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ABSTRACT: OBJECTIVE: We determined mortality rates and predictors of survival in 273 patients with Parkinson's disease based on a 20-year follow-up longitudinal study. MATERIAL AND METHODS: We examined 273 patients with Parkinson's disease during a 20-year follow-up, recruited between 1978 and 1998. All patients were regularly followed at the Department of Neurology until December 31, 1998, or death. RESULTS: By then, 69 patients had died, crude mortality was rate 4.43, and standardized mortality ratio for the total patient group was 1.39 (95% CI, 1.10-1.50). As Parkinson's disease is a chronic progressive disorder in adult life, disease-related mortality would be expected to increase in later stages after 15 or 20 years. Mean age at death in our cohort was 78.27 (95% CI, 76.90-79.20). Median time of death was 11 years (95% CI, 9.50-12.49). Independent predictors of mortality during the follow-up were age at onset (hazard ratio, 1.05; 95% CI, 1.01-1.09; P = 0.01), clinical form - akinesia and rigidity (hazard ratio, 2.20; 95% CI, 1.06-4.88; P = 0.03) - and treatment with dopaminergic agonist (hazard ratio, 0.49; 95% CI, 0.23-1.03; P = 0.06). Cardiovascular disease was the most frequent cause of death in 42%. CONCLUSIONS: This study suggests a link between mortality with age of onset and treatment without dopamine agonists as initial treatment. So, there is an association between decreased mortality and tremor as initial clinical forms at onset.
Acta Neurologica Scandinavica 09/2012; · 2.47 Impact Factor
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Muscle & Nerve 04/1998; 21(4):550-1. · 2.37 Impact Factor
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ABSTRACT: We sought to analyze the etiology and underlying vascular risk factors of transient ischemic attacks (TIAs) and minor ischemic strokes (MISs).
We prospectively studied the vascular risk factors and etiologic categories in 235 patients with TIAs and MISs from a community-based register in a rural area of Spain. Five etiologic categories were considered: (1) cardioembolism, (2) large-artery atherosclerosis, (3) small-artery disease, (4) other etiologies, and (5) undetermined etiology. Systematic investigations included neuroimaging (CT/MRI) and vascular studies (duplex scan/MR angiography and angiography in selected cases).
The two most frequent etiologic categories were small-artery disease (31%) and cardioembolism (26%). Large-artery atherosclerosis was detected in 11% of the patients. Significant carotid stenosis (> or =50%) was present in 13% of patients with carotid territory events. No cause could be found or it was uncertain in almost one third of the patients. The distribution of etiologic categories was similar in TIAs and MISs. The most prevalent vascular risk factors were as follows: arterial hypertension (50%), smoking (26%), atrial fibrillation (20%), hypercholesterolemia (17%), diabetes (15%), ischemic heart disease (12%), and peripheral vascular disease (3%). Carotid bruits were detected in 3% of the patients.
An etiologic classification of TIAs and MISs is feasible. The two most frequent pathogenetic mechanisms in our study were small-artery disease and cardioembolism. The prevalence of large-artery atherosclerosis was low.
Stroke 02/1998; 29(1):40-5. · 5.73 Impact Factor
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Anales de medicina interna (Madrid, Spain: 1984) 03/1997; 14(2):102-3.
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Clinical Neuropharmacology 01/1997; 19(6):539-40. · 2.17 Impact Factor
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ABSTRACT: Involuntary movements are an infrequent complication of treatment with phenytoin and include tremor, asterixis, myoclonus, parkinsonism, and dyskinesias. The mechanism by which phenytoin exerts its actions is unclear. Phenytoin has been observed to exert variable effects on dopamine metabolites and also may induce changes in serotonergic activity. In this report, we discuss the available experimental evidence concerning the possible mechanisms of involuntary movements induced by phenytoin. We describe a case of postural myoclonus during treatment with phenytoin.
Clinical Neuropharmacology 01/1997; 19(6):536-8. · 2.17 Impact Factor
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Movement Disorders 10/1996; 11(5):582-3. · 4.51 Impact Factor
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Parkinsonism & Related Disorders 08/1996; 2(3):125-6. · 3.80 Impact Factor
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ABSTRACT: One hundred consecutive adult patients with headache of recent onset were prospectively studied. Every patient was examined by craneal CT scan. Their mean age was 46 years (range 17-82). Neurological examination was normal in 80 patients. Organic headache represented 39% of the entire group, and 26% of them had a normal neurological examination. The yield of CT scan in patients with headaches and a normal neurological examination was 22.5% (95% IC: 14%-33%); of which we encountered the following pathologies: intracranial tumors (13), hydrocephalus (2), arachnoid cyst (1), toxoplasmic abscess (1) and parenchymal hemorrhage (1). The clinical characteristics of the headache on their own was insufficient to rule out the possibility of an intracranial tumor. Neuroimaging studies should be performed in all adult patients with non-vascular headache of recent onset, and previously headache-free individuals.
Acta Neurologica Scandinavica 08/1996; 94(1):67-70. · 2.47 Impact Factor
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ABSTRACT: The aim of this study was to determine the incidence of transient ischemic attacks (TIAs) and minor ischemic strokes (MISs) in Segovia, Spain.
A 2-year prospective community-based register of TIAs and MISs established in Segovia from February 16, 1992, to February 15, 1994. Every patient underwent underwent a complete clinical evaluation and cranial CT scan. Sex- and age-specific incidence rates with 95% confidence intervals (CIs) were calculated for all ages.
The total series included 235 patients; 103 suffered TIAs and 132 suffered MISs. Mean age was 70.8 years (range, 29 to 96 years); 92 were women and 143 were men. The crude annual incidence was 0.80/1000 (95% CI, 0.70 to 0.90): 0.35/1000 (95% CI, 0.28 to 0.42) for TIAs and 0.45/1000 (95% CI, 0.37 to 0.53) for MISs. The incidence of TIAs and MISs increased with age. Approximately 78 of TIAs and MISs were in the carotid distribution, 19% were vertebrobasilar, and 3% were considered of uncertain vascular distribution. Cranial CT scan was performed in all patients. CT showed cerebral infarcts in 30.1% (31/103; 95% CI, 21% to 39%) of TIAs and 70% (92/132; 95% CI, 62% to 78%) of MISs (P<.00001).
Our study is the first community-based register that provides sex-and age-specific rates for MISs and in which a CT scan was obtained in all patients. The incidence of TIAs in Segovia is comparable to that in other previous similar studies.
Stroke 04/1996; 27(4):667-71. · 5.73 Impact Factor
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ABSTRACT: A questionnaire designed to screen Parkinson's disease (PD) in literate populations has been developed. It consists of nine questions, self-administered at medical facilities or by mail, and a scale of weights for ascribing scores to specific questions when the answer is positive. The questions were chosen to be symptom specific for PD and the weights were determined from answers provided by 37 PD patients in a neurological outpatient clinic. The questionnaire sensitivity was tested on a different PD population from the same outpatient clinic--50 individuals--and the specificity on a group of 100 ophthalmological patients. The sensitivity was 100% and the specificity was 100%. Three individuals who screened positive among the 100 ophthalmological patients were assessed and given a new diagnosis of PD. This questionnaire therefore constitutes an instrument that should prove valuable as the first stage of a door-to-door survey. It has high sensitivity and specificity.
Movement Disorders 10/1995; 10(5):643-9. · 4.51 Impact Factor
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ABSTRACT: Cisapride, a substituted piperidinyl benzamide that is chemically related to metoclopramide, is a prokinetic agent that facilitates motility of the gastrointestinal tract (1). The mechanism by which cisapride exerts its actions is not clear. It enhances acetylcholine release in the myenteric plexus of the gut, and evidence exists that it has an agonistic action on a serotonin receptor, probably the 5-HT4 receptor (2). The drug is well tolerated, and no central nervous system side effects have been reported. We describe two patients with parkinsonism who experienced aggravation of tremor while on therapy with cisapride.
Clinical Neuropharmacology 03/1995; 18(1):76-8. · 2.17 Impact Factor
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Movement Disorders 02/1995; 10(1):115-6. · 4.51 Impact Factor
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Neurology 02/1995; 45(1):202. · 8.31 Impact Factor
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Journal of Neurology 02/1995; 242(2):114-5. · 3.47 Impact Factor
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ABSTRACT: We report a patient with a relapsing form of acute brainstem encephalitis. Pathological examination demonstrated necrotizing encephalitis in the cerebral cortex and, more pronounced, throughout the diencephalon, as well as in the pes pontis. Neurons and glial cells in the cerebral cortex and brainstem contained herpesvirus antigens. The clinical interrelationship of brainstem encephalitis, Miller Fisher syndrome and Landry-Guillain-Barré syndrome is discussed.
Journal of Neurology 06/1994; 241(6):401-3. · 3.47 Impact Factor
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Chest 05/1994; 105(4):1301-2. · 5.25 Impact Factor
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Movement Disorders 02/1994; 9(1):114-5. · 4.51 Impact Factor
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ABSTRACT: In order to test the value of Hodkinson's test (HT) for the detection of dementia and other milder forms of cognitive impairment in community surveys, we have studied two separate groups of 50 individuals; one of the groups included individuals with dementia or mild cognitive impairment (MCI), and the other individuals with no cognitive disturbances. Both groups were drawn from the same rural population and subjected to HT and a neuropsychological exam for positive and differential diagnosis of cognitive impairment. The gold standard criteria for the diagnosis of dementia and MCI were the DSM-IIIR criteria and a simplified and adapted version of the criteria established for age-associated memory impairment. We found that the best cutoff of HT providing maximum sensitivity and specificity for the diagnosis of both dementia and MCI was 7. For this cutoff, sensitivity and specificity for the diagnosis of MCI were 94 and 90%, respectively; for the diagnosis of dementia sensitivity and specificity were 100 and 53%, respectively. This together with its brevity, low cost and independence of sensory impairment and cultural background makes the HT useful for large population-based screening of dementia and MCI.
Neuroepidemiology 02/1994; 13(1-2):64-8. · 2.31 Impact Factor
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ABSTRACT: The efficacy of PRD was evaluated in 21 patients with Parkinson's disease who presented motor fluctuations or a bad quality "on" time despite treatment with L-dopa or dopaminergic agonists. Eighteen of the 21 patients completed three months of treatment and only 14 (66.6%) were able to complete 12 months. The four patients who stopped treatment in this period did so because of subjective complaints despite obtaining good clinical response to PRD. Only three patients suspended the dietetic regime during first month of treatment. The 14 who completed the year of treatment showed a decrease in the "off" time (4.10 to 1.65: p < 0.01) and an improvement in motor response (14.89 to 10.39; p < 0.05) during the follow up period. Improvement appeared at the end of the second week of initiation of treatment. The diet was well tolerated with scarce complications, with only one patient presenting visual hallucinations. Other secondary effects were mild and did not require discontinuation of the diet. We conclude that proteic redistribution diet improves the "on" time in patients with Parkinson disease receiving L-dopa and delays the possibility of increasing the doses of L-dopa. The dietetic regimens with proteic redistribution seems a simple, useful and cheap approach without morbidity for the patients with Parkinson's disease showing a poor response or oscillation to L-dopa treatment.
Neurologia (Barcelona, Spain) 11/1993; 8(8):248-51. · 0.79 Impact Factor
