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García-Ull J, González-García N, Torres-Ferrús M, García-Azorín D, Molina-Martínez IFJ, Beltrán-Blasco I, Santos-Lasaosa S, Latorre G, Gago-Veiga AB, Láinez JM, Porta-Etessam J, Nieves-Castellanos C, Mínguez-Olaondo A, López-Bravo A, Quintas S, Morollón N, Díaz-Insa S, Belvís R, Irimia P. Diagnosis and treatment of disorders of intracranial pressure: consensus statement of the Spanish Society of Neurology's Headache Study Group. Neurologia 2024:S2173-5808(24)00048-8. [PMID: 38431253 DOI: 10.1016/j.nrleng.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Primary intracranial pressure disorders include idiopathic intracranial hypertension and spontaneous intracranial hypotension. Remarkable advances have been made in the diagnosis and treatment of these 2entities in recent years. Therefore, the Spanish Society of Neurology's Headache Study Group (GECSEN) deemed it necessary to prepare this consensus statement, including diagnostic and therapeutic algorithms to facilitate and improve the management of these disorders in clinical practice. This document was created by a committee of experts belonging to GECSEN, and is based on a systematic review of the literature, incorporating the experience of the participants, and establishes practical recommendations with levels of evidence and grades of recommendation.
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Affiliation(s)
- J García-Ull
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain.
| | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | - M Torres-Ferrús
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D García-Azorín
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Spain
| | - I F J Molina-Martínez
- Servicio de Neurología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - I Beltrán-Blasco
- Unidad de Cefaleas, Servicio de Neurología, Hospital General Universitario Dr. Balmis de Alicante, Spain
| | - S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - G Latorre
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - A B Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - J M Láinez
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - C Nieves-Castellanos
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario y Politécnico la Fe, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - A Mínguez-Olaondo
- Servicio de Neurología, Hospital Universitario Donostia, Instituto de Investigación Biodonostia, Athenea Neuroclinicis, Donostia, Facultad de Ciencias de la Salud, Universidad de Deusto, Bilbao, Spain
| | - A López-Bravo
- Servicio de Neurología, Hospital Reina Sofía de Tudela, Navarra, Spain
| | - S Quintas
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - N Morollón
- Unidas de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - S Díaz-Insa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario y Politécnico la Fe, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - R Belvís
- Unidas de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - P Irimia
- Unidad de Cefaleas, Servicio de Neurología, Clínica Universitaria de Navarra, Pamplona, Spain
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Porta-Etessam J, Santos-Lasaosa S, Rodríguez-Vico J, Núñez M, Ciudad A, Díaz-Cerezo S, Comellas M, Pérez-Sádaba FJ, Lizán L, Guerrero-Peral AL. Evaluating the Impact of a Training Program in Shared Decision-Making for Neurologists Treating People with Migraine. Neurol Ther 2023; 12:1319-1334. [PMID: 37310593 PMCID: PMC10310651 DOI: 10.1007/s40120-023-00495-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/09/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Migraine symptoms vary significantly between patients and within the same patient. Currently, an increasing number of therapeutic options are available for symptomatic and preventive treatment. Guidelines encourage physicians to use shared decision-making (SDM) in their practice, listening to patients' treatment preferences in order to select the most suitable and effective therapy. Although training for healthcare professionals could increase their awareness of SDM, results concerning its effectiveness are inconclusive. This study aimed to analyze the impact of a training activity to promote SDM in the context of migraine care. This was addressed by evaluating the impact on patients' decisional conflict (main objective), patient-physician relationship, neurologists' perceptions of the training and patient's perception of SDM. METHODS A multicenter observational study was conducted in four highly specialized headache units. The participating neurologists received SDM training targeting people with migraine in clinical practice to provide techniques and tools to optimize physician-patient interactions and encourage patient involvement in SDM. The study was set up in three consecutive phases: control phase, in which neurologists were blind to the training activity and performed the consultation with the control group under routine clinical practice; training phase, when the same neurologists participated in the SDM training; and SDM phase, in which these neurologists performed the consultation with the intervention group after the training. Patients in both groups with a change of treatment assessment during the visit completed the Decisional conflict scale (DCS) after the consultation to measure the patient's decisional conflict. Also, patients answered the patient-doctor relationship questionnaire (CREM-P) and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). The mean ± SD scores obtained from the study questionnaires were calculated for both groups and compared to determine whether there were significant differences (p < 0.05). RESULTS A total of 180 migraine patients (86.7% female, mean age of 38.5 ± 12.3 years) were included, of which 128 required a migraine treatment change assessment during the consultation (control group, n = 68; intervention group, n = 60). A low decisional conflict was found without significant differences between the intervention (25.6 ± 23.4) and control group (22.1 ± 17.9; p = 0.5597). No significant differences in the CREM-P and SDM-Q-9 scores were observed between groups. Physicians were satisfied with the training and showed greater agreement with the clarity, quality and selection of the contents. Moreover, physicians felt confident communicating with patients after the training, and they applied the techniques and SDM strategies learned. CONCLUSION SDM is a model currently being actively used in clinical practice for headache consultation, with high patient involvement in the process. This SDM training, while useful from the physician's perspective, may be more effective at other levels of care where there is still room for optimization of patient involvement in decision-making.
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Affiliation(s)
- J Porta-Etessam
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - S Santos-Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | | | | | | | | | - L Lizán
- Outcomes'10, Castellón, Spain.
- Department of Medicine, Jaume I University, Av. Sos Baynat s/n, 12071, Castellón, Spain.
| | - A L Guerrero-Peral
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
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Latorre G, González-García N, García-Ull J, González-Oria C, Porta-Etessam J, Molina FJ, Guerrero-Peral AL, Belvís R, Rodríguez R, Bescós A, Irimia P, Santos-Lasaosa S. Diagnosis and treatment of trigeminal neuralgia: consensus statement from the Spanish Society of Neurology's Headache Study Group. Neurologia 2023:S2173-5808(23)00027-5. [PMID: 37116695 DOI: 10.1016/j.nrleng.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/25/2021] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder affecting one or more branches of the trigeminal nerve. Despite its relatively low global prevalence, TN is an important healthcare problem both in neurology departments and in emergency departments due to the difficulty of diagnosing and treating the condition and its significant impact on patients' quality of life. For all these reasons, the Spanish Society of Neurology's Headache Study Group has developed a consensus statement on the management of TN. DEVELOPMENT This document was drafted by a panel of neurologists specialising in headache, who used the terminology of the International Headache Society. We analysed the published scientific evidence on the diagnosis and treatment of TN and establish practical recommendations with levels of evidence. CONCLUSIONS The diagnosis of TN is based on clinical criteria. Pain attributed to a lesion or disease of the trigeminal nerve is divided into TN and painful trigeminal neuropathy, according to the International Classification of Headache Disorders, third edition. TN is further subclassified into classical, secondary, or idiopathic, according to aetiology. Brain MRI is recommended in patients with clinical diagnosis of TN, in order to rule out secondary causes. In MRI studies to detect neurovascular compression, FIESTA, DRIVE, or CISS sequences are recommended. Pharmacological treatment is the initial choice in all patients. In selected cases with drug-resistant pain or poor tolerance, surgery should be considered. [[es]]Resumen INTRODUCCIóN: la neuralgia del trigémino (NT) es un tipo de dolor neuropático que afecta a una o más ramas del nervio trigémino. Aunque su prevalencia poblacional es relativamente baja, la NT supone un problema muy importante tanto en las consultas de neurología como en las urgencias por la dificultad para el diagnóstico y tratamiento y el elevado impacto sobre la calidad de vida de las personas que la padecen. Por estos motivos, el Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología ha elaborado un documento de consenso sobre el manejo de esta patología. DESARROLLO: este documento ha sido redactado por un comité de expertos utilizando la nomenclatura de la clasificación de la International Headache Society (IHS), analizando la evidencia científica publicada sobre diagnóstico y tratamiento y estableciendo unas recomendaciones prácticas con niveles de evidencia. CONCLUSIONES El diagnóstico de la NT es clínico. La International Classification of Headache Disorders en su tercera edición (ICHD-3) clasifica el dolor atribuible a una lesión o enfermedad del nervio trigémino en NT y neuropatía trigeminal dolorosa. A su vez la NT puede dividirse en tres tipos principales según la etiología del dolor: clásica, idiopática y secundaria. Es recomendable la realización de una resonancia magnética (RM) craneal a todo paciente con diagnóstico clínico de NT para descartar causas secundarias. Para estudiar la presencia de una compresión neurovascular con RM se recomienda la aplicación de los protocolos de imagen FIESTA, DRIVE o CISS. El tratamiento inicialmente será farmacológico y en pacientes seleccionados con respuesta insuficiente o mala tolerancia a fármacos se debe valorar el tratamiento quirúrgico.
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Affiliation(s)
- G Latorre
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain.
| | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | - J García-Ull
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - C González-Oria
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - F J Molina
- Servicio de Neurología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - A L Guerrero-Peral
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Departamento de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - R Belvís
- Unidad de Cefaleas y Neuralgias, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Rodríguez
- Servicio de Neurocirugía, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Bescós
- Servicio de Neurocirugía, Hospital Vall d´Hebron, Barcelona, Spain
| | - P Irimia
- Departamento de Neurología, Clínica Universitaria de Navarra, Pamplona, Spain
| | - S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón (IIS-Aragón), Zaragoza, Spain
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Escribano-Paredes JB, Natera-Villalba E, Porta-Etessam J, Vela L, García-Ruiz Espiga P, Alonso-Cánovas A, López-Sendón J, Pérez-Torre P, Fanjul S, Lledó L, Martínez-Castrillo JC, Pareés I. [What do medical students think about functional neurological disorders?]. Rev Neurol 2023; 76:265-271. [PMID: 37046395 PMCID: PMC10478140 DOI: 10.33588/rn.7608.2022409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Functional neurological disorders (FND) are a frequent reason for visits in neurology. However, specific training on these disorders during undergraduate and residency training is limited. This study assesses the knowledge, attitude and exposure of medical students to FNDs before completing their medical degree. PATIENTS AND METHODS We conducted a 15-item survey to explore understanding, exposure and attitudes towards FNDs among sixth-year medical students at four Spanish universities. RESULTS A total of 118 students (mean age 23.6 ± 1.2 years; 71.2% female) returned the survey. Of these, 88 (74.6%) were aware of the concept of FNDs and 78 (66.1%) had studied them in psychiatry classes. The term 'psychosomatic' was chosen by 54.1% of the students as the most appropriate term to refer to these disorders, and 111 (94.1%) believed that a history of sexual or physical abuse was common among FND patients. Fifty-seven students (48.3%) assumed that the diagnosis of FND was mostly a clinical diagnosis of exclusion and 63 (53.4%) indicated that it is managed only by psychiatry. One hundred and one students (85.6%) considered that adequate training on FNDs is an important aspect of their medical training. CONCLUSIONS Medical students are aware of the existence of FNDs, but their preferred terminology, as well as the perceived aetiological factors, reflect that the historical view of these disorders is still deeply rooted. Medical students feel that they should receive adequate education on FNDs from specialists in neurology and psychiatry as part of their training.
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Affiliation(s)
| | | | | | - L Vela
- Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, España
| | | | | | | | - P Pérez-Torre
- Hospital Universitario Ramón y Cajal, 28034 Madrid, España
| | - S Fanjul
- Hospital Universitario Ramón y Cajal, Madrid, España
| | - L Lledó
- Universidad de Alcalá, 28871 Alcalá de Henares, España
| | | | - I Pareés
- Hospital Universitario Ramón y Cajal, Madrid, España
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García-Azorín D, Abelaira-Freire J, Rodriguez-Adrada E, González-García N, Guerrero ÁL, Porta-Etessam J, Martín-Sánchez FJ. Study about the Manchester Triage System subtriage in patients that visited the Emergency Department due to headache. Neurología (English Edition) 2023; 38:270-277. [PMID: 37030513 DOI: 10.1016/j.nrleng.2020.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/14/2020] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Headache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of sub-triage in patients attending the emergency department due to headache. MATERIAL AND METHODS We studied a series of consecutive patients who came to the emergency department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. RESULTS We registered a total of 1120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, 2 patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and 5 as not urgent (2%). The percentage of patients under-triaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. CONCLUSION During the study period, at least one in 10 patients attending the emergency department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS under-triaged most patients with warning signs suggesting a potential emergency.
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Affiliation(s)
- D García-Azorín
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - J Abelaira-Freire
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Á L Guerrero
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
| | - F J Martín-Sánchez
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
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Ly-Yang F, Gómez-Calleja V, Pérez-García P, González-Gómez N, Porta-Etessam J, Santos-Bueso E. Intercritical photophobia in the migrainous patient. Proposal for diagnostic criteria. Neurologia (Engl Ed) 2022:S2173-5808(22)00077-3. [PMID: 35842130 DOI: 10.1016/j.nrleng.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Photophobia is a symptom of abnormal light intolerance without pain sensation that requires an anamnesis and an examination to diagnose an underlying etiology. BASIC PROCEDURE This article focuses on 30 clinical cases with isolated intense photophobia and on the review of the literature. OBJECTIVE The purpose of this article is to establish diagnostic criteria for photophobia. RESULTS The etiology of photophobia appears to be at the level of the intrinsically photosensitive retinal ganglion cells known as melanopsin cells and at a neurochemical level mediated by calcitonin-related peptide and the pituitary activating peptide cyclase. CONCLUSION The treatment of photophobia could consist of monoclonal antibodies against calcitonin-related peptide and/or pituitary activating peptide cyclase.
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Affiliation(s)
- F Ly-Yang
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - V Gómez-Calleja
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - P Pérez-García
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - N González-Gómez
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - J Porta-Etessam
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - E Santos-Bueso
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Santos-Lasaosa S, Belvís R, Cuadrado ML, Díaz-Insa S, Gago-Veiga A, Guerrero-Peral AL, Huerta M, Irimia P, Láinez JM, Latorre G, Leira R, Pascual J, Porta-Etessam J, Sánchez Del Río M, Viguera J, Pozo-Rosich P. Calcitonin gene-related peptide in migraine: from pathophysiology to treatment. Neurologia (Engl Ed) 2022; 37:390-402. [PMID: 35672126 DOI: 10.1016/j.nrleng.2019.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/07/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION It has been observed in recent years that levels of such molecules as calcitonin gene-related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase-activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients' migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity. DEVELOPMENT The Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics. CONCLUSIONS The clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.
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Affiliation(s)
- S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain.
| | - R Belvís
- Unidad de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M L Cuadrado
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - S Díaz-Insa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Fe, Valencia, Spain
| | - A Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - A L Guerrero-Peral
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Investigación de Salamanca (IBSAL), Spain
| | - M Huerta
- Sección de Neurología, Hospital de Viladecans, Barcelona, Spain
| | - P Irimia
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, Spain
| | - J M Láinez
- Servicio de Neurología, Hospital Clínico Universitario de Valencia, Universidad Católica de Valencia, Valencia, Spain
| | - G Latorre
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - R Leira
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - J Pascual
- Hospital Universitario Marqués de Valdecilla e IDIVAL, Santander, Spain
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - M Sánchez Del Río
- Departamento de Neurología, Clínica Universidad de Navarra, Madrid, Spain
| | - J Viguera
- Consulta de Cefalea, Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - P Pozo-Rosich
- Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grupo de Investigación en Cefalea, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
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Santos-Lasaosa S, Belvís R, Cuadrado ML, Díaz-Insa S, Gago-Veiga A, Guerrero-Peral AL, Huerta M, Irimia P, Láinez JM, Latorre G, Leira R, Pascual J, Porta-Etessam J, Sánchez Del Río M, Viguera J, Pozo-Rosich P. Calcitonin gene-related peptide in migraine: from pathophysiology to treatment. Neurologia 2022; 37:390-402. [PMID: 31326215 DOI: 10.1016/j.nrl.2019.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/07/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION It has been observed in recent years that levels of such molecules as calcitonin gene-related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase-activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients' migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity. DEVELOPMENT The Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics. CONCLUSIONS The clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.
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Affiliation(s)
- S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto Aragonés de Ciencias de la Salud, Zaragoza, España.
| | - R Belvís
- Unidad de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M L Cuadrado
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - S Díaz-Insa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Fe, Valencia, España
| | - A Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, España
| | - A L Guerrero-Peral
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España; Instituto de Investigación de Salamanca (IBSAL), España
| | - M Huerta
- Sección de Neurología, Hospital de Viladecans, Barcelona, España
| | - P Irimia
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, España
| | - J M Láinez
- Servicio de Neurología, Hospital Clínico Universitario de Valencia. Universidad Católica de Valencia, Valencia, España
| | - G Latorre
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario de Fuenlabrada. Universidad Rey Juan Carlos, Madrid, España
| | - R Leira
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - J Pascual
- Hospital Universitario Marqués de Valdecilla e IDIVAL, Santander, España
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - M Sánchez Del Río
- Departamento de Neurología, Clínica Universidad de Navarra, Madrid, España
| | - J Viguera
- Consulta de Cefalea, Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - P Pozo-Rosich
- Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Investigación en Cefalea; VHIR; Universitat Autònoma de Barcelona, Barcelona, España
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9
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Latorre G, González-García N, García-Ull J, González-Oria C, Porta-Etessam J, Molina F, Guerrero-Peral A, Belvís R, Rodríguez R, Bescós A, Irimia P, Santos-Lasaosa S. Diagnóstico y tratamiento de la neuralgia del trigémino: documento de consenso del Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Caronna E, José Gallardo V, Alpuente A, Torres-Ferrus M, Sánchez-Mateo NM, Viguera-Romero J, López-Veloso AC, López-Bravo A, Gago-Veiga AB, Irimia Sieira P, Porta-Etessam J, Santos-Lasaosa S, Pozo-Rosich P. Safety of anti-CGRP monoclonal antibodies in patients with migraine during the COVID-19 pandemic: Present and future implications. Neurologia (Engl Ed) 2021; 36:611-617. [PMID: 34654536 PMCID: PMC8506139 DOI: 10.1016/j.nrleng.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 11/04/2022] Open
Abstract
Background and objective CGRP, a neuropeptide involved in migraine pathophysiology, is also known to play a role in the respiratory system and in immunological conditions such as sepsis. We analyzed the impact of the use of CGRP antagonists in patients with migraine during the COVID-19 pandemic, caused by the SARS-CoV-2 coronavirus. Methods This is a multicentre cross-sectional study. From May to November 2020, through a national survey distributed by the Spanish Society of Neurology, we collected data about the presence of COVID-19 symptoms including headache and their characteristics and severity in patients with migraine treated with anti-CGRP monoclonal antibodies (mAb), and compared them with patients with migraine not receiving this treatment. We also conducted a subanalysis of patients with COVID-19 symptoms. Results We recruited 300 patients with migraine: 51.7% (155/300) were taking anti-CGRP mAbs; 87.3% were women (262/300). Mean age (standard deviation) was 47.1 years (11.6). Forty-one patients (13.7%) met diagnostic criteria for COVID-19, with no statistically significant difference between patients with and without anti-CGRP mAb treatment (16.1% vs 11.0%, respectively; P = .320). Of the patients with COVID-19, 48.8% (20/41) visited the emergency department and 12.2% (5/41) were hospitalised. Likewise, no clinical differences were found between the groups of patients with and without anti-CGRP mAb treatment. Conclusion Anti-CGRP mAbs may be safe in clinical practice, presenting no association with increased risk of COVID-19.
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Affiliation(s)
- E Caronna
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V José Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Alpuente
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Torres-Ferrus
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N M Sánchez-Mateo
- Headache Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Viguera-Romero
- Headache Unit, Neuroscience Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - A C López-Veloso
- Neurology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, Spain
| | - A López-Bravo
- Neurology Department, Hospital Reina Sofia, Tudela, Spain
| | - A B Gago-Veiga
- Headache Unit, Neurology Department, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - P Irimia Sieira
- Neurology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - J Porta-Etessam
- Department of Neurology, Institute of Neurosciences, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - S Santos-Lasaosa
- Headache Unit, Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - P Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Láinez-Andrés JM, Ashina M, Belvís R, Díaz-Insa S, Ezpeleta D, García-Azorín D, González-Oria C, Guerrero AL, Guillém A, Holle-Lee D, Huerta-Villanueva M, Irimia P, Leira R, Pascual J, Porta-Etessam J, Pozo-Rosich P, Rodríguez-Vico JS, Sánchez Del Río M, Santos-Lasaosa S, Silberstein S. 1st Post-European Headache Federation Meeting: a review of the latest developments presented at the 2020 European Headache Federation Congress. Rev Neurol 2021; 72:S1-S19. [PMID: 34180043 DOI: 10.33588/rn.72s02.2021155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION After the European Headache Federation (EHF) Congress, renowned Spanish neurologists specialised in migraine presented the most significant latest developments in research in this field at the Post-EHF Meeting. DEVELOPMENT The main data presented concerning the treatment of chronic and episodic migraine were addressed, with attention paid more specifically to those related to preventive treatments and real-life experience in the management of the disease. An important review was carried out of the new therapeutic targets and the possibilities they offer in terms of understanding the pathophysiology of migraine and its treatment. An update was also presented of the latest developments in the treatment of migraine with fremanezumab, a monoclonal antibody recently authorised by the European Medicines Agency. Participants were also given an update on the latest developments in basic research on the pathology, as well as an overview of the symptoms of migraine and COVID-19. Finally, the repercussions of migraine in terms of its burden on the care and economic resources of the health system were addressed, along with its impact on society. CONCLUSIONS The meeting summarised the content presented at the 14th EHF Congress, which took place in late June/early July 2020.
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Affiliation(s)
| | - M Ashina
- Rigshospitalet Glostrup, Glostrup, Dinamarca
| | - R Belvís
- Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, España
| | - S Díaz-Insa
- Hospital Universitario La Fe, Valencia, España
| | - D Ezpeleta
- Hospital Universitario Quirón Salud Madrid, Pozuelo de Alarcón, España
| | - D García-Azorín
- Hospital Universitario Clínico de Valladolid, Valladolid, España
| | | | - A L Guerrero
- Hospital Universitario Clínico de Valladolid, Valladolid, España
| | - A Guillém
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | | | - P Irimia
- Clínica Universitaria de Navarra, 31008 Pamplona, España
| | - R Leira
- Hospital Clínico Universitario de Santiago de Compostela, A Coruña, España
| | - J Pascual
- Hospital Universitario Marqués de Valdecilla, Santander, España
| | | | - P Pozo-Rosich
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
| | | | | | - S Santos-Lasaosa
- Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, España
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12
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Caronna E, José Gallardo V, Alpuente A, Torres-Ferrus M, Sánchez-Mateo NM, Viguera-Romero J, López-Veloso AC, López-Bravo A, Gago-Veiga AB, Irimia Sieira P, Porta-Etessam J, Santos-Lasaosa S, Pozo-Rosich P. Safety of anti-CGRP monoclonal antibodies in patients with migraine during the COVID-19 pandemic: Present and future implications. Neurologia 2021; 36:S0213-4853(21)00056-6. [PMID: 33832802 PMCID: PMC7973059 DOI: 10.1016/j.nrl.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE CGRP, a neuropeptide involved in migraine pathophysiology, is also known to play a role in the respiratory system and in immunological conditions such as sepsis. We analyzed the impact of the use of CGRP antagonists in patients with migraine during the COVID-19 pandemic, caused by the SARS-CoV-2 coronavirus. METHODS This is a multicentre cross-sectional study. From May to November 2020, through a national survey distributed by the Spanish Society of Neurology, we collected data about the presence of COVID-19 symptoms including headache and their characteristics and severity in patients with migraine treated with anti-CGRP monoclonal antibodies (mAb), and compared them with patients with migraine not receiving this treatment. We also conducted a subanalysis of patients with COVID-19 symptoms. RESULTS We recruited 300 patients with migraine: 51.7% (155/300) were taking anti-CGRP mAbs; 87.3% were women (262/300). Mean age (standard deviation) was 47.1 years (11.6). Forty-one patients (13.7%) met diagnostic criteria for COVID-19, with no statistically significant difference between patients with and without anti-CGRP mAb treatment (16.1% vs 11.0%, respectively; P=.320). Of the patients with COVID-19, 48.8% (20/41) visited the emergency department and 12.2% (5/41) were hospitalised. Likewise, no clinical differences were found between the groups of patients with and without anti-CGRP mAb treatment. CONCLUSION Anti-CGRP mAbs may be safe in clinical practice, presenting no association with increased risk of COVID-19.
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Affiliation(s)
- E Caronna
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V José Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Alpuente
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Torres-Ferrus
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N M Sánchez-Mateo
- Headache Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Viguera-Romero
- Headache Unit, Neuroscience Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - A C López-Veloso
- Neurology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, Spain
| | - A López-Bravo
- Neurology Department, Hospital Reina Sofia, Tudela, Spain
| | - A B Gago-Veiga
- Headache Unit, Neurology Department, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - P Irimia Sieira
- Neurology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - J Porta-Etessam
- Department of Neurology, Institute of Neurosciences, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - S Santos-Lasaosa
- Headache Unit, Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - P Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Ly-Yang F, Gómez-Calleja V, Pérez-García P, González-Gómez N, Porta-Etessam J, Santos-Bueso E. Intercritical photophobia in the migraineous patient. Proposal for diagnostic criteria. Neurologia 2021; 38:S0213-4853(21)00005-0. [PMID: 33622562 DOI: 10.1016/j.nrl.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Photophobia is a symptom of abnormal light intolerance without pain sensation that requires an anamnesis and an examination to diagnose an underlying etiology. BASIC PROCEDURE This article focuses on 30 clinical cases with isolated intense photophobia and on the review of the literature. OBJECTIVE The purpose of this article is to establish diagnostic criteria for photophobia. RESULTS The etiology of photophobia appears to be at the level of the intrinsically photosensitive retinal ganglion cells known as melanopsin cells and at a neurochemical level mediated by calcitonin-related peptide and the pituitary activating peptide cyclase. CONCLUSION The treatment of photophobia could consist of monoclonal antibodies against calcitonin-related peptide and/or pituitary activating peptide cyclase.
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Affiliation(s)
- F Ly-Yang
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - V Gómez-Calleja
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - P Pérez-García
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - N González-Gómez
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - J Porta-Etessam
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - E Santos-Bueso
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
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Porta-Etessam J, González-García N, Guerrero ÁL, García-Azorín D. Failure to monoclonal antibodies against CGRP or its receptor does not preclude lack of efficacy to other drugs from the same therapeutic class. Neurologia 2020; 36:S0213-4853(20)30312-1. [PMID: 33176918 DOI: 10.1016/j.nrl.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología. Hospital Clínico Universitario San Carlos, Madrid, España; Departamento de Medicina, Universidad Complutense de Madrid, Madrid, España; Instituto de Investigación Biomédica, Hospital Clínico San Carlos, Madrid, España.
| | - N González-García
- Unidad de Cefaleas, Servicio de Neurología. Hospital Clínico Universitario San Carlos, Madrid, España
| | - Á L Guerrero
- Unidad de Cefaleas, Servicio de Neurología. Hospital Clínico Universitario de Valladolid, Valladolid, España; Departamento de Medicina, Universidad de Valladolid, Valladolid, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - D García-Azorín
- Unidad de Cefaleas, Servicio de Neurología. Hospital Clínico Universitario de Valladolid, Valladolid, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
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Porta-Etessam J, Yus M, González García N, Valcarcel A, Barrado-Cuchillo J, Pérez-Somarriba J. Brain inflammatory thrombogenic vasculopathy related with SARS-CoV-2 infection. Neurología (English Edition) 2020. [PMID: 32917434 PMCID: PMC7832718 DOI: 10.1016/j.nrleng.2020.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- J Porta-Etessam
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain.
| | - M Yus
- Radiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - A Valcarcel
- Internal Medicine Department, Hospital Clínico San Carlos, Madrid, Spain
| | - J Barrado-Cuchillo
- Internal Medicine Department, Hospital Clínico San Carlos, Madrid, Spain
| | - J Pérez-Somarriba
- Internal Medicine Department, Hospital Clínico San Carlos, Madrid, Spain
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García-Azorín D, Abelaira-Freire J, Rodriguez-Adrada E, González-García N, Guerrero ÁL, Porta-Etessam J, Martín-Sánchez FJ. Study about the Manchester Triage System subtriage in patients that visited the Emergency Department due to headache. Neurologia 2020; 38:S0213-4853(20)30275-9. [PMID: 33268106 DOI: 10.1016/j.nrl.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Headache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of sub-triage in patients attending the Emergency Department due to headache. MATERIAL AND METHODS We studied a series of consecutive patients who came to the Emergency Department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. RESULTS We registered a total of 1,120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, two patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and five as not urgent (2%). The percentage of patients under-triaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. CONCLUSION During the study period, at least one in 10 patients attending the Emergency Department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS under-triaged most patients with warning signs suggesting a potential emergency.
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Affiliation(s)
- D García-Azorín
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - J Abelaira-Freire
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, España
| | | | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, España
| | - Á L Guerrero
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España; Departamento de Medicina, Facultad de Medicina, Universidad de Valladolid, Valladolid, España
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, España; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España.
| | - F J Martín-Sánchez
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
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Santos-Lasaosa S, Cuadrado M, Gago-Veiga A, Guerrero-Peral A, Irimia P, Láinez J, Leira R, Pascual J, Porta-Etessam J, Sánchez del Río M, Viguera Romero J, Pozo-Rosich P. Evidencia y experiencia del uso de onabotulinumtoxinA en neuralgia del trigémino y cefaleas primarias distintas de la migraña crónica. Neurologia 2020; 35:568-578. [DOI: 10.1016/j.nrl.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/20/2022] Open
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Castillo-Álvarez F, González-García N, Cuadrado M, Porta-Etessam J. Drug-resistant secondary headache associated with administration of biological drugs. Neurología (English Edition) 2020. [DOI: 10.1016/j.nrleng.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Silva-Hernández L, Gil Rojo C, González García N, Porta-Etessam J. Tapia syndrome following orotracheal intubation: a case report. Neurología (English Edition) 2020. [DOI: 10.1016/j.nrleng.2018.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Pascual-Prieto J, Narváez-Palazón C, Porta-Etessam J, Gómez-de-Liaño R. COVID-19 epidemic: Should ophthalmologists be aware of oculomotor paresis? Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:361-362. [PMID: 32517875 PMCID: PMC7245284 DOI: 10.1016/j.oftal.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
Affiliation(s)
- J Pascual-Prieto
- Servicio de Oftalmología, Hospital Clínico San Carlos, Madrid, España.
| | - C Narváez-Palazón
- Servicio de Oftalmología, Hospital Clínico San Carlos, Madrid, España
| | - J Porta-Etessam
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | - R Gómez-de-Liaño
- Servicio de Oftalmología, Hospital Clínico San Carlos, Madrid, España
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Silva-Hernández L, Gil Rojo C, González García N, Porta-Etessam J. Tapia syndrome following orotracheal intubation: A case report. Neurologia 2020; 35:421-423. [PMID: 30076038 DOI: 10.1016/j.nrl.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- L Silva-Hernández
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España.
| | - C Gil Rojo
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | | | - J Porta-Etessam
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
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Castillo-Álvarez F, González-García N, Cuadrado M, Porta-Etessam J. Cefalea secundaria farmacorresistente asociada a fármacos biológicos. Neurologia 2020; 35:425-426. [DOI: 10.1016/j.nrl.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022] Open
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23
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Pascual-Prieto J, Narváez-Palazón C, Porta-Etessam J, Gómez-de-Liaño R. COVID-19 epidemic: Should ophthalmologists be aware of oculomotor paresis? Archivos de la Sociedad Española de Oftalmología (English Edition) 2020. [PMCID: PMC7303631 DOI: 10.1016/j.oftale.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Beltrán-Corbellini Á, Chico-García JL, Martínez-Poles J, Rodríguez-Jorge F, Natera-Villalba E, Gómez-Corral J, Gómez-López A, Monreal E, Parra-Díaz P, Cortés-Cuevas JL, Galán JC, Fragola-Arnau C, Porta-Etessam J, Masjuan J, Alonso-Cánovas A. Acute-onset smell and taste disorders in the context of COVID-19: a pilot multicentre polymerase chain reaction based case-control study. Eur J Neurol 2020; 27:1738-1741. [PMID: 32320508 PMCID: PMC7264557 DOI: 10.1111/ene.14273] [Citation(s) in RCA: 229] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 11/27/2022]
Abstract
Background and purpose Specific respiratory tract infections, including COVID‐19, may cause smell and/or taste disorders (STDs) with increased frequency. The aim was to determine whether new‐onset STDs are more frequent amongst COVID‐19 patients than influenza patients. Method This was a case–control study including hospitalized patients of two tertiary care centres. Consecutive patients positive for COVID‐19 polymerase chain reaction (cases) and patients positive for influenza polymerase chain reaction (historical control sample) were assessed during specific periods, employing a self‐reported STD questionnaire. Results Seventy‐nine cases and 40 controls were included. No significant differences were found in basal features between the two groups. New‐onset STDs were significantly more frequent amongst cases (31, 39.2%) than in the control group (5, 12.5 %) [adjusted odds ratio 21.4 (2.77–165.4, P = 0.003)]. COVID‐19 patients with new‐onset STDs were significantly younger than COVID‐19 patients without STDs (52.6 ± 17.2 vs. 67.4 ± 15.1, P < 0.001). Amongst COVID‐19 patients who presented STDs, 22 (70.9%) recalled an acute onset and it was an initial manifestation in 11 (35.5%). Twenty‐five (80.6%) presented smell disorders (mostly anosmia, 14, 45.2%) and 28 (90.3%) taste disorders (mostly ageusia, 14, 45.2%). Only four (12.9 %) reported concomitant nasal obstruction. The mean duration of STD was 7.5 ± 3.2 days and 12 patients (40%) manifested complete recovery after 7.4 ± 2.3 days of onset. Conclusion New‐onset STDs were significantly more frequent amongst COVID‐19 patients than influenza patients; they usually had an acute onset and were commonly an initial manifestation. The use of STD assessment in anamnesis as a hint for COVID‐19 and to support individuals’ self‐isolation in the current epidemic context is suggested.
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Affiliation(s)
| | - J L Chico-García
- Department of Neurology, University Hospital Ramón y Cajal, Madrid, Spain
| | - J Martínez-Poles
- Department of Neurology, Hospital La Luz, Madrid, Spain.,Neurological Disorders Study Group, Institute for Sanitary and Biomedical Research Clínico San Carlos (IdISSC), University Hospital Clínico San Carlos, Madrid, Spain
| | - F Rodríguez-Jorge
- Department of Neurology, University Hospital Ramón y Cajal, Madrid, Spain
| | - E Natera-Villalba
- Department of Neurology, University Hospital Ramón y Cajal, Madrid, Spain
| | - J Gómez-Corral
- Department of Neurology, University Hospital Ramón y Cajal, Madrid, Spain
| | - A Gómez-López
- Department of Neurology, University Hospital Ramón y Cajal, Madrid, Spain
| | - E Monreal
- Department of Neurology, University Hospital Ramón y Cajal, Madrid, Spain
| | - P Parra-Díaz
- Department of Neurology, University Hospital Ramón y Cajal, Madrid, Spain
| | - J L Cortés-Cuevas
- Department of Clinical Microbiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - J C Galán
- Department of Clinical Microbiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - C Fragola-Arnau
- Department of Otorhinolaryngology, University Hospital Ramón y Cajal, Madrid, Spain
| | - J Porta-Etessam
- Neurological Disorders Study Group, Institute for Sanitary and Biomedical Research Clínico San Carlos (IdISSC), University Hospital Clínico San Carlos, Madrid, Spain.,Department of Neurology, University Hospital Clínico San Carlos, Madrid, Spain
| | - J Masjuan
- Department of Neurology, University Hospital Ramón y Cajal, Madrid, Spain
| | - A Alonso-Cánovas
- Department of Neurology, University Hospital Ramón y Cajal, Madrid, Spain
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Santos-Lasaosa S, Porta-Etessam J. OnabotulinumtoxinA infiltration and nerve blocks in patients with headache and neuralgia: safety recommendations to prevent SARS-CoV-2 infection. Neurologia 2020; 35:291-294. [PMID: 32410765 PMCID: PMC7221361 DOI: 10.1016/j.nrl.2020.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 01/11/2023] Open
Abstract
Introducción La infección por SARS-CoV-2 y la situación de pandemia hacen necesario un cambio en nuestra práctica clínica, en relación con la adopción de nuevas estrategias que permitan la asistencia integral de los pacientes con cefalea y neuralgia. Material y métodos Ante la elevada capacidad de transmisión del virus, determinados procedimientos, como la infiltración de onabotulinumtoxinA y la realización de bloqueos anestésicos, deben realizarse adoptando medidas que garanticen un nivel adecuado de seguridad. Resultados Nuestro objetivo es presentar una serie de recomendaciones basadas en las medidas establecidas por nuestro sistema sanitario para evitar el contagio. Diferenciaremos entre aquellas medidas relacionadas con el paciente y el facultativo, con la técnica, con la infraestructura (sala de espera y consulta) y con la gestión asistencial.
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Affiliation(s)
- S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa. Instituto de Investigación Sanitaria Aragón (IIS-Aragón), Zaragoza, España
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, España.
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Matías-Guiu J, Porta-Etessam J, Lopez-Valdes E, Garcia-Morales I, Guerrero-Solá A, Matias-Guiu JA. Management of neurological care during the COVID-19 pandemic. Neurologia 2020; 35:233-237. [PMID: 32336528 PMCID: PMC7151454 DOI: 10.1016/j.nrl.2020.04.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The COVID-19 epidemic has led to the need for unprecedented decisions to be made to maintain the provision of neurological care. This article addresses operational decision-making during the epidemic. DEVELOPMENT We report the measures taken, including the preparation of a functional reorganisation plan, strategies for hospitalisation and emergency management, the use of telephone consultations to maintain neurological care, provision of care at a unit outside the hospital for priority patients, decisions about complementary testing and periodic in-hospital treatments, and the use of a specific telephone service to prioritise patients with epileptic seizures. CONCLUSION Despite the situation of confinement, neurology departments must continue to provide patient care through different means of operation. Like all elements of management, these must be evaluated.
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Affiliation(s)
- J Matías-Guiu
- Servicio de Neurología, Instituto de Neurociencias Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España.
| | - J Porta-Etessam
- Servicio de Neurología, Instituto de Neurociencias Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
| | - E Lopez-Valdes
- Servicio de Neurología, Instituto de Neurociencias Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
| | - I Garcia-Morales
- Servicio de Neurología, Instituto de Neurociencias Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
| | - A Guerrero-Solá
- Servicio de Neurología, Instituto de Neurociencias Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
| | - J A Matias-Guiu
- Servicio de Neurología, Instituto de Neurociencias Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
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27
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Matías-Guiu J, Gomez-Pinedo U, Montero-Escribano P, Gomez-Iglesias P, Porta-Etessam J, Matias-Guiu JA. Should we expect neurological symptoms in the SARS-CoV-2 epidemic? Neurologia 2020; 35:170-175. [PMID: 32299636 PMCID: PMC7136883 DOI: 10.1016/j.nrl.2020.03.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION There is growing evidence that SARS-CoV-2 can gain access to the central nervous system (CNS). We revise the literature on coronavirus infection of the CNS associated with neurological diseases. DEVELOPMENT Neurological symptoms were rarely reported in the SARS-CoV and MERS-CoV epidemics, although isolated cases were described. There are also reports of cases of neurological symptoms associated with CoV-OC43 and CoV-229E infection. The presence of neurological lesions, especially demyelinating lesions in the mouse hepatitis virus model, may explain the mechanisms by which coronaviruses enter the CNS, particularly those related with the immune response. This may explain the presence of coronavirus in patients with multiple sclerosis. We review the specific characteristics of SARS-CoV-2 and address the question of whether the high number of cases may be associated with greater CNS involvement. CONCLUSION Although neurological symptoms are not frequent in coronavirus epidemics, the high number of patients with SARS-CoV-2 infection may explain the presence of the virus in the CNS and increase the likelihood of early- or delayed-onset neurological symptoms. Follow-up of patients affected by the SARS-CoV-2 epidemic should include careful assessment of the CNS.
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Affiliation(s)
- J Matías-Guiu
- Servicio de Neurología, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España.
| | - U Gomez-Pinedo
- Servicio de Neurología, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
| | - P Montero-Escribano
- Servicio de Neurología, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
| | - P Gomez-Iglesias
- Servicio de Neurología, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
| | - J Porta-Etessam
- Servicio de Neurología, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
| | - J A Matias-Guiu
- Servicio de Neurología, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
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28
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Matías-Guiu J, Gomez-Pinedo U, Montero-Escribano P, Gomez-Iglesias P, Porta-Etessam J, Matias-Guiu J. Should we expect neurological symptoms in the SARS-CoV-2 epidemic? Neurología (English Edition) 2020. [PMCID: PMC7164915 DOI: 10.1016/j.nrleng.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction There is growing evidence that SARS-CoV-2 can gain access to the central nervous system (CNS). We revise the literature on coronavirus infection of the CNS associated with neurological diseases. Development Neurological symptoms were rarely reported in the SARS-CoV and MERS-CoV epidemics, although isolated cases were described. There are also reports of cases of neurological symptoms associated with CoV-OC43 and CoV-229E infection. The presence of neurological lesions, especially demyelinating lesions in the mouse hepatitis virus model, may explain the mechanisms by which coronaviruses enter the CNS, particularly those related with the immune response. This may explain the presence of coronavirus in patients with multiple sclerosis. We review the specific characteristics of SARS-CoV-2 and address the question of whether the high number of cases may be associated with greater CNS involvement. Conclusion Although neurological symptoms are not frequent in coronavirus epidemics, the high number of patients with SARS-CoV-2 infection may explain the presence of the virus in the CNS and increase the likelihood of early- or delayed-onset neurological symptoms. Follow-up of patients affected by the SARS-CoV-2 epidemic should include careful assessment of the CNS.
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Porta-Etessam J, Yus M, González García N, Valcarcel A, Barrado-Cuchillo J, Pérez-Somarriba J. [Brain inflammatory thrombogenic vasculopathy related with SARS-CoV-2 infection]. Neurologia 2020; 35:701-703. [PMID: 32917434 PMCID: PMC7396959 DOI: 10.1016/j.nrl.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 01/07/2023] Open
Affiliation(s)
- J. Porta-Etessam
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain,Corresponding author
| | - M. Yus
- Radiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - A. Valcarcel
- Internal Medicine Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - J. Pérez-Somarriba
- Internal Medicine Department, Hospital Clínico San Carlos, Madrid, Spain
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Villar-Quiles R, Gómez-Ruiz N, Jorquera-Moya M, Porta-Etessam J. The great imitator: mesial temporal alterations in MRI in an atypical case of neurosyphilis. Neurología (English Edition) 2020. [DOI: 10.1016/j.nrleng.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Carrillo I, Pozo-Rosich P, Guilabert M, Ignacio E, Pascual J, Porta-Etessam J, Guerrero-Peral AL, Mira JJ. [Portfolio of services and basic table of quality indicators for Headache Units: a consensus study]. Rev Neurol 2019; 68:118-122. [PMID: 30687919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM To develop a proposal for a portfolio of services and a set of indicators for Headache Units. DEVELOPMENT Qualitative study that applied techniques of consensus with the participation of 15 professionals who are experts in the treatment of headaches (experience of 15 years) and in quality assurance. The description of the indicators included: statement, definition, standard, type of indicator, dimension, source, level of evidence, and clarification of terms. The proposal for a portfolio of services included the following areas: clinical management, patient-centered care, community involvement, knowledge management, translational research, and social dissemination. The proposal converged in 13 indicators exploring five dimensions. CONCLUSIONS This proposal contributes to ensure and assess the level of quality of a Headache Unit or outpatient clinic.
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Affiliation(s)
- I Carrillo
- Universidad Miguel Hernandez, Elche, Espana
| | | | | | - E Ignacio
- Universidad de Cadiz. Facultad de Ciencias de la Salud, Cadiz, Espana
| | - J Pascual
- Hospital Universitario Marques de Valdecilla, Santander, Espana
| | | | | | - J J Mira
- Universidad Miguel Hernandez, Elche, Espana
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Toledo M, Carnero-Pardo C, Carreno-Martinez M, Escudero-Torrella J, Gaig C, Garcia-Ribas G, Gil-Nagel A, Grandas FJ, Kulisevsky J, Lainez-Andres JM, Pareja JA, Porta-Etessam J, Poza-Aldea JJ, Rodriguez-Oroz MC, Serratosa JM, Villanueva V. [«Apuntes en Neurologia» (Notes in Neurology): a synthesis of the evidence on common paroxysmal neurological disorders and on neurodegenerative disorders]. Rev Neurol 2018; 67:S1-S21. [PMID: 30484273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
«Apuntes en Neurologia» is an initiative in which prominent national and international leaders, with broad academic recognition, came together to synthesise the most outstanding clinical aspects within their area of interest and to discuss the latest developments in a more accessible language. Understanding the factors that affect the onset and progression of any neurological disease through a review is important to be able to develop strategies to reduce the burden of these diseases. Moreover, knowledge of the clinical aspects is essential to solve the problems of daily clinical practice. The data collected here reflect the weight of evidence and some of them anticipate a promising future in the treatment of these diseases. This first edition focuses on common paroxysmal neurological disorders such as migraine, epilepsy and sleep disorders, as well as neurodegenerative disorders such as Parkinson's disease and cognitive impairment. These are clearly different pathologies, although some of them such as migraine and epilepsy, may share clinical symptoms. Sleep disorders, however, are important manifestations of neurodegenerative diseases that are sometimes clinically apparent long before the onset of other neurological symptoms. After recalling pathophysiology and diagnosis, the current review focuses on bringing together the main advances in five of the major neurological diseases.
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Affiliation(s)
- M Toledo
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
| | - C Carnero-Pardo
- Hospital Universitario Virgen de las Nieves, 18013 Granada, Espana
| | | | | | - C Gaig
- Hospital Clinic de Barcelona, 08036 Barcelona, Espana
| | - G Garcia-Ribas
- Hospital Universitario Ramon y Cajal, 28034 Madrid, Espana
| | - A Gil-Nagel
- Hospital Ruber Internacional, 28034 Madrid, Espana
| | - F J Grandas
- Hospital General Universitario Gregorio Maranon, Madrid, Espana
| | - J Kulisevsky
- Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Espana
| | | | - J A Pareja
- Hospital Universitario Fundacion Alcorcon, 28922 Alcorcon, Espana
| | | | | | - M C Rodriguez-Oroz
- Clinica Universidad de Navarra, Pamplona, Espana
- CIBERNED. Centro de Investigacion Biomedica en Red Enfermedades Neurodegenerativas, Madrid, Espana
- Ikerbasque, Fundacion Vasca para la Ciencia, Bilbao, Espana
- Centro Vasco de Cognicion, Cerebro y Lenguaje, San Sebastian, Espana
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Cárcamo Fonfría A, Santos-Bueso E, Benítez-del-Castillo J, Porta-Etessam J. A new mutation in a patient with Wolfram syndrome. Neurología (English Edition) 2018. [DOI: 10.1016/j.nrleng.2016.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Cárcamo Fonfría A, Santos-Bueso E, Benítez-del-Castillo J, Porta-Etessam J. Descripción de una nueva mutación en una paciente con síndrome de Wolfram. Neurologia 2018; 33:618-619. [DOI: 10.1016/j.nrl.2016.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 12/01/2022] Open
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González-García N, García-Azorín D, Porta-Etessam J. Eagle syndrome: Toward a clinical delimitation. Neurologia 2018. [PMID: 30032933 DOI: 10.1016/j.nrl.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES Orofacial and cervical pain are a frequent reason for neurology consultations and may be due to multiple pathological processes. These include Eagle syndrome (ES), a very rare entity whose origin is attributed to calcification of the stylohyoid ligament or elongation of the temporal styloid process. We present a series of five patients diagnosed with ES. MATERIAL AND METHODS We describe the demographic and clinical characteristics and response to treatment of 5 patients who attended the headache units of two tertiary hospitals for symptoms compatible with Eagle syndrome. RESULTS The patients were three men and two women aged between 24 and 51, presenting dull, intense pain, predominantly in the inner ear and the ipsilateral tonsillar fossa. All patients had chronic, continuous pain in the temporal region, with exacerbations triggered by swallowing. Four patients had previously consulted several specialists at otorhinolaryngology departments; one had been prescribed antibiotics for suspected Eustachian tube inflammation. In all cases, the palpation of the tonsillar fossa was painful. Computed tomography scans revealed an elongation of the styloid process and/or calcification of the stylohyoid ligament in three patients. Four patients improved with neuromodulatory therapy (duloxetine, gabapentin, pregabalin) and only one required surgical excision of the styloid process. CONCLUSIONS Eagle syndrome is a rare and possibly underdiagnosed cause of craniofacial pain. We present five new cases that exemplify both the symptoms and the potential treatments of this entity.
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Affiliation(s)
| | - D García-Azorín
- Hospital Clínico Universitario de Valladolid, Valladolid, España
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Carreón E, Muñiz S, Di Capua D, Porta-Etessam J. Tolosa-Hunt syndrome with spontaneous remission and recurrence. Neurología (English Edition) 2018. [DOI: 10.1016/j.nrleng.2015.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Santos-Bueso E, Serrador-García M, Sáenz-Francés F, Méndez-Hernández C, Morales-Fernández L, Martínez-de-la-Casa JM, García-Feijoo J, Porta-Etessam J. Charles Bonnet syndrome in a child with congenital glaucoma. Arch Soc Esp Oftalmol 2017; 92:398-400. [PMID: 28038923 DOI: 10.1016/j.oftal.2016.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 06/06/2023]
Abstract
CASE REPORT The case is presented of a 12 year-old boy with congenital glaucoma and low visual acuity diagnosed with Charles Bonnet syndrome. This consisted of the acute onset of complex, repetitive, persistent, and with visual hallucinations (people, brooms and coffeemakers) of self-limited evolution without treatment. The patient was diagnosed with congenital glaucoma at 3 years of age, and subjected to a trabeculectomy in right eye, and trabeculectomy and keratoplasty in his left eye. DISCUSSION Charles Bonnet syndrome symptoms have been described in adults, but their presence in children is poorly reflected in literature, with unknown characteristics and prevalence.
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Affiliation(s)
- E Santos-Bueso
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - M Serrador-García
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - F Sáenz-Francés
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - C Méndez-Hernández
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - L Morales-Fernández
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - J M Martínez-de-la-Casa
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - J García-Feijoo
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - J Porta-Etessam
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
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Pérez-Bartolomé F, Sanz-Pozo C, Darío Rosati S, Santos-Bueso E, Porta-Etessam J. Visual impairment due to venous sinus thrombosis in neuro-Behçet's disease. Neurología (English Edition) 2017. [DOI: 10.1016/j.nrleng.2015.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Pérez-Bartolomé F, Sanz-Pozo C, Darío Rosati S, Santos-Bueso E, Porta-Etessam J. Pérdida visual debido a trombosis de senos venosos en neuro-Behçet. Neurologia 2017; 32:413-416. [DOI: 10.1016/j.nrl.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/25/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022] Open
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Santos Lasaosa S, Cuadrado Pérez M, Guerrero Peral A, Huerta Villanueva M, Porta-Etessam J, Pozo-Rosich P, Pareja J. Consensus recommendations for anaesthetic peripheral nerve block. Neurología (English Edition) 2017. [DOI: 10.1016/j.nrleng.2016.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Santos Lasaosa S, Cuadrado Pérez M, Guerrero Peral A, Huerta Villanueva M, Porta-Etessam J, Pozo-Rosich P, Pareja J. Guía consenso sobre técnicas de infiltración anestésica de nervios pericraneales. Neurologia 2017; 32:316-330. [DOI: 10.1016/j.nrl.2016.04.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 12/20/2022] Open
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Santos-Bueso E, Muñoz-Hernández AM, Avalos-Franco N, García-Sáenz S, Sáenz-Francés F, Porta-Etessam J. Visual snow in a paediatric patient. ACTA ACUST UNITED AC 2017; 92:602-604. [PMID: 28526524 DOI: 10.1016/j.oftal.2017.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 11/30/2022]
Abstract
CASE REPORT The case is presented of an 11 year-old girl referring to a one year history of photophobia and continuously seeing white spots in both eyes. The patient had a visual acuity of unity in both eyes, and a normal eye examination, and was referred to the Neuro-ophthalmology Unit. Once complete laboratory and imaging tests ruled out the possibility of any neurological pathology, she was diagnosed with visual snow (VS). DISCUSSION VS is an isolated symptom, possibly part of the migraine aura, that is referred by patients reporting numerous and constant white dots moving in the visual field of BE. It can significantly interfere with patient's daily activities by altering their quality of life, and ending up as a misdiagnosis. Paediatric patients also present a diagnostic challenge due to the complex interpretation that the presence of VS involves in them.
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Affiliation(s)
- E Santos-Bueso
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - A M Muñoz-Hernández
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - N Avalos-Franco
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - S García-Sáenz
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - F Sáenz-Francés
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - J Porta-Etessam
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
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Cárcamo Fonfría A, Gómez-Vicente L, Pedraza M, Cuadrado-Pérez M, Guerrero Peral A, Porta-Etessam J. Burning mouth syndrome: clinical description, pathophysiological approach, and a new therapeutic option. Neurología (English Edition) 2017. [DOI: 10.1016/j.nrleng.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Santos-Bueso E, Arteaga-Sánchez A, Porta-Etessam J, Vinuesa-Silva JM, García-Sánchez J. Ocular pathology in The Nobleman with his Hand on his Chest, Doménikos Theotokópoulos (El Greco). ACTA ACUST UNITED AC 2017; 92:e63-e64. [PMID: 28385277 DOI: 10.1016/j.oftal.2017.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/18/2017] [Accepted: 02/03/2017] [Indexed: 11/17/2022]
Affiliation(s)
- E Santos-Bueso
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - A Arteaga-Sánchez
- Servicio de Oftalmología, Hospital Universitario de Móstoles, Madrid, España
| | - J Porta-Etessam
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | - J M Vinuesa-Silva
- Cátedra de Oftalmología, Universidad de Salamanca, Salamanca, España
| | - J García-Sánchez
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
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Santos-Bueso E, Arteaga-Sánchez A, Porta-Etessam J, Vinuesa-Silva J, García-Sánchez J. Wrong diagnosis in the supposed self-portrait of El Greco. J Neurol Sci 2017; 375:476-477. [DOI: 10.1016/j.jns.2017.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
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46
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Pérez-Bartolomé F, Santos-Bueso E, Ávalos-Franco N, Porta-Etessam J. Unilateral retrobulbar optic neuropathy as the initial manifestation of human immunodeficiency virus infection. Neurología (English Edition) 2017. [DOI: 10.1016/j.nrleng.2015.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Villar-Quiles RN, Porta-Etessam J. [Neurosyphilis in the 21st century: a descriptive study in a tertiary hospital in Madrid]. Rev Neurol 2016; 63:393-402. [PMID: 27779299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Neurosyphilis can occur at any time following infection by Treponema pallidum and its incidence has increased over recent years. The epidemiological and clinical pattern has undergone a substantial change in the post-antibiotic era. AIMS To describe and analyse the population of patients diagnosed with neurosyphilis at a tertiary hospital in Madrid from January to May 2015. PATIENTS AND METHODS A retrospective analysis of the following data was performed: demographic, clinical, complementary tests -serology, cerebrospinal fluid (CSF), neuroimaging- and progression of 28 patients diagnosed between 2008 and 2015. RESULTS Most of the patients were males (89.3%), Spanish (60.7%), with a mean age of 53 ± 16.4 years. The most frequent forms were asymptomatic (39.3%), followed by ocular syphilis (21%), non-classical forms (14.3%), cognitive deterioration and neuropsychiatric alterations (11%). Fifty per cent presented a concomitant infection by human immunodeficiency virus, most of them asymptomatic, with a significant correlation between CD4+ T-cells and asymptomatic neurosyphilis. Only 50% presented VDRL+ in CSF, the diagnosis being based on the clinical features, serology and alterations in CSF (cytobiochemical or serological). Neuroimages were unspecific in most cases. The early and ocular forms were associated to a better clinical course. CONCLUSIONS With respect to the pre-antibiotic era, an important decrease can be observed in the late-onset forms, as well as the appearance of non-classical forms that can mimic other conditions such as viral encephalitis. Diagnosis is complex and based on the clinical features, the serology and study of CSF, often with a complex interpretation, and thus clinical suspicion plays a fundamental role in the diagnosis.
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Santos-Bueso E, Porta-Etessam J. Charles Bonnet syndrome. Diagnostic criteria. Arch Soc Esp Oftalmol 2016; 91:511-512. [PMID: 27542522 DOI: 10.1016/j.oftal.2016.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/04/2016] [Accepted: 07/16/2016] [Indexed: 06/06/2023]
Affiliation(s)
- E Santos-Bueso
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - J Porta-Etessam
- Unidad de Neurooftalmología, Servicio de Neurología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
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Matías-Guiu J, Porta-Etessam J, García-Azorín D, Martín-Sánchez F. Análisis de las interconsultas al neurólogo de guardia por cefaleas en un servicio de urgencias. Neurologia 2016; 31:577. [DOI: 10.1016/j.nrl.2014.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/23/2014] [Indexed: 11/30/2022] Open
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50
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Matías-Guiu J, Porta-Etessam J, García-Azorín D, Martín-Sánchez F. Analysis of in-hospital consultations between the emergency department and the on-call neurologist due to headaches. Neurología (English Edition) 2016. [DOI: 10.1016/j.nrleng.2014.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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