Publications by authors named "María Pilar Navarro-Pérez"

8 Publications

  • Page 1 of 1

Delayed Neurological Improvement After Full Endovascular Reperfusion in Acute Anterior Circulation Ischemic Stroke.

Stroke 2021 May 20:STROKEAHA120032066. Epub 2021 May 20.

Neurology Department, Hospital Clínico Universitario de Valladolid, Spain. (B.T., B.G.-V., J.F.A.).

Background And Purpose: We aimed to determine the prevalence and predictors of delayed neurological improvement (DNI) after complete endovascular reperfusion in anterior circulation acute ischemic stroke (AIS).

Methods: Retrospective analysis of an online multicenter prospective reperfusion registry of patients with consecutive anterior circulation AIS treated with endovascular thrombectomy (EVT) from January 2018 to June 2019 in tertiary stroke centers of the NORDICTUS (NORD-Spain Network for Research and Innovation in ICTUS) network. We included patients with AIS with a proximal occlusion in whom a modified Thrombolysis in Cerebral Infarction 3 reperfusion pattern was obtained. DNI was defined if, despite absence of early neurological improvement during the first 24 hours, patients achieved functional independence on day 90. Clinical and radiological variables obtained before EVT were analyzed as potential predictors of DNI.

Results: Of 1565 patients with consecutive AIS treated with EVT, 1381 had proximal anterior circulation occlusions, 803 (58%) of whom achieved a modified Thrombolysis in Cerebral Infarction 3. Of these, 628 patients fulfilled all selection criteria and were included in the study. Mean age was 73.8 years, 323 (51.4%) were female, and median baseline National Institutes of Health Stroke Scale was 16. Absence of early neurological improvement was observed in 142 (22.6%) patients; 32 of these (22.5%) achieved good long-term outcome and constitute the DNI group. Predictors of DNI in multivariable-adjusted logistic regression were male sex (odds ratio, 6.4 [95% CI, 2.1-22.3] =0.002), lower pre-EVT National Institutes of Health Stroke Scale score (odds ratio, 1.4 [95% CI, 1.2-1.5], <0.001), and intravenous thrombolysis (odds ratio, 9.1 [95% CI, 2.7-30.90], <0.001).

Conclusions: One-quarter of patients with anterior circulation AIS who do not clinically improve within the first 24 hours after complete cerebral endovascular recanalization will achieve long-term functional independence, regardless of the poor early clinical course. Male sex, lower initial clinical severity, and use of intravenous thrombolysis before EVT predicted this clinical pattern.
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http://dx.doi.org/10.1161/STROKEAHA.120.032066DOI Listing
May 2021

Effects of the onabotulinumtoxinA follow-up delay in migraine course during the COVID-19 lockdown.

Neurol Sci 2021 Mar 26. Epub 2021 Mar 26.

Headache Unit, Department of Neurology, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.

Background: Face-to-face procedures have been postponed during COVID-19 pandemic. We aim to evaluate the impact of onabotulinumtoxinA follow-up delay in migraine during COVID-19 pandemic.

Methods: Subjective worsening, intensity of migraine attacks, and frequency of headache and migraine were retrospectively compared between patients with unmodified and interrupted onabotulinumtoxinA follow-up in Headache Units.

Results: We included 67 patients with chronic migraine or high-frequency episodic migraine under onabotulinumtoxinA treatment, 65 (97.0%) female, 44.5 ± 12.1 years old. Treatment administration was voluntarily delayed in 14 (20.9%) patients and nine (13.4%) were unable to continue follow-up. Patients with uninterrupted follow-up during lockdown presented 7.6 and 8.1 less monthly days with headache (adjusted p = 0.017) and migraine attacks (adjusted p = 0.009) compared to patients whose follow-up was interrupted, respectively.

Conclusion: Involuntary delay of onabotulinumtoxinA follow-up in patients with migraine due to COVID-19 pandemic was associated with a higher frequency of headache and migraine attacks. Safe administration of onabotulinumtoxinA during lockdown should be promoted.
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http://dx.doi.org/10.1007/s10072-021-05180-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994064PMC
March 2021

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

Evaluation of the Impact of the COVID-19 Lockdown in the Clinical Course of Migraine.

Pain Med 2021 Feb 28. Epub 2021 Feb 28.

Headache Unit, Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.

Objective: Previous studies have demonstrated that emotional stress, changes in lifestyle habits and infections can worsen the clinical course of migraine. We hypothesize that changes in habits and medical care during coronavirus disease 2019 (COVID-19) lockdown might have worsened the clinical course of migraine.

Design: Retrospective survey study collecting online responses from migraine patients followed-up by neurologists at three tertiary hospitals between June and July 2020.

Methods: We used a web-based survey that included demographic data, clinical variables related with any headache (frequency) and migraine (subjective worsening, frequency, and intensity), lockdown, and symptoms of post-traumatic stress.

Results: The response rate of the survey was 239/324 (73.8%). The final analysis included 222 subjects. Among them, 201/222 (90.5%) were women, aged 42.5 ± 12.0 (mean±SD). Subjective improvement of migraine during lockdown was reported in 31/222 participants (14.0%), while worsening in 105/222 (47.3%) and was associated with changes in migraine triggers such as stress related to going outdoors and intake of specific foods or drinks. Intensity of attacks increased in 67/222 patients (30.2%), and it was associated with the subjective worsening, female sex, recent insomnia, and use of acute medication during a headache. An increase in monthly days with any headache was observed in 105/222 patients (47.3%) and was related to symptoms of post-traumatic stress, older age and living with five or more people.

Conclusions: Approximately half the migraine patients reported worsening of their usual pain during the lockdown. Worse clinical course in migraine patients was related to changes in triggers and the emotional impact of the lockdown.
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http://dx.doi.org/10.1093/pm/pnaa449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108628PMC
February 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

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