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López-Bravo A, Bellosta-Diago E, Viloria-Alebesque A, Marín-Gracia M, Laguna-Sarriá J, Santos-Lasaosa S. Headache as a reason for consultation: the primary care perspective. Neurologia (Engl Ed) 2021; 36:597-602. [PMID: 34654534 DOI: 10.1016/j.nrleng.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/16/2018] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Headache is a frequent reason for consultation with primary care (PC) physicians. However, the condition is underdiagnosed and undertreated. One reason for this may be the lack of specific training on headache in PC. METHODS We conducted a descriptive cross-sectional study of data gathered with a self-administered survey that was completed by PC physicians from our health district. We collected sociodemographic data and information on previous training in neurology and headache, and training needs. RESULTS The survey was completed by 104 PC physicians, 53% of whom were women; mean age was 49 years. Most respondents worked in urban settings (42.3%) and had been trained via residency (77.9%). Although 65.4% spent more time with patients with headache than with other patients, only 32.7% used the International Classification of Headache Disorders. In our sample, 68.3% of respondents reported a high or very high interest in headache, and 75.9% wished to receive further training on the condition; theoretical and practical courses and update lectures were regarded as the most useful tools. In clinical practice, 90% used triptans and 78% used preventive treatments. The most frequently used drug was amitriptyline; only 22.1% choose topiramate. CONCLUSIONS PC physicians are in frequent contact with patients with headache and show interest in receiving training on this condition. This could be helpful in designing training programmes aimed at improving quality of care in this area.
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Affiliation(s)
- A López-Bravo
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - E Bellosta-Diago
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A Viloria-Alebesque
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - M Marín-Gracia
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J Laguna-Sarriá
- Servicio de Medicina Familiar y Comunitaria, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - S Santos-Lasaosa
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Navarro-Pérez MP, Viloria-Alebesque A. Acerca de la atención de las crisis epilépticas en pacientes con epilepsia en servicios de urgencias hospitalarios. Réplica. Rev Neurol 2021; 73:259-260. [PMID: 34569037 DOI: 10.33588/rn.7307.2021387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- M P Navarro-Pérez
- Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, España.,Instituto de Investigación Sanitaria Aragón, Zaragoza, España
| | - A Viloria-Alebesque
- Hospital General de la Defensa de Zaragoza, Zaragoza, España.,Instituto Investigación Sanitaria Aragón, Zaragoza, España
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López-Bravo A, Sanabria-Sanchinel A, Marín-Gracia M, Viloria-Alebesque A. Sweating as a presentation of focal epilepsy: clinical case report. Neurología (English Edition) 2021. [DOI: 10.1016/j.nrleng.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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López-Bravo A, Sanabria-Sanchinel A, Marín-Gracia M, Viloria-Alebesque A. Sudoración como presentación de epilepsia focal: descripción de un caso clínico. Neurologia 2021; 36:332-334. [DOI: 10.1016/j.nrl.2020.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/04/2020] [Accepted: 06/12/2020] [Indexed: 11/25/2022] Open
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Navarro-Pérez MP, Viloria-Alebesque A, Garcés-Antón E, Marín-Gracia M, García-Noain JA, Santos-Lasaosa S, Mauri-Llerda JA. [Emergency department management of epileptic seizures in patients with epilepsy]. Rev Neurol 2021; 72:419-425. [PMID: 34109997 DOI: 10.33588/rn.7212.2020590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIM To analyse the care of patients with epilepsy (PwE) who visit the hospital emergency department (ED) due to an epileptic seizure. MATERIALS AND METHODS Single-centre retrospective observational study, based on the clinical history of the PwE seen in the ED for epileptic seizures between January 2016 and December 2018. Demographic, clinical and ED management variables were collected. Specifically, the results of a computed tomography (CT) brain scan and electroencephalogram and the presence of precipitating factors for epileptic seizures were analysed. RESULTS A total of 232 PwE were identified, with a mean age of 49.8 years. The most frequent reason for the visit was focal epileptic seizures (50.4%). In 106 cases (45.6%) possible precipitating factors were found, of which poor therapy adherence was the most frequent. An urgent CT brain scan was performed in 67 cases (28.9%) and acute alterations were found in only one patient. An electroencephalogram was carried out in 16 of them (6.9%). Adjustments were made to the antiepileptic treatment in 135 patients (58.1%). A total of 195 were discharged without being hospitalised (84.1%). CONCLUSIONS PwE accounted for a considerable proportion of the patients seen for epileptic seizures in the ED. The presence of a potentially controllable precipitating factor was identified in almost half of the cases, the most frequent being poor adherence to therapy. In addition, a high number of urgent complementary tests were performed, which in many cases may be unnecessary and avoidable.
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Affiliation(s)
- M P Navarro-Pérez
- Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, España.,Instituto de Investigación Sanitaria Aragón, Zaragoza, España
| | - A Viloria-Alebesque
- Hospital General de la Defensa de Zaragoza, Zaragoza, España.,Instituto Investigación Sanitaria Aragón, Zaragoza, España
| | - E Garcés-Antón
- Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, España
| | - M Marín-Gracia
- Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, España
| | - J A García-Noain
- Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, España
| | - S Santos-Lasaosa
- Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, España.,Instituto de Investigación Sanitaria Aragón, Zaragoza, España
| | - J A Mauri-Llerda
- Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, España
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López-Bravo A, Bellosta-Diago E, Viloria-Alebesque A, Marín-Gracia M, Laguna-Sarriá J, Santos-Lasaosa S. Headache as a reason for consultation: the primary care perspective. Neurologia 2018; 36:S0213-4853(18)30183-X. [PMID: 30072273 DOI: 10.1016/j.nrl.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/14/2018] [Accepted: 06/16/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Headache is a frequent reason for consultation with primary care (PC) physicians. However, the condition is underdiagnosed and undertreated. One reason for this may be the lack of specific training on headache in PC. METHODS We conducted a descriptive cross-sectional study of data gathered with a self-administered survey that was completed by PC physicians from our health district. We collected sociodemographic data and information on previous training in neurology and headache, and training needs. RESULTS The survey was completed by 104 PC physicians, 53% of whom were women; mean age was 49 years. Most respondents worked in urban settings (42.3%) and had been trained via residency (77.9%). Although 65.4% spent more time with patients with headache than with other patients, only 32.7% used the International Classification of Headache Disorders. In our sample, 68.3% of respondents reported a high or very high interest in headache, and 75.9% wished to receive further training on the condition; theoretical and practical courses and update lectures were regarded as the most useful tools. In clinical practice, 90% used triptans and 78% used preventive treatments. The most frequently used drug was amitriptyline; only 22.1% choose topiramate. CONCLUSIONS PC physicians are in frequent contact with patients with headache and show interest in receiving training on this condition. This could be helpful in designing training programmes aimed at improving quality of care in this area.
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Affiliation(s)
- A López-Bravo
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - E Bellosta-Diago
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - A Viloria-Alebesque
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M Marín-Gracia
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J Laguna-Sarriá
- Servicio de Medicina Familiar y Comunitaria, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - S Santos-Lasaosa
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Bellosta-Diago E, Viloria-Alebesque A, Santos-Lasaosa S, Lopez Del Val LJ. [The hypothalamus in Huntington's disease]. Rev Neurol 2017; 65:415-422. [PMID: 29071701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Disorders affecting sleep and the circadian rhythm, autonomic clinical signs and symptoms, and neuroendocrine alterations are frequent characteristics in Huntington's disease, some of which present in early stages of the disease. It is reasonable to think that some of these features could result from a hypothalamic dysfunction affecting the centre regulating sleep, metabolism and the autonomic nervous system. AIM The study presents the evidence available to date that suggests the involvement of a hypothalamic disorder in Huntington's disease. DEVELOPMENT Histopathological, hormonal and neuroimaging research relates this area of the brain to Huntington's disease. The experimental findings and those obtained with animal models or in studies conducted with patients are summarised. Likewise, the clinical repercussions (sleep and circadian rhythm disorders, psychiatric and cognitive pathologies, and the clinical signs and symptoms linked to autonomic dysfunction) secondary to possible involvement of the hypothalamus in this disease are also described. CONCLUSIONS The hypothalamus acts as a centre that integrates the neuroendocrine and autonomic functions, and plays a significant role in cognitive and behavioural signs and symptoms. Disorders of this type have been highlighted in Huntington's disease. Further studies are needed to elucidate the role and scope of this region of the brain in this disease.
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Affiliation(s)
- E Bellosta-Diago
- Hospital Clinico Universitario Lozano Blesa, 50009 Zaragoza, Espana
| | | | - S Santos-Lasaosa
- Hospital Clinico Universitario Lozano Blesa, 50009 Zaragoza, Espana
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Bellosta-Diago E, Velazquez-Benito A, Viloria-Alebesque A, Iniguez-Martinez C, Santos-Lasaosa S. [A study of sexual function in migraine and cluster headache]. Rev Neurol 2016; 62:487-492. [PMID: 27222082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The sexual erectile dysfunction are common symptoms and many chronic diseases whose diagnosis will determine the therapeutic management of patients. AIM To assess sexual function in men with migraine or cluster headache (CH) compared with a control group. SUBJECTS AND METHODS Cross-sectional study of 34 patients with migraine, 31 patients with CH and 60 control subjects less than 46 years old. Erectile dysfunction was assessed using the International Index of Erectile Dysfunction (IIEF). Emotional state was evaluated using the Beck Depression Inventory. RESULTS The average score on the IIEF was 68.41 ± 10.09, 64.26 ± 5.73 and 59.33 ± 15.89 in the control group, migraine and CH respectively (p = 0.041) being the significant difference between controls and CH (p = 0.036). In the group of migraine patients, three patients had mild and one moderate erectile dysfunction. In the group of patients with CH, twelve scored in rank of mild erectile dysfunction, and two met the criteria for severe erectile dysfunction (p < 0.05). By analyzing differences in the different domains of IIEF, they were significant in the domain of overall satisfaction (p = 0.015) between the control group and patients with CH (p = 0.012). CONCLUSIONS In our study we found a higher frequency of and involvement in sexual function in terms of overall satisfaction in patients with migraine and CH. We believe that the evaluation of sexual function in this type of headache should be integrated into our clinical practice.
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Affiliation(s)
- E Bellosta-Diago
- Hospital Clinico Universitario Lozano Blesa, 50009 Zaragoza, Espana
| | | | | | | | - S Santos-Lasaosa
- Hospital Clinico Universitario Lozano Blesa, 50009 Zaragoza, Espana
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Santos-Lasaosa S, Viloria-Alebesque A, Morandeira-Rivas C, Lopez Del Val LJ, Bellosta-Diago E, Velazquez-Benito A. [Mnemonic complaints and chronic migraine]. Rev Neurol 2013; 57:145-149. [PMID: 23884868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION. Patients with chronic migraine often report lower cognitive performance, which affects their quality of life. AIMS. To analyse whether the mnemonic capacity of patients with chronic migraine is altered or not. SUBJECTS AND METHODS. A cross-sectional study was conducted in patients with chronic migraine evaluated consecutively in our unit, and paired by age (18-60 years) and gender with a control group consisting of cognitively healthy volunteers. The following cognitive instruments were administered: Folstein Minimental State Examination (MMSE), Memory Alteration Test (M@T), Montreal Cognitive Assessment (MoCA) and working memory. RESULTS. A total of 30 patients with chronic migraine were included (mean age: 49.33 ± 10.05 years) paired with a control group of 30 healthy volunteers (mean age: 44.83 ± 10.91 years). The mean elapsed time since onset of the patients with chronic migraine was 4.47 ± 2.74 years. On performing a comparative analysis between the two groups, significant differences were found with overall lower scores in the group of patients with chronic migraine in the MoCA (24.16 versus 29), M@T (43.76 versus 48.8) and working memory tests (17.5 versus 24.26). Performance in the MMSE was similar in both groups. CONCLUSIONS. Patients with chronic migraine can have lower cognitive performance regardless of distracting elements, such as pharmacological factors or psychiatric comorbidity, since chronic migraine can be understood as yet another element within the spectrum of chronic pain.
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Affiliation(s)
- S Santos-Lasaosa
- Hospital Clinico Universitario Lozano Blesa, 50009 Zaragoza, Espana.
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