NeurologiaPub Date : 2023-11-01DOI: 10.1016/j.nrleng.2021.01.010
J. López-Gómez , B. Sacristán Enciso , M.A. Caro Miró , M.R. Querol Pascual
{"title":"Clinically isolated syndrome: Diagnosis and risk of developing clinically definite multiple sclerosis","authors":"J. López-Gómez , B. Sacristán Enciso , M.A. Caro Miró , M.R. Querol Pascual","doi":"10.1016/j.nrleng.2021.01.010","DOIUrl":"10.1016/j.nrleng.2021.01.010","url":null,"abstract":"<div><h3>Introduction</h3><p>In most cases, multiple sclerosis (MS) initially presents as clinically isolated syndrome (CIS). Differentiating CIS from other acute or subacute neurological diseases and estimating the risk of progression to clinically definite MS is essential since presenting a second episode in a short time is associated with poorer long-term prognosis.</p></div><div><h3>Development</h3><p>We conducted a literature review to evaluate the usefulness of different variables in improving diagnostic accuracy and predicting progression from CIS to MS, including magnetic resonance imaging (MRI) and such biofluid markers as oligoclonal IgG and IgM bands, lipid-specific oligoclonal IgM bands in the CSF, CSF kappa free light-chain (KFLC) index, neurofilament light chain (NfL) in the CSF and serum, and chitinase 3–like protein 1 (CHI3L1) in the CSF and serum.</p></div><div><h3>Conclusions</h3><p>Codetection of oligoclonal IgG bands and MRI lesions reduces diagnostic delays and suggests a high risk of CIS progression to MS. A KFLC index > 10.6 and CSF NfL concentrations > 1150 ng/L indicate that CIS is more likely to progress to MS within one year (40%–50%); 90% of patients with CIS and serum CHI3L1 levels > 33 ng/mL and 100% of those with lipid-specific oligoclonal IgM bands present MS within one year of CIS onset.</p></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"38 9","pages":"Pages 663-670"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2173580823000561/pdfft?md5=9b57c5badc6455c3c4987dfc6116d5e6&pid=1-s2.0-S2173580823000561-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NeurologiaPub Date : 2023-11-01DOI: 10.1016/j.nrleng.2023.10.001
R. Belvís , S. Santos-Lasaosa , P. Irimia , R.L. Blanco , M. Torres-Ferrús , N. Morollón , A. López-Bravo , D. García-Azorín , A. Mínguez-Olaondo , Á. Guerrero , J. Porta , E. Giné-Ciprés , Á. Sierra , G. Latorre , C. González-Oria , J. Pascual , D. Ezpeleta
{"title":"Telemedicine in the management of patients with headache: current situation and recommendations of the Spanish Society of Neurology’s Headache Study Group","authors":"R. Belvís , S. Santos-Lasaosa , P. Irimia , R.L. Blanco , M. Torres-Ferrús , N. Morollón , A. López-Bravo , D. García-Azorín , A. Mínguez-Olaondo , Á. Guerrero , J. Porta , E. Giné-Ciprés , Á. Sierra , G. Latorre , C. González-Oria , J. Pascual , D. Ezpeleta","doi":"10.1016/j.nrleng.2023.10.001","DOIUrl":"10.1016/j.nrleng.2023.10.001","url":null,"abstract":"<div><h3>Introduction</h3><p>The COVID-19 pandemic has caused an unexpected boost to telemedicine. We analyse the impact of the pandemic on telemedicine applied in Spanish headache consultations, review the literature, and issue recommendations for the implementation of telemedicine in consultations.</p></div><div><h3>Method</h3><p>The study comprised 3 phases: <em>1)</em> review of the MEDLINE database since 1958 (first reported experience with telemedicine); <em>2)</em> Google Forms survey sent to all members of the Spanish Society of Neurology’s Headache Study Group (GECSEN); and <em>3)</em> online consensus of GECSEN experts to issue recommendations for the implementation of telemedicine in Spain.</p></div><div><h3>Results</h3><p>COVID-19 has increased waiting times for face-to-face consultations, increasing the use of all telemedicine modalities: landline telephone (from 75% before April 2020 to 97% after), mobile telephone (from 9% to 27%), e-mail (from 30% to 36%), and video consultation (from 3% to 21%). Neurologists are aware of the need to expand the availability of video consultations, which are clearly growing, and other e-health and m-health tools.</p></div><div><h3>Conclusions</h3><p>The GECSEN recommends and encourages all neurologists who assist patients with headaches to implement telemedicine resources, with the optimal objective of offering video consultation to patients under 60-65 years of age and telephone calls to older patients, although each case must be considered on an individual basis. Prior approval and advice must be sought from legal and IT services and the centre’s management. Most patients with stable headache and/or neuralgia are eligible for telemedicine follow-up, after a first consultation that must always be held in person.</p></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"38 9","pages":"Pages 635-646"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2173580823000536/pdfft?md5=9cfc5bfe492fa72fcb341375e8932911&pid=1-s2.0-S2173580823000536-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NeurologiaPub Date : 2023-11-01DOI: 10.1016/j.nrleng.2021.04.009
A. Arauz , M.A. Barboza , L.C. Quintero , C. Cantu , E. Chiquete , F. Serrano
{"title":"Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy","authors":"A. Arauz , M.A. Barboza , L.C. Quintero , C. Cantu , E. Chiquete , F. Serrano","doi":"10.1016/j.nrleng.2021.04.009","DOIUrl":"10.1016/j.nrleng.2021.04.009","url":null,"abstract":"<div><h3>Introduction</h3><p>Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC.</p></div><div><h3>Materials and methods</h3><p>Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed.</p></div><div><h3>Results</h3><p>Twenty-six patients were included (20 female, age 35.4<!--> <!-->±<!--> <!-->12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction<!--> <!-->±<!--> <!-->hemorrhagic lesion)<!--> <!-->><!--> <!-->6<!--> <!-->cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization.</p></div><div><h3>Conclusion</h3><p>In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.</p></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"38 9","pages":"Pages 617-624"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2173580822001663/pdfft?md5=cb907e33e57bfd27d0b83f2f2ff9b807&pid=1-s2.0-S2173580822001663-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NeurologiaPub Date : 2023-10-01DOI: 10.1016/j.nrleng.2023.07.002
P. Martín-Jiménez , M. Sánchez-Tornero , S. Llamas-Velasco , M.P. Guerrero-Molina , M. González-Sánchez , A. Herrero-San Martín , V. Blanco-Palmero , P. Calleja-Castaño , J. Francisco-Gonzalo , A. Hilario , A. Ramos , E. Salvador , Ó. Toldos , A. Hernández-Lain , D.A. Pérez-Martínez , A. Villarejo-Galende
{"title":"Cerebral amyloid angiopathy–related inflammation: clinical features and treatment response in a case series","authors":"P. Martín-Jiménez , M. Sánchez-Tornero , S. Llamas-Velasco , M.P. Guerrero-Molina , M. González-Sánchez , A. Herrero-San Martín , V. Blanco-Palmero , P. Calleja-Castaño , J. Francisco-Gonzalo , A. Hilario , A. Ramos , E. Salvador , Ó. Toldos , A. Hernández-Lain , D.A. Pérez-Martínez , A. Villarejo-Galende","doi":"10.1016/j.nrleng.2023.07.002","DOIUrl":"10.1016/j.nrleng.2023.07.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Cerebral amyloid angiopathy–related inflammation (CAA-ri) is an entity characterised by an inflammatory response to β-amyloid deposition in the walls of cerebral microvessels.</p></div><div><h3>Methods</h3><p>We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria.</p></div><div><h3>Results</h3><p>The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (n = 6), behavioural alterations (n = 5), epileptic seizures (n = 5), focal neurological signs (n = 4), and headache (n = 2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (n = 7), subcortical white matter hyperintensities on T2-FLAIR sequences (n = 7), and leptomeningeal enhancement (n = 6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (n = 5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed.</p></div><div><h3>Conclusions</h3><p>Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.</p></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"38 8","pages":"Pages 550-559"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9903335","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}
NeurologiaPub Date : 2023-10-01DOI: 10.1016/j.nrleng.2020.10.011
R. López-Blanco , A. Sorrentino Rodriguez , E. Cubo , Í. Gabilondo , D. Ezpeleta , M.Á. Labrador-Espinosa , Á. Sánchez-Ferro , C. Tejero , M. Matarazzo , on behalf of the SEN's New Technologies Ad-Hoc Committee
{"title":"Impact of new technologies on neurology in Spain. Review by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology","authors":"R. López-Blanco , A. Sorrentino Rodriguez , E. Cubo , Í. Gabilondo , D. Ezpeleta , M.Á. Labrador-Espinosa , Á. Sánchez-Ferro , C. Tejero , M. Matarazzo , on behalf of the SEN's New Technologies Ad-Hoc Committee","doi":"10.1016/j.nrleng.2020.10.011","DOIUrl":"10.1016/j.nrleng.2020.10.011","url":null,"abstract":"<div><h3>Introduction</h3><p>New technologies are increasingly widespread in biomedicine. Using the consensus definition of new technologies established by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology (SEN), we evaluated the impact of these technologies on Spanish neurology, based on communications presented at Annual Meetings of the SEN.</p></div><div><h3>Material and methods</h3><p>We defined the concept of new technology in neurology as a novel technology or novel application of an existing technology, characterised by a certain degree of coherence persisting over time, with the potential to have an impact on the present and/or future of neurology. We conducted a descriptive study of scientific communications presented at the SEN’s annual meetings from 2012 to 2018, analysing the type of technology, the field of neurology, and the geographical provenance of the studies.</p></div><div><h3>Results</h3><p>We identified 299 communications related with new technologies from a total of 8139 (3.7%), including 120 posters and 179 oral communications, ranging from 1.6% of all communications in 2012 to 6.8% in 2018. The technologies most commonly addressed were advanced neuroimaging (24.7%), biosensors (17.1%), electrophysiology and neurostimulation (14.7%), and telemedicine (13.7%). The neurological fields where new technologies were most widely employed were movement disorders (18.4%), cerebrovascular diseases (15.7%), and dementia (13.4%). Madrid was the region presenting the highest number of communications related to new technologies (32.8%), followed by Catalonia (26.8%) and Andalusia (9.0%).</p></div><div><h3>Conclusions</h3><p>The number of communications addressing new technologies follows an upward trend. The number of technologies used in neurology has increased in parallel with their availability. We found scientific communications in all neurological subspecialties, with a heterogeneous geographical distribution.</p></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"38 8","pages":"Pages 591-598"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40510483","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}