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Resumen Introduccion El sindrome de piernas inquietas (SPI) es un trastorno caracterizado por la necesidad imperiosa de mover las piernas, estando a menudo acompanado de sensaciones desagradables. Su frecuencia es superior en pacientes con esclerosis multiple (EM) que en la poblacion general. Objetivos Evaluar la prevalencia del SPI, segun el cumplimiento de los 4 requisitos esenciales incluidos en los criterios diagnosticos propuestos por la International Restless leg syndrome study group (IRLSSG, 2003), en una cohorte de pacientes con EM e identificar posibles factores de riesgo y repercusion clinica. Resultados Se incluyeron 120 pacientes con EM, con una edad media de inicio de 40 anos y un tiempo medio de evolucion de 46 meses. La prevalencia de SPI, segun el cumplimiento de criterios diagnosticos de la IRLSSG, fue del 23,3%. El tiempo de evolucion de EM, desde la aparicion de los primeros sintomas, fue significativamente menor en pacientes con SPI (p=0,001). La presencia de un brote reciente, asi como de sintomas de ansiedad, depresion y dolor neuropatico se asociaron de forma significativa con el riesgo de SPI (p=0,001, p Conclusiones El SPI debe ser considerado en la evaluacion neurologica de pacientes con EM, cuyo diagnostico y tratamiento precoz mejoraria la calidad de vida de estos sujetos.

Resumen Introduccion Las enfermedades desmielinizantes del sistema nervioso central (SNC) constituyen un grupo heterogeneo de enfermedades autoinmunes en las que se desarrolla un dano de la mielina. De todas ellas, la esclerosis multiple (EM) es la mas prevalente, siendo la causa mas frecuente de discapacidad neurologica cronica no traumatica en adultos jovenes y de mediana edad. Por este motivo, su adecuado manejo terapeutico, desde fases iniciales de la enfermedad, es esencial. Resultados El manejo terapeutico de la EM incluye tanto la busqueda del control de su actividad clinica y radiologica, como el tratamiento sintomatico y rehabilitador de sus complicaciones y/o secuelas. En esta actualizacion se revisaran los tratamientos de las reagudizaciones, y en especial los farmacos modificadores de la enfermedad, sus indicaciones segun escenario de la enfermedad, posologia, efectos adversos, interacciones y criterios de sustitucion. Conclusion Actualmente se dispone de un amplio arsenal terapeutico para el tratamiento de la EM, con farmacos capaces de modificar el curso de esta enfermedad, lo que ha supuesto un cambio importante en la historia natural de esta patologia. El uso precoz de estos tratamientos es un factor esencial para mejorar el pronostico de los pacientes con EM.

Aim. To evaluate the effectiveness on tissue response of the new nutritional supplement made of oligomeric proanthocyanidins in induced gingivitis after 21 days of use. Material and Methods. A prospective, double-blind, randomized, controlled clinical trial was carried out on 20 patients; it is divided into an experimental group and a control group after fulfilling the selection criteria. Patients had to come 4 times during the study to register the Silness and Löe index, the gingival bleeding index, the plaque index, the inflammatory crevicular fluid study (IL6), and the changes in the brightness of the gingiva. No complementary hygiene methods were allowed during the 21 days. Results. The Silness and Löe index was higher in the control group than in the experimental group, reaching a twofold difference between the groups (p<0.0001). The gingival bleeding index also supports this fact, since the bleeding was lower in the experimental group (p<0.005). However, the dental plaque on the tooth surface according to the plaque index was 33% higher in the experimental group (p<0.006). Some differences in the IL-6 were found in the crevicular fluid (p<0.0001). Conclusion. Oligomeric proanthocyanidins have an effect on the periodontal tissue’s health. No effects on the accumulation of plaque on the tooth surface were found, so further studies are needed to determine the nature of the plaque.

Background: Patients with a clinically isolated demyelinating syndrome (CIS) are at risk of developing a second attack, thus converting into clinically definite multiple sclerosis (CDMS). Therefore, an accurate prognostic marker for that conversion might allow early treatment. Brain MRI and oligoclonal IgG band (OCGB) detection are the most frequent paraclinical tests used in MS diagnosis. A new OCGB test has shown high sensitivity and specificity in differential diagnosis of MS. Objective: To evaluate the accuracy of the new OCGB method and of current MRI criteria (MRI-C) to predict conversion of CIS to CDMS. Methods: Fifty-two patients with CIS were studied with OCGB detection and brain MRI, and followed up for 6 years. The sensitivity and specificity of both methods to predict conversion to CDMS were analyzed. Results: OCGB detection showed a sensitivity of 91.4% and specificity of 94.1%. MRI-C had a sensitivity of 74.23% and specificity of 88.2%. The presence of either OCGB or MRI-C studied simultaneously showed a sensitivity of 97.1% and specificity of 88.2%. Conclusions: The presence of oligoclonal IgG bands is highly specific and sensitive for early prediction of conversion to multiple sclerosis. MRI criteria have a high specificity but less sensitivity. The simultaneous use of both tests shows high sensitivity and specificity in predicting clinically isolated demyelinating syndrome conversion to clinically definite multiple sclerosis.

Background: Recently the International Panel on Diagnosis of Multiple Sclerosis (MS) has proposed new magnetic resonance imaging (MRI) criteria for the diagnosis of MS in patients with clinically isolated syndromes (CIS). We aimed to evaluate the accuracy of these new criteria for lesions dissemination in space (DIS) and time (DIT), from a single MRI scan, to predict conversion from CIS to clinically definite MS. Methods: We studied 67 CIS patients with baseline MRI performed within the first 3 months after onset. The follow-up was of at least 24 months. The sensitivity, specificity and accuracy of Barkhof–Tintoré criteria and the new proposed MRI criteria for DIS and DIT were calculated with SPSS v.15.0. Results: The mean age for clinical onset was 30 years and 64% of patients were female. The overall conversion rate was 74%. In our cohort, Barkhof–Tintoré criteria showed a sensitivity of 71.43%, a specificity of 66.67%, with an accuracy of 73.1%. New DIS criteria showed a sensitivity of 85.71%, a specificity of 64.71% and an accuracy of 80.30%. We also evaluated the new DIT criteria with a single MRI scan in 54 patients with baseline scans that included gadolinium-enhanced images. The sensitivity of the test was 52.63% with a specificity of 75.00% and an accuracy of 59.26%. Conclusion: New DIS criteria are simpler and more sensitive than previous criteria. The sensitivity of DIT criterion using a single MRI scan was rather low, as other previous studies showed, reflecting its stringency, but it could improve the accuracy of early MS diagnosis in that group of patients with typical CIS and gadolinium-enhancing and non-enhancing lesions on their baseline scans. These results reinforce their use in MS diagnosis.

Introduccion. La meralgia parestesica es una patologia frecuente en la consulta de neurologia extrahospitalaria. A pesar de ello, el diagnostico, tratamiento y pronostico de este cuadro no estan bien establecidos. Pacientes y metodos. Estudio retrospectivo de 140 pacientes. Se recogen datos demograficos, clinica, estudio diagnostico, etiologia, tratamiento y evolucion. Resultados. Hubo un predominio masculino, con una mediana de 54 anos. El seguimiento medio fue de 25 meses. Los sintomas narrados fueron: acorchamiento, dolor urente, hormigueo o pinchazos en el territorio nervioso. En la exploracion se hallo hipoestesia como signo mas frecuente. Hubo historia de otra neuropatia compresiva en el 13,6%. El diagnostico se baso en la historia clinica y la exploracion neurologica. El estudio neurofisiologico y las pruebas complementarias se reservaron para casos atipicos. La etiologia mas frecuente fue la espontanea, y se hallaron solo tres casos secundarios a lesion estructural. Un tercio de los pacientes recibio tratamiento farmacologico. Aunque el cuadro fue benigno, en la mayoria tendio a cronificarse. Los pacientes tratados farmacologicamente no mostraron una mejoria significativa frente a los que no recibieron tratamiento. El dato pronostico mas importante para la mejoria del cuadro fue la identificacion y correccion de los factores desencadenantes de compresion del nervio. Conclusiones. La meralgia parestesica es una patologia frecuente, benigna, pero con tendencia a cronificarse, en la que es importante identificar y corregir factores mecanicos, con pobre respuesta al tratamiento farmacologico, y solo en casos excepcionales secundaria a lesion estructural.

IGF-I is an anabolic hormone which has been reported to increase bone formation in several conditions of undernutrition. Advanced liver cirrhosis is associated with osteopenia and also with low serum levels of IGF-I. Previous results showed that low doses of IGF-I increase osteoblastic activity and decrease bone reabsorption in early liver cirrhosis. The aim of this study was to evaluate whether IGF-I-treatment also induces beneficial effect on osteopenia associated with advanced cirrhosis. Rats with ascitic cirrhosis were divided into two groups: group CI (n=10) which received saline and group CI+IGF (n=10) which were treated with IGF-I (2 microg/100 g bw x day, sc, during 21 days). Healthy controls which received saline were studied in parallel (CO n=10). On the 22nd day, the animals were sacrificed, and bone parameters were analyzed in femur. Posterior-anterior diameter was similar in all groups. No significant differences were observed in bone content of calcium, total proteins, collagen and hydroxyapatite in cirrhotic rats as compared with controls. However, CI rats showed significant reductions in total bone density (-13.5%, p0.001) assessed by densitometry and radiological study. In CI+IGF rat bone density (assessed by densitometry) improved significantly as compared with CI animals. In summary, osteopenia characterized by loss of bone mass and preserved bone composition was found in rats with advanced cirrhosis induced by CCl4 and phenobarbital in drinking water. This bone disorder is partially restored by treatment with low doses of IGF-I during only three weeks. Thus, IGF-I could be considered as a possible therapy for osteopenia associated with advanced liver cirrhosis.