Biomedical subjects

J López-Trigo

Publications and source records attributed to J López-Trigo.

12 recordsLinked to original sources

PubMed2006

[Pregabalin. A new treatment for neuropathic pain].

Neuropathic pain is a condition affecting a significant proportion of the world's population. Many therapeutic drugs have been used. They achieve less than satisfactory results and are associated to common side effects that affect the daily life of patients. Pregabalin is a new drug that has been shown to be effective for treating partial epilepsy and peripheral neuropathic pain in clinical trials. It is a structural, but not functional, analogue of GABA. It acts as a ligand of the alpha2-delta subunit, a protein associated to the voltage-dependent calcium channels. Modulation of these channels decreases calcium entry into nerve endings, resulting in a decreased release of several excitatory neurotransmitters. Pregabalin had a linear pharmacokinetics with little variability between the different subjects. It does not bind to plasma proteins, has no liver metabolism, and is excreted trough the kidneys. Few interactions with other drugs may be expected based on these characteristics. In clinical trials, pregabalin has been shown to be effective in postherpetic neuralgia and painful diabetic neuropathy at doses ranging from 150-600 mg/day. The analgesic effects of pregabalin occur in the first few days of treatment and are sustained over time. Side effects are few; most are transient and well-tolerated by patients, and the treatment discontinuation rate is minimal.

Analgesics↗

PubMed1998

Prognostic value of motor evoked potential obtained by transcranial magnetic brain stimulation in motor function recovery in patients with acute ischemic stroke.

BACKGROUND AND PURPOSE: The early prognostic application of transcranial magnetic brain stimulation (TMS) for assessing motor and functional recovery in ischemic stroke patients has yielded contradictory results. We performed a prospective study of patients with acute ischemic stroke and motor deficit to evaluate the early prognostic value of TMS in motor and functional recovery. METHODS: Fifty patients with different degrees of hemiparesis were studied in the first week after ischemic stroke and evaluated by clinical scales (Medical Research Council Scale, Canadian Neurological Scale, Barthel Index), with clinical follow-up over 6 months. TMS (Magstim 200) was performed at the same time, recording the motor evoked potential (MEP) in the thenar eminence muscles, with facilitation by voluntary contraction. RESULTS: Of the total group of 50 patients, MEP was absent in 20 and present in 30 (17 with normal and 13 with delayed central conduction time [CCT]). The patients with MEP showed better motor and functional recovery than those without. The MEP provided information on patient recovery, regardless of the initial strength and/or Barthel values. The degree of recovery was better in those patients with normal CCT than in those with delayed CCT. CONCLUSIONS: MEP obtained by TMS in patients with hemiparesis after acute ischemic stroke is useful as an early prognostic indicator of motor and functional recovery. This technique would allow the early identification of those patients who will have a good recovery, particularly among those with severe initial paresis.

Activities of Daily Living↗

PubMed1992

Idiopathic trigeminal sensory neuropathy.

Idiopathic trigeminal sensory neuropathy is a rare disorder characterized by transient sensory disturbances in the territory of one or more branches of the trigeminal nerve. Acute and chronic forms of the disease have been recognized, but the boundaries between these groups are not clearly defined. Six cases of idiopathic trigeminal sensory neuropathy are reported. All patients presented with sensory abnormalities limited to the territory of one trigeminal nerve, in the absence of other clinical features. The symptoms were on the left side of the face in five cases and on the right side in one. No bilateral involvement was seen. There were no cases of muscle weakness, and the corneal reflex was always present. In two cases, sensory disturbances began in the tongue or lips and later spread through the entire territory of the three trigeminal branches. Both patients recovered completely after 3 months. The other four patients had involvement of the second and third branches (two cases), or the third branch alone (two cases), and the symptoms persisted unmodified for 2 to 4 years. There were no clinical variables at onset to enable one to predict an acute or chronic evolution of the disease.

Adult↗

PubMed1989

[Neurophysiologic study in patients with human immunodeficiency virus infection].

Peripheral nervous system (PNS) involvement in the form of different neuropathies in human immunodeficiency virus (HIV) infection is increasingly more common. We present a series of 20 HIV + patients subjected to neurophysiological study. The most commonly observed neurological disorder was a slight axonal-type sensitivo-distal polyneuropathy that predominantly affected the lower limbs during the early stages of infection. As HIV infection evolves, the polyneuropathy worsens and becomes a sensitivo-motor polyneuropathy with a more important axonal component. Secondary demyelinization is observed, with additional involvement of the upper limbs in the final stages of infection. The most frequent neurophysiological finding was a decrease in somatosensory evoked potential (SEP) and conduction velocity (CV) of the sural nerve.

Acquired Immunodeficiency Syndrome↗

PubMed1989

[Spinal cord involvement by the human immunodeficiency virus. Vacuolar myelopathy].

Vacuolar myelopathy is the most frequent spinal syndrome in patients infected with the human immunodeficiency virus, presently considered to be related to a direct action of the virus. The authors review the historical, clinical, pathological and etiopathogenetic aspects of this new entity, stressing the difficulties posed by its differential diagnosis and its scarce therapeutic possibilities.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[Reference values for the central motor conduction time and silent period obtained by the transcranial magnetic stimulation].

INTRODUCTION: Normal values of reference to transcranial magnetic stimulation for the motor central conduction time (CCT) and silent period (SP) is recorded in 30 healthy control subjects over abductor pollicis brevis. MATERIAL AND METHODS: We get for the CCT four measurements: two with low intensity of stimulus, 5% plus the motor threshold, with and without facilitation (CCT1 and CCT1 fac.); and two with high intensities of stimulus, elevating the magnetic stimulation intensity to 1.5 times the threshold (CCT2 and CCT2 fac.). RESULTS AND CONCLUSIONS: The mean and standard deviation of each measurement are: CCT1: 9.34 +/- 1.19, CCT1 fac.: 7.12 +/- 1.1. CCT2: 8.84 +/- 1.05 and CCT2 fac.: 6.57 +/- 1.05. Given that the CCT and SP doesn't follow a normal distribution, the medium and the 5-95% percentiles for the normal values of reference are calculated; there are: CCT1: 7.15-11.32, CCT1 fac: 5.27-9.42. CCT2: 7.05-10.73 and CCT2 fac: 4.91-9.14. For the silent period gets only one measurement employing high intensities. These last measurement were recorded in two localizations: on vertex and on motor area, selecting the greater duration. Given the great individual variability of this period in normal population absolute and ratio for the difference duration of SP between both sides are calculated. The latency of the SP is 50.2 +/- 5.99, 95 percentiles 39.1-64.63, the duration 151 +/- 32.51, 95 percentiles 102.63-239.55. The total SP measured from the discharge of the stimulus to the end of the silent period is 201.71 +/- 33.27; 95 percentiles: 151.39-296.4. The comparison of both hemispheres would give us pathological security for the 99.99% of the population for more than 14.94 ms of absolute difference, and for less of the 79.81% of ratio difference. A summary of the discoveries of the silent period in different pathologies is contributed in the discussion.

Adult↗

PubMedDate not supplied

[Prognosis of epilepsy and suppression of treatment. Prognosis of epilepsy].

OBJECTIVE: On the occasion of the XXXVII Annual Meeting of the Spanish Anti-Epilepsy League we have reviewed the prognosis of epilepsy. DEVELOPMENT: The latest population studies of prognosis indicate that the long-term prognosis of epilepsy is good. Over 80% of these patients experience remission of their illness for at least three years, within nine years of diagnosis. The probability of remission is little influenced by the aetiology of the epilepsy. The mortality of epileptic patients is 2.5-3 times greater than that of the general population, adjusted for age, is markedly influenced by the aetiology and generally occurs within the first few years after diagnosis.

Adult↗

PubMedDate not supplied

[Monotherapy using gabapentin in epilepsy].

DEVELOPMENT: We report a study of 62 patients with partial seizures treated with gabapentin as monotherapy for two years. After two years 78% of the patients were still on the same treatment. In 67.7% of the patients there was more than 50% reduction in major seizures and 11.1% were free of seizures. There was little difference in efficacy and tolerance when the first and second years were compared. We reviewed the data published in the literature, both in clinical trials and open studies. CONCLUSIONS: Gabapentin is an effective, well tolerated drug used as monotherapy in newly diagnosed epilepsy.

Acetates↗

PubMedDate not supplied

[Encephalitis caused by Rickettsia conorii without exanthema].

INTRODUCTION: Mediterranean boutonneuse fever, caused by Rickettsia conorii, is an endemic disease in the Mediterranean area. The serious forms of the disease, which include encephalitis, are infrequent but are associated with a high mortality rate. Diagnostic suspicion is backed up by the development of exanthema. We report the case of a patient who developed encephalitis caused by Rickettsia conorii without exanthema. Clinical case. A 27 year old woman who had nauseas, headache, fever, abdominal upset and generalised pain during the days before being admitted to hospital. On the day she was admitted, she noticed reduced strength in the left limbs, together with numbness and pins and needles in the left side of the body. In the casualty department she presented tonic seizures in the left extremities and later generalised tonic clonic seizures. Exploration showed facial paresis and 4/5 hemiparesis on the left side. Complementary tests carried out in casualty, including cerebrospinal fluid (CSF), did not reveal any significant findings. She was admitted after a loading dose of phenytoin. After 48 hours she presented fever and repeated complex partial seizures. A new CSF analysis was normal. She was treated with valproate, clonazepam, ceftriaxone, doxycycline and acyclovir. An electroencephalogram (EEG) showed theta activity in the left centroparietal areas and slow delta waves in the right temporal regions. Magnetic resonance imaging (MRI) of the brain showed contrast enhancement in the meninges. 24 later, due to the frequency of the seizures, phenobarbital and methylprednisolone were added, which enabled the seizures to be controlled. The posterior brain MRI revealed a right parasylvian lesion. Serological Rickettsia conorii IgM +, IgG 1/256 was administered. After eight months, she has presented no seizures or neurological deficit. CONCLUSIONS: There are cases of encephalitis from Rickettsia conorii that can present without exanthema. This means that in endemic areas early treatment with doxycycline could be advisable when faced with encephalitis of unknown aetiology, bearing in mind the high mortality rate that occurs when no early treatment is administered and the good tolerance to doxycycline.

Acyclovir↗

PubMedDate not supplied

[Study of the facial nerve motor pathway with the transcranial cerebral magnetic stimulation technique].

Transcranial magnetic stimulation method permits the study of the facial nerve in all its aspects (motor cortex-alpha moto-neurone-facial muscle) in an non invasive and painless way. We studied 12 patients using two levels of stimuli, the first was at an occipital level and the second at the primary motor cortex in the frontal lobe. We compared the results of this technique with those obtained by electric stimulation of the nerve.

Electric Stimulation↗

PubMedDate not supplied

[Cost-minimisation analysis of the pharmacological treatment of epilepsy in Spain].

AIM: To use a model of economic evaluation to analyse the efficiency of therapy with the antiepileptic drugs indicated in recently diagnosed partial and generalised epilepsy. MATERIALS AND METHODS: The treatment of partial epilepsy and generalised epilepsy in Spain was taken as the basis to design two flexible simulation models of the decision tree type. The time horizon of the study was one year and the perspective was that of the Spanish National Health System, and indirect costs were also included. Clinical effectiveness data were obtained from a review of the literature on clinical trials. Information about resources was obtained from the opinions of a panel of experts. Unitary costs of resources were drawn from Spanish databases (euro 2003). The findings of the study were expressed in terms of average cost per patient with each therapeutic strategy, as well as the incremental cost of the different treatment strategies with respect to valproic acid. RESULTS: According to the literature that was reviewed, there are no differences in effectiveness from one antiepileptic drug to another. The incremental cost of the different therapeutic strategies, with respect to valproic acid, lies between 211 and 911 euros per patient and year in partial epilepsy, and between 1,355 and 1,297 euros per patient and year in the case of generalised epilepsy. CONCLUSIONS: The use of sustained-release valproic acid in recently diagnosed partial and generalised epilepsy would allow savings to be made in resources, with respect to the other antiepileptic drugs, and can therefore be considered to be the most effective therapeutic option.

Anticonvulsants↗

PubMedDate not supplied

[Pseudoneurologic conversion and factitious disorders: differential diagnosis in 2 clinical cases].

The recognition and differentiation of conversion and factitious disorders could be difficult when they coexist with physical problems and their psychopathology is not evident. We present two illustrative cases of patients who share the existence of neurological disorders and present a similar psychiatric semiology, which is phenomenologically different related with their physical deficits. The psychopathological assessment was made by means of a standardized instrument for diagnosis (SCAN) and suitable paraclinical techniques for each case. The test MMPI (Minnesota Multiphasic Personality Inventory) was used in both cases, and an exploration with Thiopental was carried out in one of them. The pertinent differential diagnosis, the advantages of coordinated interdisciplinary interventions in order to elucidate these mental disorders, and the convenience of using appropriated psychometric instruments and exploratory methods are expounded in the present paper.

Conversion Disorder↗