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We describea series of patients with COVID-19 who presented with seizures, reported in the Spanish Society of Neurology's COVID-19 Registry. This observational, descriptive,multicentre, registry-based study includes patients with confirmed COVID-19 who experienced seizures during active infection.Wedescribe theclinicalpresentation of COVID-19,seizures,and resultsof complementary tests.Wealsodescribe the suspectedaetiologyof the seizures. Of 232 reported cases, 26 (11.2%) presented with seizures;7 of these patients (26.9%) had prior history of epilepsy, whereas the remaining 19 (73.1%) had no history of seizures.In most cases, seizures presented on days 0 and 7 after onset of COVID-19. By seizure type, 8 patients (30.7%) presentedgeneralised tonic-clonic seizures, 7 (26.9%) status epilepticus, 8 (30.7%) focal impaired-awareness seizures, and 4 (11.7%) secondary generalised seizures.Six patients (23.1%) also presented other neurological symptoms, includingaltered mental status and decreased level of consciousness. Predisposing factors for seizures (eg, dementia, tumour, cerebrovascular disease) were observed in 10 of the 19 patients with no prior history of epilepsy (52.6%). Patients with COVID-19 may present with seizures over the course of the disease,either alone or in the context of encephalopathy.Seizures may present in patients with no prior history of epilepsy; however, most of these patients present predisposing factors.

We describe the epidemiological and clinical characteristics of thrombosis with thrombocytopenia syndrome (TTS) cases reported in Spain.We included all venous or arterial thrombosis with thrombocytopenia following adenovirus vector-based vaccines (AstraZeneca or Janssen) to prevent COVID-19 disease between February 1Sixty-one cases were reported and 45 fulfilled eligibility criteria, 82% women. The crude TTS rate was 4/1,000,000 doses and 14-15/1,000,000 doses between 30-49 years. The number of observed cases of cerebral venous thrombosis was 6-18 higher than the expected in patients younger than 49 years. Symptoms started 10 (interquartile range (IQR): 7-14) days after vaccination. Eighty percent (95% confidence interval (CI): 65-90%) had thrombocytopenia at the time of the emergency department visit, and 65% (95% CI: 49-78%) had D-dimer2000 ng/mL. Patients had multiple location thrombosis in 36% and fatal outcome in 24% cases. A platelet nadir50,000 /μL (odds ratio (OR): 7.4; CI 95%: 1.2-47.5) and intracranial hemorrhage (OR: 7.9; IC95%: 1.3-47.0) were associated with fatal outcome.TTS must be suspected in patients with symptoms 10 days after vaccination and thrombocytopenia and/or D-dimer increase.

Introduction: Since the beginning of the Covid-19 epidemic produced by SARS2-Cov virus, olfactory alterations have been observed at a greater frequency than in other coronavirus epidemics. While olfactory alterations may be observed in patients with rhinovirus, influenza virus, or parainfluenza virus infection, they are typically explained by nasal obstruction with mucus or direct epithelial damage; in the case of SARS-CoV-2, olfactory alterations may present without nasal congestion with mucus. We performed a study of patients presenting olfactory/gustatory alterations in the context of SARS-CoV-2 infection in order to contribute to the understanding of this phenomenon. Material and Methods: We performed a descriptive, cross-sectional, observational study of the clinical characteristics of olfactory/gustatory alterations using a self-administered, anonymous online questionnaire. Results: A total of 909 patients with SARS-CoV-2 infection and olfactory/gustatory alterations responded to the questionnaire in the 4-day data collection period; 824 cases (90.65%) reported simultaneous olfactory and gustatory involvement. Patients' responses to the questionnaire revealed ageusia (581, 64.1% of respondents), hypogeusia (256, 28.2%), dysgeusia (22, 2.4%), anosmia (752 82.8%), hyposmia (142, 15.6%), and dysosmia (8, 0.9%). Fifty-four percent (489) did not report concomitant nasal congestion or mucus. Conclusion: Olfactory alterations are frequent in patients with SARS-CoV-2 infection and is only associated with nasal congestion in half of the cases.

We aimed to describe admission rates and outcomes of hospitalized people with Alzheimer's disease (AD) or senile dementia stratified by type 2 diabetes (T2D) in Spain, 2004 to 2013 (N = 541 858, 143 501 [26.5%] of whom had T2D). We excluded alternative causes of dementia. Hospitalization rates were higher in people with T2D (130.5 vs 91.5 cases/105 people). People older than 84 years and comorbidity increased over time. Crude inhospital mortality (IHM) decreased over time both in people with and without T2D (all P values

Objective We report the findings from the Spanish Society of Neurology's NeuroCOVID-19 Registry. Methods We performed a multicentre study of patients with neurological manifestations of COVID-19. Participating physicians reported demographic, clinical, and paraclinical data and judged the involvement of COVID-19 in causing neurological symptoms. Results A total of 233 cases were submitted, including 74 different combinations of manifestations. The most frequently reported were stroke (27%), neuromuscular symptoms (23.6%), altered mental status (23.6%), anosmia (17.6%), headache (12.9%), and seizures (11.6%). The mean age of patients was 61.1 years, with 42.1% being women; a higher proportion of women was recorded among patients with altered mental status, anosmia, and headache. The onset of symptoms differed within categories. Onset of anosmia occurred a mean (standard deviation) of 2.9 (2.5) days after the first general symptom, whereas neuromuscular symptoms appeared after 13.9 (10.1) days. Neurological symptoms were persistent in 33% of patients. General symptoms were present in 97.7% of patients, and results from general laboratory studies were abnormal in 99.4% of patients. Cerebrospinal fluid analysis findings were abnormal in 62.7% of the cases in which this test was performed (n = 51), but positive results for SARS-CoV-2 were only found in one case. Conclusions The neurological manifestations of COVID-19 are diverse. Anosmia, myalgia, and headache occur earlier in the course of the disease. Altered mental status, neuromuscular symptoms, and stroke are associated with greater severity. COVID-19 must be incorporated into most clinical and radiological differential diagnoses. COVID-19 may cause persistent and disabling neurological symptoms., Highlights • NeuroCovid-19 is polymorph: Authors reported >70 different combinations of neurological syndromic presentations. • The timing of the neurological symptoms differ: from the early onset (anosmia, headache, myalgia) to later stages (altered mental status, seizures, stroke, neuromuscular symptoms). • Some neurological symptoms might persist, as headache or anosmia; while other may cause persistent disability, as stroke or polyneuropathies. • Cerebrospinal fluid was frequently abnormal but direct isolation of SARS-CoV-2 occurred only in 1/233 cases. • Neurologists must be prepared to face the various neurological syndromes that may be associated with Covid-19 infection.

Introduccion. Tras la celebracion del congreso de la European Headache Federation (EHF), reconocidos neurologos espanoles expertos en el tratamiento de la migrana expusieron en la Reunion Post-EHF las principales novedades presentadas en el congreso y relacionadas con ese ambito. Desarrollo. Se abordan los principales datos presentados relacionados con el tratamiento de la migrana cronica y episodica; concretamente, los relacionados con los tratamientos preventivos y la experiencia en vida real en el manejo de la enfermedad. Se hizo una importante revision de las nuevas dianas terapeuticas y las posibilidades que ofrecen en cuanto al conocimiento de la fisiopatologia de la migrana y su tratamiento. Asimismo, se hizo una actualizacion de las novedades presentadas en el tratamiento de la migrana con fremanezumab, anticuerpo monoclonal recientemente autorizado por la Agencia Europea de Medicamentos. Se hizo una actualizacion de las novedades en investigacion basica en la patologia, asi como una relacion de los sintomas de migrana y COVID-19. Finalmente, se abordaron las implicaciones de la migrana en la carga sanitaria asistencial y economica, y su impacto en la sociedad. Conclusiones. En la reunion se hizo un resumen del contenido presentado en el 14 Congreso de la EHF, que tuvo lugar a finales de junio y principios de julio de 2020.

La cefalea tensional es la cefalea mas frecuente. En el 80% de los casos aparece antes de los 40 anos de edad. En su prevencion se ha utilizado una gran variedad de farmacos antidepresivos. Los triciclicos son los unicos antidepresivos de los que se ha demostrado eficacia en el tratamiento de la cefalea tensional cronica, y de ellos la amitriptilina es el farmaco de eleccion. Los inhibidores selectivos de la recaptacion de serotonina y otras familias de antidepresivos no han mostrado aun resultados concluyentes. El presente trabajo es una revision de las evidencias cientificas disponibles sobre amitriptilina y otros farmacos antidepresivos en el tratamiento de esta cefalea.

Chronic migraine is the most frequent complication of migraine. It is defined by the presence of headache on 15 or more days a month, of which at least eight must meet the criteria of migraine without aura for a minimum of three months. In addition they must not be due to medication abuse or attributable to any other cause.The prevalence of chronic migraine ranges between 1-3% of the population and its incidence has been estimated to be 2.5% per year. It produces from four to six times more disability, decreased productivity and disruption of quality of life than episodic migraine. The development of chronic migraine has been associated with both non-modifiable risk factors (being female, low socio-economic status and level of schooling) and modifiable risk factors (anxiety, depression, sleep apnoea/snoring, obesity, consumption of painkillers and caffeine). Patients with chronic migraine suffer from chronic pain, anxiety or depression two to three times more often than those with episodic migraine. Management requires identification and control of the risk factors that predispose patients to develop the condition, detoxification therapy in the event of abuse of analgesics, specific treatment for migraine attacks and preventive treatment. The effectiveness of the preventive drugs topiramate and Onabotulinumtoxin A in this complication of migraine has been proved in large-scale placebo-controlled clinical trials.Chronic migraine is a common condition that requires global management aimed at reducing the frequency of the attacks, lowering the associated disability and improving the patients' quality of life.

Headache is like a poker player that often hides an ace up its sleeve. Sometimes because of the cruelty of the cause, other times because of misfortune and still others because of clinician error or the various steps involved in accessing healthcare, there are processes that manifest as isolated events or mainly as headache and whose consequences may be catastrophic. This article provides a brief but committed analysis of some of the main causes of catastrophic headache and aims to increase awareness of the importance of headache as a reason for consultation and of the thin line between innocuous and serious processes, between protocol and art, and between knowing too little and knowing too much.

Tension-type headache is the most common form of headache. Eighty percent of cases occur before 40 years of age. A wide variety of antidepressants have been used to treat it. Tricyclics are the only antidepressants that have demonstrated their effectiveness in treating chronic tension-type headache, amitriptyline being the drug of choice. Selective serotonin reuptake inhibitors and other families of antidepressants have not shown conclusive results yet. The present study is a review of the scientific evidence available on antidepressants for treatment of this kind of headache.

Durante la LX Reunion Anual de la Sociedad Espanola de Neurologia (noviembre de 2008), el Grupo de Estudio de Neurologia Critica e Intensivista dedico su manana cientifi ca al analisis de las “catastrofes neurologicas”, un puro acto de contricion proyectado en forma de ponencias. Todas las plazas de la sala estaban ocupadas y muchos asistentes tuvieron que escuchar a los ponentes y moderadores de pie e incluso sentados en el suelo. La temperatura ambiental subio varios grados y fue obvia la disparidad entre continente y contenido; en otras palabras, la sesion estuvo a punto de entrar en estado de shock, de modo que la organizacion se vio obligada a impedir el acceso a un buen numero de colegas para evitar el colapso. Por ellos, y por el interes de los temas que se trataron, nos prometimos sacar adelante este suplemento de NEUROLOGIA. La idea de organizar algun dia algo asi surgio en la 59.a Reunion Anual de la American Academy of Neurology (Boston, 2007) curioseando la exposicion de una editorial medica, en cuyo mostrador destacaba el libro Catastrophic Neurologic Disorders in the Emergency Department, obra de Eelco F.M. Wijdicks (tabla 1). Es la tercera vez que se aborda este temario: la primera se ha mencionado en el primer parrafo y la segunda fue en la 4.a edicion del “Aula Interactiva de Neurologia” de MSD en forma de teleconferencias impartidas mediante internet durante el primer semestre de 2010. Las omisiones no se han debido a desidia o desinteres. No se trataron ni ahora se publican otras catastrofes neurologicas frecuentes, por ejemplo, las relacionadas con sindromes epilepticos catastrofi cos y otros tipos de ictus, o las

Objective: We will communicate the personal experience about the on-call shifts during a neurology residency in a Spanish tertiary hospital. Background Specialized neurology 24-hour on-call shifts are considered a fundamental tool in residency training. In Spain, these shifts are mandatory and aimed to teach neurology residents how to manage urgent or unexpected neurological disease. In our center, residents start neurology shifts on the second semester of their first year, always under the supervision of an attending physician. Design/Methods: Prospective quantitative analysis of the number of patients attended and pathology encountered during the on-call shifts made by a neurology resident on his residency training, between the years 2007 and 2011. Results: Neurology 24 hrs on-call shifts: 147; Number of patients attended: 1767, shifts per month: 3.65 (3-6); average number of patients per shift: 12.02 (5-25). Reasons for consultation: cerebrovascular disease: 590 patients (33.38%); Seizures: 288 (16.29%); headache: 132 (7.47%); neuromuscular disorders: 120 (6.79%); neuro-ophthalmology: 112 (6.33%); cognitive disorders: 91 (5.14%); altered level of consciousness: 82 (4.60%); Demyelinating disease: 66 (3, 77%); gait disturbance: 53 (2.99%); movement disorders: 39 (2.20%); dizziness / vertigo: 39 (2.20%); other causes: 155 (8.7%). Conclusions: Through communicating the experience of a neurology resident in a hospital in Spain, we expect to be able to show an example of the high prevalence of neurological disorders in the emergency room. The increase in the number of neurological diseases which require immediate attention, and the difficulty in diagnosis these may sometimes entail, can make the presence of an on-call neurologist essential in determining the course and prognosis of these diseases in many of our patients. Disclosure: Dr. Cuello has nothing to disclose. Dr. Rodriguez Cruz has nothing to disclose. Dr. Perez Gonzalez de Apodaca has nothing to disclose. Dr. De Andres has nothing to disclose. Dr. Martinez Gines has nothing to disclose. Dr. Mateo Gonzalez has nothing to disclose. Dr. Ezpeleta has nothing to disclose.