Neurologia最新文献

{"title":"Optimizando el manejo de la hemorragia intracerebral espontánea: proyecto ActúA. Documento de recomendaciones basado en opinión de expertos sobre el manejo de la hemorragia intracerebral espontánea","authors":"M.M. Freijo,&nbsp;D. Rodríguez-Luna,&nbsp;M. Castellanos,&nbsp;X. Jiménez,&nbsp;A. Martin,&nbsp;J. Masjuan,&nbsp;F. Moniche,&nbsp;M. Quintana-Diaz,&nbsp;C. Molina","doi":"10.1016/j.nrl.2026.502041","DOIUrl":"10.1016/j.nrl.2026.502041","url":null,"abstract":"<div><h3>Introduction</h3><div>Spontaneous intracerebral hemorrhage (ICH) is a neurological emergency. While the Stroke Code has improved the management of ischemic stroke in Spain, ICH lacks a specific protocol, leading to significant variability in its treatment. The ActúA project aims to standardize ICH care through recommendations tailored to the Spanish healthcare system.</div></div><div><h3>Material and methods</h3><div>The project was conducted in four phases: (1)<!--> <!-->initial recommendation proposal by a multidisciplinary scientific committee (MSC); (2)<!--> <!-->seven regional workshops to review and assess applicability; (3)<!--> <!-->final version prepared by the MSC; and (4)<!--> <!-->final validation using the Delphi methodology. Indicators were defined to evaluate the implementation and impact of the recommendations.</div></div><div><h3>Results</h3><div>The MSC identified key areas and proposed a total of 42 recommendations (17 pre-hospital, 12 in-hospital, and 13 post-hospital). These address, among other aspects, the activation of the Stroke Code, the use of validated neurological scales, the implementation of essential care bundles, and early rehabilitation. Simultaneously, 27 clinical performance indicators were established. Subsequently, 217 healthcare professionals participated in the regional workshops. Finally, 43 experts took part in the validation phase, achieving consensus on all recommendations in a single round.</div></div><div><h3>Conclusions</h3><div>The ActúA project provides a comprehensive framework for standardizing ICH management in Spain, based on available evidence and the consensus of a multidisciplinary panel. The coordinated implementation of these recommendations has the potential to contribute to more consistent and structured care, laying the groundwork for the development of a future national ICH Code.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"41 7","pages":"Article 502041"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relevancia de la determinación de los neurofilamentos en suero como biomarcador en esclerosis múltiple","authors":"J.M. García Domínguez,&nbsp;L.M. Villar,&nbsp;G. Arrambide,&nbsp;Y. Blanco,&nbsp;M.C. Calles,&nbsp;B. Casanova,&nbsp;T. Castillo-Triviño,&nbsp;L. Costa-Frossard França,&nbsp;S. Eichau,&nbsp;M.Á. Hernández Pérez,&nbsp;L. Landete,&nbsp;J. Meca Lallana,&nbsp;C. Oreja-Guevara,&nbsp;J.M. Prieto,&nbsp;L. Querol,&nbsp;A.B. Caminero","doi":"10.1016/j.nrl.2026.502141","DOIUrl":"10.1016/j.nrl.2026.502141","url":null,"abstract":"<div><h3>Introduction</h3><div>Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system with a complex and uncertain etiology. Although therapeutic advances have improved disease control, both prognosis and treatment monitoring continue to be challenging. Serum neurofilament light chain (sNfL), a marker of neuroaxonal damage, is emerging as a useful biomarker, providing neurologists with a tool to improve disease monitoring.</div></div><div><h3>Development</h3><div>This paper addresses the interpretation of sNfL levels in MS patients and their correlation with inflammatory activity and disease progression. Additionally, the role of sNfL in detecting subclinical axonal damage, which may allow for adjustments in therapeutic decision-making at different stages of the disease, is thoroughly discussed.</div></div><div><h3>Conclusions</h3><div>Incorporating sNfL measurement into the routine practice of neurologists, as a complement to clinical evaluation and imaging with magnetic resonance, represents an advance in the follow-up of MS patients. In defined scenarios, as detailed in the article, it can help optimize therapeutic decisions and prevent further neuroaxonal damage. While the current evidence is already strong, further validation of its application is necessary. The widespread use of this biomarker by neurologists is key to generating that evidence.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"41 7","pages":"Article 502141"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meningitis linfocitaria e hipertensión intracraneal en probable contexto con consumo de «tusi» o «cocaína rosa»","authors":"A. Cartanyà-Gutiérrez,&nbsp;Á. Domenech-Cubí,&nbsp;A. Conde-Martín,&nbsp;M. Vicente-Pascual","doi":"10.1016/j.nrl.2025.501946","DOIUrl":"10.1016/j.nrl.2025.501946","url":null,"abstract":"","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"41 7","pages":"Article 501946"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two consecutive double-blind phases for two-period disease-modifying therapy trials: A personal viewpoint methodological proposal","authors":"D. Santos-García,&nbsp;Á. Solleiro,&nbsp;T.M. Figueiras Vázquez","doi":"10.1016/j.nrl.2026.502010","DOIUrl":"10.1016/j.nrl.2026.502010","url":null,"abstract":"","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"41 7","pages":"Article 502010"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptación al castellano y validación de la escala Simplified Evaluation of Consciousness Disorder (SECONDs)","authors":"E. Noé,&nbsp;R. Llorens,&nbsp;C. Colomer,&nbsp;M.D. Navarro,&nbsp;M. ÓValle,&nbsp;A. Barra,&nbsp;A. Galvao-Carmona,&nbsp;B. Moliner,&nbsp;J. Ferri","doi":"10.1016/j.nrl.2026.502042","DOIUrl":"10.1016/j.nrl.2026.502042","url":null,"abstract":"<div><h3>Introduction</h3><div>The Simplified Evaluation of Disorders of Consciousness (SECONDs) has been proposed as a brief and efficient tool for the accurate diagnosis of patients with prolonged disorders of consciousness (DoC). Previous validation studies have only compared its total score with that of the Coma Recovery Scale-Revised (CRS-R). Our objective was to validate the Spanish version of the SECONDs, including its additional index, and to compare it with other scales such as the Disability Rating Scale (DRS).</div></div><div><h3>Materials and methods</h3><div>Thirty-two patients with prolonged DoC were included. Each patient was assessed using the CRS-R, DRS, and SECONDs on two consecutive days. The SECONDs was translated into Spanish following the methodology proposed by Beaton et al. (2000). Diagnostic agreement (weighted kappa coefficient) and inter-scale correlations (Spearman's rho) were analyzed.</div></div><div><h3>Results</h3><div>The SECONDs showed excellent agreement with the CRS-R (κ<!--> <!-->=<!--> <!-->0.81-0.83) and high intra- and inter-rater reliability (κ<!--> <!-->=<!--> <!-->0.70-0.77). Administration time was significantly shorter than that of the CRS-R (7.2<!--> <!-->±<!--> <!-->1.4 vs. 16.6<!--> <!-->±<!--> <!-->2.4<!--> <!-->minutes; <em>P</em>&lt;.001). Correlation with the DRS was moderate (r<!--> <!-->=<!--> <!-->–0.5 to –0.64).</div></div><div><h3>Conclusions</h3><div>The SECONDs is a valid, reliable, and rapid tool for assessing patients with DoC in Spanish-speaking populations. Although it does not replace the CRS-R, its brevity makes it ideal for use in critical care settings or as an initial screening instrument, optimizing resources and clinical time.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"41 7","pages":"Article 502042"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valor semiológico de los movimientos rítmicos ictales no clónicos de la mano (RINCH) en las crisis epilépticas","authors":"M. Garcés-Pellejero,&nbsp;S. López-Maza,&nbsp;I. Pérez Vizuete,&nbsp;M. Quintana Luque,&nbsp;D. Campos-Fernández,&nbsp;L. Abraira,&nbsp;E. Santamarina Pérez,&nbsp;I. Casado-Naranjo,&nbsp;M. Toledo,&nbsp;E. Fonseca Hernandez","doi":"10.1016/j.nrl.2026.502031","DOIUrl":"10.1016/j.nrl.2026.502031","url":null,"abstract":"<div><h3>Objective</h3><div>To study the semiological significance of rhythmic ictal nonclonic hand (RINCH) motions in epileptic seizures, as observed in prolonged video-EEG monitoring (mVEEG).</div></div><div><h3>Material and methods</h3><div>Retrospective observational study of patients with epilepsy admitted for prolonged mVEEG between 2020 and 2024, who exhibited RINCH during recorded seizures. Electroclinical data were collected and analyzed, focusing on the duration and associated semiology of RINCH.</div></div><div><h3>Results</h3><div>Among 379 patients admitted for mVEEG, RINCH were observed in 12 (66.6% male, mean age 44.7<!--> <!-->±<!--> <!-->11.3 years). All patients were right-handed. The seizure onset was the temporal lobe in 10 cases (83.3%) and left hemisphere in 11 (91.6%). The etiology was structural (n<!--> <!-->=<!--> <!-->9; 75%), unknown (n<!--> <!-->=<!--> <!-->2; 6,7%) and autoinmune-related (n<!--> <!-->=<!--> <!-->1; 8.3%).</div><div>All seizures were associated with impaired awareness and automatisms. Critical or postcritical language impairment were observed in nine (75%). Only one case progressed to bilateral tonic-clonic seizure. RINCH involved in the right hand in all seizures, and in one case spread to the contralateral hand. These movements appeared within a median of 25<!--> <!-->seconds (IQR: 12-90) after clinical onset, with a median duration of 19<!--> <!-->seconds (IQR: 11-48). EEG onset occurred after clinical onset in 7 cases (58.3%), and was consistently observed over the left anterior temporal region, except for one case with a parietal origin.</div></div><div><h3>Conclusion</h3><div>RINCH represent an uncommon but distinctive manifestation of epileptic seizures, often accompanied by impaired awareness, automatisms and aphasia. These movements typically occur in the contralateral to seizure-onset zone hand. The most frequent seizures onset localization is the left temporal lobe (dominant) in right-handed patients.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"41 7","pages":"Article 502031"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative care in stroke: Guidelines of the Spanish Society of Neurology's Stroke Study Group","authors":"Á. Ximénez-Carrillo,&nbsp;J.C. López Fernández,&nbsp;M. Alonso de Leciñana,&nbsp;E. López-Cancio Martinez,&nbsp;F. Moniche,&nbsp;M. Rubiera,&nbsp;O. Ayo,&nbsp;M. Castellanos,&nbsp;J. Marta-Moreno,&nbsp;A.M. Morales,&nbsp;A. Ponz,&nbsp;J.M. Ramirez-Moreno,&nbsp;S. Tur,&nbsp;M. Freijo Guerrero","doi":"10.1016/j.nrl.2026.502035","DOIUrl":"10.1016/j.nrl.2026.502035","url":null,"abstract":"<div><div>These guidelines address the relief of suffering and the optimal management of patients with stroke at the end of life. Their main purpose is to contribute to the development of skills in communication, setting treatment objectives, and decision-making. Furthermore, they focus on symptom management and specific care in patients with severe stroke. The recommendations are based on a systematic review of the literature and international guidelines on the subject. The levels of evidence and grade of recommendation are based on those established in the 2016 classification of the American College of Cardiology and the American Heart Association Task Force.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"41 7","pages":"Article 502035"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consenso de expertos españoles sobre el uso de levodopa inhalada para el tratamiento de las fluctuaciones en la enfermedad de Parkinson","authors":"J. Pagonabarraga,&nbsp;M. Blázquez-Estrada,&nbsp;E. Freire-Álvarez,&nbsp;L. López-Manzanares,&nbsp;N. López-Ariztegui,&nbsp;Á. Sánchez-Ferro,&nbsp;D. Santos-García","doi":"10.1016/j.nrl.2026.502040","DOIUrl":"10.1016/j.nrl.2026.502040","url":null,"abstract":"<div><h3>Introduction</h3><div>The majority of Parkinson's disease (PD) patients undergoing treatment with levodopa (LD)—the first-line therapy for motor manifestations in PD—experience OFF episodes, characterized by symptom exacerbation. Inhaled LD is an on-demand therapy aimed at managing OFF episodes.</div></div><div><h3>Methods</h3><div>A scientific committee comprising six PD experts developed statements regarding inhaled LD based on evidence and their clinical practice experience. Using a two-round Delphi study, these statements were evaluated on a Likert scale ranging from 1 (completely disagree) to 9 (completely agree) by a panel of Spanish neurologists specializing in the management of PD patients. Consensus was considered achieved if ≥66.67% of responses fell within the same tertile as the median response for each statement ([1-3] disagreement, [4-6] neutral, [7-9] agreement).</div></div><div><h3>Results</h3><div>Forty-four statements across six thematic areas were developed. A total of 48 experts were invited to participate in the Delphi study, with participation rates of 91.7% in the first round and 83.3% in the second. After two rounds, consensus was reached in agreement on 40 out of 44 statements (91%). There was a high degree of expert consensus on the utility of inhaled LD for the rapid and reliable on-demand treatment of both motor and non-motor fluctuations in PD patients.</div></div><div><h3>Conclusions</h3><div>Inhaled LD was deemed a useful, effective, and safe on-demand treatment for OFF episodes in PD.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"41 7","pages":"Article 502040"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paraneoplastic opsoclonus–myoclonus ataxia syndrome associated with breast carcinoma: Report of two cases with distinct clinical and immunological profiles","authors":"Ş. Benli,&nbsp;F. Dal,&nbsp;E.M. Sözüer,&nbsp;F.F. Erdoğan","doi":"10.1016/j.nrl.2026.502011","DOIUrl":"10.1016/j.nrl.2026.502011","url":null,"abstract":"","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"41 7","pages":"Article 502011"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid regression of myeloradicular compression following anti-BCMA CAR-T therapy in refractory multiple myeloma","authors":"C. Pérez-Prol,&nbsp;D. Aquerreta,&nbsp;P. Rodríguez-Otero,&nbsp;J.Gállego Pérez-Larraya","doi":"10.1016/j.nrl.2026.502012","DOIUrl":"10.1016/j.nrl.2026.502012","url":null,"abstract":"","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"41 7","pages":"Article 502012"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}