Nuestros investigadores

Pablo Irimia Sieira

Líneas de investigación
Cefaleas primarias, Ictus
Índice H
12, (Scopus, 31/03/2017)

Publicaciones científicas más recientes (desde 2010)

Autores: Santos-Lasaosa, S. , (Autor de correspondencia); Cuadrado, M. L.; Gago-Veiga, A. B.; et al.
Revista: NEUROLOGIA
ISSN 0213-4853  Vol. 35  Nº 8  2020  págs. 568 - 578
Introduction: In the field of headaches, onabotulinumtoxinA (onabotA) is well established as a treatment for chronic migraine (CM). In recent years, it has been used increasingly to treat other primary headaches (high-frequency episodic migraine, trigeminal-autonomic cephatalgias, nummular headache) and trigeminal neuralgia. As this treatment will progressively be incorporated in the management of these patients, we consider it necessary to reflect, with a fundamentally practical approach, on the possible indications of onabotA, beyond CM, as well as its administration protocol, which will differ according to the type of headache and/or neuralgia. Development: This consensus document was drafted based on a thorough review and analysis of the existing literature and our own clinical experience. The aim of the document is to serve as guidelines for professionals administering onabotA treatment. The first part will address onabotA's mechanism of action, and reasons for its use in other types of headache, from a physiopathological and clinical perspective. In the second part, we will review the available evidence and studies published in recent years. We will add an "expert recommendation" based on our own clinical experience, showing the best patient profile for this treatment and the most adequate dose and administration protocol. Conclusion: Treatment with onabotA should always be individualised and considered in selected patients who have not responded to conventional therapy. (C) 2017 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U.
Autores: Mínguez Olaondo, Ane; Martínez Valbuena, Iván; Romero, S.; et al.
Revista: JOURNAL OF HEADACHE AND PAIN
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: Moreno Ajona, David; Irimia Sieira, Pablo (Autor de correspondencia); Rodríguez García, José Antonio; et al.
Revista: BMC CARDIOVASCULAR DISORDERS
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 (Autor de correspondencia); Garrido-Cumbrera, M.; Santos-Lasaosa, S.; et al.
Revista: EUROPEAN JOURNAL OF NEUROLOGY
ISSN 1351-5101  Vol. 27  Nº 12  2020  págs. 2616 - 2624
Background and purpose Migraine is a common and costly neurological disorder. The aims of this study were to quantify the costs of chronic (CM) and episodic migraine (EM) in Spain, evaluating the impact of psychiatric comorbidities and disability, and to estimate the economic savings associated with reducing the number of migraine-days by 50%. Methods This was an observational, cross-sectional analysis of data from migraine patients who participated in the Spanish Migraine Atlas. The participants were invited to complete a structured questionnaire including the following scales: the Headache Needs Assessment, the Hospital Anxiety and Depression Scale, and the Migraine Disability Assessment Scale (MIDAS). Results A total of 475 patients were included, of whom 187 had CM (39.4%). Total costs per patient/year were: euro16 578.2 +/- euro34 568.1 for CM and euro6227.8 +/- euro6515.7 for EM. A higher degree of disability, according to MIDAS, significantly increased the total cost of migraine, while the presence of psychiatric comorbidity increased costs for EM patients only. A reduction of 1 migraine-day per month decreased average total costs by euro744.14 per patient/year for EM and euro663.20 per patient/year for CM, while a reduction in the number of migraine-days by 50% would result in economic savings of euro2232.44 per patient/year (R-2 = 0.927) for EM and euro6631.99 per patient/year (R-2 = 0.886) for CM. Conclusions The costs associated with migraine were driven by migraine frequency and the degree of disability, whereas psychiatric comorbidity only influenced the cost of EM. These results highlight the need to optimize migraine management to reduce the economic migraine burden. Future studies are needed to confirm our results.
Autores: Alpuente, A. ; Gallardo, V. J.; Torres-Ferrus, M.; et al.
Revista: EUROPEAN JOURNAL OF NEUROLOGY
ISSN 1351-5101  Vol. 27  Nº 10  2020  págs. 2102 - 2108
Background and purpose OnabotulinumtoxinA is an effective preventive treatment for chronic migraine (CM). In CM, in addition to a reduction in headache frequency, a decreased reliance on oral prophylactics is also indicative of treatment effectiveness. This study aimed to quantify the change in the use of oral prophylactics after treatment with onabotulinumtoxinA in patients with CM. Methods This was a retrospective, multicentric, cross-sectional study. Patients with CM (International Classification of Headache Disorders-3beta) that had been treated with onabotulinumtoxinA were enrolled consecutively. We collected parameters related to each patient's pre-treatment situation, as well as their current situation, focusing on frequency and intensity of migraine, number of oral prophylactics and the respective cycle of onabotulinumtoxinA. Univariate and logistic regression analyses were performed. Results We included 542 patients, 90.0% of whom were taking oral preventive treatments. During treatment with onabotulinumtoxinA, 47.8% withdrew at least one prophylactic and 41.6% stopped using oral prophylactics altogether. Factors associated with a reduction or cessation of oral prophylactics were >50% improvement in frequency and intensity, remission to episodic migraine, use of topiramate as an initial treatment, increased number of infiltrations and shorter chronification period (P < 0.05). The multivariate analysis showed that a chronification period <20 months, more than five cycles of onabotulinumtoxinA, >50% improvement in pain intensity and topiramate as an initial treatment were predictors of a reduction in oral prophylactics (area under the curve, 70.3%;P < 0.001). Conclusions Our study demonstrated the efficacy and safety of onabotulinumtoxinA. This treatment reduced the use of oral prophylactics. Withdrawal of oral prophylactics was most likely to occur after five cycles of treatment.
Autores: Irimia Sieira, Pablo; Minguez-Olaondo, A. ; Martínez Valbuena, Iván; et al.
Revista: CEPHALALGIA
ISSN 0333-1024  Vol. 40  Nº 1_SUPPL  2020  págs. 34 - 35
Autores: Gago-Veiga, A. B.; Santos-Lasaosa, S.; Cuadrado, M. L.; et al.
Revista: NEUROLOGÍA (BARCELONA. ED. IMPRESA)
ISSN 0213-4853  Vol. 34  Nº 6  2019  págs. 408 - 417
OnabotulinumtoxinA has been demonstrated to be effective as a preventive treatment in patients with chronic migraine (CM). Five years after the approval of onabotulinumtoxinA in Spain, the Headache Study Group of the Spanish Society of Neurology considered it worthwhile to gather a group of experts in treating patients with CM in order to draw up, based on current evidence and our own experience, a series of guidelines aimed at facilitating the use of the drug in daily clinical practice. For this purpose, we posed 12 questions that we ask ourselves as doctors, and which we are also asked by our patients. Each author responded to one question, and the document was then reviewed by everyone. We hope that this review will constitute a practical tool to help neurologists treating patients with CM.
Autores: Diener, H. C., (Autor de correspondencia); Goadsby, P. J.; Ashina, M. ; et al.
Revista: CEPHALALGIA
ISSN 0333-1024  Vol. 39  Nº 12  2019  págs. 1475 - 1487
Introduction Non-invasive vagus nerve stimulation (nVNS; gammaCore (R)) has the potential to prevent migraine days in patients with migraine on the basis of mechanistic rationale and pilot clinical data. Methods This multicentre study included a 4-week run-in period, a 12-week double-blind period of randomised treatment with nVNS or sham, and a 24-week open-label period of nVNS. Patients were to administer two 120-second stimulations bilaterally to the neck three times daily (6-8 hours apart). Results Of 477 enrolled patients, 332 comprised the intent-to-treat (ITT) population. Mean reductions in migraine days per month (primary outcome) were 2.26 for nVNS (n = 165; baseline, 7.9 days) and 1.80 for sham (n = 167; baseline, 8.1 days) (p = 0.15). Results were similar across other outcomes. Upon observation of suboptimal adherence rates, post hoc analysis of patients with >= 67% adherence per month demonstrated significant differences between nVNS (n = 138) and sham (n = 140) for outcomes including reduction in migraine days (2.27 vs. 1.53; p = 0.043); therapeutic gains were greater in patients with aura than in those without aura. Most nVNS device-related adverse events were mild and transient, with application site discomfort being the most common. Conclusions Preventive nVNS treatment in episodic migraine was not superior to sham stimulation in the ITT population. The "sham" device inadvertently provided a level of active vagus nerve stimulation. Post hoc analysis showed significant effects of nVNS in treatment-adherent patients. Study identification and registration: PREMIUM; NCT02378844;
Autores: Moreno Ajona, David; Moreno Artero, Ester; García de Eulate Ruiz, María Reyes; et al.
Revista: CEPHALALGIA
ISSN 0333-1024  Vol. 39  Nº 4  2019  págs. 564 - 568
Background Localized facial scleroderma usually presents as frontal linear morphea or progressive hemifacial atrophy. Only isolated cases of trigeminal painful neuropathy have been described. Case report A 43-year-old woman developed an oval lesion on the right cheek. After 1 year, she noticed constant "pulling" pain and episodes of lancinating pain, both spontaneous and triggered by chewing and cold drinks. She was diagnosed with solitary morphea profunda and CT scan, ultrasonography, cranial MRI and biopsy were completed. Methylprednisolone (1¿gr/day for 3 days) was prescribed. For pain, gabapentin, oxcarbazepine, amitryptiline, pregabalin and eslicarbacepine were all ineffective. A capsaicin patch was placed with prolonged benefit. Later on, the pain slightly worsened; occipital blockade was effective and methotrexate was recommended. Conclusion This is the first case of solitary morphea profunda associated with painful trigeminal neuropathy. Treatment should include immunosuppressants and treatment of neuropathic pain, in which local therapies seem particularly beneficial.
Autores: Irimia Sieira, Pablo; Moreno Ajona, David; Sanchez del Río González, Margarita; et al.
Revista: MEDICINE (ELSEVIER)
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.
Revista: MEDICINE (ELSEVIER)
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.
Revista: MEDICINE (ELSEVIER)
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: Irimia Sieira, Pablo (Autor de correspondencia); Martínez Vila, Eduardo Antonio
Revista: ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN 1137-6627  Vol. 42  Nº 1  2019  págs. 119 - 120
Autores: Lasaosa, S. S. ; Irimia Sieira, Pablo (Autor de correspondencia)
Revista: ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN 1137-6627  Vol. 42  Nº 2  2019  págs. 235 - 238
Autores: Irimia Sieira, Pablo; Garrido-Cumbrera, M. ; Blanch, C.; et al.
Revista: CEPHALALGIA
ISSN 0333-1024  Vol. 39  2019  págs. 130 - 130
Autores: Moreno Ajona, David (Autor de correspondencia); Irimia Sieira, Pablo; Fernández Matarrubia, Marta
Revista: HEADACHE
ISSN 0017-8748  Vol. 58  Nº 5  2018  págs. 746 - 749
ObjectiveTo expand the differential diagnosis of headache and ophthalmoparesis by describing a case report in which anti-GQ1b was demonstrated to be the cause. BackgroundAnti-GQ1b antibody syndrome refers to a clinical spectrum of conditions that share common mechanisms and overlapping manifestations, including the Miller-Fisher syndrome, pharyngeal-cervical-brachial weakness, and Bickerstaff brainstem encephalitis. Rare atypical cases presenting as acute ophthalmoparesis (AO) without ataxia or areflexia have been described. Headache is a rare condition in these disorders. MethodsA 49-year-old woman with no history of headaches began experiencing an acute severe bilateral throbbing headache associated with nausea and photophobia. Five days later, she developed constant binocular horizontal diplopia. ResultsBilateral paresis of both sixth nerves was noted. Her ocular fundi, tendon reflexes, and other findings of the physical exam were normal. In addition, both a brain MRI performed with gadolinium and a lumbar puncture yielded normal results. Serum anti-GQ1b IgG was found to be positive. Her symptoms resolved completely following treatment with immunoglobulins (0.4 g/kg/day for 5 days). ConclusionsThis is the first reported case of AO related to anti-GQ1b antibodies presenting with headache as its initial symptom. The presence of anti-GQ1b antibodies should be determined in patients with headache and AO of unknown origin. Immunoglobulins could hasten the resolution of symptoms in these patients.
Autores: Diener, H. C.; Goadsby, P. J.; Ashina, M. ; et al.
Revista: JOURNAL OF HEADACHE AND PAIN
ISSN 1129-2369  Vol. 19  Nº Supl. 1  2018 
Autores: Diener, H. C.; Goadsby, P. J.; Ashina, M.; et al.
Revista: CEPHALALGIA
ISSN 0333-1024  Vol. 38  Nº Supl. 1  2018  págs. 58 - 59
Autores: Lainez, M. J. A.; Santos, S. ; Pozo-Rosich, P.; et al.
Revista: HEADACHE
ISSN 0017-8748  Vol. 58  Nº 8  2018  págs. 1309 - 1309
Autores: Mínguez Olaondo, Ane; Romero, S.; Fruhbeck Martínez, Gema; et al.
Revista: JOURNAL OF HEADACHE AND PAIN
ISSN 1129-2369  Vol. 19  Nº Supl. 1  2018  págs. P161
Autores: Torres-Ferrus, M.; Lasaosa, S. S.; Peral, A. G.; et al.
Revista: JOURNAL OF HEADACHE AND PAIN
ISSN 1129-2369  Vol. 19  Nº Supl. 1  2018  págs. P114
Autores: Romero, S.; Mínguez Olaondo, Ane; Lainez, J. M.; et al.
Revista: EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
ISSN 0014-2972  Vol. 48  Nº Supl 1  2018  págs. 206 - 207
Autores: Irimia Sieira, Pablo; Garrido-Cumbrera, M. ; Santos-Lasaosa, S.; et al.
Revista: JOURNAL OF HEADACHE AND PAIN
ISSN 1129-2369  Vol. 19  Nº Supl. 1  2018  págs. P170
Autores: Calabuig Goena, Álvaro; Barba Cosials, Joaquín; Guembe MJ; et al.
Revista: REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
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: Wegmann-Vicuña, R., (Autor de correspondencia); Muñoz-Hernández, D. E.; Gallegos-Constantino, V.; et al.
Revista: ACTA OTO-LARYNGOLOGICA CASE REPORTS
ISSN 2377-2484  Vol. 2  Nº 1  2017  págs. 131 - 136
Isolated acute vestibular syndrome remains a diagnostic challenge in the emergency department and the initial approach should include the identification of a central or peripheral etiology. This is the case report of an elderly patient with known cardiovascular risk factors presenting with acute vertigo and unsteadiness. Neurological examination was notable only for down-beat nystagmus and diffusion-weighted MRI showed normal findings. He was treated as having an emerging anterior-inferior cerebellar artery (AICA) stroke. Even when MRI showed no signs of hemorrhage or infarction, the neurotological bedside examination was a determinant. The cochleovestibular system was not spared by the ischemic injury but a more extensive neurological damage was probably avoided by approaching this case as a stroke.
Autores: Calabuig Goena, Álvaro; Barba Cosials, Joaquín; Guembe, M. J. ; et al.
Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
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: Garriz Luis, Maite; Irimia Sieira, Pablo; Alcalde Navarrete, Juan Manuel; et al.
Revista: NEUROPEDIATRICS
ISSN 0174-304X  Vol. 48  Nº 1  2016  págs. 53-56
There are only four previous pediatric reports of the glossopharyngeal neuralgic form of the stylohyoid complex syndrome. Stylohyoid complex has merely been described as cases of glossopharyngeal neuralgia in children. Case Report¿A 12-year-old boy came to our hospital because of recurrent episodes of severe cranial pain (9/10) lasting for 5 to 15 minutes. Pain affected the right tonsillar fossa, ear, and mastoid region. Since the start at the age of 9 years, the frequency of painful episodes has progressively increased: when admitted to our clinics 3 years later, the child was having up to five episodes daily in spite of analgesic, antiepileptic, and antidepressant drugs; he had abandoned school and leisure. Between episodes, neurological examination detected only discomfort to pressure on the right tonsillar fossa. Three-dimensional computed tomography images of the skull base showed an elongated right styloid process and bilateral calcification of the stylohyoid ligament. After surgical excision of the right styloid process and of part of the stylohyoid ligament, the glossopharyngeal painful episodes ceased. The patient remains asymptomatic seven years later. Conclusion¿In spite of its rarity in childhood, this debilitating but treatable syndrome should be kept in mind for the differential diagnosis of recurrent cranial pain in the pediatric population.
Autores: Treviño Peinado, Cristina de los Angeles; Arbizu Lostao, Javier; Irimia Sieira, Pablo; et al.
Revista: CLINICAL NUCLEAR MEDICINE
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.
Revista: NUTRICION HOSPITALARIA
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.
Revista: NEUROLOGÍA (BARCELONA. ED. IMPRESA)
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: Ortega Cubero, Sara; Pagola Lorz, María Inmaculada; Luquin Piudo, María Rosario Isabel; et al.
Revista: NEUROLOGÍA (BARCELONA. ED. IMPRESA)
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.
Revista: REVISTA DE NEUROLOGIA
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.
Revista: REVISTA DE NEUROLOGIA
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.
Revista: NEUROLOGÍA (BARCELONA. ED. IMPRESA)
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: Irimia Sieira, Pablo; Palma Carazo, José Alberto; Idoate Gastearena, Miguel Ángel; et al.
Revista: HEADACHE
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: Lainez-Andrés, José Miguel; Caminero A; Díaz-Insa S; et al.
Revista: REVISTA DE NEUROLOGIA
ISSN 0210-0010  Vol. 56  Nº 3  2013  págs. 143-51
La valoración global en una escala analógica visual estuvo por encima de 7 para todos los triptanes, sin diferencias entre ellos. Al analizar la utilización de un determinado triptán en función de las características de las crisis, no se encontraron diferencias estadísticamente significativas. Conclusiones. En este grupo seleccionado de pacientes, los triptanes son un tratamiento por el que los pacientes muestran un alto grado de satisfacción. Aunque no existen diferencias globales en las puntuaciones entre los diferentes triptanes, el hecho de que determinados triptanes sean más utilizados por los pacientes después de experiencias previas con otros sugiere una mayor eficacia por su parte. No hemos encontrado ningún parámetro que prediga la utilización de un determinado triptán.
Autores: Gállego Pérez de Larraya, Jaime; Irimia Sieira, Pablo; Martínez Vila, Eduardo Antonio; et al.
Revista: JOURNAL OF CLINICAL ULTRASOUND
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: Ortega Cubero, Sara; Pagola Lorz, María Inmaculada; Domínguez Echávarri, Pablo Daniel; et al.
Revista: CEPHALALGIA
ISSN 0333-1024  Vol. 32  Nº 16  2012  págs. 1220 - 1221
Autores: Sáiz Mendiguren, Ramón; García de Eulate Ruiz, María Reyes; García-Lallana Valbuena, Amaia; et al.
Revista: ANALES DEL SISTEMA SANITARIO DE NAVARRA
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: Carod-Artal, FJ; Irimia Sieira, Pablo; Ezpeleta, D;
Revista: REVISTA DE NEUROLOGIA
ISSN 0210-0010  Vol. 54  Nº 10  2012  págs. 629-37
El desarrollo de migraña crónica se ha asociado con varios factores de riesgo no modificables (sexo femenino, estatus socioeconómico y nivel educativo bajos) y modificables (ansiedad, depresión, apnea del sueño/ronquido, obesidad, consumo de analgésicos y cafeína). Los pacientes con migraña crónica sufren dolor crónico, ansiedad o depresión con una frecuencia 2-3 veces superior a la migraña episódica. Su abordaje requiere la identificación y el manejo de los factores de riesgo que predisponen a su desarrollo, deshabituación de analgésicos cuando hay abuso, tratamiento específico de las crisis de migraña y tratamiento preventivo. Entre los fármacos preventivos, el topiramato y la Onabotulinumtoxin A han demostrado, en grandes ensayos clínicos controlados frente a placebo, su eficacia en esta complicación de la migraña. Conclusiones. La migraña crónica es una entidad frecuente que requiere un manejo global cuyos objetivos son reducir la frecuencia de las crisis, la discapacidad asociada y mejorar la calidad de vida de los pacientes.
Autores: Palma Carazo, José Alberto; Irimia Sieira, Pablo; Fernández Torrón, Roberto; et al.
Revista: REVISTA DE NEUROLOGIA
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
Revista: CLINICAL MEDICINE REVIEWS IN VASCULAR HEALTH
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.
Revista: CEPHALALGIA
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: Irimia Sieira, Pablo; Carmona Abellán, María del Mar; Martínez Vila, Eduardo Antonio
Revista: EXPERT OPINION ON EMERGING DRUGS
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: Irimia Sieira, Pablo; Palma Carazo, José Alberto; Fernández Torrón, Roberto; et al.
Revista: BMC NEUROLOGY
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.
Revista: ATHEROSCLEROSIS
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: Gállego Pérez de Larraya, Jaime; Palma Carazo, José Alberto; Carmona Iragui, María; et al.
Revista: JOURNAL OF NEURO-ONCOLOGY
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: Murie Fernández, Manuel; Irimia Sieira, Pablo; Martínez Vila, Eduardo Antonio; et al.
Revista: NEUROLOGIA
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: Guembe, M. J.; Toledo Atucha, Estefanía; Barba Cosials, Joaquín; et al.
Revista: ATHEROSCLEROSIS
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: Irimia Sieira, Pablo; Palma Carazo, José Alberto; Fernández Torrón, Roberto; et al.
Revista: REVISTA DE NEUROLOGIA
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: 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