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Different gastrointestinal symptoms, such as excessive salivation, deterioration and other disorders affecting the teeth, dysphagia, gastroparesis, gastroesophageal reflux, constipation, difficult defecation or loss of weight are frequent events in all the stages of the development of Parkinson's disease and affect at least a third of the patients. These symptoms reflect the dysfunction of the enteric nervous system, and the stomach is one of the organs where alpha-synuclein is first deposited. Other factors, such as the dysfunction of structures in the central nervous system like the dorsal motor nucleus of the vagal nerve, hormonal factors or secondary effects deriving from the consumption of antiparkinsonian drugs, are involved in its origin. The present article offers a detailed review of the epidemiological, pathophysiological, clinical and therapeutic management aspects of the different gastrointestinal symptoms in Parkinson's disease.

Continuous infusion of intraduodenal levodopa/carbidopa is an effective treatment that improves the motor complications and the quality of life of patients in the advanced stages of Parkinson's disease. However, it is not free of complications. These may present in the post-operative period following surgery (gastrostomy) or in the long-term during the follow-up period and can be related with the medication (levodopa/carbidopa), the stoma, the gastrostomy or the device (pump, enteral tube, parts of the FREKA system). The aim of this review is to report on the management of the complications that can be observed in patients with advanced Parkinson's disease treated with continuous infusion of intraduodenal levodopa/carbidopa.

Introduccion. El estudio del sistema motor y de sus trastornos ha sido un tema importante para la neurofisiologia, siendo uno de sus objetivos intentar comprender los mecanismos fisiopatologicos que subyacen a las disfunciones del mismo. Desarrollo: Se revisa lo mas relevante acerca de: (1) Tecnicas neurofisiologicas utilizadas en el diagnostico de la EP y otros parkinsonismos; (2) Utilidad de la estimulacion magnetica transcraneal (EMT); (3) Estudios neurofisiologicos de los trastornos del sueno en la EP; (4) Aspectos neurofisiologicos de la estimulacion cerebral profunda (ECP). Conclusiones: Las pruebas neurofisiologicas puede ayudar en el diagnostico diferencial del parkinsonismo ademas de profundizar en la fisiopatologia de los sintomas y signos parkinsonianos. Diferentes tecnicas pueden emplearse en el estudio de los trastornos del sueno en la EP. La EMT resulta util tanto desde el punto de vista diagnostico como probablemente tambien terapeutico en la EP. Actualmente, los registros con microelectrodos constituyen la forma mas precisa de poder identificar la diana seleccionada en la cirugia de la EP.

In recent years we have witnessed a growing tendency to opt for the use of dopamine agonists (DA) as treatment for Parkinson's disease (PD), with the aim of delaying as far as possible the development of fluctuations and dyskinesias. Yet, levodopa continues to be the most effective antiparkinson drug and is probably the one that improves the greatest number of symptoms of the disease. This article reports on the results of a comprehensive review of the literature dealing with the benefits and risks of levodopa treatment in patients with PD which was conducted by a group of expert neurologists and members of the Spanish Neurology Society's Movement Disorder Group. The main conclusion reached in this article is that levodopa continues to be the most effective treatment for PD. Although the risk and incidence of developing dyskinesias remains at a lower level in the group initially treated with DA, the number of patients who develop disabling dyskinesias is very low in all the studies and is similar for DA and for levodopa. Scores on the quality of life scales are also similar in the two groups, which casts some doubt on the impact that these motor complications have on the quality of life of patients with PD. In view of these findings, we should consider whether there is any real justification for depriving patients of the good control of their symptoms offered by levodopa owing to the fear of developing dyskinesias or mild motor fluctuations that are not really going to have any negative effect on their quality of life. There is also the possibility of their developing severe side effects, which are more frequent with the use of DA.

El tratamiento con infusion continua de levodopa/carbidopa intraduodenal (Duodopa®) constituye una opcion de tratamiento para pacientes con enfermedad de Parkinson (EP) avanzada que no responden de forma satisfactoria al tratamiento convencional. Publicaciones previas han reportado que Duodopa mejora las complicaciones motoras, sintomas no motores, calidad de vida y autonomia de los pacientes asi como el grado de estres y sobrecarga del cuidador. Asegura la mayoria de las veces la monoterapia evitando otros farmacos con efectos secundarios. Las complicaciones graves son excepcionales, mientras que las menores relacionadas con el estoma y el dispositivo son frecuentes. El presente trabajo revisa la evidencia cientifica existente sobre Duodopa y aspectos practicos para el manejo de los pacientes con EP tratados con dicha terapia.

Brachial artery flow mediated dilation (FMD) is a validated, noninvasive physiological measure widely used as a research tool to quantify endothelial function. FMD is diminished in patients with several coronary risk factors, coronary artery disease, peripheral arterial disease, stroke, and is an independent predictor of cardiovascular events. FMD represents a useful method for identify asymptomatic atherosclerotic subjects with raised risk of developing atherothrombotic complications and improves with risk-reduction therapy such as antihypertensive or antidiabetic drugs, antiplatelet agents and statins. FMD could be a great usefulness in ischemic stroke such as stroke subtypes classification, prognostic significance in acute phase, and independent predictor for new-onset vascular event after first-ever stroke, but also in other disease such as cerebral haemorrhage, migraine or syncope. In this review article, brachial artery FMD and its role in experimental and clinical practice is extensively discussed.

Introduccion. Los trastornos no motores de la enfermedad de Parkinson (EP) comprenden todos aquellos trastornos que no son sintomas motores: trastornos neuropsiquiatricos y de la conducta (demencia, depresion, ansiedad, psicosis), autonomicos (hipotension postural, trastornos gastrointestinales, genitourinarios, diaforesis), trastornos del sueno (insomnio, somnolencia, trastorno de conducta en fase REM, apnea), sensitivomotores (fatiga, diplopia, sindrome de piernas inquietas) y sensoriales. Desarrollo. Se revisa lo mas relevante acerca de los sintomas no motores sensoriales en la EP: alteraciones visuales, disfuncion olfatoria, alteraciones del gusto, hipoacusia y otros trastornos auditivos, y dolor y sintomas sensitivos asociados. Conclusiones. El dolor es un sintoma muy prevalente e infradiagnosticado en la EP, siendo muy importante su identificacion y tipificacion para un correcto tratamiento. La hiposmia es un sintoma muy frecuente que podria utilizarse como marcador precoz de la EP. Diversas alteraciones visuales y auditivas deben tenerse en cuenta igualmente en los pacientes con EP.

Introduction. Chronic migraine refractory to preventive treatment is a common clinical situation in general neurology clinics. The aim is to analyse our experience with zonisamide in the preventive treatment of patients with frequent refractory migraine. Patients and methods. Those patients with no response or intolerance to topiramate and at least one more preventative received zonisamide. This drug was increased 25 mg per week up to 200 mg/day. The efficacy of zonisamide was evaluated in terms of 'response' (reduction in attack frequency below 50%) at the third month of treatment. Results. Our series comprises a total of 172 patients, with ages ranging from 22 to 69 years. 85% were women. The final dosage of zonisamide was 50-200 mg/day, with the 100 mg/day being the most frequently administered dose. Zonisamide was efficacious (response) in 76 (44%) patients; response being excellent in 22 (13%). MIDAS score was reduced by 43.2%. Zonisamide was not tolerated by 27% of the patients, mainly due to subjective mental slowness or digestive symptoms. Conclusions. These results, obtained in a big sample of patients refractory or intolerant to topiramate and other preventatives, indicate that, at least in conditions of daily clinical practice, zonisamide, at relatively low dosages, is an option to be considered for the preventive treatment of patients with frequent migraine. © 2010 Revista de Neurologia.

Introduction. The risk of side effects secondary to global and non-specific immune suppression has limited the systematic application of immunosuppressive therapy in multiple sclerosis (MS). However, when a patient with MS develops a cancer, cytostatic drugs as treatment for the neoplastic process may induce improvement not only of the cancer but also of MS. Case reports. We present a series of four women with clinically defined MS and subjected to cytostatic therapy (cisplatin, 5-fluorouracil, leukovorin, adriamycin, tamoxifen and anastrozole) after the development of cancer: two presented breast cancer, one colon cancer, and the fourth parotid gland malignancy. Their clinical and neuroimaging course is described, following chemotherapy for the malignant disease. None of the patients have suffered further MS outbreaks. The four women have improved and remain clinically stable after neoplastic treatment. Magnetic resonance imaging showed persistence of the same lesion burden in three patients, and reduction in the other. At the present one patient receives weekly intramuscular interferon-beta 1a, whereas the other did not received any treatment. Conclusions. Probably there are no specific cytostatics for MS. Immunosuppressive therapy could be a therapeutic option among patients with an aggressive clinical course. © 2009, Revista de Neurologia.

Introduccion. El sindrome de piernas inquietas (SPI) es un trastorno del movimiento de origen neurologico, que se manifiesta por clinica sensitivomotora localizada principalmente en las extremidades inferiores. Desarrollo. Se revisan las caracteristicas epidemiologicas, fisiopatologicas clinicas y terapeuticas de esta enfermedad, y se hace un especial enfasis en los criterios diagnosticos. Conclusiones. El diagnostico del SPI es eminentemente clinico y se basa en los criterios de la conferencia de consenso de los National Institutes of Health de 2002. Existen criterios especificos para grupos especiales (ancianos con deterioro cognitivo y ninos) en los cuales no es posible determinar si existe SPI mediante los criterios diagnosticos habituales.