Repositorio Institucional Fleni
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Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA
No full textBackground: Trials have evaluated the use of clopidogrel and aspirin to prevent stroke after an ischemic stroke or transient ischemic attack (TIA). In a previous trial, ticagrelor was not better than aspirin in preventing vascular events or death after stroke or TIA. The effect of the combination of ticagrelor and aspirin on prevention of stroke has not been well studied.
Methods: We conducted a randomized, placebo-controlled, double-blind trial involving patients who had had a mild-to-moderate acute noncardioembolic ischemic stroke, with a National Institutes of Health Stroke Scale (NIHSS) score of 5 or less (range, 0 to 42, with higher scores indicating more severe stroke), or TIA and who were not undergoing thrombolysis or thrombectomy. The patients were assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive a 30-day regimen of either ticagrelor (180-mg loading dose followed by 90 mg twice daily) plus aspirin (300 to 325 mg on the first day followed by 75 to 100 mg daily) or matching placebo plus aspirin. The primary outcome was a composite of stroke or death within 30 days. Secondary outcomes were first subsequent ischemic stroke and the incidence of disability within 30 days. The primary safety outcome was severe bleeding.
Results: A total of 11,016 patients underwent randomization (5523 in the ticagrelor-aspirin group and 5493 in the aspirin group). A primary-outcome event occurred in 303 patients (5.5%) in the ticagrelor-aspirin group and in 362 patients (6.6%) in the aspirin group (hazard ratio, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P = 0.02). Ischemic stroke occurred in 276 patients (5.0%) in the ticagrelor-aspirin group and in 345 patients (6.3%) in the aspirin group (hazard ratio, 0.79; 95% CI, 0.68 to 0.93; P = 0.004). The incidence of disability did not differ significantly between the two groups. Severe bleeding occurred in 28 patients (0.5%) in the ticagrelor-aspirin group and in 7 patients (0.1%) in the aspirin group (P = 0.001).
Conclusions: Among patients with a mild-to-moderate acute noncardioembolic ischemic stroke (NIHSS score ≤5) or TIA who were not undergoing intravenous or endovascular thrombolysis, the risk of the composite of stroke or death within 30 days was lower with ticagrelor-aspirin than with aspirin alone, but the incidence of disability did not differ significantly between the two groups. Severe bleeding was more frequent with ticagrelor. (Funded by AstraZeneca; THALES ClinicalTrial.gov number, NCT03354429.).Fil: Ameriso, Sebastián Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.Fil: Johnston, S Claiborne. University of Texas at Austin. Dell Medical School. Dean's Office; Estados Unidos.Fil: Amarenco, Pierre. University of Paris. Bichat-Claude Bernard Hospital. Department of Neurology and Stroke Center; Francia.Fil: Denison, Hans. AstraZeneca. Biopharmaceuticals Research and Development; Suecia.Fil: Himmelmann, Anders. AstraZeneca. Biopharmaceuticals Research and Development; Suecia.Fil: Knutsson, Mikael. AstraZeneca. Biopharmaceuticals Research and Development; Suecia.Fil: Ladenvall, Per. AstraZeneca. Biopharmaceuticals Research and Development; Suecia.Fil: James, Stefan. Uppsala University. Department of Medical Sciences; Suecia.Fil: Evans, Scott R. George Washington University. the Biostatistics Center; Estados Unidos.Fil: Molina, Carlos A. Vall d'Hebron Hospital. The Stroke Unit; España.Fil: Molina, Carlos A. Vall d'Hebron Hospital. The Stroke Unit; España.Fil: Wang, Yongjun. Capital Medical University. Tiantan Hospital. Department of Neurology; China
Neurological symptoms as the initial manifestation of IgG4-related disease
No full textResumen no disponibleFil: Alessandro, Lucas. Fleni. Departamento de Neurología; Argentina.Fil: Pastor Rueda, Juan Manuel. Fleni. Departamento de Neurología; Argentina.Fil: Calandri, Ismael Luis. Fleni. Departamento de Neurología; Argentina.Fil: Cammarota, Ángel Norberto. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina
A novel mutation in PSEN1 (p.T119I) in an Argentine family with early- and late-onset Alzheimer's disease
No full textMutations inPSEN1are the most common cause of early-onset Alzheimer’s disease (AD). In this article,we present an Argentine family with autosomal dominant early- and late-onset AD. The proband and 6family members were available for genetic testing and clinical and neuropsychological assessments.Cerebrospinalfluid biomarkers were analyzed in the proband and a cousin (mutation carrier), who alsounderwent positron emission tomography using F-18-2-fluoro-2-deoxy-D-glucose and Pittsburghcompound B. Exon sequencing ofPSEN1,PSEN2, andAPPrevealed a novel heterozygous variant inPSEN1(c.356C>T; p.T119I). Median age of onset in the family was 56 years. However, the proband’s uncleshowed initial symptoms at age 71. Although no DNA was available, he was an obligate carrier becausehis daughter (proband’s cousin) carried the mutation. Both the proband and his cousin exhibitedbiomarker evidence (cerebrospinalfluid or imaging) of underlying Alzheimer’s pathology. Overall, ourresults support that thePSEN1p.T119I variant is likely pathogenic.Fil: Itzcovich, Tatiana. Fleni. Departamento de Neuropatología y Biología Molecular. Laboratorio de Enfermedades Neurodegenerativas; Argentina.Fil: Chrem Méndez, Patricio Alexis. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina.Fil: Vázquez, Silvia. Fleni. Departamento de Diagnóstico por Imágenes. Centro de Imágenes Moleculares; Argentina.Fil: Barbieri-Kennedy, Micaela. Fleni. Departamento de Neuropatología y Biología Molecular. Laboratorio de Enfermedades Neurodegenerativas; Argentina.Fil: Niikado, Matías. Fleni. Departamento de Neuropatología y Biología Molecular. Laboratorio de Enfermedades Neurodegenerativas; Argentina.Fil: Martinetto, Horacio. Fleni. Departamento de Neuropatología y Biología Molecular. Laboratorio de Enfermedades Neurodegenerativas; Argentina.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Sevlever, Gustavo Emilio. Fleni. Departamento de Neuropatología y Biología Molecular. Laboratorio de Enfermedades Neurodegenerativas; Argentina.Fil: Surace, Ezequiel Ignacio. Fleni. Departamento de Neuropatología y Biología Molecular. Laboratorio de Enfermedades Neurodegenerativas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Cytotoxic lesion of the corpus callosum in a patient with aphasic status epilepticus
No full textA 47-year-old man with a history of aphasic seizures presented to the emergency room with a 12-hour global aphasia. Upon admission, brain MRI did not reveal acute lesions, and EEG showed sharp waves in the left frontal-temporal region. An Aphasic Status Epilepticus was diagnosed and antiepileptic treatment was initiated with adequate response. A week after the episode, a new brain MRI showed a high-signal ovoid lesion on T2-weighted and FLAIR sequences in the central part of the splenium of the corpus callosum. On diffusion-weighted images (DWI) the lesion was hyperintense with decreased apparent diffusion coefficient (ADC) values, indicating restricted diffusion consistent with a cytotoxic lesion of the corpus callosum (CLOCC). Follow-up MRI one month later showed complete image resolution. CLOCCs are secondary lesions associated with various entities in which high levels of cytokines and extracellular glutamate cause intracellular edema and reduced diffusion, a condition called cytotoxic edema, which affects vulnerable brain regions such as the splenium of the corpus callosum. In epileptic patients, CLOCCs may be due to the effect of seizures, especially prolonged ones, as well as antiepileptic treatment itself. CLOCCs are rare radiological findings and must be recognized to avoid misdiagnosis.Fil: Castiglione, Juan Ignacio. Fleni. Departamento de Neurología; Argentina.Fil: Ricciardi, Mario Emiliano. Fleni. Departamento de Neurología; Argentina.Fil: Bensi, Catalina. Fleni. Departamento de Neurología; Argentina
GAS6 signaling tempers Th17 development in patients with multiple sclerosis and helminth infection
No full textMultiple sclerosis (MS) is a highly disabling neurodegenerative autoimmune condition in which an unbalanced immune response plays a critical role. Although the mechanisms remain poorly defined, helminth infections are known to modulate the severity and progression of chronic inflammatory diseases. The tyrosine kinase receptors TYRO3, AXL, and MERTK (TAM) have been described as inhibitors of the immune response in various inflammatory settings. We show here that patients with concurrent natural helminth infections and MS condition (HIMS) had an increased expression of the negative regulatory TAM receptors in antigen-presenting cells and their agonist GAS6 in circulating CD11bhigh and CD4+ T cells compared to patients with only MS. The Th17 subset was reduced in patients with HIMS with a subsequent downregulation of its pathogenic genetic program. Moreover, these CD4+ T cells promoted lower levels of the co-stimulatory molecules CD80, CD86, and CD40 on dendritic cells compared with CD4+ T cells from patients with MS, an effect that was GAS6-dependent. IL-10+ cells from patients with HIMS showed higher GAS6 expression levels than Th17 cells, and inhibition of phosphatidylserine/GAS6 binding led to an expansion of Th17 effector genes. The addition of GAS6 on activated CD4+ T cells from patients with MS restrains the Th17 gene expression signature. This cohort of patients with HIMS unravels a promising regulatory mechanism to dampen the Th17 inflammatory response in autoimmunity.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Ortiz Wilczyñski, Juan M. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental; Argentina.Fil: Olexen, Cinthia M. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental; Argentina.Fil: Errasti, Andrea E. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacología; Argentina.Fil: Schattner, Mirta. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental; Argentina.Fil: Carrera Silva, Eugenio A. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental; Argentina.Fil: Rothlin, Carla V. Yale University. Department of Immunobiology and Pharmacology; Estados Unidos
Nosology and Phenomenology of Psychosis in Movement Disorders
No full textBackground: Psychotic symptoms, such as delusions and hallucinations, are part of the clinical picture of several conditions presenting movement disorders. Phenomenology and epidemiology of psychosis in Parkinson's disease have received wide attention; however, the presence of psychosis in other movement disorders is, comparatively, less well known.
Objectives: To review psychotic symptoms present in different movement disorders.
Methods: A comprehensive and structured literature search was performed to identify and analyze data on patients with movement disorders and comorbid psychosis.
Results: In monogenic parkinsonisms, such as PARK-GBA, PARK-LRRK2, and PARK-SNCA, visual hallucinations related to dopamine replacement therapy are frequent as well as are delusions in PARK-LRRK2 and PARK-SNCA, but not in PARK-GBA. Different types of delusions and hallucinations are found in Huntington's disease and other choreic disorders. In Tourette's syndrome, paranoid delusions as well as visual, olfactory, and auditory hallucinations have been described, which usually develop after an average of 10 years of disease. Delusions in ataxias are more frequent in ATX-TBP, ATX-ATN1, and ATX-ATXN3, whereas it is rare in Friedreich's ataxia. Psychosis is also a prominent and frequent clinical feature in Fahr's disease, Wilson's disease, neurodegeneration with brain iron accumulation, and some lysosomal storage disorders, whereas it is uncommon in atypical parkinsonisms and dystonia. Psychosis usually occurs at late disease stages, but may appear as onset symptoms of the disease, especially in Wilson's disease, Huntington's disease, late-onset Tays-Sachs, and Niemann-Pick.
Conclusion: Psychosis is a frequent comorbidity in most hyper- and hypokinetic movement disorders. Appropriate recognition is relevant both in the early and late disease stages.Fil: Rossi, Malco. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina.Fil: Merello, Marcelo. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina. Universidad Católica Argentina; Argentina.Fil: Farcy, Nicole. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina.Fil: Starkstein, Sergio E. University of Western Australia. School of Psychiatry and Clinical Neurosciences; Australia
Fading of Deep Brain Stimulation Efficacy Versus Disease Progression: Untangling a Gordian Knot
No full textFil: Fasano, Alfonso. Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital. Edmond J. Safra Program in Parkinson's Disease; Canadá. Division of Neurology University of Toronto; Canadá. Krembil Brain Institute; Canadá.Fil: Merello, Marcelo. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina. Universidad Católica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Multidisciplinary Rehabilitation for Adult Patients With Stroke
Get PDFIt is estimated that two thirds of people who have suffered a stroke have sequels that condition their quality of life. The rehabilitation of the stroke is a complex process, which requires the multidisciplinary approach of specialized professionals (doctors, kinesiologists, nurses, occupational therapists, phonoaudiologists, neuropsychologists and nutritionists). Currently, the practices carried out are a consequence of the combination of evidence and consensus, most of them through international stroke rehabilitation guides. The objective of this review is to adjust the international recommendations on stroke rehabilitation to what is applied to daily practice, in order to unify the criteria of the recommendations and to reduce the variability of the practices carried out. This work is a review of the literature on stroke rehabilitation guides developed in the last 10 years. Each section was supervised by different professionals specialized in these areas. We analyze the time and organization necessary to develop rehabilitation, recommendations for motor, cognitive and visual rehabilitation, the management of dysphagia and nutrition, the approach of comorbidities (venous thrombosis, skin ulcers, pain, psychiatric disorders and osteoporosis) and the necessary tasks to favor the return to the activities of daily life.Fil: Alessandro, Lucas. Fleni. Departamento de Neurología; Argentina.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Olmos, Lisandro Emilio. Fleni. Centro de Rehabilitación Adultos CR; Argentina.Fil: Bonamico, Lucas. Fleni. Centro de Rehabilitación Adultos CR. Servicio de Neurorehabilitación; Argentina.Fil: Gianella, Matías Gabriel. Fleni. Centro de Rehabilitación Adultos CR. Servicio de Kinesiología; Argentina.Fil: Russo, María Julieta. Fleni. Departamento de Neurología; Argentina.Fil: Ameriso, Sebastián Francisco. Fleni. Centro Integral de Neurología Vascular; Argentina.Fil: Muzio, Diana María. Fleni. Departamento de Medicina de Rehabilitación; Argentina.Fil: Campora, Horacio. Fleni. Centro de Rehabilitación Adultos CR. Servicio de Kinesiología; Argentina.Fil: Vescovo, María Ester. Fleni. Centro de Rehabilitación Adultos CR; Argentina.Fil: Lado, Vanina. Fleni. Centro de Rehabilitación Adultos CR. Servicio de Terapia Ocupacional; Argentina.Fil: Butus, Ayelén. Fleni. Centro de Rehabilitación Adultos CR. Servicio de Kinesiología; Argentina.Fil: Galluzzi, Hugo Daniel. Fleni. Departamento de Enfermería; Argentina.Fil: Décima, Graciela. Fleni. Departamento de Enfermería; Argentina.Fil: Mastroberti, Liliana Roxana. Fleni. Servicio de Nutrición; Argentina; Argentina.Fil: Ahumada, Martina H. Fleni. Centro de Rehabilitación Adultos CR. Servicio de Neurorehabilitación; Argentina.Fil: Delorme, Ricardo. Fleni. Departamento de Medicina Interna; Argentina
La investigación y los investigadores clínicos continúan huérfanos en el sistema nacional de ciencia y técnica…
No full textFil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina
Consenso sobre el uso de anticuerpos monoclonales en la migraña en Argentina
Get PDFIntroducción. La migraña es un trastorno muy prevalente que se estima que afecta a alrededor del 15% de los sujetos adultos. Durante los últimos años, se ha evaluado la eficacia y la seguridad de los anticuerpos monoclonales que actúan sobre la vía del péptido relacionado con el gen de la calcitonina (AM-PRGC) en la migraña. Diversos grupos de trabajo internacionales han intentado clarificar y normatizar el uso de estos medicamentos en la migraña. Sin embargo, en muchas ocasiones se extrapolan datos de otras regiones que no contemplan la realidad de cada lugar o son difíciles de implementar.
Objetivo. Proveer recomendaciones sobre el uso de AM-PRGC en pacientes con migraña en Argentina.
Desarrollo. Un grupo de expertos de Argentina conformado por neurólogos, mediante metodología de ronda de encuestas en la distancia y reuniones presenciales, llevó adelante la elaboración del consenso pretendido para el uso de AM-PRGC en pacientes con migraña en Argentina. Se establecieron las recomendaciones basadas en la evidencia publicada y en el criterio de los expertos que participaron. Las recomendaciones se enfocaron en el momento de usar los AM-PRGC en la migraña tanto crónica como episódica, la duración, los cuidados y el entorno para hacerlo.
Conclusión. Las recomendaciones establecidas en el presente consenso permitirán optimizar el manejo de los AM-PRGC en pacientes con migraña en Argentina.Fil: Doctorovich, Eduardo D. Hospital Italiano de Buenos Aires. Sección de Cefaleas; Argentina.Fil: Martín-Bertuzzi, Fiorella. Hospital Italiano de Buenos Aires. Sección de Cefaleas; Argentina.Fil: Goicochea, María Teresa. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Bonamico, Lucas. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Miranda, Silvina. Instituto Central de Medicina de La Plata. Servicio de Neurología; Argentina.Fil: Figuerola, María L. Hospital de Clínicas. División de Neurología; Argentina. Universidad de Buenos Aires; Argentina. Hospital Alemán. Servicio de Neurología; Argentina.Fil: Schubaroff, Pablo A. Hospital Municipal Profesor Dr. Bernardo A. Houssay; Argentina.Fil: Buonanotte, Federico. Hospital Nacional de Clínicas de Córdoba. Servicio de Neurología; Argentina.Fil: Rocchi, Viviana. Hospital General de Agudos Dr. Juan A. Fernández. Servicio de Neurología; Argentina.Fil: Rua, Isabel. Hospital Nacional Profesor A. Posadas. Servicio de Neurología; Argentina.Fil: Bruera, Osvaldo. Instituto de Neurociencias de Buenos Aires. Secciones de Cefaleas y Dolor; Argentina. Fundación Favaloro. Instituto de Neurociencias; ArgentinaFil: Giglio, Jorge. Hospital R. Rossi. Servicio de Neurología; Argentina. Instituto de Diagnóstico de La Plata; Argentina.Fil: De Paz, José J. Asociación Mendocina de Neurología Clínica; Mendoza.Fil: Pelli-Noble, Raúl. Centro Neurológico Tucumán; Tucumán.Fil: Arago, Laura. Hospital Interzonal General de Agudos Eva Perón. Servicio de Neurología; Argentina.Fil: Burgos, Marcos. Hospital San Bernardo. Servicio de Neurología; Argentina.Fil: Ayala, Leonardo S. Hospital General de Agudos José María Penna. Servicio de Neurología; Argentina.Fil: Davidow, Laura. Fundación Rosarina de Neurorrehabilitación; Santa Fe