follow-up. To adapt neurological care to these patients, we created a specific consultation for patients with progressive MS in our centre in 2019. OBJECTIVES: To explore the main unmet care needs of patients with progressive MS in our setting, and to establish the usefulness of the specific consultation to address them. METHODS: Literature review and interviews with patients and healthcare professionals were conducted to identify the main unmet needs in routine follow-up. Two questionnaires were developed, assessing the importance of the unmet needs identified and the usefulness of the consultation to meet them, for patients under follow-up in the specific consultation and their informal caregivers. RESULTS: Forty-one patients and nineteen informal caregivers participated. The most important unmet needs were the information about the disease, access to social services and coordination between specialists. A positive correlation was found between the importance of these unmet needs and the responsiveness to each of them in the specific consultation. CONCLUSIONS: The creation of a specific consultation may improve attention to the healthcare needs of patients with progressive MS.

Classification of radiologically isolated syndrome and clinically isolated syndrome with machine-learning techniques.

BACKGROUND AND PURPOSE: The unanticipated detection by magnetic resonance imaging (MRI) in the brain of asymptomatic subjects of white matter lesions suggestive of multiple sclerosis (MS) has been named radiologically isolated syndrome (RIS). As the difference between early MS [i.e. clinically isolated syndrome (CIS)] and RIS is the occurrence of a clinical event, it is logical to improve detection of the subclinical form without interfering with MRI as there are radiological diagnostic criteria for that. Our objective was to use machine-learning classification methods to identify morphometric measures that help to discriminate patients with RIS from those with CIS. METHODS: We used a multimodal 3-T MRI approach by combining MRI biomarkers (cortical thickness, cortical and subcortical grey matter volume, and white matter integrity) of a cohort of 17 patients with RIS and 17 patients with CIS for single-subject level classification. RESULTS: The best proposed models to predict the diagnosis of CIS and RIS were based on the Naive Bayes, Bagging and Multilayer Perceptron classifiers using only three features: the left rostral middle frontal gyrus volume and the fractional anisotropy values in the right amygdala and right lingual gyrus. The Naive Bayes obtained the highest accuracy [overall classification, 0.765; area under the receiver operating characteristic (AUROC), 0.782]. CONCLUSIONS: A machine-learning approach applied to multimodal MRI data may differentiate between the earliest clinical expressions of MS (CIS and RIS) with an accuracy of 78%.

Paresia del VI par tras anestesia epidural. Réplica / Paralysis of VI cranial pair after epidural anaesthesia. Reply

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Enfermedad de Whipple: Múltiples recaídas sistémicas y neurológicas. Réplica / Whipple's Disease: Multiple systemic and neurological relapses. Reply

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Temblor ortostático: una entidad enigmática / Orthostatic tremor: an enigmatic condition

Introducción. El temblor ortostático es un tipo de temblor poco frecuente que se caracteriza clínicamente por sensación de inestabilidad o caída inminente al adoptar la bipedestación, que desaparece o mejora al caminar, y está ausente en sedestación o con el decúbito. Objetivo. Elucidar las principales características de este síndrome tremórico. Desarrollo. En primer lugar, se define su espectro clínico, enfatizando aquellas características clave que nos permiten realizar una aproximación sindrómica inicial. Posteriormente, se describen las principales características neurofisiológicas que configuran el perfil electromiográfico propio del temblor ortostático. Finalmente, se abordan las hipótesis fisiopatológicas en relación con la génesis de este tipo de temblor y se describen las opciones terapéuticas disponibles en la actualidad. Conclusiones. La convergencia de todos los datos revisados proporciona un análisis crítico y completo de este enigmático trastorno motor, permitiendo un enfoque riguroso de sus principales características, facilitando su reconocimiento clínico y un adecuado manejo terapéutico (AU)

Introduction. Orthostatic tremor is a rare kind of tremor which is clinically characterised by a feeling of instability or being about to fall that is experienced on standing up, which disappears or improves on walking and is absent when sitting or lying down. Aim. To shed light on the main features of this tremor syndrome. Development. First, its clinical spectrum is defined, with emphasis on the key characteristics that enable us to make an initial approximation to its syndromes. Then the main neurophysiological features that make up the electromyographicprofile of orthostatic tremor are described. Finally, the pathophysiological hypotheses regarding the genesis of this kind of tremor are addressed and the therapeutic options currently available are described. Conclusions. The convergence of all the data reviewed provides a complete, critical analysis of this enigmatic motor disorder, thus allowing a rigorous approach to its main characteristics, which makes both its clinical recognition and its therapeutic management easier (AU)

[Orthostatic tremor: an enigmatic condition]. / Temblor ortostatico: una entidad enigmatica.

INTRODUCTION: Orthostatic tremor is a rare kind of tremor which is clinically characterised by a feeling of instability or being about to fall that is experienced on standing up, which disappears or improves on walking and is absent when sitting or lying down. AIM: To shed light on the main features of this tremor syndrome. DEVELOPMENT: First, its clinical spectrum is defined, with emphasis on the key characteristics that enable us to make an initial approximation to its syndromes. Then the main neurophysiological features that make up the electromyographic profile of orthostatic tremor are described. Finally, the pathophysiological hypotheses regarding the genesis of this kind of tremor are addressed and the therapeutic options currently available are described. CONCLUSIONS: The convergence of all the data reviewed provides a complete, critical analysis of this enigmatic motor disorder, thus allowing a rigorous approach to its main characteristics, which makes both its clinical recognition and its therapeutic management easier.

Carta en relación con el artículo «Importancia del estudio electromiográfico en el diagnóstico del temblor ortostático» / Letter with reference to the article «Importance of electromyographic studies in the diagnosis of orthostatic tremor»

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Síndrome POEMS y mieloma osteoesclerótico / POEMS syndrome and osteosclerotic myeloma

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Síndrome de hipotensión intracraneal: revisión de hallazgos en resonancia magnética / Intracranial hypotension syndrome: a review of the magnetic resonance findings

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