Spanish expert consensus on the use of safinamide in Parkinson's disease

Safinamide is a new add-on drug to levodopa for the treatment of Parkinson's disease (PD) with motor fluctuations. Due to the recent incorporation of safinamide into routine clinical practice, no post-authorisation phase IV studies on the safety of safinamide have been conducted to date. This study provides clinical management guidelines for safinamide based on the opinion of a group of experts in movement disorders. This project was developed in 2 phases: 16 local meetings in phase 1 and a national meeting in phase 2. The meetings followed a pre-established agenda. The present clinical practice guidelines are based on the main conclusions reached during the national meeting. The group concluded that safinamide is effective in reducing motor and non-motor fluctuations. PD patients with mild-to-moderate fluctuations benefit most from treatment, although the drug may also improve the clinical status of patients with advanced PD. The dose of other dopaminergic drugs may be reduced after introducing safinamide, which would contribute to reducing such adverse reactions as impulse control disorder. At doses higher than those usually prescribed, safinamide may also improve dyskinesia. The experts agreed that safinamide is well tolerated and causes few adverse reactions when compared with placebo.

[Granulomatous angiitis of the basilar artery related to herpes zoster of the 7th cranial nerve]

Granulomatous angiitis of the central nervous system is an uncommon condition characterized by vascular wall necrosis, inflammatory exudate and development of giant cells in medium and small size vessels. The pathogenesis of this disease remains unknown, but it has been associated with immune complexes, mechanical factors and infection by the varicella-zoster virus. We report a young patient who presented with herpes zoster involving the VII cranial nerve and contralateral hemiplegia. Subsequently, pontine infarct and fatal subarachnoid hemorrhage developed. The pathological study showed granulomatous angiitis of basilar artery.

[Deep venous thrombosis related to cranioencephalic injury]

The clinical onset of cerebral venous thrombosis (CVT) is very variable and the causes that may lead to its development are also quite numerous. Although characteristic CT diagnostic signs have been described, in most cases only nonspecific findings are present and angiography is required to confirm the diagnosis. The prognosis is variable. Classically, the mortality is high when the deep venous system is involved. We report a male with CVT involving Galen's vein and its major tributary vessels, who had a favorable outcome with heparin therapy and drugs for cerebral edema. We discuss the etiologic factors in this patient, the characteristic neuroradiologic findings, and their evolution during the course of therapy.