Neurologia最新文献

{"title":"Inicio temprano de alemtuzumab: cambio en el paradigma de tratamiento en esclerosis múltiple. Análisis intermedio del estudio LEMVIDA","authors":"J.E. Meca-Lallana ,&nbsp;J.C. Álvarez-Cermeño ,&nbsp;B. Casanova Estruch ,&nbsp;G. Izquierdo Ayuso ,&nbsp;R. Ortiz Castillo ,&nbsp;A. Rodríguez-Antigüedad ,&nbsp;C. Calles Hernández ,&nbsp;en nombre del Grupo de Estudio LEMVIDA","doi":"10.1016/j.nrl.2021.06.007","DOIUrl":"10.1016/j.nrl.2021.06.007","url":null,"abstract":"<div><h3>Introduction</h3><p>LEMVIDA is a real-world prospective study of 3-year follow-up on quality of life of patients with multiple sclerosis (MS) receiving alemtuzumab in Spain.</p></div><div><h3>Methods</h3><p>This is an interim analysis evaluating the baseline characteristics of patients who started alemtuzumab between October 2016-September 2018. For 3 additional subanalysis patients were categorized by baseline EDSS score; time of alemtuzumab initiation during the recruitment period (cohort 1: October 2016-March 2017, cohort 2: April-September 2017, cohort 3: October 2017-March 2018 and cohort 4: April-September 2018); and the presence of highly active MS criteria.</p></div><div><h3>Results</h3><p>161 patients were analyzed: 67.1% female, age 38.7<!--> <!-->±<!--> <!-->9.4 years, MS duration 8.5<!--> <!-->±<!--> <!-->6.0 years, EDSS 3.3<!--> <!-->±<!--> <!-->1.7 and number of relapses in the previous 2 years 1.8<!--> <!-->±<!--> <!-->1.3. 48.3% of patients presented gadolinium-enhanced (Gd<!--> <!-->+) lesions (mean: 5.2<!--> <!-->±<!--> <!-->6.9) and 63.1% had received prior treatment with fingolimod or natalizumab. Baseline EDSS scores and number of Gd<!--> <!-->+<!--> <!-->lesions were higher in cohort 1 than in cohort 4 (4.1<!--> <!-->±<!--> <!-->1.8 <em>vs</em>. 3.2<!--> <!-->±<!--> <!-->1.7; p<!--> <!-->=<!--> <!-->0.040 and 10.9<!--> <!-->±<!--> <!-->11.9 <em>vs</em> 4.5<!--> <!-->±<!--> <!-->5.7; p<!--> <!-->=<!--> <!-->0.020). The frequency of prior treatment with fingolimod and natalizumab was lower in cohort 4 (60.6%) than in cohort 1 (70.6%) (comparison between groups not analyzed).</p></div><div><h3>Conclusions</h3><p>Unlike phase 3 studies of alemtuzumab, the patients included in LEMVIDA are older, have a longer duration of MS, higher disability and have received previous immunosuppressants. However, throughout the recruitment period, there is a tendency towards an early beginning of treatment with alemtuzumab, probably due to the evidence of higher effectiveness in the early stages of MS.</p></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"39 5","pages":"Pages 383-391"},"PeriodicalIF":3.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0213485321001353/pdfft?md5=6345bf67a107486085b326baddcb0744&pid=1-s2.0-S0213485321001353-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48946971","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":"Factores predictivos de destino al alta tras una lesión medular","authors":"E. Bárbara-Bataller ,&nbsp;J.L. Méndez-Suárez ,&nbsp;C. Alemán-Sánchez ,&nbsp;P. Peñaloza-Polo ,&nbsp;J. Sánchez-Enríquez ,&nbsp;P. Saavedra-Santana","doi":"10.1016/j.nrl.2021.09.012","DOIUrl":"https://doi.org/10.1016/j.nrl.2021.09.012","url":null,"abstract":"<div><h3>Introduction</h3><p>One of the main goals of the rehabilitation of patients with spinal cord injury (SCI) is the reintegration of the individual to their family, social, and work setting. The objective of this study was to identify the factors that determine the discharge destination after a traumatic spinal cord injury.</p></div><div><h3>Material and methods</h3><p>We conducted a retrospective descriptive study of 305 patients with SCI who completed the rehabilitation treatment at the spinal injury unit of Hospital Insular de Gran Canaria between 2001 and 2018.</p></div><div><h3>Results</h3><p>During the study period, we observed an increase in the number of patients referred to long-term care centres, from 9.14% between 2001 and 2010 to 18.4% between 2011 and 2018 (p &lt; .01). Of 20 variables that presented a significant association with destination at discharge in the univariate study, 7 presented a significant association in the multivariate study: age (OR: 1.05; 95% CI, 1.02-1.08), living with a partner (OR: 0.26; 95% CI, 0.09-0.76), residing on another island (OR: 3.57; 95% CI, 1.32-9.63), smoking (OR: 3.44; 95% CI, 1.26-9.44), diabetes (OR: 6.51; 95% CI, 1.46-29.02), history of psychiatric disorders (OR: 3.79; 95% CI, 1.31-10.93), and scores on the Spinal Cord Independence Measure-III (SCIM-III) (OR: 0.48; 95% CI, 0.33-0.69).</p></div><div><h3>Conclusions</h3><p>Our findings identified advanced age, living on the island of Tenerife, not being married, smoking, type 2 diabetes mellitus, history of psychiatric disorders, and low SCIM-III scores as predictive factors of referral to a long-term care centre in patients with traumatic SCI in the Canary Islands.</p></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"39 5","pages":"Pages 432-441"},"PeriodicalIF":3.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0213485321002735/pdfft?md5=cf46e2bc6cb59f83b5e4c3781bb56d05&pid=1-s2.0-S0213485321002735-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141240440","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":"3-Acetylpyridine-induced ataxic-like motor impairments are associated with plastic changes in the Purkinje cells of the rat cerebellum","authors":"D. González-Tapia ,&nbsp;N. Vázquez-Hernández ,&nbsp;F. Urmeneta-Ortiz ,&nbsp;N. Navidad-Hernandez ,&nbsp;M. Lazo-Yepez ,&nbsp;A. Tejeda-Martínez ,&nbsp;M. Flores-Soto ,&nbsp;I. González-Burgos","doi":"10.1016/j.nrl.2021.09.005","DOIUrl":"10.1016/j.nrl.2021.09.005","url":null,"abstract":"<div><p>Ataxias are characterized by aberrant movement patterns closely related to cerebellar dysfunction. Purkinje cell axons are the sole outputs from the cerebellar cortex, and dysfunctional activity of Purkinje cells has been associated with ataxic movements. However, the synaptic characteristics of Purkinje cells in cases of ataxia are not yet well understood. The nicotinamide antagonist 3-acethylpyridine (3-AP) selectively destroys inferior olivary nucleus neurons so it is widely used to induce cerebellar ataxia. Five days after 3-AP treatment (65<!--> <!-->mg/kg) in adult male Sprague-Dawley rats, motor incoordination was revealed through BBB and Rotarod testing. In addition, in Purkinje cells from lobules V–VII of the cerebellar vermis studied by the Golgi method, the density of dendritic spines decreased, especially the thin and mushroom types. Western blot analysis showed a decrease in AMPA and PSD-95 content with an increase of the α-catenin protein, while GAD-67 and synaptophysin were unchanged. Findings suggest a limited capacity of Purkinje cells to acquire and consolidate afferent excitatory inputs and an aberrant, rigid profile in the movement-related output patterns of Purkinje neurons that likely contributes to the motor-related impairments characteristic of cerebellar ataxias.</p></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"39 5","pages":"Pages 408-416"},"PeriodicalIF":3.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0213485321002541/pdfft?md5=8a546b4cf34512dfbae2bfc8059aae75&pid=1-s2.0-S0213485321002541-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49577789","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":"Status epilepticus—Therapeutic management at the pediatric emergency department","authors":"I. Pais-Cunha ,&nbsp;D. Valente ,&nbsp;D.B. Abreu ,&nbsp;J. Fonseca ,&nbsp;C. Melo ,&nbsp;M. Sampaio ,&nbsp;L.A. Santos ,&nbsp;R. Sousa","doi":"10.1016/j.nrl.2021.09.009","DOIUrl":"10.1016/j.nrl.2021.09.009","url":null,"abstract":"<div><h3>Introduction</h3><p>Status epilepticus is an important cause of pediatric neurological emergency. Immediate treatment is essential to prevent definitive neurological damage. Several antiepileptic drugs are available for the management of status epilepticus.</p></div><div><h3>Methods</h3><p>Retrospective study of patients admitted at the emergency department of a tertiary hospital for 5 years (2014–2019). We analyzed the compliance to the treatment guidelines for pediatric status epilepticus.</p></div><div><h3>Results</h3><p>One hundred and seventeen admissions were identified, 23.9% of these were febrile status epilepticus. Among the other cases, the most frequent cause was genetic (22.2%). The majority were convulsive status epilepticus (93.1%), 58.7% of which were generalized tonic–clonic seizures. Benzodiazepines were the most used first and second line drug (98.2% and 94.8%). The most frequent third drug used was diazepam (56.4%) followed by phenytoin (18.2%). An infra-therapeutic antiepileptic drug dose was given in 48.7% of cases. 49.6% presented with a prolonged status epilepticus and 6.8% needed intensive care. Incorrect sequence of drugs and infra-therapeutic doses were associated with prolonged status (<em>p</em> <!-->&lt;<!--> <!-->0.001 and <em>p</em> <!-->&lt;<!--> <!-->0.05) and an increased number of antiepileptic drugs used (<em>p</em> <!-->&lt;<!--> <!-->0.001 and <em>p</em> <!-->&lt;<!--> <!-->0.05).</p></div><div><h3>Conclusions</h3><p>Benzodiazepines were the most frequently first and second line drugs used for status epilepticus management. Surprisingly, the most frequently third line drugs used were also benzodiazepines. These findings were partially explained by the misuse of infra-therapeutic doses of these drugs. Noncompliance with the implemented guidelines was associated with unfavorable outcomes.</p></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"39 5","pages":"Pages 426-431"},"PeriodicalIF":3.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0213485321002619/pdfft?md5=7dac88fa5c8cded46215a359e5ce7896&pid=1-s2.0-S0213485321002619-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47311927","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":"Manejo de la atención paliativa de los pacientes con enfermedad de Parkinson y otros trastornos del movimiento en España. Encuesta Nacional a neurólogos","authors":"M. Álvarez Saúco ,&nbsp;R. García- Ramos ,&nbsp;I. Legarda Ramírez ,&nbsp;F. Carrillo García ,&nbsp;J. Fernández Bueno ,&nbsp;S. Martí Martínez ,&nbsp;B. González García ,&nbsp;A. Moya-Martínez ,&nbsp;D. Santos-García","doi":"10.1016/j.nrl.2021.09.008","DOIUrl":"10.1016/j.nrl.2021.09.008","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introducción&lt;/h3&gt;&lt;p&gt;La atención paliativa en enfermedades neurodegenerativas es útil pero infrautilizada. El objetivo de este estudio es conocer cómo se aplican en nuestro país los cuidados paliativos (CP) en los pacientes con trastornos del movimiento (TM) de cara a identificar posibles limitaciones y necesidades no cubiertas.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material y métodos&lt;/h3&gt;&lt;p&gt;Se trata de un estudio descriptivo, observacional, transversal, tipo encuesta anónima de 20 preguntas, dirigida y contestada por neurólogos dedicados a los TM en España.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Resultados&lt;/h3&gt;&lt;p&gt;Se obtuvieron 58 respuestas de neurólogos de 15 comunidades autónomas. El 69% contestó no disponer de enfermería especializada en TM pero sí de equipo de CP en su centro (81%). No se identificó ningún protocolo específico para CP en TM. Todos salvo un neurólogo afirmaron carecer de formación suficiente en CP, siendo la principal necesidad formativa la «explicación de voluntades anticipadas». Solo uno de cada 4 neurólogos contestó explicar rutinariamente la planificación anticipada de la asistencia sanitaria a sus pacientes, reconociendo hasta el 84,5% de los neurólogos desconocer cómo evaluar la competencia del paciente. El 60,3% de los encuestados respondió que entre el 10 y 30% de sus pacientes serían candidatos a CP, aunque 1 de cada 3 afirmó no tener claro en qué momento derivar al paciente a CP. El 100% de los neurólogos afirmó la necesidad prioritaria de implementar protocolos de CP en TM.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusiones&lt;/h3&gt;&lt;p&gt;Nuestro estudio evidencia un déficit formativo en CP en TM y en la asistencia al paciente con TM y su entorno, debiéndonos servir como punto de partida para elaborar protocolos de atención consensuados.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;p&gt;Palliative care in neurodegenerative diseases is useful but underused. The objective of this study is to know how palliative care (PC) is applied in our country in order to identify limitations and unmet needs.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;p&gt;It is a descriptive, observational, cross-sectional study, anonymous survey type of 20 questions, directed and answered by neurologists dedicated to TM in Spain.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;58 responses were obtained from neurologists from 15 autonomous communities. 69% answered that they did not have a specialized TM nursing facility but did have a PC team in their center (81%). No specific protocol for CP in TM was identified. All except one neurologist stated that they lacked sufficient training in PC, the main training need being the “advance directives explanation”. Only 1 in 4 neurologists answered routinely explaining advance healthcare planning to their patients, recognizing up to 84.5% of neurologists not knowing how to assess the patient's competence. 60.3% of those surveyed answered that between 10 and 30% of their patients would be candidates for PC, although 1 in 3 said they were not clear when to refer the patient to PC. 100% of neu","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"39 5","pages":"Pages 417-425"},"PeriodicalIF":3.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0213485321002577/pdfft?md5=5caec52e7119d4edcfac2221a8b2c282&pid=1-s2.0-S0213485321002577-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42446473","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":"Mortalidad y recurrencia a largo plazo del ictus isquémico en adultos jóvenes en Aragón","authors":"H. Tejada-Meza ,&nbsp;A. Lambea-Gil ,&nbsp;B. Pardiñas-Barón ,&nbsp;D. Sagarra-Mur ,&nbsp;M. Viscasillas-Sancho ,&nbsp;C. Moreno-Loscertales ,&nbsp;C. Tejero-Juste ,&nbsp;C. Pérez-Lázaro ,&nbsp;J. Artal-Roy ,&nbsp;O. Alberti-González ,&nbsp;P. Ruiz-Palomino ,&nbsp;N. Hernando-Quintana ,&nbsp;I. Campello-Morer ,&nbsp;A. Giménez-Muñoz ,&nbsp;M. Palacín-Larroy ,&nbsp;C. García-Arguedas ,&nbsp;L. Ballester-Marco ,&nbsp;J. Marta-Moreno ,&nbsp;en representación del Grupo de Estudio de Enfermedades Neurovasculares de Aragón (GEENV-Aragón)","doi":"10.1016/j.nrl.2023.02.005","DOIUrl":"10.1016/j.nrl.2023.02.005","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 &gt;<!--> <!-->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 etiology were associated with a higher cumulative risk of stroke recurrence.</div></div><div><h3>Conclusions</h3><div>Mortality and recurrence of ischemic 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":19300,"journal":{"name":"Neurologia","volume":"40 4","pages":"Pages 333-343"},"PeriodicalIF":2.9,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherencia al tratamiento en pacientes con esclerosis múltiple: factores de riesgo","authors":"L.A. Rodríguez de Antonio ,&nbsp;R. Fernández de Córdoba-García ,&nbsp;N. Herrero-Muñoz ,&nbsp;A. Ontañón-Nasarre ,&nbsp;I. García-Castañón","doi":"10.1016/j.nrl.2023.06.005","DOIUrl":"10.1016/j.nrl.2023.06.005","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 years) were analyzed, 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> <!-->&lt;<!--> <!-->.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":19300,"journal":{"name":"Neurologia","volume":"40 4","pages":"Pages 353-360"},"PeriodicalIF":2.9,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Análisis de costes del tratamiento con recambio plasmático terapéutico frente al tratamiento con inmunoglobulinas endovenosas en pacientes con enfermedades neurológicas de base inmune. Propuesta de optimización del uso de hemoderivados plasmáticos","authors":"M. Luisa Antelo ,&nbsp;S. Zalba Marcos ,&nbsp;I. Jericó ,&nbsp;M. Sarobe ,&nbsp;L. Torné ,&nbsp;M. Elena Erro ,&nbsp;J.A. García-Erce","doi":"10.1016/j.nrl.2023.08.002","DOIUrl":"10.1016/j.nrl.2023.08.002","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.</div><div>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, hospitalization, 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: €2,279 [€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, optimizes 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":19300,"journal":{"name":"Neurologia","volume":"40 4","pages":"Pages 344-352"},"PeriodicalIF":2.9,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliable change indices for 16 neuropsychological tests at six different time points","authors":"O. Sáez-Atxukarro ,&nbsp;J. Peña ,&nbsp;R. del Pino ,&nbsp;N. Ibarretxe-Bilbao ,&nbsp;N. Ojeda","doi":"10.1016/j.nrl.2023.06.004","DOIUrl":"10.1016/j.nrl.2023.06.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Neuropsychological assessment often involves repeated testing in order to assess a cognitive change or conduct a longitudinal follow-up study of a patient. To assess whether the change between assessments is relevant or not, longitudinal reference data are needed. The aim of this study is to provide reference data to enable interpretation of score changes between assessments for 16 commonly used tests, at six different time intervals between successive assessments, using five reliable change indices.</div></div><div><h3>Methods</h3><div>The study is part of the Normacog project, in which 388 healthy participants recruited in Spain (aged 18–84 years) were assessed on two occasions. A baseline assessment was carried out, and then followed up at 1 month (<em>n</em> <!-->=<!--> <!-->67), 3 months (<em>n</em> <!-->=<!--> <!-->64), 6 months (<em>n</em> <!-->=<!--> <!-->59), 9 months (<em>n</em> <!-->=<!--> <!-->60), 12 months (<em>n</em> <!-->=<!--> <!-->68), or 24 months (<em>n</em> <!-->=<!--> <!-->70). Longitudinal data were analyzed, and reliable change indices were calculated.</div></div><div><h3>Results</h3><div>A significant improvement was observed between assessment scores for all time points, especially in memory-related variables. Reference data are provided using the following indices: discrepancy scores expressed in percentiles, standard deviation index (SDI), reliable change index (RCI), RCI<!--> <!-->+<!--> <!-->practice effect (RCI<!--> <!-->+<!--> <!-->PE), and standardized regression-based formulae.</div></div><div><h3>Conclusions</h3><div>This study provides data to analyze whether or not a cognitive change can be considered reliable. The results support the use of these reliable change indices to avoid biases related to successive assessments. This study will lay the foundations for the implementation of these tools in clinical practice, and will be a reference for the creation of reliable change indices.</div></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 3","pages":"Pages 256-278"},"PeriodicalIF":2.9,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775434","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":"Distonía lingual: respuesta al tratamiento con toxina botulínica","authors":"A. Fernández Revuelta,&nbsp;E. López Valdés,&nbsp;R. García-Ramos","doi":"10.1016/j.nrl.2023.08.001","DOIUrl":"10.1016/j.nrl.2023.08.001","url":null,"abstract":"","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"40 3","pages":"Pages 331-332"},"PeriodicalIF":2.9,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139812419","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}