Vínculos existentes entre cefalea y epilepsia: terminología y conceptos actuales / No disponible

Introducción y objetivos: Cefalea (especialmente la migraña) y epilepsia son entidades con elevada comorbilidad que pueden confundirse desde el punto de vista clínico. Existe una relación bidireccional entre ambas, conocida desde hace siglos, pero aún no bien comprendida. Describimos las distintas modalidades de asociación existentes entre ellas, los mecanismos fisiopatológicos y genéticos subyacentes y los tratamientos recomendados. Método: Hemos revisado las publicaciones más relevantes sobre la asociación entre migraña/cefalea y epilepsia utilizando la base de datos de PubMed. Descripción: En un mismo individuo, la epilepsia puede coexistir con algún tipo de cefalea (sobre todo migraña) por azar o a través de una etiología subyacente común. En ambos casos, los ataques de una y otra se presentan en diferentes momentos temporales («cefalea interictal»). Cuando la cefalea es parte de la propia crisis, estamos ante una hemicránea epiléptica o ante una cefalea epiléptica ictal. La cefalea que aparece tras la crisis, define una cefalea post-ictal. La cefalea que la precede se denomina cefalea preictal. Un tipo especial de esta última es la migralepsia, término que hace referencia a las crisis que aparecen durante o poco después del aura migrañosa. Conclusiones: La terminología y los conceptos que definen las posibles asociaciones entre cefalea/ migraña y epilepsia han ido evolucionando a lo largo del tiempo, en virtud del mayor conocimiento clínico y fisiopatogénico. Se ha propuesto suprimir el término de migralepsia y utilizar de forma restringida y uniforme los términos cefalea epiléptica ictal y hemicránea epiléptica en todos los sistemas de clasificación

Introduction and objectives: Headaches (including migraines) and epilepsy have a high level of comorbidity and may be confused during diagnosis. Although physicians have known for centuries that these two conditions are somehow linked, their relationship remains poorly understood. Herein we describe the known associations between them, their underlying physiopathologic and genetic mechanisms, and the treatments recommended for them. Method: We have reviewed the most relevant publication of headache/migraine and epilepsy by using the PubMed data base. Description: An individual can suffer both from headaches (either migraine and/or other type of headache) and epilepsy, either by chance or because of a common underlying pathology. In these cases, the headache usually occurs at a different moment than the seizure (‘‘interictal headache’’). However, headaches sometimes occur simultaneously with, or very close in time to, the seizure: one that occurs at the same time as an epileptic seizure is known as an "ictal epileptic headache" or as ‘"hemicrania epileptica"; one that precedes a seizure is known as a "pre-ictal headache"; and one that follows a seizure is known as a "post-ictal headache". There is a particular type of pre-ictal headache, known as "migralepsy", which occurs during or just after a migraine aura. Conclusions: The terminology and concepts employed to describe possible associations betweenheadaches (mainly migraines) and epilepsy have evolved over time with increasing clinical and physiopathogenic knowledge. Some researchers have suggested eliminating the term migralepsy and using the terms ictal epileptic headache and hemicrania epileptica exclusively and uniformly in all classification systems

Links between headaches and epilepsy: current knowledge and terminology.

INTRODUCTION AND OBJECTIVES: Headaches (including migraines) and epilepsy have a high level of comorbidity and may be confused during diagnosis. Although physicians have known for centuries that these two conditions are somehow linked, their relationship remains poorly understood. Herein we describe the known associations between them, their underlying physiopathologic and genetic mechanisms, and the treatments recommended for them. METHOD: We have reviewed the most relevant publication of headache/migraine and epilepsy by using the PubMed data base. DESCRIPTION: An individual can suffer both from headaches (either migraine and/or other type of headache) and epilepsy, either by chance or because of a common underlying pathology. In these cases, the headache usually occurs at a different moment than the seizure ("interictal headache"). However, headaches sometimes occur simultaneously with, or very close in time to, the seizure: one that occurs at the same time as an epileptic seizure is known as an "ictal epileptic headache" or as "hemicrania epileptica"; one that precedes a seizure is known as a "pre-ictal headache"; and one that follows a seizure is known as a "post-ictal headache". There is a particular type of pre-ictal headache, known as "migralepsy", which occurs during or just after a migraine aura. CONCLUSIONS: The terminology and concepts employed to describe possible associations between headaches (mainly migraines) and epilepsy have evolved over time with increasing clinical and physiopathogenic knowledge. Some researchers have suggested eliminating the term migralepsy and using the terms ictal epileptic headache and hemicrania epileptica exclusively and uniformly in all classification systems.

Complicaciones de la estimulación cerebral profunda en la enfermedad de Parkinson / Complications of deep brain stimulation in Parkinson's disease

Introduccion. La estimulación cerebral profunda (ECP) es un tratamiento muy efectivo para las complicaciones motoras de la enfermedad de Parkinson (EP) avanzada, pero como todo procedimiento neuroquirúrgico intracerebral no está libre de complicaciones. Objetivo. Revisión bibliográfica sobre las complicaciones de la ECP en la EP. Desarrollo. Las complicaciones de la ECP ocurren en todas las etapas del procedimiento: antes, durante y después de la cirugía (en el postoperatorio inmediato y remoto). En la precirugía el aspecto más importante es la selección del candidato apropiado, no solo referido a beneficio sintomático, sino también en cuanto a conocer su estado cognitivo y comorbilidades. Durante la cirugía la complicación más grave y temida es la hemorragia cerebral. En el postoperatorio las complicaciones pueden relacionarse con la intervención (por ejemplo, síndrome confusional en el postoperatorio inmediato), con la estimulación (contracciones musculares tónicas, desviación ocular, midriasis, hipersudoración hemicorporal, empeoramiento de la acinesia, alteraciones de determinadas áreas cognitivas o conductuales), con el sistema implantado (rotura de electrodos, desconexión, desplazamientos, infecciones), con cambios en la medicación (por ejemplo, depresión) o con cambios en la funcionalidad y otras de origen desconocido (como aumento de peso). Conclusion. La ECP mejora la discapacidad y la calidad de vida de la EP avanzada, pero conlleva complicaciones o efectos adversos. Conocer estas complicaciones contribuye a minimizarlas y al perfeccionamiento de la técnica (AU)

Introduction. Deep brain stimulation (DBS) is a very effective treatment for the motor complications that appear in advanced Parkinson's disease (PD), but like all intracerebral neurochemical procedures it is not free of complications. Aims. The purpose of this work is to carry out a review of the literature on the complications of DBS in PD. Development. The complications of DBS occur in all the different stages of the procedure, that it to say, before, during and after the intervention (in the immediate and remote post-operative period). The most important aspect before the operation is to ensure an appropriate candidate is selected, not only with regard to the symptomatic benefits, but also in terms of knowing his or her cognitive status and comorbidities. During the surgical intervention the most severe and feared complication is a brain haemorrhage. In the post-operative period, complications can be related with the intervention (for example, confusional syndrome in the immediate post-operative period), with the stimulation (tonic muscular contractions, eye deviation, mydriasis, hyperhidrosis in half of the body, exacerbation of the akinesia, alterations of certain cognitive or behavioural areas), with the system implemented (breakage of electrodes, disconnection, movements, infections), with changes in the medication (for example, depression) or with changes in functionality, as well as others of an unknown origin (such as an increase in weight). Conclusions. DBS improves disability and the quality of life in advanced PD, but entails complications or side (AU)

[Nonmotor symptoms in Parkinson's disease and deep brain stimulation]. / Síntomas no motores en la enfermedad de Parkinson y estimulación cerebral profunda.

INTRODUCTION: The efficacy of deep brain stimulation (DBS) for the motor symptoms of advanced Parkinson's disease (PD) is well established. However, the effects of DBS on nonmotor symptoms (NMS) are less clear. AIM: To review the published literature on nonmotor aspects of DBS for PD. DEVELOPMENT: The outcome of NMS after DBS in PD varies across studies. Some symptoms improve -sleep disorders, pain or sensory complaints, obsessive-compulsive disorder- and other aspects decline or appear -word fluency, apathy, body weight gain-. Isolated studies note mild improvements in working memory, visuomotor sequencing and conceptual reasoning, some gastrointestinal, urogenital, sweating and olfactory disturbances; whereas other studies have reported declines in verbal memory (long delay recall), visuospatial memory, processing speed and executive function; orthostatic hypotension remains without changes. The reasons for such a range of symptoms observed is due to the multifactorial etiology of the NMS, including preoperative vulnerability, changes in dopaminergic medications, surgical and stimulation effects, underlying PD-related factors and psychosocial effects. Specific patient subgroups may be at greater risk of cognitive deficits -e.g., those older than 69 years or with cognitive impairment prior to surgery- or depression, mania and suicide -e.g., those ones with preoperative psychiatric symptoms-. CONCLUSIONS: Patients who undergo DBS must be well-selected, weighing the risks and benefits, in order to obtain the best results with this treatment. Further multicentre studies are necessary to understand the role of DBS on NMS.

[Comorbidity in the migraine: depression, anxiety, stress and insomnia]. / Comorbilidad en la migraña: depresión, ansiedad, estrés y trastornos del sueño.

INTRODUCTION: Migraine is frequently associated to other pathologies or factors. AIM: To analyze the migraine's profile in a neurologic consultation and to determinate its comorbidity. PATIENTS AND METHODS: 155 patients (36 men and 119 women) were studied in a neurologic consultation of the University Hospital of Salamanca during the year 2005. Migraine was diagnosed according the International Headache Society criteria, and associated disorders were measured using the Goldberg's Anxiety and Depression Scale, the Perceived Stress Questionnaire and the Oviedo Sleep Questionnaire. RESULTS: 99 patients suffered from migraine without aura and 56 with aura; mean age was 36 years; age at onset 20.64 years. 43 migraneurs had depression, anxiety 34, insomnia 58, stress 79, none of these pathologies 62 (40%). Depression and dream upheavals were close to equal between the migraine subtypes (although depression was something more common in migraine without aura), while anxiety and stress were more frequent in migraine with aura (RR: 1.42; 95% CI: 0.92-2.2; and RR: 1.38; 95% CI: 0.9-2.12, respectively). Depression and insomnia were more likely among women with nonsignificant differences (RR: 1.3; 95% CI: 0.95-1.34; and RR: 1.13; 95% CI: 0.95-1.34, respectively), whereas anxiety and stress were similar in both genders. Another associations were found between: migraine's family-history and migraine with aura (OR: 1.31; 95% CI: 0.63-2.71); some dietary factors and migraine without aura (OR: 2.27; 95% CI: 0.57-9.07). CONCLUSIONS: 60% of our migraneurs had at least one of the following disorders: depression (27.74%), anxiety (21.94%), stress (50.97%) or insomnia (37.42%); can trigger or worsen migraine attacks.

Comorbilidad en la migraña: depresión, ansiedad, estrés y trastornos del sueño / Comorbidity in the migraine: depression, anxiety, stress and insomnia

La migraña se asocia frecuentemente a trastornos psicológicos y a otros factores considerados predisponentes.Objetivo. Analizar el perfil de las migrañas en una consulta neurológica y determinar su comorbilidad. Pacientes y métodos. Se estudiaron 155 pacientes (36 hombres y 119 mujeres) en una consulta neurológica del Hospital Universitario de Salamanca durante el 2005. Se utilizaron los criterios diagnósticos de la Sociedad Internacional de Cefaleas y, para los trastornosasociados, la escala de ansiedad y depresión de Goldberg, el cuestionario de estrés percibido y el cuestionario Oviedo de sueño. Resultados. 99 pacientes tenían migraña sin aura y 56 con aura, con una edad media de 36 años, y una edad de inicio de 20,64 años. 43 migrañosos asociaron depresión; 34, ansiedad; 58, insomnio; 79, estrés; y 62, ninguna de estas patologías(40%). La depresión y los trastornos del sueño estuvieron presentes en la migraña sin y con aura (la depresión fue algo más común en la migraña sin aura; la ansiedad y el estrés fueron más frecuentes en la migraña con aura) (RR: 1,42; IC 95%:0,92-2,2; y RR: 1,38; IC 95%: 0,9-2,12, respectivamente). La depresión y el insomnio se manifestaron más frecuentes en mujeres(RR: 1,3; IC 95%: 0,95-1,34; y RR: 1,13; IC 95%: 0,95-1,34, respectivamente), y la ansiedad y el estrés fueron semejantes en ambos sexos. Se encontraron otras asociaciones entre: antecedentes familiares de migraña (OR: 1,31; IC 95%: 0,63-2,71) y migraña con aura, y determinados alimentos (OR: 2,27; IC 95%: 0,57-9,07) con migraña sin aura. Conclusiones. El 60% delos migrañosos presentaba alguno de los siguientes trastornos: depresión (27,74%), ansiedad (21,94%), estrés (50,97%) o insomnio (37,42%); pueden desencadenar o empeorar los episodios de migraña

Migraine is frequently associated to other pathologies or factors. Aim. To analyze the migraine’sprofile in a neurologic consultation and to determinate its comorbidity. Patients and methods. 155 patients (36 men and 119 women) were studied in a neurologic consultation of the University Hospital of Salamanca during the year 2005. Migraine was diagnosed according the International Headache Society criteria, and associated disorders were measured using theGoldberg’s Anxiety and Depression Scale, the Perceived Stress Questionnaire and the Oviedo Sleep Questionnaire. Results. 99 patients suffered from migraine without aura and 56 with aura; mean age was 36 years; age at onset 20.64 years. 43 migraneurs had depression, anxiety 34, insomnia 58, stress 79, none of these pathologies 62 (40%). Depression and dream upheavals were close to equal between the migraine subtypes (although depression was something more common in migrainewithout aura), while anxiety and stress were more frequent in migraine with aura (RR: 1.42; 95% CI: 0.92-2.2; and RR: 1.38; 95% CI: 0.9-2.12, respectively). Depression and insomnia were more likely among women with nonsignificant differences (RR: 1.3; 95% CI: 0.95-1.34; and RR: 1.13; 95% CI: 0.95-1.34, respectively), whereas anxiety and stress were similar in bothgenders. Another associations were found between: migraine’s family-history and migraine with aura (OR: 1.31; 95% CI:0.63-2.71); some dietary factors and migraine without aura (OR: 2.27; 95% CI: 0.57-9.07). Conclusions. 60% of our migraneurs had at least one of the following disorders: depression (27.74%), anxiety (21.94%), stress (50.97%) or insomnia (37.42%);can trigger or worsen migraine attacks