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Lage C, Sánchez-Rodríguez A, Rivera-Sánchez M, Sierra M, González-Aramburu I, Madera J, Delgado-Alvarado M, López-García S, Martínez-Dubarbie F, Fernández-Matarrubia M, Martínez-Amador N, Martínez-Rodríguez I, Calvo-Córdoba A, Rodríguez-Rodríguez E, García-Cena C, Sánchez-Juan P, Infante J. Oculomotor Dysfunction in Idiopathic and LRRK2-Parkinson's Disease and At-Risk Individuals. J Parkinsons Dis 2024:JPD230416. [PMID: 38701160 DOI: 10.3233/jpd-230416] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background Video-oculography constitutes a highly-sensitive method of characterizing ocular movements, which could detect subtle premotor changes and contribute to the early diagnosis of Parkinson's disease (PD). Objective To investigate potential oculomotor differences between idiopathic PD (iPD) and PD associated with the G2019S variant of LRRK2 (L2PD), as well as to evaluate oculomotor function in asymptomatic carriers of the G2019S variant of LRRK2. Methods The study enrolled 129 subjects: 30 PD (16 iPD, 14 L2PD), 23 asymptomatic carriers, 13 non-carrier relatives of L2PD patients, and 63 unrelated HCs. The video-oculographic evaluation included fixation, prosaccade, antisaccade, and memory saccade tests. Results We did not find significant differences between iPD and L2PD. Compared to controls, PD patients displayed widespread oculomotor deficits including larger microsaccades, hypometric vertical prosaccades, increased latencies in all tests, and lower percentages of successful antisaccades and memory saccades. Non-carrier relatives showed oculomotor changes with parkinsonian features, such as fixation instability and hypometric vertical saccades. Asymptomatic carriers shared multiple similarities with PD, including signs of unstable fixation and hypometric vertical prosaccades; however, they were able to reach percentages of successful antisaccade and memory saccades similar to controls, although at the expense of longer latencies. Classification accuracy of significant oculomotor parameters to differentiate asymptomatic carriers from HCs ranged from 0.68 to 0.74, with BCEA, a marker of global fixation instability, being the parameter with the greatest classification accuracy. Conclusions iPD and LRRK2-G2019S PD patients do not seem to display a differential oculomotor profile. Several oculomotor changes in asymptomatic carriers of LRRK2 mutations could be considered premotor biomarkers.
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Affiliation(s)
- Carmen Lage
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California - San Francisco (UCSF), San Francisco, CA, USA
| | - Antonio Sánchez-Rodríguez
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- Neurology Service, Hospital de Cabueñes, Gijón, Spain
| | - María Rivera-Sánchez
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - María Sierra
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Isabel González-Aramburu
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Jorge Madera
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Manuel Delgado-Alvarado
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
- Neurology Service, Hospital de Sierrallana, Santander, Spain
| | - Sara López-García
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Francisco Martínez-Dubarbie
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Marta Fernández-Matarrubia
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Néstor Martínez-Amador
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- Nuclear Medicine Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Isabel Martínez-Rodríguez
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- University of Cantabria, Santander, Spain
- Nuclear Medicine Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Alberto Calvo-Córdoba
- Universidad Politécnica de Madrid, Centre for Automation and Robotics, Escuela Técnica de Ingenieros Industriales (ETSII), Madrid, Spain
| | - Eloy Rodríguez-Rodríguez
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Cecilia García-Cena
- Universidad Politécnica de Madrid, Centre for Automation and Robotics, UPM-CSIC, Escuela Técnica Superiorde Ingeniería y Diseño Industrial, Madrid, Spain
| | - Pascual Sánchez-Juan
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- CIEN Foundation/Queen Sofia Foundation Alzheimer Center, Madrid, Spain
| | - Jon Infante
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
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Gárate G, Pascual J, Pascual-Mato M, Madera J, Martín MMS, González-Quintanilla V. Untangling the mess of CGRP levels as a migraine biomarker: an in-depth literature review and analysis of our experimental experience. J Headache Pain 2024; 25:69. [PMID: 38684990 PMCID: PMC11057141 DOI: 10.1186/s10194-024-01769-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Calcitonin gene-related peptide (CGRP) is the most promising candidate to become the first migraine biomarker. However, literature shows clashing results and suggests a methodological source for such discrepancies. We aimed to investigate some of these methodological factors to evaluate the actual role of CGRP as biomarker. METHODS Previous to the experimental part, we performed a literature review of articles measuring CGRP in migraine patients. Using our 399 bio-bank sera samples, we performed a series of experiments to test the validity of different ELISA kits employed, time of sample processing, long-term storage, sampling in rest or after moderate exercise. Analysis of in-house data was performed to analyse average levels of the peptide and the effect of sex and age. RESULTS Literature review shows the high variability in terms of study design, determination methods, results and conclusions obtained by studies including CGRP determinations in migraine patients. CGRP measurements depends on the method and specific kit employed, also on the isoform detected, showing completely different ranges of concentrations. Alpha-CGRP and beta-CGRP had median with IQR levels of 37.5 (28.2-54.4) and 4.6 (2.4-6.4)pg/mL, respectively. CGRP content is preserved in serum within the 24 first hours when samples are stored at 4°C after clotting and immediate centrifugation. Storages at -80°C of more than 6 months result in a decrease in CGRP levels. Moderate exercise prior to blood extraction does not modulate the concentration of the peptide. Age positively correlates with beta-CGRP content and men have higher alpha-CGRP levels than women. CONCLUSIONS We present valuable information for CGRP measurements in serum. ELISA kit suitability should be tested prior to the experiments. Alpha and beta-CGRP levels should be analysed separately as they can show different behaviours even within the same condition. Samples can be processed in a 24-h window if they have been kept in 4°C and should not be stored for more than 6 months at -80°C before assayed. Patients do not need to rest before the blood extraction unless they have performed a high-endurance exercise. For comparative studies, sex and age should be accounted for as these parameters can impact CGRP concentrations.
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Affiliation(s)
- Gabriel Gárate
- Instituto de Investigación Marqués de Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla & Universidad de Cantabria, Santander, Spain.
| | - Julio Pascual
- Instituto de Investigación Marqués de Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla & Universidad de Cantabria, Santander, Spain
| | - Marta Pascual-Mato
- Instituto de Investigación Marqués de Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla & Universidad de Cantabria, Santander, Spain
| | - Jorge Madera
- Instituto de Investigación Marqués de Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla & Universidad de Cantabria, Santander, Spain
| | - María Muñoz-San Martín
- Instituto de Investigación Marqués de Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla & Universidad de Cantabria, Santander, Spain
| | - Vicente González-Quintanilla
- Instituto de Investigación Marqués de Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla & Universidad de Cantabria, Santander, Spain
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González-Quintanilla V, Madera J, Pascual J. A response: Update on cough, exertional and sex headache. Cephalalgia 2024; 44:3331024241246242. [PMID: 38573744 DOI: 10.1177/03331024241246242] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Affiliation(s)
- Vicente González-Quintanilla
- University Hospital Marques de Valdecilla, Santander, Spain
- Universidad de Cantabria, Santander, Spain
- IDIVAL, Santander, Spain
| | - Jorge Madera
- University Hospital Marques de Valdecilla, Santander, Spain
- Universidad de Cantabria, Santander, Spain
- IDIVAL, Santander, Spain
| | - Julio Pascual
- University Hospital Marques de Valdecilla, Santander, Spain
- Universidad de Cantabria, Santander, Spain
- IDIVAL, Santander, Spain
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Pascual-Mato M, Gárate G, de Prado-Tejerina C, García MJ, Castro B, González-Quintanilla V, Madera J, Crespo J, Pascual J, Rivero M. Increased prevalence of migraine in women with inflammatory bowel disease: A cross-sectional study. Cephalalgia 2024; 44:3331024241233979. [PMID: 38427755 DOI: 10.1177/03331024241233979] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
BACKGROUND Some studies have suggested an association between migraine and inflammatory bowel disease. We determined migraine prevalence in a cohort of patients with inflammatory bowel disease. METHODS Patients with inflammatory bowel disease aged 18-65 years were interviewed using an ad hoc headache questionnaire. Those who admitted a history of headache in the last year answered the three questions of the ID-Migraine questionnaire. Those who answered "yes" to the three of them were classified as "definite" and those who answered "yes" to two were classified as "probable" migraine. RESULTS We interviewed 283 patients with inflammatory bowel disease. Of these, 176 (62.2%) had headache. Fifty-nine (20.8%; 95% CI 16.3-26.0%) met migraine criteria either definite (n = 33; 11.7%; 95% CI 8.2-16.0%) or probable (n = 26; 9.2%; 95% CI 6.1-13.2). When divided by gender, 12 men (9.6%; 95% CI 5.1-16.2%) and 47 women (29.8%; 95% CI 22.8-37.5%) met migraine criteria. The prevalence of migraine was increased in inflammatory bowel disease patients from the current cohort (20.8%) versus that reported for our general population for the same age group (12.6%; p < 0.0001). These differences remained significant in female inflammatory bowel disease patients (29.8% versus 17.2% in our general population; p < 0.0001), but not in males (9.6% in inflammatory bowel disease vs 8.0%; p = 0.30). Seventeen patients with inflammatory bowel disease (6.0%; 95% CI 3.54-9.44%) fulfilled chronic migraine criteria. There were no differences in migraine prevalence by inflammatory bowel disease subtypes. CONCLUSION Migraine prevalence, including chronic migraine, seems to be increased in patients with inflammatory bowel disease. The fact that this association was stronger for women suggests an influence of sex-related factors.
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Affiliation(s)
- Marta Pascual-Mato
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | - Gabriel Gárate
- Service of Neurology; University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - Carlota de Prado-Tejerina
- Service of Neurology; University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - María José García
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | - Beatriz Castro
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | - Vicente González-Quintanilla
- Service of Neurology; University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - Jorge Madera
- Service of Neurology; University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - Javier Crespo
- Service of Neurology; University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - Julio Pascual
- Service of Neurology; University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - Monserrat Rivero
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
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Gárate G, González-Quintanilla V, González A, Pascual M, Pérez-Pereda S, Madera J, Pascual J. Serum alpha and beta-CGRP levels in chronic migraine patients before and after monoclonal antibodies against CGRP or its receptor. Ann Neurol 2023. [PMID: 37038806 DOI: 10.1002/ana.26658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To analyse the evolution of alpha and beta-CGRP circulating levels throughout CGRP monoclonal antibodies (mAb) treatment in chronic migraine (CM) patients. METHODS We recruited CM patients beginning mAb along with sex and age paired healthy controls (HC). Blood was extracted before, two-weeks (M0.5) and three months (M3) after first dose of mAb, always in free-migraine periods, and once for HCs. Alpha and beta-CGRP serum levels were measured using ELISAs specific for each isoform. RESULTS Baseline alpha-CGRP levels were significantly elevated in 103 CM patients (median [95% CI]: 50.3 [40.5-57.0] pg/mL) compared to 78 HC (37.5 [33.9-45.0] pg/mL; 95% CI of differences: 2.85-17.08 pg/mL) and significantly decreased (n=96) over the course of mAb treatment (M0.5: 40.4 [35.6-48.2] pg/mL; M3: 40.9 [36.3-45.9] pg/mL). Absolute decrease of alpha-CGRP throughout the treatment positively correlated with the decrease in monthly migraine days. Negative modulation of alpha-CGRP significantly associated with positive scores at the patient global impression of change scale and with analgesic overuse reversal. Beta-CGRP did not differ at baseline between CM patients (4.2 [3.0-4.8] pg/mL) and HC (4.4 [3.4-5.6] pg/mL; -1.09 to 0.60) nor was modulated by mAb treatment (n=96) (M0.5: 4.5 [3.5-5.2] pg/mL; M3: 4.6 [3.7-5.2] pg/mL). INTERPRETATION Treatment with mAb, regardless of its target, is able to progressively normalize basally increased alpha-CGRP levels in CM and this effect correlates with efficacy measures, which supports a role of this neuropeptide as the first CM biomarker. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gabriel Gárate
- Service of Neurology of the University Hospital Marqués de Valdecilla
- Instituto de Investigación Valdecilla, IDIVAL
- Universidad de Cantabria
| | - Vicente González-Quintanilla
- Service of Neurology of the University Hospital Marqués de Valdecilla
- Instituto de Investigación Valdecilla, IDIVAL
| | - Andrea González
- Service of Neurology of the University Hospital Marqués de Valdecilla
| | - Marta Pascual
- Instituto de Investigación Valdecilla, IDIVAL
- Universidad de Cantabria
- Service of Gastroenterology of the University Hospital Marqués de Valdecilla
| | - Sara Pérez-Pereda
- Service of Neurology of the University Hospital Marqués de Valdecilla
- Instituto de Investigación Valdecilla, IDIVAL
- Universidad de Cantabria
| | - Jorge Madera
- Service of Neurology of the University Hospital Marqués de Valdecilla
- Instituto de Investigación Valdecilla, IDIVAL
- Universidad de Cantabria
| | - Julio Pascual
- Service of Neurology of the University Hospital Marqués de Valdecilla
- Instituto de Investigación Valdecilla, IDIVAL
- Universidad de Cantabria
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Madera J, M. Rodríguez-Rodríguez E, González-Quintanilla V, Pérez-Pereda S, Pascual J. [Peripheral stimulation of the trigeminal nerve by nasopharyngeal swabbing as a possible trigger of migraine attacks]. Rev Neurol 2023; 76:227-233. [PMID: 36973886 PMCID: PMC10478117 DOI: 10.33588/rn.7607.2022271] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION The role of the central and peripheral nervous system in the generation of migraine is not well understood. Our aim was to determine whether peripheral trigeminal nerve stimuli, such as nasopharyngeal swabs, could trigger migraine attacks. SUBJECTS AND METHODS A survey was sent to 658 doctors, nurses and medical students, asking about the presence of headache suggestive of migraine after carrying out a SARS-CoV-2 swab test, their previous history of migraine, and demographic and headache-related characteristics. Those who tested positive or had associated clinical signs and symptoms of COVID were excluded. RESULTS A total of 377 people were recruited, 309 of whom were included in the sample. Forty-seven (15.2%) reported headache suggestive of migraine after the swab test and 42 (89.4%) of them had a previous history of migraine. The risk of developing migraine was higher in the subgroup of patients with a history of headache suggestive of migraine - odds ratio: 22.6 (95% confidence interval: 8.597-59.397); p < 0.001. No differences were found between the main characteristics of attacks suggestive of migraine before and after the swab test, except for a lower percentage of associated aura afterwards (42.8% vs. 26.1%; p = 0.016). Individuals with previous attacks suggestive of migraine with a frequency of more than two episodes per month had a higher risk of developing a headache suggestive of migraine after the test - odds ratio = 2.353 (95% confidence interval: 1.077-5.145); p = 0.03. CONCLUSIONS Nasopharyngeal swabbing may trigger migraine attacks, with a greater likelihood in individuals with a higher frequency of previous migraines. This would confirm the idea that peripheral stimuli on the trigeminal nerve can trigger migraine attacks in individuals with migraine, according to their degree of trigeminovascular sensitisation.
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Affiliation(s)
- Jorge Madera
- Servicio de Neurología. Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria-IDIVAL. Santander, EspañaHospital Universitario Marqués de ValdecillaHospital Universitario Marqués de ValdecillaSantanderEspaña
| | - Eloy M. Rodríguez-Rodríguez
- Servicio de Neurología. Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria-IDIVAL. Santander, EspañaHospital Universitario Marqués de ValdecillaHospital Universitario Marqués de ValdecillaSantanderEspaña
| | - Vicente González-Quintanilla
- Servicio de Neurología. Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria-IDIVAL. Santander, EspañaHospital Universitario Marqués de ValdecillaHospital Universitario Marqués de ValdecillaSantanderEspaña
| | - Sara Pérez-Pereda
- Servicio de Neurología. Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria-IDIVAL. Santander, EspañaHospital Universitario Marqués de ValdecillaHospital Universitario Marqués de ValdecillaSantanderEspaña
| | - Julio Pascual
- Servicio de Neurología. Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria-IDIVAL. Santander, EspañaHospital Universitario Marqués de ValdecillaHospital Universitario Marqués de ValdecillaSantanderEspaña
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Gárate G, Toriello M, González-Quintanilla V, Pérez-Pereda S, Madera J, Pascual M, Olmos JM, Pascual J. Serum alpha-CGRP levels are increased in COVID-19 patients with headache indicating an activation of the trigeminal system. BMC Neurol 2023; 23:109. [PMID: 36932352 PMCID: PMC10021037 DOI: 10.1186/s12883-023-03156-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/09/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Headache is among the most frequent symptoms of acute COVID-19 infection. Its mechanisms remain obscure, but due to its migraine-like characteristics, the activation of the trigeminal system could account for its underlying pathophysiology. METHODS Our aim was to compare the serum levels of CGRP, as a theoretical marker of trigemino-vascular activation, in 25 COVID-19 inpatients with lung involvement experiencing headache, against 15 COVID-19 inpatients without headache and with those of 25 matched healthy controls with no headache history. RESULTS Morning serum alpha-CGRP levels, as measured by ELISA (Abbexa, UK), were increased in COVID-19 patients with headache (55.2±34.3 pg/mL) vs. controls (33.9±14.0 pg/mL) (p < 0.01). Alpha-CGRP levels in COVID-19 patients without headache were also significantly increased (43.3 ± 12.8 pg/mL; p = 0.05) versus healthy controls, but were numerically lower (-28.2%; p = 0.36) as compared to COVID-19 patients with headache. CONCLUSION CGRP levels are increased in COVID-19 patients experiencing headache in the acute phase of this disease, which could explain why headache frequently occurs in COVID-19 and strongly supports a role for trigeminal activation in the pathophysiology of headache in this viral infection.
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Affiliation(s)
- Gabriel Gárate
- Service of Neurology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, Santander, Cantabria, 39008, Spain
| | - María Toriello
- Service of Neurology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, Santander, Cantabria, 39008, Spain
| | - Vicente González-Quintanilla
- Service of Neurology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, Santander, Cantabria, 39008, Spain
| | - Sara Pérez-Pereda
- Service of Neurology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, Santander, Cantabria, 39008, Spain
| | - Jorge Madera
- Service of Neurology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, Santander, Cantabria, 39008, Spain
| | - Marta Pascual
- Service of Gastroenterology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - José Manuel Olmos
- Service of Internal Medicine, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - Julio Pascual
- Service of Neurology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, Santander, Cantabria, 39008, Spain.
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González-Quintanilla V, Madera J, Pascual J. Update on headaches associated with physical exertion. Cephalalgia 2023; 43:3331024221146989. [PMID: 36786294 DOI: 10.1177/03331024221146989] [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] [Indexed: 02/15/2023]
Abstract
BACKGROUND Headaches associated with physical exertion include headache precipitated by coughing or other Valsalva maneuvers, headache brought on by prolonged physical exercise, sexual headaches and cardiac cephalalgia. OBJECTIVE To review and update the clinical characteristics, etiologies, pathophysiology and management of these headaches related to exertion. METHODS In depth review of the publications, both in PubMed and in the main textbooks, of the different headaches induced by physical exercise. RESULTS Cough, exercise and sexual headaches can be primary or secondary; therefore, complementary studies are mandatory to rule out structural lesions. However, clinical characteristics, such as an old age and response to indomethacin for cough headache or being a young male and response to beta-blockers for exercise and sexual headaches, plus a normal examination are suggestive of a primary etiology. Etiology for secondary varieties, as posterior fossa lesions for cough headache or vascular malformations for exercise and sexual headaches, are also different. Finally, headache as a distant manifestation of myocardial ischemia, also known as "cardiac cephalalgia", appears at exertion in around two-thirds of cases and typically lasts less than 30 minutes and is relieved by nitroglycerine. CONCLUSIONS Primary and secondary cough headache can usually be suspected based on clinical characteristics and separated from exercise and sexual headaches, which share many aspects. Cardiac cephalalgia is not necessarily an exertional headache and should be considered in adult patients with short lasting headaches and patent vascular risk factors.
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Affiliation(s)
| | - Jorge Madera
- University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - Julio Pascual
- University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
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Gallo D, Manrique L, Polanco M, González-Mandly A, Torres E, Palacio E, Vázquez JL, Pérez-Pereda S, González-Quintanilla V, Madera J, Pascual J. De novo headache in ischemic stroke patients treated with thrombectomy: a prospective study. J Headache Pain 2022; 23:85. [PMID: 35864440 PMCID: PMC9306161 DOI: 10.1186/s10194-022-01455-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background and aim Headache attributed to intracranial endovascular procedures is described in the ICHD-3. Our aim was to study the frequency and characteristics of headache specifically related to thrombectomy in patients with ischemic stroke. Methods Prospective evaluation of clinical features of headache after thrombectomy using an ad hoc questionnaire. Results One hundred seventeen patients were included (52.1% females). Most had an anterior circulation artery occlusion (91.5%). 93 (79.5%) received general anaesthesia. 111 (94.9%) required stent retriever, 21 (24.4%) angioplasty and 19 (16.2%) aspiration thrombectomy. 31 (26.5%; 95% CI 18.8–35.5%) had headache related to thrombectomy, and it was associated with a history of primary headache (p = 0.004). No differences about sex, initial NIHSS score, or the type or complexity of the procedure were observed. Headache was usually moderate and oppressive, ipsilateral to the artery occlusion and usually lasted less than 48 hours. Conclusions Almost one-third of patients with ischemic stroke who undergo endovascular thrombectomy experience headache in the first 24 hours, occurring more frequently in patients who had a previous history of headaches regardless of the procedure complexity. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01455-3. - About one third of the patients who undergo a thrombectomy for acute stroke
experience headache directly related to the procedure. - Having a previous history of primary headache is associated with the presence
of headache after thrombectomy. - Headache related to thrombectomy usually coincides with the distribution of the affected artery, although it is bilateral in 45% of the cases, mostly oppressive, of an average duration between 1 and 2 days and of a moderate intensity.
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Affiliation(s)
- Daniel Gallo
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Leire Manrique
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Marcos Polanco
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Andrés González-Mandly
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Eduardo Torres
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Enrique Palacio
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - José Luis Vázquez
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Sara Pérez-Pereda
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Vicente González-Quintanilla
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Jorge Madera
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Julio Pascual
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain.
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Gárate G, Pereda SP, González-Quintanilla V, Madera J, Pascual J. Increase in CGRP levels in a case of hemicrania continua normalizes after a successful response to galcanezumab. Neurol Sci 2022; 43:4581-4582. [DOI: 10.1007/s10072-022-06063-2] [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: 03/27/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022]
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11
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Pérez-Pereda S, Madera J, Munuera CS, Recio MF, Pascual J. Response to Comment on “Is conventional brain MRI useful for the diagnosis of cluste headache in patients who meet ICHD-3 criteria? Experience in three hospitals in Spain”. J Neurol Sci 2022; 438:120176. [DOI: 10.1016/j.jns.2022.120176] [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: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
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12
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Pérez-Pereda S, Madera J, González-Quintanilla V, Drake-Pérez M, Marzal Espí CN, Serrano Munuera C, García SC, Aguilella Linares C, Fernández Recio M, Velamazán Delgado G, Pascual J. Is conventional brain MRI useful for the diagnosis of cluster headache in patients who meet ICHD-3 criteria? Experience in three hospitals in Spain. J Neurol Sci 2021; 434:120122. [PMID: 34979370 DOI: 10.1016/j.jns.2021.120122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/24/2021] [Accepted: 12/21/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the frequency of symptomatic structural lesions and the diagnostic yield of conventional brain MRI in cluster headache (CH). BACKGROUND In contrast to migraine, brain MRI is recommended in patients with CH to exclude potential mimics. The prevalence of symptomatic CH is not known. METHODS We retrospectively analysed in detail the brain MRIs of patients diagnosed as CH in 3 Neurology Services in Spain and reviewed their clinical history. Clinical diagnoses were reassessed based on the ICHD-3 criteria. RESULTS We included 130 patients: 113 (86.9%) were male; mean age at diagnosis being 41.4 years (range 7-82). Forty-nine (37.7%) showed some abnormal MRI finding. Only in two cases potential symptomatic lesions were found: one trigeminal schwannoma and one craneopharyngioma, but both presented atypical features (facial hypoesthesia on examination and episodes of prolonged duration that had progressed to continuous refractory pain without specific pattern, respectively) and therefore did not fulfil the ICHD-3 CH criteria. The remaining abnormal MRI findings were: white matter lesions (24 patients; 18.4%), sinus inflammatory changes (13; 10.0%), small arachnoid cysts (5; 3.8%), empty sella turca (3; 2.3%), and other unspecific findings (8; 6.2%). All of them were not symptomatic based on neuroimaging characteristics, clinical course and response to treatment. CONCLUSIONS Brain MRI in patients who meet ICHD-3 CH criteria, with no atypical clinical features, does not show any clinically-relevant findings, suggesting that these criteria are highly predictive of its primary origin and that systematic MRI is not useful for the diagnosis of typical CH.
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Affiliation(s)
- Sara Pérez-Pereda
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Jorge Madera
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Vicente González-Quintanilla
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Marta Drake-Pérez
- Service of Radiology, University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain
| | | | | | - Silvia Cusó García
- Service of Neurology, Fundació Hospital Sant Joan de Déu, Martorell, Barcelona, Spain
| | | | | | | | - Julio Pascual
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain.
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13
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Sánchez-Rodríguez A, Martínez-Rodríguez I, Sánchez-Juan P, Sierra M, González-Aramburu I, Rivera-Sánchez M, Andrés-Pacheco J, Gutierrez-González Á, García-Hernández A, Madera J, Delgado-Alvarado M, Infante J. Serial DaT-SPECT imaging in asymptomatic carriers of LRRK2 G2019S mutation: 8 years' follow-up. Eur J Neurol 2021; 28:4204-4208. [PMID: 34407293 DOI: 10.1111/ene.15070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/11/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Carriers of the G2019S mutation of LRRK2 provide a great opportunity to investigate the premotor stages of Parkinson's disease (PD). We have studied by serial clinical and dopamine transporter single photon emission computed tomography (DaT-SPECT) evaluations a cohort of asymptomatic carriers of the LRRK2-G2019S mutation in order to evaluate the usefulness of these tools as biomarkers. Here we report the results of the extended follow-up of this cohort at 8 years. METHODS Seventeen participants, of the 25 available from the 4-year evaluation, completed the 8-year assessment. UPDRS-III, UPSIT test and DaT-SPECT imaging (123 I-ioflupane) were performed. We used repeated-measures linear mixed effects models to examine the changes in DaT binding over time. RESULTS Three carriers had converted to PD at 4 years. One additional carrier converted at 8 years. PD-converters had lower striatal DaT binding at baseline than non-converters. There was a significant decline of DaT binding over time, with a mean annual rate of 3.5%, with somewhat inter-individual and intra-individual variability and comparable between PD-converters and non-converters. No carrier with DAT binding ratio above an undefined threshold between 0.5 and 0.8 developed PD symptoms. The age-adjusted UPSIT score did not change significantly over time. CONCLUSIONS The rate of conversion to PD at 8 years in this cohort aged ~58 years at baseline was 16%. The observed decline of DaT binding over time and its association with the phenotype render DaT-SPECT a potentially useful tool for monitoring the premotor stage of the disease, although at the individual level its ability to predict phenoconversion is limited.
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Affiliation(s)
- Antonio Sánchez-Rodríguez
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria (UC), Santander, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Isabel Martínez-Rodríguez
- Nuclear Medicine Department, Molecular Imaging Group (IDIVAL), University Hospital Marqués de Valdecilla, Santander, Spain
| | - Pascual Sánchez-Juan
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria (UC), Santander, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - María Sierra
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria (UC), Santander, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Isabel González-Aramburu
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria (UC), Santander, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - María Rivera-Sánchez
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria (UC), Santander, Spain
| | - Javier Andrés-Pacheco
- Nuclear Medicine Department, Molecular Imaging Group (IDIVAL), University Hospital Marqués de Valdecilla, Santander, Spain.,Neurology Service, Sierrallana Hospital-IDIVAL, University of Cantabria (UC), Torrelavega, Spain
| | - Ángela Gutierrez-González
- Nuclear Medicine Department, Molecular Imaging Group (IDIVAL), University Hospital Marqués de Valdecilla, Santander, Spain
| | - Adrián García-Hernández
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria (UC), Santander, Spain
| | - Jorge Madera
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria (UC), Santander, Spain
| | - Manuel Delgado-Alvarado
- Nuclear Medicine Department, Molecular Imaging Group (IDIVAL), University Hospital Marqués de Valdecilla, Santander, Spain
| | - Jon Infante
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria (UC), Santander, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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14
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González-Quintanilla V, Pérez-Pereda S, González-Suárez A, Madera J, Toriello M, Pascual J. Restless legs-like syndrome as an emergent adverse event of CGRP monoclonal antibodies: A report of two cases. Cephalalgia 2021; 41:1272-1275. [PMID: 34082583 DOI: 10.1177/03331024211017879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND One of the advantages of CGRP monoclonal antibodies is their excellent safety and tolerability. However, postmarketing surveillance, is essential to detect potential rare emergent adverse events. OBJECTIVES To report two patients who developed restless legs syndrome symptoms after treatment with CGRP antibodies. METHODS AND RESULTS Two women with chronic refractory migraine, with no significant medical antecedents, developed typical restless legs syndrome symptoms 1.5 and 4 months after starting erenumab 140 mg, respectively. In case 1 symptoms resolved when erenumab was stopped for two months but reappeared on galcanezumab. In both patients migraine attacks had dramatically decreased and no iron deficiency was found. CONCLUSIONS Even though caution is needed before establishing a causal relationship, these cases suggest that restless legs-like symptoms might be an emergent adverse event of CGRP antibodies, regardless of the mechanism of action. We propose that plastic changes in CGRP sensory fibers, which are very abundant in legs, induced by CGRP monoclonal antibodies could be the reason for restless legs syndrome development.
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Affiliation(s)
- Vicente González-Quintanilla
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Sara Pérez-Pereda
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Andrea González-Suárez
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Jorge Madera
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - María Toriello
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Julio Pascual
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
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15
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Madera J, Sánchez-Soblechero A, Navarrete Solano P, Corro Verde U, Marco de Lucas E, Pacheco Baldor M, Prada PJ, Pascual J. Late vascular complications after cranial radiotherapy: A report of two illustrative cases. Cancer Radiother 2021; 25:786-789. [PMID: 33903008 DOI: 10.1016/j.canrad.2021.04.003] [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: 01/18/2021] [Revised: 03/23/2021] [Accepted: 04/06/2021] [Indexed: 11/15/2022]
Abstract
Cranial radiotherapy (CRT) is used to treat a large variety of benign and malignant disorders. We present two cases of late neurological complications after CRT and briefly discuss its diagnosis and their shared pathophysiological aspects. The first case is a patient with cognitive impairment associated to mineralizing microangiopathy ten years after CRT for nasopharyngeal carcinoma and the second one is a woman with Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome two years after CRT for anaplastic meningioma. Nowadays, higher survival rates might cause an increase in appearance of late neurological complications after CTR. These reported cases show that late complications can mimic a wide variety of neurological conditions and the importance of magnetic resonance image (MRI) to get a diagnosis.
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Affiliation(s)
- J Madera
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Av. Valdecilla s/n, 39008 Santander, Spain
| | - A Sánchez-Soblechero
- Service of Neurology, University Hospital Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - P Navarrete Solano
- Service of Oncology and Radiotherapy, University Hospital Marqués de Valdecilla and IDIVAL, Av. Valdecilla s/n, 39008 Santander, Spain
| | - U Corro Verde
- Service of Oncology and Radiotherapy, University Hospital Marqués de Valdecilla and IDIVAL, Av. Valdecilla s/n, 39008 Santander, Spain
| | - E Marco de Lucas
- Service of Radiology, University Hospital Marqués de Valdecilla and IDIVAL, Av. Valdecilla s/n, 39008 Santander, Spain
| | - M Pacheco Baldor
- Service of Oncology and Radiotherapy, University Hospital Marqués de Valdecilla and IDIVAL, Av. Valdecilla s/n, 39008 Santander, Spain
| | - P J Prada
- Service of Oncology and Radiotherapy, University Hospital Marqués de Valdecilla and IDIVAL, Av. Valdecilla s/n, 39008 Santander, Spain
| | - J Pascual
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Av. Valdecilla s/n, 39008 Santander, Spain.
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16
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Pérez‐Pereda S, González‐Quintanilla V, Madera J, Pascual J. Chronic Migraine With Apparent Loss of Response to Onabotulinum Toxin Type A Due to Local Nitroglycerin Treatment for an Anal Fissure: A Case Report. Headache 2020; 60:2570-2572. [DOI: 10.1111/head.13863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sara Pérez‐Pereda
- Service of Neurology University Hospital Marqués de ValdecillaIDIVAL and University of Cantabria Santander Spain
| | - Vicente González‐Quintanilla
- Service of Neurology University Hospital Marqués de ValdecillaIDIVAL and University of Cantabria Santander Spain
| | - Jorge Madera
- Service of Neurology University Hospital Marqués de ValdecillaIDIVAL and University of Cantabria Santander Spain
| | - Julio Pascual
- Service of Neurology University Hospital Marqués de ValdecillaIDIVAL and University of Cantabria Santander Spain
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Cerveró A, Sedano-Tous MJ, Madera J, López-de-Eguileta A, Casado A. Use of ganglion cell layer analysis for diagnosing anti-glycoprotein neuromyelitis optica of oligodendrocyte myelin. ACTA ACUST UNITED AC 2020; 95:146-149. [PMID: 31980323 DOI: 10.1016/j.oftal.2019.11.011] [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: 07/31/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
The case concerns a 26-year-old patient with bilateral recurrent optic neuritis episodes in the context of suspected neuromyelitis optica. In the first outbreak, she had greatly impaired visual acuity of the left eye, as well as seeing ganglion cell layer damage in both eyes in the optic coherence tomography, with evidence of a possible extensive lesion in the optic chiasma. Likewise, MRI with contrast showed a great involvement of the left optic nerve that compromises the chiasma increasing the suspicion of a neuromyelitis origin. Althogh the anti-myelin oligodendrocyte glycoprotein (MOG) and anti-AQP4 (aquaporin-4) antibodies were negative at first, bilateral involvement of the ganglion cells suggested an extensive lesion that is more characteristic of seropositive anti-MOG neuromyelitis.
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Affiliation(s)
- A Cerveró
- Departamento de Oftalmología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, España
| | - M J Sedano-Tous
- Departamento de Neurología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, España
| | - J Madera
- Departamento de Neurología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, España
| | - A López-de-Eguileta
- Departamento de Oftalmología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, España
| | - A Casado
- Departamento de Oftalmología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, España.
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Madera J, Alba E, Luque G. Performance Evaluation of the Parallel Polytree Approximation Distribution Algorithm on Three Network Technologies. Int Artif 2007. [DOI: 10.4114/ia.v11i35.901] [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: 11/20/2022] Open
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