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Background Scant evidence is available on the use of intravenous pain treatment in acute exacerbations of trigeminal neuralgia. The aim of this descriptive study was to evaluate the effectiveness and security of intravenous lacosamide and phenytoin in the treatment of acute trigeminal neuralgia pain. Methods We reviewed patients who attended the emergency department of a tertiary hospital between 2012 and 2020 for exacerbations of trigeminal neuralgia pain and were treated with either intravenous phenytoin or lacosamide for the first time. Primary endpoints were pain relief and adverse effects during the hospital stay. A comparative analysis between both treatment groups was performed. Results We studied 144 episodes in 121 patients (median age 61 years, 66.1% women). Trigeminal neuralgia etiology was secondary in 9.9%. Pain relief was observed in 77.8% of 63 patients receiving lacosamide infusions, and adverse effects in 1.6%. Pain relief was observed in 72.8% of 81 phenytoin infusions and adverse effects in 12.3%, all mild. No difference was observed in pain relief between groups, but the proportion of adverse effects was significantly different (p = 0.023). Statistically significant differences were also detected in readmissions within six months, time to readmission, and pain relief status at first follow-up visit. Conclusion Intravenous lacosamide and phenytoin can be effective and safe treatments for acute pain in trigeminal neuralgia. According to our series, lacosamide might be better tolerated than phenytoin and lead to lower readmissions and sustained pain relief.

Background and Objectives First-line treatment for trigeminal neuralgia (TN) is limited to carbamazepine and oxcarbazepine, and in refractory cases, alternatives are scarce. Lacosamide has been suggested as a valid option. In this study, we describe a series of patients who received oral lacosamide as treatment for TN after first-line drug failure.Methods In this retrospective descriptive cohort study, we included patients with refractory TN who attended a tertiary center between 2015 and 2021 and were prescribed oral lacosamide after first-line treatment failure. The primary endpoints were pain relief and adverse effects. We secondarily analyzed clinical outcomes and compared responders versus nonresponders in the search for potential predictors of response.Results Eighty-six patients were included (mean age: 62 [SD 15.6] years; 54/86 [63%] female). The TN etiology was secondary in 16/86 (19%) patients. Concomitant continuous pain was present in 29/86 (34%) patients. The mean number of previous treatments was 2.7 [SD 1.5]. Pain relief was achieved in 57/86 (66%) cases, with 28/86 (33%) patients presenting adverse effects, all of which were mild. No statistically significant differences were observed between responders and nonresponders, but subtle clinical differences suggested potential predictors of response.Conclusion Lacosamide may be an effective and relatively safe treatment for refractory pain in TN patients after first-line treatment failure.

Introduccion. Tras la celebracion del congreso de la European Headache Federation (EHF), reconocidos neurologos espanoles expertos en el tratamiento de la migrana expusieron en la Reunion Post-EHF las principales novedades presentadas en el congreso y relacionadas con ese ambito. Desarrollo. Se abordan los principales datos presentados relacionados con el tratamiento de la migrana cronica y episodica; concretamente, los relacionados con los tratamientos preventivos y la experiencia en vida real en el manejo de la enfermedad. Se hizo una importante revision de las nuevas dianas terapeuticas y las posibilidades que ofrecen en cuanto al conocimiento de la fisiopatologia de la migrana y su tratamiento. Asimismo, se hizo una actualizacion de las novedades presentadas en el tratamiento de la migrana con fremanezumab, anticuerpo monoclonal recientemente autorizado por la Agencia Europea de Medicamentos. Se hizo una actualizacion de las novedades en investigacion basica en la patologia, asi como una relacion de los sintomas de migrana y COVID-19. Finalmente, se abordaron las implicaciones de la migrana en la carga sanitaria asistencial y economica, y su impacto en la sociedad. Conclusiones. En la reunion se hizo un resumen del contenido presentado en el 14 Congreso de la EHF, que tuvo lugar a finales de junio y principios de julio de 2020.

Aims The aims of this study were to assess the sensitivity of the International Behavioural Variant FTD Criteria Consortium (FTDC) revised criteria of behavioural variant frontotemporal dementia (bvFTD) in a pathological cohort and to determine their predictive values in a clinical context suggestive of bvFTD. In addition, the study aimed to assess the influence of the age at onset and underlying pathology in the clinicopathological correlations. Methods Retrospective, blinded review of the clinical and neuropathological data from the Neurological Tissue Bank of the Biobank Hospital Clinic–IDIBAPS, Barcelona (Spain) was conducted, assessing the fulfilment of the diagnostic criteria on a case-by-case basis. Two separate nonexclusive cohorts were selected: Cohort 1 (n = 58) subjects with pathological diagnosis of frontotemporal lobar degeneration (FTLD) and Cohort 2 (n = 66) subjects with the premortem diagnosis of bvFTD. Results The FTDC criteria reached a sensitivity of 93% for possible and 80% for probable bvFTD. Early-onset cases displayed significantly more disinhibition, loss of empathy and compulsive behaviour with respect to late-onset bvFTD, leading to a slightly higher sensitivity of the diagnostic criteria (97% vs. 91%). There were no differences in the diagnostic performance between tau-positive and tau-negative cases. In subjects clinically diagnosed as bvFTD, a ‘possible bvFTD’ diagnosis reached a positive predictive value for FTLD pathology of 90%, irrespective of underlying proteinopathy. False-positive clinical diagnoses were mainly Alzheimer's disease. These cases were significantly older, had less family history of dementia and had a predominantly apathetic clinical picture. Conclusions The revised bvFTD criteria present good sensitivity and positive predictive value in both early- and late-onset cases and regardless of the underlying FTLD pathology.

La cefalea por abuso de medicacion es una cefalea cronica que aparece en pacientes con migrana o cefalea tensional por un consumo excesivo de la medicacion utilizada para su tratamiento. Los profesionales sanitarios jugamos un importante papel en su prevencion, y en su identificacion de cara a revertir una situacion que, de otra forma, se cronificara.

Ana Ma Alcantara Fernandez. Licenciada en Psicopedagogia. Maestra en Educacion Especial. Ma Aguasantas Barbado Sanchez. Licenciada en Ciencias de la Educacion y Maestra en Educacion Especial. Psicomotricista de la Asociacion de Paraliticos Cerebrales de Badajoz (ASPACEBA) Ma Eladia Carron Matos. Diplomada en Fisioterapia. Fisioterapeuta de la Asociacion de Paraliticos Cerebrales de Badajoz (ASPACEBA) Celina Fernandez de Cora Ruiz. Licenciada en Psicopedagogia y Maestra en Educacion Infantil. Ma Elena Garcia-Baamonde Sanchez. Licenciada en Psicologia. Especialista en Logopedia. Centro de Psicologia y Logopedia ALTHEA. Badajoz. Juan Jose Garcia Munoz. Maestro en Audicion y Lenguaje. Logopeda del Aula Estable de Autismo. Colegio Publico San Jose de Calasanz (Badajoz). Ma Emilia Gonzalez Cuenda. Maestra. Preparadora laboral. Presidenta de la Asociacion para la Formacion y Empleo de Personas con Discapacidad Intelectual de Badajoz (AFEDIBA). Ma Paz Gonzalez Cuenda. Maestra. Preparadora laboral. Vicepresidenta de la de la Asociacion para la Formacion y Empleo de Personas con Discapacidad Intelectual de Badajoz (AFEDIBA). Francisco Javier Macias Canchales. Profesor de Tecnologia. Instituto de Educacion Secundaria Valle del Jerte. Navaconcejo (Caceres). Ramon Madrigal Moiron. Maestro en Audicion y Lenguaje. Presidente de la Asociacion Extremena para la Investigacion y Formacion de Profesionales de la Educacion EUREKA. Eva Martin Lopez. Licenciada en Historia y Ciencia de la Musica. Doctora en Psicopedagogia. Maestra de Educacion Musical Colegio Publico Torres Naharro. Torre de Miguel Sesmero (Badajoz). Ma Nazaret Mendez Liberal. Licenciada en Psicopedagogia y Maestra en Educacion Musical. Olga Mesias Zafra. Maestra en Audicion y Lenguaje. Colegio Publico Virgen de la Luz. Cheles (Badajoz). Pedro Javier Montero Gonzalez. Maestro y Logopeda. Asociacion de Paraliticos Cerebrales de Badajoz (ASPACEBA) Juan Manuel Moreno Manso. Licenciado en Psicologia. Doctor en Psicopedagogia. Profesor del Departamento de Psicologia y Antropologia. Universidad de Extremadura. Yolanda Moreno Manso. Licenciada en Filologia Inglesa. Profesora del Colegio de Espanol para Extranjeros Don Quijote. Salamanca Montserrat Ortiz Hernandez. Maestra en Audicion y Lenguaje. Logopeda de la Asociacion de Paraliticos Cerebrales de Badajoz (ASPACEBA). Gema Perez Falcato. Terapeuta Ocupacional. Asociacion Extremena de Esclerosis Multiple de Badajoz (AEXEM). Maria Jose Rabazo Mendez. Licenciada en Psicologia. Doctora en Psicopedagogia. Profesora del Departamento de Psicologia y Antropologia. Universidad de Extremadura. Agustin Regalado Bonilla. Maestro en Educacion Especial. Educador en la Asociacion de Paraliticos Cerebrales de Badajoz (ASPACEBA)

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

Objetivos. Se analiza si existen cambios en la demanda de asistencia, demografia y patologia atendida en las consultas externas de neurologia de la region sanitaria de Tortosa entre 1997 y 2003. Pacientes y metodos. Se recogieron prospectivamente los datos de la demanda y asistencia de las primeras visitas de neurologia los periodos de 1997 y marzo del 2003 a febrero de 2004. Se compararon edad, sexo, grupos de patologias, diagnosticos, indices de solicitud de primera visita, origen de la demanda y destino tras la visita. Resultados. La edad media crecio de 49 a 56 anos (p < 0,001). Los pacientes mayores de 70 anos aumentaron del 23,7% al 35,9% (p < 0,001), mientras en la poblacion del area solo del 15,8 al 17,1%. La proporcion de mujeres paso del 52 al 62% (p < 0,001). La demanda (indice de solicitudes de primeras visitas/1.000 habitantes y ano mayores de 15 anos) crecio del 8,5 al 9,3, un 9,8% (p = 0,03). La demanda desde atencion primaria crecio del 52 al 69% (p < 0,001). Los trastornos cognitivos (6,5% y 15,9%) crecieron un 144,6% (p < 0,001). Las cefaleas (23,9% y 24,1%), el mayor grupo diagnostico, y los diagnosticos no neurologicos (18% y 18,5%) se mantienen (p = NS). Las altas en primera visita no cambian, 22,8% y 21,1% (p = NS). Conclusiones. Destaca el aumento de la demanda, fundamentalmente desde atencion primaria, el aumento de edad de la poblacion atendida y el marcado incremento de los trastornos cognitivos. Estos cambios cuantitativos y cualitativos de la demanda incrementan las necesidades de recursos.