Biomedical subjects

R Alarcia

Publications and source records attributed to R Alarcia.

12 recordsLinked to original sources

PubMed2005

[Importance and factors related to chronic fatigue in multiple sclerosis].

INTRODUCTION: The importance of fatigue in multiple sclerosis (MS) is determined by its high frequency and it is an important cause of disability. OBJECTIVE: To determine factors that are related to the presence of chronic fatigue in patients with MS. PATIENTS AND METHODS: The series comprises patients with MS, consecutively attended in the demyelinizating diseases unit, who met the following criteria: clinically definite MS (RR or SP), MS duration of more than two years, and no relapses during the previous month. Analyzed variables were as follows: chronic fatigue, demographic data, functional systems, EDSS, ISS, ESS, disease activity, Hamilton, depression scale GHQ-28, PSQI, and interferon. Statistical study: bivariate and multivariate analysis by logistic regression. RESULTS: A hundred patients were included, 72 female and 28 male. Mean age was 39.27 years. Of the 100 patients 88 had RR disease and 12 SP disease. MS mean duration was 11.2 years. Mean EDSS 2.54. Chronic fatigue was 53 %. The presence of depression increased the probability of chronic fatigue 3.6 fold, and every point in PSQI-7 increases it 3.5 fold. CONCLUSION: Depression and the PSQI-7 subscale (day sleep dysfunction) are the only variables independently related to chronic fatigue in patients with MS.

Adult↗

PubMed2004

[Modifications of the lipid metabolism induced by interferon beta in multiple sclerosis patients and its relationship with the disease activity].

INTRODUCTION: It has been recently suggested that total cholesterol and low density lipoproteins (LDL) levels can behave as biological markers of activity in demyelinating diseases. Thus, our aim has been to describe the modifications of the plasma levels of total cholesterol and triglyceride due to treatment with interferon-beta in multiple sclerosis (MS) patients and to determine their relationship with the disease activity. PATIENTS AND METHODS: Study of the follow-up of MS patients under treatment with interferon-beta. Clinical and analytical controls were performed before initiating treatment and than at 1, 3, 6, 12, 18 and 24 months of its initiation. RESULTS: Fifty six patients have been studied, 41 of them women. Mean age was 37.4 years. Fifty were relapsing- remitting forms and the rest secondary progressive forms. The mean plasma levels of triglyceride increased and total cholesterol levels diminished during the 24 months of treatment with interferon, mainly in the first 3 months. No statistically significant relationship was found between disease activity and mean plasma levels of triglyceride and total cholesterol before the beginning of the treatment and during the period of follow-up. CONCLUSIONS: Treatment with interferon-beta in the MS patients originates changes in the plasma lipid profile, but neither these changes nor the plasma lipid levels before the treatment behave as biological markers of disease activity.

Adjuvants, Immunologic↗

PubMed2004

[Predicting factors for depression in multiple sclerosis].

INTRODUCTION: We assess frequency and intensity of depression in multiple sclerosis (MS) patients, the degree at which it is detected and its relationship to the treatment with beta interferon and other clinical and paraclinical factors. METHODS: The series comprises MS patients, seen in the Demyelinating Disease Unit of a tertiary hospital, who fulfilled the following criteria: clinically defined MS (relapsing-remitting or secondary progressive), disease duration greater than two years and absence of relapses during the month prior to the study. The variables analyzed were detection and assessment of depression with the Hamilton Depression Scale, general demographic data, functional systems, EDSS, ISS, ESS, Pittsburgh Sleep Quality Index, interferon treatment, chronic fatigue and a series of analytical variables. Statistical study: both variate and multivariate analysis by logistic regression. RESULTS: 100 patients (72 female and 28 male). Mean age: 39.27 years. RR MS form, 88%, and SPMS form, 12 %. Mean evolution time, 11.2 years. Mean EDSS, 2.54. Depression was present in 44 % of the patients in our group and was not related to neurological degree of disability, disease evolution time, clinical form, interferon treatment, or to sleep disorders. However, depression was related to the presence of both chronic fatigue and ESS scores. CONCLUSIONS: Depression is common in MS patients and is associated with the presence of chronic fatigue and a worse social status.

Adolescent↗

PubMed2004

[Sleep disorders in multiple sclerosis].

INTRODUCTION: To determine the frequency of sleep disorders in multiple sclerosis (MS) patients and their relation with other manifestations of the disease. METHODS: Selected patients had clinically definite MS (relapsing-remitting and secondary progressive forms) and duration of the disease over two years. They were serially evaluated at the unit of demyelinating diseases of a third level hospital. The following scales were applied: the Pittsburgh Sleep Quality Index, the Hamilton Depression Rating Scale, EDSS, ISS and ESS. Statistical analysis by means of non parametric test and logistic regression was carried out. RESULTS: One hundred patients were included (72% women and 28% males). Mean age was 39 years. Eighty eight were relapsing-remitting forms and the rest secondary progressive forms. Mean EDSS was: 2.5. Mean duration of evolution: 11.2 years. The prevalence of sleep disorders was 36%. Age, sex, evolutionary form, degree of disability and chronic fatigue did not relate with the sleep disorders in these patients. In the multivariant analysis by means of logistic regression, we found that every point more in Hamilton's scale multiplies the probability of presenting sleep disorders by 1.2. CONCLUSIONS: Depression is the only variable that independently relates, with the presence of sleep disorders in MS patients.

Adolescent↗

PubMed1998

[Electroclinical and neuroimaging studies in epilepsy].

INTRODUCTION AND MATERIAL: During 54 months, we have studied the electro-clinical and neuroimaging features in outpatients with active epilepsy. Each patient was interviewed for one of us. Then, we have reviewed the medical records about both the clinical featuring. EEG and neuroimaging (NI) studies and seizures frequency (SF) outcome. Differences in crude proportions were assessed by chi 2 test for independence by 2 x 2 tables. RESULTS AND CONCLUSIONS: It has been 207 patients with 49 +/- 19.6 years of mean age at review. Partial seizures was significantly related with both a higher SF at onset and politherapy. Also, with a focal EEG distribution but only in case of complex partial seizures. Abnormal NI was significantly more frequent in oldest patients. A greater proportion of patients were in politherapy in four situation: SF at onset > 1 by day, a focal EEG distribution, duration of epilepsy longer than 20 years and age of onset lesser than 60 years. A 37.2% was seizures-free in the last year and in 34% the SF was improved a 50% or more from the beginning. A significantly greater proportion of patients was following with seizures in four cases: when the SF at onset has been > or = 1 by day, being partial seizures, women and having politherapy.

Adult↗

PubMed1998

[The referral of hospitalized patients with cerebrovascular pathology. Where, when and why. A cross-sectional multicenter study of the referral of patients with ischemia and predisposing factors].

OBJECTIVES: Referral of patients with ictus on discharge from hospital is a daily problem for neurologists, both because of the suitability of one place or another for maximum recovery of the patient and because of the effect on average stay, complications and use of resources. The aim of this study was to determine where and when patients with ictus were referred and what factors affect whether a patient goes to one place or another. PATIENTS AND METHODS: A transversal multicentric study (3 months) using a questionnaire was sent to all Insalud hospitals in Aragon, recording data of 128 patients from four hospitals. There were questions on medical, functional, demographic and socio-economic factors which might affect referral. RESULTS: On discharge 20% of the patients did not return to their own homes. In 50% of the cases where patients went to a supporting hospital (SH) socio-economic factors were decisive and in 20% were the only cause. Referral to SH was related to functional state and type of ictus, need for nursing care or rehabilitation, age, sex, marital status and place of residence. CONCLUSIONS: Apart from clinical criteria, many socio-economic factors determine the need for referral of patients to one place or another.

Adult↗

PubMed1998

[Spontaneous intracranial hypotension: findings of cerebral NMR].

INTRODUCTION: The intracranial hypotension syndrome is characterized by a cerebrospinal fluid (CSF) pressure of less than 60 mmH2O and presents as postural hypotension which is often accompanied by nausea, vomiting, cervicalgia and some degree of neck rigidity. It is considered to be spontaneous when there is no known precipitating factor. It is believed that there is a CSF leak across the subarachnoid space, although it is not always possible to detect this. In recent years several authors have described different pathological findings on magnetic resonance (MR) studies. CLINICAL CASE: We present the radiological studies of a patient with clinical evidence of headache which was worse on standing and improved when lying down. The outflow pressure of CSF was 6 mmH2O when lying down. On isotopic cisternography using Tc DTPA-99m there was no detectable CSF leak. On cerebral MR there was diffuse pachymeningeal thickening with increased signals in T1 sequences. This was more pronounced in T2 with lineal dural uptake of contrast at infra and supratentorial levels. The brain stem meninges were intact. In parallel with a favorable clinical course, following clinical resolution the radiological images were seen to have returned to normal. CONCLUSIONS: Radiological findings, together with a compatible clinical condition, help to establish the diagnosis of spontaneous intracranial hypotension and avoids the use of unnecessary clinical investigations.

Adult↗

PubMedDate not supplied

[Severe polyneuropathy after using nitrous oxide as an anesthetic. A preventable disease?].

INTRODUCTION: Nitrous oxide is a commonly used anaesthetic agent. One complication of this is due to its capacity to inactivate cobalamin. Therefore, in patients with poor reserves of vitamin B12, neurological and hematological alterations may be induced after a short period of exposure to nitrous oxide. CLINICAL CASE: A 69 year old man was anesthetized for three hours with 50% nitrous oxide during a surgical operation. Two weeks later he complained of severe mixed, mainly sensory polyneuropathy and was unable to walk. On diagnostic studies, vitamin B12 levels were found to be 18 pg/ml. The Shilling test confirmed that there was lack of intrinsic factor. In the preoperative studies a striking increase in motor conduction velocity was observed. Neurophysiological studies showed that there was mixed polyneuropathy, predominantly axonal. After starting treatment with hydroxycobalamin there was marked improvement and the patient became able to walk unaided. CONCLUSION: Since nitrous oxide may cause serious neurological alterations in patients with subclinical deficits of cobalamin, which may not always be accompanied by hematological changes, we consider the need for determination of plasma levels of vitamin B12 and if possible, of methylmalonic acid and homocysteine in elderly patients who are to have general anesthetics involving nitrous oxide.

Aged↗

PubMedDate not supplied

[Therapeutic benefits of monotherapy with lamotrigine].

OBJECTIVE: To analyze the overall therapeutic benefit (effect on seizures and quality of life) in 100 patients, aged 14-89 years, treated with lamotrigine (LTG) as primary (25) or secondary (75) monotherapy, followed up for between one and six years. PATIENTS AND METHODS: The patients were selected for treatment, under open observation, and not randomized at all. Thirty patients suffered from generalized seizures and 70 from partial crises, with progression to generalized tonic-clonic crises in 36 cases. The usual LTG serum level when bi-therapy was used was 2 to 4 mg and was similar with monotherapy. The predominant dosage of LTG (100 to 200 mg) was similar for monotherapy and for bi-therapy in those treated with valproate, as compared with 200-400 mg in most of those in whom the associated drug was carbamazepine (24), phenobarbital (14), phenytoin (6) or other drug, with a considerable reduction in dose (of 100 mg to 250 mg) when they were treated by monotherapy instead. RESULTS: Overall therapeutic benefit was obtained in 79 cases, partly due to suppression or reduction of the seisures, or maintenance free of them, but mainly due to correction of the side-effects, especially somnolence, attention disorders, obesity, tremor, ataxia, reduced global productivity, hyperlipidaemia and liver enzyme changes. CONCLUSION: Lamotrigine was more effective and better tolerated in smaller doses as monotherapy, and better than other drugs in reference to quality of life, especially by the supression of side-effects, demonstrating that it is valuable in obtaining overall improvement of the disease and its consequences.

Adolescent↗

PubMedDate not supplied

[Cerebral ischemia and epilepsy].

INTRODUCTION: We review the characteristics and evolution of epileptic crises (EC) related to non-hemorrhagic ictus. Patients and methods. Since June 1994 we have studied patients with EC both at the time of the ictus (acute symptomatic crises, ASC) and later (remote symptomatic crises RSC). One hundred and fifteen fulfilled the criteria and were followed-up until recurrence of EC, death or the end of the study (30.06.98). There were 66 men and 49 women (average age at the time of ictus = 67.4 +/- 12 years). RESULTS: Ninety one patients had RSC; reversible ischemic neurological deficit (DNIR) (50%), atherothrombotic pathology (58.5%) and anterior territory (70%) predominated. There was a similar proportion of partial and generalized crises (51.5% compared with 48.5%). Fifteen patients had presented with ASC. Thirty-nine patients presented with ASC, with predominance of established ictus (48.5%), atherothrombotic pathology (56.5%), anterior territory (82%) and generalized crises (59%). There was recurrence in 50.5% of those with RSC (follow-up 18.5 +/- 24 months). STATISTICAL ANALYSIS: there was a predominance of ASC in patients with established ictus and RSC in the case of DNIR. In cases of abnormal EEG there was a greater proportion of patients with a history of ASC. In patients over 60 years old, CSR was commoner. In those with atherothrombosis there was a predominance of one crisis and in patients with embolisms two or more crises. There were more recurrences in patients with no previous history of ASC (p = 0.001), those with all the anterior territory affected (p = 0.002), those < 59 years old (p = 0.01), those previously untreated (p = 0.04) and those with abnormal EEG (p = 0.03). There was an increased RR in the abnormal EEG, involvement of the entire anterior territory and age < 59 years. Multivariate analysis showed that the probability of recurrence increased 1.23 times when there was a previous history of ASC; 14.73 times if the EEG was abnormal, and 18.12 times when both these factors were present.

Acute Disease↗

PubMedDate not supplied

[Demyelinating pseudotumoral lesion prior to a primary cerebral lymphoma].

INTRODUCTION: Some case of demyelinating pseudotumoral lesions preceding the appearance of primary cerebral lymphoma have been reported. The relation between the two conditions is not known. We report the case of a woman in whom a demyelinating pseudotumoral lesion had been diagnosed on biopsy and who developed a primary cerebral lymphoma 13 months later. CLINICAL CASE: In October 1997 a 38 year old woman presented with a secondarily generalized focal motor seizure. Neuroimaging showed a left frontal tumour with marked oedema and uptake of contrast medium. Based on the clinicoradiological suspicion of a primary cerebral tumour or metastasis, treatment was started with dexamethasone. Approximately two weeks later a stereotaxic biopsy was done, in which there was demyelination with conservation of the axons and perivascular inflammatory infiltration with polyclonal T and B lymphocytes. The diagnosis was 'a pseudotumoral form of a demyelinating disease'. Thirteen months later the patient had episodes of falling to the floor, followed by subsequent slight confusion and difficulty in speaking. On neuroimaging studies (cerebral CAT and MR) there was a tumour of the left basal ganglia, considerable oedema and homogeneous marking following the injection of contrast. Anatomopathological study of the lesion showed a B cell lymphoma. CONCLUSION: In cases of pseudotumoral demyelinating lesions the possibility of a primary cerebral lymphoma of the central nervous system must be remembered.

Adult↗

PubMedDate not supplied

[Hypoxic encephalopathy and cortical laminar necrosis].

INTRODUCTION: Cortical laminar necrosis is characterized by destruction of the cerebral cortex, mainly of the third layer, in situations of reduced energy supply to the brain. The cerebral lesions caused are known through studies made at autopsies, but there are few descriptions in the literature of the neuroimaging changes. We report the case of a patient who suffered hypoxic encephalopathy secondary to prolonged status epilepticus, and in whom cerebral MR showed changes compatible with cortical laminar necrosis. CLINICAL CASE: A 16 year old girl who had been epileptic since infancy presented with a state of generalized tonic-clonic convulsions followed by coma. Three weeks later she was mute, had a blink reflect to threats and followed visual stimuli with eye movements but no voluntary motor or verbal response. She also showed generalized hypertonia and fine tremor of her arms, which she moved spontaneously with no asymmetry. After two months her clinical condition became stable. Cerebral MR at this time showed diffuse hypersignal of the cortex and basal ganglia in T2 and FLAIR sequences and hyposignal of the subcortical white matter associated with a marked hypersignal delimiting the grooves of convexity in T1 sequences. CONCLUSIONS: Situations of prolonged hypoxia, such as in status epilepticus, lead to necrosis of layers of the cerebral cortex. Clinically this is seen as the appearance of hypoxic encephalopathy and radiologically as characteristic alterations of neuroimaging known as cortical laminar necrosis.

Basal Ganglia↗