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Guasp M, Rosa-Justicia M, Muñoz-Lopetegi A, Martínez-Hernández E, Armangué T, Sugranyes G, Stein H, Borràs R, Prades L, Ariño H, Planagumà J, De-La-Serna E, Escudero D, Llufriu S, Sánchez-Valle R, Santamaria J, Compte A, Castro-Fornieles J, Dalmau J, Páramo D, Medrano V, Casado V, Guanyabens N, Giné-Servén E, Ángeles del Real M, Pardo J, Martin-Gil L, Barrero-Hernández FJ, García-Barragán N, Falip M, Simó M, Rodríguez E, Ruiz Ezquerro JJ, Bataller L, Safont G, Vicente-Hervàs J, Brieva L, Casado I, Portilla JC, Escalante S, Arenillas JF, Erro E, Jericó-Pascual I, Fuerte-Hortigón A, Morató A, Saiz A, Blanco Y, Sepúlveda M, Ruiz R, Naranjo L, Rodés M, Aguilar E, Alba M, Caballero E. Clinical characterisation of patients in the post-acute stage of anti-NMDA receptor encephalitis: a prospective cohort study and comparison with patients with schizophrenia spectrum disorders. Lancet Neurol 2022; 21:899-910. [DOI: 10.1016/s1474-4422(22)00299-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] [Received: 04/30/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 10/14/2022]
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Lleixà C, Martín-Aguilar L, Pascual-Goñi E, Franco T, Caballero M, de Luna N, Gallardo E, Suárez-Calvet X, Martínez-Martínez L, Diaz-Manera J, Rojas-García R, Cortés-Vicente E, Turón J, Casasnovas C, Homedes C, Gutiérrez-Gutiérrez G, Jimeno-Montero MC, Berciano J, Sedano-Tous MJ, García-Sobrino T, Pardo-Fernández J, Márquez-Infante C, Rojas-Marcos I, Jericó-Pascual I, Martínez-Hernández E, Morís de la Tassa G, Domínguez-González C, Juárez C, Illa I, Querol L. Autoantibody screening in Guillain-Barré syndrome. J Neuroinflammation 2021; 18:251. [PMID: 34719386 PMCID: PMC8559393 DOI: 10.1186/s12974-021-02301-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/18/2021] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an acute inflammatory neuropathy with a heterogeneous presentation. Although some evidences support the role of autoantibodies in its pathogenesis, the target antigens remain unknown in a substantial proportion of GBS patients. The objective of this study is to screen for autoantibodies targeting peripheral nerve components in Guillain-Barré syndrome. METHODS Autoantibody screening was performed in serum samples from all GBS patients included in the International GBS Outcome study by 11 different Spanish centres. The screening included testing for anti-ganglioside antibodies, anti-nodo/paranodal antibodies, immunocytochemistry on neuroblastoma-derived human motor neurons and murine dorsal root ganglia (DRG) neurons, and immunohistochemistry on monkey peripheral nerve sections. We analysed the staining patterns of patients and controls. The prognostic value of anti-ganglioside antibodies was also analysed. RESULTS None of the GBS patients (n = 100) reacted against the nodo/paranodal proteins tested, and 61 (61%) were positive for, at least, one anti-ganglioside antibody. GBS sera reacted strongly against DRG neurons more frequently than controls both with IgG (6% vs 0%; p = 0.03) and IgM (11% vs 2.2%; p = 0.02) immunodetection. No differences were observed in the proportion of patients reacting against neuroblastoma-derived human motor neurons. Reactivity against monkey nerve tissue was frequently detected both in patients and controls, but specific patterns were only detected in GBS patients: IgG from 13 (13%) patients reacted strongly against Schwann cells. Finally, we confirmed that IgG anti-GM1 antibodies are associated with poorer outcomes independently of other known prognostic factors. CONCLUSION Our study confirms that (1) GBS patients display a heterogeneous repertoire of autoantibodies targeting nerve cells and structures; (2) gangliosides are the most frequent antigens in GBS patients and have a prognostic value; (3) further antigen-discovery experiments may elucidate other potential antigens in GBS.
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Affiliation(s)
- Cinta Lleixà
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lorena Martín-Aguilar
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elba Pascual-Goñi
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teresa Franco
- Immunology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Caballero
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Noemí de Luna
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Eduard Gallardo
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Xavier Suárez-Calvet
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Laura Martínez-Martínez
- Immunology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Diaz-Manera
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Ricard Rojas-García
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Elena Cortés-Vicente
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Joana Turón
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Carlos Casasnovas
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain.,Neuromuscular Unit, Department of Neurology, Bellvitge University Hospital, Barcelona, Spain.,Neurometabolic Diseases Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Christian Homedes
- Neuromuscular Unit, Department of Neurology, Bellvitge University Hospital, Barcelona, Spain
| | | | | | - José Berciano
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain.,Department of Neurology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria, Santander, Spain
| | - Maria José Sedano-Tous
- Department of Neurology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria, Santander, Spain
| | - Tania García-Sobrino
- Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago, Spain
| | - Julio Pardo-Fernández
- Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago, Spain
| | | | - Iñigo Rojas-Marcos
- Department of Neurology, Hospital Universitario Reina Sofia, Córdoba, Spain
| | | | - Eugenia Martínez-Hernández
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain.,Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Cristina Domínguez-González
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain.,Neuromuscular Diseases Unit, Department of Neurology, Research Institute imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cándido Juárez
- Immunology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Illa
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Luis Querol
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain.
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3
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Martín-Aguilar L, Camps-Renom P, Lleixà C, Pascual-Goñi E, Díaz-Manera J, Rojas-García R, De Luna N, Gallardo E, Cortés-Vicente E, Muñoz L, Alcolea D, Lleó A, Casasnovas C, Homedes C, Gutiérrez-Gutiérrez G, Jimeno-Montero MC, Berciano J, Sedano-Tous MJ, García-Sobrino T, Pardo-Fernández J, Márquez-Infante C, Rojas-Marcos I, Jericó-Pascual I, Martínez-Hernández E, Morís de la Tassa G, Domínguez-González C, Illa I, Querol L. Serum neurofilament light chain predicts long-term prognosis in Guillain-Barré syndrome patients. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-323899. [PMID: 33154183 DOI: 10.1136/jnnp-2020-323899] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study baseline serum neurofilament light chain (sNfL) levels as a prognostic biomarker in Guillain-Barré syndrome (GBS). METHODS We measured NfL in serum (98 samples) and cerebrospinal fluid (CSF) (24 samples) of patients with GBS prospectively included in the International GBS Outcome Study (IGOS) in Spain using single-molecule array (SiMoA) and compared them with 53 healthy controls (HCs). We performed multivariable regression to analyse the association between sNfL levels and functional outcome at 1 year. RESULTS Patients with GBS had higher NfL levels than HC in serum (55.49 pg/mL vs 9.83 pg/mL, p<0.0001) and CSF (1308.5 pg/mL vs 440.24 pg/mL, p=0.034). Patients with preceding diarrhoea had higher sNfL than patients with respiratory symptoms or no preceding infection (134.90 pg/mL vs 47.86 pg/mL vs 38.02 pg/mL, p=0.016). sNfL levels correlated with Guillain-Barré Syndrome Disability Score and Inflammatory Rasch-built Overall Disability Scale (I-RODS) at every timepoint. Patients with pure motor variant and Miller Fisher syndrome showed higher sNfL levels than patients with sensorimotor GBS (162.18 pg/mL vs 95.50 pg/mL vs 38.02 pg/mL, p=0.025). Patients with acute motor axonal neuropathy cute motor axonal neuropathy had higher sNfL levels than other variants (190.55 pg/mL vs 46.79 pg/mL, p=0.013). sNfL returned to normal levels at 1 year. High baseline sNfL levels were associated with inability to run (OR=1.65, 95% CI 1.14 to 2.40, p=0.009) and lower I-RODS (β -2.60, 95% CI -4.66 to -0.54, p=0.014) at 1 year. Cut-off points predicting clinically relevant outcomes at 1 year with high specificity were calculated: inability to walk independently (>319 pg/mL), inability to run (>248 pg/mL) and ability to run (<34 pg/mL). CONCLUSION Baseline sNfL levels are increased in patients with GBS, are associated with disease severity and axonal variants and have an independent prognostic value in patients with GBS.
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Affiliation(s)
- Lorena Martín-Aguilar
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pol Camps-Renom
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cinta Lleixà
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elba Pascual-Goñi
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Díaz-Manera
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Ricardo Rojas-García
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Noemi De Luna
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Eduard Gallardo
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Elena Cortés-Vicente
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Laia Muñoz
- Department of Neurology, Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Daniel Alcolea
- Department of Neurology, Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Alberto Lleó
- Department of Neurology, Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Carlos Casasnovas
- Neuromuscular Diseases Unit, Department of Neurology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Neurometabolic Diseases Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Christian Homedes
- Neuromuscular Diseases Unit, Department of Neurology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | | | | - José Berciano
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Neurology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria, Santander, Spain
| | - María José Sedano-Tous
- Department of Neurology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria, Santander, Spain
| | - Tania García-Sobrino
- Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Julio Pardo-Fernández
- Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Iñigo Rojas-Marcos
- Department of Neurology, Hospital Universitario Reina Sofia, Cordoba, Spain
| | | | | | | | | | - Isabel Illa
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Luis Querol
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
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Garcia-Solaesa V, Serrano-Lorenzo P, Ramos-Arroyo MA, Blázquez A, Pagola-Lorz I, Artigas-López M, Arenas J, Martín MA, Jericó-Pascual I. A Novel Missense Variant Associated with A Splicing Defect in A Myopathic Form of PGK1 Deficiency in The Spanish Population. Genes (Basel) 2019; 10:genes10100785. [PMID: 31658606 PMCID: PMC6826351 DOI: 10.3390/genes10100785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 11/16/2022] Open
Abstract
Phosphoglycerate kinase (PGK)1 deficiency is an X-linked inherited disease associated with different clinical presentations, sometimes as myopathic affectation without hemolytic anemia. We present a 40-year-old male with a mild psychomotor delay and mild mental retardation, who developed progressive exercise intolerance, cramps and sporadic episodes of rhabdomyolysis but no hematological features. A genetic study was carried out by a next-generation sequencing (NGS) panel of 32 genes associated with inherited metabolic myopathies. We identified a missense variant in the PGK1 gene c.1114G > A (p.Gly372Ser) located in the last nucleotide of exon 9. cDNA studies demonstrated abnormalities in mRNA splicing because this change abolishes the exon 9 donor site. This novel variant is the first variant associated with a myopathic form of PGK1 deficiency in the Spanish population.
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Affiliation(s)
- Virginia Garcia-Solaesa
- Department of Medical Genetics, Complejo Hospitalario de Navarra, IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain, (M.A.R.-A.).
| | - Pablo Serrano-Lorenzo
- Laboratorio de Enfermedades Mitocondriales y Neurometabólicas. Instituto de Investigación Hospital 12 de Octubre, 28041 Madrid, Spain, (P.S.-L.).
| | - Maria Antonia Ramos-Arroyo
- Department of Medical Genetics, Complejo Hospitalario de Navarra, IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain, (M.A.R.-A.).
| | - Alberto Blázquez
- Laboratorio de Enfermedades Mitocondriales y Neurometabólicas. Instituto de Investigación Hospital 12 de Octubre, 28041 Madrid, Spain, (P.S.-L.).
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28041 Madrid, Spain.
| | - Inmaculada Pagola-Lorz
- Department of Neurology, Complejo Hospitalario de Navarra, IdiSNA (Navarra Institute for Health Research), 31008 Pamplona, Spain, (I.P.-L.).
| | - Mercè Artigas-López
- Department of Medical Genetics, Complejo Hospitalario de Navarra, IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain, (M.A.R.-A.).
| | - Joaquín Arenas
- Laboratorio de Enfermedades Mitocondriales y Neurometabólicas. Instituto de Investigación Hospital 12 de Octubre, 28041 Madrid, Spain, (P.S.-L.).
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28041 Madrid, Spain.
| | - Miguel A Martín
- Laboratorio de Enfermedades Mitocondriales y Neurometabólicas. Instituto de Investigación Hospital 12 de Octubre, 28041 Madrid, Spain, (P.S.-L.).
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28041 Madrid, Spain.
| | - Ivonne Jericó-Pascual
- Department of Neurology, Complejo Hospitalario de Navarra, IdiSNA (Navarra Institute for Health Research), 31008 Pamplona, Spain, (I.P.-L.).
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Mendióroz M, Jericó-Pascual I, Méndez I, Gastón-Zubimendi I, Arteaga J, Montaner J. [Hyperintensity in the anterior region of the temporal lobes in Fabry's disease]. Rev Neurol 2009; 48:599-600. [PMID: 19472159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- M Mendióroz
- Laboratorio de Investigación Neurovascular, Hospital General Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Jericó-Pascual I, Gállego-Cullere J. [Stroke, tranexamic acid and patent foramen ovale]. Rev Neurol 2008; 46:186. [PMID: 18297631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Jericó-Pascual I, Mauri-Llerda JA. [Discontinuation of anti-epileptic drugs]. Rev Neurol 1997; 25:1603-6. [PMID: 9462991] [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: 02/06/2023]
Abstract
OBJECTIVE It is well known that in the long term most patients achieve/gain control over their epileptic crises and the morbidity associated with chronic anti-epileptic drug treatment. We have tried to review the criteria for discontinuation of such treatment and evaluate drug toxicity and the risks of discontinuation. DEVELOPMENT It is correctly accepted that 70-80% of all epileptic patients experience remission of the disorder, in most cases easily. The greatest risk of recurrence after discontinuation of treatment is during the first year (25-30%). The most important factors to consider with regard to the risk of recurrence are: the age at onset (in nearly all the series studied there was less risk of recurrence when onset occurred before the age of 12, aetiology (greater risk in symptomatic than in idiopathic crises) and EEG (there is a greater risk when focal slowing or bilateral paroxystic activity is seen). CONCLUSIONS The ideal type of patient in whom to discontinue anti-epileptic drugs is a patient who has been free of crises for two years whilst being treated, only one type of crisis present which as always been well controlled, normal neurological examination and IQ, idiopathic epilepsy (except for juvenile myoclonic epilepsy) and with normalization of the EEG whilst on treatment. The decision to discontinue treatment should be made jointly with the patient, especially when adult, regarding fundamental aspects such as driving vehicles and the problem of work and/or loss of a job.
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Affiliation(s)
- I Jericó-Pascual
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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