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López-Gómez J, Ballesteros-Pomar M, Torres-Torres B, Pintor de la Maza B, Penacho-Lázaro M, Palacio-Mures J, Abreu-Padín C, Sanz-Gallego I, De Luis-Román D. SUN-PO170: Impact of Percutaneous Endoscopic Gastrostomy (PEG) on the Evolution of the Disease in Patients with Amiotrophic Lateral Sclerosis (ALS). Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32802-x] [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: 11/28/2022]
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Pulido-Valdeolivas I, Gómez-Andrés D, Sanz-Gallego I, Rausell E, Arpa J. Patterns of motor signs in spinocerebellar ataxia type 3 at the start of follow-up in a reference unit. Cerebellum Ataxias 2016; 3:4. [PMID: 26909158 PMCID: PMC4763420 DOI: 10.1186/s40673-016-0042-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/23/2016] [Indexed: 12/19/2022]
Abstract
Background Spinocerebellar ataxia type 3 (SCA3) is a neurodegenerative disorder that affects the cerebellar system and other subcortical regions of the brain. As for other cerebellar diseases, the severity of this type of ataxia can be assessed with the Scale for Assessment and Rating of Ataxia (SARA) which gives a total score that reflects functional impairment out of 8 cerebellar function tests. SCA3 patients score profile is heterogeneous on at the start of follow up. This study investigates possible patterns in those profiles and analyses the impact of other usually concurrent signs of impairment of extracerebellar motor systems in that profile variability by means of multivariate statistical approaches. Methods Seventeen patients with SCA3 underwent systematic anamnesis, neurological and SARA assessment, visual evaluation of 123I-Ioflupane (DaTSCAN) single-photon emission computed tomography (SPECT) imaging and electrophysiological studies (nerve conduction and electromyography). Patterns in the profiles of SARA item scores were investigated by hierarchical clustering after multivariate correspondence analysis. A network analysis was used to represent relationships between SARA item scores, clinical, genetic and neurological examination parameters as well as abnormalities of DaTSCAN SPECT imaging and electrophysiological studies. Results The most frequently altered SARA items in all patients are gait and stance, and three profiles of SCA3 patients can be distinguished depending mainly on their degree of impairment in those two items. Other SARA items like the score on heel-shin slide contribute less to the classification. Network analysis shows that SARA item scores configure a single domain that is independent of the size of the mutated expanded allele and age of onset, which are, in turn closely and inversely correlated. The severity of cerebellar dysfunction is correlated with longer disease duration, altered visual evaluation of DaTSCAN SPECT imaging and decreased patellar reflexes. Neither the presence of pyramidal or extrapyramidal signs nor the intensity of polyneuropathy is correlated with the SARA items scores. Conclusions Pattern recognition approaches are useful tools to describe clinical phenotypes of ataxias and to identify particular configurations of cerebellar signs. Electronic supplementary material The online version of this article (doi:10.1186/s40673-016-0042-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irene Pulido-Valdeolivas
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 4, 28029 Madrid, Spain ; Trastornos del Desarrollo y Maduración Neurológica (TRADESMA), IdiPaz-UAM, Madrid, Spain ; Department of Neurology, Hospital Universitario La Paz, Madrid, Spain
| | - David Gómez-Andrés
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 4, 28029 Madrid, Spain ; Trastornos del Desarrollo y Maduración Neurológica (TRADESMA), IdiPaz-UAM, Madrid, Spain ; Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | | | - Estrella Rausell
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 4, 28029 Madrid, Spain ; Trastornos del Desarrollo y Maduración Neurológica (TRADESMA), IdiPaz-UAM, Madrid, Spain
| | - Javier Arpa
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 4, 28029 Madrid, Spain
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Martínez-Sánchez P, Cazorla-García R, Sanz-Gallego I, Correas-Callero E, Pulido-Valdeolivas I, Arpa J. Substantia nigra echogenicity in hereditary ataxias with and without nigrostriatal pathology: a pilot study. Cerebellum 2015; 14:240-6. [PMID: 25592070 DOI: 10.1007/s12311-014-0642-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Our objective was to determine whether substantia nigra (SN) hyperechogenicity is greater in spinocerebellar ataxias (SCA) with nigrostriatal affectation than in ataxias without it. A cross-sectional case-control study analyzing four groups of patients was conducted: 1) nigrostriatal ataxias (SCA3 and SCA6), 2) nigrostriatal healthy controls matched by age and sex, 3) non-nigrostriatal ataxias (FRDA and SCA7), and 4) non-nigrostriatal healthy controls matched by age and sex. All the patients underwent a transcranial ultrasound performed by an experienced sonographer blinded to the clinical, genetic, and neuroimaging data. The SN area was measured and compared in the four groups. The SN area was also correlated with clinical features and genetic data in the two ataxia groups. We examined 12 patients with nigrostriatal ataxia (11 SCA3 and 1 SCA6), 12 nigrostriatal healthy control patients, 7 patients with non-nigrostriatal ataxia (5 FRDA and 2 SCA7), and 7 non-nigrostriatal healthy control patients. The median (IQR) SN area (cm(2)) was greater in the nigrostriatal ataxias compared with the controls (right SN, 0.43 [0.44] vs. 0.11 [0.25]; P=0.001; left SN, 0.32 [0.25] vs. 0.11 [0.16]; P=0.001), but was similar among the non-nigrostriatal ataxias and controls. There were no statistically significant differences in the SN area between the nigrostriatal and non-nigrostriatal ataxias, although there was a tendency for a greater left SN area in the nigrostriatal compared with the non-nigrostriatal ataxias (0.32 [0.25] vs. 0.16 [0.24], P=0.083). SN echogenicity is markedly greater in ataxias with nigrostriatal pathology than in controls. The role of SN hyperechogenicity in differentiating ataxias with and without nigrostriatal pathology should be elucidated in future studies.
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Affiliation(s)
- Patricia Martínez-Sánchez
- Department of Neurology and Stroke Center, La Paz University Hospital, Autonoma of Madrid University IdiPAZ Health Research Institute, Paseo de la Castellana 261, 28046, Madrid, Spain,
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Sanz-Gallego I, Rodriguez-de-Rivera FJ, Pulido I, Torres-Aleman I, Arpa J. IGF-1 in autosomal dominant cerebellar ataxia - open-label trial. Cerebellum Ataxias 2014; 1:13. [PMID: 26331037 PMCID: PMC4552149 DOI: 10.1186/s40673-014-0013-8] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 07/12/2014] [Indexed: 11/16/2022]
Abstract
Background The objective of this clinical open-label trial was to test the safety, tolerability and efficacy of IGF-1 therapy for autosomal dominant cerebellar ataxia (ADCA) patients. Results A total of 19 molecularly confirmed patients with SCA3, 1 patient with SCA6 and 6 patients with SCA7 completed our study. They were 8 females and 18 males, 28 to 74 years of age (average ± SD: 49.3 ± 14.1). Patients were treated with IGF-1 therapy with a dosage of 50 μg/kg twice a day for 12 months. The efficacy of this therapy was assessed by change from baseline on the scale for the assessment and rating of ataxia (SARA). Ten patients, consecutively selected, continued their assigned dosages in a second year open-label extension trial. A statistically significant improvement in SARA scores was observed for patients with SCA3, patients with SCA7 and all patients grouped together after the first year of IGF-1 therapy, while a stabilization of the disease was confirmed during the second year (extension study). The single patient with SCA6 showed 3 improvement points in SARA score after 3 four-month periods of IGF-1 therapy when compared with baseline measurements. Our data indicate that IGF-1 is safe and well tolerated in general. Conclusions Our data, in comparison with results from previous cohorts, indicate a trend for IGF-1 treatment to stabilize the disease progression for patients with SCA, indicating that IGF-1 therapy is able to decrease the progressivity of ADCA.
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Affiliation(s)
- Irene Sanz-Gallego
- Reference Unit of Hereditary Ataxias and Paraplegias, Department of Neurology, IdiPAZ, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Francisco J Rodriguez-de-Rivera
- Reference Unit of Hereditary Ataxias and Paraplegias, Department of Neurology, IdiPAZ, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Irene Pulido
- Reference Unit of Hereditary Ataxias and Paraplegias, Department of Neurology, IdiPAZ, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Ignacio Torres-Aleman
- Neuroendocrinology Laboratory, Functional and Systems Neurobiology Department, Cajal Institute, CSIC, and CIBERNED, Avda Dr. Arce, 37, 28002 Madrid, Spain
| | - Javier Arpa
- Reference Unit of Hereditary Ataxias and Paraplegias, Department of Neurology, IdiPAZ, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
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Pandolfo M, Arpa J, Delatycki MB, Le Quan Sang KH, Mariotti C, Munnich A, Sanz-Gallego I, Tai G, Tarnopolsky MA, Taroni F, Spino M, Tricta F. Deferiprone in Friedreich ataxia: a 6-month randomized controlled trial. Ann Neurol 2014; 76:509-21. [PMID: 25112865 DOI: 10.1002/ana.24248] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/23/2014] [Accepted: 08/04/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We conducted a 6-month, randomized, double-blind, placebo-controlled study to assess safety, tolerability, and efficacy of deferiprone in Friedreich ataxia (FRDA). METHODS Seventy-two patients were treated with deferiprone 20, 40, or 60mg/kg/day or placebo, divided into 2 daily doses. Safety was the primary objective; secondary objectives included standardized neurological assessments (Friedreich Ataxia Rating Scale [FARS], International Cooperative Ataxia Rating Scale [ICARS], 9-Hole Peg Test [9HPT], Timed 25-Foot Walk, Low-Contrast Letter Acuity), general functional status (Activities of Daily Living), and cardiac assessments. RESULTS Deferiprone was well tolerated at 20mg/kg/day, whereas more adverse events occurred in the 40mg/kg/day than in the placebo group. The 60mg/kg/day dose was discontinued due to worsening of ataxia in 2 patients. One patient on deferiprone 20mg/kg/day experienced reversible neutropenia, but none developed agranulocytosis. Deferiprone-treated patients receiving 20 or 40mg/kg/day showed a decline in the left ventricular mass index, compared to an increase in the placebo-treated patients. Patients receiving 20mg/kg/day of deferiprone had no significant change in FARS, similar to the placebo-treated patients, whereas those receiving 40mg/kg/day had worsening in FARS and ICARS scores. The lack of deterioration in the placebo arm impaired the ability to detect any potential protective effect of deferiprone. However, subgroup analyses in patients with less severe disease suggested a benefit of deferiprone 20mg/kg/day on ICARS, FARS, kinetic function, and 9HPT. INTERPRETATION This study demonstrated an acceptable safety profile of deferiprone at 20mg/kg/day for the treatment of patients with FRDA. Subgroup analyses raise the possibility that, in patients with less severe disease, deferiprone 20mg/kg/day may reduce disease progression, whereas higher doses appear to worsen ataxia.
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Affiliation(s)
- Massimo Pandolfo
- Department of Neurology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Sanz-Gallego I, Torres-Aleman I, Arpa J. IGF-1 in Friedreich's Ataxia - proof-of-concept trial. Cerebellum Ataxias 2014; 1:10. [PMID: 26331034 PMCID: PMC4552279 DOI: 10.1186/2053-8871-1-10] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/25/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Friedreich's ataxia is an autosomal recessive, severely incapacitating disorder. There is little objective evidence regarding FRDA management. Abnormalities in the insulin/insulin-like growth factor 1 (IGF-1) system (IIS) signalling pathway were thought to play a role in the physiopathological processes of various neurodegenerative disorders, including spinocerebellar ataxias. The objective of the study was to test the safety, tolerability, and efficacy of therapy with IGF-1 in Friedreich's ataxia (FRDA) patients in a clinical pilot study. RESULTS A total of 4 females and 1 male were included in the study; 23 to 36 years of age (average 26.6 ± 5.4), diagnosed with FRDA with normal ventricular function. Patients were treated with IGF-1 therapy with 50 μg/kg twice a day subcutaneously for 12 months. The efficacy of this therapy was assessed by changes from baseline on the scale for the assessment and rating of ataxia, (SARA) and by changes from baseline in echocardiogram parameters. The annual worsening rate (AWR) was estimated in this series as a SARA score of -0.4 ± 0.83 (CI 95%: -1.28 to 0.48) SARA score, whereas the AWR for our FRDA cohort was estimated as a SARA score of 2.05 ± 1.23 (CI 95%: 1.58 to 2.52). Echocardiographic parameters remained normal and stable. CONCLUSION Our results seem to indicate a benefit of this IGF-1 therapy to neurological functions in FRDA.
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Affiliation(s)
- Irene Sanz-Gallego
- Reference Unit of Hereditary Ataxias and Paraplegias, Department of Neurology, IdiPAZ, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Ignacio Torres-Aleman
- Neuroendocrinology Laboratory, Functional and Systems Neurobiology Department, Cajal Institute, CSIC, and CIBERNED, Avda Dr. Arce, 37, 28002 Madrid, Spain
| | - Javier Arpa
- Reference Unit of Hereditary Ataxias and Paraplegias, Department of Neurology, IdiPAZ, Hospital Universitario La Paz, 28046 Madrid, Spain
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Arpa J, Sanz-Gallego I, Rodríguez-de-Rivera FJ, Domínguez-Melcón FJ, Prefasi D, Oliva-Navarro J, Moreno-Yangüela M. Triple therapy with deferiprone, idebenone and riboflavin in Friedreich's ataxia - open-label trial. Acta Neurol Scand 2014; 129:32-40. [PMID: 23668357 DOI: 10.1111/ane.12141] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of the study was to test the efficacy, safety and tolerability of triple therapy with deferiprone, idebenone and riboflavin in Friedreich's ataxia (FRDA) patients in a clinical pilot study. PATIENTS AND METHODS Patients included in this study were 10 males and three females, 14-61 years of age (average 30.2 ± 12.1), diagnosed with FRDA with normal ventricular function. Patients were treated with triple therapy with deferiprone at 5-25 mg/kg/day, idebenone at 10-20 mg/kg/day and riboflavin at 10-15 mg/kg/day for 15-45 months. The efficacy of this triple therapy was assessed by change from baseline on the scale for the assessment and rating of ataxia (SARA) and by the change from baseline in echocardiogram parameters. RESULTS Four patients discontinued due to adverse events (AEs) related with deferiprone. The annual worsening rate (AWR) was estimated in this series as 0.96 (CI 95%: 0.462-1.608) SARA score, whereas AWR for our FRDA cohort was estimated as 2.05 ± 1.23 SARA score. LVMI only decreased by 6.5 g/m(2) (6.2%) at the end of the first year of therapy. LVEF remained stable, except in case of three patients. CONCLUSION Our results seem to indicate some uncertain benefit on the neurological and heart functions of this triple therapy in FRDA.
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Affiliation(s)
- J. Arpa
- Reference Unit of Hereditary Ataxias and Paraplegias; Departments of Neurology; IdiPAZ; Hospital Universitario La Paz; Madrid Spain
| | - I. Sanz-Gallego
- Reference Unit of Hereditary Ataxias and Paraplegias; Departments of Neurology; IdiPAZ; Hospital Universitario La Paz; Madrid Spain
| | - F. J. Rodríguez-de-Rivera
- Reference Unit of Hereditary Ataxias and Paraplegias; Departments of Neurology; IdiPAZ; Hospital Universitario La Paz; Madrid Spain
| | | | - D. Prefasi
- Reference Unit of Hereditary Ataxias and Paraplegias; Departments of Neurology; IdiPAZ; Hospital Universitario La Paz; Madrid Spain
| | - J. Oliva-Navarro
- Reference Unit of Hereditary Ataxias and Paraplegias; Departments of Neurology; IdiPAZ; Hospital Universitario La Paz; Madrid Spain
| | - M. Moreno-Yangüela
- Departments of Cardiology; IdiPAZ; Hospital Universitario La Paz; Madrid Spain
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González-Suárez I, Sanz-Gallego I, Rodríguez de Rivera FJ, Arpa J. Guillain-Barré syndrome: natural history and prognostic factors: a retrospective review of 106 cases. BMC Neurol 2013; 13:95. [PMID: 23876199 PMCID: PMC3723666 DOI: 10.1186/1471-2377-13-95] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/11/2013] [Indexed: 11/21/2022] Open
Abstract
Background Guillain-Barre syndrome (GBS) is characterized by acute onset and progressive course, and is usually associated with a good prognosis. However, there are forms of poor prognosis, needing ventilatory support and major deficits at discharge. With this study we try to identify the factors associated with a worse outcome. Methods 106 cases of GBS admitted in our hospital between years 2000–2010 were reviewed. Epidemiological, clinical, therapeutical and evolutionary data were collected. Results At admission 45% had severe deficits, percentage which improves throughout the evolution of the illness, with full recovery or minor deficits in the 87% of patients at the first year review. Ages greater than 55 years, severity at admission (p < 0.001), injured cranial nerves (p = 0.008) and the needing of ventilator support (p = 0.003) were associated with greater sequels at the discharge and at the posterior reviews in the following months. 17% required mechanical ventilation (MV). Values < 250 L/min in the Peak Flow-test are associated with an increased likelihood of requiring MV (p < 0.001). Conclusions Older age, severe deficits at onset, injured cranial nerves, requiring MV, and axonal lesion patterns in the NCS were demonstrated as poor prognostic factors. Peak Flow-test is a useful predictive factor of respiratory failure by its easy management.
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Arpa J, Sanz-Gallego I, Medina-Báez J, Portela LVC, Jardim LB, Torres-Aleman I, Saute JAM. Subcutaneous insulin-like growth factor-1 treatment in spinocerebellar ataxias: an open label clinical trial. Mov Disord 2010; 26:358-9. [PMID: 20960476 DOI: 10.1002/mds.23423] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 07/17/2010] [Accepted: 08/05/2010] [Indexed: 11/12/2022] Open
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Martínez-Sánchez P, Fuentes B, Mendieta C, Fernádez-Prieto A, García-Raya P, Sanz-Gallego I, Ruiz-Ares G, Díez-Tejedor E. Noninvasive Imaging of Carotid Giant Pseudoaneurysm. J Neuroimaging 2009; 20:287-9. [DOI: 10.1111/j.1552-6569.2009.00376.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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