Tratamiento médico de la estenosis arterial intracraneal. ¿Es el mismo en prevención primaria que en secundaria?

In this study we review the risk factors associated with the formation and progression of an atheroma plaque, the mechanism involved in cerebral ischemia secondary to intracranial atheromatosis and possible medical treatment in primary and secondary prevention. DEVELOPMENT: Medical treatment of intracranial stenoses (ICS) is aimed at stopping the progression of the atheroma plaque and at preventing recurrences in the case of symptomatic stenoses. It is based on the control of vascular risk factors, the use of statins and antithrombotic therapy (antiplatelet or anticoagulation drugs). Although antiplatelet agents have not proved to be beneficial in the primary prevention of stroke, they are recommended in patients with ICS in order to lower the risk of heart attack associated with this pathology. The use of antiplatelet drugs in the secondary prevention of ischemic stroke secondary to an ICS is based on clinical trials which have shown that antiaggregation prevents non-cardioembolic strokes. Nevertheless, several retrospective studies have observed that oral anticoagulation is better than antiaggregation with aspirin. Two prospective clinical trials are currently being conducted which will, in the next few years, help to determine what the first choice medical treatment is for this group of patients. CONCLUSIONS: Medical treatment of ICS patients must include the control of vascular risk factors and the use of statins. New studies are needed to be able to establish the first choice antithrombotic drug in secondary prevention

Urgencias neurológicas y guardias de Neurología

In recent years different studies have highlighted a progressive increase in the demand for neurological care in emergency departments. To analyze the convenience of specific neurology shifts or the role that the neurologist should play in the emergency department, it is necessary to answer questions such as: What is the demand for emergency neurological care? What are the most frequent neurological emergencies? Who should attend to neurological emergencies and why? Are specific neurology shifts necessary? Neurological emergencies account for between 2.6% and 14% of medical emergencies. Stroke represents a third of all neurological emergencies, while the diagnoses of acute cerebrovascular disease, epilepsy and cephalea constitute 50% of all neurological care in the emergency department. On the basis of quality of care criteria and professional competence, the best care for patients with a neurological emergency is provided by a specialist in neurology. The implementation of specific neurology shifts, with a 24 hour physical presence, is associated with greater quality of care, better diagnostic and therapeutic orientation from the moment the patient arrives in emergency department, reduces unnecessary admissions, reduces costs and strengthens the neurology service

Recomendaciones de uso de anticuerpos monoclonales para el tratamiento de la migraña del grupo de consenso de navarra y aragón

Sr. Editor: La migraña es una patología neurológica que afecta al 14% de la población general (18% en mujeres); representa la segunda causa de discapacidad en el mundo en pacientes de mediana edad y genera importantes gastos socio-sanitarios1. Las causas de la migraña no son bien conocidas pero existe una activación del denominado sistema trigémino-vascular (STV) que causa la liberación de diferentes mediadores proinflamatorios y vasodilatadores, entre los que destaca el péptido regulador del gen de la calcitonina (CGRP)2. El CGRP es un péptido que participa en la transmisión del estímulo doloroso, cuyos niveles se elevan durante las crisis de migraña y en el periodo intercrítico3. El diagnóstico de la migraña es clínico y está basado en unos criterios de consenso que forman parte de la Clasificación Internacional de Cefaleas4. De forma general, la migraña se divide en migraña episódica (ME) y migraña crónica (MC). La ME es aquella en la que la cefalea aparece menos ..

Emotion Transfer for Hand Animation

We propose a new data-driven framework for synthesizing hand motion at different emotion levels. Specifically, we first capture high-quality hand motion using VR gloves. The hand motion data is then annotated with the emotion type and a latent space is constructed from the motions to facilitate the motion synthesis process. By interpolating the latent representation of the hand motion, new hand animation with different levels of emotion strength can be generated. Experimental results show that our framework can produce smooth and consistent hand motions at an interactive rate

Cefalea en urgencias

Headache is among the most frequent neurological symptoms in the Emergency department. Although most of the patients suffer from primary headaches (migraine), an acute headache might be the only symptom of a serious disease, such as subarachnoid haemorrhage. The physician’s task is to make the diagnosis, carry out an appropriate selection of the patients who require further diagnostic evaluation and relieve the pain. An accurate history will identify most of the patients with secondary headaches. Clinicians should suspect secondary causes in sudden onset headache, headache in patients aged over 50 years, and also in those patients with abnormalities on neurological examination

Estimation of the Economic Burden and Labor Impact of Migraine in Spain: Results from the Spanish Atlas of Migraine Survey 2018

P170 Objectives: To estimate the average annual cost per patient and theimpact on work t of migraine in Spain. Material and Method: This is a prospective, online, anonymous, cross-sectional survey, conducted between June and September2017, promoted by the Spanish Association of Patients with Headache(AEPAC) within the framework of the Spanish Atlas of Migraine2018. People who completed the survey answered questions in relationto their migraine. A distinction was made between chronic migraine(CM) and episodic migraine (EM), considering the monthlyheadache days declared by patients. The economic burden of migrainewas evaluated: direct health costs (including visits to specialists, medical tests, emergency visits, hospital admissions andmedication), indirect costs (lost labor productivity), and those assumedby the migraineur. The labor consequences of migraine overthe last year were analyzed. Chi-square and Mann- Whitney testswere used as contrast tests. Ethics Approval: A central ethics reviewboard approved the study design. Results: 1, 281 people with migraine participated in the survey, 34.2%with CM, 88.2% women, with an average age of 37.3 (SD 11.5). Thedirect health costs for the last year were estimated at €3, 847.29 forCM and €964.19 for EM (p<0, 001). The costs assumed by the patientin the last year were €1, 609.89 for CM and €878.04 for EM (p<0.001).The indirect cost was estimated at €7, 464.83 for CM and €3, 199.15for EM (p <0.001). The total average cost per patient/year rised to€12, 922.01 for CM and €5, 041.41 for EM (p<0.001). Regarding the jobstatus: 62.2% with EM and 49.0% with CM were working, 2.6% withEM and 9.1% with CM were on sick leave and 12.2% with EM and16.8% with CM were unemployed (p <0.05). In the last year, becauseof migraine, 17.8% of patients with EM and 27.2% with CM (p<0.01)requested days of leave or leave of absence, and reduced their workinghours 8.5% with EM and 11.1% CM (p=0.270). Labor efficiencywas reduced in 61.1% of patients with EM and 65.7% with CM(p=0.257). Conclusion: Migraine represents an important economic burden inSpain, particularly in patients with CM. Migraine causes importantproductivity losses resulting from absenteeism, presentism, decreasingthe working hours and the probabilities to keep working, and itsimpact is significantly greater in CM

Fisioterapia en cefalea tensional. ¿Debe recomendarse a nuestros pacientes?

La cefalea tensional es la patología neurológica más prevalente, y a pesar de su elevada frecuencia, la investigación en esta cefalea primaria es escasa, su fisiopatología es desconocida y el número de tratamientos médicos disponibles es muy limitado. Por ello, resulta muy gratificante encontrar publicaciones de grupos españoles abordando el tratamiento de la cefalea tensional desde el punto de vista de la atención fisioterápica

Trastornos neuropsiquiátricos en la enfermedad de Parkinson

This paper reviews the main neuropsychiatric disorders associated with Parkinson’s disease (PD) and describes the neuropathological hypothesis proposed to explain these symptoms. Development. This disease is usually associated with neuropsychiatric complications such as depression, anxiety and apathy. Besides, psychiatric symptoms are one of the most common side effects of antiparkinsonian drug-therapy. Conclusions. Depression is the most frequent emotional disorder reported in patients with PD. Up to 20% of parkinsonian patients meet DSM-IV criteria for major depressive episode and another 20% for dysthymia, while the prevalence of depression in normal aged population is about 2-8%. The relationship between PD and depression has not been fully established. Some investigators have suggested that depressive symptoms in PD are causally related to the underlying neuropathological process, affecting predominantly serotoninergic and dopaminergic pathways. Alternatively, depression in PD may represent a normal reaction to the progressive physical impairment induced by the disease. Otherwise, up to 20% of parkinsonian patients present levodopa-induced psychiatric complications. Visual hallucinations are the commonest, but delusions, confusional states, sexual disorders and sleep disorders have also been described. Serotonine and dopamine have been implicated in the neuropathological basis of these disorders