Publications by authors named "Elena Bellosta-Diago"

10 Publications

  • Page 1 of 1

Acute migraine management in the emergency department: experience from a large Spanish tertiary hospital.

Intern Emerg Med 2021 Mar 12. Epub 2021 Mar 12.

Neurology department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Zaragoza, Spain.

To assess the characteristics of the management of patients with migraine who present to the emergency department (ED) with a migraine attack. Retrospective, observational study analyzing demographic, clinical, diagnostic and therapeutic characteristics of patients with migraine diagnosis presenting to ED for a migraine attack between 2016 and 2019. We reviewed the clinical records of 847 cases. 82.2% were women with mean age of 34.9 years. 87.2% had episodic migraine and 12.2% chronic migraine. 62.3% (528/847) had taken analgesics before visiting the ED [non-steroidal-anti-inflammatory drugs (NSAIDs) (300/528; 56.9%) and triptans (261/528; 49.5%)]. 25.4% (215/847) received blood testing and 6.4% (55/847) received cranial CT. Medication was administered in 77.2% cases (654/847). The median time-to-treatment was 70 min (IQR 42-120). NSAIDs (81%, 530/654), antiemetics (43.1%, 282/654) and metamizole (39% 255/654) were the most used. Triptans were administered in 7 cases (1.1%) and opioids in 84 (12.8%). At discharge, preventive treatment was prescribed or modified in 8.2% of cases (69/839) and triptans were prescribed in 129 cases (15.3%). 70.5% (592/839) were instructed to follow-up with their primary care provider (PCP), 21.5% (181/839) with a general neurologist and 7.9% (66/839) with a headache specialist. The majority of migraine patients were not receiving the recommended acute migraine-specific medication, both in the outpatient and in the ED setting, being especially remarkable the rare use of triptans in the ED. Furthermore, we found an elevated use of urgent complementary tests, mainly blood tests.
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http://dx.doi.org/10.1007/s11739-021-02698-9DOI Listing
March 2021

Cognitive performance in patients with episodic cluster headache outside and inside the active cluster.

Headache 2021 Jan;61(1):209-215

Neurology Department, University Clinic Hospital Lozano Blesa, Zaragoza, Spain.

Background: Previous studies have shown worse cognitive performance in cluster headache (CH) patients compared to healthy controls; however, little is known about cognitive performance in episodic CH (ECH) patients outside and inside the active cluster (AC).

Objective: Our aim is to compare cognitive function in ECH patients outside and inside the AC.

Methods: In this cross-sectional, observational study, four neuropsychological tests (Trail Making Test [TMT], Stroop Test [ST], verbal fluency [VF], and Symbol Digit Modalities Test [SDT]) were completed by 21 ECH patients at two different points in time: outside and inside the AC. We also assessed self-reported sleep quality and the presence of anxiety or depressive symptoms. Scores were compared.

Results: There was not any difference between the scores of the neuropsychological tests performed outside and inside the AC (TMT-A: 23 vs. 23.5; p = 0.984; TMT-B: 96.5 vs. 85.9; p = 0.104; ST word reading: 101.0 vs. 101.2; p = 0.938; ST color naming: 73.0 vs. 73.4; p = 0.858; ST color word: 44.0 vs. 46.0; p = 0.498; SDMT: 44.0 vs. 44.6; p = 0.961; VF phonemic: 29.5 vs. 30.2; p = 0.714; VF semantic: 20 vs. 21; p = 0.489). We found a worsening in the sleep quality component of the Pittsburgh Sleep Quality Index median scores in patients outside the AC (2 vs. 1; p = 0.046).

Conclusions: Our findings suggest that patients with ECH have a similar cognitive performance outside and during the AC.
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http://dx.doi.org/10.1111/head.14052DOI Listing
January 2021

Impact of 24-Hour On-Call Shifts on Headache in Medical Residents: A Cohort Study.

Headache 2020 07 3;60(7):1427-1431. Epub 2020 Jun 3.

Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.

Background: During 24-hour on-call shifts medical residents are exposed to diverse circumstances such as sleep deprivation and stress.

Objective: Our aim is to assess the effect of 24-hour on-call shifts on medical residents' headache-related disability.

Methods: The Migraine Disability Assessment Scale (MIDAS), the Headache Impact Test (HIT-6), the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS) questionnaires were administered to medical residents who had never performed on-call shifts at baseline and 6 months after beginning 24-hour on-call shifts. Scores were compared.

Results: About 66 medical residents completed this study. About 21.2% (n = 14) had history of migraine, 42.4% (n = 28) had a history of tension-type headache (TTH) and 12.1% (n = 8) had a history of both migraine and TTH. Among medical residents with migraine, the median MIDAS score was significantly higher after starting 24-hour on-call shifts than at a baseline (4.0 vs 8.0; Wilcoxon, P = .001), meaning that, on average, disability increased from little or no disability, to moderate disability. No difference in HIT-6 scores was found. The median score of PSQI and HADS was higher at 6 months (PSQI: 7.0 vs 8.0; P = .003), (HADS: 5.0 vs 8.0; P < .001) for the general group.

Conclusions: In medical residents with migraine, migraine-related disability increased after starting 24-hour on-call shifts. We also found a worsening in depression and anxiety symptoms and self-reported sleep quality in medical residents with and without headache history.
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http://dx.doi.org/10.1111/head.13861DOI Listing
July 2020

Familial association of genetic generalised epilepsy with limb-girdle muscular dystrophy through a mutation in .

Epilepsy Behav Case Rep 2019 21;11:122-124. Epub 2019 Mar 21.

Hospital Clínico Universitario Lozano Blesa, Avda. San Juan Bosco 15, 50009 Zaragoza, Spain.

•We present a family that includes members with phenotypes of generalized epilepsy and limb-girdle muscular dystrophy.•Subjects with heterozygous mutation developed epilepsy; a subject with homozygous mutation developed limb-girdle dystrophy.•Mutations in CAPN3 may play a role in the complex genetics of genetic generalized epilepsies.
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http://dx.doi.org/10.1016/j.ebcr.2019.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460322PMC
March 2019

Cognitive Performance in Episodic Cluster Headache.

Pain Med 2019 05;20(5):1032-1037

Neurology Department, University Clinical Hospital Lozano Blesa, Zaragoza, Spain.

Background: Cluster headache is one of the most disabling of all headache conditions. Although some studies have investigated the psychological profile of patients with cluster headache, research on its impact on cognitive function in patients with episodic cluster headache outside the cluster bout is scant.

Methods: Cross-sectional study to evaluate various aspects of neuropsychological assessment and cognitive function including working memory, selective attention, verbal fluency, and executive function in 40 patients with episodic cluster headache. The patients were compared with 40 age-, gender-, and level of education-matched healthy controls.

Results: Episodic cluster headache patients performed significantly worse than healthy controls on all cognitive tests, except for the Interference Score (P = 0.281). They had significantly higher Hospital Anxiety Scale scores (P = 0.002). However, we found no significant association between cognitive performance, anxiety, sleep quality, and disease duration.

Conclusions: Patients with episodic cluster headache outside the bout showed worse executive functioning, working memory, language, and selective attention compared with healthy controls, regardless of the duration of disease or sleep quality.
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http://dx.doi.org/10.1093/pm/pny238DOI Listing
May 2019

Circadian Rhythm, Cognition, and Mood Disorders in Huntington's Disease.

J Huntingtons Dis 2018 ;7(2):193-198

Department of Neurology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.

Background: Sleep disturbances are an early and prominent feature of Huntington's disease (HD).

Objective: The current study investigated the relation between sleep quality impairment and cognitive and psychiatric symptoms in patients with HD.

Methods: Sleep quality, daytime sleepiness, and neurocognitive symptoms were assessed in 38 mutation carriers (23 premanifest and 15 early stage) and 38 age-and sex-matched controls using standardized questionnaires (the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, the cognitive section of the Unified Huntington's Disease Rating Scale, the Hospital Anxiety and Depression Scale, and the Irritability Scale).

Results: Compared to controls, HD patients had worse sleep quality (p = 0.016), which was associated with more severe cognitive impairment and higher anxiety, depression and irritability scores. These findings suggest that HD patients may have a delayed sleep phase, as indicated by the increased sleep onset latency (p = 0.019) and later wake-up time (0.013), which was associated with worse cognitive performance and greater depressive and anxiety symptoms.

Conclusions: Our data provide further evidence for an association between sleep quality in HD and cognitive performance and psychiatric symptoms.
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http://dx.doi.org/10.3233/JHD-180291DOI Listing
October 2019

Circadian rhythm and autonomic dysfunction in presymptomatic and early Huntington's disease.

Parkinsonism Relat Disord 2017 Nov 15;44:95-100. Epub 2017 Sep 15.

Neurology Department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009 Zaragoza, Spain; Research Group of Movement Disorders and Headache (GIIS070), Aragon Institute of Health Sciences, San Juan Bosco 13, 50009 Zaragoza, Spain.

Introduction: Sleep and circadian rhythm disturbances are common in patients with neurodegenerative diseases such as Huntington's disease (HD). The aim of this study was to evaluate variability in circadian blood pressure (BP) to determine the association between abnormal circadian BP and sleep quality in patients with HD.

Methods: Cross-sectional, multicenter study of 38 HD mutation carriers (23 premanifest and 15 early stage patients) who were compared to 38 age- and sex-matched controls. BP was evaluated by ambulatory blood pressure monitoring (ABPM). Based on the percentage decrease in nocturnal BP, subjects were classified as either dippers (≥10%) or non-dippers (<10%). Sleep quality and daytime sleepiness were measured, respectively, using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Daytime Sleepiness Scale (ESS) and the scores on these indices were correlated with the ABPM findings.

Results: Sixty-three percent HD mutation carriers were non-dippers (86.7% of the symptomatic and 47.8% of the premanifest patients) versus 23.7% of controls (p = 0.001). In the HD group, sleep quality was significantly more impaired (PSQI>5) (p = 0.016) with more excessive daytime sleepiness (ESS>9) (p = 0.001) than in the control group. Nocturnal non-dipping was associated with worse sleep quality in patients (p = 0.011) but not in controls.

Conclusion: These results show that patients with HD present early disturbances in the circadian rhythm of BP and that this altered nocturnal BP is associated with poor sleep quality. These findings suggest the potential role of subtle hypothalamic dysfunction in this population.
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http://dx.doi.org/10.1016/j.parkreldis.2017.09.013DOI Listing
November 2017

Neurological manifestations of Behçet's disease: Case report and literature review.

Reumatol Clin (Engl Ed) 2019 Sep - Oct;15(5):e36-e38. Epub 2017 May 22.

Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.

Neurological involvement in Behçet's disease is rare, especially at the onset. It can present in the form of parenchymal changes or as damage to the vascular structures in its nonparenchymal form. The coexistence of both kinds of manifestations in the same patient is exceptional. We report the case of a 32-year-old patient with a history of deep venous thrombosis, who was being treated for holocranial headache, apathy, and oral and genital ulcers. Brain magnetic resonance imaging showed hyperintense lesions in the basal ganglia and white matter, and the vascular study evidenced venous thrombosis of the left transverse sinus. After confirming the diagnosis of Behçet's disease with parenchymal and nonparenchymal cerebral involvement, immunosuppressive and corticosteroid therapy was started, resulting in the remission of the symptoms.
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http://dx.doi.org/10.1016/j.reuma.2017.04.009DOI Listing
April 2020

[Acute sensory-motor axonal neuropathy (Guillain-Barre syndrome) following vertebroplasty].

Med Clin (Barc) 2014 Sep 18;143(6):282-3. Epub 2014 Jan 18.

Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.

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http://dx.doi.org/10.1016/j.medcli.2013.11.017DOI Listing
September 2014