RESUMEN
BACKGROUND: Disproportionate fear of contracting COVID-19 (coronaphobia) may result in inappropriate use of preventive measures that could, in turn, result in severe harm to the patient. OBJECTIVE: To describe a patient with subacute parkinsonism and cognitive dysfunction and magnetic resonance imaging (MRI) evidence of bilateral deep white matter and basal ganglia damage. CASE PRESENTATION: A 56-year-old female presented with a 4-week history of insomnia, cognitive decline, and parkinsonism. Brain MRI revealed a bilateral lesion of both globus pallidus, deep white matter, and cerebellar hemispheres. Her son reported that, for the previous month, she had been cleaning her facial mask three times a day with a pure methanol solution as a disinfectant due to an intense fear of acquiring COVID-19. Previously, she had used 97% isopropyl alcohol and had inadvertently switched to methanol. After the exposure ended, she slowly improved but 4 months later she remains severely disabled. CONCLUSIONS: The repeated exposure to methanol vapor, the MRI findings, and the absence of other etiologies for her cognitive and parkinsonian features led to the diagnosis of chronic methanol intoxication with severe central nervous system damage. Misinformation is a likely contributory factor to such scenario. Efforts should be made by the scientific community to educate the general public on avoiding self-damaging behaviors as a result of coronaphobia.
Asunto(s)
COVID-19 , Metanol , Miedo , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , SARS-CoV-2RESUMEN
Introducción. La migraña crónica es frecuentemente incapacitante y se asocia a abuso de analgésicos. La reciente aprobación de la toxina botulínica tipo A -OnabotulinumtoxinA (OnabotA)- supone un avance considerable. Objetivo. Describir la casuística en el uso compasivo preautorización. Pacientes y métodos. Son 35 casos con migraña crónica de una consulta de cefaleas, tratados entre julio de 2009 y diciembre de 2011. Se inyectaron 100 U de OnabotA en 21 puntos de la musculatura facial y craneal, según el protocolo modificado del ensayo PREEMPT. Para el análisis se determinaron, antes y después del tratamiento, los episodios y días de migraña, la intensidad de dolor y los días de incapacidad (Migraine Dissability Assessment Scale), y los datos cuantitativos de la medicación. En el seguimiento se repitieron las dosis en los respondedores, en un intervalo terapéutico individualizado de respuesta. Se consideró respuesta: caída de la intensidad del dolor a la mitad o ≥ 4 puntos en la escala visual analógica (VAS), y descenso de días de dolor en ≥ 7/mes o conversión a no abuso de fármacos. Resultados. Observamos respuesta en 27 casos (80%). En ellos apreciamos: disminución de la intensidad de la cefalea, tanto en intensidad del dolor (VAS < 0,001) como en días mensuales de incapacidad (3,2 frente a 0,4; p < 0,001); mejoría en el número de días mensuales de dolor (19,8 frente a 13,8; p < 0,05); y reducción significativa de casos de abuso de analgésicos (69% frente a 13%; p < 0,01). La duración media del efecto fue de 15 semanas; el seguimiento medio, de 9,8 meses. Encontramos efectos adversos (ptosis palpebral o dolor local) en cinco casos (14%). Conclusiones. La OnabotA demostró eficacia en el tratamiento preventivo de la migraña crónica. Observamos mejoría, con especial significado clínico, en la intensidad de la cefalea. Se redujo también el abuso de analgésicos. Los efectos adversos fueron escasos (AU)
Introduction. Chronic migraine is very disabling, with medication overuse commonly associated. The recent approval of botulinum toxin-A -OnabotulinumtoxinA (OnabotA)- means a hallmark. Aim. To describe our experience in compassionate use before approval Patients and methods. 35 cases with chronic migraine assessed between July 2009-December 2011 in a specialized headache consultation. 100 U of OnabotA were injected in 21 points over the facial and pericranial muscles, according to a modified PREEMPT protocol. We determined before and after treatment: number of episodes and migraine days; pain intensity and days of disability extracted from MIDAS score, and data regarding drug intake. After follow-up, new injections were given at intervals dictated by individualized response timing. Therapeutic response was considered when: intensity of pain was reduced to a half o ≥ 4 VAS points, or the number of monthly days of pain descended ≥ 7/month, or the case converted to non-drug overuser. Results. In 27 cases (80%) it was proved clinical improvement. This effect was confirmed by: a reduction in headacheseverity, reflected as much in pain intensity (VAS scale < 0.001) as in the number of days with disability (3.2 vs 0.4, p < 0.001); an improvement in the number of monthly days of pain (19.8 vs 13.8, p < 0.05; a significant decrease in the number of cases of medication overuse (69% vs 13%, p < 0.01). Mean duration of effect was 15 weeks and mean follow-up 9.8 months. Conclusions. OnabotA disclosed efficacy as prophylactic treatment of chronic migraine. It is mainly expressed as a reduction of pain intensity. Medication overuse also descended. Adverse events were sparse (AU)
Asunto(s)
Humanos , Trastornos Migrañosos/tratamiento farmacológico , Toxinas Botulínicas Tipo A/uso terapéutico , Analgésicos/uso terapéutico , Prevención de EnfermedadesRESUMEN
INTRODUCTION: Chronic migraine is very disabling, with medication overuse commonly associated. The recent approval of botulinum toxin-A -OnabotulinumtoxinA (OnabotA)- means a hallmark. AIM: To describe our experience in compassionate use before approval. PATIENTS AND METHODS: 35 cases with chronic migraine assessed between July 2009-December 2011 in a specialized headache consultation. 100 U of OnabotA were injected in 21 points over the facial and pericranial muscles, according to a modified PREEMPT protocol. We determined before and after treatment: number of episodes and migraine days; pain intensity and days of disability extracted from MIDAS score, and data regarding drug intake. After follow-up, new injections were given at intervals dictated by individualized response timing. Therapeutic response was considered when: intensity of pain was reduced to a half o ≥ 4 VAS points, or the number of monthly days of pain descended ≥ 7/month, or the case converted to non-drug overuser. RESULTS: In 27 cases (80%) it was proved clinical improvement. This effect was confirmed by: a reduction in headache severity, reflected as much in pain intensity (VAS scale < 0.001) as in the number of days with disability (3.2 vs 0.4, p < 0.001); an improvement in the number of monthly days of pain (19.8 vs 13.8, p < 0.05; a significant decrease in the number of cases of medication overuse (69% vs 13%, p < 0.01). Mean duration of effect was 15 weeks and mean follow-up 9.8 months. CONCLUSIONS: OnabotA disclosed efficacy as prophylactic treatment of chronic migraine. It is mainly expressed as a reduction of pain intensity. Medication overuse also descended. Adverse events were sparse.