Oral lacosamide for the treatment of refractory trigeminal neuralgia: A retrospective analysis of 86 cases

Background and Objectives First-line treatment for trigeminal neuralgia (TN) is limited to carbamazepine and oxcarbazepine, and in refractory cases, alternatives are scarce. Lacosamide has been suggested as a valid option. In this study, we describe a series of patients who received oral lacosamide as treatment for TN after first-line drug failure.Methods In this retrospective descriptive cohort study, we included patients with refractory TN who attended a tertiary center between 2015 and 2021 and were prescribed oral lacosamide after first-line treatment failure. The primary endpoints were pain relief and adverse effects. We secondarily analyzed clinical outcomes and compared responders versus nonresponders in the search for potential predictors of response.Results Eighty-six patients were included (mean age: 62 [SD 15.6] years; 54/86 [63%] female). The TN etiology was secondary in 16/86 (19%) patients. Concomitant continuous pain was present in 29/86 (34%) patients. The mean number of previous treatments was 2.7 [SD 1.5]. Pain relief was achieved in 57/86 (66%) cases, with 28/86 (33%) patients presenting adverse effects, all of which were mild. No statistically significant differences were observed between responders and nonresponders, but subtle clinical differences suggested potential predictors of response.Conclusion Lacosamide may be an effective and relatively safe treatment for refractory pain in TN patients after first-line treatment failure

Clinical and myopathological evaluation of early- and late-onset subtypes of myofibrillar myopathy

Myofibrillar myopathies (MFM) are a group of disorders associated with mutations in DES, CRY A B, M YOT, ZASP, FLNC, or BAG3 genes and characterized by disintegration of myofibrils and accumulation of degradation products into intracellular inclusions. We retrospectively evaluated 53 M FM patients from 35 Spanish families. Studies included neurologic exam, muscle imaging, light and electron microscopic analysis of muscle biopsy, respiratory function testing and cardiologic work-up. Search for pathogenic mutations was accomplished by sequencing of coding regions of the six genes known to cause MFM. Mutations in M YOT were the predominant cause of MFM in Spain affecting 18 of 35 families, followed by DES in 11 and ZASP in 3; in 3 families the cause of MFM remains undetermined. Comparative analysis of DES, MYOT and ZASP associated phenotypes demonstrates substantial phenotypic distinctions that should be considered in studies of disease pathogenesis, for optimization of subtype-specific treatments and management, and directing molecular analysis. (C) 2011 Elsevier B.V. All rights reserved

Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients

Background Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life. Methods In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies. Results A total of 162 patients were included, median age 68 years (range 65-87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.17.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days >= 30%,>= 50%,>= 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%). Conclusions Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Análisis de la asistencia neurológica en dos hospitales comarcales de las Terres de L'Ebre y Baix Llobregat

[spa] Conocer las necesidades de asistencia neurológica de una población será esencial para una planificación racional de la misma. OBJETIVOS: estudiar la demanda de asistencia neurológica especializada ambulatoria en el hospital comarcal en nuestro ámbito, evaluar la evolución de la demanda de nuevas consultas entre los años 1997 y 2003 en el Hospital de Tortosa (HT), comparar la demanda de una población de un área rural, el HT, y una metropolitana, el Hospital de Viladecans (HV), y por último evaluar en el HV globalmente la asistencia neurológica en un hospital comarcal y su modelo de atención.MATERIAL Y MÉTODOS: Se recogieron de forma prospectiva los datos de las primeras visitas de las consultas de neurología del Hospital de Viladecans durante el periodo de un año marzo 2003 - febrero 2004 y del Hospital de Tortosa durante el periodo del año 1997 y durante el mismo periodo en que se recogieron en el HV. Ambos hospitales dan servicio a toda la demanda de asistencia neurológica especializada ambulatoria pública de sus áreas de referencia. Se crearon grupos diagnósticos que facilitasen las comparaciones cualitativas de la demanda. Para los estudios cuantitativos de la demanda la variable principal fueron las solicitudes de primera consulta ajustadas a la población de referencia mayor de 14 años. Para los estudios cualitativos la variable principal fueron las proporciones de los grupos diagnósticos. Para el análisis de la asistencia en el hospital de Viladecans se evaluó el total de visitas. Para un periodo de evaluación de solo un año se definió la asistencia de tipo directo como aquella con índice de reiteración de segundas/primeras visitas > 2, índice de reiteración de segundas visitas (número visitas / número de pacientes) > 1,5 y proporción de altas por visita 2.RESULTS: Demand for new visits in population over 14 years old in the HT area grew 9'8% (p=0,03) in the period 1997-2003. Cognitive disorders increased 228,1% (p<0,001%) while epilepsy decreased 20% (p=0,002) and neuropathies 10% (0,005). Neurological new outpatient demand was 72,2% higher in HV than in HT area. The proportions of epilepsy (5,2% vs 3,2%, p=0,014) and movement disorders (16,6% vs 8,6%, p=0,012) were bigger in HT while the proportion of cerebrovascular diseases was bigger in HV. Global demand (number of new and follow-up visits) for population over 14 years old was 31.5 visits/1000 inhabitants-year in the HV area. Model of neurological care was direct care for epilepsy, cognitive disorders, movement disorders, and cerebrovascular diseases, and consultant for the rest.CONCLUSIONS: Demand for ambulatory specialized neurological care in the HT area has grown, with increase in cognitive disorders and reduction of epilepsy and neuropathies. Request for neurological care is higher in the HV metropolitan area than in the HT rural area. Global demand in the HV area can be considered high. The model of outpatient neurological care is mixed (direct care for some diagnostic groups and consultant for others)

Estudo da procura de electromiografía num hospital geral básico

La cuantificación de la demanda asistencial es esencial en la gestión de la asistencia neurológica, tanto por lo que respecta a la evaluación de la idoneidad de la utilización de los recursos ya destinados a cubrir unas determinadas necesidades asistenciales, como en lo referente a la planificación de la adjudicación de nuevos recursos

Calcitonin gene-related peptide in migraine : from pathophysiology to treatment CGRP en migraña: de la fisiopatología a la terapéutica

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. 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. 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

Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years : a real-life multicentre analysis of 162 patients

Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life. In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies. A total of 162 patients were included, median age 68 years (range 65-87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.1 ± 7.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days ≥ 30%, ≥ 50%, ≥ 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%). Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice. The online version contains supplementary material available at 10.1186/s10194-023-01585-2