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1. Agonistas dopaminérgicos en la enfermedad de Parkinson

Author

A. Alonso Cánovas, R. Luquin Piudo, P. García Ruiz-Espiga, J.A. Burguera, V. Campos Arillo, A. Castro, G. Linazasoro, J. López del Val, L. Vela, and J.C. Martínez Castrillo

Subjects
Neurology. Diseases of the nervous system, RC346-429
Abstract

Resumen: Introducción: Los agonistas dopaminérgicos no ergóticos (AD) son tratamientos útiles en la enfermedad de Parkinson (EP). Revisamos la farmacología, el grado de evidencia en cuanto a eficacia y tolerabilidad de pramipexol, ropinirol y rotigotina, y proponemos algunas recomendaciones para su uso en la práctica clínica. Desarrollo: En el momento actual se dispone de formas de liberación prolongada (LP) de pramipexol y ropinirol y de administración transdérmica de rotigotina, que contribuyen a una mayor estabilidad plasmática de los valores del fármaco. En la EP inicial los 3 fármacos mejoran de forma significativa las escalas de incapacidad de los pacientes, retrasan la aparición de discinesias y permiten retrasar la introducción de levodopa. En la EP avanzada reducen el tiempo off, mejoran la Unified Parkinson's Disease Rating Scale (UPDRS) en on y en off y permiten reducir la dosis total de levodopa. Además, los 3 han sido capaces de inducir una mejora significativa en las escalas de la calidad de vida relacionada con la salud. Las fórmulas de LP han demostrado la no inferioridad frente a las de liberación inmediata, e incluso una mejor tolerabilidad (ropinirol). A pesar de su buen perfil de seguridad, entre los efectos adversos graves cabe destacar el trastorno de control de impulsos, cuya aparición puede ser precoz, y los accesos de sueño (sleep attacks). Aunque la terapia combinada no ha sido estudiada específicamente, algunas asociaciones (como la de apomorfina y otros AD) pueden ser beneficiosas. El cambio de un AD a otro es factible de un día para otro, aunque en los primeros días puede haber una sumación de efectos adversos dopaminérgicos que debe tenerse en cuenta. La suspensión brusca del tratamiento con AD puede inducir un síndrome de deprivación dopaminérgica. La retirada de cualquier AD, en particular pramipexol, se ha asociado a aparición de apatía que puede ser grave. Conclusiones: Los nuevos AD no ergóticos constituyen una opción válida de tratamiento de la EP tanto inicial como avanzada. A pesar de su buen perfil de tolerabilidad, no están exentos de efectos adversos graves, que pueden tener un efecto patoplástico en la EP y que deben monitorizarse. Abstract: Background: Non-ergoline dopamine agonists (DA) are effective treatments for Parkinson's disease (PD). This review presents the pharmacology, evidence of efficacy and safety profile of pramipexole, ropinirole, and rotigotine, and practical recommendations are given regarding their use in clinical practice. Results: Extended-release formulations of pramipexole and ropinirole and transdermal continuous delivery rotigotine patches are currently available; these may contribute to stabilising of plasma levels.In early PD, the three drugs significantly improve disability scales, delay time to dyskinesia and allow a later introduction of levodopa. In late PD they reduced total 'off'-time, improved Unified Parkinson's Disease Rating Scale (UPDRS) in both 'on' and 'off' state and allowed a reduction in total levodopa dosage. A significant improvement in quality of life scales has also been demonstrated. Extended-release formulations have proved to be non-inferior to the immediate release formulations and are better tolerated (ropinirole). Despite a generally good safety profile, serious adverse events, such as impulse control disorder and sleep attacks, need to be routinely monitored. Although combination therapy has not been addressed in scientific literature, certain combinations, such as apomorphine and another DA, may be helpful. Switching from one DA to another is feasible and safe, although in the first days an overlap of dopaminergic side effects may occur. When treatment with DA is stopped abruptly, dopamine withdrawal syndrome may present. Suspending any DA, especially pramipexole, has been linked to onset of apathy, which may be severe. Conclusions: New non-ergotine DAs are a valuable option for the treatment of both early and late PD. Despite their good safety profile, serious adverse effects may appear; these effects may have a pathoplastic effect on the course of PD and need to be monitored. Palabras clave: Agonistas dopaminérgicos, Pramipexol, Ropinirol, Rotigotina, Liberación prolongada, Equivalencia, Keywords: Dopamine agonists, Pramipexole, Ropinirole, Rotigotine, Prolonged release, Equivalence

Published
2014
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2. Dopaminergic agonists in Parkinson's disease

Author

A. Alonso Cánovas, R. Luquin Piudo, P. García Ruiz-Espiga, J.A. Burguera, V. Campos Arillo, A. Castro, G. Linazasoro, J. López Del Val, L. Vela, and J.C. Martínez Castrillo

Subjects
Neurology. Diseases of the nervous system, RC346-429
Abstract

Background: Non-ergoline dopamine agonists (DA) are effective treatments for Parkinson's disease (PD). This review presents the pharmacology, evidence of efficacy and safety profile of pramipexole, ropinirole, and rotigotine, and practical recommendations are given regarding their use in clinical practice. Results: Extended-release formulations of pramipexole and ropinirole and transdermal continuous delivery rotigotine patches are currently available; these may contribute to stabilising of plasma levels.In early PD, the three drugs significantly improve disability scales, delay time to dyskinesia and allow a later introduction of levodopa. In late PD they reduced total ‘off’-time, improved Unified Parkinson's Disease Rating Scale (UPDRS) in both ‘on’ and ‘off’ state and allowed a reduction in total levodopa dosage. A significant improvement in quality of life scales has also been demonstrated. Extended-release formulations have proved to be non-inferior to the immediate release formulations and are better tolerated (ropinirole). Despite a generally good safety profile, serious adverse events, such as impulse control disorder and sleep attacks, need to be routinely monitored. Although combination therapy has not been addressed in scientific literature, certain combinations, such as apomorphine and another DA, may be helpful. Switching from one DA to another is feasible and safe, although in the first days an overlap of dopaminergic side effects may occur. When treatment with DA is stopped abruptly, dopamine withdrawal syndrome may present. Suspending any DA, especially pramipexole, has been linked to onset of apathy, which may be severe. Conclusions: New non-ergotine DAs are a valuable option for the treatment of both early and late PD. Despite their good safety profile, serious adverse effects may appear; these effects may have a pathoplastic effect on the course of PD and need to be monitored. Resumen: Introducción: Los agonistas dopaminérgicos no ergóticos (AD) son tratamientos útiles en la Enfermedad de Parkinson (EP). Revisamos la farmacología, el grado de evidencia en cuanto a eficacia y tolerabilidad de pramipexol, ropinirol y rotigotina, y proponemos algunas recomendaciones para su uso en la práctica clínica. Desarrollo: En el momento actual se dispone de formas de liberación prolongada (LP) de pramipexol y ropinirol y de administración transdérmica de rotigotina, que contribuyen a una mayor estabilidad plasmática de los niveles del fármaco. En la EP inicial los tres fármacos mejoran de forma significativa las escalas de incapacidad de los pacientes, retrasan la aparición de discinesias y permiten retrasar la introducción de levodopa. En la EP avanzada reducen el tiempo off, mejoran la UPDRS en on y en off y permiten reducir la dosis total de levodopa. Además, los tres han sido capaces de inducir una mejoría significativa en las escalas de la calidad de vida relacionada con la salud. Las fórmulas de LP han demostrado la no inferioridad frente a las de liberación inmediata, e incluso una mejor tolerabilidad (ropinirol). A pesar de su buen perfil de seguridad, entre los efectos adversos graves cabe destacar el trastorno de control de impulsos, cuya aparición puede ser precoz, y los accesos de sueño (sleep attacks). Aunque la terapia combinada no ha sido estudiada específicamente, algunas asociaciones (como la de apomorfina y otros AD) pueden ser beneficiosas. El cambio de un AD a otro es factible de un día para otro, aunque en los primeros días puede haber una sumación de efectos adversos dopaminérgicos que debe tenerse en cuenta. La suspensión brusca del tratamiento con AD puede inducir un síndrome de deprivación dopaminérgica. La retirada de cualquier AD, en particular pramipexol, se ha asociado a aparición de apatía que puede ser grave. Conclusiones: Los nuevos AD no ergóticos constituyen una opción válida de tratamiento de la EP tanto inicial como avanzada. A pesar de su buen perfil de tolerabilidad, no están exentos de efectos adversos graves, que pueden tener un efecto patoplástico en la EP y que deben monitorizarse. Keywords: Dopamine agonists, Pramipexole, Ropinirole, Rotigotine, Prolonged release, Equivalence, Palabras clave: Agonistas dopaminérgicos, Pramipexol, Ropinirol, Rotigotina, Liberación prolongada, Equivalencia

Published
2014
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3. Enfermedad de Parkinson avanzada. Características clínicas y tratamiento. Parte II

Author

J. Kulisevsky, M.R. Luquin, J.M. Arbelo, J.A. Burguera, F. Carrillo, A. Castro, J. Chacón, P.J. García-Ruiz, E. Lezcano, P. Mir, J.C. Martinez-Castrillo, I. Martínez-Torres, V. Puente, Á. Sesar, F. Valldeoriola-Serra, and R. Yañez

Subjects
Neurology. Diseases of the nervous system, RC346-429
Abstract

Resumen: Introducción: Muchos de los pacientes con enfermedad de Parkinson (EP) presentan al cabo de varios años fluctuaciones y discinesias graves que requieren de terapias algo más agresivas como la estimulación cerebral profunda del núcleo subtalámico o globo pálido medial, la infusión continua de apomorfina y la infusión intestinal continua de levodopa-carbidopa. Objetivo: Establecer las indicaciones y resultados de las 3 técnicas disponibles en la actualidad para el tratamiento de la EP avanzada. Desarrollo: Revisión exhaustiva de los datos publicados en la literatura sobre las indicaciones y resultados de la estimulación cerebral profunda del núcleo subtalámico, infusión subcutánea de apomorfina e infusión intestinal continua de levodopa-carbidopa en pacientes con EP avanzada. Conclusiones: Aunque existen numerosos estudios que han descrito la eficacia de cada una de estas 3 técnicas, faltan estudios comparativos que permitan definir el candidato ideal para cada una de las técnicas. Abstract: Introduction: Many patients who have had Parkinson's disease (PD) for several years will present severe motor fluctuations and dyskinesias which require more aggressive therapies. The different approaches which are now available include deep brain stimulation of the subthalamic nucleus or medial globus pallidus, subcutaneous infusion of apomorphine, and intestinal infusion of levodopa-carbidopa. Objective: To define the indications and results for the 3 available therapies for advanced PD. Development: Exhaustive review of the literature concerning the indications and results of deep brain stimulation, subcutaneous apomorphine infusion and duodenal infusion of levodopa/carbidopa gel to treat patients with advanced Parkinson disease. Conclusions: Although numerous studies have confirmed the efficacy of the 3 different therapies in advanced PD, there are no comparative studies that would allow us to define the best candidate for each technique. Palabras clave: Enfermedad de Parkinson avanzada, Estimulación cerebral profunda, Infusión de apomorfina, Infusión intestinal de levodopa-carbidopa, Keywords: Advanced Parkinson's disease, Deep brain stimulation, Subcutaneous apomorphine infusion, Intestinal levodopa-carbidopa infusion

Published
2013
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4. Advanced Parkinson's disease: Clinical characteristics and treatment. Part II

Author

J. Kulisevsky, M.R. Luquin, J.M. Arbelo, J.A. Burguera, F. Carrillo, A. Castro, J. Chacón, P.J. García-Ruiz, E. Lezcano, P. Mir, J.C. Martinez-Castrillo, I. Martínez-Torres, V. Puente, Á. Sesar, F. Valldeoriola-Serra, and R. Yañez

Subjects
Neurology. Diseases of the nervous system, RC346-429
Abstract

Introduction: Many patients who have had Parkinson's disease (PD) for several years will present severe motor fluctuations and dyskinesias which require more aggressive therapies. The different approaches which are now available include deep brain stimulation of the subthalamic nucleus or medial globus pallidus, subcutaneous infusion of apomorphine, and intestinal infusion of levodopa–carbidopa. Objective: To define the indications and results for the 3 available therapies for advanced PD. Development: Exhaustive review of the literature concerning the indications and results of deep brain stimulation, subcutaneous apomorphine infusion and duodenal infusion of levodopa/carbidopa gel to treat patients with advanced Parkinson disease. Conclusions: Although numerous studies have confirmed the efficacy of the 3 different therapies in advanced PD, there are no comparative studies that would allow us to define the best candidate for each technique. Resumen: Introducción: Muchos de los pacientes con enfermedad de Parkinson (EP) presentan al cabo de varios años fluctuaciones y discinesias graves que requieren de terapias algo más agresivas como la estimulación cerebral profunda del núcleo subtalámico o globo pálido medial, la infusión continua de apomorfina y la infusión intestinal continua de levodopa-carbidopa. Objetivo: Establecer las indicaciones y resultados de las 3 técnicas disponibles en la actualidad para el tratamiento de la EP avanzada. Desarrollo: Revisión exhaustiva de los datos publicados en la literatura sobre las indicaciones y resultados de la estimulación cerebral profunda del núcleo subtalámico, infusión subcutánea de apomorfina e infusión intestinal continua de levodopa-carbidopa en pacientes con EP avanzada. Conclusiones: Aunque existen numerosos estudios que han descrito la eficacia de cada una de estas 3 técnicas, faltan estudios comparativos que permitan definir el candidato ideal para cada una de las técnicas. Keywords: Advanced Parkinson's disease, Deep brain stimulation, Subcutaneous apomorphine infusion, Intestinal levodopa–carbidopa infusion, Palabras clave: Enfermedad de Parkinson avanzada, Estimulación cerebral profunda, Infusión de apomorfina, Infusión intestinal de levodopa-carbidopa

Published
2013
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5. Advanced Parkinson's disease: Clinical characteristics and treatment (part 1)

Author

J. Kulisevsky, M.R. Luquin, J.M. Arbelo, J.A. Burguera, F. Carrillo, A. Castro, J. Chacón, P.J. García-Ruiz, E. Lezcano, P. Mir, J.C. Martinez-Castrillo, I. Martínez-Torres, V. Puente, A. Sesar, F. Valldeoriola-Serra, and R. Yañez

Subjects
Neurology. Diseases of the nervous system, RC346-429
Abstract

Introduction: A large percentage of patients with Parkinson's disease (PD) develop motor fluctuations, dyskinesias, and severe non-motor symptoms (NMS) within 3 to 5 years of starting dopaminergic therapy, and these motor complications are refractory to treatment. Several authors refer to this stage of the disease as advanced PD. Objective: To define the clinical manifestations of advanced PD and the risk factors for reaching this stage of the disease. Development: This consensus document has been prepared by using an exhaustive literature search and by discussion of the contents by an expert group on movement disorders of the Sociedad Española de Neurología (Spanish Neurology Society), coordinated by two of the authors (JK and MRL). Conclusions: Severe motor fluctuations and dyskinesias, axial motor symptoms resistant to levodopa, and cognitive decline are the main signs in the clinical phenotype of advanced PD. Resumen: Introducción: Un porcentaje importante de pacientes con enfermedad de Parkinson (EP) desarrollan complicaciones motoras en forma de fluctuaciones motoras, discinesias y síntomas no motores al cabo de 3–5 años del inicio del tratamiento que resultan de difícil control terapéutico. Esta fase de la enfermedad ha sido definida por algunos autores como fase avanzada de la EP. Objetivo: Definir las características clínicas y los factores de riesgo que condicionan que una EP evolucione a un estadio avanzado. Desarrollo: Este documento de consenso se ha realizado mediante una búsqueda bibliográfica exhaustiva y discusión de los contenidos llevadas a cabo por un grupo de expertos en trastornos del movimiento de la Sociedad Espãnola de Neurología coordinados por dos de los autores (JK y MRL). Conclusiones: La presencia de fluctuaciones motoras y discinesias graves, síntomas motores axiales resistentes a la levodopa y síntomas no motores, como los trastornos cognitivos, representan las principales manifestaciones fenotípicas de una EP avanzada. Keywords: Advanced Parkinson's disease, Risk factors, Clinical phenotype, Motor scales, Non-motor scales, Quality of life scales, Palabras clave: Enfermedad de Parkinson avanzada, Factores de riesgo, Fenotipo clínico, Escalas de valoración motora, Escalas de valoración no motora, Escalas de calidad de vida

Published
2013
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13. Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS

Author

Caroline Lavie, Fabien Rollot, Françoise Durand-Dubief, Romain Marignier, Iuliana Ionescu, Romain Casey, Thibault Moreau, Patricia Tourniaire, Michael Hutchinson, Marie Béatrice D’Hooghe, David-Axel Laplaud, Pierre Clavelou, Jérôme De Sèze, Marc Debouverie, David Brassat, Jean Pelletier, Christine Lebrun-Frenay, Emmanuelle Le Page, Giovanni Castelnovo, Eric Berger, Patrick Hautecoeur, Olivier Heinzlef, Luca Durelli, Marinella Clerico, Maria Trojano, Francesco Patti, Sandra Vukusic, A. Alpérovitch, H. Carton, M.B. d’Hooghe, O. Hommes, M. Hutchinson, P. Adeleine, A. Biron, P. Cortinovis-Tourniaire, J. Grimaud, M. Hours, T. Moreau, S. Vukusic, C. Confavreux, G. Chauplannaz, D. Latombe, M. Clanet, G. Lau, L. Rumbach, J.Y. Goas, F. Rouhart, A. Mazingue, E. Roullet, M. Madigand, P. Hautecoeur, P. Brunet, G. Edan, C. Allaire, G. Riffault, J. Leche, T. Benoit, C. Simonin, F. Ziegler, J.C. Baron, Y. Rivrain, R. Dumas, D. Loche, J.C. Bourrin, B. Huttin, B. Delisse, I. Gibert, C. Boulay, M. Verceletto, G. Durand, G. Bonneviot, R. Gil, M.A. Hedreville, C. Belair, R.J. Poitevin, J.L. Devoize, P. Wyremblewski, F. Delestre, A. Setiey, G. Comi, M. Filippi, A. Ghezzi, V. Martinelli, P. Rossi, M. Zaffaroni, M.R. Tola, M.P. Amato, C. Fioretti, G. Meucci, M. Inglese, G.L. Mancardi, D. Gambi, A. Thomas, M. Cavazzuti, A. Citterio, A. Heltberg, H.J. Hansen, O. Fernandez, F. Romero, T. Arbizu, J.J. Hernandez, C. De Andres de Frutos, D. Geffner Sclarky, Y. Aladro Benito, P. Reyes Yanes, M Aguilar, J.A. Burguera, R. Yaya, W. Bonakim Dib, D. Arzua-Mouronte, C.J.M. Sindic, R. Medaer, H. Roose, K.M.J. Geens, D. Guillaume, M. Van Zandycke, J. Janssens, M. Cornette, L. Mol, F. Weilbach, P. Flachenecker, H.P. Hartung, J. Haas, I. Tendolkar, E. Sindrn, H.W. Kölmel, D. Reichel, M. Rauch, S. Preuss, S. Poser, E. Mauch, S. Strausser-Fuchs, H. Kolleger, S. Hawkins, S.J.L. Howell, J.E. Rees, A. Thompson, M. Johnson, M. Boggild, R.P. Gregory, D. Bates, I. Bone, C. Polman, S. Frequin, P. Jongen, J. Correia de Sa, M.E. Rio, S. Huber, J. Lechner-Scott, L. Kappos, I. Ionescu, C. Cornu, M. El-Etr, E.E. Baulieu, M Schumacher, D.H. Miller, M. Pugeat, C. d’Archangues, J. Conard, J. Ménard, R. Sitruk-Ware, C. Pelissier, S. Dat, J. Belaïsch-Allard, N. Athéa, D. Büschsenschutz, O. Lyon-Caen, R. Gonsette, J.P. Boissel, P. Ffrench, F. Durand-Dubief, F. Cotton, C. Pachai, L. Bracoud, G. Androdias, R. Marignier, D.A. Laplaud, S. Wiertlewski, C. Lanctin-Garcia, G. Couvreur, G. Madinier, P. Clavelou, F. Taithe, D. Aufauvre, N. Guy, A. Ferrier, J. De Sèze, N. Collongues, M. Debouverie, F. Viala, D. Brassat, A. Gerdelat-Mas, P. Henry, J. Pelletier, A. Rico-Lamy, C. Lebrun-Frenay, E. Lepage, V. Deburghraeve, G. Castelnovo, E. Berger, M. Blondiau, O. Heinzlef, M. Coustans, C. Clerc, L. Rieu, M. Lauxerois, G. Hinzelin, J.C. Ouallet, D. Minier, P. Vion, N. Gromaire-Fayolle, N. Derache, E. Thouvenot, M. Sallansonnet-Froment, P. Tourniaire, L. Toureille, F. Borgel, B. Stankoff, C. Moroianu, A.M. Guennoc, C.L. Tournier-Gervason, S. Peysson, M. Trojano, F. Patti, E. D’Amico, L. Motti, L. Durelli, A. Tavella, Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL), Observatoire Français de la Sclérose En Plaques [Lyon] (OFSEP), Service de neurologie fonctionnelle et d'épileptologie [Hôpital Pierre Wertheimer-HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Neurologie générale, vasculaire et dégénérative (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Henri Duffaut (Avignon), National MS Center Melsbroek, Vrije Universiteit Brussel [Bruxelles] (VUB), Vrije Universiteit Brussel (VUB), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Service de Neurologie [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Neuro-Dol (Neuro-Dol), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA), Laboratoire de Neuroimagerie in Vivo (LNV), CHU Strasbourg-Centre National de la Recherche Scientifique (CNRS), Les Hôpitaux Universitaires de Strasbourg (HUS), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Neurologie vasculaire, pathologie neuro-dégénérative et explorations fonctionnelles du système nerveux [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse], Centre de Physiopathologie Toulouse Purpan (CPTP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier Universitaire de Nice (CHU Nice), Université Côte d'Azur (UCA), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de Neurologie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL), centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Università degli studi di Torino = University of Turin (UNITO), University of Catania [Italy], Hospices Civils de Lyon, Departement de Neurologie (HCL), Biostatistiques santé, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), CHU Toulouse [Toulouse], Protéines membranaires transductrices d'énergie (PMTE), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Institut des Géosciences de l’Environnement (IGE), Institut de Recherche pour le Développement (IRD)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre de Recherches sur les Macromolécules Végétales (CERMAV ), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Environnement Ville Société (EVS), École normale supérieure - Lyon (ENS Lyon)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Lumière - Lyon 2 (UL2)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet [Saint-Étienne] (UJM)-École Nationale des Travaux Publics de l'État (ENTPE)-École nationale supérieure d'architecture de Lyon (ENSAL)-Centre National de la Recherche Scientifique (CNRS), Solvay (France), Laboratoire des Mécanismes et Transfert en Géologie (LMTG), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Observatoire Midi-Pyrénées (OMP), Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Université Fédérale Toulouse Midi-Pyrénées-Météo-France -Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Météo-France -Centre National de la Recherche Scientifique (CNRS), Institute of Evolutionary Biology, University of Edinburgh, Université de Lille, Sciences et Technologies, Service de Génétique Médicale [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Différenciation, interaction, activation et migration des sous-populations lymphocitaires humaines, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Motricité, interactions, performance EA 4334 / Movement - Interactions - Performance (MIP), Le Mans Université (UM)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR des Sciences et Techniques des Activités Physiques et Sportives (UFR STAPS), Laboratoire Ecologie Fonctionnelle et Environnement (ECOLAB), Institut Ecologie et Environnement (INEE), Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Toulouse III - Paul Sabatier (UT3), Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Université Fédérale Toulouse Midi-Pyrénées-Météo-France -Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Météo-France -Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées, Laboratoire de Chimie Physique D'Orsay (LCPO), Université Paris-Sud - Paris 11 (UP11)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), RMN et optique : De la mesure au biomarqueur, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Department of Neurology, CHU Lyon, Institut de Recherche de Chimie Paris (IRCP), Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Ministère de la Culture (MC), Hôpital de Hautepierre [Strasbourg], Laboratoire de Réactivité des Surfaces et des Interfaces (LRSI), Département de Physico-Chimie (DPC), CEA-Direction des Energies (ex-Direction de l'Energie Nucléaire) (CEA-DES (ex-DEN)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-CEA-Direction des Energies (ex-Direction de l'Energie Nucléaire) (CEA-DES (ex-DEN)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Empenn, Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes 1 (UR1), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Service de Neurologie [Rennes] = Neurology [Rennes], CHU Pontchaillou [Rennes], Biologie des Interactions Neurones / Glie, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Fondation pour l'Aide à la Recherche sur la Sclérose en Plaques, European Leukodystrophies Association, PHRC National, Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pierre Wertheimer, Département de Neurologie, Laboratoire de Mathématiques (LAMA), Centre National de la Recherche Scientifique (CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Nottingham Scientific Limited, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service de neurologie [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Turin, Università degli studi di Torino (UNITO), University of Bari Aldo Moro (UNIBA), Department of Neurosciences, Università degli studi di Catania [Catania], Centre de recherche en neurosciences de Lyon (CRNL), Neuroépidémiologie, Institut de Physique du Globe de Paris (IPGP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut national des sciences de l'Univers (INSU - CNRS)-IPG PARIS-Université Paris Diderot - Paris 7 (UPD7)-Université de La Réunion (UR)-Centre National de la Recherche Scientifique (CNRS), Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut de Recherche pour le Développement (IRD)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-École nationale supérieure d'architecture de Lyon (ENSAL)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École Nationale des Travaux Publics de l'État (ENTPE)-Université Jean Monnet [Saint-Étienne] (UJM)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université Lumière - Lyon 2 (UL2)-École normale supérieure - Lyon (ENS Lyon), Météo France-Centre National d'Études Spatiales [Toulouse] (CNES)-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Météo France-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut Ecologie et Environnement (INEE), Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Observatoire Midi-Pyrénées (OMP), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Ministère de la Culture (MC), Université de Bretagne Sud (UBS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National de Recherche en Informatique et en Automatique (Inria)-École normale supérieure - Rennes (ENS Rennes)-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-CentraleSupélec-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Bretagne Sud (UBS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-École normale supérieure - Rennes (ENS Rennes)-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Lavie, Caroline, Rollot, Fabien, Durand-Dubief, Françoise, Marignier, Romain, Ionescu, Iuliana, Casey, Romain, Moreau, Thibault, Tourniaire, Patricia, Hutchinson, Michael, D’Hooghe, Marie Béatrice, Laplaud, David-Axel, Clavelou, Pierre, De Sèze, Jérôme, Debouverie, Marc, Brassat, David, Pelletier, Jean, Lebrun-Frenay, Christine, Le Page, Emmanuelle, Castelnovo, Giovanni, Berger, Eric, Hautecoeur, Patrick, Heinzlef, Olivier, Durelli, Luca, Clerico, Marinella, Trojano, Maria, Patti, Francesco, Vukusic, Sandra, on behalf of PRIMS and POPARTMUS, Investigator, Filippi, Massimo, Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Environnement, Ville, Société (EVS), École normale supérieure de Lyon (ENS de Lyon)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-École Nationale des Travaux Publics de l'État (ENTPE)-École nationale supérieure d'architecture de Lyon (ENSAL)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Neuroimagerie: méthodes et applications (Empenn), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Laboratoire de glaciologie et géophysique de l'environnement (LGGE), Observatoire des Sciences de l'Univers de Grenoble (OSUG), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherches sur les Macromolécules Végétales (CERMAV), Université Joseph Fourier - Grenoble 1 (UJF)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP], Laboratoire Motricité, Interactions, Performance, Université de Nantes (UN), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Paris-Sud - Paris 11 (UP11)-Centre National de la Recherche Scientifique (CNRS), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS), Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL (ENSCP)-Centre National de la Recherche Scientifique (CNRS)-Ministère de la Culture (MC), Centre Hospitalier Universitaire de Strasbourg (CHU de Strasbourg ), CEA-Direction de l'Energie Nucléaire (CEA-DEN), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-CEA-Direction de l'Energie Nucléaire (CEA-DEN), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Service de neurologie [Besançon], Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Jean Minjoz, Service de Neurologie [CHU Besançon], Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Service de Neurologie [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Clinical sciences, Neuroprotection & Neuromodulation, and Neurology

Subjects
relapses, Neurology, [SDV]Life Sciences [q-bio], MESH: Pregnancy Complications / physiopathology, 0302 clinical medicine, MESH: Pregnancy, Anesthesia, Conduction, Recurrence, MESH: Anesthesia, Conduction / adverse effects, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, reproductive and urinary physiology, relapse, Postpartum Period, post-partum, MESH: Follow-Up Studies, MESH: Multiple Sclerosis / physiopathology, Obstetrical Analgesia, MESH: Multiple Sclerosis / chemically induced, Anesthesia, Female, pregnancy, Adult, medicine.medical_specialty, Clinical Neurology, Multiple sclerosis, MESH: Postpartum Period, 03 medical and health sciences, medicine, Humans, Multiple sclerosi, Post partum, Retrospective Studies, Pregnancy, MESH: Humans, MESH: Pregnancy Complications / chemically induced, business.industry, Neurotoxicity, MESH: Adult, MESH: Retrospective Studies, neuraxial analgesia, medicine.disease, MESH: Recurrence, Multiple sclerosis, neuraxial analgesia, post-partum, pregnancy, Pregnancy Complications, Increased risk, Neurology (clinical), [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract

Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.

Published
2019
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14. Genome-wide association analysis of dementia and its clinical endophenotypes reveal novel loci associated with Alzheimer's disease and three causality networks : The GR@ACE project

Author

Jordi Clarimón, G. Monté-Rubio, Miguel A. Santos-Santos, L. Vargas, E. Pelejà, M.T. Martínez, E. Alarcón-Martín, A. Mauleón, P. Martínez-Lage Álvarez, A. Carracedo, N. Aguilera, Goo Amer-Ferrer, M.J. Bullido, Pascual Sánchez-Juan, Olalla Maroñas, J.A. Pineda, Carmen Martínez, Carmen Lage, Antonio González-Pérez, V. Martínez, Angel Carracedo, Susana Ruiz, A. López de Munáin, E. L. Martin, O. Maroñas, Manuel Menéndez-González, Begoña Hernández-Olasagarre, Luis Miguel Real, S. Ruiz, Marta Marquié, Pablo Mir, Montse Alegret, María J. Bullido, Pilar Gómez-Garre, A. Sanabria, Carla Abdelnour, Silvia Jesús, M.M. de Pancorbo, J. Clarimón, Agustín Ruiz, M. Boada, José María García-Alberca, J.M. Cruz-Gamero, Ignacio Alvarez, P. Mir, Adelina Orellana, Alberto Rábano, J.L. Royo, Alberto Lleó, M.J. Casajeros, O. Sotolongo-Grau, R. Sanchez del Valle Díaz, Ana Espinosa, Nuria Aguilera, G. Piñol Ripoll, J. Pérez Tur, S. Manzanares, M. Marquié, Miguel Medina, S. Rodrigo, Teresa Periñán-Tocino, A. Rábano, A. Martín Montes, A. Gailhajenet, Daniel Macias, Ana Mauleón, E. Franco, Miguel Calero, Adela Orellana, P. Cañabate, M. Rosende-Roca, Jose Luis Royo, Gemma Ortega, M. Moreno, Juan A. Pineda, Marina Guitart, Marta Ibarria, A. Benaque, Maria Eugenia Sáez, Manuel Serrano-Ríos, A. Ruiz, Carmen Antúnez, Mariola Moreno, Juan Macías, Pilar Cañabate, L.M. Real, A. Lafuente, Astrid Adarmes-Gómez, Fátima Carrillo, A. Espinosa, T. Marín, S. Preckler, T. del Ser, Eloy Rodríguez-Rodríguez, S. Moreno-Grau, Susana Diego, Gemma Monté-Rubio, L. Montrreal, Rafael Blesa, Mercè Boada, M.P. Vicente, Asunción Lafuente, Emilio Franco, B. Martínez, Laura Montrreal, Itziar de Rojas, I. Hernández, Mario Carrión-Claro, Alba Benaque, I. de Rojas, Emilio Alarcón-Martín, Jesús Avila, S. Garcia Madrona, S. Valero, D. Real de Asúa, L. Vivancos, Ana Frank-García, J.A. Burguera, Liliana Vargas, Labrador Espinosa, Sara López-García, Angela Sanabria, Ana Pancho, A.B. Pastor, Juan Fortea, A. Legaz, Oscar Sotolongo-Grau, Laura Madrid, Sonia Moreno-Grau, J. Marín-Muñoz, M. Calero, Emilio Alarcón, Lluís Tárraga, M. Marín, Miquel Baquero, Sergi Valero, Mar Buendía, José-Luis Molinuevo, M. Mendioroz Iriarte, Alba Pérez-Cordón, C. Abdelnour, V. Álvarez, Pau Pastor, Silvia Gil, J.M. García-Alberca, A. González Pérez, A. Pérez-Cordon, Maitée Rosende-Roca, O. Rodríguez-Gómez, Victoria Alvarez, Isabel Sastre, Inés Quintela, Guillermo García-Ribas, Isabel Hernández, Octavio Rodriguez-Gomez, Arturo Corbatón, G. Ortega, C. Antúnez, P. García González, Monica Diez-Fairen, P. Pastor, P. Sánchez-Juan, L. Tárraga, G. Garcia-Ribas, Montserrat Alegret, S. Hevilla, Maria Jose Bernal, María Eugenia Sáez, M. Medina, I. Quintela, Silvia Preckler, M. Antequera, Dolores Buiza-Rueda, M.A. Santos-Santos, Gerard Piñol-Ripoll, S. Gil, European Commission, Universidad de Cantabria, Fundación La Caixa, Grifols (Spain), Fundació ACE, Instituto de Salud Carlos III, Ministerio de Sanidad (España), Unión Europea, Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), Regional Government of Andalusia (España), National Institutes of Health (Estados Unidos), United States Department of Defense, NIH - National Institute on Aging (NIA) (Estados Unidos), NIH - National Institute of Biomedical Imaging and Bioengineering (NIBIB) (Estados Unidos), Innovative Medicines Initiative, Unión Europea. Comisión Europea. 6 Programa Marco, Alzheimer's Disease Genetics Consortium, GRIFOLS, European Union, European Regional Development Fund (ERDF/FEDER), Gobierno de Andalucía, National Institutes of Health (United States), Department of Defense USA, National Institute on Aging, National Institute of Biomedical Imaging and Bioengineering, and 6º Programa Marco - Comisión Europea

Subjects
0301 basic medicine, Male, Epidemiology, humanos, vascular pathology, enfermedad de Alzheimer, Genome-wide association study, Disease, demencia, 0302 clinical medicine, sitios genéticos, GWAS, Cerebrovascular disease, mediana edad, anciano, Health Policy, gwas, Alzheimer's disease, Middle Aged, rare, Causality, 3. Good health, Psychiatry and Mental health, Biological Pathway, alzheimer's disease, Female, Cerebral amyloid angiopathy, Malalties cerebrovasculars, biological pathway, metaanalysis, Endophenotypes, onset, Vascular Pathology, Computational biology, Biology, Polymorphism, Single Nucleotide, 03 medical and health sciences, Cellular and Molecular Neuroscience, Developmental Neuroscience, Alzheimer Disease, medicine, Dementia, Humans, Genetic Predisposition to Disease, Alzheimer’s Disease, endofenotipos, gene, Gene, cerebral amyloid angiopathy, cognitive function, Aged, Mechanism (biology), predisposición genética a la enfermedad, medicine.disease, mutations, immunity, Cerebral Amyloid Angiopathy, 030104 developmental biology, Malaltia d'Alzheimer, Spain, Genetic Loci, Endophenotype, estudio de asociación genómica completa, Neurology (clinical), vascular risk, Geriatrics and Gerontology, 030217 neurology & neurosurgery, Genome-Wide Association Study
Abstract

Introduction: Large variability among Alzheimer's disease (AD) cases might impact genetic discoveries and complicate dissection of underlying biological pathways. Methods: Genome Research at Fundacio ACE (GR@ACE) is a genome-wide study of dementia and its clinical endophenotypes, defined based on AD's clinical certainty and vascular burden. We assessed the impact of known AD loci across endophenotypes to generate loci categories. We incorporated gene coexpression data and conducted pathway analysis per category. Finally, to evaluate the effect of heterogeneity in genetic studies, GR@ACE series were meta-analyzed with additional genome-wide association study data sets. Results: We classified known AD loci into three categories, which might reflect the disease clinical heterogeneity. Vascular processes were only detected as a causal mechanism in probable AD. The meta-analysis strategy revealed the ANKRD31-rs4704171 and NDUFAF6-rs10098778 and confirmed SCIMP-rs7225151 and CD33-rs3865444. Discussion: The regulation of vasculature is a prominent causal component of probable AD. GR@ACE meta-analysis revealed novel AD genetic signals, strongly driven by the presence of clinical heterogeneity in the AD series., The authors would like to thank patients and controls who participated in this project. The Genome Research @ Fundacio ACE project (GR@ACE) is supported by Fundacion bancaria La Caixa, Grifols SA, Fundacio ACE, and ISCIII (Ministry of Health, Spain). They also want to thank the private sponsors who support the basic and clinical projects of our institution (Piramal AG, Laboratorios Echevarne, Araclon Biotech S.A., and Fundacio ACE). They are indebted to the Trinitat Port-Carbo legacy and her family for their support of Fundacio ACE research programs. Fundacio ACE is a participating center in the Dementia Genetics Spanish Consortium (DEGESCO). A.R. and M.B. receive support from the European Union/EFPIA Innovative Medicines Initiative Joint undertaking ADAPTED and MOPEAD projects (grant numbers 115975 and 115985, respectively). M.B. and A.R. are also supported by national grants PI13/02434, PI16/01861, and PI17/01474. Accion Estrategica en Salud is integrated into the Spanish National R + D + I Plan and funded by ISCIII (Instituto de Salud Carlos III)-Subdireccion General de Evaluacion and the Fondo Europeo de Desarrollo Regional (FEDER-Una manera de Hacer Europa). L.M.R. is supported by Consejeria de Salud de la Junta de Andalucia (grant PI-0001/2017). Control samples and data from patients included in this study were provided in part by the National DNA Bank Carlos III (www.bancoadn.org, University of Salamanca, Spain) and Hospital Universitario Virgen de Valme (Sevilla, Spain); they were processed after standard operating procedures with the appropriate approval of the Ethical and Scientific Committee. The present work was performed as part of the Biochemistry, Molecular Biology, and Biomedicine doctoral program of S. MorenoGrau at Universitat Autonoma de Barcelona (Barcelona, Spain).r Data collection and sharing for this project was partially funded by the Alzheimer's Disease Neuroimaging Initiative (ADNI) (National Institutes of Health grant U01 AG024904) and DOD ADNI (Department of Defense award number W81XWH-12-2-0012). The ADNI is funded by the National Institute on Aging and the National Institute of Biomedical Imaging and Bioengineering, as well as through generous contributions from the following: AbbVie; the Alzheimer's Association; the Alzheimer's Drug Discovery Foundation; Araclon Biotech; BioClinica, Inc.; Biogen; Bristol-Myers Squibb Company; CereSpir, Inc.; Cogstate; Eisai Inc.; Elan Pharmaceuticals, Inc.; Eli Lilly and Company; EuroImmun; F. Hoffmann-La Roche Ltd and its affiliated company Genentech, Inc.; Fujirebio; GE Healthcare; IXICO Ltd.; Janssen Alzheimer Immunotherapy Research & Development, LLC.; Johnson & Johnson Pharmaceutical Research & Development LLC.; Lumosity; Lundbeck; Merck & Co., Inc.; Meso Scale Diagnostics, LLC.; NeuroRx Research; Neurotrack Technologies; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Piramal Imaging; Servier; Takeda Pharmaceutical Company; and Transition Therapeutics. The Canadian Institutes of Health Research provides funds to support ADNI clinical sites in Canada. Private sector contributions are facilitated by the Foundation for the National Institutes of Health (www.fnih.org). The grantee organization is the Northern California Institute for Research and Education, and the study was coordinated by the Alzheimer's Therapeutic Research Institute at the University of Southern California. ADNI data are disseminated by the Laboratory for NeuroImaging at the University of Southern California.; r The AddNeuroMed data are from a public-private partnership supported by EFPIA companies and SMEs as part of InnoMed (Innovative Medicines in Europe), an integrated project funded by the European Union of the Sixth Framework program priority FP6-2004-LIFESCIHEALTH-5. Clinical leads responsible for data collection are Iwona K1oszewska (Lodz), Simon Lovestone (London), Patrizia Mecocci (Perugia), Hilkka Soininen (Kuopio), Magda Tsolaki (Thessaloniki), and Bruno Vellas (Toulouse). Imaging leads are Andy Simmons (London), Lars-Olad Wahlund (Stockholm), and Christian Spenger (Zurich). Bioinformatics leads are Richard Dobson (London) and Stephen Newhouse (London).r Funding support for the Alzheimer's Disease Genetics Consortium (ADGC) was provided through the NIA Division of Neuroscience (U01-AG032984).r The Mayo Clinic Alzheimer's Disease Genetic Studies, led by Dr. Nilufer Ertekin-Taner and Dr. Steven G. Younkin at the Mayo Clinic in Jacksonville, FL, used samples from the Mayo Clinic Study of Aging, the Mayo Clinic Alzheimer's Disease Research Center, and the Mayo Clinic Brain Bank. Data collection was supported through funding by NIA grants P50 AG016574, R01 AG032990, U01 AG046139, R01 AG018023, U01 AG006576, U01 AG006786, R01 AG025711, R01 AG017216, and R01 AG003949, NINDS grant R01 NS080820, the CurePSP Foundation, and support from the Mayo Foundation.r The Neocodex-Murcia study was funded by the Fundacion Alzheimur (Murcia), the Ministerio de Educacion y Ciencia (Gobierno de Espana), Corporacion Tecnologica de Andalucia, Agencia IDEA (Consejeria de Innovacion, Junta de Andalucia), the Diabetes Research Laboratory, and the Biomedical Research Foundation. University Hospital Clinico San Carlos has been supported by CIBER de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM); CIBERDEM is an ISCIII Project.r The ROS/MAP study data were provided by the Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago. Data collection was supported through funding by NIA grants P30AG10161, R01AG15819, R01AG17917, R01AG30146, R01AG36836, U01AG32984 and U01AG46152, the Illinois Department of Public Health, and the Translational Genomics Research Institute.r The TGEN study was supported by Kronos Life Science Laboratories, the National Institute on Aging (Arizona Alzheimer's Disease Center grants P30 AG19610 and RO1 AG023193, the Mayo Clinic Alzheimer's Disease Center grant P50 AG16574, and the Intramural Research Program), the National Alzheimer's Coordinating Center (U01 AG016976), and the state of Arizona.r The authors thank the International Genomics of Alzheimer's Project (IGAP) for providing summary result data for these analyses. The investigators within IGAP contributed to the design and implementation of IGAP and/or provided data but did not participate in analysis or writing of this report. IGAP was made possible by the generous participation of the control subjects, the patients, and their families. The i-Select chip was funded by the French National Foundation on Alzheimer's disease and related disorders. European Alzheimer's Disease Initiative (EADI) was supported by the LABEX (laboratory of excellence program investment for the future) DISTALZ grant, Inserm, Institut Pasteur de Lille, Universite de Lille 2, and the Lille University Hospital. GERAD was supported by the Medical Research Council (grant no. 503480), Alzheimer's Research UK (grant no. 503176), the Wellcome Trust (grant no. 082604/2/07/Z), and German Federal Ministry of Education and Research (BMBF): Competence Network Dementia (CND) grant no.; 01GI0102, 01GI0711, 01GI0420. CHARGE was partly supported by the NIH/NIA grant R01 AG033193 and the NIA AG081220 and AGES contract N01-AG12100, the NHLBI grant R01 HL105756, the Icelandic Heart Association, and the Erasmus Medical Center and Erasmus University. ADGC was supported by the NIH/NIA grants: U01 AG032984, U24 AG021886, U01 AG016976, and the Alzheimer's Association grant ADGC-10-196728.

Published
2019

15. Trastornos del movimiento (IV): otros trastornos del movimiento

Author

H. Alonso-Navarro, J.A. Burguera Hernández, Félix Javier Jiménez-Jiménez, and M.R. Luquin Piudo

Subjects
business.industry, Medicine, General Medicine, business, Humanities
Abstract

Resumen Se describen las caracteristicas clinicas, aspectos semiologicos, diagnosticos y terapeuticos de otros trastornos del movimiento que incluyen el temblor esencial familiar, que es el trastorno del movimiento mas frecuente, sindromes mioclonicos, espasmo hemifacial y tics, y sindromes de piernas inquietas, de pies dolorosos y dedos en movimiento, sobresalto y persona rigida.

Published
2015
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16. BDNF Val66Met polymorphism in primary adult-onset dystonia: A case-control study and meta-analysis

Author

Miguel Angel Moya, Nuria Rodríguez, Marta Bonilla-Toribio, Javier Gutiérrez-García, Francisco Escamilla-Sevilla, Inmaculada Bernal-Bernal, María Carmen Fernández-Moreno, J.A. Burguera, Pedro J García-Ruiz, Juan José Ochoa-Sepulveda, Pablo Mir, Eva Lopez-Valdes, Sandra Giacometti-Silveira, Adolfo Mínguez-Castellanos, Raúl Espinosa-Rosso, José Manuel García-Moreno, Carolina Méndez-Lucena, Irene Martinez-Torres, Alberto Blanco-Ollero, María José Catalán-Alonso, Tomás Ojea, Ismael Huertas-Fernández, María Teresa Cáceres-Redondo, Miriam Sillero-Sánchez, Silvia Jesús, Pilar Gómez-Garre, Araceli Alonso-Canovas, María Pilar Medialdea-Natera, Manuel Carballo, Laura Vargas-González, Fátima Carrillo, Juan García-Caldentey, and Juan Carlos Martínez-Castrillo

Subjects
Oncology, Dystonia, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Blepharospasm, Case-control study, medicine.disease, nervous system diseases, Neurology, Internal medicine, Meta-analysis, Genetic model, otorhinolaryngologic diseases, medicine, Physical therapy, Neurology (clinical), Cervical dystonia, medicine.symptom, Psychology, Allele frequency, Dystonic disorder
Abstract

Background A polymorphism in brain-derived neurotrophic factor (BDNF) (Val66Met) has been reported as a risk factor in primary dystonia. However, overall the results have been inconclusive. Our aim was to clarify the association of Val66Met with primary dystonia, and with the most prevalent clinical subtypes, cervical dystonia and blepharospasm. Methods We conducted a Spanish multicenter case-control study (including 680 primary dystonia patients and 788 healthy controls) and performed a meta-analysis integrating our study and six previously published studies (including a total of 1,936 primary dystonia patients and 2,519 healthy controls). Results We found no allelic or genotypic association with primary dystonia, cervical dystonia, or blepharospasm risks, for the allele A (Met) from a BDNF Val66Met polymorphism in our case-control study. This was confirmed by results from our meta-analysis in white and mixed ethnic populations in any genetic model. Conclusion We did not find any evidence supporting the association of the BDNF Val66Met polymorphism with primary dystonia. © 2014 International Parkinson and Movement Disorder Society

Published
2014
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17. Dopaminergic agonists in Parkinson's disease

Author

Gurutz Linazasoro, P. García Ruiz-Espiga, V. Campos Arillo, J.C. Martínez Castrillo, A. Alonso Cánovas, J López del Val, J.A. Burguera, Lydia Vela, A. Castro, and R. Luquin Piudo

Subjects
Levodopa, Parkinson's disease, Pramipexole, Dopaminergic, Rotigotine, medicine.disease, lcsh:RC346-429, Ropinirole, Dyskinesia, Anesthesia, medicine, medicine.symptom, Adverse effect, Psychology, lcsh:Neurology. Diseases of the nervous system, medicine.drug
Abstract

Background: Non-ergoline dopamine agonists (DA) are effective treatments for Parkinson's disease (PD). This review presents the pharmacology, evidence of efficacy and safety profile of pramipexole, ropinirole, and rotigotine, and practical recommendations are given regarding their use in clinical practice. Results: Extended-release formulations of pramipexole and ropinirole and transdermal continuous delivery rotigotine patches are currently available; these may contribute to stabilising of plasma levels.In early PD, the three drugs significantly improve disability scales, delay time to dyskinesia and allow a later introduction of levodopa. In late PD they reduced total ‘off’-time, improved Unified Parkinson's Disease Rating Scale (UPDRS) in both ‘on’ and ‘off’ state and allowed a reduction in total levodopa dosage. A significant improvement in quality of life scales has also been demonstrated. Extended-release formulations have proved to be non-inferior to the immediate release formulations and are better tolerated (ropinirole). Despite a generally good safety profile, serious adverse events, such as impulse control disorder and sleep attacks, need to be routinely monitored. Although combination therapy has not been addressed in scientific literature, certain combinations, such as apomorphine and another DA, may be helpful. Switching from one DA to another is feasible and safe, although in the first days an overlap of dopaminergic side effects may occur. When treatment with DA is stopped abruptly, dopamine withdrawal syndrome may present. Suspending any DA, especially pramipexole, has been linked to onset of apathy, which may be severe. Conclusions: New non-ergotine DAs are a valuable option for the treatment of both early and late PD. Despite their good safety profile, serious adverse effects may appear; these effects may have a pathoplastic effect on the course of PD and need to be monitored. Resumen: Introducción: Los agonistas dopaminérgicos no ergóticos (AD) son tratamientos útiles en la Enfermedad de Parkinson (EP). Revisamos la farmacología, el grado de evidencia en cuanto a eficacia y tolerabilidad de pramipexol, ropinirol y rotigotina, y proponemos algunas recomendaciones para su uso en la práctica clínica. Desarrollo: En el momento actual se dispone de formas de liberación prolongada (LP) de pramipexol y ropinirol y de administración transdérmica de rotigotina, que contribuyen a una mayor estabilidad plasmática de los niveles del fármaco. En la EP inicial los tres fármacos mejoran de forma significativa las escalas de incapacidad de los pacientes, retrasan la aparición de discinesias y permiten retrasar la introducción de levodopa. En la EP avanzada reducen el tiempo off, mejoran la UPDRS en on y en off y permiten reducir la dosis total de levodopa. Además, los tres han sido capaces de inducir una mejoría significativa en las escalas de la calidad de vida relacionada con la salud. Las fórmulas de LP han demostrado la no inferioridad frente a las de liberación inmediata, e incluso una mejor tolerabilidad (ropinirol). A pesar de su buen perfil de seguridad, entre los efectos adversos graves cabe destacar el trastorno de control de impulsos, cuya aparición puede ser precoz, y los accesos de sueño (sleep attacks). Aunque la terapia combinada no ha sido estudiada específicamente, algunas asociaciones (como la de apomorfina y otros AD) pueden ser beneficiosas. El cambio de un AD a otro es factible de un día para otro, aunque en los primeros días puede haber una sumación de efectos adversos dopaminérgicos que debe tenerse en cuenta. La suspensión brusca del tratamiento con AD puede inducir un síndrome de deprivación dopaminérgica. La retirada de cualquier AD, en particular pramipexol, se ha asociado a aparición de apatía que puede ser grave. Conclusiones: Los nuevos AD no ergóticos constituyen una opción válida de tratamiento de la EP tanto inicial como avanzada. A pesar de su buen perfil de tolerabilidad, no están exentos de efectos adversos graves, que pueden tener un efecto patoplástico en la EP y que deben monitorizarse. Keywords: Dopamine agonists, Pramipexole, Ropinirole, Rotigotine, Prolonged release, Equivalence, Palabras clave: Agonistas dopaminérgicos, Pramipexol, Ropinirol, Rotigotina, Liberación prolongada, Equivalencia

Published
2014

18. Protocolo diagnóstico y terapéutico de los síndromes parkinsonianos

Author

H. Alonso-Navarro, Félix Javier Jiménez-Jiménez, J.A. Burguera Hernández, and M.R. Luquin Piudo

Subjects
Pediatrics, medicine.medical_specialty, business.industry, Clinical diagnosis, medicine, General Medicine, Disease, Differential diagnosis, Psychiatry, business, Triage
Abstract

In this protocol diagnostic-therapeutic diagnostic triage of a patient with rigid-akinetic syndromes in general and Parkinson's disease in particular (most frequent cause syndromes rigid-akinetic) is summarized, both as regards clinical diagnosis as complementary tests and use of biological markers in the differential diagnosis. Treatments used in these syndromes, which has been more effective in Parkinson's disease are also discussed.

Published
2015
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19. Trastornos del movimiento (II): otros s?ndromes parkinsonianos

Author

H. Alonso-Navarro, Félix Javier Jiménez-Jiménez, J.A. Burguera Hernández, and M.R. Luquin Piudo

Subjects
Pathology, medicine.medical_specialty, business.industry, Parkinsonism, Postencephalitic parkinsonism, General Medicine, Disease, medicine.disease, nervous system diseases, Progressive supranuclear palsy, Atrophy, Neurochemical, Medicine, Corticobasal degeneration, business, Lewy body disease
Abstract

This chapter contains an update on the epidemiological, neuropathological, neurochemical, etiopathogenic, clinical, diagnostic and therapeutic aspects of the primary parkinsonian syndromes (with the exception of Parkinson's disease). This includes drug-induced parkinsonism, vascular postencephalitic parkinsonism, progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration and diffuse Lewy body disease.

Published
2007
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20. S?ndromes at?xicos. Ataxias heredodegenerativas y adquiridas

Author

H. Alonso-Navarro, Félix Javier Jiménez-Jiménez, M.R. Luquin Piudo, and J.A. Burguera Hernández

Subjects
business.industry, Medicine, General Medicine, business, Humanities
Abstract

Concepto: La ataxia es un trastorno del movimiento caracterizado por errores en la velocidad, rango, direccion, duracion, tiempo y fuerza de la actividad motora. Clasificacion: Existen formas geneticas y adquiridas. En las primeras destacan la ataxia de Friedrich y entre las adquiridas las ataxias asociadas a enfermedades endocrino-nutricionales, farmacos, sindromes paraneoplasticos y autoinmunes e infecciosas. Diagnostico: Pueden ser necesarias diversas pruebas analiticas, estudio del liquido cefalorraquideo, pruebas de neuroimagen cerebral y medular, y estudios geneticos. Ataxia de Friedreich: La mas frecuente de las ataxias autosomicas recesivas. Causada por mutaciones del gen 9q13-21.1 (expansion de tripletes GAA) que codifica proteina mitocondrial frataxina. Se caracteriza neuropatologicamente por degeneracion de cordones posteriores, via corticoespinal, fasciclos espinocerebelosos, celulas de Purkinje y nervios perifericos, de lo que derivan los sintomas y signos neurologicos tipicos. Suele haber afectacion cardiaca y alteraciones esqueleticas. El diagnostico se confirma por genetica molecular. Mal pronostico funcional. No existe tratamiento curativo. Otras ataxias autosomicas recesivas: Incluyen ataxia por deficit de vitamina E, abetalipoproteinemia, de islas Cayman, ataxia-telangiectasia (se asocia a otros trastornos del movimiento, telangiectasias faciales, deficit de inmunidad celular y humoral y cambios progericos y retraso del crecimiento), ataxia cerebelosa con reflejos conservados, con mioclonias, con hipogonadismo y otras. Ataxias espinocerebelosas autosomicas dominantes (SCA): Hasta la fecha se han descrito 25 tipos (SCA-1 A SCA-25 y atrofia dentado-rubro-palido-luysiana o DRPLA). Caracterizadas por sindrome cerebeloso lentamente progresivo al que pueden asociarse dependiendo del tipo varias combinaciones de trastornos oculomotores, disartria, dismetria, temblor cinetico y/o marcha ataxica, pudiendo tambien presentar retinopatia pigmentaria, trastornos del movimiento (parkinsonismo, temblor, mioclonias, distonia, corea), signos piramidales, sintomas corticales y neuropatia sensorial. Algunos de estos sintomas son predictivos para el defecto genetico, si bien el diagnostico se confirma por genetica molecular si la tecnica esta disponible.

Published
2007
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23. Trastornos del movimiento (IV): otros trastornos del movimiento (temblor, mioclon?as, tics, s?ndrome de piernas inquietas)

Author

H. Alonso-Navarro, J.A. Burguera Hernández, Félix Javier Jiménez-Jiménez, and M.R. Luquin Piudo

Subjects
business.industry, Medicine, General Medicine, business, Humanities
Abstract

Temblor esencial: Prototipo de temblor postural, trastorno del movimiento mas frecuente, casi siempre familiar. Suele afectar a miembros superiores, mas raramente cabeza, voz y otras localizaciones. Los tratamientos medicos mas eficaces son propranolol y primidona. Mioclonias: Movimientos rapidos y breves de agonista-antagonista causados por contraccion (positivas) o inhibicion de tono muscular (negativas o asterixis). Pueden ser reflejas a estimulos. Se tratan con farmacos como valproico, clonazepam, piracetam, levetirazetam o 5-hidroxitriptofano segun las causas. Espasmo hemifacial: Movimientos involuntarios simultaneos casi siempre clonicos de musculatura de una hemicara, relacionados con irritacion de nervio facial. Suele ser idiopatico. El tratamiento de eleccion es la toxina botulinica y en casos severos descomprension del nervio facial. Tics: La causa mas frecuente es el sindrome de Tourette con todas sus variantes, de herencia autosomica dominante. Los tics (tratamiento de eleccion: neurolepticos) suelen coexistir con trastorno obsesivo-compulsivo (tratamiento con inhibidores de recaptacion de serotonina) y deficit de atencion-hiperactividad (tratamiento con psicoestimulantes). Sindrome de piernas inquietas: Sindrome neurologico sensitivomotor caracterizado por urgencia para mover las piernas y/o brazos acompanada de paretesias-disestesias en los miembros afectados que mejora con el movimiento y reaparece con el reposo. Con frecuencia es idiopatico y familiar, aunque hay formas secundarias (sobre todo a deficit de hierro, insuficiencia renal y neuropatia periferica). Los tratamientos y los opiaceos son tratamiento de segunda linea.

Published
2007
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24. Trastornos del movimiento (I): conceptos generales. Clasificaci?n de los s?ndromes parkinsonianos. Enfermedad de Parkinson

Author

H. Alonso-Navarro, Jiménez-Jiménez, J.A. Burguera Hernández, and M.R. Luquin Piudo

Subjects
medicine.medical_specialty, Movement disorders, business.industry, General Medicine, Disease, Neuropathology, humanities, body regions, Parkinsonian syndromes, Basal ganglia, Epidemiology, medicine, Neurochemistry, medicine.symptom, business, Surgical treatment, Neuroscience, health care economics and organizations
Abstract

This chapter contains an introduction to movement disorders in which we review the anatomy, neurochemistry and functional organization of the basal ganglia. The chapter also mentions the classification of the various types of movement disorders and the semiological aspects of parkinsonian syndromes, with the etiologic classification of these syndromes. The chapter also reviews all aspects related to the epidemiology, neuropathology, neurochemistry, etiopathogenesis, genetics, symptoms, diagnosis and drug and surgical treatment of idiopathic Parkinson's disease.

Published
2007
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26. Pain and dyskinesia in Parkinson's disease

Author

J.A. Burguera, Jose A. Obeso, Maria C. Rodriguez-Oroz, Carlos Juri, and Jorge Guridi

Subjects
medicine.medical_specialty, Deep brain stimulation, Parkinson's disease, business.industry, medicine.medical_treatment, Pain management, Paroxysmal dyskinesia, medicine.disease, Subthalamic nucleus, Physical medicine and rehabilitation, Neurology, Dyskinesia, medicine, Neurology (clinical), medicine.symptom, business
Published
2009
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27. Drug-induced tardive syndromes

Author

M. Ortí-Pareja, Martín Zurdo, Pablo Martinez-Martin, Félix Javier Jiménez-Jiménez, M J Catalán, JoséAntonio Molina, Antonio Vázquez, and J.A. Burguera

Subjects
Dystonia, Pediatrics, medicine.medical_specialty, Movement disorders, Tics, business.industry, medicine.medical_treatment, medicine.disease, Tardive dyskinesia, Akathisia, nervous system diseases, Tourettism, Neurology, Dyskinesia, Anesthesia, medicine, Neurology (clinical), Geriatrics and Gerontology, medicine.symptom, Antipsychotic, business
Abstract

We reviewed the database of five Movement Disorders Units to establish drugs responsible for tardive syndromes or TS (tardive dyskinesia, dystonia, akathisia, tremor, tics or tourettism, and myoclonus). The diagnostic criteria for TS included: (1) appearance of persistent dyskinesia, dystonia, akathisia, tremor, tics or tourettism, or myoclonus, related to prolonged drug exposure, (2) exclusion of other possible causes of these movement disorders. One-hundred patients fulfilled the diagnostic criteria for TS (26 males, 74 females, mean age 69.4+/-15.8 years). TS were related to 1, 2, 3, 4 and 5 drugs in 58, 27, 9, 5 and 1 patients, respectively. The most frequently offending drugs were antipsychotic drugs, substituted benzamides, thietylperazine and calcium-channel blockers. Seventy-two patients had buccolinguomasticatory syndrome, 30 had tremor, 22 akathisia and 16 dystonia (35 patients had a combination of at least two of these TS). Forty-two patients had coexistent parkinsonism. The TS disappeared following withdrawal of the offending drug in 40 cases. Old age and being female were more frequently associated with TS, with the exception of tardive dystonia. Substituted benzamides, calcium-channel blockers and thiethylperazine (a neuroleptic used for vertigo) were a frequent cause of TS in our series.

Published
1999
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29. Indicaciones de derivaci?n del paciente con movimientos anormales de medicina primaria a especializada. Aspectos de la valoraci?n laboral del paciente con movimientos anormales

Author

H. Alonso-Navarro, M.R. Luquin Piudo, J.A. Burguera Hernández, and Félix Javier Jiménez-Jiménez

Subjects
Dystonia, Gynecology, Athetosis, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Movement disorders, Tics, business.industry, Parkinsonism, Chorea, General Medicine, Motor Stereotypies, medicine.disease, nervous system diseases, mental disorders, Medicine, medicine.symptom, business, Myoclonus
Abstract

Movement disorders are divided into rigid-akinetic syndromes (Parkinson's disease and parkinsonism) and dyskinetic (tremor, chorea, tribalism, athetosis, dystonia, myoclonus, tics, tardive dyskinesias and motor stereotypies). In this diagnostic-therapeutic protocol indications referring patients to specific queries movement disorders, with special emphasis on diagnostic and therapeutic stages of Parkinson's disease and aspects of job evaluation latter are summarized.

Published
2007
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33. Mesencephalic area measured by transcranial sonography in the differential diagnosis of parkinsonism

Author

Juan Francisco Vázquez, Jose Ignacio Tembl, Ignacio Rubio-Agusti, Isabel Sastre-Bataller, Jose Manuel Ferrer, Irene Martínez-Torres, Patricia Sahuquillo, Caridad Valero, and J.A. Burguera

Subjects
Male, medicine.medical_specialty, Pathology, Ultrasonography, Doppler, Transcranial, Progressive supranuclear palsy, Diagnosis, Differential, Parkinsonian Disorders, Mesencephalon, medicine, Humans, Aged, Third Ventricle, Aged, 80 and over, Third ventricle, business.industry, Parkinsonism, Middle Aged, medicine.disease, Predictive value, eye diseases, medicine.anatomical_structure, Neurology, Clinical diagnosis, Current technology, Female, Neurology (clinical), Radiology, Geriatrics and Gerontology, Differential diagnosis, business
Abstract

Transcranial B-mode sonography (TCS) has become an important tool in the differential diagnosis of parkinsonism given that current technology enables an adequate assessment of brain structures. In this study we aimed at evaluating the usefulness of midbrain area measured by TCS in the differential diagnosis between Parkinson's Disease (PD) and Progressive Supranuclear Palsy (PSP).Patients with a diagnosis of PD or PSP according to current clinical criteria were recruited. PSP patients were classified as Richardson's syndrome and PSP-parkinsonism. TCS was performed and the mesencephalic area and third ventricle width were measured offline by an examiner blinded to clinical diagnosis.TCS was performed in 60 patients (75% PD, 25% PSP). Eight patients (13,3%) had inadequate acoustic window. Patients with PSP had a smaller mesencephalic area (3.58 cm(2) vs 5.28 cm(2), p0.001). A mesencephalic area ≥4.27 cm(2) discriminates PD from PSP with a positive predictive value 100%. Patients with PSP also had a higher third ventricle diameter (8.84 mm vs 5.11 mm, p0.001). Within the PSP group patients with Richardson's syndrome had a wider third ventricle than patients with PSP-Parkinsonism phenotype (9.57 mm vs 7 mm, p = 0.01), but no differences were found in the mesencephalic area between both phenotypes.Measurement of the mesencephalic area and the third ventricle width by TCS is a non-invasive, easily accessible technique that is useful in the differential diagnosis between PD and PSP, at least in the late stages of the disease.

Published
2012

34. LRRK2 haplotype-sharing analysis in Parkinson's disease reveals a novel p.S1761R mutation

Author

Mario Ezquerra, Eduardo Tolosa, Francesc Valldeoriola, Oswaldo Lorenzo-Betancor, Jordi Pérez-Tur, M. R. Luquin, Pau Pastor, Lluis Samaranch, Owen A. Ross, Elena Lorenzo, Carles Gaig, Maria A. Pastor, Maria Jose Marti, Alexandra I. Soto-Ortolaza, Jose A. Obeso, Maria C. Rodriguez-Oroz, J.A. Burguera, and Jaione Irigoyen

Subjects
Adult, Male, Parkinson's disease, Genetic Linkage, DNA Mutational Analysis, Biology, Protein Serine-Threonine Kinases, medicine.disease_cause, Bioinformatics, Arginine, Leucine-Rich Repeat Serine-Threonine Protein Kinase-2, medicine, Serine, Missense mutation, Humans, Kinase activity, Aged, Genetics, Family Health, Mutation, Chromosomes, Human, Pair 12, Parkinsonism, Haplotype, Age Factors, Parkinson Disease, Middle Aged, medicine.disease, Penetrance, LRRK2, nervous system diseases, Neurology, Haplotypes, Female, Neurology (clinical)
Abstract

Background and objective. Mutations in the Leucine-Rich Repeat Kinase 2 (LRRK2) gene at chromosome 12q12 are the most common genetic cause of sporadic and familial late-onset Parkinson's disease. Our aim was to identify novel LRRK2 mutations in late-onset Parkinson's disease families. Design. We analyzed chromosome 12p11.2-q13.1 haplotypes in 14 late-onset Parkinson's disease families without known LRRK2 mutations. Results. Haplotype analysis identified 12 families in which the affected subjects shared chromosome 12p11.2-q13.1 haplotypes. LRRK2 sequencing revealed a novel co-segregating missense mutation in exon 36 (c.5281A>C; p.S1761R) located within a highly conserved region of the COR [C-terminal of ROC (Ras of complex proteins)] domain wherein it could deregulate LRRK2 kinase activity by modifying ROC-COR dimer stability. p.S1761R was present in a late-onset Parkinson's disease family and in 2 unrelated Parkinson's disease subjects, but not in 2491 healthy controls. LRRK2 p.S1761R carriers developed levodopa-responsive asymmetrical parkinsonism, with variable age at onset (range: 37–72 years) suggesting age-dependent penetrance. These findings indicate that mutations interfering with LRRK2 ROC-COR domain dimerization lead to typical Parkinson's disease. © 2011 Movement Disorder Society

Published
2011

35. Action hand dystonia after cortical parietal infarction

Author

J.A. Burguera, C. Valero, and L. Bataller

Subjects
Male, Sensory processing, medicine.medical_treatment, Infarction, Neurological disorder, Central nervous system disease, Parietal Lobe, otorhinolaryngologic diseases, medicine, Humans, Carotid Stenosis, Tomography, Emission-Computed, Single-Photon, Dystonia, business.industry, Cerebral infarction, Parietal lobe, Cerebral Infarction, Anatomy, Middle Aged, medicine.disease, Magnetic Resonance Imaging, nervous system diseases, Paresis, Neurology, Action (philosophy), Dystonic Disorders, Neurology (clinical), business, Neuroscience, Carotid Artery, Internal
Abstract

A 46-year-old patient with a pure left cortical infarct affecting mainly the gyrus postcentralis developed action dystonia in the right hand. Mechanisms involved in the genesis of focal secondary dystonia are discussed with emphasis on abnormal cortical sensory processing.

Published
2001
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37. The SCOPA-Motor Scale for assessment of Parkinson's disease is a consistent and valid measure

Author

A. Castro, Javier del Val, Juan Carlos Martínez-Castrillo, Nadèje van Blercom, Gurutz Linazasoro, Julián Benito-León, Belén Frades, Francisco Vivancos, Pablo Martinez-Martin, Francesc Valldeoriola, Antonio Vázquez, and J.A. Burguera

Subjects
Male, medicine.medical_specialty, Psychometrics, Epidemiology, business.industry, Reproducibility of Results, Parkinson Disease, Scopa, Motor Activity, Severity of Illness Index, Surgery, Disability Evaluation, Standard error, Physical medicine and rehabilitation, Cross-Sectional Studies, Convergent validity, Cronbach's alpha, Floor effect, Clinical Global Impression, medicine, Ceiling effect, Humans, Female, business, Aged
Abstract

The SCOPA-Motor Scale (S-MS) for assessment of Parkinson's disease (PD), contains 21 items in three domains: Motor examination, Disability, and Complications. Our objective was to validate the S-MS Spanish version.This validation study was based on a multicenter, cross-sectional, one-point-in-time evaluation design. The applied measures were: Unified Parkinson's Disease Rating Scale-3.0 (UPDRS); S-MS; PD Global Evaluation (PDGE); and Clinical Global Impression of severity (CGI). Completeness of data collection, floor and ceiling effect, internal consistency, precision, and construct and discriminative validity were analyzed in 151 PD patients.Scores from S-MS were fully computable. Floor effect was high for Complications (43.7%). Cronbach's alpha was0.90 for every domain, and item-total correlation was0.70 except for Examination. Standard error of measurement (SEM) ranged from 0.40 to 2.4. Convergent validity with corresponding UPDRS sections yielded coefficients0.90. Discriminative validity across Hoehn and Yahr (HY) and CGI stages was significant (Kruskal-Wallis, P.0001). Insofar as internal consistency was concerned, alpha-values of the Examination sections were marginally higher for the UPDRS than for the S-MS (a finding perhaps accounted for by redundancy in this part of the UPDRS).The S-MS is a consistent and valid scale, shorter by almost half than the UPDRS.

Published
2004

40. Evaluación de la sustancia negra mediante ultrasonografía transcraneal

Author

Juan F. Vázquez-Costa, María Nieves Vivo-Orti, J.A. Burguera, Jose Ignacio Tembl, Patricia Sahuquillo, and Isabel Sastre-Bataller

Subjects
Percentile, business.industry, Echogenicity, Substantia nigra, General Medicine, Transcranial Doppler ultrasonography, Reference values, Clinical diagnosis, Ultrasound imaging, Medicine, Neurology (clinical), Ultrasonography, Nuclear medicine, business
Abstract

AIM. To describe the prevalence of hyperechogenicity of the substantia nigra in two samples of patients: one group who had been diagnosed with Parkinson's disease (PD) in accordance with United Kingdom Parkinson's Disease Society criteria and a control population, so as to be able to establish the reference values for our neurosonology laboratory. SUBJECTS AND METHODS. Two samples of patients consisting of healthy controls with no neurodegenerative disease and patients with PD were selected. Planimetric measurements of the area of echogenicity in the substantia nigra were performed in both groups. The greatest area of echogenicity measured on each side of each patient was considered. Descriptive statistics of the sample were carried out. The ROC curve was constructed in order to show the overall precision, sensitivity and specificity of transcranial Doppler ultrasonography in comparison to the clinical diagnosis of PD. RESULTS. Altogether 45 patients with PD and 91 controls were analysed. Using our own cut-off point (percentile 90 of the controls = 0.22 cm2), hyperechogenicity of the substantia nigra was observed in 73.33% of patients with PD and 8.79% of the controls (p = 0). An area below the curve of 93% was seen, which represents good overall precision for transcranial Doppler ultrasonography in the diagnosis of PD. CONCLUSIONS. The evaluation of the substantia nigra conducted in our laboratory using ultrasound imaging reveals significant differences between subjects with PD and normal subjects. The values obtained in our laboratory are slightly below those established as an international reference and offer excellent values for specificity and an acceptable level of sensitivity in our locale.

Published
2013
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42. Propuesta alternativa al test de apomorfina habitual

Author

J.A. Burguera Hernández and Juan Carlos Martínez Castrillo

Subjects
Neurology (clinical), General Medicine
Abstract

La apomorfina en inyecciones subcutaneas intermitentes se emplea como tratamiento de rescate de los periodos off en la enfermedad de Parkinson moderada-avanzada y para cuando se requiera evaluar la respuesta dopaminergica. No es recomendable como prueba diagnostica en la enfermedad de Parkinson, porque tiene mas efectos adversos y es inferior a la respuesta cronica con levodopa. Para calcular la dosis se hace un test con apomorfina, que, en general, conlleva bastante tiempo y pruebas con dosis diversas. Proponemos un test alternativo, con una sola inyeccion, con una dosis inicial mayor, de entre 2-4 mg, y pautar el tratamiento segun la respuesta obtenida a esta dosis. Con ello se gana tiempo y, ademas, se pueden preestablecer mucho mejor los tiempos de atencion.

Published
2012
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43. Levodopa en el tratamiento de la enfermedad de Parkinson: mitos y realidades

Author

Rocío García-Ramos, María José Martí, J.A. Burguera, Renée Ribacoba-Montero, Caridad Valero-Merino, Juan Carlos Martínez-Castrillo, Francisco Grandas, Pedro J García-Ruiz, Jesús Olivares, Javier Gutierrez, Marina Mata, Carmen Durán-Herrera, Lydia Vela, Ana Rojo, José R Chacón, M.J. Sierra, Víctor Campos-Arillo, Maria-Rosario Luquin, Diego Santos-García, Juan Carlos Gómez-Esteban, Mariano Bravo-Utrera, José Manuel Fernández-García, and Juan Juni

Subjects
Pediatrics, medicine.medical_specialty, Levodopa, Neurology, business.industry, Incidence (epidemiology), General Medicine, Disease, nervous system diseases, Antiparkinson drug, Quality of life, medicine, Effective treatment, In patient, Neurology (clinical), business, medicine.drug
Abstract

In recent years we have witnessed a growing tendency to opt for the use of dopamine agonists (DA) as treatment for Parkinson's disease (PD), with the aim of delaying as far as possible the development of fluctuations and dyskinesias. Yet, levodopa continues to be the most effective antiparkinson drug and is probably the one that improves the greatest number of symptoms of the disease. This article reports on the results of a comprehensive review of the literature dealing with the benefits and risks of levodopa treatment in patients with PD which was conducted by a group of expert neurologists and members of the Spanish Neurology Society's Movement Disorder Group. The main conclusion reached in this article is that levodopa continues to be the most effective treatment for PD. Although the risk and incidence of developing dyskinesias remains at a lower level in the group initially treated with DA, the number of patients who develop disabling dyskinesias is very low in all the studies and is similar for DA and for levodopa. Scores on the quality of life scales are also similar in the two groups, which casts some doubt on the impact that these motor complications have on the quality of life of patients with PD. In view of these findings, we should consider whether there is any real justification for depriving patients of the good control of their symptoms offered by levodopa owing to the fear of developing dyskinesias or mild motor fluctuations that are not really going to have any negative effect on their quality of life. There is also the possibility of their developing severe side effects, which are more frequent with the use of DA.

Published
2012
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44. Discinesia paroxística cinesigénica idiopática familiar: evolución natural y estudio descriptivo en tres familias españolas

Author

Juan J. Vílchez-Padilla, Vicente E Villanueva, J.A. Burguera, Juan Palau-Bargues, and Ignacio Rubio-Agusti

Subjects
business.industry, Medicine, Neurology (clinical), General Medicine, business, Humanities
Abstract

Introduccion. La discinesia paroxistica cinesigenica (DPC) es un trastorno caracterizado por episodios breves de movimientos involuntarios inducidos por movimientos subitos. Pacientes y metodos. Se describe a nueve pacientes pertenecientes a tres familias no relacionadas, afectados de DPC en su forma idiopatica familiar. Resultados. Un 77,7 % de los pacientes son varones. La edad media de inicio es 10,3 anos. Todos los sujetos presentaban movimientos subitos como desencadenante de la crisis. La duracion de estas fue < 10 s en el 88,8% de los casos. Un 66,6% de los pacientes recibio tratamiento con carbamacepina, fenitoina y acido valproico; en todos los casos se obtuvo una buena respuesta. En el 62,5% de los pacientes mayores de 20 anos se ha producido una remision espontanea y en un 25% una disminucion significativa del numero de crisis. Conclusiones. En nuestra muestra hay una proporcion mayor de pacientes que presentan una remision espontanea respecto a lo descrito en estudios anteriores. Al igual que en otras series, encontramos respuestas positivas a otros farmacos antiepilepticos diferentes de la carbamacepina.

Published
2010
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46. P1.121 Non-motor symptoms in different Parkinson disease stages

Author

M.E. Bosca-Blasco, J.C. Lopez-Poma, J.A. Burguera Hernandez, I. Martinez-Torres, and T. Perez-Saldaña

Subjects
medicine.medical_specialty, Physical medicine and rehabilitation, Neurology, business.industry, Disease stages, medicine, Non motor, Neurology (clinical), Geriatrics and Gerontology, business
Published
2009
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47. Entacapona: ¿es útil como tratamiento complementario a la levodopa?

Author

Horga de la Parte Jf, Matías-Guiu J, Martí F, J.A. Burguera, Jaume Kulisevsky, R. Luquin, Jose A. Obeso, and Francisco Grandas

Subjects
Levodopa, Benserazide, business.industry, medicine.medical_treatment, General Medicine, Pharmacology, nervous system diseases, Carbidopa, Medicine, In patient, Entacapone, Neurology (clinical), Biological half-life, business, Adverse effect, Adjuvant, medicine.drug
Abstract

Entacapone (Comtan) is a potent, selective inhibitor of peripheral catechol-O-methyltransferase (COMT) with therapeutic potential as an adjuvant to levodopa therapy in patients with Parkinson's disease. Entacapone decreases peripheral conversion of levodopa to 3-O-methyldopa increasing central extracellular levodopa and consequently striatal dopamine concentrations. At doses of 200 mg 2 to 10 times daily coadministered with levodopa/carbidopa or levodopa/benserazide entacapone may increase the duration of clinical response both after the first single dose and after repeated dosing in patients with end-of-dose fluctuations. At this dosage, it has a time to peak-plasma concentration of 1.2 hours and an elimination half life of 3.4 hours. In two multicentric, long-term (approximately 6 month), randomized and placebo-controlled studies, the duration of 'on' time was increased and the duration of 'off time' was decreased in patients who received adjunctive entacapone therapy. Moreover, patients randomized to entacapone reduced their levodopa requirements. In these and other phase III studies, entacapone was generally well tolerated, with few reported adverse events, mainly dyskinesias and gastrointestinal disorders. The dyskinesias were generally well controlled by decreasing the mean daily levodopa dose. Entacapone appears as a clinically significant and beneficial adjunct to levodopa therapy in Parkinson's disease patients with end-of-dose fluctuations.

Published
1999
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48. Significant Changes in the Tau A0 and A3 Alleles in Progressive Supranuclear Palsy and Improved Genotyping by Silver Detection

Author

Mario Ezquerra, Rafael Oliva, Eduardo Tolosa, Francesc Valldeoriola, José Luis Molinuevo, Matilde Calopa, Marga Villa, J.A. Burguera, and Francisca Ballesta

Subjects
Male, Genotype, Tau protein, Population, tau Proteins, Progressive supranuclear palsy, Arts and Humanities (miscellaneous), Polymorphism (computer science), medicine, Humans, Allele, education, Gene, Genotyping, Alleles, Aged, DNA Primers, Genetics, education.field_of_study, Polymorphism, Genetic, biology, Middle Aged, medicine.disease, eye diseases, Case-Control Studies, biology.protein, Female, Supranuclear Palsy, Progressive, Neurology (clinical)
Abstract

Background Progressive supranuclear palsy (PSP) is characterized by intraneuronal inclusions of neurofibrillary tangles formed by aggregated tau protein. A significant association between the tau gene A0/A0 genotype and PSP recently has been reported. Objectives To determine if a significant association between the tau gene A0/A0 genotype and PSP could be found in an independent population with a genetic background different from that in which the initial association was reported, and to standardize a nonradioactive method for tau gene genotyping. Setting Hospital and university research laboratories. Subjects and Methods To facilitate genotyping of the tau gene, we standardized the conditions for silver-based detection of the tau gene dinucleotide polymorphism. Thirty patients from Spain clinically diagnosed as having probable PSP were included in the study and compared with different control groups. Results A highly significant overrepresentation of the A0/A0 genotype ( P A0/A3 genotype were found in the Spanish patients with PSP compared with the control group. A method based on silver detection was standardized for the genotyping of the tau gene. Conclusions The detection of a significant association between the tau gene A0/A0 genotype and PSP in 2 independent populations rules out genetic stratification as an explanation for the association and indicates that the presence of the tau A0/A0 genotype is a risk factor for developing PSP independent of genetic background. Alternatively, the results could be interpreted as a protective effect of the A3 allele.

Published
1998
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