V Fernández

Hospital Regional Universitario de Málaga, Málaga, Andalusia, Spain

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Publications (22)54.69 Total impact

  • Clinical Neurophysiology 06/2014; 125:S101. DOI:10.1016/S1388-2457(14)50334-3 · 2.98 Impact Factor
  • Oscar Fernández, Victoria Fernández
    Multiple Sclerosis 12/2013; 19(14):1822-3. DOI:10.1177/1352458513506955 · 4.86 Impact Factor
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    ABSTRACT: The first European case of tetrodotoxin intoxication is reported in a patient who ingested a trumpet shellfish from the Atlantic Ocean in Southern Europe. He suffered general acute paralysis with respiratory failure necessitating ventilation. Early neurophysiologic studies showed complete peripheral nerve inexcitability, with no recordable sensory or motor responses, and normal electroencephalography. Tetrodotoxin was detected in high quantities in the patient's blood and urine through high performance liquid chromatography-mass spectrometry analysis. Seventy-two hours after admission the patient recovered normal strength, reflexes and sensation.
    Neurophysiologie Clinique/Clinical Neurophysiology 12/2013; 43(5-6):299-302. DOI:10.1016/j.neucli.2013.08.013 · 1.46 Impact Factor
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    ABSTRACT: Objective To establish clinical guidelines for the clinical use and interpretation of motor evoked potentials (MEP) in diagnosing and monitoring patients with multiple sclerosis (MS). Recommendations for MEP use and interpretation will help us rationalise and optimise resources used in MS patient diagnosis and follow up. Method We completed an extensive literature review and pooled our own data to produce a consensus statement with recommendations for the clinical use of MEPs in the study of MS. Results MEPs, in addition to spinal and cranial magnetic resonance imaging (MRI), help us diagnose and assess MS patients whose disease initially presents as spinal cord syndrome and those with non-specific brain MRI findings, or a normal brain MRI and clinical signs of MS. Conclusions Whenever possible, a multimodal evoked potential study should be performed on patients with suspected MS in order to demonstrate involvement of the motor pathway which supports a diagnosis of dissemination in space.
    Neurologia (Barcelona, Spain) 09/2013; 28(7):408–416. DOI:10.1016/j.nrl.2012.07.007 · 1.35 Impact Factor
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    ABSTRACT: Le premier cas européen d’intoxication par tétrodotoxine est rapporté chez un patient ayant ingéré un coquillage trompette de l’océan Atlantique, dans le sud de l’Europe. Il a développé une paralysie générale aiguë et une insuffisance des muscles respiratoire justifiant une intubation. Les études neurophysiologiques ont montré une inexcitabilité nerveuse initiale totale, motrice et sensitive, et un électroencéphalogramme normal. La tétrodotoxine du mollusque a été retrouvée en quantités élevées dans le sang et l’urine du patient par une analyse en chromatographie liquide à haute performance couplée à une spectrométrie de masse. L’évolution a été rapidement favorable en 72 heures.
    Neurophysiologie Clinique/Clinical Neurophysiology 01/2013; · 1.46 Impact Factor
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    ABSTRACT: OBJECTIVE: To establish clinical guidelines for the clinical use and interpretation of motor evoked potentials (MEP) in diagnosing and monitoring patients with multiple sclerosis (MS). Recommendations for MEP use and interpretation will help us rationalise and optimise resources used in MS patient diagnosis and follow up. METHOD: We completed an extensive literature review and pooled our own data to produce a consensus statement with recommendations for the clinical use of MEPs in the study of MS. RESULTS: MEPs, in addition to spinal and cranial magnetic resonance imaging (MRI), help us diagnose and assess MS patients whose disease initially presents as spinal cord syndrome and those with non-specific brain MRI findings, or a normal brain MRI and clinical signs of MS. CONCLUSIONS: Whenever possible, a multimodal evoked potential study should be performed on patients with suspected MS in order to demonstrate involvement of the motor pathway which supports a diagnosis of dissemination in space.
    Neurologia 09/2012; 28(7). DOI:10.1016/j.nrleng.2013.09.003 · 1.35 Impact Factor
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    ABSTRACT: The Multiple Sclerosis International Quality Of Life (MusiQoL) questionnaire, a 31-item, multidimensional, self-administrated questionnaire that is available in 14 languages including Spanish, has been validated using a large international sample. We investigated the validity and reliability of the Spanish version of MusiQoL in Spain. Consecutive patients with different types and severities of multiple sclerosis (MS) were recruited from 22 centres across Spain. All patients completed the MusiQoL questionnaire, the 36-Item Short Form (SF-36) health survey, and a symptoms checklist at baseline and 21 days later. External validity, internal consistency, reliability and reproducibility were tested. A total of 224 Spanish patients were evaluated. Dimensions of MusiQoL generally demonstrated a high internal consistency (Cronbach's alpha: 0.70-0.92 for all but two MusiQoL domain scores). External validity testing revealed that the MusiQoL index score correlated significantly with all SF-36 dimension scores (Pearson's correlation: 0.46-0.76), reproducibility was satisfactory (intraclass correlation coefficient: 0.60-0.91), acceptability was high, and the time taken to complete the 31-item questionnaire was reasonable (mean [standard deviation]: 9.8 [11.8] minutes). The Spanish version of the MusiQoL questionnaire appears to be a valid and reliable instrument for measuring quality of life in patients with MS in Spain and constitutes a useful instrument to measure health-related quality of life in the clinical setting.
    BMC Neurology 10/2011; 11(1):127. DOI:10.1186/1471-2377-11-127 · 2.49 Impact Factor
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    ABSTRACT: Although not definitively proven, there is commonly accepted to be a latitudinal gradient in the distribution of multiple sclerosis (MS), which is more frequent in temperate zones. The European Mediterranean countries are situated in a zone of median frequency, although ever increasing figures have been noted in the last decades. The objective of this study was to assess the current prevalence rate of MS in the province of Malaga, Southern Spain. The capture-recapture method (CRM) uses independent sources of data and permits the number of non-registered cases of a given disease to be estimated, and by doing so, to avoid ascertainment bias. Use of this method showed the estimated prevalence rate of MS in the province of Malaga, Southern Spain, to be 125/10(5) (95% confidence interval: 102/10(5)-169/10(5)), higher than the figures published previously. Although we recognize that these data need to be confirmed in further studies and in other areas of the country using a similar method, we believe this study is the first to find such high figure of prevalence, being very similar to the figures reported in recent years in other southern European countries.
    Multiple Sclerosis 08/2011; 18(3):372-6. DOI:10.1177/1352458511421917 · 4.86 Impact Factor
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    ABSTRACT: Multiple sclerosis (MS) can be considered a disease that appears in genetically predisposed persons who, by chance, are also affected by some unknown environmental factor, probably infectious, that sets in motion an abnormal immune response leading to an autoimmune disease. Infectious agents are involved in the appearance of autoreactive T cells against myelin via various mechanisms, such as molecular mimetism or acting as superantigens. Numerous possible microorganisms have been suggested, including bacteria like Chlamydophila pneumoniae and many viruses, e.g., canine distemper virus, measles, varicella zoster, human herpes virus 6 (HHV-6) and Epstein-Barr virus (EBV). The association with EBV is the best studied over recent years. The frequency (incidence and prevalence) of MS seems to be increasing, which is better explained by the effect of some environmental factor. In this study we analyze some of the infectious agents that have been associated with the disease and discuss the hygiene hypothesis, which is one of the possible explanations for the epidemiological changes reported over recent decades.
    Current Immunology Reviews 01/2011; 7(1):75-82. DOI:10.2174/157339511794474262
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    ABSTRACT: Natalizumab is a monoclonal antibody shown to be highly effective in the treatment of relapsing-remitting multiple sclerosis (RRMS). Patients treated with natalizumab can develop antibodies directed against this agent that may affect the efficacy and safety of the drug. In this observational study, the kinetics of the appearance and the incidence of anti-natalizumab antibodies were followed prospectively for 18 months in a cohort of 64 consecutive patients treated with natalizumab for relapsing MS. Blood samples were drawn immediately before starting natalizumab therapy and each month afterwards. The presence of antibodies against natalizumab was assessed by enzyme-linked immunosorbent assay (ELISA) in all patients. Anti-natalizumab antibodies were detected in nine (14.1%) natalizumab-treated patients, three (4.68%) of whom were transiently positive while six (9.37%) were persistently positive (these patients discontinued natalizumab). All positive titres were observed during the first 4 months of treatment. One patient with a hypersensitivity reaction also had persistent antibodies. We conclude that antibodies against natalizumab develop early, within the first 6 months of therapy with natalizumab. Although no antibodies were detected after 4 months of therapy in this particular study, this does not rule out their development later on in exceptional cases.
    Multiple Sclerosis 12/2010; 17(3):368-71. DOI:10.1177/1352458510385508 · 4.86 Impact Factor
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    ABSTRACT: Little is known about how the level of disability at the start of treatment with natalizumab affects its efficacy. Objectives: The aim of this study was to investigate the effect of natalizumab on relapses in patients with different levels of baseline disability associated with MS. This single-centre observational study collected demographic data for patients followed prospectively and who were scheduled to start natalizumab therapy due to the presence of disease activity. The annualized relapse rate (ARR) and Kurtzke Expanded Disability Status Scale scores were analysed for the previous year, on starting treatment (baseline) and 1 year after starting therapy. Seventy-seven patients (mean age: 39.0 years, mean disease duration: 12.4 years) were included. The difference between ARR before and after starting treatment was 0.92 for baseline Expanded Disability Status Scale ≤ 3.5 (p < 0.0005), 0.70 for Expanded Disability Status Scale 4.0-6.0 (p < 0.007) and 0.57 for Expanded Disability Status Scale ≥ 6 (p = 0.386). Expanded Disability Status Scale did not vary during the study. One patient discontinued treatment due to an adverse event and nine patients discontinued due to positive anti-natalizumab antibodies. The findings support the efficacy of natalizumab in reducing ARR in the year after starting treatment in patients with baseline Expanded Disability Status Scale ≤ 6.
    Multiple Sclerosis 11/2010; 17(2):192-7. DOI:10.1177/1352458510385507 · 4.86 Impact Factor
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    ABSTRACT: Multiple sclerosis (MS) is a disease supposedly of autoimmune origin, with reactivity directed against myelin antigens. From the neuropathological point of view, MS produces inflammation, demyelination and axonal and neuronal degeneration. Inflammatory phenomena are predominant in the initial phase of the disease, followed later by neurodegenerative processes. Over the last decade, early treatment, during the most inflammatory phase of the disease, has been considered the best strategy to treat MS. Accordingly, we decided to determine the periods of delay between the first symptoms and the time to the first medical visit, the time to referral to a specialised MS unit, the delay in undertaking clinical and paraclinical tests, the diagnostic criteria used and the overall delay in diagnosis and treatment. The median time from onset of first symptoms to the first visit to a physician was 19.2 months, which represented the greatest delay. The median time between this initial medical consultation and the confirmation of the diagnosis by a specialised MS unit was 5.7 months, and the overall time from symptom onset to diagnosis was 24.9 months (2.08 years). The median time between onset of the first symptoms and the decision to give the first treatment was 2 years. The most important delay was that from symptom onset to the first medical visit, with the other delays being less. Thus, it is during this initial period that greater effort is required in order to reduce the time to diagnosis, by increasing awareness of the problem of MS among the general population and primary care physicians.
    Journal of Neurology 04/2010; 257(9):1500-7. DOI:10.1007/s00415-010-5560-1 · 3.84 Impact Factor
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    ABSTRACT: Occasional reports have mentioned the prevalence of multiple sclerosis (MS) among Gypsies, and no studies have examined to date the prevalence of MS or human leukocyte antigen (HLA) genetics associations in the Spanish Gypsy population. We decided to study the prevalence, mitochondrial DNA (mtDNA) haplogroups and HLA class II distribution among gypsies with MS in southern Spain. We searched for Gypsy MS patients and studied HLA class II alleles by polymerase chain reaction with sequence-specific oligonucleotide (PCR/SSO) probe hybridization or sequence-specific primers amplification. An additional study of the mtDNA haplogroups by sequencing of the hypervariable segments of the control region was also performed to provide details of their ethnic origin. Estimated prevalence of MS in the Gypsy population in Malaga was 52/100,000. No significant differences were found in mtDNA between Gypsy MS patients and Gypsy controls. DRB1*1501, DQB1*0602 and DQB1*0608 alleles were the only positive HLA association with MS. The Gypsies in our series have the same anthropological origin as other European gypsy groups, as shown by mtDNA haplogroups. Although interpreted with great caution because of the small sample size, we found that the prevalence of MS in Gypsies in Malaga is not as low as that in Central Europe, although it is significantly less than that found in Caucasians from Spain (75-79/100,000). DQB1*0602 was the strongest positive association found with Gypsy MS patients, and DRB1*1501-DQB1*0602 was the most frequent haplotype in this group.
    Tissue Antigens 06/2008; 71(5):426-33. DOI:10.1111/j.1399-0039.2008.01016.x · 2.35 Impact Factor
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    ABSTRACT: To determine the gene expression of IFNAR1, IFNAR2 and MxA protein and the association with IFNbeta treatment response in MS patients. MS patients treated with IFNbeta had a significant decrease in IFNAR1 and IFNAR2 expression, and a significant increase in MxA compared to non-treated patients and healthy controls. Also, those patients who had a good response to treatment had a significant decrease in IFNAR1 and IFNAR2 expression compared to non-responders, non-treated patients and healthy controls. IFNbeta influences the expression of its receptors, and is greater in patients who respond to IFNbeta treatment. This down-regulation could be indicative of the response to IFNbeta.
    Journal of Neuroimmunology 03/2007; 183(1-2):225-31. DOI:10.1016/j.jneuroim.2006.11.010 · 2.79 Impact Factor
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    ABSTRACT: To study the relationship between human leucocyte antigen (HLA) genotype and clinical response to interferon-beta (IFN-beta). We analysed the HLA class II genotypes of 96 multiple sclerosis (MS) patients treated with IFN-beta. The patients were classified as responders or non-responders according to clinical criteria: one or more relapses or a sustained increase after 1 year treatment compared with the year prior to IFN-beta therapy of > or = 0.5 points on the Expanded Disability Status Scale (EDSS). There were 66 (69%) responders and 30 (31%) non-responders. Baseline clinical characteristics were similar. We found no association between HLA class II alleles and clinical response to IFN-beta. HLA genotype does not appear to influence the clinical response to IFN-beta in MS patients.
    Acta Neurologica Scandinavica 01/2006; 112(6):391-4. DOI:10.1111/j.1600-0404.2005.00415.x · 2.44 Impact Factor
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    ABSTRACT: We investigated the role of three polymorphisms in the IFNAR1 (SNPs 18417 and -408) and IFNAR2 (SNP 11876) genes in multiple sclerosis (MS) susceptibility and in the IFNbeta treatment response in a group of 147 patients and 210 controls undergoing interferon therapy during the last 2 years. Only the 18417 and the 11876 SNPs showed an association with disease susceptibility (p=0.001 and 0.035, respectively) although no differential genotype distribution were observed between interferon responders and non-responder MS patients. No alteration of the expression level of IFNAR-1 was observed with respect to the -408 genotypes or to interferon treatment response. These data suggest a role for the IFNAR pathway in susceptibility to MS.
    Journal of Neuroimmunology 07/2005; 163(1-2):165-71. DOI:10.1016/j.jneuroim.2005.02.010 · 2.79 Impact Factor
  • O Fernández, V Fernández, E De Ramón
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    ABSTRACT: Evidence for the effectiveness of immunosuppressive agents in MS is scanty. There are few good quality trials; most have methodological limitations, such as a small sample size and short duration. Moreover, there is no consistency in treatment regimes, patient groups or outcome measures and the clinical benefits remain unclear. Although azathioprine appears to reduce the relapse rate in MS patients, its effect on disability progression has not been demonstrated. Methotrexate may alter the course of disease favourably in patients with progressive MS, but the evidence is again sparse.
    Journal of the Neurological Sciences 09/2004; 223(1):29-34. DOI:10.1016/j.jns.2004.04.016 · 2.26 Impact Factor
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    ABSTRACT: The human leukocyte antigen (HLA) class II DR2 haplotype (DRB1*1501, DQA1*0102, DQB1*0602) has been associated with multiple sclerosis (MS) in all ethnic groups and very strongly in Caucasians. To investigate the possible HLA class II (DRB1, DQA1 and DQB1) associations with MS in Malaga, southern Spain. We analysed the HLA class II sub-regions DRB1, DQA1 and DQB1 by polymerase chain reaction (PCR) and sequence-specific oligonucleotide probe hybridization (PCR/SSO) for DRB1 and DQB1 and with sequence-specific primers (PCR/SSP) for DRB1 subtypes and DQA1. Possible HLA class II associations with clinical MS characteristics were investigated in 149 subjects with and 160 without MS. Associations were detected between MS and the HLA class II alleles DRB1*1501 (45.6 % vs. 21.3%, p=0.001), DQA1*0102 (44% vs. 29.4%, p=0.001) and DQB1*0602 (45% vs. 20.6%, p=0.001). The DR2 haplotype (DRB1*1501, DQA1*0102, DQB1*0602) was associated with MS (43.6 % vs. 20%, p=0.002). DQB1*0602 was the only allele that maintained an association with MS in a logistic regression model. No HLA class II alleles or genotypes were significantly associated with any clinical characteristics of MS. Our results confirm the positive association of the DR2 haplotype with MS, particularly the allele DQB1*0602, in the population studied. DR4 was not associated with the disease in Malaga. HLA class II alleles or haplotypes were not associated with clinical or demographic characteristics, or clinical form or severity of MS.
    Journal of Neurology 05/2004; 251(4):440-4. DOI:10.1007/s00415-004-0350-2 · 3.84 Impact Factor
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    Focus on Multiple Sclerosis Research, 01/2004; Columbus.

Publication Stats

242 Citations
54.69 Total Impact Points

Institutions

  • 2006–2013
    • Hospital Regional Universitario de Málaga
      • Departamento de Neurología
      Málaga, Andalusia, Spain
  • 2011
    • University of Malaga
      Málaga, Andalusia, Spain
  • 2004
    • Instituto de Neurociencias
      Alicante, Valencia, Spain
  • 2002
    • Centro Informático Científico de Andalucía
      Hispalis, Andalusia, Spain