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Sant Josep de sa Talaia, Spain

Pergola P.E.,University of Texas Health Science Center at San Antonio | White C.L.,University of Texas Health Science Center at San Antonio | Szychowski J.M.,University of Alabama at Birmingham | Talbert R.,University of Texas at Austin | And 8 more authors.
American Journal of Hypertension | Year: 2014

Background Lowering blood pressure (BP) after stroke remains a challenge, even in the context of clinical trials. The Secondary Prevention of Small Subcortical Strokes (SPS3) BP protocol, BP management during the study, and achieved BPs are described here. methods Patients with recent symptomatic lacunar stroke were randomized to 1 of 2 levels of systolic BP (SBP) targets: lower: <130 mm Hg, or higher: 130-149 mm Hg. SBP management over the course of the trial was examined by race/ethnicity and other baseline conditions. results Mean SBP decreased for both groups from baseline to the last followup, from 142.4 to 126.7 mm Hg for the lower SBP target group and from 143.6 to 137.4 mm Hg for the higher SBP target group. At baseline, participants in both groups used an average of 1.7 ± 1.2 antihypertensive medications, which increased to a mean of 2.4 ± 1.4 (lower group) and 1.8 ± 1.4 (higher group) by the end-study visit. It took an average of 6 months for patients to reach their SBP target, sustained to the last follow- up. Black participants had the highest proportion of SBP =150 mm Hg at both study entry (40%) and end-study visit (17%), as compared with whites (9%) and Hispanics (11%). conclusions These results show that it is possible to safely lower BP even to a SBP goal <130 mm Hg in a variety of patients and settings, including private and academic centers in multiple countries. This provides further support for protocol-driven care in lowering BP and consequently reducing the burden of stroke. © American Journal of Hypertension, Ltd 2014.

Aguirregomozcorta M.,University College London | Aguirregomozcorta M.,Hospital Universitari Dr Josep Trueta Of Girona | Mancini L.,University College London | Jenkins T.M.,University College London | And 5 more authors.
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2011

Background: Non-arteritic anterior ischaemic optic neuropathy (NA-AION) can cause disabling visual loss and traditionally, visual prognosis has been considered poor, although recent studies have demonstrated improvements in visual acuity in about 30% of patients over time. The aim of the study was to determine whether there was significant cortical reorganisation with functional MRI (fMRI) after acute NA-AION by comparing affected individuals with healthy controls. Methods: 9 patients with NA-AION were studied acutely and then after 1, 2, 3 and 6 months. 23 healthy volunteers underwent scanning at least twice. At each time point, patients were assessed clinically and with fMRI. For the fMRI experiments, subjects underwent monocular visual stimulation (wearing goggles with flashing LED displays). Results: When stimulating the affected eye, occipital activation was reduced in patients compared with controls. Also, within the NA-AION group, activation in the right Brodmann areas (BA) 44 and 45 was seen during the early phase of the condition. The same areas were activated within the NA-AION group several months later for fellow eye stimulation. When the NA-AION and healthy control groups were formally compared however, these areas (BA 44/45) were not significantly different. NA-AION subjects did show greater activation in visual related areas compared with controls when stimulating the fellow eye. Visual acuity was correlated with more occipital cortex activation when stimulating the affected eye. Conclusions: There is cortical re-organisation of the fMRI response in extra-visual areas, seen when both affected and fellow eyes are stimulated after NA-AION.

Lopez-Pousa S.,Institute DAssistencia Sanitaria | Calvo-Perxas L.,Institute DAssistencia Sanitaria | Lejarreta S.,Unitat de Valoracio de la Memoria I Les Demencies | Cullell M.,Servei de Neurologia | And 12 more authors.
American Journal of Alzheimer's Disease and other Dementias | Year: 2012

Introduction: Clinical evidence indicates that acetylcholinesterase inhibitors (AChEIs) are not efficacious to treat frontotemporal lobar degeneration (FTLD). The British Association for Psychopharmacology recommends avoiding the use of AChEI and memantine in patients with FTLD. Methods: Cross-sectional design using 1092 cases with Alzheimer's disease (AD) and 64 cases with FTLD registered by the Registry of Dementias of Girona. Bivariate analyses were performed, and binary logistic regressions were used to detect variables associated with antidementia drugs consumption. Results: The AChEIs were consumed by 57.6% and 42.2% of the patients with AD and FTLD, respectively. Memantine was used by 17.2% and 10.9% of patients with AD and FTLD, respectively. Binary logistic regressions yielded no associations with antidementia drugs consumption. Conclusions: There is a discrepancy regarding clinical practice and the recommendations based upon clinical evidence. The increased central nervous system drug use detected in FTLD requires multicentric studies aiming at finding the best means to treat these patients. © The Author(s) 2012.

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