Pub Date : 2025-04-01Epub Date: 2023-08-04DOI: 10.1016/j.nrl.2023.02.001
I. Saldaña-Inda , H. Tejada-Meza , B. Domínguez-Lagranja , M.R. Barrena-Caballo , A. Sancho-Saldaña , M. Serrano-Ponz , J. Marta-Moreno
Introduction
Posterior circulation stroke accounts for 15%-20% of ischaemic strokes, but is associated with poor functional and vital prognosis in over 60% of cases. Due to its clinical and radiological peculiarities, diagnosis and management are more complex than in anterior circulation stroke. This study analyses and characterises patients with vertebrobasilar strokes treated with mechanical thrombectomy in our region.
Methods
We conducted a descriptive, retrospective analysis of patients with vertebrobasilar stroke and treated with mechanical thrombectomy at our centre, a reference centre for cerebrovascular emergencies for the region of Aragon. We recorded baseline characteristics, risk factors, signs and symptoms at onset, radiological assessment scale scores, procedure-related variables, management times, and functional prognosis at 3 months.
Results
We selected 37 patients (39.5% women; mean age [standard deviation], 68.34 [14.1] years). Cardioembolic stroke (42.1%) was the most common aetiology, followed by atherothrombosis (28.9%). The top of the basilar artery was the most common site of obstruction (55.3%). The most frequent clinical features were somnolence (76.3%), motor deficits (71.1%), and nausea (55.3%). Successful reperfusion (mTICI ≥ 2b) was achieved in 81.1% of patients. Functional outcome at 90 days was poor (mRS < 3) in 59% of patients.
Conclusions
Posterior circulation stroke is associated with high rates of morbidity and mortality. Its subacute, nonspecific clinical course prolongs management times and hinders early detection. Mechanical thrombectomy is a safe and effective procedure, although further studies are needed to establish the optimal patient profile.
{"title":"Tratamiento endovascular del ictus isquémico vertebrobasilar en Aragón: características clínicas, radiológicas, tiempos de atención y pronóstico a los 3 meses","authors":"I. Saldaña-Inda , H. Tejada-Meza , B. Domínguez-Lagranja , M.R. Barrena-Caballo , A. Sancho-Saldaña , M. Serrano-Ponz , J. Marta-Moreno","doi":"10.1016/j.nrl.2023.02.001","DOIUrl":"10.1016/j.nrl.2023.02.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Posterior circulation stroke accounts for 15%-20% of ischaemic strokes, but is associated with poor functional and vital prognosis in over 60% of cases. Due to its clinical and radiological peculiarities, diagnosis and management are more complex than in anterior circulation stroke. This study analyses and characterises patients with vertebrobasilar strokes treated with mechanical thrombectomy in our region.</div></div><div><h3>Methods</h3><div>We conducted a descriptive, retrospective analysis of patients with vertebrobasilar stroke and treated with mechanical thrombectomy at our centre, a reference centre for cerebrovascular emergencies for the region of Aragon. We recorded baseline characteristics, risk factors, signs and symptoms at onset, radiological assessment scale scores, procedure-related variables, management times, and functional prognosis at 3 months.</div></div><div><h3>Results</h3><div>We selected 37 patients (39.5% women; mean age [standard deviation], 68.34 [14.1] years). Cardioembolic stroke (42.1%) was the most common aetiology, followed by atherothrombosis (28.9%). The top of the basilar artery was the most common site of obstruction (55.3%). The most frequent clinical features were somnolence (76.3%), motor deficits (71.1%), and nausea (55.3%). Successful reperfusion (mTICI ≥ 2b) was achieved in 81.1% of patients. Functional outcome at 90 days was poor (mRS < 3) in 59% of patients.</div></div><div><h3>Conclusions</h3><div>Posterior circulation stroke is associated with high rates of morbidity and mortality. Its subacute, nonspecific clinical course prolongs management times and hinders early detection. Mechanical thrombectomy is a safe and effective procedure, although further studies are needed to establish the optimal patient profile.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 3","pages":"Pages 239-248"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42626905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2023-08-05DOI: 10.1016/j.nrl.2022.11.005
M. Saint-Gerons , M.A. Rubio , A. Matheu
Objectives
To describe the prevalence and form of onset of different causes of binocular diplopia in our setting.
Methods
We conducted a single-centre, cross-sectional, retrospective study reviewing the medical records of all patients visiting a tertiary-level centre between May 2019 and June 2021 with binocular diplopia as the main symptom. All patients underwent a complete neuro-ophthalmological evaluation and complementary tests for the aetiological diagnosis of diplopia. Data were collected on demographic variables, ocular deviation pattern, complementary test results, and diagnosis.
Results
A total of 204 patients with binocular diplopia were identified during the study period. The most frequent causes of diplopia overall were fourth nerve palsy (19.12%), sixth nerve palsy (14.71%), decompensated strabismus (14.22%), sagging eye syndrome (12.25%), third nerve palsy (10.78%), myasthenia (7.35%), supranuclear disorders (6.37%), and myopic esotropia (5.88%). Presentation was acute (≤ 2 weeks progression) in 51% of cases. The most frequent causes of acute-onset diplopia were sixth nerve palsy (27.88%), third nerve palsy (21.15%), fourth nerve palsy (19.23%), supranuclear disorders (12.5%), and decompensated strabismus (6.73%). The most frequent causes of subacute/chronic presentation (more than 2 weeks) were decompensated strabismus (22%), sagging eye syndrome (22%), fourth nerve palsy (19%), myopic esotropia (12%), and myasthenia (11%).
Conclusions
The most frequent aetiology of diplopia in our environment was fourth nerve palsy, followed by sixth nerve palsy, decompensated strabismus, and sagging eye syndrome. Knowing the frequency of each cause of diplopia can help prioritise neuroimaging studies in each case.
{"title":"Diplopía binocular: estudio retrospectivo de 204 casos","authors":"M. Saint-Gerons , M.A. Rubio , A. Matheu","doi":"10.1016/j.nrl.2022.11.005","DOIUrl":"10.1016/j.nrl.2022.11.005","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the prevalence and form of onset of different causes of binocular diplopia in our setting.</div></div><div><h3>Methods</h3><div>We conducted a single-centre, cross-sectional, retrospective study reviewing the medical records of all patients visiting a tertiary-level centre between May 2019 and June 2021 with binocular diplopia as the main symptom. All patients underwent a complete neuro-ophthalmological evaluation and complementary tests for the aetiological diagnosis of diplopia. Data were collected on demographic variables, ocular deviation pattern, complementary test results, and diagnosis.</div></div><div><h3>Results</h3><div>A total of 204 patients with binocular diplopia were identified during the study period. The most frequent causes of diplopia overall were fourth nerve palsy (19.12%), sixth nerve palsy (14.71%), decompensated strabismus (14.22%), sagging eye syndrome (12.25%), third nerve palsy (10.78%), myasthenia (7.35%), supranuclear disorders (6.37%), and myopic esotropia (5.88%). Presentation was acute (≤<!--> <!-->2 weeks progression) in 51% of cases. The most frequent causes of acute-onset diplopia were sixth nerve palsy (27.88%), third nerve palsy (21.15%), fourth nerve palsy (19.23%), supranuclear disorders (12.5%), and decompensated strabismus (6.73%). The most frequent causes of subacute/chronic presentation (more than 2 weeks) were decompensated strabismus (22%), sagging eye syndrome (22%), fourth nerve palsy (19%), myopic esotropia (12%), and myasthenia (11%).</div></div><div><h3>Conclusions</h3><div>The most frequent aetiology of diplopia in our environment was fourth nerve palsy, followed by sixth nerve palsy, decompensated strabismus, and sagging eye syndrome. Knowing the frequency of each cause of diplopia can help prioritise neuroimaging studies in each case.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 3","pages":"Pages 221-228"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49046106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2025-03-06DOI: 10.1016/j.nrl.2022.10.001
U. Gómez-Pinedo , L. Torre-Fuentes , J.A. Matías-Guiu , V. Pytel , D.D. Ojeda-Hernández , B. Selma-Calvo , P. Montero-Escribano , L. Vidorreta-Ballesteros , J. Matías-Guiu
Introduction
Several studies have analysed the presence of P2RX7 variants in patients with MS, reporting diverging results.
Methods
Our study analyses P2RX7 variants detected through whole-exome sequencing (WES).
Results
We analysed P2RX7, P2RX4, and CAMKK2 gene variants detected by whole-exome sequencing in all living members (n = 127) of 21 families including at least 2 individuals with multiple sclerosis. P2RX7 gene polymorphisms previously associated with autoimmune disease. Although no differences were observed between individuals with and without multiple sclerosis, we found greater polymorphism of gain-of-function variants of P2RX7 in families with individuals with multiple sclerosis than in the general population. Copresence of gain-of-function and loss-of-function variants was not observed to reduce the risk of presenting the disease. Three families displayed heterozygous gain-of-function SNPs in patients with multiple sclerosis but not in healthy individuals. We were unable to determine the impact of copresence of P2RX4 and CAMKK2 variants with P2RX7 variants, or the potential effect of the different haplotypes described in the gene. No clinical correlations with other autoimmune diseases were observed in our cohort.
Conclusions
Our results support the hypothesis that the disease is polygenic and point to a previously unknown mechanism of genetic predisposition to familial forms of multiple sclerosis. P2RX7 gene activity can be modified, which suggests the possibility of preventive pharmacological treatments for families including patients with familial multiple sclerosis.
{"title":"Exonic variants of the P2RX7 gene in familial multiple sclerosis","authors":"U. Gómez-Pinedo , L. Torre-Fuentes , J.A. Matías-Guiu , V. Pytel , D.D. Ojeda-Hernández , B. Selma-Calvo , P. Montero-Escribano , L. Vidorreta-Ballesteros , J. Matías-Guiu","doi":"10.1016/j.nrl.2022.10.001","DOIUrl":"10.1016/j.nrl.2022.10.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Several studies have analysed the presence of <em>P2RX7</em> variants in patients with MS, reporting diverging results.</div></div><div><h3>Methods</h3><div>Our study analyses <em>P2RX7</em> variants detected through whole-exome sequencing (WES).</div></div><div><h3>Results</h3><div>We analysed <em>P2RX7</em>, <em>P2RX4</em>, and <em>CAMKK2</em> gene variants detected by whole-exome sequencing in all living members (n = 127) of 21 families including at least 2 individuals with multiple sclerosis. <em>P2RX7</em> gene polymorphisms previously associated with autoimmune disease. Although no differences were observed between individuals with and without multiple sclerosis, we found greater polymorphism of gain-of-function variants of <em>P2RX7</em> in families with individuals with multiple sclerosis than in the general population. Copresence of gain-of-function and loss-of-function variants was not observed to reduce the risk of presenting the disease. Three families displayed heterozygous gain-of-function SNPs in patients with multiple sclerosis but not in healthy individuals. We were unable to determine the impact of copresence of <em>P2RX4</em> and <em>CAMKK2</em> variants with <em>P2RX7</em> variants, or the potential effect of the different haplotypes described in the gene. No clinical correlations with other autoimmune diseases were observed in our cohort.</div></div><div><h3>Conclusions</h3><div>Our results support the hypothesis that the disease is polygenic and point to a previously unknown mechanism of genetic predisposition to familial forms of multiple sclerosis. <em>P2RX7</em> gene activity can be modified, which suggests the possibility of preventive pharmacological treatments for families including patients with familial multiple sclerosis.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 2","pages":"Pages 150-160"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2023-08-07DOI: 10.1016/j.nrl.2023.05.003
A. Barragán-Prieto , S. Pérez-Sánchez , M. Castellanos , A. González , J. Montaner
Introduction
In recent years, Telestroke programmes have been established as a fundamental tool for extending acute stroke care to hospitals that lack an on-call neurology service. The main objective of this study is to describe the existence and functioning of the different Telestroke systems and networks (TS) in Spain.
Method
We conducted a cross-sectional study to analyse the current situation of TS in Spain using a structured survey distributed among the members of the Stroke Study Group of the Spanish Society of Neurology.
Results
Responses were received from 12 of the 17 Spanish autonomous communities, of which 10 had implemented TS. In addition, a literature search revealed that 2 other systems were in operation. Twelve of the 17 regions in the country have TS, achieving coverage of at least 20% of the Spanish population. Of these 10 TS, organisation was regional in 7, provincial in 2, and hospital-based in one. Most TS (9) included at least simple CT and angio-CT studies; 4 also included perfusion imaging. Nine TS operated with professional videoconferencing equipment. However, the suboptimal quality of examination via videoconferencing scan was the main problem identified in 50% of TS. Other problems detected are difficulty obtaining data from registries and the transfer of images between hospitals.
Conclusion
In recent years, a significant expansion of TS has taken place in Spain, which has improved the accessibility of specialised care in patients with symptoms of acute stroke. This study allows us to describe the different types of TS in Spain and to detect areas for improvement and expansion, and could contribute to defining regional telestroke implementation strategies to offer quality care to the whole population.
{"title":"Estudio de la situación actual del Teleictus en España","authors":"A. Barragán-Prieto , S. Pérez-Sánchez , M. Castellanos , A. González , J. Montaner","doi":"10.1016/j.nrl.2023.05.003","DOIUrl":"10.1016/j.nrl.2023.05.003","url":null,"abstract":"<div><h3>Introduction</h3><div>In recent years, Telestroke programmes have been established as a fundamental tool for extending acute stroke care to hospitals that lack an on-call neurology service. The main objective of this study is to describe the existence and functioning of the different Telestroke systems and networks (TS) in Spain.</div></div><div><h3>Method</h3><div>We conducted a cross-sectional study to analyse the current situation of TS in Spain using a structured survey distributed among the members of the Stroke Study Group of the Spanish Society of Neurology.</div></div><div><h3>Results</h3><div>Responses were received from 12 of the 17 Spanish autonomous communities, of which 10 had implemented TS. In addition, a literature search revealed that 2 other systems were in operation. Twelve of the 17 regions in the country have TS, achieving coverage of at least 20% of the Spanish population. Of these 10 TS, organisation was regional in 7, provincial in 2, and hospital-based in one. Most TS (9) included at least simple CT and angio-CT studies; 4 also included perfusion imaging. Nine TS operated with professional videoconferencing equipment. However, the suboptimal quality of examination via videoconferencing scan was the main problem identified in 50% of TS. Other problems detected are difficulty obtaining data from registries and the transfer of images between hospitals.</div></div><div><h3>Conclusion</h3><div>In recent years, a significant expansion of TS has taken place in Spain, which has improved the accessibility of specialised care in patients with symptoms of acute stroke. This study allows us to describe the different types of TS in Spain and to detect areas for improvement and expansion, and could contribute to defining regional telestroke implementation strategies to offer quality care to the whole population.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 2","pages":"Pages 182-190"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44375680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-11-19DOI: 10.1016/j.nrl.2023.09.001
M. Gómez-Eguílaz , S. López-Alava , J.L. Ramón-Trapero , F. Castillo-Álvarez , N. Gómez Loizaga , C. García-Penco , N. Boukichou-Abdelkader , L. Pérez-Martínez
Introduction
More than 100 million people have been infected worldwide by the SARS-CoV-2 virus, which is responsible for an acute disease called COVID-19. Multiple studies have shown how various symptoms in these patients can persist for several months after resolution of the acute process, known as post-COVID syndrome. The neurological clinic is varied, but with constant presentation of fatigue.
Objective
Analyze post-COVID fatigue.
Methods
We present a single-center, prospective, case-control study comparing patients with fatigue in the context of a post-COVID syndrome with patients who have passed COVID-19 without post-COVID fatigue. A baseline record (April 2021) and a control record at 6 months were made. Clinical variables, fatigue questionnaires, sleep disorders, depression, anxiety, cognitive impairment and quality of life are recorded. Basic analyzes of the two visits are collected. In addition, a substudy of inflammatory (IL-6, IL-1β, TNF-α) and anti-inflammatory (IL-10) cytokines is performed.
Results
The fatigue of the patients measured by Chadler is of moderate and mixed intensity (physical and psychological). At 6 months, physical fatigue improves, but psychological fatigue does not. Significant differences were found in sleepiness, cognitive deterioration, anxiety and quality of life. Significant alterations are evident of TNF-α values, but not in the rest of the cytokines.
Conclusions
Patients with fatigue have a poorer quality of life, with improvement in control being observed at 6 months, which suggests a course that could be self-limiting, but this will have to be confirmed with longer studies.
{"title":"Profundizando en la fatiga del síndrome post-COVID","authors":"M. Gómez-Eguílaz , S. López-Alava , J.L. Ramón-Trapero , F. Castillo-Álvarez , N. Gómez Loizaga , C. García-Penco , N. Boukichou-Abdelkader , L. Pérez-Martínez","doi":"10.1016/j.nrl.2023.09.001","DOIUrl":"10.1016/j.nrl.2023.09.001","url":null,"abstract":"<div><h3>Introduction</h3><div>More than 100 million people have been infected worldwide by the SARS-CoV-2 virus, which is responsible for an acute disease called COVID-19. Multiple studies have shown how various symptoms in these patients can persist for several months after resolution of the acute process, known as post-COVID syndrome. The neurological clinic is varied, but with constant presentation of fatigue.</div></div><div><h3>Objective</h3><div>Analyze post-COVID fatigue.</div></div><div><h3>Methods</h3><div>We present a single-center, prospective, case-control study comparing patients with fatigue in the context of a post-COVID syndrome with patients who have passed COVID-19 without post-COVID fatigue. A baseline record (April 2021) and a control record at 6<!--> <!-->months were made. Clinical variables, fatigue questionnaires, sleep disorders, depression, anxiety, cognitive impairment and quality of life are recorded. Basic analyzes of the two visits are collected. In addition, a substudy of inflammatory (IL-6, IL-1β, TNF-α) and anti-inflammatory (IL-10) cytokines is performed.</div></div><div><h3>Results</h3><div>The fatigue of the patients measured by Chadler is of moderate and mixed intensity (physical and psychological). At 6<!--> <!-->months, physical fatigue improves, but psychological fatigue does not. Significant differences were found in sleepiness, cognitive deterioration, anxiety and quality of life. Significant alterations are evident of TNF-α values, but not in the rest of the cytokines.</div></div><div><h3>Conclusions</h3><div>Patients with fatigue have a poorer quality of life, with improvement in control being observed at 6<!--> <!-->months, which suggests a course that could be self-limiting, but this will have to be confirmed with longer studies.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 2","pages":"Pages 204-215"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2023-08-04DOI: 10.1016/j.nrl.2022.11.004
A.R. Ramos-Molina , A.R. Tejeda-Martínez , J.M. Viveros-Paredes , V. Chaparro-Huerta , M.F. Urmeneta-Ortíz , L.J. Ramírez-Jirano , M.E. Flores-Soto
Introduction
Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder worldwide. Although the precise pathogenesis of PD remains unclear, several studies demonstrate that oxidative stress, inflammation, low levels of antioxidants, and the presence of biomolecules that generate reactive oxygen species can disrupt the blood–brain barrier (BBB) as an essential feature of the disease.
Aims
This study aimed to test whether agonism to cannabinoid receptor type 2 (CB2) through the administration of β-caryophyllene (BCP) could correct BBB permeability in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) parkinsonism induction model.
Methods
We conducted a molecular assessment of proteins (immunochemistry and western blot), BBB permeability, and related biomarkers of PD (lipid peroxidation) in the MPTP mouse model of the disease.
Results
Expression of zonula occludens (ZO-1) and occludin tight junction (TJ) proteins was dampened in the striatum and substantia nigra pars compacta of mice, while lipid peroxidation and BBB permeability increased in the striatum in the MPTP-treated group, and these effects were reversed under BCP administration. This phytocannabinoid was able to restore protein expression and immunoreactivity of tyrosine hydroxylase (TH), ionized calcium-binding adapter molecule 1 (Iba-1), and glial fibrillary acidic protein (GFAP), as well as nuclear factor-erythroid 2-related factor (NRF2) translocation to the nucleus, and NADPH quinone oxidase 1 (NQO1) expression in mice treated with MPTP.
Conclusion
These results highlight the role of CB2 as a therapeutic target for PD, suggesting that its activation may ameliorate PD-related BBB disruption and oxidative stress, reducing the selective death of dopaminergic neurons.
{"title":"Beta-caryophyllene inhibits the permeability of the blood–brain barrier in MPTP-induced parkinsonism","authors":"A.R. Ramos-Molina , A.R. Tejeda-Martínez , J.M. Viveros-Paredes , V. Chaparro-Huerta , M.F. Urmeneta-Ortíz , L.J. Ramírez-Jirano , M.E. Flores-Soto","doi":"10.1016/j.nrl.2022.11.004","DOIUrl":"10.1016/j.nrl.2022.11.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder worldwide. Although the precise pathogenesis of PD remains unclear, several studies demonstrate that oxidative stress, inflammation, low levels of antioxidants, and the presence of biomolecules that generate reactive oxygen species can disrupt the blood–brain barrier (BBB) as an essential feature of the disease.</div></div><div><h3>Aims</h3><div>This study aimed to test whether agonism to cannabinoid receptor type 2 (CB2) through the administration of β-caryophyllene (BCP) could correct BBB permeability in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) parkinsonism induction model.</div></div><div><h3>Methods</h3><div>We conducted a molecular assessment of proteins (immunochemistry and western blot), BBB permeability, and related biomarkers of PD (lipid peroxidation) in the MPTP mouse model of the disease.</div></div><div><h3>Results</h3><div>Expression of zonula occludens (ZO-1) and occludin tight junction (TJ) proteins was dampened in the striatum and substantia nigra pars compacta of mice, while lipid peroxidation and BBB permeability increased in the striatum in the MPTP-treated group, and these effects were reversed under BCP administration. This phytocannabinoid was able to restore protein expression and immunoreactivity of tyrosine hydroxylase (TH), ionized calcium-binding adapter molecule 1 (Iba-1), and glial fibrillary acidic protein (GFAP), as well as nuclear factor-erythroid 2-related factor (NRF2) translocation to the nucleus, and NADPH quinone oxidase 1 (NQO1) expression in mice treated with MPTP.</div></div><div><h3>Conclusion</h3><div>These results highlight the role of CB2 as a therapeutic target for PD, suggesting that its activation may ameliorate PD-related BBB disruption and oxidative stress, reducing the selective death of dopaminergic neurons.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 2","pages":"Pages 191-203"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41563456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-02-04DOI: 10.1016/j.nrl.2023.02.003
C. Guijarro-Castro , L. Estallo-Guijarro
{"title":"Síndrome de opsoclono-mioclono y cáncer de próstata. Una entidad a tener en cuenta","authors":"C. Guijarro-Castro , L. Estallo-Guijarro","doi":"10.1016/j.nrl.2023.02.003","DOIUrl":"10.1016/j.nrl.2023.02.003","url":null,"abstract":"","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 2","pages":"Pages 216-217"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139888115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2025-03-06DOI: 10.1016/j.nrl.2023.04.002
D. Santos García , J. Pagonabarraga Mora , F. Escamilla Sevilla , P.J. García Ruiz , J. Infante Ceberio , J. Kulisevsky Bojarski , G. Linazasoro Cristóbal , M.R. Luquín Piudo , J.C. Martínez Castrillo , S. Jesús Maestre , L. Vela Desojo , F.J. Campos Lucas , F. Caballero Martínez , P. Mir , Panel of Experts Phase 1
Background
Different types of therapies were proven effective for the medical management of motor and non-motor symptoms in Parkinson’s disease (PD). We aimed to gain consensus on the dopamine agonist (DA) therapy use in different clinical scenarios of Parkinson’s disease (PD) patients.
Methods
This consensus study was based on the nominal group technique. Initially, a consensus group comprising 12 expert neurologists in the PD field identified the topics to be addressed and elaborated different evidence-based preliminary statements. Next, a panel of 48 Spanish neurologists expressed their opinion on an internet-based systematic voting program. Finally, initial ideas were reviewed and rewritten according to panel contribution and were ranked by the consensus group using a Likert-type scale. The analysis of data was carried out by using a combination of both qualitative and quantitative methods. The consensus was achieved if the statement reached ≥ 3.5 points in the voting process.
Results
The consensus group produced 76 real-world recommendations. The topics addressed included 12 statements related to DA therapy in early PD, 20 statements concerning DA treatment strategy in patients with motor complications, 11 statements associated with DA drugs and their side effects, and 33 statements regarding DA therapy in specific clinical scenarios. The consensus group did not reach a consensus on 15 statements.
Conclusion
The findings from this consensus method represent an exploratory step to help clinicians and patients in the appropriate use of DA in different stages and clinical situations of PD.
{"title":"Dopamine agonist therapy in Parkinson’s disease: Spanish expert consensus on its use in different clinical situations","authors":"D. Santos García , J. Pagonabarraga Mora , F. Escamilla Sevilla , P.J. García Ruiz , J. Infante Ceberio , J. Kulisevsky Bojarski , G. Linazasoro Cristóbal , M.R. Luquín Piudo , J.C. Martínez Castrillo , S. Jesús Maestre , L. Vela Desojo , F.J. Campos Lucas , F. Caballero Martínez , P. Mir , Panel of Experts Phase 1","doi":"10.1016/j.nrl.2023.04.002","DOIUrl":"10.1016/j.nrl.2023.04.002","url":null,"abstract":"<div><h3>Background</h3><div>Different types of therapies were proven effective for the medical management of motor and non-motor symptoms in Parkinson’s disease (PD). We aimed to gain consensus on the dopamine agonist (DA) therapy use in different clinical scenarios of Parkinson’s disease (PD) patients.</div></div><div><h3>Methods</h3><div>This consensus study was based on the nominal group technique. Initially, a consensus group comprising 12 expert neurologists in the PD field identified the topics to be addressed and elaborated different evidence-based preliminary statements. Next, a panel of 48 Spanish neurologists expressed their opinion on an internet-based systematic voting program. Finally, initial ideas were reviewed and rewritten according to panel contribution and were ranked by the consensus group using a Likert-type scale. The analysis of data was carried out by using a combination of both qualitative and quantitative methods. The consensus was achieved if the statement reached ≥ 3.5 points in the voting process.</div></div><div><h3>Results</h3><div>The consensus group produced 76 real-world recommendations. The topics addressed included 12 statements related to DA therapy in early PD, 20 statements concerning DA treatment strategy in patients with motor complications, 11 statements associated with DA drugs and their side effects, and 33 statements regarding DA therapy in specific clinical scenarios. The consensus group did not reach a consensus on 15 statements.</div></div><div><h3>Conclusion</h3><div>The findings from this consensus method represent an exploratory step to help clinicians and patients in the appropriate use of DA in different stages and clinical situations of PD.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 2","pages":"Pages 171-181"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2022-11-02DOI: 10.1016/j.nrl.2022.09.007
J. Tejada García , L.L. Lezama , R. de la Fuente Blanco , A. Pérez de Prado , L. Benavente Fernández , M. Rico Santos , M.D. Fernández Couto , L. Naya Ríos , I. Couso Pazó , P.V. Alba , L. Redondo-Robles , L. López Mesonero , S. Arias-Rivas , M. Santamaría Cadavid , H. Tejada Meza , L. Horna Cañete , I. Azkune Calle , A. Pinedo Brochado , J.M. García Sánchez , I. Caballero Romero , M. Martínez Zabaleta
Introduction
There is an extending use of percutaneous closure of patent foramen ovale (PFO) as therapy for PFO-associated cryptogenic strokes. The aim of our study was to investigate the clinical practice of percutaneous closure of PFO and to analyse the variables for decision-making on the selection of patients for this procedure.
Method
A prospective observational multicentric survey was conducted using all the cases of cryptogenic stroke/transient ischemic attack associated with PFO recorded in the NORDICTUS hospital registry during the period 2018-2021. Clinical data, radiological patterns, echocardiogram data and factors related to PFO-associated stroke (thromboembolic disease and paradoxical embolism criteria) were recorded. The indication for closure was analysed according to age (≤/ > 60 years) and the characteristics of the PFO.
Results
In the group ≤60 years (n = 488), 143 patients (29.3%) underwent PFO closure. The most influential variables for this therapy were detection of a high-risk PFO (OR 4,11; IC 2,6-6,5, p< 0,001), criteria for paradoxical embolism (OR 2,61; IC 1,28-5,28; p = 0,008) and previous use of antithrombotics (OR 2,67; IC 1,38-5,18; p = 0,009). In the group >60 years old (n = 124), 24 patients had PFO closure (19%). The variables related to this option were history of pulmonary thromboembolism, predisposition to thromboembolic disease, paradoxical embolism criteria and high-risk PFO.
Conclusions
The detection of a high-risk PFO (large shunt, shunt with associated aneurysm) is the main criterion for a percutaneous closure-based therapy. Other conditions to consider in the eligibility of patients are the history of thromboembolic disease, paradoxical embolism criteria or the previous use of antithrombotics.
{"title":"Selección de pacientes para cierre percutáneo en el ictus isquémico no lacunar criptogénico asociado a foramen oval permeable. Datos del registro cooperativo NORDICTUS","authors":"J. Tejada García , L.L. Lezama , R. de la Fuente Blanco , A. Pérez de Prado , L. Benavente Fernández , M. Rico Santos , M.D. Fernández Couto , L. Naya Ríos , I. Couso Pazó , P.V. Alba , L. Redondo-Robles , L. López Mesonero , S. Arias-Rivas , M. Santamaría Cadavid , H. Tejada Meza , L. Horna Cañete , I. Azkune Calle , A. Pinedo Brochado , J.M. García Sánchez , I. Caballero Romero , M. Martínez Zabaleta","doi":"10.1016/j.nrl.2022.09.007","DOIUrl":"10.1016/j.nrl.2022.09.007","url":null,"abstract":"<div><h3>Introduction</h3><div>There is an extending use of percutaneous closure of patent foramen ovale (PFO) as therapy for PFO-associated cryptogenic strokes. The aim of our study was to investigate the clinical practice of percutaneous closure of PFO and to analyse the variables for decision-making on the selection of patients for this procedure.</div></div><div><h3>Method</h3><div>A prospective observational multicentric survey was conducted using all the cases of cryptogenic stroke/transient ischemic attack associated with PFO recorded in the NORDICTUS hospital registry during the period 2018-2021. Clinical data, radiological patterns, echocardiogram data and factors related to PFO-associated stroke (thromboembolic disease and paradoxical embolism criteria) were recorded. The indication for closure was analysed according to age (≤/<!--> <!-->> 60 years) and the characteristics of the PFO.</div></div><div><h3>Results</h3><div>In the group ≤60 years (n<!--> <!-->=<!--> <!-->488), 143 patients (29.3%) underwent PFO closure. The most influential variables for this therapy were detection of a high-risk PFO (OR 4,11; IC 2,6-6,5, p<<!--> <!-->0,001), criteria for paradoxical embolism (OR 2,61; IC 1,28-5,28; p<!--> <!-->=<!--> <!-->0,008) and previous use of antithrombotics (OR 2,67; IC 1,38-5,18; p<!--> <!-->=<!--> <!-->0,009). In the group<!--> <!-->>60 years old (n<!--> <!-->=<!--> <!-->124), 24 patients had PFO closure (19%). The variables related to this option were history of pulmonary thromboembolism, predisposition to thromboembolic disease, paradoxical embolism criteria and high-risk PFO.</div></div><div><h3>Conclusions</h3><div>The detection of a high-risk PFO (large shunt, shunt with associated aneurysm) is the main criterion for a percutaneous closure-based therapy. Other conditions to consider in the eligibility of patients are the history of thromboembolic disease, paradoxical embolism criteria or the previous use of antithrombotics.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 2","pages":"Pages 139-149"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49273719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-02-04DOI: 10.1016/j.nrl.2023.02.004
J. Martín Prieto , E. García-Serrano Fuertes , J. Iglesias Bermejillo , A. Luna Rodríguez
{"title":"Mutaciones en el gen del colágeno tipo IV (COL4A1) como etiología infrecuente de enfermedad cerebrovascular en el adulto joven","authors":"J. Martín Prieto , E. García-Serrano Fuertes , J. Iglesias Bermejillo , A. Luna Rodríguez","doi":"10.1016/j.nrl.2023.02.004","DOIUrl":"10.1016/j.nrl.2023.02.004","url":null,"abstract":"","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 2","pages":"Pages 217-220"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139889007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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