Pub Date : 2025-11-01DOI: 10.1016/j.nrleng.2025.10.003
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 analyse 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 analysed 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.
{"title":"Multiple sclerosis mortality trends by sex in Chile, 1997–2019","authors":"J. Arriagada Opazo , V. Farah González , M. González Delgadillo , L. Núñez-Franz , C. Morales Garcia , P. Jiménez Rodríguez","doi":"10.1016/j.nrleng.2025.10.003","DOIUrl":"10.1016/j.nrleng.2025.10.003","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Aim</h3><div>This study aims to analyse the trend of the MS mortality rate in Chile from 1997 to 2019 disaggregated by sex and latitude.</div></div><div><h3>Methods</h3><div>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 analysed 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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 9","pages":"Pages 840-848"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.nrleng.2025.10.005
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 generalised 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 specialised 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 generalised epilepsy. Stressful situations were the most reported precipitant. 93.75% of the patients initially presented palpebral myoclonic seizures and after several years presented generalised 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 subsidised 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.
{"title":"Case series of epilepsy with eyelid myoclonia","authors":"M. Henao-Pérez , D.C. López-Medina , A. Arboleda-Ramírez , N.L. Patiño-Jaramillo , J.F. Zapata-Berruecos , R. Andrade","doi":"10.1016/j.nrleng.2025.10.005","DOIUrl":"10.1016/j.nrleng.2025.10.005","url":null,"abstract":"<div><h3>Introduction</h3><div>epilepsy with palpebral myoclonus is an idiopathic generalised 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 specialised in neurology, between the years 2017 and 2022. Clinical histories and videoelectroencephalograms were evaluated.</div></div><div><h3>Results</h3><div>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 generalised epilepsy. Stressful situations were the most reported precipitant. 93.75% of the patients initially presented palpebral myoclonic seizures and after several years presented generalised 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 subsidised 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.</div></div><div><h3>Conclusion</h3><div>the importance of suspecting this pathology before palpebral myoclonus in children should be highlighted, guaranteeing quality and timely management.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 9","pages":"Pages 855-863"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.nrleng.2025.10.004
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 (58%) 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.
{"title":"Primary headaches as the reason for consultation in Primary Care: a prospective study","authors":"I. Rivera , N. Fontanillas , L. Cadelo , J. Pascual","doi":"10.1016/j.nrleng.2025.10.004","DOIUrl":"10.1016/j.nrleng.2025.10.004","url":null,"abstract":"<div><h3>Objectives</h3><div>To prospectively study the rate of consultation, diagnoses, burden and historical management patterns of those patients attending due to primary headache in Primary Care.</div></div><div><h3>Patients and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (58%) of cases had been referred to Neurology and preventive treatments had been initiated in Primary Care in only 5.5% of patients.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 9","pages":"Pages 849-854"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.nrleng.2025.08.002
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.
{"title":"Evaluation of autonomic dysfunction in hereditary transthyretin amyloidosis","authors":"F. Martínez-Valle , C. Casasnovas-Pons , M. Romero-Acebal , L. Galán-Dávila","doi":"10.1016/j.nrleng.2025.08.002","DOIUrl":"10.1016/j.nrleng.2025.08.002","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Development</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 9","pages":"Pages 915-923"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.nrleng.2025.10.007
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).
Methods
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 = .875]. 64.3% of dehydrated patients vs. 46.7% of non-dehydrated patients had a poor outcome at discharge (P = .026). In multivariable logistic regression analysis, dehydration was an independent predictor of poor outcome at discharge (OR 2.50; P = .011) and at three months of follow-up (OR 2.27; P = .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：前瞻性多中心研究，前循环AIS患者接受MT治疗（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≥295mmol/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：入院时脱水与接受MT治疗的AIS患者预后不良相关，但与CC无关。
{"title":"Influence of dehydration on collateral circulation and clinical outcome after endovascular therapy in patients with acute ischemic stroke","authors":"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","doi":"10.1016/j.nrleng.2025.10.007","DOIUrl":"10.1016/j.nrleng.2025.10.007","url":null,"abstract":"<div><h3>Introduction</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>P</em> = .875]. 64.3% of dehydrated patients vs. 46.7% of non-dehydrated patients had a poor outcome at discharge (<em>P</em> = .026). In multivariable logistic regression analysis, dehydration was an independent predictor of poor outcome at discharge (OR 2.50; <em>P</em> = .011) and at three months of follow-up (OR 2.27; <em>P</em> = .046).</div></div><div><h3>Conclusions</h3><div>Dehydration on admission is associated with poor outcome in patients with AIS treated with MT, but it is not related to CC.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 9","pages":"Pages 822-829"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.nrleng.2025.09.006
F. Vázquez-Sánchez , M.C. Lloria-Gil , B. García-López , O. Pérez-Gil , A. Saponaro-González , E. Rivas-Navas , A.I. Gómez-Menéndez
Introduction
The electroencephalogram (EEG) is a useful tool in the diagnosis of pathologies such as non-convulsive status epilepticus (NCSE) or brain death (BD), cardiac arrest (CA), and status epilepticus (SE) treatment monitoring. In addition, it provides irreplaceable information depending on the time it is performed, as is the case with the diagnosis of epilepsy after a first epileptic seizure (ES) or to differentiate these from non-epileptic paroxysmal events (NEPE). Its usefulness is maintained outside the usual working day, but it is not available in many centers.
Subjects and methods
Retrospective observational study based on the clinical history of 86 patients who underwent an on-call EEG (ocEEG) at our hospital during 2020.
Results
One hundred two records requested by Intensive Care (41.1%), Neurology (37.3%), Pediatrics (17.6%) or other services (4%) were made. Suspected NCSE represented 56.7%, followed by treatment monitoring in EE (21.6%). The ME accounted for only 6.9% of the total. The ocEEG avoided potential iatrogenesis in a 56.3% of cases with therapeutic implications, allowed to treat 27.58% of patients who would have remained without treatment until the conventional EEG. An increase in the level of care was required in only 22,2% of all cases. The ocEEG was anticipated a mean of 31.6 hours to the next conventional EEG that would have been available.
Conclusions
The availability of ocEEG is beneficial in terms of diagnosis, therapy, and hospital management, advancing decision-making and avoiding iatrogenesis. Its availability should become widespread.
{"title":"Healthcare impact of electroencephalography performed during clinical neurophysiology on-call duty in a third-level hospital","authors":"F. Vázquez-Sánchez , M.C. Lloria-Gil , B. García-López , O. Pérez-Gil , A. Saponaro-González , E. Rivas-Navas , A.I. Gómez-Menéndez","doi":"10.1016/j.nrleng.2025.09.006","DOIUrl":"10.1016/j.nrleng.2025.09.006","url":null,"abstract":"<div><h3>Introduction</h3><div>The electroencephalogram (EEG) is a useful tool in the diagnosis of pathologies such as non-convulsive status epilepticus (NCSE) or brain death (BD), cardiac arrest (CA), and status epilepticus (SE) treatment monitoring. In addition, it provides irreplaceable information depending on the time it is performed, as is the case with the diagnosis of epilepsy after a first epileptic seizure (ES) or to differentiate these from non-epileptic paroxysmal events (NEPE). Its usefulness is maintained outside the usual working day, but it is not available in many centers.</div></div><div><h3>Subjects and methods</h3><div>Retrospective observational study based on the clinical history of 86 patients who underwent an on-call EEG (ocEEG) at our hospital during 2020.</div></div><div><h3>Results</h3><div>One hundred two records requested by Intensive Care (41.1%), Neurology (37.3%), Pediatrics (17.6%) or other services (4%) were made. Suspected NCSE represented 56.7%, followed by treatment monitoring in EE (21.6%). The ME accounted for only 6.9% of the total. The ocEEG avoided potential iatrogenesis in a 56.3% of cases with therapeutic implications, allowed to treat 27.58% of patients who would have remained without treatment until the conventional EEG. An increase in the level of care was required in only 22,2% of all cases. The ocEEG was anticipated a mean of 31.6 hours to the next conventional EEG that would have been available.</div></div><div><h3>Conclusions</h3><div>The availability of ocEEG is beneficial in terms of diagnosis, therapy, and hospital management, advancing decision-making and avoiding iatrogenesis. Its availability should become widespread.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 746-752"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.nrleng.2025.09.001
L. Fernández-Llarena, A. Moreno-Estébanez, A. González-Eizaguirre, A. Jauregi-Barrutia
{"title":"Sensory neuronopathy in a patient with anti-FGFR3 antibodies and lung adenocarcinoma, coincidence or causality?","authors":"L. Fernández-Llarena, A. Moreno-Estébanez, A. González-Eizaguirre, A. Jauregi-Barrutia","doi":"10.1016/j.nrleng.2025.09.001","DOIUrl":"10.1016/j.nrleng.2025.09.001","url":null,"abstract":"","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 807-810"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.nrleng.2025.09.008
J. Corroza , C. Alburquerque , L. Martínez-Martínez , I. Gastón , L. Torné , M.C. Gil-Alzueta , J. Oteiza , T. Cabada , M.C. Viguria , A. Panizo , M.E. Erro
Background
Intravascular lymphoma (IVL) is a diffuse large B-cell lymphoma characterized by occlusion of small vessels of organs by malignant cells with special tropism for the nervous system. Our purpose has been to describe a series of IVL diagnosed in our center and to compare the results with those of the literature.
Methods
A retrospective review of the clinical, imaging, and pathological data of consecutive patients with IVL in the last 20 years was performed. Pathology department database was the source of patient identification.
Results
We identified six cases (three males and three females), with a median age at diagnosis of 54.64 (interquartile range (IR) 51.93–59.67). Five of them (83.3%) debuted with neurological manifestations. The median time to diagnosis was 3.77 months. On cranial magnetic resonance imaging, the findings consisted of multiple white matter and corpus callosum lesions (some of them with enhancement or hemorrhagic foci) and multifocal infarcts with hemorrhagic transformation. One patient displayed leptomeningeal branch aneurysms. A proton emission tomography with fluorodeoxyglucose (PET-FDG) was performed in five patients showing areas of elevated metabolism in all of them. Four patients underwent targeted biopsy, which allowed the diagnosis of IVL to be established in three. Four of the five patients who received treatment remained in complete remission with a median progression-free survival of 69.62 months (IR 49.11–162.82).
Conclusions
IVL begins frequently with neurological manifestations, which must alert the neurologist to be aware of this entity. PET-FDG helps to identify biopsy-accessible lesions and facilitate early diagnosis of IVL.
{"title":"A single institution series of intravascular lymphoma: Neurological manifestations and neuroimaging findings","authors":"J. Corroza , C. Alburquerque , L. Martínez-Martínez , I. Gastón , L. Torné , M.C. Gil-Alzueta , J. Oteiza , T. Cabada , M.C. Viguria , A. Panizo , M.E. Erro","doi":"10.1016/j.nrleng.2025.09.008","DOIUrl":"10.1016/j.nrleng.2025.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Intravascular lymphoma (IVL) is a diffuse large B-cell lymphoma characterized by occlusion of small vessels of organs by malignant cells with special tropism for the nervous system. Our purpose has been to describe a series of IVL diagnosed in our center and to compare the results with those of the literature.</div></div><div><h3>Methods</h3><div>A retrospective review of the clinical, imaging, and pathological data of consecutive patients with IVL in the last 20 years was performed. Pathology department database was the source of patient identification.</div></div><div><h3>Results</h3><div>We identified six cases (three males and three females), with a median age at diagnosis of 54.64 (interquartile range (IR) 51.93–59.67). Five of them (83.3%) debuted with neurological manifestations. The median time to diagnosis was 3.77 months. On cranial magnetic resonance imaging, the findings consisted of multiple white matter and corpus callosum lesions (some of them with enhancement or hemorrhagic foci) and multifocal infarcts with hemorrhagic transformation. One patient displayed leptomeningeal branch aneurysms. A proton emission tomography with fluorodeoxyglucose (PET-FDG) was performed in five patients showing areas of elevated metabolism in all of them. Four patients underwent targeted biopsy, which allowed the diagnosis of IVL to be established in three. Four of the five patients who received treatment remained in complete remission with a median progression-free survival of 69.62 months (IR 49.11–162.82).</div></div><div><h3>Conclusions</h3><div>IVL begins frequently with neurological manifestations, which must alert the neurologist to be aware of this entity. PET-FDG helps to identify biopsy-accessible lesions and facilitate early diagnosis of IVL.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 768-776"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.nrleng.2025.09.004
S. Portela-Sánchez , I. Catalina , S. López Muñoz , A. Lozano Ros , A. Sánchez-Soblechero , E. Sola Vendrell , P. Sánchez-Mateos , J.L. Muñoz-Blanco
Objectives
To describe the main features and the clinical management of a cohort of patients with immune-mediated necrotizing myopathy (IMNM).
Methods
We conducted an observational, monocentric, retrospective study of IMNM patients diagnosed in the Neuromuscular Unit of a tertiary hospital in Madrid (Spain) between 2013 and 2021.
Results
Sixteen IMNM cases were diagnosed, with a median age of 71.5 years (range 36−80), nine of whom (56.3%) were female. Thirteen (81.3%) patients had previously been treated with statins. The time from symptom onset to diagnosis was less than six months in eleven (68.8%) patients and the most common clinical symptoms were proximal weakness and myalgia. The only myositis specific autoantibodies detected were anti-3-hydroxy-3-methyl-coenzyme A reductase in thirteen patients. The treatment strategy was based on prednisone, although a combination with other immunosuppressive drugs was required in eight (50%) patients.
Conclusions
There has been an increase in the diagnosis of immune-mediated necrotizing myopathies in the last few years. The anti-HMGCR antibodies were the only detected in this sample showing their key role in the diagnosis. Early recognition of the disease facilitate to start treatment as soon as possible, which should be based on the initial response to corticosteroids and usually requires a combination of several drugs.
{"title":"Immune-mediated necrotizing myopathy: an emerging disorder","authors":"S. Portela-Sánchez , I. Catalina , S. López Muñoz , A. Lozano Ros , A. Sánchez-Soblechero , E. Sola Vendrell , P. Sánchez-Mateos , J.L. Muñoz-Blanco","doi":"10.1016/j.nrleng.2025.09.004","DOIUrl":"10.1016/j.nrleng.2025.09.004","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the main features and the clinical management of a cohort of patients with immune-mediated necrotizing myopathy (IMNM).</div></div><div><h3>Methods</h3><div>We conducted an observational, monocentric, retrospective study of IMNM patients diagnosed in the Neuromuscular Unit of a tertiary hospital in Madrid (Spain) between 2013 and 2021.</div></div><div><h3>Results</h3><div>Sixteen IMNM cases were diagnosed, with a median age of 71.5 years (range 36−80), nine of whom (56.3%) were female. Thirteen (81.3%) patients had previously been treated with statins. The time from symptom onset to diagnosis was less than six months in eleven (68.8%) patients and the most common clinical symptoms were proximal weakness and myalgia. The only myositis specific autoantibodies detected were anti-3-hydroxy-3-methyl-coenzyme A reductase in thirteen patients. The treatment strategy was based on prednisone, although a combination with other immunosuppressive drugs was required in eight (50%) patients.</div></div><div><h3>Conclusions</h3><div>There has been an increase in the diagnosis of immune-mediated necrotizing myopathies in the last few years. The anti-HMGCR antibodies were the only detected in this sample showing their key role in the diagnosis. Early recognition of the disease facilitate to start treatment as soon as possible, which should be based on the initial response to corticosteroids and usually requires a combination of several drugs.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 729-738"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.nrleng.2025.09.002
M. Álvarez Saúco , I. Legarda Ramírez , S. Martí Martínez , F. Carrillo García , B. González García , J. Fernández Bueno , R. García-Ramos , D. Santos-García
Introduction
One of the current challenges in Parkinson's disease (PD) and other movement disorders (MD) is how and when to apply palliative care. Aware of the scarce training and implementation of this type of approach, we propose some consensual recommendations for palliative care (PC) in order to improve the quality of life of patients and their environment.
Material and methods
After a first phase of needs analysis through a survey carried out on Spanish neurologists and a review of the literature, we describe recommendations for action structured in: palliative care models, selection of the target population, when, where and how to implement the PC.
Results
Models of neuropalliative care are reviewed, advocating for the role of the neurologist as a driving force. The members of the multidisciplinary team are described, as well as the main clinical markers and tools that help the clinician to decide which patients have greater palliative needs; sender and receiver are defined and it is detailed in what evolutionary moment and how to proceed when sending the patient to palliative care. A scheme of steps to follow in any PC protocol, whether basic or specialized, is provided, emphasizing the framework in the shared planning of care and the comprehensive approach.
Conclusions
It would be desirable to integrate the PC in the management of PD and other MD and to validate models of neuropalliative care in our environment, analyzing their usefulness through the use of indicators, in order to improve the care and quality of life of our patients.
{"title":"Palliative Care in Parkinson's Disease and other Movement Disorders. Recommendations and protocol of a multidisciplinary group of experts","authors":"M. Álvarez Saúco , I. Legarda Ramírez , S. Martí Martínez , F. Carrillo García , B. González García , J. Fernández Bueno , R. García-Ramos , D. Santos-García","doi":"10.1016/j.nrleng.2025.09.002","DOIUrl":"10.1016/j.nrleng.2025.09.002","url":null,"abstract":"<div><h3>Introduction</h3><div>One of the current challenges in Parkinson's disease (PD) and other movement disorders (MD) is how and when to apply palliative care. Aware of the scarce training and implementation of this type of approach, we propose some consensual recommendations for palliative care (PC) in order to improve the quality of life of patients and their environment.</div></div><div><h3>Material and methods</h3><div>After a first phase of needs analysis through a survey carried out on Spanish neurologists and a review of the literature, we describe recommendations for action structured in: palliative care models, selection of the target population, when, where and how to implement the PC.</div></div><div><h3>Results</h3><div>Models of neuropalliative care are reviewed, advocating for the role of the neurologist as a driving force. The members of the multidisciplinary team are described, as well as the main clinical markers and tools that help the clinician to decide which patients have greater palliative needs; sender and receiver are defined and it is detailed in what evolutionary moment and how to proceed when sending the patient to palliative care. A scheme of steps to follow in any PC protocol, whether basic or specialized, is provided, emphasizing the framework in the shared planning of care and the comprehensive approach.</div></div><div><h3>Conclusions</h3><div>It would be desirable to integrate the PC in the management of PD and other MD and to validate models of neuropalliative care in our environment, analyzing their usefulness through the use of indicators, in order to improve the care and quality of life of our patients.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 717-728"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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