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S Giménez-Roldán

Publications and source records attributed to S Giménez-Roldán.

At least 19 recordsLinked to original sources
PubMed2006

Epidemiological assessment of levodopa use in Cuba: 1993-1998.

PURPOSE: The purpose of this study is to describe and evaluate the use of levodopa in Cuba in order to provide a basis for intervention aimed at improving pharmacological treatment of individuals presenting with Parkinson's disease (PD). METHODS: We studied the amount of levodopa, both plain and combined, distributed by the central laboratory to hospital and community pharmacies in Cuba in the period 1993-1998. An internationally established drug-classification system and a reported method for epidemiological assessment of levodopa sales were applied. Sweden in 1994 served as the reference population. RESULTS: National crude rates of levodopa use basically remained stable since 1994, and in 1998 stood at 0.11 defined daily dose (DDD) per 1000 inhabitants/day, approximately 15 times lower than the corresponding figure for the reference population. Annual provincial use of levodopa showed considerable geographical variation, with the lowest rates in the eastern provinces and the highest rates in Havana City (Ciudad de La Habana). Adjustment for age reduced such differences by approximately 50%. CONCLUSIONS: Levodopa use in Cuba is low and consistent with the reported low prevalence of the diagnosis of PD. Results suggest that the diagnosis and treatment of PD can be improved, with emphasis on better detection of PD.

Cuba↗
PubMed2006

[Long-term risk of relapses in Tolosa-Hunt syndrome].

INTRODUCTION: The reviewed diagnostic criteria of Tolosa- Hunt síndrome (THS) by the International Classification of Headache Disorders (ICHD-II, 2004) includes demonstration of inflammatory changes by magnetic resonance imaging (MRI) in the cavernous sinus region as an alternative to biopsy. Careful follow-up is required to exclude other possible causes of painful ophthalmoplegia. It remains unclear for how long such close observation should be extended to assure the diagnosis nor whether THS represents a self-limited condition in the long-term. CASE REPORT: An observational study along 13 years of a patient fulfilling current ICHD-II criteria for THS to clarify the natural history of the disorder. RESULTS: We witnessed three episodes, the presenting one causing severe left orbital pain, ipsilateral abducens palsy , and hypoesthesia in the territory of the ophthalmic branch of the trigeminal nerve. Gadolinium MRI showed enhancement of tissue infiltrating the lateral wall of the carotid sinus. A relapse 21 months later caused involvement of left oculomotor and abducens nerves in addition to orbital pain which responded rapidly to steroids. Ensuing remission maintained for up to 11 years concluded in a new relapse again characterized by severe ipsilateral orbital pain and frontal numbness, but no ophthalmoplegia. A gadolinium-MRI did not show enhancement on this occasion despite prompt response to steroids. CONCLUSION: The risk of relapses in THS and its response to steroids may be maintained for as long as 13 years.

Adult↗
PubMed2005

[Saint Orosia's convulsionaries].

Annual outbreaks of mass motor hysteria have been observed in the past during some religious celebrations. In Jaca, a Northern Spanish town close to the Pyrenees, the convulsionaries have been well known since the eleventh century, though little attention has been paid to this phenomenon in the medical literature. Pilgrims from remote parts of the valleys gathered in procession on June 25th in front of Saint Orosia sarcophagus. Epileptics, psychotics, the paralyzed and hysterics joined the procession looking for healing together with in exorcist rituals. Reig and Gascó, a military physician, described in 1881 the atmosphere of fervour, ignorance and vestigial paganism accompanying these unusual behaviours. Saint Orosia's convulsionaries ended in 1947 following prohibition by local Catholic Authorities, probably the recurrent outbreak of mass motor hysteria lasting to most recent years in Europe.

Catholicism↗
PubMed2004

Combining entacapone with levodopa/DDCI improves clinical status and quality of life in Parkinson's Disease (PD) patients experiencing wearing-off, regardless of the dosing frequency: results of a large multicentre open-label study.

The efficacy of entacapone and its impact on patient quality of life (QOL) was investigated in an open-label study of 899 patients with idiopathic Parkinson's Disease (PD) experiencing wearing-off fluctuations. Patients were divided into 3 groups (3, 4 or 5 doses daily) based on their current levodopa dosage frequency. Patients received 200 mg entacapone with each levodopa/dopa-decarboxylase inhibitor (DDCI) dose, while continuing their same levodopa/DDCI dosage regimen for 4 weeks. Primary efficacy measure was the Investigators' Clinical Global Impression of Change (CGIC). Patient QoL was assessed using the validated 8-item Parkinson's Disease Questionnaire (PDQ-8). Investigators' CGIC revealed that 76.5% of entacapone treated patients experienced an improvement in global status after 4 weeks. Treatment with entacapone was also associated with improvement in patient QoL, with a mean reduction (improvement) in PDQ-8 score of 1.8 from baseline. This study confirms and extends the results of earlier studies demonstrating that, independent of dosing frequency, completing levodopa/DDCI therapy with entacapone provides clinically relevant improvements in global status and QoL in PD patients experiencing wearing-off on their current levodopa dosing frequency.

Aged↗
PubMed2004

[The neurologist and patients driving motor vehicles].

Driving motor vehicles is a complex visuomotor task that challenges normal nervous system functioning. Indemnity of sensory organs and intact alertness are essential. In addition, safe driving is extremely sensitive to disturbances of attention as well as to some forms of cortical dysfunction. Epilepsy, cognitive impairment, Parkinson's disease, stroke and sleep disorders, among other conditions, may interfere with driving through different mechanisms. The individual rights to maintain important privileges such as having a driver's license may enter in conflict with a society demanding safer regulations. Current trends favor more liberal restrictions and may provide specific limits on an individual basis to patients with impairments caused by neurological diseases. So far, there is no information on the consequences in terms of rate of accidents following newly introduced changes in driver license regulations for neurological patients.

Accidents, Traffic↗
PubMed2003

Efficacy and tolerability of entacapone in patients with Parkinson's disease treated with levodopa plus a dopamine agonist and experiencing wearing-off motor fluctuations. A randomized, double-blind, multicentre study.

The efficacy and tolerability of entacapone was investigated in a randomized, double-blind, placebo-controlled, 3-month study of 162 patients with Parkinson's disease (PD) treated with levodopa and a dopamine agonist and experiencing wearing-off motor fluctuations. Patients were randomized in a 3 : 2 ratio to entacapone 200 mg or placebo, administered with each dose of levodopa. Efficacy was judged on the improvement of "on" and "off" time while awake (Patient Diary and UPDRS part IV Item 39), Investigators' Global Assessment, the SF-36 Health Survey, and changes in levodopa dosages. Patients were monitored for adverse events, laboratory safety and vital signs throughout the study. Improvements in "on" time as assessed using patient diary data showed a trend in favour of entacapone, however these did not reach statistical significance. "Off" time while awake (UPDRS part IV Item 39) showed an improvement of at least one category in 36% of entacapone-treated patients, compared with 22% in the control group (p = 0.0038). The proportion of patients showing an improvement at the Investigators' Global Assessment was significantly higher (p = 0.0006) in the entacapone-treated group of patients. Also, the proportion of patients with a reduction in their daily levodopa dose was significantly higher (p = 0.02) in the entacapone group (28%) compared with placebo (13%). As expected, the most frequent adverse events were dopamine-mediated (dyskinesia: entacapone 31% versus placebo 13%), and harmless urinary discoloration. The modest increase in dyskinesias could be readily managed by levodopa down-adjustment, and, at study end there was no significant difference for the UPDRS "overall dyskinesia score" between entacapone and placebo. In conclusion, although the primary efficacy variable did not reach statistical significance, the present results demonstrate that entacapone provides additional antiparkinsonian benefits to levodopa therapy and is well tolerated in levodopa-treated PD patients experiencing wearing-off motor fluctuations despite adjunct dopamine agonist therapy.

Aged↗
PubMed2003

[Neurocysticercosis and immigration].

Formerly an endemic disorder, the frequency of neurocysticercosis (NCC) in Spain has been declining during recent decades until reaching its near extinction. However, the strong migratory flow during recent years towards large cities from countries where NCC is highly prevalent, particularly the Andean area of South America, has been followed by a growing increase ot this infestation among immigrants. Since NCC is commonly acquired by direct contamination from carriers of the tapeworm Taenia solium, there may be an emergence of NCC among Spanish-born population unless preventive measures are taken.

Emigration and Immigration↗
PubMed2002

[Dominant autosomal cerebral arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). A review].

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a familial condition caused by a mutation of the Notch3 gen in chromosome 19. Accumulation of osmiophilic granular material (GOM) on the middle layer of small and medium-sized cerebral arteries leads to progressive narrowing of the blood vessels. As a result, clinical findings include migraine, cerebrovascular ischemic events, vascular dementia and a number of neuropsychiatric disorders associated to an extensive leukoencephalopathy readily shown by MRI studies. GOM deposits, however, are systemic and maybe shown ultrastructuraly on skin vessels by means of a biopsy. Detection of mutations of the Notch3 gen by molecular genetics may also allow accurate diagnosis during life. So far, there is no effective treatment for this disorder.

Adult↗
PubMed2001

Efficacy and safety of clozapine and olanzapine: an open-label study comparing two groups of Parkinson's disease patients with dopaminergic-induced psychosis.

Clozapine, an atypical neuroleptic agent, improves dopaminergic-induced psychosis in parkinsonian patients without increasing motor disability. However, because of the risk of agranulocytosis periodic hematological controls are mandatory. Olanzapine, another atypical neuroleptic, does not require such monitoring, which may represent a practical advantage. Therefore, for 12weeks we compared the tolerability and efficacy of clozapine and olanzapine in two groups of nine consecutive parkinsonian psychotic patients treated with these compounds. All the patients on clozapine (mean starting dose: 13.1+/-7.9mg/d) completed the study despite reporting a number of adverse events, including somnolence, falls, orthostatic hypotension, and syncope. In contrast, early withdrawal occurred in three of the nine patients receiving olanzapine, due to severe gait deterioration and drowsiness (mean starting dose: 3.9+/-1.3mg/d). Psychotic symptoms improved in both groups, as reflected by a reduction of 71.7% in clozapine and a 61.7% reduction in olanzapine, in five selected items from the Neuropsychiatric Inventory. On conclusion of the study, parkinsonism had improved in the clozapine group with a 19.7% decrease in the raw scores and a 7.9% decrease in the weighted scores according to the Cornell University Rating Scale for parkinsonism (mean dose: 16.9+/- 10.3mg/d). Conversely, the six patients receiving olanzapine who finished the study experienced aggravated parkinsonian symptoms, with a 25.5% worsening in the raw scores and a 24.6% worsening in the weighted scores (mean dose: 4.7+/-2.3mg/d). We postulate that the early drop-outs in the olanzapine-treated parkinsonian group may be attributable to a non-specific effect of the drug as a result of starting at too high a dose, and that the worsening of parkinsonism following prolonged treatment may have been caused by the drug's blocking effect on striatal D2 receptors.

Journal Article↗
PubMed1999

[Neurological complications of Mediterranean boutonneuse fever. Presentation of a case of acute encephalomeningomyelitis and review of the literature].

Mediterranean spotted fever is an infectious disease due to Rickettsia conorii usually considered as benign; however, 10% of cases may have severe complications. We report a patient with celiac disease who developed encephalomeningomyelitis secondary to Mediterranean spotted fever. Meningoencephalitic involvement occurred during the acute phase, with myelitis appearing early during convalescence, as acute onset paraplegia involving the lumbosacral spinal cord. A magnetic resonance study showed multifocal white matter disturbances, with no lesions in the spinal cord. One month following onset, R. conorii antibodies serum level was 1/640. A cutaneous biopsy performed during the acute phase revealed endothelial hyperplasia, intraluminal thrombosis and lymphocytic perivascular infiltrate. Several immunological disturbances were found (circulating immune complexes, antinuclear antibodies, IgG paraproteinemia). The development of a systemic vasculitis is the major pathogenetic factor in the origin of systemic complications of Mediterranean spotted fever. We review the neurological syndromes reported in association with R. conorii infection. Our case is the second described as acute myelopathy complicating Mediterranean spotted fever.

Acute Disease↗
PubMed1998

[Vehicle drivers with Parkinson disease: behavior schedules of a patient sample from the Community of Madrid].

The aim of this study was to evaluate features of the disease, habits patterns at the wheel, and reasons to give up driving motor vehicles in subjects with Parkinson's disease (PD). Prospective study using a semistructured questionnaire comparing current or former drivers with PD patients and a control group matched for age, sex and social background. In a PD and movement disorders clinic in an university hospital. Sixty-two out of 166 PD subjects interviewed owned a driving licence. Only 19.2% of PD subjects were currently active drivers. Compared to parkinsonian ex-drivers, they were 6 years younger on average, most were in disease stage II, and were less often under antidepressant medication. Nevertheless, disabling motor fluctuations and dyskinesias were present in 19% of the patients. A 47% of the active drivers reported no difficulty at the wheel; the remaining declared to experience a wide range of difficulties, particularly to manage pedals or to assess distances properly. PD itself lead to driving withdrawal in 80% of ex-drivers in contrast to 6% of controls who stop driving due to other illness. Only 40% of PD subjects were driving 5 years after diagnosis. Medical advice was influential in deciding to stop driving in a single patient. Disease onset in early adulthood often allowed to keep driving for 10 years or longer. Most subjects with PD give up driving during the first 5 years following disease onset, most due to the disease itself. Most active drivers adapt themselves to their physical circumstances, either by reducing the number of hours at the wheel or reducing speed. They are usually in early stages of the disease, despite which many experience subjective motor and visuospatial difficulties during driving. A minority keep on driving despite disabling fluctuations. This subset presumably represent a group at risk to suffer an increased rate of traffic accidents and in whom medical advice would be desirable.

Accidents, Traffic↗
PubMed1998

[Information about the diagnosis: a subjective experience of patients with multiple sclerosis and rheumatoid arthritis].

INTRODUCTION: It may be difficult to determine the adequate mement, the information content and the most convenient person to inform patients with chronic, incurable disorders with uncertain prognosis as sclerosis multiple (MS). MATERIAL AND METHODS: To gain information on how these aspects had been carried-out and the extent to which patients felt satisfied, we studied 60 definite MS ambulatory patients by means of a semistructured questionnaire attending a hospital-based MS unit. The results were compared with those from 40 patients with rheumatoid arthritis (RA), a chronic disabling disorder of the locomotor system with variable course, examined in a similar way. RESULTS: In the vast majority of patients (81.7 and 82.9%, respectively) in both groups the diagnosis had been delivered by a specialist, a point on which most patients agreed upon as convenient. However, most MS patients (78.4%) and nearly all of those with RA (97.6%) should have desired to receive information on their diagnosis as soon as this might had been firmly established. Though more than half the patients (61.7 of MS and 56.1% of RA) admitted to have developed depressive symptoms following information on their diagnosis, a majority expressed their desire to have been informed early about 'all the truth' regarding their prognosis (78.4 and 87.8%, respectively). CONCLUSIONS: Though data from this study should be taken with caution when applied to MS patients shortly after experiencing their first symptoms, and it is therefore unwise to give rigid rules, the vast majority of MS patients express the desire to receive early, accurate, and individualized information on their diagnosis provided by a competent specialist.

Adult↗
PubMed1998

[Abnormal movements in a case of extrapontine myelinolysis. Review of the literature].

INTRODUCTION AND CLINICAL CASE: We present a case of extra-pontine myelinolysis caused by acute hypernatraemia in which a complex picture of late onset extrapyramdial features, choreodystonia and parkinsonism developed. Repeated physical examinations, neurophysiological and neuroimaging studies using magnetic resonance all indicated an extra-pontine site of the lesions, which symmetrically affected the striate and to a lesser extent both thalami. We review the relevant literature available and analyze the cases described as having abnormal movements associated with a myelinolytic syndrome. CONCLUSIONS: Extra-pontine myelinolysis is a cause of acquired dystonia, chorea and parkinsonism, generally of late onset and with varying response to treatment. The association of hypernatraemia, hyperglycaemia and liver transplant seem to predispose to the development of extra-pontine lesions.

Acute Disease↗
PubMed1998

[Phenomenology of motor crisis in non-epileptic patients with psychogenic crises].

INTRODUCTION: Recognition of different ictal motor patterns in psychogenic seizures may be useful in terms of differentiation from epileptic seizures and may also improve understanding the underlying psychopathology. OBJECTIVE: To outline recognizable ictal motor patterns that may help to distinguish psychogenic motor seizures from epileptic convulsive episodes. PATIENTS AND METHODS: Chart review from 54 patients with motor psychogenic seizures and no clinical or EEG evidence of concomitant epilepsy. RESULTS: Only 5 patients (9.2%) experienced more than one ictal motor pattern along their illness. Categorization into four subtypes according to ictal motor behaviour was possible in all other patients: psychogenic seizures with flaccid unconsciousness (32.6%), combativeness (32.6%), a hypermobile subtype (24.4%) as defined by the presence of intentional movements or slow rhythmic oscillations of a segment or the entire body, and rigidity (10.2%). CONCLUSIONS: Many psychogenic motor seizures consistently present with recognizable motor phenomena which may be readily identified providing the availability of a reliable witness. Psychogenic seizures as presented spontaneously in a general neurology setting may differ from those reported in biased referrals to video-EEG laboratories. Recognition of characteristic patterns may help differentiation from tonic-clonic convulsions, avoid unnecessary examinations, and may provide insights into their underlying psychopathological mechanisms.

Adolescent↗
PubMed1997

Early combination of bromocriptine and levodopa in Parkinson's disease: a prospective randomized study of two parallel groups over a total follow-up period of 44 months including an initial 8-month double-blind stage.

To determine if the combination of levodopa (LD) plus bromocriptine (Br) in the early stages of Parkinson's disease (PD) permits reduction of LD dosage and consequently results in fewer motor fluctuations and dyskinesias, a double-blind, multicenter prospective study in 50 PD patients who had responded favorably to LD while under treatment with that drug for < or = 6 months was undertaken. Patients were randomized into two parallel groups (LD alone and LD plus Br). During the first placebo-controlled stage of the study lasting 8 months, association of a fixed dose of Br (15 mg/day) in the LD regimen did not allow a significant reduction in the daily LD dose. Still, in patients on combined LD plus Br, there was a tendency toward smaller daily requirements of LD as compared with those on LD alone, and the difference in LD dose between the two groups was significantly different (515.4 +/- 240 vs. 725.6 +/- 230 mg/day; p < 0.01) after 44 months of continuous treatment in the 40 patients still enrolled in the open-label stage. At that point in time, the mean dose of Br had been increased by 9.2 mg in the combined treatment group, and the mean dose of LD was 40.7% lower than in the group receiving LD alone. On subsequent evaluations, the number of patients with dyskinesias or describing wearing-off fluctuations severe enough to require changes in treatment was lower than in the group under combined therapy, the differences being significant after 20 and 44 months, respectively (36.8 vs. 9.5 and 47.3 vs. 14.2%). Our results support early combined LD-Br therapy in PD, but no conclusions can be drawn as to whether this dopamine agonist exerts a preventive effect on the late side effects of LD or has another mechanism of action.

Aged↗