Pub Date : 2025-10-01DOI: 10.1016/j.nrl.2023.02.014
E. Goufa , A. Chentouf , S. Belabbas , W. Boughrara
Introduction
Muslims all over the world practice fasting during Ramadan yearly. A plethora of studies have reported severe worsening of migraine attacks cases due to fasting. The aim is to investigate the effect of Ramadan fasting on migraine frequency and severity among practicing Muslim migraine sufferers.
Methods
This is a cross-sectional study conducted during the month of Ramadan of the year 2021. This research project has included adult patients meeting the migraine criteria of “International Classification of Headache Disorders, 3rd edition”. The frequency and severity of migraine headache were compared to the month preceding Ramadan. In order to analyse the factors associated with breaking the fast motivated by migraine headache during Ramadan, a logistic regression analysis was performed.
Results
The study has included 101 migraine sufferers with a clear female predominance. The average duration of migraine was 9 ± 2 years. Compared to the month of Shaban, we noted an increase in the number of attacks, the number of headache days, and the number of days with analgesic medication taken to relieve the attacks. However, the severity and duration of headache did not change significantly between the two months. Most patients changed their eating and sleeping habits during Ramadan. Twenty-two patients broke the fast for several days due to headaches. Ramadan fasting aggravates the frequency of migraine attacks among practicing Algerian Muslims.
Conclusion
Physicians should educate their migraine patients on the importance of lifestyle measures to better manage their headaches during Ramadan.
{"title":"Impact of fasting during Ramadan on migraine in the Algerian population","authors":"E. Goufa , A. Chentouf , S. Belabbas , W. Boughrara","doi":"10.1016/j.nrl.2023.02.014","DOIUrl":"10.1016/j.nrl.2023.02.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Muslims all over the world practice fasting during Ramadan yearly. A plethora of studies have reported severe worsening of migraine attacks cases due to fasting. The aim is to investigate the effect of Ramadan fasting on migraine frequency and severity among practicing Muslim migraine sufferers.</div></div><div><h3>Methods</h3><div>This is a cross-sectional study conducted during the month of Ramadan of the year 2021. This research project has included adult patients meeting the migraine criteria of “International Classification of Headache Disorders, 3rd edition”. The frequency and severity of migraine headache were compared to the month preceding Ramadan. In order to analyse the factors associated with breaking the fast motivated by migraine headache during Ramadan, a logistic regression analysis was performed.</div></div><div><h3>Results</h3><div>The study has included 101 migraine sufferers with a clear female predominance. The average duration of migraine was 9<!--> <!-->±<!--> <!-->2 years. Compared to the month of Shaban, we noted an increase in the number of attacks, the number of headache days, and the number of days with analgesic medication taken to relieve the attacks. However, the severity and duration of headache did not change significantly between the two months. Most patients changed their eating and sleeping habits during Ramadan. Twenty-two patients broke the fast for several days due to headaches. Ramadan fasting aggravates the frequency of migraine attacks among practicing Algerian Muslims.</div></div><div><h3>Conclusion</h3><div>Physicians should educate their migraine patients on the importance of lifestyle measures to better manage their headaches during Ramadan.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 762-767"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.nrl.2023.01.004
M. Marín-Gracia , N.L. Ciano-Petersen , P. Cabezudo-García , V. Fernández-Sánchez , J.A. Salazar-Benítez , R. Muñoz-Zea , M. Vidal-Denis , G. García-Martín , M.J. Postigo-Pozo , N. García-Casares , A. Gutierrez-Cardo , P.J. Serrano-Castro
Introduction
Late-onset Rasmussen encephalitis (LORE) is a rare, unihemispheric, progressive, inflammatory disorder causing severe neurological dysfunction and drug-resistant epilepsy with onset during late adolescence or adulthood. Due to the scarcity of available evidence, this study aims to improve its clinical characterization and summarize the distinctive features.
Development
Three illustrative cases are presented, including the clinical, neurophysiological, and neuroimaging work-up. Our findings are discussed with reference to previous evidence gathered through a comprehensive search.
The reported patients presented adult onset within a wide age range. The initial clinical manifestation was variable, including refractory focal epilepsy, progressive hemiparesis, and epilepsia partialis continua, in line with previous findings. Progressive hemiatrophy with frontal or posterior predominance in MRI and extensive hypometabolism in functional neuroimaging were documented. Unihemispheric slow background activity and epileptiform discharges progressively developed during the long-term follow-up, as described in the literature. According to the European consensus diagnostic criteria, 2 patients met the Part A and one the Part B criteria. As reported in previous publications, slower neurological decline was observed with immunotherapy.
Conclusions
Despite the wide range of clinical manifestations at onset, overall, LORE presents milder neurological deterioration and responds favorably to immunotherapy, which implies a better prognosis. Further studies are needed to establish the best strategy.
{"title":"Late-onset Rasmussen encephalitis: 3 illustrative cases and a review of the literature","authors":"M. Marín-Gracia , N.L. Ciano-Petersen , P. Cabezudo-García , V. Fernández-Sánchez , J.A. Salazar-Benítez , R. Muñoz-Zea , M. Vidal-Denis , G. García-Martín , M.J. Postigo-Pozo , N. García-Casares , A. Gutierrez-Cardo , P.J. Serrano-Castro","doi":"10.1016/j.nrl.2023.01.004","DOIUrl":"10.1016/j.nrl.2023.01.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Late-onset Rasmussen encephalitis (LORE) is a rare, unihemispheric, progressive, inflammatory disorder causing severe neurological dysfunction and drug-resistant epilepsy with onset during late adolescence or adulthood. Due to the scarcity of available evidence, this study aims to improve its clinical characterization and summarize the distinctive features.</div></div><div><h3>Development</h3><div>Three illustrative cases are presented, including the clinical, neurophysiological, and neuroimaging work-up. Our findings are discussed with reference to previous evidence gathered through a comprehensive search.</div><div>The reported patients presented adult onset within a wide age range. The initial clinical manifestation was variable, including refractory focal epilepsy, progressive hemiparesis, and epilepsia partialis continua, in line with previous findings. Progressive hemiatrophy with frontal or posterior predominance in MRI and extensive hypometabolism in functional neuroimaging were documented. Unihemispheric slow background activity and epileptiform discharges progressively developed during the long-term follow-up, as described in the literature. According to the European consensus diagnostic criteria, 2 patients met the Part A and one the Part B criteria. As reported in previous publications, slower neurological decline was observed with immunotherapy.</div></div><div><h3>Conclusions</h3><div>Despite the wide range of clinical manifestations at onset, overall, LORE presents milder neurological deterioration and responds favorably to immunotherapy, which implies a better prognosis. Further studies are needed to establish the best strategy.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 7","pages":"Pages 686-699"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.nrl.2023.01.005
J. Madera, S. Pérez Pereda, V. González Quintanilla, A. González Suárez, E. Benito, J. Pascual
Introduction
There are practically no series of cluster headache (CH) in our country. Our aim was to longitudinally describe the characteristics of patients with CH seen in our Hospital since 1980.
Methods
Retrospective analysis of the clinical charts of patients diagnosed as CH.
Results
We included 153 patients diagnosed as CH. 137 (89,5%) males, with a mean age (MA) at diagnosis of 39.5 years (mean deviation 11.4) and a MA at the beginning of the symptoms of 32.8 years (mean deviation 11.3). 128 suffered from episodic CH (eCH; 92.2% males) and 25 chronic CH (cCH; 76% males). The MA at the beginning was delayed in cCH as compared with eCH (37.6 versus 31.8; P=.023). Four patients (2.6%) had familial antecedents. Only 3 (2%) referred to visual aura. At diagnosis, 66% were smokers and 15% heavy alcohol drinkers. The median duration of cluster period was 60 days, with a median frequency of every 2 years. 16 cases (10.5%) presented a benign course with only one cluster period.
Conclusions
The minimal prevalence of CH in our area was 0.05%, with eCH being the most frequent phenotype. Up to one out of 10 patients showed a benign form with just one cluster period. The diagnostic delay close to 7 years indicates an insufficient recognition of this entity. A high proportion of CH patients showed, already at diagnosis, unhealthy life habits. Cluster periods lasted an average of 2 months and occurred approximately every 2 years. A late beginning and being a woman were associated with the variant of cCH.
{"title":"Cuatro décadas de experiencia con la cefalea en racimos: descripción de una serie de un hospital de tercer nivel","authors":"J. Madera, S. Pérez Pereda, V. González Quintanilla, A. González Suárez, E. Benito, J. Pascual","doi":"10.1016/j.nrl.2023.01.005","DOIUrl":"10.1016/j.nrl.2023.01.005","url":null,"abstract":"<div><h3>Introduction</h3><div>There are practically no series of cluster headache (CH) in our country. Our aim was to longitudinally describe the characteristics of patients with CH seen in our Hospital since 1980.</div></div><div><h3>Methods</h3><div>Retrospective analysis of the clinical charts of patients diagnosed as CH.</div></div><div><h3>Results</h3><div>We included 153 patients diagnosed as CH. 137 (89,5%) males, with a mean age (MA) at diagnosis of 39.5 years (mean deviation 11.4) and a MA at the beginning of the symptoms of 32.8 years (mean deviation 11.3). 128 suffered from episodic CH (eCH; 92.2% males) and 25 chronic CH (cCH; 76% males). The MA at the beginning was delayed in cCH as compared with eCH (37.6 versus 31.8; <em>P</em>=.023). Four patients (2.6%) had familial antecedents. Only 3 (2%) referred to visual aura. At diagnosis, 66% were smokers and 15% heavy alcohol drinkers. The median duration of cluster period was 60 days, with a median frequency of every 2 years. 16 cases (10.5%) presented a benign course with only one cluster period.</div></div><div><h3>Conclusions</h3><div>The minimal prevalence of CH in our area was 0.05%, with eCH being the most frequent phenotype. Up to one out of 10 patients showed a benign form with just one cluster period. The diagnostic delay close to 7 years indicates an insufficient recognition of this entity. A high proportion of CH patients showed, already at diagnosis, unhealthy life habits. Cluster periods lasted an average of 2 months and occurred approximately every 2 years. A late beginning and being a woman were associated with the variant of cCH.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 7","pages":"Pages 613-619"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.nrl.2023.08.004
J. García-de Soto , G. Fernández Pajarín , D.A. García Estévez , Á. Sesar-Ignacio
{"title":"Distonía con respuesta a dopa y parkinsonismo juvenil en una paciente con mutación en heterocigosis en SPR y PRKN tratada con estimulación palidal","authors":"J. García-de Soto , G. Fernández Pajarín , D.A. García Estévez , Á. Sesar-Ignacio","doi":"10.1016/j.nrl.2023.08.004","DOIUrl":"10.1016/j.nrl.2023.08.004","url":null,"abstract":"","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 7","pages":"Pages 713-715"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.nrl.2023.05.007
P. Mayo Rodríguez , M. Romeral Jiménez , B. Parejo Carbonell , C. Lastras Fernández-Escandón , R. Sánchez-del-Hoyo , I. García Morales
Objective
Analyse the current status of the management of urgent epileptic seizures (ES) in a tertiary referral hospital in the Community of Madrid at each stage of the care process and by the different medical teams involved, including out-of-hospital emergency services, hospital emergency departments and neurology teams.
Method
Cross-sectional descriptive study with a subsequent 30-day prospective longitudinal follow-up of a consecutive sample of patients with urgent EC, recruited between October 2021 and March 2022.
Results
Fifty-three patients were included. The mean age was 57.6 (21.2) years. 39.6% were women. 35.8% had a previous diagnosis of epilepsy. The most frequent cause of urgent ES was high-risk seizures (57%), followed by status epilepticus (24%) and cluster seizures (19%). A total of 90.5% of the seizures occurred in the out-of-hospital setting. The median time between ES and emergency services assessment was 40 (27–78) min, and between ES and neurology assessment 165 (97.5–290) min. 86.8% were treated with benzodiazepines and 81.1% with at least one anti-crisis medication. Urgent video-EEG monitoring was performed in 60.4%. The most frequent destination after emergency management was hospital discharge (47.2%), followed by hospitalisation (39.6%). At 30 days, 20.8% of patients had a new ES and 5.7% had died.
Conclusions
Analysis of the current state of emergency EC management shows significant delays at all levels, both in assessment and drug administration.
{"title":"Manejo actual de las crisis epilépticas urgentes en un hospital de tercer nivel de la Comunidad de Madrid, estudio descriptivo","authors":"P. Mayo Rodríguez , M. Romeral Jiménez , B. Parejo Carbonell , C. Lastras Fernández-Escandón , R. Sánchez-del-Hoyo , I. García Morales","doi":"10.1016/j.nrl.2023.05.007","DOIUrl":"10.1016/j.nrl.2023.05.007","url":null,"abstract":"<div><h3>Objective</h3><div>Analyse the current status of the management of urgent epileptic seizures (ES) in a tertiary referral hospital in the Community of Madrid at each stage of the care process and by the different medical teams involved, including out-of-hospital emergency services, hospital emergency departments and neurology teams.</div></div><div><h3>Method</h3><div>Cross-sectional descriptive study with a subsequent 30-day prospective longitudinal follow-up of a consecutive sample of patients with urgent EC, recruited between October 2021 and March 2022.</div></div><div><h3>Results</h3><div>Fifty-three patients were included. The mean age was 57.6 (21.2) years. 39.6% were women. 35.8% had a previous diagnosis of epilepsy. The most frequent cause of urgent ES was high-risk seizures (57%), followed by status epilepticus (24%) and cluster seizures (19%). A total of 90.5% of the seizures occurred in the out-of-hospital setting. The median time between ES and emergency services assessment was 40 (27–78)<!--> <!-->min, and between ES and neurology assessment 165 (97.5–290)<!--> <!-->min. 86.8% were treated with benzodiazepines and 81.1% with at least one anti-crisis medication. Urgent video-EEG monitoring was performed in 60.4%. The most frequent destination after emergency management was hospital discharge (47.2%), followed by hospitalisation (39.6%). At 30 days, 20.8% of patients had a new ES and 5.7% had died.</div></div><div><h3>Conclusions</h3><div>Analysis of the current state of emergency EC management shows significant delays at all levels, both in assessment and drug administration.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 7","pages":"Pages 661-667"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.nrl.2024.08.002
M. Suárez-Calvet , C. Abdelnour , D. Alcolea , M. Mendióroz-Iriarte , M. Balasa , E. Morenas-Rodríguez , A. Puig-Pijoan , P. Sánchez-Juan , A. Villarejo-Galende , R. Sánchez-Valle , por el Grupo de trabajo en biomarcadores en sangre del Grupo de Estudio de Conducta y Demencias de la Sociedad Española de Neurología
Introduction
The development of blood biomarkers for detecting Alzheimer's disease (AD) represents one of the most significant recent advances, and some are already available for clinical practice. Therefore, the Grupo de Estudio de Conducta y Demencias de la Sociedad Española de Neurología has formed a working group to review the current status and develop consensus recommendations for their clinical implementation.
Development
This document was prepared by neurologists from the Grupo de Estudio de Conducta y Demencias de la Sociedad Española de Neurología in two phases. First, a coordinating group defined the basic guidelines of the document, agreed on initial recommendations based on a literature review, and drafted a preliminary version. Subsequently, the proposal was reviewed by the entire working group, all comments were considered, and the coordinating group adjusted the recommendations until consensus was achieved among the participants.
Conclusions
The consensus document highlights the importance of early diagnosis of AD. It recommends interpreting blood biomarkers in the patient's clinical context, not in isolation. Specialized units can start using them, but this should be accompanied by ongoing research. More data are needed for their use in general neurology and primary care. Their use is not recommended in asymptomatic individuals, population screenings, or as direct-to-consumer tests. Public health systems should facilitate their implementation through appropriate funding to ensure equitable access. This document should be understood as an initial framework subject to periodic updates as new data emerge.
用于检测阿尔茨海默病（AD）的血液生物标志物的开发是最近最重要的进展之一，其中一些已经可用于临床实践。因此，社会老年痴呆症研究小组Española de Neurología成立了一个工作组，审查目前的状况，并为其临床实施制定共识建议。该文件由社会痴呆症研究小组Española de Neurología的神经学家分两个阶段编写。首先，一个协调小组确定了文件的基本准则，在文献审查的基础上就初步建议达成一致，并起草了初步版本。随后，整个工作组对提案进行了审查，审议了所有意见，协调小组对建议进行了调整，直到与会者达成共识为止。结论共识文件强调了早期诊断AD的重要性。它建议在患者的临床背景下解释血液生物标志物，而不是孤立地。专业单位可以开始使用它们，但这应该伴随着正在进行的研究。它们在普通神经病学和初级保健中的应用需要更多的数据。不建议在无症状个体、人群筛查或直接面向消费者的检测中使用。公共卫生系统应通过提供适当资金以确保公平获取来促进其实施。本文档应被理解为一个初始框架，随着新数据的出现，需要定期更新。
{"title":"Biomarcadores en sangre para la enfermedad de Alzheimer: posicionamiento y recomendaciones de uso del Grupo de Estudio de Conducta y Demencias de la Sociedad Española de Neurología","authors":"M. Suárez-Calvet , C. Abdelnour , D. Alcolea , M. Mendióroz-Iriarte , M. Balasa , E. Morenas-Rodríguez , A. Puig-Pijoan , P. Sánchez-Juan , A. Villarejo-Galende , R. Sánchez-Valle , por el Grupo de trabajo en biomarcadores en sangre del Grupo de Estudio de Conducta y Demencias de la Sociedad Española de Neurología","doi":"10.1016/j.nrl.2024.08.002","DOIUrl":"10.1016/j.nrl.2024.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>The development of blood biomarkers for detecting Alzheimer's disease (AD) represents one of the most significant recent advances, and some are already available for clinical practice. Therefore, the <em>Grupo de Estudio de Conducta y Demencias de la Sociedad Española de Neurología</em> has formed a working group to review the current status and develop consensus recommendations for their clinical implementation.</div></div><div><h3>Development</h3><div>This document was prepared by neurologists from the <em>Grupo de Estudio de Conducta y Demencias de la Sociedad Española de Neurología</em> in two phases. First, a coordinating group defined the basic guidelines of the document, agreed on initial recommendations based on a literature review, and drafted a preliminary version. Subsequently, the proposal was reviewed by the entire working group, all comments were considered, and the coordinating group adjusted the recommendations until consensus was achieved among the participants.</div></div><div><h3>Conclusions</h3><div>The consensus document highlights the importance of early diagnosis of AD. It recommends interpreting blood biomarkers in the patient's clinical context, not in isolation. Specialized units can start using them, but this should be accompanied by ongoing research. More data are needed for their use in general neurology and primary care. Their use is not recommended in asymptomatic individuals, population screenings, or as direct-to-consumer tests. Public health systems should facilitate their implementation through appropriate funding to ensure equitable access. This document should be understood as an initial framework subject to periodic updates as new data emerge.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 7","pages":"Pages 700-712"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.nrl.2023.03.004
J.A. Gil-Montoya , M.J. Gerez-Muñoz , E. Triviño-Ibáñez , I. Carrera-Muñoz , M. Bravo , M. Rashki , P. Solis-Urra , I. Esteban-Cornejo , M. Gómez-Río
Introduction
Increases in brain β-amyloid protein (Aβ) levels have been demonstrated in animal models following oral inoculation of periodontopathogens or their enzyme gingipain. We investigated the association between periodontitis and brain Aβ protein levels in mild cognitive impairment (MCI).
Methods
An observational study was designed. All participants underwent a periodontal examination and an amyloid-PET scan. Subsequently, the following groups were established: MCI and suspected Alzheimer disease (AD) (MCI/Aβ+ group) (n = 45); MCI and suspected non-AD pathology (MCI/Aβ– group) (n = 59); cognitively healthy elderly individuals with negative PET-amyloid scan results (non-MCI/Aβ– group) (n = 60).
Results
Patients with moderate-severe periodontitis had a higher risk of abnormal accumulation of Aβ in the brain, with an odds ratio (OR) of 3.30 (95% confidence interval [CI], 1.30–8.26) when comparing patients from the MCI/Aβ+ and MCI/Aβ– groups, and an OR of 4.94 (95% CI, 1.65–14.84) when comparing the MCI/Aβ+ group against the non-MCI/Aβ– group.
Conclusions
Our findings suggest that periodontal disease may be associated with anomalous accumulation of cerebral Aβ protein in older people, independently of cognitive impairment.
在动物模型中，口腔接种牙周病病原体或其酶牙龈蛋白酶后，脑β-淀粉样蛋白（Aβ）水平升高。我们研究了轻度认知障碍（MCI）患者牙周炎与脑Aβ蛋白水平之间的关系。方法设计观察性研究。所有参与者都接受了牙周检查和淀粉样蛋白pet扫描。随后，建立以下组：MCI和疑似阿尔茨海默病（AD） （MCI/Aβ+组）（n = 45）；MCI和疑似非ad病理（MCI/Aβ -组）（n = 59）；认知健康老年人pet -淀粉样蛋白扫描结果阴性（非mci /Aβ -组）（n = 60）。结果中重度牙周炎患者发生脑内a β异常积聚的风险较高，MCI/ a β+组和MCI/ a β -组的比值比（OR）为3.30(95%可信区间[CI]， 1.30 ~ 8.26)， MCI/ a β+组与非MCI/ a β -组的比值比（OR）为4.94 （95% CI, 1.65 ~ 14.84）。结论牙周病可能与老年人大脑Aβ蛋白异常积累有关，与认知障碍无关。
{"title":"Periodontal disease and brain amyloid pathology in mild cognitive impairment","authors":"J.A. Gil-Montoya , M.J. Gerez-Muñoz , E. Triviño-Ibáñez , I. Carrera-Muñoz , M. Bravo , M. Rashki , P. Solis-Urra , I. Esteban-Cornejo , M. Gómez-Río","doi":"10.1016/j.nrl.2023.03.004","DOIUrl":"10.1016/j.nrl.2023.03.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Increases in brain β-amyloid protein (Aβ) levels have been demonstrated in animal models following oral inoculation of periodontopathogens or their enzyme gingipain. We investigated the association between periodontitis and brain Aβ protein levels in mild cognitive impairment (MCI).</div></div><div><h3>Methods</h3><div>An observational study was designed. All participants underwent a periodontal examination and an amyloid-PET scan. Subsequently, the following groups were established: MCI and suspected Alzheimer disease (AD) (MCI/Aβ+ group) (<em>n</em> <!-->=<!--> <!-->45); MCI and suspected non-AD pathology (MCI/Aβ– group) (<em>n</em> <!-->=<!--> <!-->59); cognitively healthy elderly individuals with negative PET-amyloid scan results (non-MCI/Aβ– group) (<em>n</em> <!-->=<!--> <!-->60).</div></div><div><h3>Results</h3><div>Patients with moderate-severe periodontitis had a higher risk of abnormal accumulation of Aβ in the brain, with an odds ratio (OR) of 3.30 (95% confidence interval [CI], 1.30–8.26) when comparing patients from the MCI/Aβ+ and MCI/Aβ– groups, and an OR of 4.94 (95% CI, 1.65–14.84) when comparing the MCI/Aβ+ group against the non-MCI/Aβ– group.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that periodontal disease may be associated with anomalous accumulation of cerebral Aβ protein in older people, independently of cognitive impairment.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 7","pages":"Pages 641-650"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.nrl.2023.11.012
D. Gonzalez-Calle , L. Nombela-Franco , H. Gutierrez-Garcia , V. Peral , J. Mesnier , G. Tirado-Conde , A. Barrero-Mier , A. Morcuende Gonzalez , G. O’Hara , L. López-Mesonero , P. Salinas , L. Sanchís , P. Cepas-Guillén , A. Laffond , X. Freixa , I. Amat-Santos , P.L. Sanchez , J. Rodes-Cabau , I. Cruz-Gonzalez
Background
Oral anticoagulation (OAC) use increases the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) and CHA2DS2-VASc ≥ 2. Left atrial appendage occlusion (LAAO) is an alternative to OAC, however data about its use in patients with prior ICH is scarce and the timing of its performance is controversial. Furthermore, the long-term outcomes in this group of patients have not been described previously.
Objective
To evaluate the safety and efficacy of LAAO in patients with non-valvular AF and prior ICH (CHA2DS2-VASc ≥ 2) and to determine adequate timing of its performance.
Methods
This is a multicenter retrospective registry that included 128 patients, whose indication for this procedure was ICH. Patients were divided into two groups: early occlusion (n = 31; 24.2%), in which the procedure was performed before 90 days had elapsed after the bleeding, and late occlusion (n = 97; 75.8%), after 90 days.
Results
Global procedural success was of 97% (124/128). Procedure-related complications occurred in 4 patients (3.15%): 2 cardiac tamponade, 1 device embolization and 1 transient ischemic attack during hospitalization. There was a significant reduction in the ischemic and bleeding rates compared to expected based on CHA2DS2-VASc and HASBLED scores (93.9% and 89.9% respectively) after a mean follow-up of 73.9 ± 34.1 months. There were no significant differences neither in baseline characteristics between the early and late occlusion groups nor in the procedural success or complications rates. Furthermore, no statistically significant differences were found in mortality, ischemic events, or hemorrhage between the early and late occlusion group.
Conclusions
Left atrial appendage occlusion is an effective and safe treatment alternative to reduce the risk of ischemic stroke in selected patients with atrial fibrillation and prior intracranial hemorrhage. In this study, we did not find differences regarding safety and efficacy in early closure compared with late closure. Further studies are needed to support early closure to reduce the complications associated with oral anticoagulation withdrawal.
{"title":"Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing","authors":"D. Gonzalez-Calle , L. Nombela-Franco , H. Gutierrez-Garcia , V. Peral , J. Mesnier , G. Tirado-Conde , A. Barrero-Mier , A. Morcuende Gonzalez , G. O’Hara , L. López-Mesonero , P. Salinas , L. Sanchís , P. Cepas-Guillén , A. Laffond , X. Freixa , I. Amat-Santos , P.L. Sanchez , J. Rodes-Cabau , I. Cruz-Gonzalez","doi":"10.1016/j.nrl.2023.11.012","DOIUrl":"10.1016/j.nrl.2023.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Oral anticoagulation (OAC) use increases the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) and CHA<sub>2</sub>DS<sub>2</sub>-VASc ≥<!--> <!-->2. Left atrial appendage occlusion (LAAO) is an alternative to OAC, however data about its use in patients with prior ICH is scarce and the timing of its performance is controversial. Furthermore, the long-term outcomes in this group of patients have not been described previously.</div></div><div><h3>Objective</h3><div>To evaluate the safety and efficacy of LAAO in patients with non-valvular AF and prior ICH (CHA<sub>2</sub>DS<sub>2</sub>-VASc ≥<!--> <!-->2) and to determine adequate timing of its performance.</div></div><div><h3>Methods</h3><div>This is a multicenter retrospective registry that included 128 patients, whose indication for this procedure was ICH. Patients were divided into two groups: early occlusion (<em>n</em> <!-->=<!--> <!-->31; 24.2%), in which the procedure was performed before 90 days had elapsed after the bleeding, and late occlusion (<em>n</em> <!-->=<!--> <!-->97; 75.8%), after 90 days.</div></div><div><h3>Results</h3><div>Global procedural success was of 97% (124/128). Procedure-related complications occurred in 4 patients (3.15%): 2 cardiac tamponade, 1 device embolization and 1 transient ischemic attack during hospitalization. There was a significant reduction in the ischemic and bleeding rates compared to expected based on CHA<sub>2</sub>DS<sub>2</sub>-VASc and HASBLED scores (93.9% and 89.9% respectively) after a mean follow-up of 73.9<!--> <!-->±<!--> <!-->34.1 months. There were no significant differences neither in baseline characteristics between the early and late occlusion groups nor in the procedural success or complications rates. Furthermore, no statistically significant differences were found in mortality, ischemic events, or hemorrhage between the early and late occlusion group.</div></div><div><h3>Conclusions</h3><div>Left atrial appendage occlusion is an effective and safe treatment alternative to reduce the risk of ischemic stroke in selected patients with atrial fibrillation and prior intracranial hemorrhage. In this study, we did not find differences regarding safety and efficacy in early closure compared with late closure. Further studies are needed to support early closure to reduce the complications associated with oral anticoagulation withdrawal.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 7","pages":"Pages 668-675"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.nrl.2023.02.009
P. Carbonell-Corvillo , E. Rivas , M. Cabrera , A. García-Redondo , A. Fernández , C. Paradas
Introduction
Muscle MRI and electrophysiological exercise testing have been reported as useful techniques in hypokalemic periodic paralysis (HypoPP). Striking clinical differences between men and women with this disorder are well known; however, little information is available on complementary tests in the asymptomatic population.
Methods
We recruited 11 individuals with HypoPP from 4 independent families, carrying the frequent p.R528H mutation in the calcium channel gene CACNA1S; the sample included 8 symptomatic men and 3 asymptomatic women, together with 9 controls recruited from the same families. Muscle MRI and electrophysiological long exercise test results were evaluated in this homogeneous cohort.
Results
Muscle MRI showed a consistent pattern of atrophy and fatty infiltration mainly involving posterior compartment muscles of the thigh, with first involvement of the adductor magnus and semimembranosus, both in symptomatic and all the asymptomatic carriers, associated with age. The long exercise test showed a delayed decrement in compound muscle action potential amplitude and area in all carriers, regardless of the symptoms, with results becoming 100% sensitive after 35 min.
Conclusions
Our findings redefine the exercise test and muscle imaging findings in HypoPP due to the p.R528H CACNA1S mutation, with a particular focus on asymptomatic carriers, who displayed the same alterations as those described in symptomatic patients, thus highlighting their value as screening tools.
{"title":"Redefining periodic paralysis with CACNA1S mutation in a Spanish cohort","authors":"P. Carbonell-Corvillo , E. Rivas , M. Cabrera , A. García-Redondo , A. Fernández , C. Paradas","doi":"10.1016/j.nrl.2023.02.009","DOIUrl":"10.1016/j.nrl.2023.02.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Muscle MRI and electrophysiological exercise testing have been reported as useful techniques in hypokalemic periodic paralysis (HypoPP). Striking clinical differences between men and women with this disorder are well known; however, little information is available on complementary tests in the asymptomatic population.</div></div><div><h3>Methods</h3><div>We recruited 11 individuals with HypoPP from 4 independent families, carrying the frequent p.R528H mutation in the calcium channel gene <em>CACNA1S</em>; the sample included 8 symptomatic men and 3 asymptomatic women, together with 9 controls recruited from the same families. Muscle MRI and electrophysiological long exercise test results were evaluated in this homogeneous cohort.</div></div><div><h3>Results</h3><div>Muscle MRI showed a consistent pattern of atrophy and fatty infiltration mainly involving posterior compartment muscles of the thigh, with first involvement of the adductor magnus and semimembranosus, both in symptomatic and all the asymptomatic carriers, associated with age. The long exercise test showed a delayed decrement in compound muscle action potential amplitude and area in all carriers, regardless of the symptoms, with results becoming 100% sensitive after 35<!--> <!-->min.</div></div><div><h3>Conclusions</h3><div>Our findings redefine the exercise test and muscle imaging findings in HypoPP due to the p.R528H <em>CACNA1S</em> mutation, with a particular focus on asymptomatic carriers, who displayed the same alterations as those described in symptomatic patients, thus highlighting their value as screening tools.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 7","pages":"Pages 630-640"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.nrl.2024.03.001
L. Cayuela , E. Zapata-Arriaza , A. de Albóniga-Chindurza , A. González García , A. Cayuela
Background
This study aims to update and evaluate the age-period-cohort (A-P-C) effects on stroke mortality in Spain over the period 1982–2021.
Methods
Data on stroke mortality and population by age and sex were obtained from the database of the National Institute of Statistics for the years 1982–2021. Joinpoint trend analysis software from the US National Cancer Institute was used to estimate the rates and their time trends. The effects of age, period, and cohort were estimated using a log-linear Poisson model with a likelihood penalty function to address the problem of identifiability.
Results
For both sexes (−4.3% for men and −4.6% for women), age-standardized mortality rates (all ages) decreased over the study period. With the exception of the 30–64 age group, where rates for women have been stable since 2012, the rate of decline has slowed in recent years for both sexes.
Since the beginning of the 20th century, the estimated relative risk in birth cohorts for both sexes followed a steady downward trend for all birth cohorts. However, the decline in risk has slowed down for women born between 1947 and 1962. Both men and women have experienced a decline in RR, which has stabilized (women) or slowed down (men) in the last decade.
Conclusions
Both period and cohort effects are present in the decline in Spanish stroke mortality between 1982 and 2021. It is unlikely that the decrease in mortality has offset the possible increase in incidence in younger cohorts. This has led to a slowing (in men) or stagnation (in women) of the current decline in stroke mortality. Therefore, we must continue to focus on prevention.
{"title":"Understanding stroke mortality trends in Spain: A comprehensive age-period-cohort and joinpoint analysis","authors":"L. Cayuela , E. Zapata-Arriaza , A. de Albóniga-Chindurza , A. González García , A. Cayuela","doi":"10.1016/j.nrl.2024.03.001","DOIUrl":"10.1016/j.nrl.2024.03.001","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to update and evaluate the age-period-cohort (A-P-C) effects on stroke mortality in Spain over the period 1982–2021.</div></div><div><h3>Methods</h3><div>Data on stroke mortality and population by age and sex were obtained from the database of the National Institute of Statistics for the years 1982–2021. Joinpoint trend analysis software from the US National Cancer Institute was used to estimate the rates and their time trends. The effects of age, period, and cohort were estimated using a log-linear Poisson model with a likelihood penalty function to address the problem of identifiability.</div></div><div><h3>Results</h3><div>For both sexes (−4.3% for men and −4.6% for women), age-standardized mortality rates (all ages) decreased over the study period. With the exception of the 30–64 age group, where rates for women have been stable since 2012, the rate of decline has slowed in recent years for both sexes.</div><div>Since the beginning of the 20th century, the estimated relative risk in birth cohorts for both sexes followed a steady downward trend for all birth cohorts. However, the decline in risk has slowed down for women born between 1947 and 1962. Both men and women have experienced a decline in RR, which has stabilized (women) or slowed down (men) in the last decade.</div></div><div><h3>Conclusions</h3><div>Both period and cohort effects are present in the decline in Spanish stroke mortality between 1982 and 2021. It is unlikely that the decrease in mortality has offset the possible increase in incidence in younger cohorts. This has led to a slowing (in men) or stagnation (in women) of the current decline in stroke mortality. Therefore, we must continue to focus on prevention.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 7","pages":"Pages 676-685"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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