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Background: Idiopathic Generalized Epilepsies (IGE) are a subset of syndromes defined by the International League against Epilepsy (ILAE) with the particularity to respond to a narrow number of ASMs and particularly to valproic acid (VPA). Recommendations have changed in the last decade. We aimed to describe changes in antiseizure medication (ASM) in adult IGE over the last 10 years., Methods: Cross-sectional study comparing two cohorts of patients ≥ 16 years receiving ASM for IGE in a tertiary center (year 2013 and 2023). We collected clinical-demographic variables and ASM, analysing diagnosis and ASM prescription., Results: 249 patients were included in 2013 (53.8 % women; mean age 35.6 years ±14.6 standard deviation [SD]) and 278 in 2023 (61.2 % women, mean age 38.1 years ±16.1 SD). In 2023, the most frequent IGE subtype syndrome was juvenile myoclonic epilepsy (JME) (39.6 % vs 33.3 % in 2013), followed by epilepsy with generalized tonic-clonic seizures alone (28.4 % vs 42.6 %). Valproic acid (VPA) was the most used ASM in both periods, although it was prescribed less frequently in 2023 compared to 2013 (49.3 % vs. 69.1 %; p < 0.001). Lamotrigine (LTG) was the second most used ASM in 2013 (14.1 %), followed by levetiracetam (LEV) (12.4 %). By contrast, in 2023 LEV was the second most used ASM (29.5 %), followed by LTG (21.6 %) (LEV p < 0.001; LTG p = 0.025). VPA use decreased in women under 45 years (57.9 % vs 20.3 %, p < 0.001), with a subsequent increase of LEV (19.6 % vs 45.8 %, p < 0.001). In men we observed no significant differences in the use of VPA (80.0 % vs 75.9 %, p = 0.463)., Conclusions: The use of VPA has decreased during the last decade for all IGEs and particularly in women of childbearing potential, along with an increase in the use of LEV and LTG., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [I. Elosua-Bayés has no conflicts of interest. L. Abraira has received research funding and speaking fees from UCB Pharma, BIAL Pharmaceutical, Jazz Pharmaceuticals, EISAI Inc, Neuraxpharm, Exeltis, Angelini Pharma and Esteve Laboratorios. E. Fonseca has received funding and speaker fees from UCB Pharma, BIAL Pharmaceutical, Jazz Pharmaceuticals, EISAI Inc, Neuraxpharm, Sanofi Genzyme, Angelini Pharma and Esteve Laboratorios. M. Toledo has received research funding and speaking fees from UCB Pharma, Angelini, Arvelle, Jazz Pharma, BIAL Pharmaceutical, EISAI Inc, and Esteve Laboratorios. E. Santamarina has received research funding and speaking fees from UCB Pharma, BIAL Pharmaceutical, EISAI Inc, and Esteve Laboratorios. D. Campos has received travel support from UCB Pharma, BIAL Pharmaceutical, Jazz Pharmaceuticals and Angelini Pharma S. Lallana has received travel support from UCB Pharma, BIAL Pharmaceutical, Jazz Pharmaceuticals and Angelini Pharma. The remaining authors have no conflicts of interest in relation to this research paper. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines]., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Approximately 30% of patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion have pre-stroke modified Rankin Scale (mRS) scores ≥2. We aimed to investigate the safety and outcomes of endovascular treatment (EVT) in patients with AIS with moderate pre-stroke disability (mRS score 3) in an extended time frame (ie, 6-24 hours from the last time known well)., Methods: Data were collected from five centers in Europe and the USA from January 2018 to January 2023 and included 180 patients who underwent EVT in an extended time frame. Patients were divided into two groups of 90 each (Group 1: pre-mRS 0-2; Group 2: pre-mRS 3; 71% women, mean age 80.3±11.9 years). Primary outcomes were: (1) 3-month good clinical outcome (Group 1: mRS 0-2, Group 2: mRS 0-3) and ΔmRS; (2) any hemorrhagic transformation (HT); and (3) symptomatic HT. Secondary outcomes were successful and complete recanalization after EVT and 3-month mortality., Results: No between-group differences were found in the 3-month good clinical outcome (26.6% vs 25.5%, P=0.974), any HT (26.6% vs 22%, P=0.733), and symptomatic HT (8.9 vs 4.4%, P=0.232). Unexpectedly, ΔmRS was significantly smaller in Group 2 compared with Group 1 (1.64±1.61 vs 2.97±1.69, P<0.001). No between-group differences were found in secondary outcomes., Conclusion: Patients with pre-stroke mRS 3 are likely to have similar outcomes after EVT in the extended time frame to those with pre-stroke mRS 0-2, with no difference in safety., Competing Interests: Competing interests: T.N. Nguyen discloses advisory board for Brainomix, Aruna Bio; Associate Editor of Stroke. The other authors declare that they have no conflict of interests., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Monoclonal antibodies targeting calcitonin gene-related peptide (CGRP-mAbs) are approved for adult migraine prevention but pose safety concerns in pregnancy. We assess the safety of CGRP-mAbs in the periconceptional period through a case series and literature review., Methods: Six migraine-diagnosed women received CGRP-mAbs; treatment ceased upon pregnancy. We collected data and conducted safety assessments. To provide a comprehensive context, we performed a literature review., Results: The series includes three erenumab, two fremanezumab and one galcanezumab case. A fremanezumab recipient experienced miscarriage; severe perinatal asphyxia linked to dystocia occurred with erenumab (140 mg). Database reviews revealed 63 spontaneous abortions, eight premature births, and seven birth defects among 286 World Health Organization and 65 European Medicines Agency cases. These rates align with untreated population rates., Conclusions: CGRP-mAbs use in the periconceptional period does not lead to clinically significant increase in pregnancy-related pathology or adverse effects on newborns within our case series and the literature reviewed., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: IEB and LM report no disclosures. AA has received honoraria from Allergan-Abbvie, Novartis, and Lilly. EC has received honoraria as a speaker for Chiesi and Novartis. MTF has received honoraria as a consultant or speaker for Allergan-Abbvie, Almirall, Chiesi, Eli Lilly, Novartis and Teva. PP-R has received honoraria as a consultant and speaker for Abbvie, Almirall, Amgen, Biohaven, Chiesi, Eli Lilly, Lundbeck, Medscape, Novartis and Teva. Her research group has received research grants from Allergan, Novartis and Teva, and has received funding for clinical trials from Alder, Abbvie, Amgen, Electrocore, Eli Lilly, Lundbeck, Novartis and Teva. She is the Honorary Secretary of the International Headache Society. She is on the editorial board of Revista de Neurologia, and an associate editor for Cephalalgia, Headache, Neurologia, Frontiers of Neurology and The Journal of Headache and Pain. She is a member of the Clinical Trials Guidelines Committee and Scientific Committee of the International Headache Society. She has edited the Guidelines for the Diagnosis and Treatment of Headache of the Spanish Neurological Society. She is the founder of www.midolordecabeza.org. PP-R does not own stocks in any pharmaceutical company.

Background: Symptomatic carotid artery stenosis is a significant contributor to ischemic strokes. Carotid artery stenting (CAS) is usually indicated for secondary stroke prevention. This study evaluates the safety and efficacy of CAS performed within a short time frame from symptom onset., Methods: We conducted a single-center, retrospective study of consecutive patients who underwent CAS for symptomatic carotid stenosis within eight days of symptom onset from July 2019 to January 2022. Data on demographics, medical history, procedural details, and follow-up outcomes were analyzed. The primary outcome measure was the recurrence of the stroke within the first month post-procedure. Secondary outcomes included mortality, the rate of intra-procedural complications, and hyperperfusion syndrome., Results: We included 93 patients with a mean age of 71.7 ± 11.7 years. The median time from symptom onset to CAS was 96 h. The rate of stroke recurrence was 5.4% in the first month, with a significant association between the number of stents used and increased recurrence risk. Mortality within the first month was 3.2%, with an overall mortality rate of 11.8% after a median follow-up of 19 months. Intra-procedural complications were present in five (5.4%) cases and were related to the number of stents used ( p  = 0.002) and post-procedural angioplasty ( p  = 0.045). Hyperperfusion syndrome occurred in 3.2% of cases., Conclusion: Early CAS within the high-risk window post-symptom onset is a viable secondary stroke prevention strategy in patients with symptomatic carotid artery stenosis. The procedure rate of complication is acceptable, with a low recurrence of stroke. However, further careful selection of patients for this procedural strategy is crucial to optimize outcomes., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Manuel Requena has a consulting agreement with Anaconda Biomed. Dr Tomasello has received personal fees from Anaconda Biomed, Balt, Medtronic, Perflow, and Stryker. MRi has a consulting agreement with Medtronic, Stryker, Johnson and Johnson, Perflow Medical, Anaconda Biomed, Apta Targets, Ceronovus, Philips, Sanofi, and Rapid AI.

Introduction: The screening for atrial fibrillation (AF) scale (SAFE score) was recently developed to provide a prediction of the diagnosis of AF after an ischemic stroke. It includes 7 items: age ≥ 65 years, bronchopathy, thyroid disease, cortical location of stroke, intracranial large vessel occlusion, NT-ProBNP ≥250 pg/mL, and left atrial enlargement. In the internal validation, a good performance was obtained, with an AUC = 0.88 (95% CI 0.84-0.91) and sensitivity and specificity of 83% and 80%, respectively, for scores ≥ 5. The aim of this study is the external validation of the SAFE score in a multicenter cohort., Methods: A retrospective multicenter study, including consecutive patients with ischemic stroke or transient ischemic attack between 2020 and 2022 with at least 24 hours of cardiac monitoring. Patients with previous AF or AF diagnosed on admission ECG were excluded., Results: Overall, 395 patients were recruited for analysis. The SAFE score obtained an AUC = 0.822 (95% CI 0.778-0.866) with a sensitivity of 87.2%, a specificity of 65.4%, a positive predictive value of 44.1%, and a negative predictive value of 94.3% for a SAFE score ≥ 5, with no significant gender differences. Calibration analysis in the external cohort showed an absence of significant differences between the observed values and those predicted by the model (Hosmer-Lemeshow's test 0.089)., Conclusions: The SAFE score showed adequate discriminative ability and calibration, so its external validation is justified. Further validations in other external cohorts or specific subpopulations of stroke patients might be required., Competing Interests: The group of authors of the Torrecardenas University Hospital who proposed the present work (MQL, LAP, JGT, AAP, and PMS) overlaps with those who developed the SAFE score. However, these authors have deliberately avoided participating in the statistical analysis of the results, focusing instead on the design of the study, data collection, and drafting of the manuscript., (Copyright © 2023 Miguel Quesada López et al.)

Background and Purpose: In clinical practice patients may report migraine worsening as a consequence of COVID-19 (either infection or vaccines), however, data in this area are lacking. We aimed to investigate the link between COVID-19 and COVID-19 vaccination with migraine worsening and its associated factors., Methods: An online survey was sent to migraine patients followed up in a Spanish Headache Clinic, collecting demographic data, and information regarding SARS-CoV-2 infection and vaccination. We asked patients if they had noticed worsening of their migraine after these events and assessed concerns about infection, vaccination and migraine worsening. We also extracted data from participants' own electronic diaries (e-diaries), including 1-month data before and after their reported infection and/or vaccination. We compared participants who self-reported migraine worsening since infection or vaccination with those who did not., Results: Of 550 participants, 44.9% (247/550) reported having had COVID-19 at least once and 83.3% (458/550) had been vaccinated. Sixty-one patients reported migraine worsening since COVID-19 and 52 since the vaccination. Among the risk factors for perceived migraine worsening in the two settings (infection and vaccination) was concern about migraine worsening itself (infection: odds ratio [OR] 2.498 [95% CI: 1.02-6.273], p = 0.046; vaccination: OR 17.3 [95% CI: confidence interval 5.3-68], p < 0.001). e-diary information was available for 136 of the 550 patients, 38.2% (52/136) for COVID-19 and 39.7% (54/136) for vaccination. We observed no significant difference in headache frequency 1 month before and after infection or vaccination, even when comparing patients with and without self-reported migraine worsening., Conclusions: Our preliminary data point to a negligible role of the infection and vaccination on migraine worsening and to the possible presence of a nocebo effect in these settings, as a remarkable proportion of patients had a clear perception of migraine worsening., (© 2023 European Academy of Neurology.)

Background: Hepatic steatosis is a public health problem with increased incidence and prevalence OBJECTIVE: To determine whether the liver steatosis, as measured by the Fatty Liver Index (FLI), is related to metabolic risk and vascular factors and, if so, to identify the clinical-metabolic factor that explains the higher vascular risk., Methods: Cross-sectional study including a sample of 531 men who came to the University of Navarra Clinic Check-up Unit. The degree of steatosis was determined by the FLI. The metabolic risk was assessed using a scale based on determinations of HDL, LDL, triglycerides, blood glucose, HOMA-IR, neutrophil/lymphocyte index, and systolic blood pressure. The vascular risk was assessed by the presence of carotid and/or femoral atheromatous plaques. The dose-response association between FLI and both risks was analysed using non-parametric models (splines) and logistic regression., Results: The sample studied had a mean age of 52.70years, with 49.3% having an FLI ≥60, as well as 33.6% with metabolic syndrome, and 43.9% with carotid and/or femoral atheromatous plaques. The relationship between FLI and metabolic risk and vascular was linear (metabolic: non-linear P=.097; linear P<.001; vascular: non-linear P=1.000; linear P=.028). For every 10 units of increase in FLI, the odds of presenting with atheroma plaques increased by 9.7% (OR=1.097; 95% confidence interval 1.010-1.191). When adjusting for triglyceridaemia, the association disappeared (OR=1.001)., Conclusions: Patients with fatty liver disease had an increased metabolic and vascular risk. The increased vascular risk is associated with the triglyceride level. On a clinical level, this study suggests that these patients could benefit from treatment of hypertriglyceridaemia., (Copyright © 2020 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: To evaluate ocular features and histopathologic changes in patients with toxic epidermal necrolysis (TEN) treated with amniotic membrane transplantation (AMT) in the acute phase., Methods: A prospective study of 5 eyes (3 patients) with severe ocular involvement and 4 eyes (2 patients) with moderate involvement treated with AMT in the acute phase of TEN was performed. Patients underwent a complete ophthalmic assessment before the intervention and 3, 6, 9, and 12 months postoperatively. Tear film break-up time (BUT), Schirmer test, fluorescein&#95;staining, corneal and conjunctival epithelial squamous metaplasia, ocular sequelae, and conjunctival retraction were measured., Results: In patients with severe involvement, 2 eyes (40%) showed mild symblepharon and peripheral corneal neovascularization, and corneal epithelial defects, lid margin malposition, and trichiasis was found in 20% of the eyes; only 1 eye (20%) required surgery for structural defects. We did not find ocular sequelae after 1-year follow-up in the patients with moderate involvement. Only 1 eye (25%) developed mild symblepharon that did not require specific treatment. Amniotic membrane transplantation significantly improved the squamous metaplasia in corneal and conjunctival nonsecretory epithelial cells, and significantly improved the goblet cells density after 1-year follow-up., Conclusions: Amniotic membrane transplantation performed for acute TEN reduced inflammation and ocular surface scarring, improved dry eye and squamous metaplasia. and decreased ocular sequelae in the chronic stage. Although further and prospective studies are needed, AMT may be the optimal treatment for acute TEN with severe or moderate ocular involvement.

Age-related macular degeneration is the leading cause of legal blindness in people over 50 in developed countries. It is a multifactorial disease resulting from the interaction of genetic and environmental factors, and the age is the only worldwide admitted risk factor. The socioeconomic impact of the disease reaches enormous proportions, if we take into account the high cost of the available antiangiogenic therapy, the strict schedule of medical visits that it requires, and the impairment that it gives rise to. The response to treatment and the visual outcomes improve with early management of the retinal lesions, thus the early diagnosis of the disease in its initial phases, based on self-control with an Amsler grid and with regular ophthalmologic assessments, is essential., (Copyright © 2011 SEGG. Published by Elsevier Espana. All rights reserved.)

The bad use and overload of hospital emergency rooms (HER) constitute a problem in present health assistance. Old patients are often blamed of a misuse of this health care assistance. The results of studies analyzing the behaviour of older patients at HER show that this group of patients utilize this service more adequately than younger adults, since they go to the emergency room with more justifiable reason, with more severe diseases and require more hospital admissions. On the other hand, older patients consume more time in the HER than what would proportionally correspond to this group in the community. It is interesting to keep these data in mind when planning health assistance.