Neurologia最新文献_第2页

Serie de casos de epilepsia con mioclonías palpebrales 伴有脑瘫肌阵挛的癫痫系列

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-11-01 DOI: 10.1016/j.nrl.2023.04.009

M. Henao-Pérez , D.C. López-Medina , A. Arboleda-Ramírez , N.L. Patiño-Jaramillo , J.F. Zapata-Berruecos , R. Andrade

Introduction

Epilepsy with palpebral myoclonus is an idiopathic generalized childhood epilepsy, which is underdiagnosed because it is confused with tics or behavioral actions.

Patients and methods

Quantitative, observational, descriptive of 16 patients with epilepsy and myoclonic eyelids treated at an institution specialized in neurology, between the years 2017 and 2022. Clinical histories and videoelectroencephalograms were evaluated.

Results

Of 16 patients, 11 were women (68.8%), the median age was 17.5 years (IQR 12.5). The first diagnosis most frequently received by patients was idiopathic generalized epilepsy. Stressful situations were the most reported precipitant. 93.75% of the patients initially presented palpebral myoclonic seizures and after several years presented generalized tonic-clonic seizures. The time elapsed between the first seizure and the diagnosis varied between 1 and more than 40 years, being greater among patients with a subsidized health system. Men had a high frequency of family history of epilepsy in the first and second degrees of consanguinity, had a longer delay in diagnosis and reported greater drug resistance. In both women and men, the posterior regions (occipital, temporoccipital and parietoccipital) presented a greater focal epileptiform activity. The photoparoxysmal response occurred with greater predominance in women, with the Waltz type iii and iv responses being the most frequent.

Conclusion

The importance of suspecting this pathology before palpebral myoclonus in children should be highlighted, guaranteeing quality and timely management.

癫痫伴睑肌阵挛是一种特发性全身性儿童癫痫，由于与抽搐或行为动作相混淆而未得到充分诊断。患者和方法对2017年至2022年间在一家神经病学专业机构接受治疗的16例癫痫和肌阵挛性眼睑患者进行定量、观察和描述性研究。评估临床病史和脑电图。结果16例患者中，女性11例（68.8%），中位年龄17.5岁（IQR 12.5）。患者最常接受的第一个诊断是特发性全身性癫痫。有压力的情况是报告中最危险的。93.75%的患者最初表现为睑肌阵挛性发作，几年后出现全身性强直阵挛性发作。从第一次发作到诊断之间的时间从1年到40多年不等，在享受补贴医疗系统的患者中时间更长。男性一、二级血缘家族癫痫家族史发生率高，诊断延误时间长，耐药程度高。在女性和男性中，后侧区域（枕部、颞枕部和顶枕部）表现出更大的局灶性癫痫样活动。光阵发性反应在女性中更占优势，华尔兹iii型和iv型反应最常见。结论应重视患儿睑肌睫状体病变诊断，保证质量，及时处理。

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引用次数: 0

Diagnóstico neuropsicológico diferencial en enfermedad de Alzheimer y demencia por cuerpos de Lewy: una revisión sistemática 路易体对阿尔茨海默病和痴呆的神经心理学差异诊断：系统综述

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-11-01 DOI: 10.1016/j.nrl.2023.03.006

T. Julio-Ramos , V. Mora-Castelleto , C. Foncea-González , C. Adames-Valencia , I. Cigarroa , C. Méndez-Orellana , D. Toloza-Ramirez

Introduction

Alzheimer's disease (AD) reports heterogeneity of neuropsychological symptoms misleading the differential diagnosis with other forms of dementia, such as dementia with Lewy bodies (DLB). About 50% of DLB patients are misdiagnosed as AD cases. Likewise, the diagnosis of both diseases is mainly based on clinical characteristics. However, differentiating AD of those with DLB based on neuropsychological symptoms and anatomical and functional brain changes remains challenging.

Aim

To establish the main neuropsychological, anatomical, and functional similarities and differences in patients with AD and DLB.

Methods

The present study followed the PRISMA guidelines and included studies from the PubMed, Scopus, and Web of Sciences databases, published between January 2000 and July 2022.

Results

Forty-one articles were included in this systematic review for critical analysis. Our results suggest that the cognitive key domains to consider in the differential diagnosis are memory, executive function, attention, visuospatial/visuoconstructive skills, and verbal fluency (both semantic and phonological). The stage and severity of both diseases would be essential for differential diagnosis. On the other hand, the anatomical and functional changes suggest a similar atrophy pattern between AD and DLB in the frontal, parietal, temporal, hippocampal, and precuneus regions.

Conclusion

The differential diagnosis between AD and DLB is challenging in clinical practice. Therefore, our results suggest exploring cognitive linguistic markers along with correlating these markers with anatomical and functional brain changes.

阿尔茨海默病（AD）报告了神经心理症状的异质性，误导了与其他形式的痴呆（如路易体痴呆（DLB））的鉴别诊断。约50%的DLB患者被误诊为AD病例。同样，这两种疾病的诊断主要基于临床特征。然而，根据神经心理症状和大脑解剖和功能变化来区分DLB患者的AD仍然具有挑战性。目的探讨AD和DLB患者主要神经心理、解剖学和功能上的异同。方法本研究遵循PRISMA指南，纳入了2000年1月至2022年7月期间发表的PubMed、Scopus和Web of Sciences数据库中的研究。结果本系统综述纳入41篇文献进行批判性分析。我们的研究结果表明，在鉴别诊断中需要考虑的认知关键领域是记忆、执行功能、注意力、视觉空间/视觉构建技能和语言流畅性（包括语义和语音）。两种疾病的分期和严重程度对于鉴别诊断至关重要。另一方面，解剖和功能变化表明AD和DLB在额叶、顶叶、颞叶、海马和楔前叶区域有相似的萎缩模式。结论AD与DLB的鉴别诊断在临床实践中具有挑战性。因此，我们的研究结果建议探索认知语言标记，并将这些标记与大脑的解剖和功能变化联系起来。

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引用次数: 0

Complex dystonia in an adolescent male with a MECP2 variant 患有MECP2变异的青少年男性的复杂肌张力障碍

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-11-01 DOI: 10.1016/j.nrl.2023.03.007

R. Baviera-Muñoz , T. Jaijo , M. Campins-Romeu , I. Martínez-Torres , I. Sastre-Bataller

引用次数: 0

The discriminative linguistic profiles of progressive supranuclear palsy and Parkinson's disease 进行性核上性麻痹和帕金森病的鉴别语言特征

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-11-01 DOI: 10.1016/j.nrl.2023.06.010

L. Busteed , A. Horta-Barba , A. Reig , C. García-Sánchez , B. Pascual-Sedano , I. Gich , P. Roy Ciffone , J. Kulisevsky , J. Pagonabarraga

Introduction

Speech and language disturbances are very frequent in progressive supranuclear palsy (PSP). Therefore, they are part of the diagnostic criteria set forth by the International Parkinson and Movement Disorder Society (MDS) for the disease and are considered a core clinical feature. However, more studies are needed to characterize the linguistic profile of PSP, thus being able to assist in the differential diagnosis. Additionally, studies assessing linguistic differences among PSP phenotypes are needed. The objective of this study is to analyze the language alterations presented by patients with PSP, as well as its different phenotypes, and differentiate them from those presented in patients with Parkinson's disease (PD).

Methods

An extensive cognitive and linguistic assessment was administered to 13 PSP patients, 19 PD patients and 19 healthy controls (HC) with similar sociodemographic features. Language assessment included evaluation of: syntactic processing, object naming, and phonetic and semantic fluencies. We included a subgroup of 6 PSP patients, 19 PD patients and 19 HC for further analysis of language. This analysis included, in addition to the general evaluation, the assessment of alternating fluency, comprehension, naming, automatic speech, repetition, object recognition, verbal and written instructions, writing to dictation, and oral expression.

Results

We found greater impairment on phonetic, semantic, and alternating fluencies, following verbal instructions, repetition, syntactic processing and writing (without phonetic paragraphia) in the PSP group compared to patients with PD and HC. Distinguishing linguistic features of PSP with a less marked reduction than the previously mentioned features were automatic speech, fluency of speech, and naming. Language analysis did not distinguish between PSP phenotypes.

Conclusions

Language disturbances distinguish PSP from PD and HC but were not able to discriminate PSP phenotypes.

进行性核上性麻痹（PSP）患者经常出现言语和语言障碍。因此，它们是国际帕金森与运动障碍协会（MDS）为该疾病制定的诊断标准的一部分，被认为是核心临床特征。然而，需要更多的研究来描述PSP的语言特征，从而能够帮助鉴别诊断。此外，还需要研究评估PSP表型之间的语言差异。本研究的目的是分析PSP患者的语言改变及其不同的表型，并将其与帕金森病（PD）患者的语言改变进行区分。方法对13例PSP患者、19例PD患者和19例具有相似社会人口统计学特征的健康对照（HC）进行广泛的认知和语言评估。语言评估包括：句法处理、对象命名、语音和语义流畅性的评估。我们纳入了6名PSP患者，19名PD患者和19名HC患者进行进一步的语言分析。除了一般评价外，该分析还包括对交替流畅性、理解、命名、自动语音、重复、物体识别、口头和书面指示、书面听写和口头表达的评估。结果我们发现，与PD和HC患者相比，PSP组在语音、语义和交替流畅性、遵循口头指示、重复、句法处理和写作（无语音段落）方面的损害更大。与前面提到的特征相比，PSP的显著性语言特征是自动语音、语言流畅性和命名。语言分析没有区分PSP表型。结论语言障碍可区分PSP与PD和HC，但不能区分PSP的表型。

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引用次数: 0

Las cefaleas primarias como motivo de consulta en Atención Primaria: un estudio prospectivo 将原发性头痛作为初级保健咨询的原因：一项前瞻性研究

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-11-01 DOI: 10.1016/j.nrl.2023.07.002

I. Rivera , N. Fontanillas , L. Cadelo , J. Pascual

Objectives

To prospectively study the rate of consultation, diagnoses, burden and historical management patterns of those patients attending due to primary headache in Primary Care.

Patients and methods

We included 200 patients with primary headache in a semi-urban health center. To study the consultation impact, 100 patients were consecutively recruited in one Primary Care quota. For every patient we obtained demographic data, comorbidities, rate of consultation, absenteeism, impact in quality of life (MIDAS and HIT-6 scales) and previous patterns of referral and treatment.

Results

A total of 2.2% of the demand consultations were due to primary headache. Migraine (60%) was the most frequent reason, followed by tension-type headache (38.5%) and trigeminal autonomic headaches (1.5%). In 58% of cases the diagnosis was incomplete or incorrect. Between 33% (MIDAS) and 50.8% (HIT-6) of cases showed at least a moderate decrease in their quality of life, which was higher for migraine (40.8% and 72.5%, respectively). There was absenteeism in 12% of patients the last year (in 87.5% of cases due to migraine). More than half (57%) of cases had been referred to neurology and preventive treatments had been initiated in Primary Care in only 5.5% of patients.

Conclusions

Primary headaches, and mainly migraine, are a frequent reason for consultation in Primary Care. Even though migraine induces a significant absenteeism and damages quality of life, there is a clear room for improvement in their management. Primary headaches should be included in the health plans of Primary Care.

目的对原发性头痛患者的问诊率、诊断率、负担及既往管理模式进行前瞻性研究。患者和方法我们在一个半城市卫生中心纳入了200例原发性头痛患者。为了研究咨询的影响，在一个初级保健配额中连续招募了100名患者。我们获得了每位患者的人口统计数据、合并症、就诊率、缺勤率、对生活质量的影响（MIDAS和HIT-6量表）以及以前的转诊和治疗模式。结果因原发性头痛就诊的占2.2%。偏头痛（60%）是最常见的原因，其次是紧张性头痛（38.5%）和三叉神经性头痛（1.5%）。在58%的病例中，诊断不完整或不正确。33% （MIDAS）至50.8% （HIT-6）的患者表现出至少中度的生活质量下降，偏头痛患者的这一比例更高（分别为40.8%和72.5%）。去年有12%的患者缺勤（其中87.5%的病例是由于偏头痛）。超过一半（57%）的病例被转介到神经病学，只有5.5%的患者在初级保健中开始了预防性治疗。结论原发性头痛，主要是偏头痛，是初级保健中常见的问诊原因。尽管偏头痛会导致严重的缺勤并损害生活质量，但在治疗上仍有明显的改进空间。原发性头痛应列入初级保健保健计划。

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引用次数: 0

Deshidratación, circulación colateral y pronóstico funcional en pacientes con ictus isquémico tratados mediante trombectomía mecánica 机械血栓切除术治疗缺血性中风患者的脱水、旁路循环和功能预后

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-11-01 DOI: 10.1016/j.nrl.2023.04.007

M. Guasch-Jiménez , P. Camps-Renom , C. Toscano-Prat , D. Guisado-Alonso , A. Martínez-Domeño , L. Prats-Sánchez , A. Ramos-Pachón , I. Fernández-Cadenas , J.P. Martínez-González , I. Fernández-Pérez , C. Avellaneda-Gómez , E. de Celis-Ruiz , J. Rodríguez-Pardo , M. del Mar Freijo , A. Luna , F. Moniche , B. Pardo-Galiana , J. Ortega-Quintanilla , J.F. Arenillas , E. Cortijo , J. Martí-Fàbregas

Introduction

Dehydration in patients with acute ischemic stroke (AIS) is associated with poor outcome. Our aim is to investigate whether dehydration is associated with collateral circulation (CC) and functional outcome in patients with AIS treated with mechanical thrombectomy (MT).

Method

Prospective multicenter study of patients with anterior circulation AIS treated with MT (January 2020–June 2021). Dehydration was assessed with two formulas: plasma osmolarity and urea/creatinine (U/C) ratio. CC was quantified with an automated software (Brainomix Ltd.) on baseline computed tomography angiography. The primary outcome was the association between CC (expressed numerically as the percentage of change between hemispheres) and dehydration (osmolarity ≥295 mmol/L, U/C ≥80). Secondary outcomes included disability at discharge and at three months of follow-up, assessed using the modified Rankin scale (poor outcome: 3–6). Multivariable logistic and ordinal regression analyses were performed.

Results

Two hundred sixty patients were included. 65.8% were dehydrated according to osmolarity and 2.9% according to U/C. There was no association between CC score and dehydration [71% in dehydrated vs 73% in non-dehydrated; p = 0.875]. 64.3% of dehydrated patients vs. 46.7% of non-dehydrated patients had a poor outcome at discharge (p = 0.026). In multivariable logistic regression analysis, dehydration was an independent predictor of poor outcome at discharge (OR 2.50; p = 0.011) and at three months of follow-up (OR 2.27; p = 0.046).

Conclusions

Dehydration on admission is associated with poor outcome in patients with AIS treated with MT, but it is not related to CC.

急性缺血性卒中（AIS）患者脱水与不良预后相关。我们的目的是研究机械取栓（MT）治疗AIS患者的脱水是否与侧支循环（CC）和功能结局相关。方法对接受MT治疗的前循环AIS患者进行前瞻性多中心研究（2020年1月- 2021年6月）。脱水评估采用血浆渗透压和尿素/肌酐（U/C）比两种公式。在基线计算机断层血管造影上，使用自动化软件（Brainomix Ltd.）对CC进行量化。主要结局是CC（以半球间变化百分比表示）与脱水（渗透压≥295 mmol/L， U/C≥80）之间的关系。次要结局包括出院时和随访3个月时的残疾，使用改进的Rankin量表进行评估（差结局：3-6）。进行了多变量逻辑回归和有序回归分析。结果共纳入260例患者。渗透压脱水率为65.8%，U/C脱水率为2.9%。CC评分与脱水无关联[脱水71% vs非脱水73%；p = 0.875]。64.3%的脱水患者和46.7%的非脱水患者出院时预后较差（p = 0.026）。在多变量logistic回归分析中，脱水是出院时不良预后的独立预测因子（OR 2.50, p = 0.011）和随访3个月时（OR 2.27, p = 0.046）。结论接受MT治疗的AIS患者入院时脱水与预后不良相关，但与CC无关。

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引用次数: 0

Evaluation of autonomic dysfunction in hereditary transthyretin amyloidosis 遗传性甲状腺转蛋白淀粉样变性患者自主神经功能障碍的评价

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-11-01 DOI: 10.1016/j.nrl.2023.04.010

F. Martínez-Valle , C. Casasnovas-Pons , M. Romero-Acebal , L. Galán-Dávila

Background

Autonomic dysfunction is a common manifestation of hereditary transthyretin (ATTRv) amyloidosis that frequently appears early and has a major impact on disease severity, survival, and quality of life. Early detection of autonomic symptoms is paramount to avoid delayed diagnosis or misdiagnosis of ATTRv amyloidosis and thereby achieve timely interventions with novel therapies. We thus require a better understanding and recognition of the warning signs of autonomic nervous system involvement in patients with ATTRv amyloidosis.

Development

According to the literature and the expertise of key opinion leaders on ATTRv amyloidosis, early signs and symptoms of autonomic dysfunction often include orthostatic hypotension, gastrointestinal disturbances, and cardiac and sudomotor sympathetic denervation. Assessment methods for a rapid and accurate diagnostic thus comprise blood pressure monitoring, nutritional status evaluation, cardiac imaging techniques, and pathological and neurophysiological tests assessing small fiber function. The COMPASS-31 and Norfolk QOL-DN tests allow assessment of the severity of autonomic dysfunction and its impact on quality of life, respectively.

Conclusion

The screening strategy for autonomic dysfunction should involve diverse neurological and non-neurological tests to encompass the wide variety of potential manifestations of autonomic dysfunction in ATTRv amyloidosis. Further studies addressing the correlations among different tests and their prognostic value in different TTR variants are required to establish a single standardized method or the minimum set of tests needed to assess autonomic dysfunction in ATTRv amyloidosis patients.

背景：自主神经功能障碍是遗传性甲状腺转甲状腺素（ATTRv）淀粉样变的常见表现，经常出现在早期，对疾病严重程度、生存和生活质量有重要影响。自主神经症状的早期发现对于避免ATTRv淀粉样变的延迟诊断或误诊至关重要，从而及时采用新疗法进行干预。因此，我们需要更好地理解和识别自主神经系统受累的警告信号与ATTRv淀粉样变患者。根据有关ATTRv淀粉样变的文献和主要意见领袖的专业知识，自主神经功能障碍的早期体征和症状通常包括直立性低血压、胃肠道紊乱、心脏和压迫性交感神经去支配。因此，快速准确诊断的评估方法包括血压监测、营养状况评估、心脏成像技术以及评估小纤维功能的病理和神经生理测试。COMPASS-31和Norfolk QOL-DN测试分别用于评估自主神经功能障碍的严重程度及其对生活质量的影响。结论自主神经功能障碍的筛查策略应包括多种神经和非神经检查，以涵盖ATTRv淀粉样变性自主神经功能障碍的各种潜在表现。需要进一步研究不同测试之间的相关性及其在不同TTR变异中的预后价值，以建立单一的标准化方法或最少的测试集来评估ATTRv淀粉样变患者的自主神经功能障碍。

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引用次数: 0

Recommendations for the critical reading of clinical trials on disease-modifying drugs for multiple sclerosis 对多发性硬化症治疗药物临床试验的批判性阅读建议

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-11-01 DOI: 10.1016/j.nrl.2023.07.004

A. Rivero-de-Aguilar , M. Mascareñas-García , M. Pérez-Ríos , M.A. Llaneza-Gonzalez , P. Mulero , M. Mendibe , À. Rovira , V. Meca-Lallana , A.J. García-Ruiz , L. Landete , J.R. Vizoso Hermida , P. Carrascal Rueda , A. Ruano-Raviña , M. Puente-Hernandez , L. Varela-Lema

Introduction

In recent years there has been an increase in the number of disease-modifying drugs (DMDs) approved for multiple sclerosis (MS). The evidence of their safety and efficacy has been obtained through several phase III and IV clinical trials. Acquiring the skills for their appraisal is indispensable for clinicians to assess the most pertinent treatment for patients. The objective of this study is to provide guidance in the critical reading of these trials.

Methods

A three-round e-Delphi study was carried out. In the preparatory phase, a multidisciplinary expert panel was established. Panel members were selected based on their scientific credentials and experience, seeking to include people involved in MS diagnosis, treatment and research. A semi-open questionnaire was developed based on key generic and MS-specific methodological instruments identified through a scoping bibliographic search. The experts were required to identify essential aspects for critically appraising clinical trials on DMDs for MS.

Results

The expert panel consisted of nine independent leading Spanish experts with long-standing experience with MS (five neurologists, a neuroradiologist, a pharmacologist, a research methodologist and an MS community representative). The e-Delphi study resulted in consensus recommendations intended to help readers in answering five major questions: “Is the study free of bias?”; “Are the included patients adequate?”; “Are the outcome measures appropriate?”; “Are the results relevant?”; and “Is the study transparent?”.

Conclusion

This study proposes consensus recommendations intended to guide neurologists in the critical reading of phase III and IV clinical trials on DMDs for MS.

近年来，批准用于多发性硬化症（MS）的疾病调节药物（dmd）数量有所增加。其安全性和有效性的证据已经通过几次III期和IV期临床试验获得。获得评估的技能对于临床医生评估患者最相关的治疗是必不可少的。本研究的目的是为这些试验的批判性阅读提供指导。方法采用三轮e-Delphi法。在筹备阶段，设立了一个多学科专家小组。小组成员是根据他们的科学资历和经验选择的，力求包括参与MS诊断、治疗和研究的人员。一份半开放式问卷是基于通过范围界定书目检索确定的关键通用和ms特有的方法学工具开发的。结果专家组由9位具有长期多发性硬化症治疗经验的西班牙独立权威专家组成（5位神经科医生、1位神经放射学家、1位药理学家、1位研究方法学家和1位多发性硬化症社区代表）。e-Delphi研究得出了一致的建议，旨在帮助读者回答五个主要问题：“研究是否没有偏见？”“纳入的病人足够吗？”“结果衡量标准是否合适？”“结果相关吗？”以及“研究是否透明？”本研究提出了共识性建议，旨在指导神经科医生对dmd治疗多发性硬化症的III期和IV期临床试验进行批判性阅读。

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引用次数: 0

Impacto de la fatiga en la calidad de vida en los adultos con esclerosis múltiple remitente recurrente 疲劳对成人多发性硬化症复发患者生活质量的影响

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-11-01 DOI: 10.1016/j.nrl.2023.06.011

R. Piñar-Morales , P.A. Guirado Ruíz , F.J. Barrero Hernández

Introduction

Fatigue in multiple sclerosis (MS) is defined as the lack of physical and/or mental energy perceived by the individual that interferes with normal activities. It is the most common symptom in MS, present up to 90% of people with MS. Fatigue along with disability, depression, cognitive impairment, and disease-modifying therapy (DMT) affect quality of life (QoL).

Method

We designed a prospective observational study in patients with MS and DMT of moderate efficacy to assess the association between fatigue and the epidemiological, clinical, and pharmacological aspects that influence in the QoL. We analyzed variables related to patients, disability, fatigue (MFIS), clinical and radiological activity, depression (BDI), cognitive impairment (SDMT), and QoL (EQ-5D).

Results

We included 91 people, 65.9% women, mean age 43.9 years. The DMT were: 27.4% interferon-β, 15.38% glatiramer acetate, 9.89% teriflunomide, and 47.25% dimethyl fumarate. The median of the EDSS was 1.5 points. 40.9% have presented fatigue, 36.3% cognitive deterioration and 30.7% of the patients depression.

Conclusions

Patients with fatigue are older, more disabled, have a higher prevalence of depression and worse QoL. Evolution time, relapses, MRI lesion load, and DMTs are not associated with fatigue. Fatigue is a frequent symptom in patients with MS that influences in the QoL, hence the importance of its diagnosis and treatment.

多发性硬化症（MS）的疲劳被定义为个体感觉到的身体和/或精神能量的缺乏，干扰了正常的活动。它是多发性硬化症中最常见的症状，高达90%的多发性硬化症患者存在疲劳、残疾、抑郁、认知障碍和疾病改善治疗（DMT）影响生活质量（QoL）。方法我们设计了一项前瞻性观察研究，对中度疗效的MS和DMT患者进行研究，以评估疲劳与影响生活质量的流行病学、临床和药理学方面的关系。我们分析了与患者、残疾、疲劳（MFIS）、临床和放射活动、抑郁（BDI）、认知障碍（SDMT）和生活质量（EQ-5D）相关的变量。结果纳入91例，女性65.9%，平均年龄43.9岁。DMT分别为：干扰素-β 27.4%，醋酸格拉替雷默15.38%，特立氟米特9.89%，富马酸二甲酯47.25%。EDSS的中位数为1.5点。40.9%的患者表现为疲劳，36.3%的患者表现为认知能力下降，30.7%的患者表现为抑郁。结论疲劳患者年龄大，残疾程度高，抑郁患病率高，生活质量差。发展时间、复发、MRI病变负荷和dmt与疲劳无关。疲劳是影响MS患者生活质量的常见症状，因此其诊断和治疗具有重要意义。

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引用次数: 0

Tendencia de la mortalidad por esclerosis múltiple según sexo: Chile 1997-2019 按性别分列的多发性硬化症死亡率趋势：智利1997-2019年

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-11-01 DOI: 10.1016/j.nrl.2023.04.008

J. Arriagada Opazo , V. Farah González , M. González Delgadillo , L. Núñez-Franz , C. Morales Garcia , P. Jiménez Rodríguez

Background

An increasing trend has been observed in the prevalence of Multiple Sclerosis (MS) globally. It is estimated that a total of 2.8 million people live with MS worldwide. In 2008, Chile started a pilot program for the Modifying Therapy of MS, and its clinical practice guideline.

Aim

This study aims to analyze the trend of the MS mortality rate in Chile from 1997 to 2019 disaggregated by sex and latitude.

Methods

MS mortality data (ICD-10, G35) from 1997-2019 were extracted from the Department of Health Statistical Information and population data from the National Institute of Statistics. Standardized mortality rates (SMRs) by age were calculated. The trend of the SMR was analyzed using Joinpoint and with RiskDiff the effect of the risk of dying, the structure, and the size of the population on the crude mortality rate was evaluated.

Results

The trend of the TME has been decreasing significantly since 2005. When disaggregating by sex the decrease was not significant. According to latitude, the north and center south have a significant decreasing trend; in the south, the decreasing trend is not significant. There is an increase of 25% in the crude mortality rate due to the change in the structure of the population and a decrease of 25.46% is attributed to the risk of dying.

Conclusion

The SMR due to MS in Chile during 1997-2019 has decreased, in addition, a decreasing SMR is evidenced only in the northern zone. The crude rate has increased as a consequence of changes in the population, however, the risk of dying has decreased, especially in men.

全球多发性硬化症（MS）患病率呈上升趋势。据估计，全球共有280万人患有多发性硬化症。2008年，智利启动了多发性硬化症改良疗法的试点项目及其临床实践指南。目的本研究旨在分析1997 - 2019年智利按性别和纬度分类的多发性硬化症死亡率趋势。方法从卫生统计信息部和国家统计局的人口数据中提取1997-2019年的sms死亡率数据（ICD-10, G35）。按年龄计算标准化死亡率（SMRs）。采用Joinpoint和RiskDiff分析了死亡风险、人口结构和人口规模对粗死亡率的影响。结果2005年以来TME呈明显下降趋势。当按性别分类时，下降不显著。从纬度上看，北部和中部南部有明显的下降趋势；在南方，下降趋势不明显。由于人口结构的变化，粗死亡率增加了25%，死亡风险降低了25.46%。结论1997-2019年智利因多发性硬化引起的SMR呈下降趋势，且仅在北部地区有所下降。由于人口的变化，粗死亡率有所上升，然而，死亡的风险却有所下降，特别是在男性中。

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