Diseases and procedures

• dementias

  They are a group of diseases that are characterized by the loss of cognitive abilities (for example, memory, language, reasoning) and that reduce the person's ability to carry out their daily activities. These diseases are linked to age. For this reason, the increase in life expectancy of the population will increase its prevalence.

  The most common type of dementia is Alzheimer's disease (it accounts for 60% of all dementias). Currently, there is no treatment that cures or stops the disease, but there are some symptomatic treatments that have shown modest effectiveness in cognitive deficits and behavioral alterations.

  For now, it is considered that the only way to clinically improve patients is to establish an early diagnosis that allows pharmacological treatment to start early, in order to favor the stabilization of cognitive, behavioral and functional impairment.

• Stroke

  Stroke or acute cerebrovascular accident is the second leading cause of death in the world and one of the most disabling diseases.

  In Catalonia, stroke is the second leading cause of death and the leading medical cause of disability, with more than 13.000 admissions per year. Basically, there are two types of stroke: ischemic, due to the closure of one of the arteries that bring blood to the brain, and hemorrhagic, due to the rupture of one of these arteries.

  Actions in the acute phase of stroke between 2005 and 2012 prevented the death of 1.107 people aged 45 and over in Catalonia. For this reason, early recognition of stroke symptoms and their treatment during the first hours of the illness is important.

  Sant Joan Despí Hospital and l'Hospitalet General Hospital are part of the stroke code network in Catalonia, an integrated system that allows the transfer of stroke patients to the nearest hospital capable of administering treatments in the initial phase of the stroke. During the year 2021, there has been a 34% increase in stroke codes treated at the center compared to 2020 and a 30% increase compared to 2019 (pre-pandemic year). All this led, with the approval of CatSalut, to the Sant Joan Despí Hospital opening the Stroke Unit during the last quarter of 2021, which has allowed better care for patients with this pathology that it accounts for almost 80% of the reason for admission to the Neurology service.

• Parkinson's disease

  Parkinson's disease is the second most common neurodegenerative disease. Although it usually appears after the age of 60, there are more and more cases that start earlier. The cause is usually unknown although it is known to be a chronic neurodegenerative disorder that involves the loss of groups of neurons in the brain.

  It can manifest itself in many different ways, although the most well-known symptoms are the motors, which tend to appear on one side of the body and then spread to the other. These motor symptoms are mainly tremor, stiffness, slowness of movement and gait and posture disorder. However, there are also many non-motor symptoms, not so visible, which can affect the mind more than the body, and influence the patient's quality of life more: pain, low blood pressure, memory loss, hallucinations , impulsivity, depression, anxiety, sleep disturbance, sweating, seborrhea or urinary and gastrointestinal disorders.

  The diagnosis of Parkinson's disease is made by a neurologist based on the clinical manifestations presented by the patient. It should be considered that not all parkinsonism is caused by Parkinson's disease. Complementary tests, such as analytical tests with different parameters, cranial CT, cranial magnetic resonance or brain SPECT, are not mandatory but may be required if the neurologist considers it appropriate to rule out other diseases that can simulate Parkinson's disease or aggravate the symptoms.

  Treatment should be initiated when symptoms interfere with any of the activities of daily living. The recommendation is always to go to the specialist. Although levodopa is the main drug in the treatment of Parkinson's disease, there are others widely used in daily practice. It is the neurologist who will initiate the best therapy according to the recommendations stipulated for each patient and each phase of the disease.

  The future of Parkinson's disease is focused on finding new drugs and, above all, on being able to identify a biomarker (genetic, molecular or neuroimaging) that allows recognizing people at risk of developing the disease, better monitoring and even researching drugs that slow down the natural progression of Parkinson's.

• Headaches

  Headache accounts for 25-30% of first visits to a general neurologist and is the most frequent reason for neurological consultation in primary care. The possible causes of a headache are numerous, but the vast majority are migraines or tension headaches, that is to say, primary headaches in which "the headache is the disease itself". In less than 10% of cases the headache is a symptom of another disease (secondary headache) and in these cases it is necessary to carry out complementary examinations to arrive at the diagnosis.

  Migraine affects 15% of the population and is three times more common among women. The maximum prevalence is between 25 and 55 years. It represents the second most incapacitating neurological pathology and with great health expenditure, only surpassed by dementia.

  Along with primary care, criteria for referral to Neurology and Emergency have been established according to the characteristics of the headache, in a fluid relationship.

  8% of migraine sufferers end up with chronic migraine, which causes the most disability. The Sant Joan Despí Hospital and the Hospital General de l'Hospitalet have a specific botulinum toxin treatment unit for patients with chronic migraine who do not respond to the usual preventive treatments.

• Epilepsy

  Epilepsy is a chronic disorder characterized by the presence of recurrent, unprovoked seizures (caused by some reversible medical condition, such as alcohol withdrawal or extremely low sugar levels). It affects 0,7-1% of the population.

  A person is considered to have epilepsy if they have had two unprovoked seizures (or one unprovoked seizure with known risk factors for recurrence present). Seizures in epilepsy may be related to brain injury or a family tendency, although the cause is often unknown.

  Having epilepsy can affect personal integrity, personal relationships, work and driving motor vehicles, among other factors. The negative prejudices of the population towards epilepsy and the treatments employed may be more important (and difficult to treat) problems than the crises themselves.

• multiple sclerosis

  Multiple sclerosis is an inflammatory, autoimmune and chronic neurological disease that affects the central nervous system (brain and spinal cord). It is the first cause of disability in young adults due to illness.

  In this disease, the immune system attacks the myelin, a substance that surrounds the nerve fibers or neurons so that the transmission of the nerve impulse is correct. If myelin is destroyed or damaged, neuronal communication is delayed or interrupted and symptoms appear, which are wide and varied and affect each person differently. The most common symptoms include fatigue, limb weakness, sensory disturbances, visual disturbances and balance problems.

  The cause of multiple sclerosis is unknown but it is thought to be a combination of a genetic predisposition and environmental causes. On the other hand, it is known that it is a non-contagious disease, neither hereditary nor fatal. Its evolution is different for each person and there are different types of multiple sclerosis.

  Today it is a disease that, although it does not have a cure, does have an effective treatment that, if applied from the beginning and individualized for each patient, can change the course of the disease and make does not develop a disability or that this is not significant. In the same way as in other neurological diseases, such as stroke, "Time is Brain", which means that consulting in time can change your prognosis.