Pub Date : 2025-05-01DOI: 10.1016/j.nrleng.2025.04.001
E. Cubo , J. Rivadeneyra , L. Simón-Vicente , L. Aguado , S. Calvo , M. Saiz-Rodríguez , N. Mariscal , I. Muñoz-Siscart , D. Diaz-Piñeiro , I. Miguel-Pérez , G. Gámez-Leyva , Á. García-Bustillo , A. Martinez-Descalls , Spanish Enroll Mortality Study
Introduction
Despite the wealth of evidence suggesting a protective role of lifestyle factors on Huntington's disease (HD) onset and progression, their association with mortality has not been extensively studied. The aim of this study was to examine whether lifestyle factors such as caffeine and alcohol consumption, smoking, physical activity level, and Mediterranean diet (MeDi) adherence are associated with mortality among a Spanish cohort of patients with HD with a 9-year surveillance period.
Methods
This national study was performed using a nested, observational, longitudinal design. We included subjects diagnosed with HD who participated in the European Huntington's disease network and Enrol-HD studies. Date of death and baseline lifestyle factor information, demographics, disease severity assessed by the Unified Huntington's Disease Rating Scale (UHDRS), Problem Behaviours Assessment, total functional capacity (TFC) scores, and comorbidities were collected. Adjusted Cox proportional hazards models were conducted to determine the association of lifestyle factors with mortality.
Results
We included 87 patients (52 females) with a mean age of 48.62 ± 14.43 years and CAG repeats of 43.76 ± 5.92. Sixteen deaths were recorded. After correcting for multiple comparisons, deceased patients had higher UHDRS scores at baseline and lower caffeine consumption than live patients. In multivariate Cox regression models, after adjusting for age, CAG repeats, and TFC, mortality risk was associated with lower caffeine consumption (HR 0.13, 95% CI 0.04, 0.45).
Conclusions
This national-based study suggests that increased caffeine consumption is associated with decreased HD mortality. Our results may help guide clinicians in counselling lifestyle practices for decreasing mortality in HD.
尽管有大量证据表明生活方式因素对亨廷顿舞蹈病（HD）的发病和进展具有保护作用，但其与死亡率的关系尚未得到广泛研究。本研究的目的是研究生活方式因素，如咖啡因和酒精的摄入、吸烟、体育活动水平和地中海饮食（MeDi）依从性是否与西班牙HD患者9年监测期的死亡率相关。方法本研究采用巢式、观察性、纵向设计。我们纳入了参与欧洲亨廷顿舞蹈病网络和罗登氏舞蹈症研究的诊断为HD的受试者。收集死亡日期和基线生活方式因素信息、人口统计学、统一亨廷顿病评定量表（UHDRS）评估的疾病严重程度、问题行为评估、总功能容量（TFC）评分和合并症。采用调整后的Cox比例风险模型来确定生活方式因素与死亡率的关系。结果87例患者（女性52例），平均年龄48.62±14.43岁，CAG重复次数43.76±5.92次。16人死亡。在对多重比较进行校正后，与活着的患者相比，死亡患者在基线时的UHDRS评分更高，咖啡因摄入量更低。在多变量Cox回归模型中，在调整了年龄、CAG重复数和TFC后，死亡风险与较低的咖啡因摄入量相关（HR 0.13, 95% CI 0.04, 0.45）。结论：这项全国性的研究表明，咖啡因摄入量的增加与HD死亡率的降低有关。我们的结果可能有助于指导临床医生咨询生活方式实践，以降低HD的死亡率。
{"title":"The association between lifestyle factors and mortality in Huntington's disease","authors":"E. Cubo , J. Rivadeneyra , L. Simón-Vicente , L. Aguado , S. Calvo , M. Saiz-Rodríguez , N. Mariscal , I. Muñoz-Siscart , D. Diaz-Piñeiro , I. Miguel-Pérez , G. Gámez-Leyva , Á. García-Bustillo , A. Martinez-Descalls , Spanish Enroll Mortality Study","doi":"10.1016/j.nrleng.2025.04.001","DOIUrl":"10.1016/j.nrleng.2025.04.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the wealth of evidence suggesting a protective role of lifestyle factors on Huntington's disease (HD) onset and progression, their association with mortality has not been extensively studied. The aim of this study was to examine whether lifestyle factors such as caffeine and alcohol consumption, smoking, physical activity level, and Mediterranean diet (MeDi) adherence are associated with mortality among a Spanish cohort of patients with HD with a 9-year surveillance period.</div></div><div><h3>Methods</h3><div>This national study was performed using a nested, observational, longitudinal design. We included subjects diagnosed with HD who participated in the European Huntington's disease network and Enrol-HD studies. Date of death and baseline lifestyle factor information, demographics, disease severity assessed by the Unified Huntington's Disease Rating Scale (UHDRS), Problem Behaviours Assessment, total functional capacity (TFC) scores, and comorbidities were collected. Adjusted Cox proportional hazards models were conducted to determine the association of lifestyle factors with mortality.</div></div><div><h3>Results</h3><div>We included 87 patients (52 females) with a mean age of 48.62<!--> <!-->±<!--> <!-->14.43 years and CAG repeats of 43.76<!--> <!-->±<!--> <!-->5.92. Sixteen deaths were recorded. After correcting for multiple comparisons, deceased patients had higher UHDRS scores at baseline and lower caffeine consumption than live patients. In multivariate Cox regression models, after adjusting for age, CAG repeats, and TFC, mortality risk was associated with lower caffeine consumption (HR 0.13, 95% CI 0.04, 0.45).</div></div><div><h3>Conclusions</h3><div>This national-based study suggests that increased caffeine consumption is associated with decreased HD mortality. Our results may help guide clinicians in counselling lifestyle practices for decreasing mortality in HD.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 4","pages":"Pages 361-371"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090363","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 : 2025-05-01DOI: 10.1016/j.nrleng.2025.04.002
H. Tejada-Meza , Á. Lambea-Gil , B. Pardiñas-Barón , D. Sagarra-Mur , M. Viscasillas-Sancho , C. Moreno-Loscertales , C. Tejero-Juste , C. Pérez-Lázaro , J. Artal-Roy , O. Alberti-González , P. Ruiz-Palomino , N. Hernando-Quintana , I. Campello-Morer , Á. Giménez-Muñoz , M. Palacín-Larroy , C. García-Arguedas , L. Ballester-Marco , J. Marta-Moreno , on behalf of the Neurovascular Diseases Study Group of Aragon (GEENV-Aragón)
Introduction
The incidence of ischemic stroke in young adults is increasing worldwide, and it is not uncommon in our region. It is associated with the presence of traditional vascular risk factors. However, there is little information about its prognosis, unlike other age groups. The objective of this study is to determine mortality, both in the short and long term follow-up, and the long-term follow-up recurrence of ischemic stroke in young adult patients in Aragon, making up the first study of this kind in Spain, and one of the few that addresses this issue in Europe.
Methods
Multicenter, observational, retrospective study of all patients between 18 and 50 years old who were admitted for an ischemic stroke in any hospital in Aragon between 2005−2015. The follow-up was carried out until March 31, 2021. Mortality, causes of death and recurrence of cerebrovascular events were collected, stratifying the sample based on the sex and age group of the patients. Logistic and Cox regression models were used to determine the factors associated with mortality and recurrence.
Results
721 patients were included (697 with long-term follow-up). Mortality was 3.3% in the first 30 days. Long-term mortality and recurrence was 9.2% and 11.9% at a median of 10.1 years of follow-up. The most frequent cause of death in the short term was of Neurovascular origin and in the long term was cancer. Having a NIHSS > 15 was associated with higher short-term mortality. Arterial hypertension, diabetes mellitus, excessive alcohol consumption, atrial fibrillation and peripheral vascular disease were associated with long-term mortality. A history of previous stroke, diabetes mellitus, and atherothrombotic aetiology were associated with a higher cumulative risk of stroke recurrence.
Conclusions
Mortality and recurrence of ischaemic stroke in young adults in Aragon, although lower than that described by other studies, is by no means negligible and is associated with the presence of traditional vascular risk factors.
{"title":"Mortality and long-term recurrence of ischaemic stroke in young adults of a northern Spanish region (Aragón)","authors":"H. Tejada-Meza , Á. Lambea-Gil , B. Pardiñas-Barón , D. Sagarra-Mur , M. Viscasillas-Sancho , C. Moreno-Loscertales , C. Tejero-Juste , C. Pérez-Lázaro , J. Artal-Roy , O. Alberti-González , P. Ruiz-Palomino , N. Hernando-Quintana , I. Campello-Morer , Á. Giménez-Muñoz , M. Palacín-Larroy , C. García-Arguedas , L. Ballester-Marco , J. Marta-Moreno , on behalf of the Neurovascular Diseases Study Group of Aragon (GEENV-Aragón)","doi":"10.1016/j.nrleng.2025.04.002","DOIUrl":"10.1016/j.nrleng.2025.04.002","url":null,"abstract":"<div><h3>Introduction</h3><div>The incidence of ischemic stroke in young adults is increasing worldwide, and it is not uncommon in our region. It is associated with the presence of traditional vascular risk factors. However, there is little information about its prognosis, unlike other age groups. The objective of this study is to determine mortality, both in the short and long term follow-up, and the long-term follow-up recurrence of ischemic stroke in young adult patients in Aragon, making up the first study of this kind in Spain, and one of the few that addresses this issue in Europe.</div></div><div><h3>Methods</h3><div>Multicenter, observational, retrospective study of all patients between 18 and 50 years old who were admitted for an ischemic stroke in any hospital in Aragon between 2005−2015. The follow-up was carried out until March 31, 2021. Mortality, causes of death and recurrence of cerebrovascular events were collected, stratifying the sample based on the sex and age group of the patients. Logistic and Cox regression models were used to determine the factors associated with mortality and recurrence.</div></div><div><h3>Results</h3><div>721 patients were included (697 with long-term follow-up). Mortality was 3.3% in the first 30 days. Long-term mortality and recurrence was 9.2% and 11.9% at a median of 10.1 years of follow-up. The most frequent cause of death in the short term was of Neurovascular origin and in the long term was cancer. Having a NIHSS > 15 was associated with higher short-term mortality. Arterial hypertension, diabetes mellitus, excessive alcohol consumption, atrial fibrillation and peripheral vascular disease were associated with long-term mortality. A history of previous stroke, diabetes mellitus, and atherothrombotic aetiology were associated with a higher cumulative risk of stroke recurrence.</div></div><div><h3>Conclusions</h3><div>Mortality and recurrence of ischaemic stroke in young adults in Aragon, although lower than that described by other studies, is by no means negligible and is associated with the presence of traditional vascular risk factors.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 4","pages":"Pages 333-343"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059503","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 : 2025-05-01DOI: 10.1016/j.nrleng.2025.04.004
Ochando Díez-Canseco M., Reguero Capilla M., Domínguez-Romero I., Menéndez-Rivero E., Prados-Castaño M.
{"title":"DRESS syndrome and flare-up due to antiepileptics: how to solve the problem","authors":"Ochando Díez-Canseco M., Reguero Capilla M., Domínguez-Romero I., Menéndez-Rivero E., Prados-Castaño M.","doi":"10.1016/j.nrleng.2025.04.004","DOIUrl":"10.1016/j.nrleng.2025.04.004","url":null,"abstract":"","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 4","pages":"Pages 406-408"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046679","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 : 2025-05-01DOI: 10.1016/j.nrleng.2025.04.005
A. Juárez-Belaúnde , C. Colomer , R. Dorado , S. Laxe , X. Miguens , J. Ferri , R. Rodríguez , T. Pérez , C. López , M. Ríos , C. González , R. Pelayo , M. Bernabeu , E. Noé , A. Gómez , I. Quemada
Introduction
We present the guidelines for pain management in neurorehabilitation of brain injury in adults of the Spanish Society of Neurorehabilitation based on the review and analysis of the available literature on the subject. We establish recommendations according to the level of evidence offered by the reviewed studies.
Development
The methodology followed by the Spanish Society of Neurorehabilitation for the elaboration of the present guide is based on the analysis of the national and international clinical practice guidelines of the last seven years, carried out according to the management considerations dictated by the evidence for the usual types of pain in the population of people who have suffered an acquired brain injury.
Conclusions
Pain is a common symptom in patients who have suffered brain damage, having a negative impact on quality of life and adherence to the rehabilitation process. When classifying the type of pain according to etiological characteristics, in order to optimise the type of therapeutic approach, we usually refer to pain as nociceptive, and neuropathic pain, although pain in such patients often has “mixed” characteristics. The most common type of pain is nociceptive ahead of neuropathic. The most common pain syndromes in this population are headache, hemiplegic shoulder pain and poststroke central pain. As pain is a subjective experience, people with impaired level of consciousness, severe cognitive impairment and/or severe language problems may have greater difficulty or even being unable to communicate it. An adequate clinical history and a directed physical examination, as well as the use of specific scales for its correct diagnosis are therefore important. Finally, many of the drugs used for its management have a negative impact on rehabilitation, affecting cognitive processes, and/or worsening other neurological symptoms. Furthermore, these patients often have several comorbidities and are frequently on several drugs which means that the approach to pain management must be carefully elaborated by a multidisciplinary team approach.
{"title":"Guidelines: Basic principles of pain management in acquired brain injury. Recommendations of the Spanish Society of Neurorehabilitation","authors":"A. Juárez-Belaúnde , C. Colomer , R. Dorado , S. Laxe , X. Miguens , J. Ferri , R. Rodríguez , T. Pérez , C. López , M. Ríos , C. González , R. Pelayo , M. Bernabeu , E. Noé , A. Gómez , I. Quemada","doi":"10.1016/j.nrleng.2025.04.005","DOIUrl":"10.1016/j.nrleng.2025.04.005","url":null,"abstract":"<div><h3>Introduction</h3><div>We present the guidelines for pain management in neurorehabilitation of brain injury in adults of the Spanish Society of Neurorehabilitation based on the review and analysis of the available literature on the subject. We establish recommendations according to the level of evidence offered by the reviewed studies.</div></div><div><h3>Development</h3><div>The methodology followed by the Spanish Society of Neurorehabilitation for the elaboration of the present guide is based on the analysis of the national and international clinical practice guidelines of the last seven years, carried out according to the management considerations dictated by the evidence for the usual types of pain in the population of people who have suffered an acquired brain injury.</div></div><div><h3>Conclusions</h3><div>Pain is a common symptom in patients who have suffered brain damage, having a negative impact on quality of life and adherence to the rehabilitation process. When classifying the type of pain according to etiological characteristics, in order to optimise the type of therapeutic approach, we usually refer to pain as nociceptive, and neuropathic pain, although pain in such patients often has “mixed” characteristics. The most common type of pain is nociceptive ahead of neuropathic. The most common pain syndromes in this population are headache, hemiplegic shoulder pain and poststroke central pain. As pain is a subjective experience, people with impaired level of consciousness, severe cognitive impairment and/or severe language problems may have greater difficulty or even being unable to communicate it. An adequate clinical history and a directed physical examination, as well as the use of specific scales for its correct diagnosis are therefore important. Finally, many of the drugs used for its management have a negative impact on rehabilitation, affecting cognitive processes, and/or worsening other neurological symptoms. Furthermore, these patients often have several comorbidities and are frequently on several drugs which means that the approach to pain management must be carefully elaborated by a multidisciplinary team approach.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 4","pages":"Pages 380-405"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013326","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 : 2025-05-01DOI: 10.1016/j.nrleng.2025.04.014
Jauregui Larrañaga C. , Villagrán-García M. , Cabello Murgui J. , Barceló Artigues M.I. , Bargay Pizarro E. , Gil Alzueta M.C. , Esparragosa Vázquez I. , Bataller Alberola L. , Velasco Fargas R. , Erro Aguirre M.E.
Introduction
Oncological patients may require evaluation by a neurologist when they are admitted to hospital. The aim of our study was to determine the frequency and characteristics of hospital interconsultations (IC) received by the neurology department concerning oncology patients admitted to the hospital.
Material and methods
A retrospective multicentre study analysing IC with neurology concerning onco-haematological patients admitted over 5 consecutive years (2016-2020) in 4 tertiary hospitals in Spain was carried out.
Results
A total of 2091 IC from 1710 patients were analysed, most of them male (55.5%; 969/2091) with a median age of 60.5 years (range 15-92). Most of the ICs came from the medical oncology (43.2%; 904/2091) and hematology (42.2%; 882/2091) departments. Neuro-oncological ICs accounted for approximately 17% (2091/12 242) of the total number of ICs performed in the neurology department during the 5 years included in this study. The most frequent reasons for consultation were limb motor deficit (18.3%; 381/2077), confusional syndrome (14.1%; 292/2077), epileptic seizures (12.2%; 254/2077), and headache (8.1%; 169/2077). The most frequent associated tumours were lung cancer (18.3%; 383/2089), leukaemia (19%; 396/2089), lymphoma (17.1%; 357/2089), and primary brain tumor (12.1%; 353/2089). The majority (69.9%; 1460/2089) of patients were undergoing active or recent cancer treatment. Final neurological diagnoses included metabolic encephalopathy (11.2%; 234/2091), tumor progression (11%; 231/2091), cerebral vascular complications (10.1%%; 212/2091), metastases (9.1%%; 191/2091), and leptomeningeal dissemination (8.9%%; 186/2091). A total of 15.4% (323/2091) of the ICs were closed with an undetermined diagnosis. The median time that the ICs were open was 3 days (range, 1-152).
Conclusions
ICs concerning onco-haematological patients are heterogeneous, with an increasing incidence and complexity, requiring management by neurologists with experience in neuro-oncological patients.
{"title":"Complexity of neuro-oncological in-hospital consultations: a multicentre study","authors":"Jauregui Larrañaga C. , Villagrán-García M. , Cabello Murgui J. , Barceló Artigues M.I. , Bargay Pizarro E. , Gil Alzueta M.C. , Esparragosa Vázquez I. , Bataller Alberola L. , Velasco Fargas R. , Erro Aguirre M.E.","doi":"10.1016/j.nrleng.2025.04.014","DOIUrl":"10.1016/j.nrleng.2025.04.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Oncological patients may require evaluation by a neurologist when they are admitted to hospital. The aim of our study was to determine the frequency and characteristics of hospital interconsultations (IC) received by the neurology department concerning oncology patients admitted to the hospital.</div></div><div><h3>Material and methods</h3><div>A retrospective multicentre study analysing IC with neurology concerning onco-haematological patients admitted over 5 consecutive years (2016-2020) in 4 tertiary hospitals in Spain was carried out.</div></div><div><h3>Results</h3><div>A total of 2091 IC from 1710 patients were analysed, most of them male (55.5%; 969/2091) with a median age of 60.5 years (range 15-92). Most of the ICs came from the medical oncology (43.2%; 904/2091) and hematology (42.2%; 882/2091) departments. Neuro-oncological ICs accounted for approximately 17% (2091/12 242) of the total number of ICs performed in the neurology department during the 5 years included in this study. The most frequent reasons for consultation were limb motor deficit (18.3%; 381/2077), confusional syndrome (14.1%; 292/2077), epileptic seizures (12.2%; 254/2077), and headache (8.1%; 169/2077). The most frequent associated tumours were lung cancer (18.3%; 383/2089), leukaemia (19%; 396/2089), lymphoma (17.1%; 357/2089), and primary brain tumor (12.1%; 353/2089). The majority (69.9%; 1460/2089) of patients were undergoing active or recent cancer treatment. Final neurological diagnoses included metabolic encephalopathy (11.2%; 234/2091), tumor progression (11%; 231/2091), cerebral vascular complications (10.1%%; 212/2091), metastases (9.1%%; 191/2091), and leptomeningeal dissemination (8.9%%; 186/2091). A total of 15.4% (323/2091) of the ICs were closed with an undetermined diagnosis. The median time that the ICs were open was 3 days (range, 1-152).</div></div><div><h3>Conclusions</h3><div>ICs concerning onco-haematological patients are heterogeneous, with an increasing incidence and complexity, requiring management by neurologists with experience in neuro-oncological patients.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 4","pages":"Pages 372-379"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059502","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 : 2025-05-01DOI: 10.1016/j.nrleng.2025.04.003
M. Luisa Antelo , S. Zalba Marcos , I. Jericó , M. Sarobe , L. Torné , M. Elena Erro , J.A. García-Erce
Introduction
Therapeutic plasma exchange (TPE) and/or the administration of endovenous immunoglobulins (IGEV) are considered the first line treatment for multiple autoimmune-based neurological diseases. According to the scientific evidence collected in several recent guidelines, the efficacy of both treatments is very similar for many of them, however, the current situation of non-self-sufficiency and the real risk of IGEV shortages make it essential to assess TPE as the first therapeutic option.
The objective of this work is to estimate the basic direct costs derived from treatment with RPT compared to treatment with IGEV in immune-mediated neurological diseases in a situation of supposed therapeutic equivalence.
Material and methods
Patients who are treated with IGEV receive a standard dose of 0.4 g/kg weight for 5 consecutive days. Patients treated with RPT with the Terumo-BCT® Optia model cell separator undergo between 5 and 7 sessions, every other day, with a substitution equivalent to 1–1.5 volumes, using 4%–5% albumin as replacement fluid. The calculation of the economic cost, for both types of treatments, in simulation of therapeutic equivalence and safety, has been carried out considering pharmaceutical expenses, calculation of the cost for each dose of IGEV, the detailed costs of consumables, replacement fluids and anticoagulant for RPT, in the worst-case scenario, with central venous catheter (CVC) placement. The price of albumin and immunoglobulins has been adjusted based on the situation of self-sufficiency or dependency and the average value of the last 4 years has been referenced for the calculations. The costs of personnel, hospitalisation, or complications derived from the treatments have not been considered. The prices are indicated in euros including VAT of 4% or 21% as appropriate.
Results
For a patient with a mean weight of 70 kg, the estimated final cost per TPR session, with CVC placement, was €612.66; while the cost for each dose of IGEV. (0.4 g/kg) was €1191. The difference is favorable to the RPT: €2279 [€1,666.4–€2,891.7]. The economic difference presented is probably greater in real clinical practice, since many of the patients do not require CVC placement to perform the TPR, and sessions were performed on an outpatient basis.
Conclusions
The use of TPE in the first line in pathologies in which the clinical results do not present significant differences with the IGEV, optimises the use of blood products and can lead to economic savings. It is necessary to expand this study by including an analysis of the efficacy in our series, as well as the adverse events associated with each type of treatment together with other expenses derived from personnel and hospital admission costs versus the use of outpatient resources (pheresis room).
{"title":"Cost analysis of treatment with therapeutic plasma exchange versus treatment with intravenous immunoglobulins in patients with immune-based neurological diseases. Proposal for optimising the use of plasmatic blood products","authors":"M. Luisa Antelo , S. Zalba Marcos , I. Jericó , M. Sarobe , L. Torné , M. Elena Erro , J.A. García-Erce","doi":"10.1016/j.nrleng.2025.04.003","DOIUrl":"10.1016/j.nrleng.2025.04.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Therapeutic plasma exchange (TPE) and/or the administration of endovenous immunoglobulins (IGEV) are considered the first line treatment for multiple autoimmune-based neurological diseases. According to the scientific evidence collected in several recent guidelines, the efficacy of both treatments is very similar for many of them, however, the current situation of non-self-sufficiency and the real risk of IGEV shortages make it essential to assess TPE as the first therapeutic option.</div><div>The objective of this work is to estimate the basic direct costs derived from treatment with RPT compared to treatment with IGEV in immune-mediated neurological diseases in a situation of supposed therapeutic equivalence.</div></div><div><h3>Material and methods</h3><div>Patients who are treated with IGEV receive a standard dose of 0.4 g/kg weight for 5 consecutive days. Patients treated with RPT with the Terumo-BCT® Optia model cell separator undergo between 5 and 7 sessions, every other day, with a substitution equivalent to 1–1.5 volumes, using 4%–5% albumin as replacement fluid. The calculation of the economic cost, for both types of treatments, in simulation of therapeutic equivalence and safety, has been carried out considering pharmaceutical expenses, calculation of the cost for each dose of IGEV, the detailed costs of consumables, replacement fluids and anticoagulant for RPT, in the worst-case scenario, with central venous catheter (CVC) placement. The price of albumin and immunoglobulins has been adjusted based on the situation of self-sufficiency or dependency and the average value of the last 4 years has been referenced for the calculations. The costs of personnel, hospitalisation, or complications derived from the treatments have not been considered. The prices are indicated in euros including VAT of 4% or 21% as appropriate.</div></div><div><h3>Results</h3><div>For a patient with a mean weight of 70 kg, the estimated final cost per TPR session, with CVC placement, was €612.66; while the cost for each dose of IGEV. (0.4 g/kg) was €1191. The difference is favorable to the RPT: €2279 [€1,666.4–€2,891.7]. The economic difference presented is probably greater in real clinical practice, since many of the patients do not require CVC placement to perform the TPR, and sessions were performed on an outpatient basis.</div></div><div><h3>Conclusions</h3><div>The use of TPE in the first line in pathologies in which the clinical results do not present significant differences with the IGEV, optimises the use of blood products and can lead to economic savings. It is necessary to expand this study by including an analysis of the efficacy in our series, as well as the adverse events associated with each type of treatment together with other expenses derived from personnel and hospital admission costs versus the use of outpatient resources (pheresis room).</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 4","pages":"Pages 344-352"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061777","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 : 2025-05-01DOI: 10.1016/j.nrleng.2025.04.013
L.A. Rodríguez de Antonio , R. Fernández de Córdoba-García , N. Herrero-Muñoz , A. Ontañón-Nasarre , I. García-Castañón
Introduction
Adherence is a modifiable factor to disease-modifying treatments response in patients with multiple sclerosis (MS). Our objective is to assess the risk factors associated with inadequate adherence.
Method
Retrospective study through review of medical records and review of the database of pharmaceutical dispensing of patients with MS of a tertiary hospital from 2004 to 2022. A multivariate logistic regression analysis of demographic, clinical, nosological, and therapeutic factors was performed between adherent and non-adherent patients and treatments.
Result
546 treatments of 284 patients (67.3% women, age 38.4 ± 10.0) were analysed, observing 87.5% adherence. Non-adherent patients presented a higher EDSS at the end of treatment, were more frequently patients with secondary progressive multiple sclerosis, and had a higher proportion of cognitive impairment, psychiatric pathology, polypharmacy, and alcohol and drug use. After the multivariable analysis, risk factors were cognitive impairment (OR: 3.82 [1.51−9.70], P = .005), and alcohol and drug use (OR: 22.83 [7.32−71.20], P < .001). On the contrary, oral drugs favored better adherence (OR 0.29 [0.12−0.75], P = .01).
Conclusions
Among many factors, alcohol or drug use and cognitive impairment are the major risk factors for low therapeutic adherence in patients with MS.
简介：依从性是多发性硬化症（MS）患者改善疾病治疗反应的一个可改变因素。我们的目的是评估与依从性不足相关的危险因素。方法：通过查阅某三级医院2004 ~ 2022年MS患者的病历资料和调剂数据库进行回顾性研究。在坚持治疗和不坚持治疗的患者之间进行人口统计学、临床、分类学和治疗因素的多因素logistic回归分析。结果：共分析284例患者546例治疗方案，其中女性67.3%，年龄38.4±10.0岁，依从性87.5%。非依从性患者在治疗结束时出现更高的EDSS，更多的是继发性进行性多发性硬化症患者，并且认知障碍、精神病理、多种药物、酒精和药物使用的比例更高。经多因素分析，危险因素为认知障碍（OR: 3.82 [1.51-9.70], P = 0.005）、酒精和药物使用（OR: 22.83 [7.32-71.20], P < 0.001）。相反，口服药物的依从性更好（OR 0.29 [0.12-0.75], P = 0.01）。结论：在诸多因素中，酒精或药物使用和认知障碍是MS患者治疗依从性低的主要危险因素。
{"title":"Treatment adherence in patients with multiple sclerosis: risk factors","authors":"L.A. Rodríguez de Antonio , R. Fernández de Córdoba-García , N. Herrero-Muñoz , A. Ontañón-Nasarre , I. García-Castañón","doi":"10.1016/j.nrleng.2025.04.013","DOIUrl":"10.1016/j.nrleng.2025.04.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Adherence is a modifiable factor to disease-modifying treatments response in patients with multiple sclerosis (MS). Our objective is to assess the risk factors associated with inadequate adherence.</div></div><div><h3>Method</h3><div>Retrospective study through review of medical records and review of the database of pharmaceutical dispensing of patients with MS of a tertiary hospital from 2004 to 2022. A multivariate logistic regression analysis of demographic, clinical, nosological, and therapeutic factors was performed between adherent and non-adherent patients and treatments.</div></div><div><h3>Result</h3><div>546 treatments of 284 patients (67.3% women, age 38.4 ± 10.0) were analysed, observing 87.5% adherence. Non-adherent patients presented a higher EDSS at the end of treatment, were more frequently patients with secondary progressive multiple sclerosis, and had a higher proportion of cognitive impairment, psychiatric pathology, polypharmacy, and alcohol and drug use. After the multivariable analysis, risk factors were cognitive impairment (OR: 3.82 [1.51−9.70], <em>P</em> = .005), and alcohol and drug use (OR: 22.83 [7.32−71.20], <em>P</em> < .001). On the contrary, oral drugs favored better adherence (OR 0.29 [0.12−0.75], <em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>Among many factors, alcohol or drug use and cognitive impairment are the major risk factors for low therapeutic adherence in patients with MS.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 4","pages":"Pages 353-360"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046796","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 : 2025-04-01DOI: 10.1016/j.nrleng.2025.03.001
M. Saint-Gerons , M.A. Rubio , A. Matheu
Objective
To describe the prevalence and form of onset of different causes of binocular diplopia in our setting.
Methods
We conducted a single-centre, cross-sectional, retrospective study reviewing the medical records of all patients visiting a tertiary-level centre between May 2019 and June 2021 with binocular diplopia as the main symptom. All patients underwent a complete neuro-ophthalmological evaluation and complementary tests for the aetiological diagnosis of diplopia. Data were collected on demographic variables, ocular deviation pattern, complementary test results, and diagnosis.
Results
A total of 204 patients with binocular diplopia were identified during the study period. The most frequent causes of diplopia overall were fourth nerve palsy (19.12%), sixth nerve palsy (14.71%), decompensated strabismus (14.22%), sagging eye syndrome (12.25%), third nerve palsy (10.78%), myasthenia (7.35%), supranuclear disorders (6.37%), and myopic esotropia (5.88%). Presentation was acute (less than 2 weeks’ progression) in 51% of cases. The most frequent causes of acute-onset diplopia were sixth nerve palsy (27.88%), third nerve palsy (21.15%), fourth nerve palsy (19.23%), supranuclear disorders (12.5%), and decompensated strabismus (6.73%). The most frequent causes of subacute/chronic presentation (more than 2 weeks) were decompensated strabismus (22%), sagging eye syndrome (22%), fourth nerve palsy (19%), myopic esotropia (12%), and myasthenia (11%).
Conclusions
The most frequent aetiology of diplopia in our environment was fourth nerve palsy, followed by sixth nerve palsy, decompensated strabismus, and sagging eye syndrome. Knowing the frequency of each cause of diplopia can help prioritise neuroimaging studies in each case.
{"title":"Binocular diplopia: a retrospective study of 204 cases","authors":"M. Saint-Gerons , M.A. Rubio , A. Matheu","doi":"10.1016/j.nrleng.2025.03.001","DOIUrl":"10.1016/j.nrleng.2025.03.001","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the prevalence and form of onset of different causes of binocular diplopia in our setting.</div></div><div><h3>Methods</h3><div>We conducted a single-centre, cross-sectional, retrospective study reviewing the medical records of all patients visiting a tertiary-level centre between May 2019 and June 2021 with binocular diplopia as the main symptom. All patients underwent a complete neuro-ophthalmological evaluation and complementary tests for the aetiological diagnosis of diplopia. Data were collected on demographic variables, ocular deviation pattern, complementary test results, and diagnosis.</div></div><div><h3>Results</h3><div>A total of 204 patients with binocular diplopia were identified during the study period. The most frequent causes of diplopia overall were fourth nerve palsy (19.12%), sixth nerve palsy (14.71%), decompensated strabismus (14.22%), sagging eye syndrome (12.25%), third nerve palsy (10.78%), myasthenia (7.35%), supranuclear disorders (6.37%), and myopic esotropia (5.88%). Presentation was acute (less than 2 weeks’ progression) in 51% of cases. The most frequent causes of acute-onset diplopia were sixth nerve palsy (27.88%), third nerve palsy (21.15%), fourth nerve palsy (19.23%), supranuclear disorders (12.5%), and decompensated strabismus (6.73%). The most frequent causes of subacute/chronic presentation (more than 2 weeks) were decompensated strabismus (22%), sagging eye syndrome (22%), fourth nerve palsy (19%), myopic esotropia (12%), and myasthenia (11%).</div></div><div><h3>Conclusions</h3><div>The most frequent aetiology of diplopia in our environment was fourth nerve palsy, followed by sixth nerve palsy, decompensated strabismus, and sagging eye syndrome. Knowing the frequency of each cause of diplopia can help prioritise neuroimaging studies in each case.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 3","pages":"Pages 221-228"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675106","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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