Marta Fragoso - Academia.edu (original) (raw)

Papers by Marta Fragoso

Brain disorders & therapy, 2015

International Journal of Neurology and Neurotherapy, 2018

Neurología (Barcelona, Spain), 2011

According to today’s most widely accepted international criteria, diffuse Lewy body disease (DLBD... more According to today’s most widely accepted international criteria, diffuse Lewy body disease (DLBD) is an illness that evolves with a spectrum of clinical manifestations, characterized by the presence of cognitive impairment, fluctuations in the state of alertness, sensoriperceptual disorders including visual hallucinations, and Parkinsonism. Over the last few years, the spectral characteristics of this disease have been recognized, with those patients who debut with and have a predominance of cognitive symptoms at one end and with the other end including those individuals in whom Parkinsonian symptoms prevail. Both extremes of the disease converge as the disease progresses, as revealed by neuropathological correlation studies. Moreover, neuropsychiatric symptoms are widely reported by various authors in both groups of patients, albeit little study has been dedicated to the onset and evolution of these symptoms in DLBD. In this article, we present a brief description of a patient who meets the criteria for DLBD and who debuted with neuropsychiatric symptoms (severe depression and visual hallucinations), many years prior to presenting cognitive and Parkinsonism-type symptoms, which has led us to conduct a review of the issue and to suggest that some patients with DLBD may begin with only neuropsychiatric symptoms and persist many years displaying only these symptoms before presenting cognitive impairment and/or Parkinsonism. A 79-year-old male patient, diagnosed with late-onset, recurring, major depressive disorder, presented a first major depressive episode in December 1994. Ever since onset, he has presented sensoriperceptual alterations in the form of visual hallucinations, with partial response to multiple treatment strategies, leading to hospitalization on sev-

World Journal of Neuroscience, 2018

The efficacy and the tolerance of the AEDs have been extensibly studied in the past, however the ... more The efficacy and the tolerance of the AEDs have been extensibly studied in the past, however the effects of them on the EEG activity of epileptic patients have been scarcely studied. Eslicarbazepine is a third generation blocker-sodium channels AED associated with a high reduction in the rate of partial seizures in epileptic patients. We designed an open label, non control study to determine the effects of Eslicarbazepine on the EEG activity of EP with focal seizures in a 12-week follow up. The EP with focal paroxystical activity enrolled in this study showed a statistical significant reduction in the rate of monthly seizures when Eslicarbazepine 800 mgs was added to a previous AED compared to those patients who only received an increase of the AED in monotherapy, concomitantly, EP treated with ESL added to a previous AED showed a statistically significant reduction in the mean occipital frequency and voltage amplitude in the central and parietal regions in the twelfth-week EEG compared to the control group.

Journal of Behavioral and Brain Science, 2016

Introduction: Continuous apomorphine infusion (CAI) is effective in improving complications in ad... more Introduction: Continuous apomorphine infusion (CAI) is effective in improving complications in advanced Parkinson's disease (APD). The effectiveness and tolerance of CAI in patients with APD with varying degrees of functional impairment was studied. Methods: In this comparative observational study, consecutive APD who started treatment with CAI were included. They were classified into two groups of functional impairment: A) moderate (Schwab and England (S & E) = 60%-80% and Hoehn and Yahr (H & Y) = 2-3; Group (A), and (B) severe (S & E < 60; H & Y > 3; Group B). Clinical follow-up was performed with concomitant medication and CAI adjustment at 3, 6 and 12 months. Clinical evaluation included a dyskinesia diary and AIMS, S & E, NPI, NMSS and HADS questionnaires. Results: Eighteen patients participated (A = 9 and B = 9) with EP diagnosed 7 (A) and 13 (B) years before. Their baseline dose of levodopa was 728 mg (A) and 925 mg (B), which did not change during follow-up. Dopamine agonists were progressively reduced in both groups. Progressive titration of CAI resulted in abandonment of apomorphine bolus administration. Both groups experienced improvements in all variables, higher in group A; motor fluctuations = 69% (A), 53% (B); AIMS = 82% (A), 71 (B); S & E = 32% (A), 18% (B); NMS = 62% (A), 19% (B); NPI = 75% (A), 50% (B); HADS (anxiety) = 26% (A), 21% (B); HADS (depression) = 52% (A), 31% (B). Adverse effects were generally mild and resolved without reducing CAI dose. There were no withdrawals. Conclusions: Patients with APD and moderate functional impairment treated with CAI may obtain greater functional, cognitive and emotional improvement than patients more severely affected.

Revista Española de Geriatría y Gerontología, 2009

La demencia es un potente predictor de dependencia que hace que sean esas personas las que vivan ... more La demencia es un potente predictor de dependencia que hace que sean esas personas las que vivan má s añ os con discapacidad. Es la enfermedad cró nica que mayor dependencia ocasiona a los 12, a los 24 y a los 36 meses de su evolució n, por delante de otras enfermedades discapacitantes, como el ictus, la enfermedad de Parkinson o las enfermedades cardiovasculares. Somos muchos los que conocemos las consecuencias devastadoras de las demencias, pero pocos sabemos reconocer los síntomas en las fases iniciales. Para poder combatir este hecho es necesario promover una mayor informació n pú blica y una mayor formació n a los profesionales de la salud. Es necesario avanzar en 3 campos para poder desarrollar una mejor atenció n en las distintas fases evolutivas de las demencias: considerar la demencia como una prioridad de salud pú blica, combatir la creencia equívoca de que no se puede hacer nada para los pacientes diagnosticados de demencia y, finalmente, no por ello menos importante, saber reconocer la demencia incipiente. Decir que las personas con demencia reciben con menor frecuencia atenció n paliativa de confort que aquellos pacientes diagnosticados de cá ncer a pesar de compartir, claramente, la necesidad de cuidados en fases avanzadas de la enfermedad y a pesar de ser demandada frecuentemente por familiares y cuidadores A forma de resumen, decir que podemos actuar y mejorar en el diagnó stico precoz de la enfermedad, de la misma forma que lo podemos hacer en las distintas fases evolutivas de la demencia y, así, poder retardar y/o minimizar la dependencia y, finalmente, mejorar las medidas de confort al final de la enfermedad.

Recent Patents on CNS Drug Discovery, 2011

Metoclopramide is a well-known anti-emetic drug with central and peripheral pharmacological effec... more Metoclopramide is a well-known anti-emetic drug with central and peripheral pharmacological effects. Some authors have reported metoclopramide as an adjunct therapy to other analgesics in patients with migraine attacks. Treatment of migraine headache using a mix of metoclopramide and an NSAID has been patented (European Patent EP1014961) as well as a short series showing great efficacy and tolerability of metoclopramide in patients wtih migraine attacks. We decided to conduct an open, single-blind, parallel control study in the emergency department to evaluate the efficacy and tolerability of metoclopramide in patients with severe migraine attacks. 93 consecutive patients with severe migraine attacks were randomized into two groups (groups A and B). Patients in group A received 10mg of intravenous metoclopramide and patients in group B received 1 g of intravenous paracetamol. Patients were evaluated 5 minutes before (baseline), 15, 30, 60 and 120 minutes after drug delivery, and before being discharged from the emergency department They were then contacted by phone 48 hours after being discharged from the hospital (phone questionnaire). Patients treated with either metoclopramide or paracetamol showed a significant reduction in the intensity of pain at the 120 minute time point, with an 86% and 82% improvement respectively. However, patients treated with metoclopramide showed a more rapid improvement at the 15 and 30 minute evaluations. Patients with severe migraine attacks treated with metoclopramide as monotherapy showed a significant improvement in terms of pain relief and a faster improvement in pain intensity compared to those treated with paracetamol. Metoclopramide and other dopamine antagonistic drugs should be considered a therapeutic option in severe migraine headache attacks.

Journal of Behavioral and Brain Science, 2021

Cervical Dystonia (CD) is the most common type of focal dystonia in the movement disorders units ... more Cervical Dystonia (CD) is the most common type of focal dystonia in the movement disorders units of any specialized hospital around the world. Botulinum Toxin (BT) infiltration is the treatment of choice for CD, according to most of the experts around the world, however the efficacy and tolerance of BT therapy in CD depend on the accuracy when BT is released into the muscles. We reviewed the medical literature in regard to the use of guiding tools for the BT infiltration in CD patients. Results: The use of guiding tools such as Ultrasound or EMG definitely improves the accuracy for releasing the BT into the muscles involved according to some authors. Conclusion: the use of Ultrasound and EMG improves the efficacy and reduce the adverse effects in the BT therapy in CD patients.

Introduction: Lower Body Parkinsonism (LBP) is a bilateral, symmetric lower limbs Parkinsonism wi... more Introduction: Lower Body Parkinsonism (LBP) is a bilateral, symmetric lower limbs Parkinsonism without a resting tremor, a poor L-dopa response and with a minimal upper limbs involvement. Patients usually demonstrate gait difficulties due to freezing gait and falls, causing a major grade of disability when compared to idiopathic Parkinson’s Disease patients (PD). Small vessel disease has been related to the pathophysiology of this type of secondary Parkinsonism. We decided to study the hemodynamic characteristics of the cerebral arteries of patients affected with LBP and compare them to PD patients using a Transcranial Doppler. Patients and Methods: We enrolled 12 LBP, 15 PD patients and 15 agematched healthy control subjects. A Transcranial Doppler was performed on patients and subjects in order to determine the systolic and diastolic velocities and pulsatility index (PI) in the anterior and posterior circuit cerebral arteries. Results: The LBP patients consisted of 7 men and 5 fem...

Journal of Neurological Disorders, 2014

Background: OnabotulinumtoxinA has proven efficacious as a preventive treatment in patients with ... more Background: OnabotulinumtoxinA has proven efficacious as a preventive treatment in patients with chronic migraine. However, non-response and tolerability problems were reported for some patients. This open-label study investigated long-term treatment with incobotulinumtoxinA in chronic migraine patients who were non-responsive to onabotulinumtoxinA injections. Methods: Patients received pericranial injections of 200 U incobotulinumtoxinA (fixed dose) into 20 injection sites (10 U/site) using a dilution of 10 U/0.1 ml saline every three months for 18 months. They were subsequently switched back to onabotulinumtoxinA (200 U fixed dose into 20 injection sites with 10 U/site every 3 months) and were followed for another six months (length of study 24 months). The primary efficacy endpoints were monthly migraine episodes, pain intensity, the impact of migraine on functioning in daily life and consumption of pain relief drugs. Results: Twenty-six patients (mean age 32 ± 4 years, 84.6% female) were included. IncobotulinumtoxinA significantly reduced mean monthly frequency of migraine episodes from 17.2 ± 2.1 to 4.3 ± 1.0 (p<0.05), pain intensity during these episodes from 9.3 ± 0.8 to 6.3 ± 0.9 (p<0.05) and consumption of acute pain medication from 32 ± 2 tablets to 5 ± 0.9 tablets after 18 months of treatment (all p<0.05). Patients' daily functioning improved from severe (29 ± 3 points) to mild disability (8.2 ± 1.2; p<0.05). Six months after switching back to onabotulinumtoxinA, the frequency of monthly migraine episodes was 4.1 ± 1.0 (p<0.05), pain intensity 5.8 ± 0.9 (p<0.05), and consumption of acute pain medication 4 ± 0.9 tablets (p<0.05). Patients' daily functioning was 8.2 ± 1.2 points (p<0.05; all p vs. baseline). Five mild adverse events were reported in the incobotulinumtoxinA treatment period. Conclusions: Both botulinum toxin type A preparations were administered at a higher total dose at fewer injection sites in higher concentrations (10 U/0.1 ml) than previously described. This treatment regimen resulted in long-term benefits in incobotulinumtoxinA treated chronic migraine patients who were non-responsive to previous onabotulinumtoxinA injections. These improvements could be sustained after switching back to onabotulinumtoxinA. Treatment was well tolerated.