J Morera-Guitart

Hospital Marina Salud, Denia, Valencia, Spain

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Publications (17)19.15 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Up to 60% of women relate their episodes of headache to menstrual cycle. Menstrual migraine has been included in the second edition of the International Classification of Headache disorders. Menstrual tension-type headache has not yet been recognised by the International Headache Society. To evaluate the prevalence of different subtypes of menstrual headache and to analyze their clinical features and the treatment prescribed. We prospectively included women attending several neurology outpatient clinics, from January to November 2008 whose headache appeared during the menstrual period. A total of 108 patients were included during the study period. Mean age was 34.8 ± 8.9 years-old. 29.3% suffered from pure menstrual migraine, 58.7% from menstrual related migraine, 4.5% from pure menstrual tension-type headache and 7.5% from menstrual related tension type headache. Our data suggest that menstrual related tension-type headaches exist with a prevalence found about 12%, in our neurology outpatient clinics.
    Revista de neurologia 10/2011; 53(8):470-6. · 1.18 Impact Factor
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    ABSTRACT: To describe the characteristics of a telephone attendance system (TAS) implemented in our dementia unit, its relevance in the global activity and the users-themselves utility and satisfaction. We retrospectively analyzed the incoming telephone calls during a period of one year. Telephone call type, user's gender and relationship with the patient, reason for calling, who answer, class of answer and patients' Global Deterioration Scale (GDS) were systematically registered. Caregivers' satisfaction was evaluated by a semi structured telephone questionnaire checking the following variables: accessibility, difficulty in answer comprehension, utility and global satisfaction. Professionals' opinion about global impression, overcharge in daily activity, TAS satisfaction and utility were evaluated by a semi structured interview. On the period of study, 444 telephone incoming calls were registered, 58.3% of them from relatives of patients with GDS 5-6. To adjust the treatment (43.2%) or to bring forward the next appointment were the most frequent responses. Next aspects were considered as good or very good for interviewed users: accessibility (58.3%), response delay (83.3%), service utility (91.6%), global satisfaction (86.5%) and answer comprehension (93.8%). Professionals' opinion were good, but with some comments about the need for a specific appointment book, improvements aspects in initial accessibility (direct telephone line), and the establishment of a specific schedule for telephonic attendance. The TAS is a formal, structured and complementary attendance service for traditional visit, with the ability to resolve most problems. The delayed reply mode allows the clinicians to choose the best moment to reply. Furthermore, the availability of the complete chart of every patient attended improve the quality of the clinical answer.
    Revista de neurologia 01/2009; 48(5):231-6. · 1.18 Impact Factor
  • M E Toribio-Díaz, J Morera-Guitart
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    ABSTRACT: INTRODUCTION: The term 'frontotemporal lobar dementia' (FTLD) covers a group of neurodegenerative diseases that are very heterogeneous in their clinical expression, genetic component and histopathological features, and this has traditionally made it difficult to study and classify them. Patients usually present a progressive change in their behaviour associated with language disorders and loss of memory, which constitutes the second most important cause of dementia in persons under the age of 65. The most significant characteristic at the histopathological level is the presence of abnormal aggregates or accumulations of proteins in neurons or glial cells; their identification has, on the one hand, helped further our knowledge of the pathogenic mechanisms and, on the other hand, has allowed this type of dementia to be classified. DEVELOPMENT AND CONCLUSIONS: In the last two decades a remarkable amount of progress has been made in our knowledge of this group of diseases, thanks to the genetic advances related to the discovery of the MAPT gene and the progranulin gene, as well as their mutations, which are responsible for a high percentage of cases of hereditary FTLD. Likewise, the development of new immunohistochemical techniques has made it possible to characterise some abnormal proteins, such as the protein TDP-43, as the main component of the neuronal inclusions in tau-negative FTLD. All this has led to a new classification of the FTLD. This work includes a thorough review of said advances and the possible clinical, histological, genetic and biomolecular correlations of the different subtypes of FTLD are also considered.
    Revista de neurologia 01/2008; 47(11):588-98. · 1.18 Impact Factor
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    ABSTRACT: Topiramate has recently proved to be safe and effective in the prevention of migraine and is currently the only neuromodulatory drug indicated for the prevention of migraine in Spain. To evaluate the adherence, effectiveness and safety of preventive treatment with topiramate in patients diagnosed with migraine. A prospective, observational, multi-centre study was conducted in general neurology departments. Patients eligible for the study were those with migraine, above 14 years of age, who needed preventive treatment and in whom other preventive treatments had failed or for whom topiramate was believed to be the most suitable therapy as regards its profile of side effects. The effectiveness of the treatment, patient satisfaction, side effects and loss of body weight were all evaluated. Effectiveness of the treatment was evaluated by means of the reduction in the frequency of migraines and the score obtained on the Headache Impact Test (HIT-6). A total of 79 patients were evaluated. The dosage of topiramate ranged between 25 and 200 mg/day, with an average of 100 mg/day. 19% of the patients dropped out of the study due to side effects. Paresthesias were the most frequent reason for dropping out. No serious side effects were observed. 14% of the patients lost more than 5% of the base weight. The percentage of patients who responded was 58%. The degree of satisfaction of the patients who completed the follow-up was: good (80%), regular (11%) and poor (9%). Preventive treatment with topiramate significantly reduces the impact of migraine and the disability that results from it. Treatment is satisfactory and improves the quality of life in a large percentage of patients.
    Revista de neurologia 01/2006; 43(5):259-63. · 1.18 Impact Factor
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    ABSTRACT: INTRODUCTION: Vascular dementia (VD) is the second most frequent cause of dementia after Alzheimer's disease in western societies. It includes a heterogeneous group of disorders in which vascular factors are believed to play a vital role in the development of cognitive impairment. Aims and development. Our aim was to determine what instruments can be used to diagnose VD and to what extent such a diagnosis is reliable. To this end, we review the diagnostic criteria that have been used up to now, the role played by neuropsychology, the value of neurosonology studies, and the growing development of neuroimaging techniques, especially magnetic resonance. CONCLUSIONS: Current diagnostic criteria for VD select a group that is clinically and aetiologically very heterogeneous. Such criteria need shifting towards new evidence-based criteria derived from analyses of population studies that focus on the early stages of the disease and that make a proper distinction between patients with mixed dementia. The subcortical subtype of vascular cognitive impairment (SVCI) is a form of vascular impairment that is more homogeneous and which selects more representative patients with a more predictable clinical pattern, natural history, response to treatment and prognosis. These characteristics make SVCI cases an ideal group for comparisons between clinical trials and studies.
    Revista de neurologia 01/2005; 41(8):484-92. · 1.18 Impact Factor
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    ABSTRACT: Neuropathic pain (NP) is defined as pain that begins with or is caused by a primary injury or by a dysfunction in the nervous system. Our aim was to evaluate how often patients visit Neurology as outpatients with NP as the main reason for referral. A descriptive, cross sectional study was carried out on the use of the health care services; patients attended for the first time in a Neurology Screening visit were included consecutively. The variables studied were the following: the number of first visits and the total number of patients attended per visiting session, rate of patients with NP per visiting day, the topography and probable causation of the NP, and the rate of patients referred to the monographic NP clinic; the different quantitative variables are expressed in terms of their mean and standard deviation (SD), whereas the qualitative variables are given as their absolute value and the percentage. A total of 1,972 patients were attended, of whom 1,422 (72.1%) were first visits, with an average of 17.5 (SD: 2.5) new patients per visiting session. In all 113 patients clinically diagnosed with NP were identified, which represents a rate of 7.95% of the first visits. NP may be among the most frequent causes of the demand for neurological ambulatory care. The most common causes of NP were found to be trigeminal neuralgia, post-herpes neuralgia and diabetic polyneuropathy.
    Revista de neurologia 01/2005; 41(11):643-8. · 1.18 Impact Factor
  • J Morera-Guitart, M J Pedro Cano
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    ABSTRACT: We analyze the changes observed between 1996 and 2001 in the distribution of the pathology attended and the follow up model used by the out-patient Neurology Clinic in the Marina Alta area, in order to confirm possible variations that may have repercussions for Human Resource needs in the provision of adequate neurological care. We prospectively registered the attendance records for visits made to the Out-patient Neurology Clinic of Marina Alta in 1996. The variation coefficients between both series were calculated and compared. The average age of patients increased in 5 years. The number of patients attended increased 42.3%, new patients 40%, visits 13%, the "Review visit/First Visit" ratio reduced 29%. The attendance of patients with Cognitive Impairment (Cog. Imp.) doubled. There were no changes in the origins of the patients. Requests due to Cog. Imp. and parkinsonism increased significantly from Primary Care and Emergency Department. The delay to be attended increased 23%. Discharges increased 43.9%, highlighting an increase of 144% observed in the Cog. Imp. group. Changes have been observed in: the age of the population studied; the follow up of patients; the delay in attending them; and the pathology attended, with a significant increase in demand due to neurodegenerative pathology (especially Cog. Imp.). All this requires an increase in care needs that the Health Service has not been able to assume, creating an incongruous care model: we suggest a direct follow up model and offer a consultancy model.
    Neurologia (Barcelona, Spain) 11/2003; 18(8):417-24. · 1.32 Impact Factor
  • A García-Gallego, J Morera-Guitart
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    ABSTRACT: To determine the prevalence and characteristics of multiple sclerosis (EM) in the Marina Alta health district. A descriptive, retrospective study localizing cases (crossed register method). Day of prevalence: 1/05/01. Registers of the area analyzed: hospital admission, Neurology Clinic, Emergency Department of the hospital and Health Centres. The criteria of Poser were used for diagnosis. We analyzed the demographic, clinical and paraclinical aspects of the episodes and treatment (interferon-beta). Male/female ratio: 2.4. Average age: 46.6 years. Prevalence of definite EM: 40.3/100,000. Prevalence of autochthonous cases of EM: 28.7/100,000. Average age at onset: 32.6 years. Average duration of illness: 12.5 years. Commonest clinical form: remitting relapsing (48.1%), followed by progressive relapsing (7%), benign (5.5%) and primary progressive (1.8%). 5.5% died, all with the progressive secondary form. EDSS disability: greater in the progressive secondary form. Magnetic resonance (MR) was the commonest investigation used (84% of the results in concordance and 13% normal). Positive BOC in 70% of cases. We studied 202 episodes. The systems most affected were: sensory and pyramidal. Worsening of EDSS after recovery from the episode: 51.7%. 29% received interferon-beta, with five cases (31%) of major side effects (one psychotic outbursts, three with neutropenia and one generalized allergic reaction). In the Marina Alta the prevalence of EM adjusted for the autochthonous population is in the medium risk zone. The clinical features and course of the disease in our patients are similar to those seen in other national and foreign series. The most worthwhile tests were cranial MR and BOC CSF. Treatment with interferon-beta requires strict control in view of the high frequency of serious side effects seen.
    Revista de neurologia 01/2002; 34(8):732-7. · 1.18 Impact Factor
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    ABSTRACT: INTRODUCTION: Developing recommendations about consultation times in neurology helps plan the endowment of human resources and can contribute to homogenize and improve quality of health-care. OBJECTIVES: To elaborate recommendations on the consultation times needed to obtain enough quality neurology visits. MATERIAL AND METHOD: We used consensus search techniques, in particular the Community Impression technique. An ad hoc committee developed a preliminary proposal which was later discussed during a unlimited attendance working meeting and eventually voted by members of the Spanish Society of Neurology. The committee drew up a final consensus report after analysing the debate results and counting the ballots. FINAL RECOMMENDATION: "It is necessary that the Spanish Society of Neurology establishes and recommends standardized consultation times for neurology outpatients visits in Spain. These standardized values refer to consultation time per patient, both in the first and follow-up visits, in a General Neurology Outpatients Clinic. Moreover, there must be considered 'recommendable times' on one hand, and 'minimal required times' on the other hand. Any time value below the minimal required time means that the consultation duration does not fulfill the minimal requirements needed to warrant a care with acceptable quality for the patient". These recommendations are: Time for first consultation. Recommendable time: 45 minutes (Minimal required time: 25 minutes). Time for follow-up consultation. Recommendable time: 20 minutes (Minimal required time: 15 minutes).
    Neurologia (Barcelona, Spain) 12/2001; 16(9):399-407. · 1.32 Impact Factor
  • J Morera-Guitart
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    ABSTRACT: INTRODUCTION: Appraisal of the process of assistance is a fundamental step in determination of the quality of medical assistance given. DEVELOPMENT AND CONCLUSIONS: In this paper we review the concept of medical assistance as a product, establishing a parallel between medical assistance and a process of industrial production. We consider the similarities and differences between them. From the point of view of production management we may distinguish different elements: the setting, structure, process of production, result and evaluation. All these are also found in healthcare assistance. We review the concept of the process of assistance both from the limited point of view of the management of disease and its complications, and from a broader perspective which includes the activities of patients in seeking and obtaining assistance. Different aspects and methods of appraisal of the process of assistance are considered: medical audit and monitoring. Finally, we approach the problem of appraisal of the process in outpatient assistance, the importance of this and the methods used in evaluation. We comment on experience of this aspect obtained in the Neurology Unit of the Hospital Marina Alta in Denia.
    Revista de neurologia 01/1999; 29(7):662-6. · 1.18 Impact Factor
  • J Morera-Guitart, M A Mas-Server, G Más-Sesé
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    ABSTRACT: To analyze the frequency, reasons and characteristics of patients who missed their appointments (NP) at the Neurology Clinic (CEN). To compare the characteristics of the NP with the patients who did not miss their appointment. Suggest measures to reduce avoidable causes of NP. During the period 1/10/99 to 30/4/2000 the cases of NP were prospectively recorded and compared with a sample of patients who attended the CEN during the same period. We analyze the data on age, sex, distance of home from CEN, diagnosis, type of consultation and date of last consultation. The NP were contacted by phone and asked why they had not gone for their appointments. The reasons given were then classified as avoidable or unavoidable. Of the 1,842 consultations scheduled, 19% were NP. When the NP and the patients who did attend were compared we found statistically significant differences regarding the distance home/CEN. According to the diagnosis, the NP had more 'symptoms/signs' and other MIA, whilst those who attended the clinic had more 'neuropathies' and 'awaiting diagnosis'. The commonest avoidable reasons (55.8%) for NP were forgetting, administrative error and communication failure, and for unavoidable reasons (44.2%) physical disability, other priorities and improvement. There is a large proportion of NP in the CEN of the Marina Alta. The distance from home to CEN (over 25 km) was the main factor affecting the rate of NP. Since 56% of the NP were due to avoidable causes, strategies could be designed to reduce this percentage. In the NP group, the main causes were forgetting, administrative errors and communication failure.
    Revista de neurologia 34(8):701-5. · 1.18 Impact Factor
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    ABSTRACT: Cerebral infarction (CI) can be classified aetiologically in several different ways using explicit diagnostic criteria. However, the extent to which these diagnostic criteria are actually implemented in clinical practice is unknown. Aims. The aim of this study was to analyse the management and use of diagnostic tests in the aetiological diagnosis of CI in two county hospitals and to compare this with the most common recommendations. We also sought to analyse the clinical and demographic variables that may help to explain why these guidelines are not followed. We reviewed the discharge abstracts of 307 cases of CI attended in two county hospitals between 1999 and 2000 and we analysed the clinical data, diagnostic tests and the final diagnosis. The diagnoses were reorganised using the TOAST, Laussane, NINDS and SEN 98 classifications and we analysed the frequency with which the diagnostic tests were employed in each aetiological subtype. Average age: 71.3 years; 59.3% were males. CAT scans were performed in 97.1% of cases, neurosonology was used in 40.1% and echocardiography was performed in 8.5%. The aetiological diagnosis was: atherothrombotic 22.4%, cardioembolic 10.7%, lacunar 26%, unusual causes 0.3% and unknown causes 1.6%. In 37.4% of cases the diagnosis was given as unspecified CI. On reclassifying the diagnoses according to SEN 98 criteria, we obtained the following: atherothrombotic 19.5%, cardioembolic 2.8%, lacunar 13.7% and of unknown origin 63.5%. 0.6% of the cases were unclassifiable. Factors that exerted an influence on the fact that diagnostic tests were less frequently carried out included age, level of awareness and mortality. The most frequent cause of incomplete studies was the absence of carotid Doppler. The guidelines for aetiological diagnosis of CI are not often followed. Systematic performance of a neurosonological study would improve aetiological diagnosis of CI.
    Revista de neurologia 36(5):405-11. · 1.18 Impact Factor
  • S Palao-Duarte, J Morera-Guitart, M E Toribio-Díaz
    Revista de neurologia 47(5):276-7. · 1.18 Impact Factor
  • J Morera-Guitart, G Más
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    ABSTRACT: A stroke is considered to be a neurological emergency, and it is recommended that an immediate CAT scan should be done in all patients. However, its usefulness may be controversial in the early stages. To show the diagnostic usefulness of early CAT scans following strokes. We made a retrospective study of a random sample of the requests for cranial CAT scans in suspected cerebrovascular disease between October 1998 and April 2000. We analyzed the diagnostic and therapeutic variations before and after CAT scans (pre CAT and post CAT moments). We selected 210 cases. Average age: 72 10.4 (57% males). There was no difference in CAT findings (normal or vascular) related to the day it was done. Pre CAT diagnosis: non specific, 39.3%; intracranial haemorrhage (ICH), 17%. Post CAT diagnosis: the commonest was thrombotic infarct (23.7%), followed by non vascular , 20%. Pre CAT treatment: no treatment 47.9%; antiaggregant 30.4%; low molecular weight heparin 7.4%. Post CAT treatment: no treatment 17%, 21.7% of the patients with ICH received antiaggregants or anticoagulants prior to cranial CAT. Hemiplegia was more often associated with a vascular CAT scan whilst isolated dysarthria was with a normal CAT scan. Nineteen patients died and all of these had vascular CAT scans. The patients with vascular CAT scans were more often admitted to hospital. The findings of cranial CAT scans during the acute stage of strokes are unpredictable. Early CAT scans in stroke patients permits improved diagnosis and treatment of patients, avoids serious errors of treatment and affects the outcome.
    Revista de neurologia 34(4):321-7. · 1.18 Impact Factor
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    ABSTRACT: O Obbjjeeccttiivveess:: to analyse the correlation between a short test of executive functions (the Frontal Assessment Battery or FAB) and other short tests of cognitive and functional assessment and of the intensity of deterioration. P Paattiieennttss aanndd mmeetthhooddss:: a sam- ple of 145 consecutive patients was systematically studied in our unit. The scores obtained in various functional scales (the Functional Activities Questionnaire (FAQ), the Disability Assessment for Dementia (DAD), the test del informador (TIN, the Spanish variant of the IQCODE)), as well as the Global Deterioration Scale (GDS) and the Mini-Mental State Examination (MMSE)) were reviewed to correlate them with the scores obtained using the FAB. The Pearson correlation coefficients (Pearson's r) and the trend lines were calculated. R Reessuullttss:: average age of patients 75.8 years (SD 9.3; Range: 17 to 91 years). 51% were males. Distribution on the GDS: GDS-2 11.1%; GDS-3: 45.2%; GDS-4: 28.1%; GDS>4: 15.6%. The FAB showed a good degree of correlation with the GDS (r: 0.93) and with the MMSE (r: 0.65), a fair correla- tion with the FAQ (r: 0.52) and a poor correlation with the TIN (r: 0.38). The FAB correlated well with the high and low segments of the DAD (80%), but not with the inter- mediate ones. The correlations between GDS and MMSE, DAD and TIN were 0.98, 0.99 and 0.98 respectively. C Coonncclluussiioonnss:: executive functioning measured with FAB does not correlate with the average functional impairment on the DAD, TIN and FAQ scales in patients with cognitive dete- rioration. However, there was a good correlation with the inten- sity of deterioration (measured with the GDS)) and with the Mini-Mental State Examination (MMSE).
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    ABSTRACT: The use of diagnostic criteria for mild cognitive impairment (MCI) that do not require the presence of amnesia enables patients to be classified into three types of MCI: pure amnestic MCI (aMCI), MCI with involvement of multiple cognitive functions and amnesia (mf-aMCI) and MCI with involvement of multiple cognitive functions without amnesia, or non-amnestic MCI (mf-nonaMCI). To determine whether patients with MCI with involvement of multiple functions (mfMCI) have a different profile of cognitive involvement depending on whether amnesia is present or not. Out of a total sample of 175 patients with MCI, we studied 138 with mfMCI. Of these, 109 (79%) had memory disorders (mf-aMCI) and 29 (21%) did not (mf-nonaMCI). For each group of patients, we determined the percentage who scored below normal in each of the items on the abbreviated Barcelona test. Patients with mf-aMCI failed more frequently in temporal orientation, naming and semantic category evocation tests. Patients with mf-nonaMCI failed more often in motor praxis and abstraction tests. Differences were statistically significant. Additionally, it was noted that patients with mf-nonaMCI tended to make more mistakes in attention tests. The presence of amnesia allows us to identify an mf-aMCI group with a cognitive profile suggesting temporal involvement, unlike the mf-nonaMCI group, whose members have a cognitive profile that suggests subcortical compromise.
    Revista de neurologia 44(8):455-9. · 1.18 Impact Factor
  • M E Toribio-Díaz, J Morera-Guitart, S Palao-Duarte
    Revista de neurologia 47(7):390-1. · 1.18 Impact Factor