Revista de neurologia最新文献

Background: The aim of this study was to determine the use and safety of triptans in a group of patients with migraine who had excessive dispensings of antimigraine drugs.

Methods: This was a cross-sectional study of patients with excessive dispensings of triptans identified by a pharmaceutical manager. The DrugBank database was used to determine rational amounts of triptans.

Results: A total of 9147 patients used triptans, 44.6% of whom received excessive dispensings. A sample of 355 patients was selected, 22.8% of whom received regular doses of triptans daily. Adverse events were common (41.1%), and some patients experienced chronic headache (32.4%) and medication-overuse headache (MOH) (8.2%). Increasing age [adjusted odds ratio (aOR): 1.042; 95% confidence interval (CI): 1.008-1.077], a history of migraine for more than 10 years (aOR: 3.73; 95% CI: 1.37-10.16), previous dispensings of simple analgesics (aOR: 2.463; 95% CI: 1.001-6.057), and concomitant psychiatric illnesses (aOR: 3.583; 95% CI: 1.452-8.844) were associated with a higher probability of MOH.

Conclusions: In this study conducted in a middle- to low-income Latin American country, triptans were commonly dispensed for patients with migraine, and their dosage did not comply with the recommendations of clinical practice guidelines for some patients. Increasing age, history of migraine ≥10 years, previous use of simple analgesics, and the presence of concomitant psychiatric disorders were associated with a higher probability of MOH. These findings reflect prescribing and dispensing patterns within the studied health-care context and may not fully represent the use of over-the-counter triptans or practices in other settings.

Introduction: Risdiplam is a pharmacological agent developed for the treatment of spinal muscular atrophy (SMA) associated with 5q deletion, with the therapeutic objective of increasing the concentration of the survival motor neuron 2 protein. Most clinical trials and real-world studies have focused on pediatric and young adult populations. Our aim was to assess the effectiveness of risdiplam treatment in adult patients with SMA type IIb and III.

Methods: We studied 8 adult patients with SMA (3 females/5 males). Patient functionality was assessed using the Egen Klassifikation version 2 (EK2) scale, upper limb function with the 9-hole peg test (9HPT, seconds), and respiratory function with peak flow (L/min) and sniff nasal inspiratory pressure (SNIP, cmH₂O). Plasma levels of neurofilament light chain (NFL, pg/mL) and glial fibrillary acidic protein (GFAP, pg/mL) were also measured. Patients were evaluated at baseline, and after 6 and 12 months of treatment.

Results: The median age was 55 years (range: 41-66). At 12 months, EK2 scores showed a trend toward improvement in swallowing [item 16] (p = 0.06), peak flow increased significantly (244 ± 112 vs. 259 ± 124 L/min, p = 0.036), and there was a trend toward decreased NFL levels (11.4 ± 4.9 vs. 9.4 ± 2.7 pg/mL, p = 0.093). Both NFL and GFAP concentrations were negatively correlated with peak flow and SNIP values.

Conclusions: In our series, treatment with risdiplam may stabilize adult patients with type IIb-III SMA.

Background: There is considerable interest in the underlying mechanisms of cryptogenic stroke, with hypercoagulable states being widely studied. An elevated level of Factor VIII has been proposed as a potential prothrombotic marker associated with ischemic stroke. The aim of this study was to investigate the association between elevated Factor VIII levels and ischemic stroke and etiological subtype.

Subjects and methods: This retrospective observational study was conducted on subjects treated for ischemic stroke in the stroke unit of our institute between October 2018 and October 2023. Coagulative Factor VIII levels outside the acute phase (≥3 months) were measured, with elevated levels defined as >150%. Stroke etiologies (cryptogenic and non-cryptogenic: atherothrombotic, cardioembolic, lacunar, unusual, and coexistent causes), main cardiovascular risk factors, and prothrombotic biomarkers (protein C, protein S, antithrombin, anticardiolipin antibodies, anti-beta2-glycoprotein, lupus anticoagulant, and D-dimer) were recorded. Patients were categorized based on their level of coagulation Factor VIII (>150% vs. ≤150%). A comparative analysis was then conducted to assess differences associated with Factor VIII level.

Results: A total of 68 patients were included, with a median age of 50.3 ± 12.2 years and a predominance of males (66.2%). The most frequent etiology was cryptogenic stroke (54.4%), followed by atherothrombotic (13.2%) and unusual causes (11.8%). Elevated Factor VIII levels were observed in 41.2% of patients. No significant associations were found between elevated Factor VIII and cryptogenic stroke (p = 0.27), stroke subtype (p = 0.38), comorbidities, or other thrombophilia biomarkers. However, a weak correlation was observed between elevated Factor VIII and antithrombin levels outside the normal range (p = 0.039), and a significant association was found between Factor VIII levels and prior atrial fibrillation (AF, p = 0.04).

Conclusions: Although a high coagulation Factor VIII level was frequently observed in patients with ischemic stroke, this was not associated with cryptogenic stroke in the present cohort. Further studies with a larger sample size are warranted to clarify whether elevated Factor VIII is independently associated with ischemic stroke subtype, and whether elevated levels are a secondary finding related to inflammatory or systemic factors.

Background: Parkinson's disease (PD) is increasingly being diagnosed in older adults. Despite this trend, the clinical features of geriatric patients with PD are not thoroughly defined. This study aimed to compare the clinical characteristics of geriatric patients (aged ≥75 years) with de novo PD against those of non-geriatric patients (aged <75 years) newly diagnosed with PD.

Methods: This retrospective analysis enrolled 110 patients aged 50 years or older with de novo PD from our hospital's Parkinsonism registry between 2017 and 2023. Clinical evaluations included motor assessment via the Unified Parkinson's Disease Rating Scale Part III and global cognitive function was measured using the Montreal Cognitive Assessment (MoCA). Nonmotor symptoms, including depression, anxiety, and fatigue, were assessed using other scales and autonomic dysfunction was assessed using the Scale for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT).

Results: Geriatric patients with PD (n = 37) exhibited significantly lower cognitive performance (lower MoCA scores, p < 0.001) and more pronounced autonomic dysfunction (higher SCOPA-AUT scores, p = 0.0103) in comparison with non-geriatric PD patients (n = 73). In multivariate logistic regression analysis, lower MoCA scores (odds ratio [OR]: 0.7642, 95% confidence interval [CI]: 0.6712-0.8701, p < 0.001) and elevated SCOPA-AUT scores (OR: 1.0640, 95% CI: 1.0031-1.1286, p = 0.0391) emerged as significant independent predictors of geriatric PD.

Conclusions: These findings reveal a distinct clinical phenotype among geriatric patients with de novo PD, underscoring the value of early detection and proactive management of cognitive and autonomic impairments in this group. The results further emphasize the need for individualized assessment and therapeutic interventions tailored to the specific requirements of geriatric patients with PD.

Introduction: The XVII edition of the post-European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) meeting was held on 4-5 October 2024 in Madrid. This event was attended by Spanish neurologists specialized in multiple sclerosis (MS), who presented a summary of the most relevant advances discussed at the ECTRIMS congress, held days before in Copenhagen.

Aim: To present new developments in neurodegeneration and progression, the prodromal phase and diagnosis, the clinical use of biomarkers and neuroimaging, as well as the current role of patient-reported outcomes and digital monitoring. Highlights on the risk of infections and comorbidities in MS are also summarized. Content and Conclusions: In active MS lesions, there is no correlation between the myeloid cell phenotype and remyelination, while memory astrocytes, regulated by the CLEC16A gene, are present in chronic active lesions. Gray matter atrophy is associated with disability and progression independent of relapses, whereas cervical spinal cord atrophy predicts the prognosis of progressive forms and may lead to earlier diagnosis. Healthcare resource utilization increases in the years preceding the first demyelinating event, and although prodromal symptoms are highly variable, they are useful in identifying risk factors for the disease. The new McDonald criteria will facilitate the diagnosis of MS in patients with a radiologically isolated syndrome. Glial fibrillary acidic protein complements neurofilaments, and both biomarkers could soon be standardized for use in clinical practice; paramagnetic rim lesions and slowly expanding lesions are promising imaging markers. In another area, patient-reported health outcomes are valuable, although they are subject to selection bias and the need to define boundaries for their use. Finally, the risk of infections increases before diagnosis and may worsen with certain treatments. Comorbidities in MS should be managed as an integral part of disease management.

Introduction: The XVII edition of the post-European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) meeting was held on 4-5 October 2024 in Madrid. This event was attended by Spanish neurologists specialized in multiple sclerosis (MS), who presented a summary of the most relevant advances discussed at the ECTRIMS congress, held days before in Copenhagen.

Aim: To summarize the main new findings in clinical research on MS. Content and Conclusions: The immunological changes throughout life and in response to MS treatments were analyzed. The impact of aging was also discussed, along with new developments related to symptomatic treatments, physical exercise, fatigue, and sleep disorders. Emphasis was placed on addressing ongoing challenges in measuring therapeutic failure and managing treatments for secondary progressive MS. Additionally, data from registries and real-world studies were presented, including new analyses on cladribine, highlighting the need to collect safety information. Regarding immune reconstitution therapies, mechanisms of action and the immune system's reconstitution process after treatment were explored. Finally, regarding therapeutic innovations, the first results from chimeric antigen receptor (CAR)-T cell therapy studies in MS were reported, representing a promising advancement in disease management.

Background: Persistent intracranial hypertension (ICH) is a difficulty that must frequently be faced in the neuro- intensive care unit (ICU). The management of ICH is quite varied, and the choice of measures is determined by the experience of attending doctors. We aimed to evaluate the efficacy of different intervention measures in treating non-traumatic persistent ICH.

Methods: A total of 119 non-traumatic intracranial hypertension cases treated in the neuro-ICU of the PLA General Hospital between 2010 and 2023 were retrospectively reviewed. Patients were divided into five groups according to the methods for controlling intracranial pressure (ICP). Based on the records of ICP, biochemical indicators, general status, and prognosis of patients in each group, the differences between groups and the differences within groups before and after intervention were compared. Repeated measures data of multiple groups were analyzed using generalized estimating equation (GEE) methods.

Results: External ventricular drain (EVD), lumbar drainage (LD) and Ommaya reservoir (OR) had advantages in reducing ICP compared with the drug therapy alone (DT) group. Among them, the Ommaya reservoir exhibited optimal efficacy. Intervention with repeated lumbar puncture (LP) and the Ommaya reservoir effectively improved the general state of patients, evidenced by decreased mRS scores. The median creatinine value in the OR group decreased significantly at three months, suggesting that this method can moderate the renal burden. The OR group had the lowest probability of electrolyte imbalances and renal function damage, while the LD and EVD groups had a higher probability of pulmonary infection.

Conclusions: The Ommaya reservoir is an effective and safe means of controlling ICP and thus has great potential in treating non-traumatic persistent ICH.

Purpose: Surgical revascularization is the preferred treatment for most patients with Moyamoya disease (MMD). Nevertheless, a considerable number of eligible patients choose non-surgical management. This study aimed to identify factors influencing treatment decisions, with particular emphasis on asymptomatic MMD patients.

Materials and methods: We conducted a retrospective analysis of MMD patients without surgical contraindications treated at our center between 2010 and 2022. Baseline characteristics were compared using Wilcoxon rank-sum and chi-squared tests. Multivariable logistic regression was used to identify factors associated with treatment selection.

Results: Among the 147 included patients, 62.6% underwent surgical treatment. Younger age (OR = 0.88, 95% CI: 0.88-0.94, p < 0.001), married status (OR = 653.3, 95% CI: 41.61-10,264.22, p < 0.001), and absence of hyperlipidemia (OR = 0.16, 95% CI: 0.03-0.85, p < 0.05) were significantly associated with choosing surgery. Asymptomatic patients underwent surgery at a higher rate than symptomatic patients (67.9% vs. 59.6%). Younger age was a significant predictor of surgical preference in both symptomatic and asymptomatic subgroups.

Conclusion: Younger age is strongly associated with the choice of surgical treatment in MMD, including in asymptomatic cases.