Nuestros investigadores

Eduardo Antonio Martínez Vila

Publicaciones científicas más recientes (desde 2010)

Autores: Mínguez Olaondo, Ane; Martínez Valbuena, Iván; Romero, S.; et al.
ISSN 1129-2369  Vol. 21  Nº 1  2020  págs. 9
Objective To investigate the specific relationship between cutaneous allodynia (CA) and the percentages of body fat (BF) and abdominal fat in migraineurs. Additionally, we compared serum levels of inflammatory biomarkers in patients with and without CA. Background Excess abdominal fat might facilitate progressive changes in nociceptive thresholds causing central sensitization, clinically reflected as CA, which could drive migraine progression. Methods This prospective cohort study included 80 patients with migraine (mean age 39 years, 81.2% female) and 39 non-migraine controls. We analysed each participant's height, body weight, and body mass index (BMI). The amount and distribution of BF was also assessed by air displacement plethysmography (ADP) and ViScan, respectively. We analysed serum levels of markers of inflammation, during interictal periods. Results We studied 52 patients with episodic migraine (EM) and 28 with chronic migraine (CM). Of the 80 patients, 53 (53.8%) had CA. Migraineurs with CA had a higher proportion of abdominal fat values than patients without CA (p = 0.04). The independent risk factors for CA were the use of migraine prophylaxis (OR 3.26, 95% CI [1.14 to 9.32]; p = 0.03), proportion of abdominal fat (OR 1.13, 95% CI [1.01 to 1.27]; p = 0.04), and presence of sleep disorders (OR 1.13, 95% CI [00.01 to 1.27]; p = 0.04). The concordance correlation coefficient between the ADP and BMI measurements was 0.51 (0.3681 to 0.6247). CA was not correlated with the mean plasma levels of inflammatory biomarkers. Conclusions There is a relation between excess abdominal fat and CA. Abdominal obesity might contribute to the development of central sensitization in migraineurs, leading to migraine chronification.
Autores: Puigdelloses Vallcorba, Montserrat; González Huarriz, María Soledad; García Moure, Marc; et al.
ISSN 2632-2498  Vol. 2  Nº 1  2020  págs. vdaa010
Background: Glioblastoma (GBM) is the most common malignant primary brain tumor in adults. Circulating biomarkers may assist in the processes of differential diagnosis and response assessment. GBM cells release extracellular vesicles containing a subset of proteins and nucleic acids. We previously demonstrated that exosomes isolated from the serum of GBM patients had an increased expression of RNU6-1 compared to healthy subjects. In this exploratory study, we investigated the role of this small noncoding RNA as a diagnostic biomarker for GBM versus other brain lesions with some potential radiological similarities. Methods: We analyzed the expression of RNU6-1 in circulating exosomes of GBM patients (n = 18), healthy controls (n = 30), and patients with subacute stroke (n = 30), acute/subacute hemorrhage (n = 30), acute demyelinating lesions (n = 18), brain metastases (n = 21), and primary central nervous system lymphoma (PCNSL; n = 12) using digital droplet PCR. Results: Expression of RNU6-1 was significantly higher in GBM patients than in healthy controls (P = .002). RNU6-1 levels were also significantly higher in exosomes from GBM patients than from patients with non-neoplastic lesions (stroke [P = .05], hemorrhage [P = .01], demyelinating lesions [P = .019]) and PCNSL (P = .004). In contrast, no significant differences were found between patients with GBM and brain metastases (P = .573). Receiver operator characteristic curve analyses supported the role of this biomarker in differentiating GBM from subacute stroke, acute/subacute hemorrhage, acute demyelinating lesions, and PCNSL (P < .05), but again not from brain metastases (P = .575). Conclusions: Our data suggest that the expression of RNU6-1 in circulating exosomes could be useful for the differentiation of GBM from non-neoplastic brain lesions and PCNSL, but not from brain metastases.
Autores: Moreno Ajona, David; Irimia Sieira, Pablo (Autor de correspondencia); Rodríguez García, José Antonio; et al.
ISSN 1471-2261  Vol. 20  Nº 1  2020  págs. 93
Background Major adverse cardiovascular events are the main cause of morbidity and mortality over the long term in patients undergoing carotid endarterectomy. There are few reports assessing the prognostic value of markers of inflammation in relation to the risk of cardiovascular disease after carotid endarterectomy. Here, we aimed to determine whether matrix metalloproteinases (MMP-1, MMP-2, MMP-7, MMP-9 and MMP-10), tissue inhibitor of MMPs (TIMP-1) and in vivo inflammation studied by F-18-FDG-PET/CT predict recurrent cardiovascular events in patients with carotid stenosis who underwent endarterectomy. Methods This prospective cohort study was carried out on 31 consecutive patients with symptomatic (23/31) or asymptomatic (8/31) severe (> 70%) carotid stenosis who were scheduled for carotid endarterectomy between July 2013 and March 2016. In addition, 26 healthy controls were included in the study. Plasma and serum samples were collected 2 days prior to surgery and tested for MMP-1, MMP-2, MMP-7, MMP-9, MMP-10, TIMP-1, high-density lipoprotein, low-density lipoprotein, high-sensitivity C-reactive protein and erythrocyte sedimentation rate. F-18-FDG-PET/CT focusing on several territories' vascular wall metabolism was performed on 29 of the patients because of no presurgical availability in 2 symptomatic patients. Histological and immunohistochemical studies were performed with antibodies targeting MMP-10, MMP-9, TIMP-1 and CD68. Results The patients with carotid stenosis had significantly more circulating MMP-1, MMP-7 and MMP-10 than the healthy controls. Intraplaque TIMP-1 was correlated with its plasma level (r = 0.42 P = .02) and with F-18-FDG uptake (r = 0.38 P = .05). We did not find any correlation between circulating MMPs and in vivo carotid plaque metabolism assessed by F-18-FDG-PET. After a median follow-up of 1077 days, 4 cerebrovascular, 7 cardiovascular and 11 peripheral vascular events requiring hospitalization were registered. Circulating MMP-7 was capable of predicting events over and above the traditional risk factors (HR = 1.15 P = .006). When the model was associated with the variables of interest, the risk predicted by F-18-FDG-PET was not significant. Conclusions Circulating MMP-7 may represent a novel marker for recurrent cardiovascular events in patients with moderate to severe carotid stenosis. MMP-7 may reflect the atherosclerotic burden but not plaque inflammation in this specific vascular territory.
Autores: Irimia Sieira, Pablo; Minguez-Olaondo, A. ; Martínez Valbuena, Iván; et al.
ISSN 0333-1024  Vol. 40  Nº 1_SUPPL  2020  págs. 34 - 35
Autores: Irimia Sieira, Pablo; Moreno Ajona, David; Sanchez del Río González, Margarita; et al.
ISSN 0304-5412  Vol. 12  Nº 71  2019  págs. 4194 - 4198
Chronic headaches encompass different types of headaches (primary and secondary). Proper clinical history and detailed physical and neurological exam are required in order to perform additional diagnostic tests. Most of the patients suffer primary headache syndromes. Sometimes, pain becomes chronic by the abuse of analgesic drugs. In patients older than 50 years of age, erythrocyte sedimentation rate has to be performed in order to rule out temporal arteritis diagnostic. When warning signs or suspicious of atypical headaches are present, brain imaging tests are required. Underlying cause determines the treatment. Sympthomatic pain treatment is required, but analgesic drugs must be limited. In order to reduce the intensity and frequency of bouts, prophylactic treatment is indicated for chronic primary headaches.
Autores: Irimia Sieira, Pablo; Esparragosa Vázquez, Inés; Valentí Azcárate, Rafael; et al.
ISSN 0304-5412  Vol. 12  Nº 70  2019  págs. 4075 - 4084
Intracerebral hemorrhage (ICH) accounts for 20% of all strokes; caused by the collection of blood within the cerebral parenchyma as the result of vascular rupture. Taking into account its etiology, primary hemorrhages are the most common and are caused by the vascular wall weakness as a result of chronic arterial hypertension or due to degenerative processes as amyloid angiopathy. Secondary causes include arteriovenous malformations, tumors, hemorrhages induced by drugs and substance abuse. The most important risk factors for developing ICH are arterial hypertension, smoking, substance abuse (alcohol and drugs). Hemorrhage location and bleeding volume determine clinical manifestations. In order to distinguish between ICH and other ischemic or structural lesions, both computed tomography (CT) and magnetic resonance imaging (MRI) may be used for the diagnosis. To determine the most likely bleed cause, bleed location and microbleed detection (only detected by MRI) are necessary. Treatment for patients with ICH is fundamentally medical, and they must be cared for in a hospital with stroke unit. Surgical treatment is only recommended for a reduced number of carefully selected cases.
Autores: Martínez Vila, Eduardo Antonio; Domínguez Echávarri, Pablo Daniel; Toledano Illán, Carlos; et al.
ISSN 0304-5412  Vol. 12  Nº 70  2019  págs. 4108 - 4119
El ictus isquémico de causa inhabitual representa el 8% de los infartos y el 30% en los adultos jóvenes. Se caracteriza por su heterogeneidad etiológica y puede ser la primera manifestación de la enfermedad de base o una complicación evolutiva más. Los síntomas/signos asociados a la enfermedad subyacente suelen orientar el diagnóstico. El tratamiento es el de la enfermedad de base, si resulta posible, y los fármacos antitrombóticos. La oclusión trombótica de las venas encefálicas y senos durales es más frecuente en adultos jóvenes y predomina en las mujeres (3:1). Las trombofilias hereditarias, embarazo y puerperio, anticonceptivos orales, neoplasias, arteriopatías inflamatorias e infecciones son los principales factores de riesgo. El síntoma más frecuente es la cefalea. Los principales síndromes de presentación son: hipertensión intracraneal aislada, encefalopatía subaguda y cuadro focal. Se trata con anticoagulantes y su pronóstico es generalmente bueno.
Autores: Martínez Valbuena, Iván; Valentí Azcárate, Rafael; Amat-Villegas, I.; et al.
ISSN 0364-5134  Vol. 86  Nº 4  2019  págs. 539 - 551
Objective Alzheimer disease (AD) is the leading cause of dementia, and although its etiology remains unclear, it seems that type 2 diabetes mellitus (T2DM) and other prediabetic states of insulin resistance could contribute to the appearance of sporadic AD. As such, we have assessed whether tau and beta-amyloid (A beta) deposits might be present in pancreatic tissue of subjects with AD, and whether amylin, an amyloidogenic protein deposited in the pancreas of T2DM patients, might accumulate in the brain of AD patients. Methods We studied pancreatic and brain tissue from 48 individuals with no neuropathological alterations and from 87 subjects diagnosed with AD. We examined A beta and tau accumulation in the pancreas as well as that of amylin in the brain. Moreover, we performed proximity ligation assays to ascertain whether tau and/or A beta interact with amylin in either the pancreas or brain of these subjects. Results Cytoplasmic tau and A beta protein deposits were detected in pancreatic beta cells of subjects with AD as well as in subjects with a normal neuropathological examination but with a history of T2DM and in a small cohort of control subjects without T2DM. Furthermore, we found amylin deposits in the brain of these subjects, providing histological evidence that amylin can interact with A beta and tau in both the pancreas and hippocampus. Interpretation The presence of both tau and A beta inclusions in pancreatic beta cells, and of amylin deposits in the brain, provides new evidence of a potential overlap in the mechanisms underlying the pathogenesis of T2DM and AD. ANN NEUROL 2019
Autores: Irimia Sieira, Pablo (Autor de correspondencia); Martínez Vila, Eduardo Antonio
ISSN 1137-6627  Vol. 42  Nº 1  2019  págs. 119 - 120
Autores: Mínguez Olaondo, Ane; Romero, S.; Fruhbeck Martínez, Gema; et al.
ISSN 1129-2369  Vol. 19  Nº Supl. 1  2018  págs. P161
Autores: Romero, S.; Mínguez Olaondo, Ane; Lainez, J. M.; et al.
ISSN 0014-2972  Vol. 48  Nº Supl 1  2018  págs. 206 - 207
Autores: Calabuig Goena, Álvaro; Barba Cosials, Joaquín; Guembe MJ; et al.
ISSN 1885-5857  Vol. 70  Nº 4  2017  págs. 254-260
In a subsample of the general population, EAT measured by echocardiography increased significantly and independently with age. Increased EAT thickness was independently associated with MS and with low high-density lipoprotein cholesterol, high triglycerides, and elevated waist circumference as individual criteria.
Autores: Calabuig Goena, Álvaro; Barba Cosials, Joaquín; Guembe, M. J. ; et al.
ISSN 0300-8932  Vol. 70  Nº 4  2017  págs. 254 - 260
Introduction and objectives: There is currently increasing interest in epicardial adipose tissue (EAT) as a marker of cardiovascular disease. Our purpose was to describe EAT, measured by transthoracic echocardiography, and to assess its association with metabolic syndrome (MS) in the RIVANA population-based study. Methods: Physical examination was performed in 880 participants aged 45 to 74 years (492 of them with MS according to the harmonized definition). Fasting glucose, high-density lipoprotein cholesterol, triglyceride, and C-reactive protein concentrations were determined in a blood sample. In all participants, EAT thickness was measured with transthoracic echocardiography at end-systole. Results: Among participants without MS, the prevalence of EAT >= 5 mm significantly increased with age (OR > 65 years vs 45-54 years = 8.22; 95% CI, 3.90-17.35; P for trend < .001). Increasing EAT quintiles were significantly associated with MS (OR fifth quintile vs first quintile = 3.26; 95% CI, 1.59-6.71; P for trend = .001). Considering the different MS criteria, increasing quintiles of EAT were independently associated with low high-density lipoprotein cholesterol (OR fifth quintile vs first quintile = 2.65; 95% CI, 1.16-6.05; P for trend = .028), high triglycerides (OR fifth quintile vs first quintile = 2.22; 95% CI, 1.26-3.90; P for trend = .003), and elevated waist circumference (OR fifth quintile vs first quintile = 6.85; 95% CI, 2.91-16.11; P for trend < .001). Conclusions: In a subsample of the general population, EAT measured by echocardiography increased significantly and independently with age. Increased EAT thickness was independently associated with MS and with low high-density lipoprotein cholesterol, high triglycerides, and elevated waist circumference as individual criteria. (C) 2016 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Cardiologia.
Autores: Puigdelloses Vallcorba, Montserrat; González Huarriz, María Soledad; García Moure, Marc; et al.
ISSN 1522-8517  Vol. 19  Nº Supl 6  2017  págs. 34
Autores: Alonso de Leciñana, M.; Egido, J. A.; Casado, I.; et al.
ISSN 0213-4853  Vol. 31  Nº 2  2016  págs. 136
Autores: Alonso de Leciñana, M.; Egido, J. A.; Casado, I.; et al.
ISSN 0213-4853  Vol. 31  Nº 2  2016  págs. 136
Reply to letter "Remarks on cerebral infarct from anotherpoint of view"
Autores: Treviño Peinado, Cristina de los Angeles; Arbizu Lostao, Javier; Irimia Sieira, Pablo; et al.
ISSN 0363-9762  Vol. 40  Nº 9  2015  págs. e441-43
A 70-year-old woman with a history of autoimmune hepatitis and renal cell carcinoma presented with subacute cognitive impairment. A brain MRI revealed mild leukoaraiosis, whereas brain F-FDG PET/CT showed diffuse cerebral hypometabolism that resembled some of the patterns described in limbic encephalitis and neurodegenerative diseases. With the suspicion of autoimmune encephalitis, the patient received immunotherapy with dramatic improvement of cognitive function and metabolic normalization at the 2-month follow-up on brain F-FDG PET/CT. Our results demonstrate that brain F-FDG PET/CT might be a useful tool in the assessment of patients with autoimmune encephalitis.
Autores: Goñi Ruiz, N.; Martínez González, Miguel Ángel; Salas Salvadó, J.; et al.
ISSN 0212-1611  Vol. 32  2015  págs. 2319-2330
en el marco del estudio PREDIMED (PREvención con Dieta MEDiterránea), se seleccionaron de manera aleatorizada 187 sujetos del centro PREDIMED-NAVARRA. A estos pacientes asintomáticos, pero con alto riesgo cardiovascular, se les realizó una ecografía carotídea basal para determinar su GIMC, y tras un año en el estudio se les repitió la misma medición. Se usó un cuestionario validado de frecuencia de consumo de alimentos (137 ítems) tanto basal como anualmente para obtener el IG y la CG, que fueron categorizados en cuartiles, tras ser ajustados por energía. Mediante modelos multivariables (ANCOVA) se estudió la posible asociación entre el IG o la CG de la dieta y el GIMC o su cambio al año. Resultados: en la población estudiada no se observó una asociación estadísticamente significativa entre el IG o la CG y el GIMC, ni al inicio ni tras un año de seguimiento.
Autores: Alonso de Leciñana M; Egido JA; Casado I; et al.
ISSN 0213-4853  Vol. 29  Nº 2  2014  págs. 102 - 122
Introducción Actualización de la guía para el tratamiento del infarto cerebral agudo de la Sociedad Española de Neurología basada en la revisión y análisis de la bibliografía existente sobre el tema. Se establecen recomendaciones en base al nivel de evidencia que ofrecen los estudios revisados. Desarrollo Los sistemas de asistencia urgente extrahospitalaria se organizarán para asegurar la atención especializada de los pacientes y el ingreso en unidades de ictus (UI). Deben aplicarse cuidados generales para mantener la homeostasis (tratar la tensión arterial sistólica >185mmHg o diastólica>105mmHg, evitar hiperglucemia >155mg/dl y controlar la temperatura, tratando con antitérmicos cifras>37,5°C), y prevenir y tratar las complicaciones. La craniectomía descompresiva debe ser considerada en casos seleccionados de edema cerebral maligno. La trombólisis intravenosa con rtPA se administrará en las primeras 4,5 horas en pacientes sin contraindicación. La trombólisis intraarterial farmacológica puede indicarse en las primeras 6 horas de evolución y la trombectomía mecánica hasta las 8 horas. En el territorio posterior la ventana puede ampliarse hasta 12-24 horas. No hay evidencias para recomendar el uso rutinario de los fármacos denominados neuroprotectores. Se recomienda la anticoagulación en pacientes con trombosis de senos venosos. Se aconseja el inicio precoz de rehabilitación. Conclusiones El tratamiento del infarto cerebral se basa en la atención especializada en UI, la aplicación urgente de cuidados generales y el tratamiento trombolítico intravenoso en las primeras 4,5 horas. La recanalización intraarterial farmacológica o mecánica pueden ser útiles en casos seleccionados. Terapias de protección y reparación cerebral están en desarrollo
Autores: Yañez M.; Matías-Guiu J; Arranz-Tagarro JA; et al.
ISSN 1660-2854  Vol. 13  Nº 2-3  2014  págs. 171 - 179
In a recent study we found that cerebrospinal fluids (CSFs) from amyotrophic lateral sclerosis (ALS) patients caused 20-30% loss of cell viability in primary cultures of rat embryo motor cortex neurons. We also found that the antioxidant resveratrol protected against such damaging effects and that, surprisingly, riluzole antagonized its protecting effects. Here we have extended this study to the interactions of riluzole with 3 other recognized neuroprotective agents, namely memantine, minocycline and lithium. We found: (1) by itself riluzole exerted neurotoxic effects at concentrations of 3-30 µM; this cell damage was similar to that elicited by 30 µM glutamate and a 10% dilution of ALS/CSF; (2) memantine (0.1-30 µM), minocycline (0.03-1 µM) and lithium (1-80 µg/ml) afforded 10-30% protection against ALS/CSF-elicited neurotoxicity, and (3) at 1-10 µM, riluzole antagonized the protection afforded by the 3 agents. These results strongly support the view that at the riluzole concentrations reached in the brain of patients, the neurotoxic effects of this drug could be masking the potential neuroprotective actions of new compounds being tested in clinical trials. Therefore, in the light of the present results, the inclusion of a group of patients free of riluzole treatment may be mandatory in future clinical trials performed in ALS patients with novel neuroprotective compounds.
Autores: Ortega Cubero, Sara; Pagola Lorz, María Inmaculada; Luquin Piudo, María Rosario Isabel; et al.
ISSN 0213-4853  Vol. 30  Nº 3  2014  págs. 144 - 152
Introducción Las prionopatías representan hasta el 62% de los casos de demencia rápidamente progresiva (DRP) en los que se alcanza un diagnóstico definitivo. La variabilidad de los síntomas y signos iniciales y las diferencias en su evolución dificultan el diagnóstico precoz. Métodos Estudio retrospectivo en el que se incluye a pacientes con prionopatía probable o definitiva, que acudieron a la consulta de Neurología de nuestro centro durante el periodo 1999-2012. Se describen las características clínicas y los resultados de las exploraciones complementarias (proteína 14-3-3, EEG, RM, PET-FDG y análisis genético), con la finalidad de identificar qué marcadores permiten un diagnóstico precoz. Resultados Se describe a 14 pacientes: 6 con enfermedad de Creutzfeldt-Jakob esporádica (ECJe) definitiva, 3 con ECJe probable, 4 con insomnio familiar fatal y uno con la nueva variante de la enfermedad de Creutzfeldt-Jakob. La mediana de edad al diagnóstico fue de 54 años y la mediana de supervivencia de 9,5 meses. El trastorno del ánimo fue el síntoma inicial más frecuente, seguido de inestabilidad de la marcha y deterioro cognitivo. La proteína 14-3-3 fue positiva en el líquido cefalorraquídeo en 7 de 11 pacientes y el EEG mostró signos típicos en 2 de 12 pacientes explorados. El estudio de neuroimagen mostró alteraciones en 13 de los 14 pacientes. Conclusiones Además de la DRP, el trastorno conductual y de la marcha son síntomas iniciales frecuentes en las prionopatías. En nuestra serie, las pruebas complementarias más útiles para apoyar el diagnóstico fueron la RM y la PET-FDG.
Autores: Pagola Lorz, María Inmaculada; Esteve Belloch, Patricia; Palma Carazo, José Alberto; et al.
ISSN 0210-0010  Vol. 58  Nº 6  2014  págs. 241 - 246
Objetivo. Identificar las características clínicas que predicen una respuesta favorable al tratamiento con onabotulinumtoxina A (OnabotA) en pacientes con migraña refractaria. Pacientes y métodos. Estudio retrospectivo de pacientes con migraña refractaria que recibieron al menos dos infiltraciones de OnabotA entre los años 2008 y 2012. Los pacientes fueron divididos en respondedores y no respondedores a OnabotA y se compararon entre ambos grupos, y de forma retrospectiva, una serie de características clínicas consideradas predictoras de respuesta en estudios previos: localización unilateral de la cefalea, presencia de tensión muscular pericraneal, tipo de dolor (implosivo, explosivo u ocular), tiempo de evolución de la migraña (menor o mayor de 10 años) y abuso de medicación analgésica. Resultados. Se incluyeron 39 pacientes (35 mujeres) con una edad media de 46 años. En 18 pacientes (46,2%) se observó una reducción mayor del 50% en el número de días de cefalea/mes (pacientes respondedores). Al analizar las diferentes características de la migraña, se observó que todas ellas fueron igualmente prevalentes en los pacientes respondedores y en los no respondedores (p > 0,05): localización unilateral (66,7% frente a 66,6%, respectivamente), dolor implosivo (27,8% frente a 38,1%), presencia de tensión muscular pericraneal (33,3% frente a 38,1%), tiempo de evolución de la migraña mayor de 10 años (77,8% frente a 69,2%) y presencia de abuso de medicación analgésica (50% frente a 81%), Conclusión. En esta serie de pacientes no se ha identificado ningún rasgo clínico que permita predecir en pacientes con migraña refractaria una respuesta favorable al tratamiento con OnabotA.
Autores: Irimia Sieira, Pablo; Esteve Belloch, Patricia; Murie Fernández, Manuel; et al.
ISSN 0210-0010  Vol. 58  Nº Supl. 2  2014  págs. S13 - S19
Introducción. La OnabotulinumtoxinA (OnabotA) está indicada para el tratamiento preventivo de los pacientes con diagnóstico de migraña crónica. Existe cierta controversia acerca de cuál es la dosis mínima eficaz de OnabotA. Objetivo. Determinar cuál es la dosis más adecuada de OnabotA para el tratamiento de la migraña crónica. Desarrollo. Se revisan los estudios controlados frente a placebo, que han evaluado la eficacia y seguridad de OnabotA para el tratamiento de la migraña, prestando especial atención a las dosis de toxina utilizadas. En los diferentes ensayos clínicos llevados a cabo antes del año 2010 se utilizaron distintos protocolos de infiltración. La experiencia obtenida de los estudios previos permitió definir un protocolo de infiltración que se utilizó en el programa PREEMPT, y que demostró que el tratamiento con OnabotA es seguro y eficaz en pacientes con migraña crónica. La dosis elegida en los ensayos PREEMPT 1 y 2 fue de 155-195 U, al observarse en los estudios en fase II que la dosis de 75 U no era eficaz y que la utilización de 150-200 U aumentaba la eficacia sin incrementar los efectos adversos. Además de la dosis, el paradigma de inyección PREEMPT también establece de manera detallada los puntos de inyección y la metodología de infiltración. Conclusiones. La evidencia científica disponible hasta la fecha sustenta que la dosis más adecuada para el tratamiento de la migraña crónica es la utilización de al menos 150 U de OnabotA, y que la infiltración debe realizarse con la metodología definida en el paradigma de inyección PREEMPT
Autores: Vivancos J.; Gilo F; Frutos R.; et al.
ISSN 0213-4853  Vol. 29  Nº 6  2014  págs. 353 - 370
Objective: To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment. Material and methods: A review and analysis of the existing literature. Recommendations are given based on the level of evidence for each study reviewed. Results: The most common cause of spontaneous subarachnoid haemorrhage (SAH) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm. Conclusions: SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes.
Autores: Palma Carazo, José Alberto; Fernández Torrón, Roberto; Esteve Belloch, Patricia; et al.
ISSN 0303-8467  Vol. 115  Nº 1  2013  págs. 19-25
Introduction: Leptomeningeal carcinomatosis (LC) is a devastating complication occurring in 5% of all patients with cancer. To date there are no well-established prognostic markers in patients with LC, except for the presence of cerebrospinal fluid (CSF) blocks and the Karnofsky performance status scale (KPS). We aimed to identify clinical, neuroradiologic and CSF prognostic factors related to LC survival and to develop an easy-to-use Prognostic Scoring Scale (PSS) to identify patients who are more likely to benefit from receiving treatment. Methods: Single-center retrospective study evaluating patients who had a diagnosis of LC during a 10-year period. Diagnosis was made by malignant cytology or imaging; suspicious cases treated as LC were also included. Results: Fifty patients with LC were analyzed (58% women). Median age was 54.4 years, and KPS was 60%. The most common types of tumor were breast (35%), lung (24%), and hematologic malignancies (16%). Thirty-two percent of patients were diagnosed by imaging, 22% by cytology, and 40% by both. Median overall survival (OS) was 10 weeks (95% confidence interval 5.1-14.9). Median OS for patients who received specific treatment was 21.2 weeks vs. 6.38 weeks for patients receiving supportive care only (p < 0.001). In multivariate analysis, initial KPS, initial CSF protein level (<112 mg/dL) and time from diagnosis of primary tumor to diagnosis of LC (>67 weeks) were significant and independent predictors of increased survival. Conclusions: Prognosis remains poor in LC. The predictive factors for patients with LC here identified could help to improve the selection of patients who are more likely to benefit from receiving treatment. (C) 2012 Elsevier B.V. All rights reserved.
Autores: Rodríguez García, José Antonio (Autor de correspondencia); Sobrino T.; Orbe Lopategui, Josune; et al.
ISSN 1538-7933  Vol. 11  Nº 8  2013  págs. 1464 - 1473
Background: Matrix metalloproteinases (MMPs) mediate tissue injury during stroke but also neurovascular remodeling and we have shown that MMP-10 is involved in atherothrombosis. Objective: The purpose of this study was to examine the relationship between proMMP-10 and clinical outcome, assessing inflammatory and proteolytic markers, in patients with acute ischemic stroke. Methods: We prospectively studied 76 patients with ischemic stroke treated with tPA within the first 3 h from symptom onset, compared with 202 non-tPA-treated ischemic stroke patients and 83 asymptomatic subjects. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Hemorrhagic transformation (HT) and severe brain edema were diagnosed by cranial CT. Good functional outcome was defined as a modified Rankin scale score ¿ 2 at 90 days. Serum levels of MMP-9, proMMP-10, TIMP-1, tumor necrosis factor-¿ (TNF¿), interleukin-6 and cellular fibronectin were measured at admission. The effect of TNF¿ on endothelial proMMP-10 was assessed in vitro. Results: Serum proMMP-10 concentration in ischemic stroke patients, non-treated or treated with t-PA, which was higher than age-matched healthy subjects (P < 0.0001), was independently associated with higher infarct volume, severe brain edema, neurological deterioration and poor functional outcome at 3 months (all P < 0.05), but not with HT. proMMP-10 levels were also independently and positively associated with circulating levels of TNF¿ (P < 0.0001), which induced its endothelial expression in vitro, both mRNA and protein. MMP-9, however, was only associated with HT and severe edema (all P < 0.05). Conclusions: Increased serum proMMP-10 after acute ischemic stroke, associated with TNF¿, is a new marker of brain damage and poor outcome.
Autores: Irimia Sieira, Pablo; Palma Carazo, José Alberto; Idoate Gastearena, Miguel Ángel; et al.
ISSN 0017-8748  Vol. 53  Nº 6  2013  págs. 994 - 997
Cephalalgia alopecia is a rare and recently described headache syndrome in which recurrent, burning head and neck pain is associated with hair loss from areas of scalp affected by the pain. We here report the case of a 33-year-old woman with continuous unilateral occipital pain and colocalized alopecia, only responsive to onabotulinumtoxin A injections. We hypothesize whether this clinical phenotype may correspond to either cephalalgia alopecia or nummular headache with trophic changes, conditions that might represent 2 manifestations of the same spectrum of disorders.
Autores: Matías-Guiu JA; García-Ramos R; Castellanos M; et al.
ISSN 0213-4853  Vol. 28  Nº 4  2013  págs. 205 - 211
Introduction: The fate of manuscripts submitted and subsequently rejected by Spanish-language journals is unknown. The present study was designed to determine whether or not articles submitted to Neurología are published following rejection, and if so, where. Methods: We searched Medline in late April 2012 and also analysed all manuscripts rejected by Neurología between October 2004 and April 2012 according to that journal's two databases. In that period, 1277 articles were submitted to the journal. Results: Of the 271 manuscripts rejected by Neurología, 54 articles (19.9%) were published in other journals. Neurology journals published 31 of the manuscripts (57.4%); 43 manuscripts (79.6%) appeared in Spanish-language journals. Of the rejected manuscripts, 24.1% of the originals, 8.3% of the letters to the editor, 28.9% of the case reports, 22.6% of the reviews and 6.3% of the images were published. Authors with three previously published articles on the same topic managed to publish their manuscripts in 34% of the cases, compared to only 11.8% of authors with fewer published articles (P < .0001). Of the total manuscripts rejected between 2004 and 2010, 24.8% were eventually published. The median time lapse between article submission and publication was 13 months (range, 2-59 months). Conclusion: Manuscripts rejected by Neurología are often published in other journals, but this scenario is not as common as in English-language journals. In the case of Neurología, the editor's decision to reject an article is more significant than it would be in an English-language journal because the author will have fewer additional possibilities of having the manuscript published.
Autores: Gállego Pérez de Larraya, Jaime; Irimia Sieira, Pablo; Martínez Vila, Eduardo Antonio; et al.
ISSN 0091-2751  Vol. 40  Nº 8  2012  págs. 479 - 485
Background. The assessment of carotid intima-media thickness (CIMT) may improve cardiovascular risk prediction. The optimal protocol for CIMT measurement is unclear. CIMT may be measured in the common carotid artery (CCA), carotid bifurcation (CB), and internal carotid artery (ICA), but measurements from CB and ICA are more difficult to obtain. We studied the influence of body mass index (BMI) and atheroma plaques on the capacity to obtain CIMT measurements at different carotid sites. Methods. Using an automatic system, CIMT was measured in 700 subjects aged 4575, in the near and far walls of CCA, CB, and ICA bilaterally. The presence of atheroma plaques, BMI and vascular risk factors were recorded. Results. CIMT measurements in CCA were possible in all except one subject. It was not possible to obtain CIMT measurements at CB or ICA in 24.1% of normal weight and 58.8% of obese subjects. The likelihood of obtaining CIMT measurement at all carotid sites decreased as the BMI increased. Atheroma plaques in a carotid segment did not preclude CIMT measurement at this site. Conclusions. CIMT measurements in distal carotid segments are more challenging in obese subjects. Measuring CIMT at CCA remains feasible in obese subjects and should be the primary endpoint in these subjects. Nevertheless, CB and ICA measurements, when feasible, would improve risk classification.
Autores: Portillo Vega, María Carmen; Senosiáin García, Juana María; Arantzamendi Solabarrieta, María; et al.
ISSN 2013-5246  Vol. 36  Nº 1  2012  págs. 31 - 38
ICS Introducción: En la bibliografía hay un vacío relacionado con la perspectiva holística del proceso de integración de la enfermedad de Parkinson en las vidas de pacientes y familiares. Objetivo: Explorar el proceso de convivencia con la enfermedad de Parkinson de pacientes y familiares, así como los factores y los mecanismos que lo favorecen o inhiben. Método: El proyecto ReNACE es un proyecto con metodología combinada, multicéntrico y multidisciplinario, de 3 años de duración, que consta de 2 fases (cualitativa y cuantitativa), realizado en la Clínica Universidad de Navarra, un centro de Salud del Servicio Navarro de Salud-Osasunbidea y la Asociación Navarra de Parkinson. Se presentan resultados preliminares de la Fase I Cualitativa. Se han recogido datos con entrevistas semiestructuradas, hojas sociodemográficas y escalas (estadio Parkinson). Se ha realizado un análisis de contenido comparativo (programa NVivo9) y un análisis estadístico (SPSS 15.0). Resultados: Participaron 15 pacientes con enfermedad de Parkinson y 16 familiares. Su mediana y rango intercuartil de edad eran de 73 (65¿76,25) y 65 (59,5¿74) años, respectivamente. En el proceso de adaptación al Parkinson, se destacan dos etapas dinámicas: 1) etapa extraordinaria, y 2) etapa de normalidad. Los principales factores y mecanismos que influían en la convivencia con el Parkinson eran: las estrategias de afrontamiento, el apoyo familiar, las redes personales y sociales, los recursos disponibles, así como la educ
Autores: Sáiz Mendiguren, Ramón; García de Eulate Ruiz, María Reyes; García-Lallana Valbuena, Amaia; et al.
ISSN 1137-6627  Vol. 35  Nº 2  2012  págs. 329 - 333
A deficit of vitamin B12, generally resulting from pernicious anaemia, can give rise to disorders of the spinal cord, brain, optic and peripheral nerves. The principal neurological syndrome is subacute combined degeneration of the spinal cord (SCD), which can cause progressive motor and/or sensitive alterations, instability and incontinency, due to the demyelination of the posterior horn of the spinal cord. The identification by magnetic resonance (MR) of signal hyperintensity in T2 weighted sequences at the level of the posterior horns of the spinal and/or cervical cord can be of great use in diagnosising the patient with SCD, above all when the symptoms are mild or nonspecific, and the patient does not have haematological or gastrointestinal alterations. Besides, the evolution of the altered signal of the posterior horns in MR can be of use in evaluating the efficacy of treatment, since their normalization is related to clinical improvement.
Autores: Palma Carazo, José Alberto; Irimia Sieira, Pablo; Fernández Torrón, Roberto; et al.
ISSN 0210-0010  Vol. 54  Nº 12  2012  págs. 705-11
Aim. To analyse our experience in the treatment of refractory chronic migraine, episodic frequent refractory migraine (>= 10 days/month), with onabotulinumtoxin A (OnabotA). Patients and methods. Retrospective analysis of patients with refractory migraine who underwent, at least two sessions of OnabotA pericranial injections following the PREEMPT protocol between 2008 and 2012. The efficacy of OnabotA was evaluated comparing the basal situation with 12-16 weeks after the second session. We analysed the subjective improvement of the patients, number of days with headache, preventive and abortive drugs consumption, and adverse effects. Results. Forty-one patients (37 women, 4 male) were identified. 65.8% patients experienced subjective improvement after OnabotA treatment. 36.58% responded (reduction of > 50% in headache days). Differences between days with headache before the first session (24.5 +/- 7.3), and 12-16 weeks after the second session (17.4 +/- 11.6), as well as the differences between the number of abortive drugs taken before the first session (26.8 +/- 23.1) and 12-16 weeks after the second session (16.7 +/- 19.3), were statistically significant (p < 0.001). Subgroups analysis showed that all differences were significant, except for the reduction of the number of days with headache in patients with episodic frequent refractory migraine. Conclusion. Our work shows that treatment with OnabotA is safe and useful in patients with episodic and chronic refractory migraine, including those patients with medication overuse headache.
Autores: Carmona Abellán, María del Mar; Irimia Sieira, Pablo; Martínez Vila, Eduardo Antonio
ISSN 1179-2566  Vol. 4  2012  págs. 55 - 63
Migraine is a common disabling disorder that affects approximately 12% of the population. Migraine treatment requires the avoidance of triggers, acute treatment to control individual attacks, and preventive treatment for patients with frequent headaches. The choice between the different drugs available for the acute management of migraine is based on the severity of the attacks and associated symptoms. Migraine-specific acute therapies, such as triptans, are recommended in patients with moderate or severe migraine attacks and also for mild episodes that do not respond to simple analgesics. The use of simple analgesics is appropriate for mild attacks or patients who cannot use triptans. Currently, ergotics are not recommended in de novo migraine patients mainly because of their lower efficacy compared to triptans and their side-effect profile. Novel methods for delivering triptans and ergotics will increase the efficacy and reduce the side effects of current formulations. New acute migraine therapies without vasoconstrictive activity and a better side-effect profile than triptans are under investigation. This review focuses on drugs to treat acute migraine attacks and covers a comprehensive selection of emerging therapies.
Autores: Fernández Torrón, Roberto; Palma Carazo, José Alberto; Riverol Fernández, Mario; et al.
Revista: Spinal Cord
ISSN 1362-4393  Vol. 50  Nº 8  2012  págs. 636 - 637
Autores: Palma Carazo, José Alberto; Fontes Villalba, Ariadna; Irimia Sieira, Pablo; et al.
ISSN 0333-1024  Vol. 32  Nº 6  2012  págs. 500-504
To our knowledge, this is the first reported case of RCVS following the administration of exogenous adrenaline. This case contributes to the understanding of the physiopathological mechanisms underlying reversible cerebral vasoconstriction.
Autores: Dávalos A; Alvarez-Sabín J; Castillo J; et al.
Revista: LANCET
ISSN 0140-6736  Vol. 380  Nº 9839  2012  págs. 349 - 357
Background Citicoline is approved in some countries for the treatment of acute ischaemic stroke. The drug has shown some evidence of efficacy in a pooled analysis. We sought to confirm the efficacy of citicoline in a larger trial. Methods We undertook a randomised, placebo-controlled, sequential trial in patients with moderate-to-severe acute ischaemic stroke admitted at university hospitals in Germany, Portugal, and Spain. Using a centralised minimisation process, patients were randomly assigned in a 1: 1 ratio to receive citicoline or placebo within 24 h after the onset of symptoms (1000 mg every 12 h intravenously during the first 3 days and orally thereafter for a total of 6 weeks [2x500 mg oral tablets given every 12 h]). All study participants were masked. The primary outcome was recovery at 90 days measured by a global test combining three measures of success: National Institutes of Health Stroke Scale <= 1, modified Rankin score <= 1, and Barthel Index >= 95. Safety endpoints included symptomatic intracranial haemorrhage in patients treated with recombinant tissue plasminogen activator, neurological deterioration, and mortality. This trial is registered, NCT00331890. Results 2298 patients were enrolled into the study from Nov 26, 2006, to Oct 27, 2011. 37 centres in Spain, 11 in Portugal, and 11 in Germany recruited patients. Of the 2298 patients who gave informed consent and underwent randomisation, 1148 were assigned to citicoline and 1150 to placebo. The trial was stopped for futility at the third interim analysis on the basis of complete data from 2078 patients. The final randomised analysis was based on data for 2298 patients: 1148 in citicoline group and 1150 in placebo group. Global recovery was similar in both groups (odds ratio 1.03, 95% CI 0.86-1.25; p=0.364). No significant differences were reported in the safety variables nor in the rate of adverse events. Interpretation Under the circumstances of the ICTUS trial, citicoline is not efficacious in the treatment of moderate-to-severe acute ischaemic stroke.
Autores: Irimia Sieira, Pablo; Carmona Abellán, María del Mar; Martínez Vila, Eduardo Antonio
ISSN 1472-8214  Vol. 17  Nº 4  2012  págs. 445 - 447
Chronic migraine is a common disabling condition. Severe migraine attacks should be treated with triptans, but these agents are contraindicated in patients with vascular problems and may not be effective or tolerated in around one third of the patients. New acute migraine therapies without vasoconstrictive activity and triptan-specific side effects are emerging. For the prophylaxis of chronic migraine, only topiramate and OnabotulinumtoxinA have been shown to be effective in placebo-controlled randomized trials, so novel therapeutic strategies are needed. The growing understanding of the pathophysiology of chronic migraine will contribute to the identification of new treatment targets.
Autores: Muñoz R; Durán-Cantolla J; Martínez Vila, Eduardo Antonio; et al.
ISSN 0001-6314  Vol. 126  Nº 3  2012  págs. 183 - 188
Objectives: Sleep apnea/hypopnea syndrome is a well-recognized independent risk factor for stroke in middle-aged population, but controversy remains in older subjects. We examined the possible association between different respiratory parameters and risk of stroke in a prospective population-based cohort of 394 stroke-free elderly subjects. Material and Methods: Fully overnight polysomnography was performed at baseline. Over the 6 year follow-up period, 20 ischemic strokes occurred. Differences in stroke-free survival between subjects according to central apnea index (CAI) were assessed. Results: We just observed association with incident ischemic stroke on central sleep apnea (CSA) episodes. Obstructive sleep apnea, time passed under 90% oxygen saturation, or arousal index were not associated. The event-free survival was lowest in the highest CAI group. This association was independent of any other vascular risk factors. Conclusions: CSA is the specific respiratory event associated with stroke in the elderly. Additionally, CSA could be a marker of silent brain ischemia, as a sign of disturbed regulation of central respiratory mechanisms, tentatively of ischemic origin.
Autores: Rodriguez-Antigüedad A; Matías-Guiu J; Hernández-Perez MA; et al.
ISSN 0213-4853  Vol. 26  Nº 5  2011  págs. 272 - 278
Introducción el periodo formativo en neurofisiología es una parte sustancial del programa de la especialidad de neurología en España. La Comisión Nacional de Neurología (CNN), que es el órgano dependiente de los Ministerios de Sanidad y Educación, debe velar por el cumplimiento del programa. Material y métodos durante el primer semestre de 2008 la CNN envió a cada una de las 69 unidades docentes acreditadas para la formación de neurología en España un cuestionario para que los responsables docentes de cada unidad lo contestaran, donde se preguntaba sobre este periodo formativo. Resultados de los 69 cuestionarios remitidos se recibieron 49 cumplimentados, lo que supone una tasa de respuesta del 71%. El periodo formativo de neurofisiología del programa de la especialidad de neurología se realiza en España en el mismo hospital en 44 centros (90%); los 5 restantes envían sus NeF a 4 hospitales diferentes. La Unidad que realiza el periodo formativo de neurofisiología está integrada en el servicio de neurología en 19 (39%) hospitales, es independiente en 27 (55%) y la fórmula es mixta en 3 (6%). El 69% de los tutores docentes estaba satisfecho con la formación, pero en el 90% de los hospitales en los que la unidad estaba integrada en neurología y en el 65% de los que no existía esta relación. Los neurólogos en formación informan EEG en el 49% de las unidades docentes, realizan EMG/ENG en el 57% e informan potenciales evocados en el 35% tras su periodo formativo. Conclusiones aunque el grado de satisfacción es alto, el nivel de responsabilidad que asumen los neurólogos en formación durante la rotación por neurofisiología parece que no cumple las exigencias previstas en el programa formativo, especialmente en aquellas unidades no integradas en servicios de neurología.
Autores: Masjuan J; Alvarez-Sabín J; Arenillas J; et al.
ISSN 0213-4853  Vol. 26  Nº 7  2011  págs. 383 - 396
Introducción El Grupo de Estudio de Enfermedades Cerebrovasculares de la Sociedad Española de Neurología publicó en el año 2006 el Plan de Atención Sanitaria del Ictus (PASI) con el objetivo de elaborar un sistema organizado de atención al ictus que dé respuesta a las necesidades de cada enfermo y optimice la utilización de los recursos sanitarios. Este plan pretendía garantizar la equidad en la atención sanitaria del paciente con ictus. La Estrategia Nacional en Ictus del Sistema Nacional de Salud aprobada en el año 2008 recogió en gran medida el tipo de modelo organizativo sanitario del PASI. Sin embargo, en el tiempo transcurrido desde su publicación, han aparecido nuevos avances en el tratamiento de la fase aguda del infarto cerebral que obligan a realizar una revisión del mismo. Fuentes Un comité de 19 neurólogos especialistas en patología neurovascular y representativos de las diferentes comunidades autónomas han revisado el PASI con el objetivo de incorporar los nuevos avances del tratamiento en la fase aguda del infarto cerebral. Esta revisión se ha basado en una revisión de la literatura científica y en la experiencia acumulada con el plan anterior. Desarrollo El nuevo modelo organizativo propuesto debe hacer hincapié en las características de los diferentes niveles asistenciales con la potenciación de Hospitales de Referencia, establecer nuevos criterios de activación del Código Ictus menos restrictivos que contemplen las nuevas posibilidades terapéuticas, establecer medidas organizativas para la implantación del intervencionismo neurovascular y permitir la utilización del recurso técnico de la telemedicina.
Autores: Irimia Sieira, Pablo; Palma Carazo, José Alberto; Fernández Torrón, Roberto; et al.
ISSN 1471-2377  Vol. 11  Nº 94  2011 
Refractory migraine is a relatively common and very disabling condition between the patients attended in a headache unit. The proposed operational criteria may be useful in identifying those patients who require care in headache units, the selection of candidates for combinations of prophylactic drugs or invasive treatments such as neurostimulation, but also to facilitate clinical studies in this patient group.
Autores: Murie Fernández, Manuel; Irimia Sieira, Pablo; Toledo E; et al.
ISSN 0021-9150  Vol. 219  Nº 1  2011  págs. 158-162
MedDiets enhanced with VOO or nuts were not effective in inducing ultrasonographic regression of carotid atherosclerosis after 1 year intervention. However, they were effective among subjects with elevated baseline IMT, suggesting that subclinical atherosclerosis may respond to dietary intervention within a relatively short time frame only among subjects with a high initial atherosclerotic burden.
Autores: Alonso de Leciñana M; Egido JA; Casado I; et al.
ISSN 0213-4853  Vol. 29  Nº 2  2011  págs. 102-122
Autores: Gállego Pérez de Larraya, Jaime; Palma Carazo, José Alberto; Carmona Iragui, María; et al.
ISSN 0167-594X  Vol. 103  Nº 3  2011  págs. 603 - 609
Central nervous system (CNS) prophylaxis is required during initial treatment of non-Hodgkin lymphoma (NHL) subtypes that carry a high risk of CNS involvement. Intrathecal (IT) liposomal cytarabine, a formulation with prolonged half-life, has been shown to be safe and effective in the treatment of meningeal disease in patients with high-grade lymphoma. We retrospectively reviewed all adult patients with high-grade NHL that received prophylactic therapy with IT liposomal cytarabine and developed neurologic complications in our institution between April 2007 and May 2009. We recorded information on hospital admission, chemotherapy regimens, clinical features, neuroimaging, cerebrospinal fluid, neurophysiology data, and outcome. Neurotoxicity was graded according to the National Cancer Institute Common Toxicity Criteria (NCI-CTC). Four of fourteen patients (28%) developed moderate or severe neurotoxicity (grades 2 and 3 of the NCI-CTC), manifested as conus medullaris/cauda equine syndrome or pseudotumour cerebri-like syndrome, after a median of 3.5 IT courses of liposomal cytarabine. All patients had received corticosteroids to prevent arachnoiditis. Liposomal cytarabine given via the IT route, even with concomitant corticosteroid administration, can result in significant neurotoxicity in some patients. We discuss the potential pathogenesis of these effects and suggest hypothetical therapeutic measures to prevent these complications. Specialists should be aware of these possible complications when administering prophylactic IT liposomal cytarabine in high-grade NHL patients, and additional prospective studies should be conducted to more clearly delineate the frequency and characteristics of these complications.
Autores: Matias-Guiu J; Moral E; García-Ramos R; et al.
ISSN 0213-4853  Vol. 25  Nº 9  2010  págs. 530 - 535
Introducción y objetivo En el proceso de evaluación externa el experto es esencial y por ello es necesario conocer cuál es el perfil y las características de los mejores evaluadores. Material y métodos Hemos analizado de forma retrospectiva el proceso de revisión externa de la revista, desde el 1 de enero de 2005 hasta el 30 de junio de 2008 a fin de poder conocer el perfil de los expertos en relación a la respuesta a las solicitudes. Se ha valorado su tasa de respuesta, tiempo medio de demora y tasa de respondedores, considerando como variables el sexo, la edad y formar parte del comité editorial. Resultados Al aumentar el número de evaluaciones, se produce una caída en la tasa de respuesta. Las mujeres presentan mayor tasa de respuesta, menor demora y mejor cumplimiento que los varones. La tasa de respuesta se comporta con tendencia decreciente con la edad y el mayor porcentaje de respondedores se encuentra entre 29 y 39 años. La condición de miembro de los comités de la revista no supone una mejor tasa de respuesta, aunque sí menor demora. La tasa de respuesta y tiempo de demora son similares aunque aumente el número de solicitudes a un revisor. Conclusiones Menor edad y sexo femenino se asocian a una mejor respuesta. No se ha observado un efecto fatiga en los buenos respondedores, pero sí hay una caída en la tasa de respuesta al tener que ampliar el número de evaluadores.
Autores: Murie Fernández, Manuel; Irimia Sieira, Pablo; Martínez Vila, Eduardo Antonio; et al.
ISSN 0213-4853  Vol. 25  Nº 3  2010  págs. 189 - 196
Introduction: The high incidence of stroke results in significant mortality and disability leading to immense health care costs. These costs lead to socioeconomic, budgetary, and staffing repercussions in developing countries. Improvements in stroke management focus mainly on acute neurological treatment, admission to stroke units, fibrinolytic treatment for ischaemic strokes and rehabilitation processes. Among these, rehabilitation has the longest therapeutic window, can be applied in both ischaemic and haemorrhagic strokes, and can improve functional outcomes months after stroke. Development: Neurologists, because of their knowledge in neuroanatomy, physiopathology, neuro-pharmacology, and brain plasticity, are in an ideal position to actively participate in the neurorehabilitation process. Several processes have been shown to play a role in determining the efficacy of rehabilitation; time from stroke onset to rehabilitation admission and the duration and intensity of treatment. Conclusions: Neurorehabilitation is a sub-speciality in which neurologists should be incorporated into multidisciplinary neurorehabilitation teams. Early time to rehabilitation admission and greater intensity and duration of treatment are associated with better functional outcomes, lower mortality/institutionalisation, and shorter length of stay. In order to be efficient, a concerted effort must be made to ensure patients receive neurorehabilitation treatment in a timely manner with appropriate intensity to maximize patient outcomes during both inpatient and outpatient rehabilitation.
Autores: Morales Ortiz A; Martín González MR; Frank García A; et al.
ISSN 0213-4853  Vol. 25  Nº 9  2010  págs. 557 - 562
Introducción La formación en urgencias neurológicas es fundamental en el programa formativo de los residentes de Neurología. La Comisión Nacional de Neurología (CNN), decidió obtener información sobre el grado en que la Unidades Docentes de Neurología acreditadas posibilitan la realización de guardias específicas de Neurología y su grado de tutorización. Métodos Realización de una encuesta a los tutores de las Unidades Docentes de Neurología para comprobar que se cumplen los criterios de la formación en guardias de neurología indicados en el programa oficial de formación. Resultados Se obtuvo respuesta del 98,5% de las unidades docentes de Neurología que existen. En el 47% el médico de plantilla de Neurología tiene guardias de presencia física de 24 horas supervisando directamente al médico residente de Neurología. En el resto existe una diversidad de modelos que no cumplen de manera completa los criterios establecidos por el programa de especialidad. La distribución de los distintos modelos de guardias de Neurología varía mucho entre las distintas unidades docentes y entre las distintas Comunidades Autónomas. Sólo el 65% de los médicos residentes de Neurología realizan su formación en unidades docentes de Neurología que tienen guardias de Neurología autorizadas de manera correcta. Conclusiones Hay una variabilidad injustificada en el cumplimiento de los criterios de formación en guardias de Neurología en las distintas unidades docentes distribuidas por todo nuestro país, habiendo diferencias de formación entre unos médicos residentes en Neurología y otros.
Autores: Guembe, M. J.; Toledo Atucha, Estefanía; Barba Cosials, Joaquín; et al.
ISSN 0021-9150  Vol. 211  Nº 2  2010  págs. 612 - 617
OBJECTIVE: To assess the association between the metabolic syndrome (MetSd) and asymptomatic cardiovascular disease and determine if the MetSd or its single risk factors perform better in discriminating prevalent asymptomatic cardiovascular disease. METHODS: A total of 880 community-dwelling subjects (423 with and 457 without MetSd according to ATPIII) underwent a physical examination, an echocardiography and an ultrasound examination of carotid arteries and blood and urine samples were collected. Associations between the subclinical organ damage markers and the MetSd were addressed with non-conditional logistic regression. AUCs of ROCs were used to compare the models' ability to discriminate asymptomatic cardiovascular disease. RESULTS: The MetSd was independently associated with carotid subclinical atherosclerosis, increased left ventricular mass index and cardiac dysfunction. The MetSd did not discriminate prevalent increased carotid intima-media thickness better than abdominal obesity and impaired fasting glucose [AUC=0.75 (95% CI: 0.71-0.78) and 0.75 (0.71-0.79), respectively; p=0.55]. The MetSd performed worse than abdominal obesity in discriminating increased left ventricular mass index among males younger than 65 years [AUC=0.66 (95% CI: 0.62-0.69) and 0.69 (0.66-0.73), respectively; p=0.02]. No differences between the ability of MetSd or its components in discriminating increased left ventricular mass index were observed among older men or women. The discrimination ability for microalbuminuria for the MetSd or impaired fasting glucose was not statistically different [AUC=0.67 (95% CI: 0.60-0.74) and 0.69 (0.62-0.76), respectively; p=0.18]. CONCLUSION: This study supports the association between the MetSd and asymptomatic cardiovascular disease. The construct of the MetSd might not be better than its single components in addressing cardiovascular risk.
Autores: Irimia Sieira, Pablo; González Redondo, Roberto; Domínguez Echávarri, Pablo Daniel; et al.
Revista: Cephalalgia
ISSN 0333-1024  Vol. 30  Nº 5  2010  págs. 626 - 630
Autores: Muñoz R; Durán-Cantolla J; Martínez Vila, Eduardo Antonio
ISSN 1073-449X  Vol. 182  Nº 10  2010  págs. 1332
Autores: Irimia Sieira, Pablo; Palma Carazo, José Alberto; Fernández Torrón, Roberto; et al.
ISSN 0210-0010  Vol. 51  Nº 11  2010  págs. 703-704
Autores: Irimia Sieira, Pablo; Toledo Atucha, Jon; Martínez Vila, Eduardo Antonio
Libro:  Manejo preventivo de la cefalea
2013  págs. 86-95
Autores: Fernández Torrón, Roberto; Irimia Sieira, Pablo; Martínez Vila, Eduardo Antonio
Libro:  Intensive care in neurology and neurosurgery : pathophysiological basis for the management of acute cerebral injury.
2013  págs. 1573 - 1585
Autores: Martínez Vila, Eduardo Antonio; Palma Carazo, José Alberto; Irimia Sieira, Pablo
Libro:  Examen neurológico
2012  págs. 279 - 292
Autores: Martínez Vila, Eduardo Antonio; Irimia Sieira, Pablo; Domínguez Echávarri, Pablo Daniel
Libro:  Enfermedades vasculares cerebrales
2012  págs. 339 - 351
Autores: Martínez Vila, Eduardo Antonio; Carmona Abellán, María del Mar; Irimia Sieira, Pablo
Libro:  Atlas de neuroimagen en enfermedad de Parkinson
2012  págs. 57-60
Autores: Matías-Guiu J.; De Pedro J.; García-Moncó JC.; et al.
Libro:  Investigación de enfermedades neurológicas en España : documento de consenso sobre estrategias y prioridades.
2011  págs. 23 - 37
Autores: Martínez Vila, Eduardo Antonio; Pagola Lorz, María Inmaculada; Irimia Sieira, Pablo
Libro:  Atlas de investigación y tratamiento. Ictus isquémico
2011  págs. 121-148
Autores: Irimia Sieira, Pablo; Gállego Pérez de Larraya, Jaime; Martínez Vila, Eduardo Antonio
Libro:  Neurosonología. Aplicaciones diagnósticas para la práctica clínica
2011  págs. 93 - 102
Autores: Irimia Sieira, Pablo; Martínez Vila, Eduardo Antonio
Libro:  Progresos en enfermedades cerebrovasculares 2009-2010
2010  págs. 95-107
Autores: Martínez Vila, Eduardo Antonio (Coordinador)
Autores: Martínez Vila, Eduardo Antonio