J López-Trigo

Consorcio Hospital General Universitario de Valencia, Valenza, Valencia, Spain

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Publications (16)17.28 Total impact

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    ABSTRACT: A peculiar feature of seronegative myasthenia gravis is that it presents negative acetylcholine-receptor antibodies; determination of muscle-specific receptor tyrosine kinase (MuSK) antibodies defines a subgroup of patients with generalised myasthenia gravis with certain clinical and neurophysiological peculiarities. Its diagnosis requires the presence of weakness with fatigability, determination of positive anti-MuSK antibodies and alterations in neurophysiological testing of the neuromuscular junction. It is usually more serious and has a poorer prognosis than the seropositive forms, develops in an acute or subacute manner, and the neurological deficit predominates in the facial, bulbar and respiratory muscles. Titration of the anti-MuSK antibodies and conducting neurophysiological tests, especially jitter assessment using single-fibre electromyography in clinically deficient muscles, are not only necessary for an early diagnosis of these clinical forms, but also so as to be able to carry out an objective evaluation of the clinical progression and response to treatment.
    Revista de neurologia 01/2008; 46(6):360-4. · 1.18 Impact Factor
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    ABSTRACT: In neuropathic pain, as occurs in epilepsy, researchers are striving to find a drug capable of inhibiting the pain-generating ectopic discharges that are produced as a result of neuronal hyperexcitability. This is mediated by ionic exchanges across the channels of the synaptic membrane. This is why the drugs that act on the different types of channels involved in this transmission can regulate neuronal hyperexcitability and therefore have an effect on the pain. In recent years researchers have gained a deeper understanding of the mechanisms of action of antiepileptic drugs and, since the discovery of their action on one or several synaptic channels, the use of these agents to treat neuropathic pain has become increasingly common. Patients suffering from central pain are also beginning to benefit from the administration of these drugs, especially agents that have proved to be capable of acting with several mechanisms of action and on several channels at the same time. In addition, fewer and less severe side effects are produced, something that is fundamental if we bear in mind the characteristics of patients with central pain, most of whom are adults and elderly. This, together with the fact that there are fewer interactions with other drugs, has led to the new antiepileptic drugs' becoming the preferred medication for this pathology today. Zonisamide acts on several types of channels and it is known to have four different mechanisms of action, which means it can be effective in treating these patients, although further studies are required (above all randomised double-blind trials) in order to really evaluate the usefulness of these drugs in the treatment of neuropathic pain.
    Revista de neurologia 01/2007; 45(7):429-32. · 1.18 Impact Factor
  • J López-Trigo, J Sancho Rieger
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    ABSTRACT: 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.
    Neurologia (Barcelona, Spain) 04/2006; 21(2):96-103. · 1.35 Impact Factor
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    ABSTRACT: 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.
    Revista de neurologia 01/2002; 35(8):731-4. · 1.18 Impact Factor
  • J Sancho-Rieger, J López-Trigo
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    ABSTRACT: 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.
    Revista de neurologia 01/2002; 34(3):290-2. · 1.18 Impact Factor
  • J Sancho-Rieger, J López-Trigo
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    ABSTRACT: 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.
    Revista de neurologia 01/2000; 30(4):333-6. · 1.18 Impact Factor
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    ABSTRACT: 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. 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.). 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.
    Revista de neurologia 01/1999; 28(3):227-32. · 1.18 Impact Factor
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    ABSTRACT: 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. 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. 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. 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.
    Stroke 10/1998; 29(9):1854-9. · 6.16 Impact Factor
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    ABSTRACT: 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.
    Archivos de neurobiologiá 02/1989; 52 Suppl 1:73-8.
  • Neuroradiology 02/1989; 31(3):289. · 2.70 Impact Factor
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    ABSTRACT: 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.
    Archivos de neurobiologiá 02/1989; 52 Suppl 1:93-103.
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    ABSTRACT: 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.
    Actas luso-españolas de neurología, psiquiatría y ciencias afines 26(1):58-62.
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    ABSTRACT: 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. Conclusion. Gabapentin is an effective, well-tolerated drug used as monotherapy in newly diagnosed epilepsy. [REV NEUROL 2002; 34: 290-2] Key words. Antiepileptic drugs. Gabapentin. Monotherapy. Partial epilepsy. INTRODUCCIÓN La gabapentina (GBP) es un antiepiléptico estructuralmente si-milar al aminoácido gamma-aminobutírico (GABA), aunque su mecanismo de acción difiere del mismo. Mientras que el GABA no atraviesa la barrera hematoencefálica, la GBP es liposoluble y ha demostrado que penetra en el sistema nervioso central [1]. La GBP se comercializa en Estados Unidos desde 1994 y ha demostrado su eficacia como terapia añadida en numerosos ensa-yos clínicos [2-5]. Una vez probada dicha eficacia, el fármaco se ha usado en monoterapia y se ha realizado un ensayo clínico [6] que demues-tra su eficacia con dosis de 900 y 1.800 mg/día, en comparación con la carbamacepina. Otro estudio hospitalario [7] –en pacientes ingresados para evaluación quirúrgica– demuestra su eficacia an-ticonvulsionante y la buena tolerabilidad del fármaco, a pesar de alcanzarse dosis de 3.600 mg/día en 24 h. Tras demostrar la eficacia de un fármaco por medio de los ensayos clínicos, los estudios observacionales ayudan a conocer su empleo en condiciones semejantes a las de la clínica habitual. En España se realizó un estudio multicéntrico abierto [8] en el que se evaluó la eficacia y tolerabilidad de la GBP en monoterapia en condiciones clínicas habituales. En el presente artículo revisamos nuestra experiencia en un seguimiento a largo plazo de 62 pacien-tes con crisis parciales que habían recibido GBP en monoterapia.
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    ABSTRACT: 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.
    Acta Otorrinolaringológica Española 43(5):335-8.
  • C. Barcia, J. López-Trigo, F. Fontana
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    ABSTRACT: We present the case of an osteoma situated in the orbital portion of the left frontal sinus in a 22 year- old male, who also presented pulsatile exophtalmos, diplopia and headache. The neuro-radiological tests revealed also a large intracranial air cavity. Surgery demonstrated the relation between the osteoma and pneumatocele, where the tumor produced effacement of the orbitary roof; this placed the sinusal cavity in contact with the subdural space. A valve mechanism is suggested to explain the accumulation of intracranial air without liquorrhea. Finally, the rarity of the case in the literature is commented on.ResumenPresentarnos un caso de osteoma intraorbitario izquierdo en un varón de 22 años, que cursó con exoftalmos pulsátil, diplopia y cefaleas. En el estudio neurorradiológico se encontró, además, una amplia colección aérea en el lóbulo frontal izquierdo. Fue intervenido, encontrándose en el acto quirúrgico la relación entre ambos: el tumor producía un defecto en el techo de la órbita y la dura, poniendo en contacto las cavidades sinusales con el espacio subdural. Se postula un mecanismo valvular para explicar el gran acúmulo de aire intracraneal sin aparición de licuorrea. Finalmente se realiza una revisión de la literatura constatándose lo excepcional del caso.
    Neurocirugía. 4(3):215–218.

Publication Stats

93 Citations
17.28 Total Impact Points

Institutions

  • 2002–2007
    • Consorcio Hospital General Universitario de Valencia
      Valenza, Valencia, Spain
  • 1998
    • Hospital Universitari General de Castellón
      Castellón, Valencia, Spain