Search

Introduction: Patients with chronic migraine (CM) and medication abuse are difficult to treat, and have a greater tendency towards chronification and a poorer quality of life than those with other types of headache., Aim: To evaluate whether the presence of medication abuse lowers the effectiveness of topiramate., Patients and Methods: A series of patients with CM were grouped according to whether they met abuse criteria or not. They were advised to stop taking the drug that they were abusing. Treatment was adjusted to match their crises and preventive treatment with topiramate was established from the beginning. The number of days with headache and intense migraine in the previous month and at four months of treatment was evaluated., Results: In all, 262 patients with CM criteria were selected and 167 (63.7%) of them fulfilled abuse criteria. In both groups there was a significant reduction in the number of days with headache/month and number of migraine attacks/month at the fourth month of treatment with topiramate. The percentage of reduction in the number of days with headache/month in CM without abuse was 59.3 ± 36.1%, and with abuse, 48.7 ± 41.7% (p = 0.0574). The percentage of reduction in the number of days with intense migraine/month in CM without abuse was 61.2%, and with abuse, 50% (p = 0.0224). Response rate according to the number of days with headache/month in CM without abuse was 69%, and with abuse, 57%. Response rate according to the number of intense migraines/month in CM without abuse was 76.8%, and in CM with abuse, 61% (p = 0.0097)., Conclusions: Topiramate was effective in patients with CM with and without medication abuse, although effectiveness is lower in the latter case.

Introduction: Topiramate and onabotulinumtoxin A have proven to be effective in chronic migraine with or without medication abuse according to recent criteria of the International Headache Society's Headache Classification., Aims: To show that flunarizine is as effective as topiramate in cases of chronic migraine without medication abuse., Patients and Methods: We conducted a prospective, non-randomised, comparative study of two groups of patients paired by age and sex, with chronic migraine without abuse, who had been treated preventively for the first time with topiramate or flunarizine., Results: Forty patients treated with flunarizine were assigned a patient of their same sex and age who was being treated with topiramate. The mean rate of reduction in intense migraines in the topiramate group was 59% and in the flunarizine group, 58.5% (p = 0.9444); the responder rate at four months of treatment did not show any significant differences either, the figures being 75% for topiramate and 70% for flunarizine (p = 0.6236). The mean reduction of other headaches in the topiramate group was 57% and in the flunarizine group, 64% (p = 0.4261); the responder rate at four months of treatment was similar in the two groups: 76%. The percentage of dropouts from treatment was higher with topiramate (19.5%) than with flunarizine (10%) (p = 0.3493). No serious side effects occurred in either of the groups. In all, 78.9% of the patients who took topiramate said they were satisfied with the drug versus 75% of those in the flunarizine group (p = 0.7903)., Conclusions: Flunarizine proved to be as effective as topiramate in the treatment of chronic migraine without medication abuse.

Introduction and Aims: This study was aimed determining the effectiveness, tolerance and satisfaction of patients with migraine as regards different triptans, according to the characteristics of their attacks. At the same time it sought to establish a predictive model that can be used to recommend one or another, depending on those characteristics., Patients and Methods: Retrospective observation-based study conducted in headache units in a number of different centres. Patients included in the study were those with migraine who used the same triptan to treat their attacks. Data concerning preference, effectiveness, speed and tolerance were analysed., Results: The analysis included 160 patients (88 females), with a mean age of 42.92 years. The most commonly used triptans were eletriptan, almotriptan and rizatriptan. Both patients and doctors reported a high degree of satisfaction (88% and 65%) with the triptan that was used. In the surveys on preference, patients preferred their current triptan to the previous one (83%) or to non-specific drugs. The overall score on a visual analogue scale was above 7 for all the triptans, without any differences from one to another. On analysing the use of a particular triptan depending on the characteristics of the attacks, no statistically significant differences were found., Conclusions: In this selected group of patients, triptans are a treatment that patients claim to be very satisfied with. Although there are no overall differences in the scores among different triptans, the fact that certain triptans are used more by patients after previous experiences with others suggests that they are more effective. We did not find any parameter that predicts the use of a particular triptan.

INTRODUCTION. Flunarizine, with level of evidence A, and nadolol, with evidence level C, would be indicated as preventive treatment of migraine. Yet, no previous studies have been conducted to compare the effectiveness of the two drugs. AIM. To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study, the same protocol being applied in both cases. PATIENTS AND METHODS. The subjects selected for the study were patients with episodic migraine (according to 2004 International Headache Society criteria) who had undergone preventive treatment for the first time, with flunarizine (5 mg/day) or nadolol (20-40 mg/day). The main effectiveness variables (reduction in the number of seizures at four months of treatment and responder rates) were analysed. RESULTS. The study included 227 patients who intended to receive treatment: 155 with flunarizine (80.5% females; mean age: 38.3 ± 12.1 years) and 72 with nadolol (63.8% females; mean age: 37.1 ± 12.0 years). The mean number of seizures prior to treatment was 6.09 ± 2.6 in the flunarizine group and 5.1 ± 1.7 in the nadolol group (p = 0.0079); at four months of treatment it was 2.61 ± 2.4 in the flunarizine group and 2.77 ± 2.4 in the nadolol group (p = NS). Percentage of reduction of migraines: 55.2% with flunarizine and 50.4% with nadolol (p = NS). The responder rate was 69% with flunarizine and 67% with nadolol (p = NS). The excellent response rate (reduction in the number of seizures by 75% or more) was 52.2% with flunarizine and 36.1% with nadolol (p = 0.0077). Percentage of adverse side effects: 48.3% with flunarizine and 25% with nadolol (p = 0.0009). The satisfaction rate was similar in both groups, 68%. CONCLUSIONS. Both flunarizine and nadolol proved to be effective in the preventive treatment of episodic migraine. Flunarizine is used more often in our milieu and was less well tolerated.

Introduction: The drop-out rate among patients receiving preventive treatment for migraine is higher than 30%. This situation is not very widely known and the risk factors that lead patients to drop out from treatment have yet to be identified., Aim: To evaluate some of the factors that can predispose patients to drop out of preventive treatment., Patients and Methods: We conducted a prospective study of patients suffering from migraine who required preventive treatment for the first time with one of what are considered the top three first-choice drugs, i.e. a beta-blocker (nadolol), a neuromodulator (topiramate) or a calcium antagonist (flunarizine). Two groups were established according to whether patients dropped out of treatment or not. Different demographic and clinical variables were analysed and compared in the two groups., Results: Of 800 patients with migraine who required preventive treatment for the first time, the drop-out rate was 19.7%. In the drop-out group, the variables 'age', 'number of seizures', 'number of seizures prior to preventive treatment' and 'side effects' showed significant differences with those from the group of patients who did not drop out of preventive treatment., Conclusions: The drug used as preventive treatment, the side effects, a younger age and a lower number of seizures before starting the preventive treatment favoured higher drop-out rates. Whether the migraine was episodic or chronic, the presence of medication abuse and the drugs used to treat the seizures were not related with dropping out of preventive treatment., (© 2011 Revista de Neurología)

Introduction: Topiramate and nadolol with levels A and C of scientific evidence, respectively, would be indicated as preventive treatments of migraine. To date only one study of satisfaction has been carried out to compare the two pharmaceuticals., Aim: To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study., Patients and Methods: From a database of 700 patients with migraine, those with episodic migraine and who had followed a course of preventive treatment, for the first time, with topiramate or nadolol were selected for the study. The effectiveness variables (reduction in the number of crises at four months of preventive treatment and responder rates) were analysed., Results: Altogether 208 patients with were included for treatment: 140 with topiramate (77.8% females; mean age, 37.9) and 68 with nadolol (69% females; mean age, 36.9). The mean number of crises in the month prior to treatment was: topiramate group, 6.3 +/- 2.6; nadolol group 5.3 +/- 2.0 (p = 0.0066). At four months after starting treatment: topiramate group, 2.69 +/- 2.6; nadolol group 2.6 +/- 2.2 (NS). The percentage of reduction in the number of migraines was 56.6% with topiramate and 51.6% with nadolol (NS). The responder rate (reduction in the frequency of crises by at least 50%) was 71.3% with topiramate versus 69% with nadolol (NS). The excellent response rate (reduction in crises by at least 75%) was 53.3% with topiramate versus 32.2% with nadolol (p = 0.0077). Adverse side effects were reported by 54% of patients treated with topiramate versus 30.8% of those treated with nadolol (p = 0.0015). The rate of satisfaction was 61% for the topiramate group and 71% for the group with nadolol (NS)., Conclusions: Both topiramate and nadolol proved to be effective in the preventive treatment of episodic migraine. Topiramate was found to be more effective than nadolol, although it was used in patients with a higher frequency of crises, and was not tolerated so well.

Introduction: Chronic migraine refractory to preventive treatment is a common clinical situation in general neurology clinics. The aim is to analyse our experience with zonisamide in the preventive treatment of patients with frequent refractory migraine., Patients and Methods: Those patients with no response or intolerance to topiramate and at least one more preventative received zonisamide. This drug was increased 25 mg per week up to 200 mg/day. The efficacy of zonisamide was evaluated in terms of 'response' (reduction in attack frequency below 50%) at the third month of treatment., Results: Our series comprises a total of 172 patients, with ages ranging from 22 to 69 years. 85% were women. The final dosage of zonisamide was 50-200 mg/day, with the 100 mg/day being the most frequently administered dose. Zonisamide was efficacious (response) in 76 (44%) patients; response being excellent in 22 (13%). MIDAS score was reduced by 43.2%. Zonisamide was not tolerated by 27% of the patients, mainly due to subjective mental slowness or digestive symptoms., Conclusions: These results, obtained in a big sample of patients refractory or intolerant to topiramate and other preventatives, indicate that, at least in conditions of daily clinical practice, zonisamide, at relatively low dosages, is an option to be considered for the preventive treatment of patients with frequent migraine.

Introduction: Patients with headache and medication abuse (HMA) are difficult to treat, have a greater tendency towards chronification and a poorer quality of life than those with other types of headache. AIM. To evaluate the indicators showing that these patients are responding to ambulatory treatment., Patients and Methods: From a series of patients with migraine, we selected those who satisfied HMA criteria according to the appendix of the 2006 International Classification of the Headache Disease (ICHD-2) and who had never previously undergone treatment. As outpatients, they were advised to stop taking the drug that they were abusing. The treatment of their seizures was adjusted with the most efficient drugs and preventive treatment was started from the outset with topiramate or flunarizine. Patients were grouped according to whether they continued with HMA or not. Comparisons were made between the number of days with headache during the previous month and after four months of treatment and the persistence of abuse., Results: HMA criteria were met by 178 patients (mean age 40.9; 88.7% females). Results showed that 68.5% (122 patients) responded and no longer met HMA criteria after treatment. The treatment used for their seizures (triptans, nonsteroidal antiinflammatory drugs, analgesics) and preventive treatment (topiramate or flunarizine) were similar in both groups. The average number of days with headache prior to treatment was 18.52 in the group that responded and 20.87 (p = 0.0263) in the group that did not respond to treatment. In the group of responders 7.3% dropped out of preventive treatment compared with 35% (p = 0.0001) in the group of non-responders., Conclusions: A higher number of days with headache during the previous month and withdrawing from preventive treatment were indicators of a bad progression.

Introduction: Chronic migraine is a primary headache that is difficult to treat and has an important impact on the patient's quality of life. The international headache classification recently modified the criteria for chronic migraine and therefore few studies have been conducted that analyse groups according to these new criteria. AIM. To analyse a group of patients with chronic migraine who were referred to a general neurology service., Patients and Methods: The first 100 patients with migraine were selected. Researchers established and analysed a number of subgroups of patients with episodic, chronic or chronic migraine with probable headache due to medication abuse, in accordance with the International Headache Society (IHS) headache classification and its revised version from 2006., Results: Of the total sample of 738 new patients, 100 (13.5%) suffered from migraines and of these 100 new patients with migraine 42 (5.6% of the total series) satisfied criteria for chronic migraine and 15 patients with chronic migraine met the criteria for probable headache due to medication abuse. Before visiting the neurology service, only 41% had been diagnosed as suffering from migraine, 38% had received no information about this condition, only 17% took triptans for symptomatic relief and 23% had followed some kind of preventive treatment., Conclusions: One notable finding was the importance of episodic and chronic migraine in a general neurology service, on applying the recent IHS criteria. A high percentage of patients with chronic migraine who were referred to the neurology service have not been diagnosed or given any information or proper treatment; an elevated degree of self-medication and medication abuse also exists. Preventive treatment and triptans in cases of intense migraines are still not commonly used in primary care.

Introduction: Chronic daily headache (CDH) includes primary headaches that last more than four hours with a frequency equal or superior to 15 days a month over the last three months. It has a prevalence of 4-5% in the general population and is a frequent reason for visiting the physician in headache units., Aim: To evaluate the effectiveness of topiramate, as the primary drug, in CDH due to probable chronic migraine with or without medication abuse., Patients and Methods: From the 447 patients with migraine in our database, we selected those: a) satisfying Silberstein criteria for CDH; b) that had not followed prior prophylactic treatment; and c) who were treated with topiramate as the primary drug. The mean number of days with headache and bouts of severe migraine in the fourth month of treatment using topiramate as compared to the month preceding treatment, as well as the percentage of responses and the rate of respondents in the fourth month were all analysed., Results: Eighty-three patients (88% females) with a mean age of 38.0 +/- 14.13 years were selected. Medication abuse was reported in 44% of cases. At the fourth month of treatment, the mean number of days with headache dropped significantly from 20.8 to 7.9 (p < 0.0001) and the mean number of bouts of severe migraine diminished from 4.4 to 1.7 (p < 0.0001). The rate of respondents was 72%. Medication abuse continued in 14% of cases. Side effects were produced in 58% of patients and the dropout rate was 24%., Conclusions: Topiramate proved to be effective in the treatment of CDH due to probable chronic migraine and with probable medication abuse in de novo migraine patients.

Introduction: Both flunarizine and, more recently, topiramate have proved to be effective in the prophylaxis of migraine., Aim: To compare two independent groups of patients with similar clinical and demographic characteristics who were treated with flunarizine or topiramate as the preferred drug in the prevention of their migraines and to evaluate effectiveness and safety according to the medication they received., Patients and Methods: All the patients reported more than four episodes a month and/or transformed migraine according to Silberstein's criteria, and had never received prophylactic treatment. Data determined: the number and average number of migraines in the previous month and at the fourth month of treatment, and the rate of respondents., Results: A total of 125 patients were included in each group. No significant differences were found between the groups as regards mean age or the average number of migraines in the previous month. With both drugs there was a significant decrease (0.0001) in the mean number of episodes in the fourth month of treatment, but with no significant difference between them: topiramate (5.88 +/- 3.7 to 2.1 +/- 2.5) and flunarizine (5.24 +/- 3.2 to 2.3 +/- 2.7). The mean reduction in the number of migraines at the fourth month was 58.2 +/- 38.2% with topiramate, and 55.4 +/- 37.5% with flunarizine. The respondent rate was 71% with topiramate and 67% with flunarizine. The percentage of dropouts with topiramate (28%) was higher than with flunarizine (11%) (0.0013). With topiramate 69 patients reported side effects and 53 patients reported them with flunarizine (0.0427)., Conclusions: Both drugs showed a high degree of effectiveness when used as the preferred drug in the preventive treatment of migraine. Topiramate offered better results as far as effectiveness is concerned, but also more side effects, none of which were serious.

Introduction: Migraine accounts for 10% of patients first visits due to neurological reasons in Spain and over half the new visits in headache units (HU) and hence the importance of this pathology., Aims: The aim of this study is to determine whether there are any differences between migraine patients referred to a general neurology service (GNS) or to a HU., Patients and Methods: Two groups of patients with migraine were compared: those sent for the first time to a GNS and the others, who were sent directly to a HU., Results: In a GNS, 10.7% (374 patients) of the overall number of new visits concerned migraines; these were compared with 107 migraines (64%) from the total number of headaches treated for the first time in the HU during the year 2000. The average age and distribution of sexes were similar in both groups. In the group of migraines from the HU there were more requests for CAT/MRI (20%), 77.5% had previous treatment, 71% were given preventive therapy, 51% received triptans and 44.8% needed an examination. In the group of migraines from visits to general service, there were fewer requests for CAT/MRI (14%), only 20% had previous therapy, preventive therapy was started in 45%, 6% received triptans and 25% required an examination., Conclusions: The group of patients with migraine who were sent to the HU presented a more serious pathology, required more preventive therapies, more triptans and more monitoring than the group of patients with migraine referred to the GNS.

Introduction: Migraine is a very common disorder and frequent cause of consultation of the neurologist. The triptanes have been a great advance in the treatment of migraine attacks. At present it is the treatment of choice in severe attacks of migraine, but it is more expensive than the other drugs used for this. Taking into account the greater efficacy and the saving in direct and indirect costs which may be due to treatment with triptanes, its use may not only be effective but also efficient., Objective: To analyze the cost effectiveness of the triptanes sold in Spain (sumatriptan, naratriptan, zolmitriptan, rizatriptan, almotriptan)., Material and Methods: We analyzed the efficacy, therapeutic gain and number of different triptanes needed for treatment. We evaluated the cost of multiplying the result of the number needing treatment by the price of each unit of the drug. The results are expressed in pesetas and in euros., Results: Rizatriptan gave the best results and was the cheapest triptan, followed by sumatriptan and zolmitriptan. When criteria of efficacy were used, naratriptan was the most expensive triptan, in spite of being the cheapest per unit., Conclusions: In chronic, recurrent disorders such as migraine, when the cost of treatment using triptans is assessed, one has not only to evaluate the cost per unit but also to introduce other parameters such as the efficacy of the drug, which is one of the most important.

Introduction: There is some controversy concerning the need to perform neuroimaging studies in patient complaining of headache. 90% of the people had a complaint of headache during their life, and it is impossible to perform neuroimaging studies in all of them., Objective: The aim of this study is knowing the reasons for indications neuroimaging studies in the evaluation of primary headaches and the effectiveness at the diagnosis., Patients and Methods: The clinical records of patients who a neuroimaging study was performed for headache during 1998 were retrospectively studied. We analysed in all patients: the age, sex, diagnosis of headache, suspicion of diagnosis, reason and time for indication the neuroimaging study, and if the study modified the diagnosis., Results: During 1998, were performed 107 neuroimaging studies in 96 patients. The mean age were 38 years. 60% were females. The suspicion of diagnosis was primary headache in 71% patients. Only one patient had an abnormality. The reasons for applying a neuroimaging study were: in 20 of the patients the migraine was more frequent and they didn t relieve with abortive drugs, in 20 there was a migraine aura, in 11 because the migraine turned to daily headache, in 17 the family asked for a neuroimaging study, there was a 17 of patients seemed to have an organic disease, in 2 the headache appeared daily, and in 7 of the cases weren't any reasons., Conclusions: Headache is the most frequent reason for asking a neuroimaging study. Primary headache is the type of headache that justifies most of indications. The most frequent reasons for performing a study were common changes in characteristics of migraine.

Introduction: Headache is the commonest cause of neurological consultation in Spain. Chronic tension headache is a common reason for consultation, although diagnosis is difficult., Objectives: To emphasize the profile of a patient with chronic tension headache and analyze the differences from other groups of neurology patients., Patients and Methods: We selected chronic tension headaches on the criteria of the International Headache Society, in patients who were seen for the first time in one of 18 Neurology Clinics of the Communidad Autonoma de Aragon during a three month period in 1995. We analysed age, sex, place of origin, provisional diagnosis made by the referring doctor, whether the referral was correct or had to be reviewed. These variables were compared with groups made up of all the patients, the other patients and headaches in general., Results: A total of 3,489 patients were seen: 889 had headache (25.5% of the total number of patients) and 268 had chronic tension headache (7.6% of all the patients). The average age was 47.4 years (SD: +/- 18.7) and 72% were women. Family doctors referred 89.5%. The provisional diagnosis was correct in 52.6% and 17% required further visits., Conclusions: Chronic tension headache leads to frequent neurological consultation. This was only exceeded by cerebral vascular pathology (12%) and migraine (10.5%), making up 29.4% of all headaches. There was a marked predominance of women, who were younger than patients with other neurological disorders. In spite of the frequency, the family doctors were correct in their provisional diagnosis less often than in other neurological conditions. Although the condition is chronic, the neurologist acted mainly as a consultant and saw few follow-up cases.

Objective: To analyze the patients sent to Neurology Clinics for headache and to investigate the differences in epidemiology, clinical findings and therapeutics as compared with those consulting for other neurological disorders., Patients and Methods: Eighteen neurologists from all the Outpatient Departments of the Community of Aragon Health Service were analysed using a specially designed questionnaire for all the patients who attended the Neurology Clinics for the first time during a period of three months., Results: Of 3,489 patients assessed, 25.5% complained of headache. Of these, 70% were women of an average age of 41.2 +/- 18.8 years. In 42% the consultation was for migraine followed by chronic tension headache in 30.1%. Family doctors sent 86.7% of the patients and requested complementary tests for 31.1%. Cerebral TAC (12.4%) and EEG (7.6%) were the investigations most often requested. Treatment was given to 68.6% of the patients with headache. Calcium-antagonists and anti-depressants were the drugs most used., Conclusions: Headache is the commonest cause for consulting a neurologist. It affects young adults, with marked predominance of the female sex. There are significative differences in clinical attention (fewer complementary tests are requested and less follow-up is necessary, although more treatment is given) than for other neurology patients.

Unlabelled: INTRODUCTION, PATIENTS AND METHODS: We studied 25 patients, 16 women and 9 men (average age 64.8 years; SD 8.6; range from 36 to 79 years) admitted to our hospital with clinical findings compatible with obstruction at the level of the bifurcation of the basilar artery. The patients were selected on clinical and neuroradiological criteria., Results and Conclusions: All patients included in the study had presented with two or more infarcts in the vertebro-basilar territory, related to pathology of the rostral region of the basilar artery. Diagnosis was confirmed on CT and MRI. Infarcts were found in the thalamus, brain-stem, cerebellum and parieto-occipital lobe. Infarct of the thalamus associated with another infarct in a different region was the most frequent lesion. The CT-MRI findings in the 25 cases were: 14 patients had unilateral thalamic infarcts associated with another infarct. There were 4 patients with bilateral thalamic infarcts and 5 with bilateral occipital infarcts. In 11 patients the occipital infarct was associated with another infarct at a different level, and 6 patients each had a cerebellar infarct together with a brain-stem infarct. In 12 patients the lesions were localized to three or more areas. The commonest clinical manifestations were: motor deficit (68%), abnormal eye movements (48%), cerebellar dysfunction (40%), alteration of the level of consciousness (32%), visual field defects (20%), pupil anomalies (16%). The risk factors most frequently associated were: arterial hypertension (64%), a history of cerebrovascular accident (28%), smoking (28%), diabetes mellitus (24%) and atrial fibrillation (20%). Mortality was 8%. Unlike the classical descriptions, motor deficit was the most frequent symptom in our series.

We studied 56 patients, 30 women and 26 men ranging from 30 to 79 years of age (average age 64.5 +/- 10.4), who were admitted to our hospital between 1982 and August 1995 with clinical features compatible with occlusion at the level of the bifurcation of the basilar artery. The patients were selected following clinical and neuro-radiological criteria. All patients included in the study had two or more recent infarcts in the vertebro-basilar territory, related to involvement of the rostral region of the basilar artery. The diagnosis was confirmed by CT or MR scanning. The infarcts were in the thalamus, brain-stem, cerebellum and parieto-occipital lobe. A thalamic infarct associated with an infarct in another region was the most frequent lesion. The CT-MR findings in the 56 cases were: 29 patients presented with a unilateral thalamic infarct associated with another infarct (23 occipital, 8 parietal, 6 brain-stem and 2 cerebellum). There were eight patients with bilateral thalamic infarcts and seven with bilateral occipital infarcts. In six patients the occipital infarct was associated with another infarct at a different level (parietal or cerebellar) and six patients had cerebellar infarcts together with an infarct of the mid-brain. In 22 of the patients, lesions were found in three or more areas. The commonest clinical findings were: Motor deficit (69.6%), abnormal eye movements (44.5%), cerebellar dysfunction (42.8%), altered level of consciousness (32.1%), visual field defects (28.5%), pupil anomalies (19.6%). The most frequently associated risk factors were: Arterial hypertension (58.9%), a history of ACV (32.1%) and atrial fibrillation (21.4%). Mortality was 5.7%. In contrast to the classical descriptions, motor defecit was the commonest symptom in our series.

Introduction: Recent studies show that a raised level of serum ferritin indicates a poor prognosis in CVA patients, as do the well-known hyperglycemia, dyslipemia and arterial hypertension. The evolution and prognosis of acute cerebrovascular accidents are determined by a series of factors, some of which can be modified. This leads to a search for factors which can be modified and therefore influence the course of the illness., Objective: To determine the ferritin levels and other parameters during the course of the illness of patients with serious cerebral vascular pathology and evaluate their effect on prognosis., Material and Methods: A prospective study was carried out on patients diagnosed as having CVA, admitted to the Neurology Department of the Miguel Servet Hospital (Zaragoza) during 1994, and who were in neurological coma (Glasgow scale less than 7) during the first 24 hours, and unable to swallow. The levels of various plasma parameters were determined (glucose, cholesterol, ferritin, etc.) on admission and then every 10 days., Conclusions: Plasma ferritin levels higher than those considered normal by the laboratory, in the first few hours after CVA, are an independent predictive factor suggesting unfavourable evolution of the vascular condition. Equally, raised ferritinemia in the first weeks after CVA indicates a worse prognosis. This laboratory test may be carried out on patients with acute CVA to obtain more information on which to base the prognosis.

Introduction: Neurological pathology as the initial form of sarcoidosis is exceptional. Neurosarcoidosis represents 5% of all cases. Central nervous system involvement is more frequent in the acute forms of this illness, whilst myositis and peripheral neuropathy are more common in chronic sarcoidosis., Clinical Case: A 60 year old woman presented with peripheral facial diplegia, diminished visual acuity and bilateral papilloedema, dysarthria and unsteady gait with left lateropulsion and paresia and dysesthesia of the distal parts of the limbs. X-ray and laboratory findings were normal. Gammography with Gallium 67 citrate showed mediastimal adenopathy. Neurographic study was compatible with mixed polyneuropathy and lumbar puncture showed aseptic meningitis. The diagnosis of neurosarcoidosis was confirmed by histopathological study of the skin and sural nerve., Discussion and Conclusions: When the presenting features of sarcoidosis are neurological, as in this case, diagnosis is difficult and pathology studies showing the presence of non-caseous granulomas are essential. Biopsy of the sural nerve may be very useful. Although the pathogenesis of sarcoid neuropathology is not completely clear, finding non-caseous granulomas associated with vasculitis in the nerve biopsy indicates that both disease processes may be involved in the peripheral nerve lesion.

Objective: To evaluate clinical, diagnostic and therapeutic aspects and how the Neurology Outpatient Departments of Aragon work in practice., Material and Methods: For three consecutive months all patients attending the Neurology Outpatient Departments of the Health Areas of the Health Service of Aragón for the first time were given a specially designed questionnaire., Results: The majority of the patients were women (57%). The average age was 51.5 +/- 20.6 years. The family doctor referred 79.5% of the patients. The average waiting time for patients to be seen was 12.4 +/- 10.7 days. Further investigations were requested in 48.9% of the patients (cerebral CT in 18.1%, MR in 2.6%, EEG in 12% and ENG-EMG in 6.8%). The commonest diagnoses were headache (25.5%), cerebrovascular pathology (12.5%), extrapyramidal pathology (7.5%), syncope (6.5%), convulsions (6%), vertigo (5.9%), psychiatric disorders (5%), non-neurological disorders (4.4%). No treatment was given to 15.64% of the patients attending for the first time. The commonest drugs used were: calcium antagonists (32.5%), platelet antiaggregants (20.9%), antidepressives (17%), antiepileptic drugs (15.6%) and NSAIDS (5.3%)., Conclusions: There is a considerable demand for neurological consultations and there are few neurologists in proportion to the population. Better selection of the patients sent for consultation and a better understanding by family doctors of the commoner neurological disorders would considerably reduce the number of patients sent to the Outpatient Department.

We describe the case of a patient whose menopause syndrome was treated with veralipride. After four months of this treatment she started to have bucco-lingual movements and marked dyspnea which caused difficult, irregular breathing and severe thoracic discomfort. After the drug was stopped there was progressive improvement and disappearance of the symptoms described. When the patient was taking a neuroleptic drug (veralipride) she developed bucco-lingual dyskinesia, considered to be the commonest late dyskinesia, together with marked respiratory dyskinesia. The latter is a type of dyskinesia seldom described, probably because it is only detected when it is severe enough to cause functional effects. It may pass unnoticed when the disorder is only slight or moderate. In the literature there are few references to disorders of movement induced by this drug, especially when compared with other benzamides which are frequently involved. However, in its mode of action there is a beneficial antigonadotropin activity together with an antidopaminergic effect which explains why they may cause such a reaction.

Objective: To evaluate the clinical, diagnostic, therapeutic and functional aspects of a Neurology Outpatient Clinic., Material and Method: An epidemiological survey was made of 552 neurology patients first seen in the Neurology Outpatient Clinic during a three month period., Results: There was a predominance of women (57.6%). The average age was 45.1 years in both sexes. 84.7% of the patients were sent by their family doctor. There was an average wait of nine days. Complementary investigations were asked for in 56% of the patients (cerebral CT scan in 13.7%, MR in 5%, EEG in 21%, ENG-EMG in 5.7%). The diagnostic groups were headache 30%, followed by vascular pathology (11.7%); psychiatric, syncopes, extrapyramidal syndromes, epilepsy and vertigo each made up 6-7% of the total. 53% of patients attending for the first time received no treatment. The most commonly used drugs were: calcium antagonists (20%), antidepressives (15%), antiepileptics (10%), platelet antiaggregants (8.4%), anti-Parkinson drugs (7.3%) and beta-blockers (4.6%)., Conclusions: Since there is a great demand for neurological attention (as with other specialties) more neurologists are required. Headache was the commonest reason for consultation. Improved selection of the patients, particularly the psychiatric patients and those with psychosomatic pathology, would considerably reduce the number of patients seen.

Thyroid ophthalmopathy (TO) or Graves ophthalmopathy embraces a broad range of eye abnormalities which up to 90% of patients with hyperthyroidism (HT) are affected with. In some 10% of TO patients, this may begin oligosymptomatically, often with double vision and with neither clinical nor biochemical signs of thyroid disease. It is imperative to carry out a differential diagnosis with countless other causes for double vision and other eye socket processes. Ophthalmopathy may also occur in patients with hypothyroidism and for this reason some authors prefer to refer to it as dysthyroid orbitopathy. We present four cases of TO in which double vision was the first clinical sign of TO which in one case became severe, in two cases preceded hyperthyroid symptomatology and in the remaining case happened after hyperthyroidism had been corrected. The most valuable diagnostic test was orbit computerised tomography (CT) scan, which proved positive in all cases, and that, along with clinical tests and thyroid function data, confirmed a diagnosis of TO. All initially improved with corticosteroids although none completely regained eye movement during the time they were under supervision. The same happens in about 50% of patients who do not respond to treatment either with corticosteroids or with radiotherapy, and response is usually incomplete in those who do so respond.