Chronic Neurology in COVID-19 Era: Clinical Considerations and Recommendations From the REPROGRAM Consortium.

With the rapid pace and scale of the emerging coronavirus 2019 (COVID-19) pandemic, a growing body of evidence has shown a strong association of COVID-19 with pre- and post- neurological complications. This has necessitated the need to incorporate targeted neurological care for this subgroup of patients which warrants further reorganization of services, healthcare workforce, and ongoing management of chronic neurological cases. The social distancing and the shutdown imposed by several nations in the midst of COVID-19 have severely impacted the ongoing care, access and support of patients with chronic neurological conditions such as Multiple Sclerosis, Epilepsy, Neuromuscular Disorders, Migraine, Dementia, and Parkinson disease. There is a pressing need for governing bodies including national and international professional associations, health ministries and health institutions to harmonize policies, guidelines, and recommendations relating to the management of chronic neurological conditions. These harmonized guidelines should ensure patient continuity across the spectrum of hospital and community care including the well-being, safety, and mental health of the patients, their care partners and the health professionals involved. This article provides an in-depth analysis of the impact of COVID-19 on chronic neurological conditions and specific recommendations to minimize the potential harm to those at high risk.

[Zonisamide in the preventive treatment of refractory migraine]. / Zonisamida en el tratamiento preventivo de la migraña refractaria.

INTRODUCTION: Chronic migraine refractory to preventive treatment is a common clinical situation in general neurology clinics. The aim is to analyse our experience with zonisamide in the preventive treatment of patients with frequent refractory migraine. PATIENTS AND METHODS: Those patients with no response or intolerance to topiramate and at least one more preventative received zonisamide. This drug was increased 25 mg per week up to 200 mg/day. The efficacy of zonisamide was evaluated in terms of 'response' (reduction in attack frequency below 50%) at the third month of treatment. RESULTS: Our series comprises a total of 172 patients, with ages ranging from 22 to 69 years. 85% were women. The final dosage of zonisamide was 50-200 mg/day, with the 100 mg/day being the most frequently administered dose. Zonisamide was efficacious (response) in 76 (44%) patients; response being excellent in 22 (13%). MIDAS score was reduced by 43.2%. Zonisamide was not tolerated by 27% of the patients, mainly due to subjective mental slowness or digestive symptoms. CONCLUSIONS: These results, obtained in a big sample of patients refractory or intolerant to topiramate and other preventatives, indicate that, at least in conditions of daily clinical practice, zonisamide, at relatively low dosages, is an option to be considered for the preventive treatment of patients with frequent migraine.

Zonisamida en el tratamiento preventivo de la migraña refractaria / Zonisamide in the preventive treatment of refractory migraine

Introducción. La migraña crónica refractaria al tratamiento preventivo habitual es una situación frecuente en consultas de neurología. Se pretende analizar la experiencia con zonisamida en el tratamiento de pacientes con migraña frecuente refractaria. Pacientes y métodos. Aquellos pacientes sin respuesta o con intolerancia a topiramato y al menos otro fármaco preventivo para la migraña recibieron zonisamida. El fármaco se incrementó a razón de 25 mg/semana, hasta un máximo de 200 mg/día. La eficacia de la zonisamida se evaluó en términos de ‘respuesta’ (disminución en la frecuencia de las crisis al menos del 50%) al tercer mes del tratamiento. Resultados. Nuestra serie comprende 172 pacientes de entre 22 y 69 años. El 81% eran mujeres. Las dosis de zonisamida oscilaron entre 50 y 200 mg/día, y la dosis más frecuentemente administrada fue de 100 mg/día. La zonisamida mostró eficacia (respuesta) en 76 (44%) de los pacientes; la respuesta fue excelente en 22 (13%). La puntuación en el test de MIDAS se redujo en un 43,2%. Un 27% de los pacientes no toleró el fármaco, fundamentalmente por bradipsiquia subjetiva o clínica digestiva. Conclusiones. Estos resultados, obtenidos en un número amplio de pacientes refractarios o intolerantes a topiramato y otros fármacos, indican que, al menos en condiciones de práctica clínica, la zonisamida, en dosis relativamente bajas, es una opción que se debe considerar en el tratamiento preventivo del paciente con migraña frecuente

Introduction. Chronic migraine refractory to preventive treatment is a common clinical situation in general neurology clinics. The aim is to analyse our experience with zonisamide in the preventive treatment of patients with frequent refractory migraine. Patients and methods. Those patients with no response or intolerance to topiramate and at least one more preventative received zonisamide. This drug was increased 25 mg per week up to 200 mg/day. The efficacy of zonisamide was evaluated in terms of ‘response’ (reduction in attack frequency below 50%) at the third month of treatment. Results. Our series comprises a total of 172 patients, with ages ranging from 22 to 69 years. 85% were women. The final dosage of zonisamide was 50-200 mg/day, with the 100 mg/day being the most frequently administered dose. Zonisamide was efficacious (response) in 76 (44%) patients; response being excellent in 22 (13%). MIDAS score was reduced by 43.2%. Zonisamide was not tolerated by 27% of the patients, mainly due to subjective mental slowness or digestive symptoms. Conclusions. These results, obtained in a big sample of patients refractory or intolerant to topiramate and other preventatives, indicate that, at least in conditions of daily clinical practice, zonisamide, at relatively low dosages, is an option to be considered for the preventive treatment of patients with frequent migrainev