Revista de neurologia


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Publications in this journal

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    ABSTRACT: INTRODUCTION. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) is safe and effective. Most series report stable long-term motor responses. AIM. To report the long-term outcome of STN-DBS in advanced stage PD patients at a Portuguese center. PATIENTS AND METHODS. Motor status was evaluated before surgery ('off' medication and best 'on'), post-operatively, and at five years ('on' medication and stimulation) using UPDRS part III. Axial symptoms subscores were quantified. Disability was assessed with the modified Rankin Scale (mRS). Development of dementia was assessed at 6 months and five years post-DBS. RESULTS. Of the 183 patients submitted to STN-DBS, 71 had completed 5 years of follow-up. Ten patients were not included: two died (cancer, myocardial infarction), five were lost to follow-up and three had their stimulation systems removed. Motor function improved by 78% and 66% postoperatively and at five years, respectively. There was improvement of axial symptoms postoperatively, with significant worsening at five years (p < 0.001). mRS scores improved postoperatively, but declined at five years, although most patients (88.5%) remained ambulatory (mRS < 4). One patient (1.6%) and 19 patients (31,2%) were demented at 6 months and 5 years, respectively. Patients who developed dementia were significantly older than non-demented patients (56.5 ± 7.8 vs 63.7 ± 5.9 years-old; p < 0.001). CONCLUSIONS. In this series STN-DBS proved its efficacy regarding motor symptom improvement even five years after the procedure. Deterioration of axial symptoms and disability, as well as new onset dementia were observed in this period, but the possible role of STN-DBS as a causative factor is yet to be defined.
    Revista de neurologia 05/2014; 58(10):433-440.
  • Revista de neurologia 05/2014; 58(10):480.
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    ABSTRACT: INTRODUCTION. The type of diet has been related with the inflammatory process that forms part of multiple sclerosis. In recent years, different lines of research have generated a large body of knowledge about the role played by diet in the pathogenesis of multiple sclerosis. AIM. To conduct a critical examination of the evidence suggesting the existence of a relationship between different types of diets and foods and multiple sclerosis. DEVELOPMENT. The work includes an update of the most significant studies that have analysed the role played by diet in the pathogenesis and treatment of multiple sclerosis. In order to explore the association between diet and the risk of multiple sclerosis, the authors examined the currently available evidence, which ranged from observation-based studies to intervention studies. CONCLUSIONS. Further research on nutrition as a risk factor is needed, as it could be related with the disease and controlling it could lead to a significant reduction in the incidence or progression of the disease.
    Revista de neurologia 05/2014; 58(10):455-64.
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    ABSTRACT: INTRODUCTION. Migraine may present with cranial autonomic symptoms typical of trigeminal-autonomic cephalalgias, thus posing diagnostic difficulties. AIM. To report a series of patients with prominent eyelid oedema associated with migraine. PATIENTS AND METHODS. Ten patients attending the headache offices in three hospitals (nine women, one man; age: 26-53 years-old) with recurrent eyelid oedema as a migraine accompaniment. RESULTS. According to the diagnostic criteria of the International Classification of Headache Disorders (ICHD-III, beta version), eight patients had migraine without aura, one had migraine with aura, and one had chronic migraine. Eyelid oedema appeared during the most severe headache attacks, and had longer duration than the pain. Pharmacological or systemic causes of the oedema were ruled out in all cases. Other associated autonomic symptoms were conjunctival injection (n = 3), lacrimation (n = 2) and rhinorrhoea (n = 1). Both the pain and the oedema improved with symptomatic and preventive therapies for migraine. CONCLUSIONS. Eyelid oedema may occasionally be a migraine accompaniment. It appears in some patients during their most severe migraine attacks, and may improve with the acute and preventive treatment for migraine.
    Revista de neurologia 05/2014; 58(9):385-8.
  • Revista de neurologia 05/2014; 58(9):429-30.
  • Revista de neurologia 05/2014; 58(9):430-2.
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    ABSTRACT: Seizures are one of the main reasons for visits to emergency and neurology. Represent a traumatic event with potential medical and social consequences. A first epileptic seizure, can be the initial manifestation of malignancy, systemic disorder or infection, but can also be the first manifestation of epilepsy. The misdiagnosis of symptomatic seizures and unprovoked seizure, significantly affects prognosis and patient outcomes. The aim of this review is to examine the general concepts that enable successful diagnostic and therapeutic approach to the patient presenting with a first epileptic seizure.
    Revista de neurologia 04/2014; 58(8):365-74.
  • Revista de neurologia 04/2014; 58(8):382-3.
  • Revista de neurologia 04/2014; 58(8):384.
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    ABSTRACT: INTRODUCTION. After a traumatic brain injury (TBI), cognitive functionality may be severely altered. Some studies have aimed at identifying the best predictive variables for cognitive recovery, however, results still remain unclear. AIMS. To assess the recovery of cognitive functionality in TBI patients after a rehabilitation programme, and to identify the variables that best predict the cognitive recovery. PATIENTS AND METHODS. We conducted a retrospective pre-post study with 58 adult TBI patients that underwent an intensive rehabilitation programme. All of them were assessed using the cognitive functions sub-scale from the FIM+FAM scale, at admission and discharge. Both scores were compared using non-parametric test Wilcoxon. Cognitive functionality gain percentage was calculated and correlated with all the collected data. A multiple linear regression analysis was carried out to identify the best predictors of cognitive functionality gain percentage by introducing all clinical, demographic and cognitive information. RESULTS. The group's cognitive functionality increased significantly from 33,6% to 85% (p < 0,01). Patients with higher cognitive functionality gain percentage were those with younger age, shorter time post-TBI, and higher scores on cognitive functions sub-scale, conditional attention and Luria's memory word tests. The best predictors for cognitive functionality gain percentage were time post-TBI and cognitive functions at admission (adjusted R2 = 55,8%). CONCLUSIONS. Patients who started rehabilitation sooner and had a higher cognitive functionality at admission, showed the greatest increase in cognitive functionality gain percentage. Other variables like age, or scores on cognitive tests must also be considered in future studies.
    Revista de neurologia 04/2014; 58(7):296-302.