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PURPOSE/AIM OF THE STUDY: To identify the inflammation indexes associated with the severity and functional prognosis in ischemic stroke. MATERIAL AND METHODS: A prospective study was conducted with ischemic stroke cases included in the i-ReNe clinical registry. Patients were divided into groups according to the severity on admission measured by the National Institutes of Health Stroke Scale (NIHSS) and the functional prognosis at 30 and 90 days of discharge measured by the modified Rankin Scale (mRS). RESULTS: We included 145 patients with a mean age of 61.5 ± 12.75, 97 (66.9%) were men. The leukocyte and neutrophil counts, Neutrophil-to-Lymphocyte ratio (NLR), Derived Neutrophil-to-Lymphocyte ratio (dNLR), Platelet-to-Lymphocyte ratio (PLR), Segmented Neutrophil-to-Monocyte ratio (SeMo ratio), and Systemic Immune-inflammation index (SII) were higher in moderate-to-severe stroke (NIHSS ≥6). NLR, PLR, SeMo ratio, and SII were higher in the group with severe disability and death at 30 days (mRS ≥4). In the multiple logistic regression analyses, SeMo ratio >14.966 and SII >623.723 were associated with moderate-to-severe stroke (NIHSS ≥6). In addition, SeMo ratio >7.845 was associated with severe disability and death at 30 days (mRS ≥4). CONCLUSIONS: Systemic inflammation indexes could be rapid and low-cost markers used in the initial evaluation of ischemic stroke, whose values could help to stratify patients according to their severity and functional prognosis. This is the first study to establish a relationship between ischemic stroke and the SeMo ratio.
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Introduction: Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives. This paper will review the 2-year advances and future plans of the Latin American alliance for stroke. Method: In March 2020, a survey based on the Declaration of Gramado items was sent to the neurologists participants of the Stroke Ministerial Meetings. The results were confirmed with representatives of the Ministries of Health and leaders from the countries at the second Latin American Stroke Ministerial Meeting. Results: In 2 years, public stroke awareness initiatives increased from 25 to 75% of countries. All countries have started programs to encourage physical activity, and there has been an increase in the number of countries that implement, at least partially, strategies to identify and treat hypertension, diabetes, and lifestyle risk factors. Programs to identify and treat dyslipidemia and atrial fibrillation still remained poor. The number of stroke centers increased from 322 to 448, all of them providing intravenous thrombolysis, with an increase in countries with stroke units. All countries have mechanical thrombectomy, but mostly restricted to a few private hospitals. Pre-hospital organization remains limited. The utilization of telemedicine has increased but is restricted to a few hospitals and is not widely available throughout the country. Patients have late, if any, access to rehabilitation after hospital discharge. Conclusion: The initiative to collaborate, exchange experiences, and unite societies and governments to improve stroke care in Latin America has yielded good results. Important advances have been made in the region in terms of increasing the number of acute stroke care services, implementing reperfusion treatments and creating programs for the detection and treatment of risk factors. We hope that this approach can reduce inequalities in stroke care in Latin America and serves as a model for other under-resourced environments.
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INTRODUCTION: The current SARS-CoV-2 pandemic has caused feelings of anxiety, confusion, and panic among the world population. Due to these psychological changes resulting from the stress produced by the disease, we sought to investigate the psychological impact of the pandemic on the university student community. MATERIAL AND METHODS: 1,283 students were surveyed, of which 1,149 students were selected. The majority of the subjects were female, and the overall average age was of 20 years. They were provided with an 82-question online questionnaire divided into four sections; looking for the prevalence of significant symptomatology of major depression and generalised anxiety using the PHQ-9 and GAD-7 scales; and factors that potentially affect the mental health of our university population. RESULTS: We found a high prevalence of significant depression (47.08%) and anxiety (27.06%) symptomatology, considering a score of 10 or more as cut-off point. There was no significant difference in depression and anxiety symptomatology between the health-care students and non-health-care students. CONCLUSIONS: Our results, together with what is observed in the literature, allow us to conclude that the college student population has a high risk of mental illness, and these should be taken into consideration for the search of effective strategies for detection and control of mental health illnesses. Undoubtedly, the COVID-19 pandemic is a red flag that shows the need to upgrade mental health programmes in universities and to validate virtual instruments.
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Ansiedad/etiología , COVID-19/psicología , Depresión/etiología , Estudiantes/psicología , Ansiedad/diagnóstico , Ansiedad/epidemiología , COVID-19/prevención & control , Estudios Transversales , Depresión/diagnóstico , Depresión/epidemiología , Femenino , Empleos en Salud/educación , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , México/epidemiología , Prevalencia , Pruebas Psicológicas , Determinantes Sociales de la Salud , Universidades , Adulto JovenRESUMEN
ABSTRACT Introduction: The current SARS-CoV-2 pandemic has caused feelings of anxiety, confusion, and panic among the world population. Due to these psychological changes resulting from the stress produced by the disease, we sought to investigate the psychological impact of the pandemic on the university student community. Material and methods: 1,283 students were surveyed, of which 1,149 students were selected. The majority of the subjects were female, and the overall average age was of 20 years. They were provided with an 82-question online questionnaire divided into four sections; looking for the prevalence of significant symptomatology of major depression and generalised anxiety using the PHQ-9 and GAD-7 scales; and factors that potentially affect the mental health of our university population. Results: We found a high prevalence of significant depression (47.08%) and anxiety (27.06%) symptomatology, considering a score of 10 or more as cut-off point. There was no significant difference in depression and anxiety symptomatology between the health-care students and non-health-care students. Conclusions: Our results, together with what is observed in the literature, allow us to conclude that the college student population has a high risk of mental illness, and these should be taken into consideration for the search of effective strategies for detection and control of mental health illnesses. Undoubtedly, the COVID-19 pandemic is a red flag that shows the need to upgrade mental health programmes in universities and to validate virtual instruments.
RESUMEN Introducción y objetivos: La actual pandemia de SARS-CoV-2ha causado sentimientos de ansiedad, confusión y pánico entre la población mundial. Debido a estos cambios psi cológicos derivados del estrés que produce la enfermedad, se buscó investigar el impacto psicológico de la pandemia en la comunidad estudiantil universitaria. Material y métodos: Se encuestó a 1.283 estudiantes, de los que se seleccionó a 1.149. La mayoría eran mujeres y la media de edad fue 20 anos. Se les proporcionó un cuestionario en línea de 82 preguntas divididas en 4 secciones para indagar la prevalencia de síntomas signi ficativos de depresión mayor y ansiedad generalizada utilizando las escalas PHQ-9 y GAD-7, además factores que pueden afectar a la salud mental de nuestra población universitaria. Resultados: Se halló una alta prevalencia de síntomas significativos de depresión (47,08%) y ansiedad (27,06%), considerando como umbral un total de 10 o más puntos. No hubo difer encias significativas entre los estudiantes relacionados con la salud y los no relacionados con la salud. Conclusiones: Nuestros resultados, en conjunto con lo observado en la literatura, muestran que la comunidad universitaria es una población en riesgo de enfermedades mentales, por lo que el Gobierno debería considerar la creación de estrategias efectivas para la detección de problemas de salud mental; sin duda alguna, la actual pandemia de COVID-19 es un foco rojo sobre las necesidad de mejores programas de salud mental en universidades y validación de instrumentos virtuales.
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No disponible.
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COVID-19 , Estudiantes de Medicina , COVID-19/epidemiología , COVID-19/psicología , Humanos , Estudiantes de Medicina/psicologíaRESUMEN
Background: Providing endovascular treatment (EVT) access for acute ischemic stroke (AIS) is a challenge in Latin America. Even though the Mexican Endovascular Reperfusion Registry (MERR) and the RESILIENT trial have demonstrated the feasibility of EVT of AIS in Latin America, the MERR has uncovered potential challenges to delivering EVT to AIS patients. Aim: To identify the perceived barriers to access EVT for AIS in Mexico. Methods: We surveyed endovascular neurologists in Mexico. The survey addressed the situation of thrombectomy in the country and the infrastructure and resources available in the participants' institutions. The questionnaire inquired about costs, barriers, and challenges to accessing EVT for AIS, emphasizing the prices and availability of medical devices needed for EVT. Results: We analyzed data from 21 hospitals. The most extreme identified barriers to access EVT were the lack of health coverage for EVT in the National Health System, the cost of the medical supplies for EVT, and inadequate knowledge of stroke symptoms in the general population. The median cost for EVT was USD 20,000 (IQR 7,500-20,000). From this amount, 60% (IQR 50-70%) corresponded to the costs involved with medical devices. EVT carried additional out-of-pocket costs in 90% of the hospitals, and in 57%, the costs exceed USD $10,000. Conclusion: Efforts at all government levels and society are required to tackle these barriers. An increase in and efficient use of public funding for EVT coverage and the deployment of continuous and targeted stroke education campaigns could reduce inequities in EVT access in Mexico.
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Introduction: The current SARS-CoV-2 pandemic has caused feelings of anxiety, confusion, and panic among the world population. Due to these psychological changes resulting from the stress produced by the disease, we sought to investigate the psychological impact of the pandemic on the university student community. Material and methods: 1,283 students were surveyed, of which 1,149 students were selected. The majority of the subjects were female, and the overall average age was of 20 years. They were provided with an 82-question online questionnaire divided into four sections; looking for the prevalence of significant symptomatology of major depression and generalised anxiety using the PHQ-9 and GAD-7 scales; and factors that potentially affect the mental health of our university population. Results: We found a high prevalence of significant depression (47.08%) and anxiety (27.06%) symptomatology, considering a score of 10 or more as cut-off point. There was no significant difference in depression and anxiety symptomatology between the health-care students and non-health-care students. Conclusions: Our results, together with what is observed in the literature, allow us to conclude that the college student population has a high risk of mental illness, and these should be taken into consideration for the search of effective strategies for detection and control of mental health illnesses. Undoubtedly, the COVID-19 pandemic is a red flag that shows the need to upgrade mental health programmes in universities and to validate virtual instruments.
Introducción y objetivos: La actual pandemia de SARS-CoV-2 ha causado sentimientos de ansiedad, confusión y pánico entre la población mundial. Debido a estos cambios psicológicos derivados del estrés que produce la enfermedad, se buscó investigar el impacto psicológico de la pandemia en la comunidad estudiantil universitaria. Material y métodos: Se encuestó a 1.283 estudiantes, de los que se seleccionó a 1.149. La mayoría eran mujeres y la media de edad fue 20 años. Se les proporcionó un cuestionario en línea de 82 preguntas divididas en 4 secciones para indagar la prevalencia de síntomas significativos de depresión mayor y ansiedad generalizada utilizando las escalas PHQ-9 y GAD-7, además factores que pueden afectar a la salud mental de nuestra población universitaria. Resultados: Se halló una alta prevalencia de síntomas significativos de depresión (47,08%) y ansiedad (27,06%), considerando como umbral un total de 10 o más puntos. No hubo diferencias significativas entre los estudiantes relacionados con la salud y los no relacionados con la salud. Conclusiones: Nuestros resultados, en conjunto con lo observado en la literatura, muestran que la comunidad universitaria es una población en riesgo de enfermedades mentales, por lo que el Gobierno debería considerar la creación de estrategias efectivas para la detección de problemas de salud mental; sin duda alguna, la actual pandemia de COVID-19 es un foco rojo sobre las necesidad de mejores programas de salud mental en universidades y validación de instrumentos virtuales.
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Experimental studies suggest that the intestinal barrier is affected in ischemic stroke. D-Lactate and intestinal fatty acid-binding protein (IFABP) are markers of intestinal mucosa integrity and barrier function. Our purpose was to evaluate the serum concentrations of these markers in patients with acute ischemic stroke (AIS). We included patients with AIS and used healthy subjects as controls. Clinical, demographic and outcome measures were recorded. Blood was drawn within 24 h of symptom onset. Serum concentrations of D-Lactate and IFABP were determined using commercially available colorimetric and ELISA kits, respectively. We included a total of 61 patients (median age of 64 years). The majority of patients were male (57.4%). The most common cause of stroke was atherosclerosis (34.4%), followed by small-vessel disease and cardioembolic (32.7% each). Mean admission NIHSS score was 8. Median IFABP and D-Lactate concentrations were significantly higher in patients than in controls. Concentrations were not associated with stroke severity or 3-month outcome. Patients with large-artery atherosclerosis and cardioembolic etiology had higher D-Lactate values than patients with small-vessel disease. D-Lactate and IFABP were significantly elevated in patients with AIS. This suggests that there is disruption of the intestinal barrier in patients with AIS.
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Isquemia Encefálica/sangre , Isquemia Encefálica/diagnóstico , Proteínas de Unión a Ácidos Grasos/sangre , Accidente Cerebrovascular Isquémico/sangre , Accidente Cerebrovascular Isquémico/diagnóstico , Ácido Láctico/sangre , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosAsunto(s)
Fibrinolíticos/uso terapéutico , Accidente Cerebrovascular Isquémico/diagnóstico , Evaluación de Síntomas , Terapia Trombolítica , Anciano , Comorbilidad , Diagnóstico Diferencial , Femenino , Fibrinolíticos/administración & dosificación , Humanos , Accidente Cerebrovascular Isquémico/tratamiento farmacológico , Accidente Cerebrovascular Isquémico/epidemiología , Masculino , México/epidemiología , Persona de Mediana Edad , Factores de Riesgo , Tiempo de TratamientoAsunto(s)
Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia Trombolítica , Fibrinolíticos/uso terapéutico , Evaluación de Síntomas , Accidente Cerebrovascular Isquémico/diagnóstico , Comorbilidad , Factores de Riesgo , Diagnóstico Diferencial , Fibrinolíticos/administración & dosificación , Tiempo de Tratamiento , Accidente Cerebrovascular Isquémico/tratamiento farmacológico , Accidente Cerebrovascular Isquémico/epidemiología , México/epidemiologíaRESUMEN
BACKGROUND: Beginning August 2017, we conducted a prospective case-control investigation in Monterrey, Mexico to assess the association between Zika virus (ZIKV) and Guillain-Barré syndrome (GBS). METHODS: For each of 50 GBS case-patients, we enrolled 2-3 afebrile controls (141 controls in total) matched by sex, age group, and presentation to same hospital within 7 days. RESULTS: PCR results for ZIKV in blood and/or urine were available on all subjects; serum ZIKV IgM antibody for 52% of case-patients and 80% of controls. Subjects were asked about antecedent illness in the two months prior to neurological onset (for case-patients) or interview (for controls). Laboratory evidence of ZIKV infection alone (PCR+ or IgM+) was not significantly different between case-patients and controls (OR: 1.26, 95% CI: 0.45-3.54) but antecedent symptomatic ZIKV infection [a typical ZIKV symptom (rash, joint pain, or conjunctivitis) plus laboratory evidence of ZIKV infection] was higher among case-patients (OR: 12.45, 95% CI: 1.45-106.64). GBS case-patients with laboratory evidence of ZIKV infection were significantly more likely to have had typical ZIKV symptoms than controls with laboratory evidence of ZIKV infection (OR: 17.5, 95% CI: 3.2-96.6). This association remained significant even when only GBS case-patients who were afebrile for 5 days before onset were included in the analysis, (OR 9.57 (95% CI: 1.07 to 85.35). CONCLUSIONS: During ZIKV epidemics, this study indicates that increases in GBS will occur primarily among those with antecedent symptomatic ZIKV.
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Síndrome de Guillain-Barré , Infección por el Virus Zika , Virus Zika , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Niño , Preescolar , Brotes de Enfermedades , Femenino , Síndrome de Guillain-Barré/complicaciones , Síndrome de Guillain-Barré/epidemiología , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Estudios Prospectivos , Adulto Joven , Infección por el Virus Zika/sangre , Infección por el Virus Zika/complicaciones , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/orinaRESUMEN
BACKGROUND: There is inequality in access to recent advancements in endovascular treatment of acute ischemic stroke (AIS), and Mexico is unusually sensitive to such inequality. AIMS: To report the initial experience of the Mexican Endovascular Reperfusion Registry (MERR). METHODS: The MERR is an academic, independent, prospective, multicenter, observational registry of patients treated with endovascular reperfusion techniques in Mexican hospitals. The registry includes information on demographic and clinical characteristics, diagnostic procedures, treatments, selected time metrics, and outcomes. RESULTS: In all, 49 (57.1% female) patients from 8 centers were included and had the following characteristics: median National Institute of Health Stroke Scale score, 16; median Alberta Stroke Program Early CT Score score, 9; received intravenous tissue-type plasminogen activator, 49%; and treated with mechanical devices, 39 (79.6%), including 20 treated with stent retriever alone, 2 with retriever and intra-arterial thrombolysis (IAt), 10 with catheter aspiration (4 in combination with IAt), 6 with a combination of catheter aspiration and stent retriever, and 1 with IAt followed by balloon angioplasty. Recanalization (TICI 2b or better) was achieved in 69.4% of the patients. The median clot to recanalization time was 30 minutes. A modified Rankin scale ≤2 was achieved in 44.9% of the patients, and 68.2% of these were treated with stent retriever (P = .011). Procedure-related morbidity was 12.2%, 7 patients presented intracerebral hemorrhage (71.4% asymptomatic), and all-cause mortality was 6.1%. CONCLUSIONS: Endovascular treatment of AIS in Mexico is feasible and has an efficacy comparable to that of other countries. Still, many challenges remain, especially pertaining to high costs and difficulties in equality in access to treatment.
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Angioplastia de Balón , Isquemia Encefálica/terapia , Países en Desarrollo , Accidente Cerebrovascular/terapia , Trombectomía , Terapia Trombolítica , Anciano , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/instrumentación , Angioplastia de Balón/mortalidad , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidad , Femenino , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Humanos , Masculino , México , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Stents , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Trombectomía/efectos adversos , Trombectomía/instrumentación , Trombectomía/mortalidad , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/mortalidad , Resultado del Tratamiento , Dispositivos de Acceso VascularRESUMEN
Alzheimer's Disease (AD) is the main cause of dementia worldwide. Inflammatory cytokines and chemokines are related to different stages of AD and may be related to the progression of the disease. A Case-control study of AD patients healthy, age and sex-matched controls was carried out at the University Hospital "Dr. José E. Gonzalez", UANL. Cytokines and chemokines were measured from blood samples taken from the cubital vein after 8 h of fast. We included 78 subjects from which 29 had AD and 49 were healthy controls. CTACK (p = 0.003), MIG (p = 0.043) and SDF-1α (p = 0.001) were increased in subjects with AD, whereas no change was observed in other cytokines and chemokines. CTACK, MIG and SDF-1α are present in the Central Nervous System and are related to inflammation and endothelial dysfunction. Longitudinal studies evaluating the change of these chemokines in AD are needed to understand their role in AD progression and possibly lead to new diagnostic and therapeutic targets.
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Enfermedad de Alzheimer/sangre , Biomarcadores/sangre , Quimiocinas/sangre , Anciano , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Humanos , Estudios Longitudinales , MasculinoRESUMEN
Resumen Introducción: La vinpocetina de liberación prolongada ha demostrado ser efectiva en el control de crisis de inicio focal en pacientes epilépticos con una baja frecuencia de eventos adversos. Se realizó un estudio clínico para evaluar la eficacia y tolerabilidad de la vinpocetina como tratamiento adyuvante en pacientes con este padecimiento. Métodos: Se realizó un estudio clínico, doble ciego, de grupos paralelos. Se reclutaron 87 pacientes con diagnóstico de epilepsia focal tratados con uno a tres fármacos antiepilépticos. Los pacientes se aleatorizaron para ser tratados con vinpocetina (n = 41) o placebo (n = 46) de manera adyuvante a su tratamiento, e ingresaron a la fase basal (4 semanas), a la fase de titulación (4 semanas) y a la fase de evaluación (8 semanas) conservando estables las dosis de la vinpocetina y de los fármacos antiepilépticos. Resultados: La vinpocetina fue más efectiva que el placebo en la reducción de las crisis al finalizar la fase de evaluación (p < 0.0001). El 69% de los pacientes tratados con vinpocetina presentaron una reducción mayor al 50% en las crisis en comparación con el 13% de los pacientes tratados con placebo. No se presentaron diferencias significativas en cuanto a la presencia de efectos adversos en los pacientes tratados con vinpocetina comparados con los tratados con placebo. Los eventos adversos más frecuentes observados con vinpocetina fueron cefalea (7.9%) y diplopía (5.2%). Conclusiones: Como tratamiento adyuvante, la vinpocetina (2 mg/kg/día) redujo eficazmente la frecuencia de crisis epilépticas y demostró ser bien tolerada. Presenta un amplio perfil de seguridad y eventos adversos conocidos, que son transitorios y sin secuelas.
Abstract Background: Extended-release vinpocetine is effective to control focal onset epileptic seizures with a low rate of adverse events. A clinical study was performed to evaluate the efficacy and tolerability of vinpocetine as an adjuvant treatment in patients with this condition. Methods: A double-blind clinical study of parallel groups was conducted, in which 87 patients with a diagnosis of focal epilepsy treated with one to three antiepileptic drugs were recruited. Patients were randomized to receive vinpocetine (n = 41) or placebo (n = 46) adjuvant to their treatment. Patients entered the baseline phase (4 weeks), the titration phase (4 weeks) and the evaluation phase (8 weeks), maintaining stable doses of vinpocetine and their respective antiepileptic drug treatment. Results: Vinpocetine was more effective than placebo in reducing seizures at the end of the evaluation phase (p < 0.0001). Sixty-nine percent of the vinpocetine-treated patients had a 50% reduction in seizures compared to 13% of placebo-treated patients. No significant differences in the presence of adverse effects in patients treated with vinpocetine compared to those treated with placebo were observed. The most frequent adverse events observed with vinpocetine were headache (7.9%) and diplopia (5.2%). Conclusions: As an adjuvant treatment, vinpocetine (2 mg/kg/day) effectively reduced the frequency of epileptic seizures and proved to be well tolerated. Vinpocetine has a wide safety profile and well-known adverse events, which are transient and with no sequelae.
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Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Alcaloides de la Vinca/administración & dosificación , Epilepsias Parciales/tratamiento farmacológico , Anticonvulsivantes/administración & dosificación , Alcaloides de la Vinca/efectos adversos , Método Doble Ciego , Estudios Longitudinales , Resultado del Tratamiento , Preparaciones de Acción Retardada , Anticonvulsivantes/efectos adversosRESUMEN
Background: Extended-release vinpocetine is effective to control focal onset epileptic seizures with a low rate of adverse events. A clinical study was performed to evaluate the efficacy and tolerability of vinpocetine as an adjuvant treatment in patients with this condition. Methods: A double-blind clinical study of parallel groups was conducted, in which 87 patients with a diagnosis of focal epilepsy treated with one to three antiepileptic drugs were recruited. Patients were randomized to receive vinpocetine (n = 41) or placebo (n = 46) adjuvant to their treatment. Patients entered the baseline phase (4 weeks), the titration phase (4 weeks) and the evaluation phase (8 weeks), maintaining stable doses of vinpocetine and their respective antiepileptic drug treatment. Results: Vinpocetine was more effective than placebo in reducing seizures at the end of the evaluation phase (p < 0.0001). Sixty-nine percent of the vinpocetine-treated patients had a 50% reduction in seizures compared to 13% of placebo-treated patients. No significant differences in the presence of adverse effects in patients treated with vinpocetine compared to those treated with placebo were observed. The most frequent adverse events observed with vinpocetine were headache (7.9%) and diplopia (5.2%). Conclusions: As an adjuvant treatment, vinpocetine (2 mg/kg/day) effectively reduced the frequency of epileptic seizures and proved to be well tolerated. Vinpocetine has a wide safety profile and well-known adverse events, which are transient and with no sequelae.
Introducción: La vinpocetina de liberación prolongada ha demostrado ser efectiva en el control de crisis de inicio focal en pacientes epilépticos con una baja frecuencia de eventos adversos. Se realizó un estudio clínico para evaluar la eficacia y tolerabilidad de la vinpocetina como tratamiento adyuvante en pacientes con este padecimiento. Métodos: Se realizó un estudio clínico, doble ciego, de grupos paralelos. Se reclutaron 87 pacientes con diagnóstico de epilepsia focal tratados con uno a tres fármacos antiepilépticos. Los pacientes se aleatorizaron para ser tratados con vinpocetina (n = 41) o placebo (n = 46) de manera adyuvante a su tratamiento, e ingresaron a la fase basal (4 semanas), a la fase de titulación (4 semanas) y a la fase de evaluación (8 semanas) conservando estables las dosis de la vinpocetina y de los fármacos antiepilépticos. Resultados: La vinpocetina fue más efectiva que el placebo en la reducción de las crisis al finalizar la fase de evaluación (p < 0.0001). El 69% de los pacientes tratados con vinpocetina presentaron una reducción mayor al 50% en las crisis en comparación con el 13% de los pacientes tratados con placebo. No se presentaron diferencias significativas en cuanto a la presencia de efectos adversos en los pacientes tratados con vinpocetina comparados con los tratados con placebo. Los eventos adversos más frecuentes observados con vinpocetina fueron cefalea (7.9%) y diplopía (5.2%). Conclusiones: Como tratamiento adyuvante, la vinpocetina (2 mg/kg/día) redujo eficazmente la frecuencia de crisis epilépticas y demostró ser bien tolerada. Presenta un amplio perfil de seguridad y eventos adversos conocidos, que son transitorios y sin secuelas.