Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

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Cerebelo: No Sólo Función Motora – A Propósito de un Caso. Cerebellum: Not Just Motor Function – About A Case.

The cerebellum constitutes a nervous structure with multiple bidirectional connections with the prefrontal cortex. This relationship allows us to understand its importance on neurocognitive processes. Multidisciplinary evaluation of neurological conditions allows us to study in depth its impact on the emotional and cognitive sphere.

Present case study aims to analyze the neurological and neuropsychological characteristics of a 64-year-old patient with cerebellar degeneration (novo progressive cerebellar atrophy) , which has 15 years of evolution but evaluated by the neuropsychology area the last four years.

After clinical evaluation carried out in two stages, and after check standardized neurocognitive tests, significant qualitative data are observed. A progressive decline in the patient’s neurocognitive sphere is evident, mainly in executive processes, such as bradypsychia, attention deficit, cognitive rigidity, foresight deficit, and categorical evocation.

The results suggest deterioration evidenced probably related to underlying cerebellar disorder, and evidence of cortex-cerebellar circuits, such dysfunction will influence on neurocognitive processes of executive type.

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Palabras clave: cerebelo, circuito cerebro-cerebelo, déficit cognitivo, funcione s ejecutivas, neuropsicología,

Keywords: cerebellum, cerebellum-cerebellar circuit, cognitive deficit, executive function s, neuropsychology,

Impacto de la COVID-19 en el Ecuador: De los datos inexactos a las muertes en exceso. Impact of COVID-19 in Ecuador: From inaccurate data to using excess mortality.

COVID19 has hit Ecuador drastically. In fact, until today around 75.000 confirmed cases and almost 9.000 deaths because of the virus has been showed by Official Statistics in the country. Good decisions can be made having data of high quality, but the national public health system was not able to provide such as input. Because of this, multiple sources of information and insights about the behavior of the pandemic in the country has appeared. From journalists and economists to health experts, all have published graphics and statistics that show how bad was managed the sanitary crisis in Ecuador. The typical elements to track a pandemic in any country are contagious and mortality curves but the difference in the results across the government, academic units and experts has woke up an intense debate. As information was not accurate, many people left to pay attention and as a result it might be seen that this disinformation contributed to the increase of contagious in our country. The crisis has been hard for many countries but international media like The Economist¹ and Financial Times² in United Kingdom developed an easy method to track the evolution of pandemics in any country.

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Palabras clave: COVID-19,

Keywords: COVID-19,

Efectos neurológicos y psicológicos de COVID-19 en niños y adolescentes. Neurological and psychological effects of COVID-19 in children and adolescents.

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Electroencefalografía en tiempos de COVID-19. Electroencephalography at the time of COVID-19.

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Síndrome de Guillain-Barré asociado con SARS-CoV-2. Guillain-Barré syndrome associated with SARS-CoV-2.

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¿Se Debe Considerar La Afectación Neurológica En La Infección Por Sars-cov-2? Should Neurological Affection Be Considered In Sars-cov-2 Infection?

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SARS-CoV2: manifestaciones neurológicas en niños. SARS-CoV2: neurological manifestations in children.

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¿Es adecuada la estructura factorial de la Escala Breve Para Valorar el Apego en Adultos? Is the factorial structure adequate of the Brief Scale to Assess Attachment in Adults?

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Efectos del Estrés Materno Intenso y Prolongado Durante el Embarazo y su Repercusión Sobre el Neurodesarrollo del Feto. Effects of Intense and Prolonged Maternal Stress During Pregnancy and its Impact on the Neurodevelopment of the Fetus.

Objective: To evaluate the possible repercussion of strong and prolonged maternal stress during pregnancy on the neurodevelopment of the fetus.

Method: Retrospective cross-sectional study with qualitative and quantitative analysis of seventy-three (73) cases of children -ages 1 through 6- who were seen in private practice between January and June 2017, in which reasons for consultation were analyzed through interviews, psychometric tests, and analysis of clinical history data. The variables were coded and entered into the statistical program SPSS version 22. Descriptive and inferential analysis tests were performed. For better understanding of the study sample, it was distributed in two groups according to the ‘type of pregnancy’ variable: group 1, non-stressed pregnancy, and group 2, stressed pregnancy.

Results: Significant differences were found between pregnancy types and reason for consultation (t (62)=2.78; p=0.007) and language signs and types of pregnancy (t (62)=5.572; p=(0.001) confirming that high stress rates have a high incidence in neurodevelopmental processes.

Conclusion: Our study has confirmed the possible repercussion of strong and prolonged maternal stress during pregnancy on the neurodevelopment of the fetus with possible future repercussions.

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Palabras clave: estrés materno en embarazo, lentitud maduracional, neurodesarrollo,

Keywords: maternal stress in pregnancy, neurodevelopment, slowed maturation,

Propuesta de un paradigma computarizado para valorar memoria de trabajo. Proposal of a computerized paradigm for evaluation of working memory.

A paradigm for evaluating working memory was validated with the use of N-back tasks in a computer program to be applied within Functional Magnetic Resonance (RMF). The study hypothesis is based on the fact that a verbal 2-back difficulty level increases the success in the performance of the task in working memory, valid to be used in RMF. Through a quantitative cross-sectional study, the N-back paradigm was adapted to a PshicoPy computer program. The task consisted of responding to the stimulus or letter that is the same as the one that appeared two places behind (2 back). 4 blocks of 30 seconds each were presented, and 4 blocks of rest of 30 seconds; in total it lasts 4 minutes. To study the validity of the paradigm, an expert validation and a pilot test were carried out with the participation of 18 adult university subjects. The data was tabulated in a spreadsheet, using statistical contingency table tests; and of sensitivity and specificity. The results offered data greater than 80% sensitivity and specificity regarding the subject’s performance before the test, and the validity of the stimuli. It is concluded that the test can be used to assess working memory by means of a computer program, which can also be used in applications such as RMF.

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Palabras clave: Memoria de Trabajo, N-back, Paradigma, PsycoPy, RMf,

Keywords: fMRI, N-back, Paradigm, PsycoPy, working memory,

Intracranial atherosclerotic disease and severe tooth loss and in community-dwelling older adults. Enfermedad aterosclerótica intracraneal y pérdida dental severa en adultos mayores.

Background: Information on the association between tooth loss and intracranial atherosclerotic disease (ICAD) is limited. Here, we aimed to assess whether non-traumatic severe tooth loss – as a surrogate for chronic inflammatory periodontal disease – is associated with ICAD in a cohort of older adults (aged ≥60 years) living in rural Ecuador.

Methods: ICAD was identified by CT determinations of high calcium content in the carotid siphons or MRA findings of significant stenosis of intracranial arteries. An oral exam assessed the level of non-traumatic severe tooth loss (<10 remaining teeth). Logistic regression models were fitted to assess the independent association between severe tooth loss and ICAD, after adjusting for demographics, cardiovascular risk factors and MRI evidence of cerebrovascular damage.

Results: Of 581 individuals, 269 (46%) had severe tooth loss and 205 (35%) had ICAD. Univariate analysis found a significant association between the two variables (p=0.002). Significance persisted when age and sex were added to the model (p=0.047), although it became non-significant in a logistic regression model including all confounders. Covariates with a significance p<0.1 included age, poor body mass index, high fasting glucose, the presence of >10 enlarged basal ganglia perivascular spaces, and both lacunar and non-lacunar strokes. After factoring in age partitioned by the median and other significant covariates, severe tooth loss remained significantly associated with ICAD.

Conclusions: Severe tooth loss and age are both associated with ICAD in the study population. Some of the effect of severe tooth loss on ICAD is captured by age.

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Palabras clave: aterosclerosis intracraneal, calcificaciones de sifones carotideos, Edentulismo, estenosis de arterias intracraneales,

Keywords: carotid siphon calcifications, intracranial artery stenosis, intracranial atherosclerosis, Tooth loss,

Efectos del ajedrez en el funcionamiento neuropsicológico infantil de la memoria de trabajo y la planificación.  Effects of chess on child neuropsychological functioning working memory and planning.

Introduction. Chess is a sport and game that benefits different cognitive capacities in the infant stage due to its actions of moving pieces, game rules, decision making and problem solving.

Objective. This article analyzes the benefit of chess in the working memory and planning of boys and girls between 7 and 11 years of age (M_age = 9.00, SD = 1.08).

Method. The design followed is of a comparative type with 30 chess players and 30 non-chess players.

Results. Statistically significant differences were found in the comparisons between the groups in: Labyrinth of Porteus t ₍₅₈₎ = 2.38, p = .02, d = .30; ENFEN t ₍₅₈₎ = 3.53, p = .001, d = .42, Color paths t ₍₅₈₎ = 2.26, p = .03, d = .28 and Ring Test t ₍₅₈₎ = 2.35, p = .02, d = .29. In the Parent Observation Questionnaire, no significant differences were found.

Conclusions. The results are discussed around previous research and underlining the positive impact that chess activity produces in the improvement of working memory and planning.

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Palabras clave: ajedrez, Funciones Ejecutivas, Memoria de Trabajo, planificación,

Keywords: chess, Executive functions, Planning, working memory,

Calidad de vida en pacientes con enfermedad cerebrovascular evaluados en un hospital venezolano. Quality of life in patients with stroke evaluated in a Venezuelan hospital.

Objective: Determine the health related quality of life (HRQL) in patients with cerebrovascular disease (CVD) evaluated in the Internal Medicine outpatient service from the Hospital General Hospital del Sur “Dr. Pedro Iturbe” en Maracaibo, Venezuela.

Materials and Methods: A descriptive and cross-sectional study was conducted, with a non-experimental design. The sample was represented by the first 80 patients with a new onset episode of CVD evaluated in the outpatient service from this hospital; to assess HRQL, the Quality of Life Scale for Stroke 38 was used.

Results: Of the subjects evaluated, 53.8% were women, the overall age was 60.7±9.4 years. Ischemic stroke was the most frequent, while 67.5% of the subjects evaluated showed some degree of involvement in their HRQL, specially moderate (36.3%) and mild (27.5%) degree.

Conclusion: no differences in HRQL were evidenced according to stroke type, although in general evaluation the majority reported a mild to moderate HRQL affectation, the analysis by domain shows a greater involvement in social functions, basic activities and physical problems.

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Palabras clave: calidad de vida, Déficit Motor, enfermedad cerebrovascular, salud, secuelas,

Keywords: Cerebrovascular disease, health, Motor Deficit, quality of life, sequelae,

Validación de un paradigma de razonamiento abstracto para Resonancia Magnética funcional (RMf). Validation of an abstract reasoning paradigm for functional magnetic resonance (fMR).

The paradigms are the experimental tasks that are used to map the brain through functional Magnetic Resonance Imaging. Its previous validation is essential to guarantee a successful record of the cognitive activity. A paradigm of abstract reasoning formed by a task of semantic and visual analogies was validated in young-adults between 18 and 30 years in the city of Cuenca-Ecuador. The paradigm was programmed in PsychoPy 3, a free software for neuroscience experiments. The results indicated that the experimental paradigm was understandable and easy to solve. It was also found that the average response time in the semantic reasoning task was significantly lower than the average resolution time of the visual reasoning task. Therefore, it was possible to establish the number of stimuli and their average exposure time needed for a functional Magnetic Resonance Imaging.

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Palabras clave: Paradigma, PsychoPy, razonamiento abstracto, resonancia magnética funcional, validación,

Keywords: abstract reasoning, Functional magnetic resonance imaging, Paradigm, PsychoPy, validation,

Aplicación de Realidad Virtual Para Tratamiento de la Mano Espástica en la Hemiplejía. Revisión Sistemática. Virtual Reality For Spastic Hand In Stroke Patient. Systematic Review.

Introduction: The virtual reality is as a real-time computer technology system whose use in neurological patients is an innovative process at the service of motor function recovery.

Aim: To determine the effect of virtual reality on the motor function of the spastic hand of the adult with hemiparesis.

Materials and methods: A systematic review of the literature was performed in PubMeD, Science direct, EMBASSE, PeDro, OT Seeker, Cochrane databases; they were selected results and controlled clinical analyzes from an analytical perspective according to the quality standards established to report experimental studies using the CONSORT 2010 strategy, for the inclusion criteria and the methodological quality studies was analyzed using the PEDro scale.

Results: The virtual reality therapy showed effectiveness in the function of the spastic hand of the adult with hemiparesis in selective activities that involve dexterity and execution of daily life skills, as well as favors the recovery of spasticity

Conclusions: Virtual reality therapy is effective in the spastic hand function of the adult with hemiplegia as a cerebrovascular consequence disease in selective activities that involve the dexterity and activities living of daily execution, as well as the recovery of the spasticity.

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Palabras clave: enfermedad cerebrovascular, Extremidad superior, Hemiparesia, Terapia de realidad virtual,

Keywords: hemiplegia, stroke, upper extremity, virtual reality therapy,

Complicaciones neurológicas del COVID-19 (SARS-CoV-2), revisión de la literatura. Neurological complications of COVID-19 (SARS-CoV-2), literature review.

Since the diagnosis of the first person infected with SARS-Cov-2, it has quickly spread throughout the world causing a pandemic and putting healthcare systems on maximal alert. Currently, evidence indicates that SARS-Cov-2 infection is not a disease limited to the respiratory system but it can also affect the central nervous system, causing anosmia, headache, seizures, stroke and altered mental status. For this reason, it is important to be aware of the neurological complications associated SARS-CoV-2 infection.

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Palabras clave: neuroinvasión, neurotropismo, SARS-CoV-2,

Keywords: neuroinvasion, neurotropism, SARS-CoV-2,

Análisis neurofutbolístico de Loris Karius: de la gloria al infierno. Loris Karius neurofutbolistic analysis: from glory to hell.

In the soccer context there have been huge errors that have cost the teams dearly. Sometimes they occur due to nerves or deconcentration, however, according to our clinical eye, sometimes the brain plays a trick and its malfunction, the product of traumatic brain injury that occurred in the same game, is what determines the score of an encounter. This is what happened to the Liverpool goalkeeper in the final of the 2018 Champions League, who, from our neuro-soccer reflection, had errors that cost him the match, due to an affectation of the cerebral magnocellular pathway that allows processing spatial visual perceptual information. In the featured article, we reflect on his brain state before and after the trauma suffered and highlight that a footballer who is awake and expressing that he can continue, is not necessarily an individual with his brain preserved, since it may be only a part of his brain mass speaking, but, as seen in Karius, however, other silencers may have been altered. We close the work by highlighting the need to incorporate neuropsychological knowledge to understand the effect of trauma on the playfield, since this work confirms that humans do not play soccer with their legs or hands, they do so with your brain.

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Palabras clave: estado de conciencia, fútbol, neuropsicología, traumatismo craneoencefálico,

Keywords: neuropsychology, soccer, state of consciousness, traumatic brain injury,

Deterioro Cognitivo y Demencias en Adultos con Trastorno del Espectro Autista. Cognitive Impairment and Dementia in Adults with Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) has been studied mainly in children. However, currently, 1/68 adults live with this neurodevelopmental disorder. ASD in adulthood shows suggestive symptoms of cognitive impairment, quickly compromising various cognitive functions. Cognitive impairment and behavioral disorders help to develop neurodegenerative diseases such as Frontotemporal dementia (FTD) and Alzheimer’s Disease (AD) in people with ASD during adulthood, which affects activities of daily living (ADL). The objective of this systematic review is to investigate the progression of ASD to cognitive impairment and dementia in adulthood. The methodology included the qualitative analysis of studies published in the years 2000 and 2020, exclusively in english. Results reveal that adults with ASD develop early cognitive impairment and dementia according to the general population, mainly affecting cognitive functions such as memory and executive functions. In conclusion, moderate to a profound degree of intellectual disability, as well as reductions in white matter, seems to be precursors for the development of cognitive impairment and dementia in adults with ASD.

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Palabras clave: Adultez, Demencias, deterioro cognitivo, Discapacidad Intelectual, Trastorno del Espectro Autista,

Keywords: Adulthood, Autism Spectrum Disorder, Cognitive Dysfunction, dementia, Intellectual Disability,

Ictus no comunicable en un adulto joven con parálisis cerebral portador del genotipo MTHFR variante C677T homocigótica. Noncommunicable stroke in a young adult with cerebral palsy carrying the homozygous variant MTHFR C677T genotype.

Cerebral palsy (CP) is a group of disorders that affect movement and muscle tone or posture. It is caused by damage that occurs in the immature brain as it develops, most often before birth.

Although there are few studies in the literature, it has been seen that the risk of stroke is increased in this type of patients. We present the case of a young adult with a recent stroke and CP carrying. The homozygous variant MTHFR C677T genotype, decreased folic acid and vitamin D were found. Stroke in CP context is a challenge for the clinician. Therefore, we think that the possibility of stroke should be considered in every patient with CP, suggesting primary prevention measures in every patient with CP.

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Palabras clave: Genotipo MTHFR variante C677T homocigótica, Ictus no comunicable, Índice de masa corporal, parálisis cerebral,

Keywords: Body mass index, cerebral palsy, Homozygous variant MTHFR C677T genotype, Noncommunicable stroke,

Mielopatía Espondilótica Cervical Como Un Imitador De Accidente Cerebrovascular. Cervical Spondylotic Myelopathy As A Stroke Mimic.

Cervical spondylotic myelopathy (CSM) is the most common nontraumatic spinal cord condition in people over 55 years of age. This disorder is due to compression of the spinal cord by a stenotic cervical canal. A 55-year-old hypertensive patient with a clinical picture that simulated a stroke is described, due to a sudden onset of a right brachiocrural motor deficit, with elevated blood pressure levels in the range of hypertensive crisis. Hours later the patient presented the same motor deficit contralaterally: Computed tomography and magnetic resonance imaging of the brain showed no abnormality. The finding of atrophy in the interosseous muscles was striking. Cervical magnetic resonance imaging was performed showing a narrow spinal canal, with spinal cord hyperintensity in T2 sequences at levels C2 to C6. The most frequent causes of stroke mimics are tumors and metabolic toxic disorders. Spinal disorders represent 1.7% of all cases, CSM being a rare cause.

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Palabras clave: Imitador de ictus, Mielitis, Mielopatía espondilótica cervical,

Keywords: Cervical spondylotic myelopathy, Spinal cord injury, Stroke mimic,

Presentación rara de síndrome antifosfolípido primario asociado a hiperhomocisteinemia como causa de enfermedad cerebrovascular isquémica recurrente en varón joven. Rare presentation of primary antiphospholipid syndrome associated with hyperhomocysteinemia as a cause of recurrent ischemic stroke in young male.

We present the case of a 38-year-old male patient with a history of recurrent ischemic cerebrovascular disease without determined etiology and venous thrombosis in lower limbs. Due to the aetiological diversity of cerebral infarction in a young adult, he underwent a series of clinical tests, which resulted in the diagnosis of a primary antiphospholipid syndrome associated with hyperhomocysteinemia.

Once the diagnosis was made, he was given therapy with anticoagulants and corticoid pulses; with posterior improvement. Antiphospholipid syndrome is part of the differential diagnosis in young women with cerebral infarction; most cases have been reported in its secondary form, but finding it in primary form and in a male patient is rare. Also, increased homocysteine values are related to the severity of the first cerebrovascular event, but not to recurrent events.

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Palabras clave: adulto joven, homocisteína, infarto cerebral, Síndrome antifosfolípido,

Keywords: Antiphospholipid syndrome, Cerebral infarction, homocysteine, young adult,

Enfermedad de Pompe de inicio tardío desencadenada por el embarazo, reporte de una variante clínica genómica descrita por primera vez en un adulto. Late onset Pompe’s disease in a woman triggered by pregnancy, a genomic clinical variant first time described in an adult.

Background: this is the first time in the world that the variant NM_000152 (GAA_V001):c.1555A˃G; p.(Met519Val), is a described in an adult woman, triggered by pregnancy. It is a substitution for a non-sense, homozygous, probably pathogenic mutation.

Case report: this is the case of a mestizo adult woman, born and resident in Ecuador, who during her breastfeeding period, after a pregnancy and cesarean delivery, it did debut with a musculoskeletal disorder. It hospitalized this patient at the Eugenio Espejo Hospital in Quito Ecuador; she has been re-admitted several times. Most relevant clinical findings were proximal muscle weakness, lower limb muscle weakness, difficulty in climbing stairs, respiratory insufficiency due to muscle weakness, edema of her lower limbs, impairment of activities of daily living, orthopnea, sleep disturbance, muscle weakness, elevated serum creatine kinase, abnormal enzyme/coenzyme activity, lumbar scoliosis, pulmonary arterial hypertension, with tricuspid regurgitation and mild mitral regurgitation, fatty replacement of skeletal muscle, pulmonary insufficiency, skeletal myopathy and myotonic discharges in EMG.

Conclusion: this is the first time worldwide that the variant NM_000152(GAA_V001):c.1555A˃G; p.(Met519Val), a substitution by a missense mutation, homozygous, likely pathogenic is describe in an adult. It is the first case triggered by pregnancy , first case of late onset described in Ecuador, and first case described in a mestizo woman from Ecuador.

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Palabras clave: complicaciones del embarazo, edad de inicio, enfermedad de almacenamiento de glucógeno tipo II, enfermedad de almacenamiento de glucógeno tipo IIb, variante genómica clínica,

Keywords: Age of Onset, clinical genomic variant, Glycogen Storage Disease Type II, Glycogen Storage Disease Type IIb, pregnancy complications,

Síndrome de Percherón. Ictus Talámico bilateral. Percheron syndrome. Bilateral thalamic stroke.

Percheron syndrome or synchronous bilateral thalamic infarction is a rare entity with a difficult clinical diagnosis. The complex structure of the thalamus in nuclei, as well as its peculiar irrigation and individual anatomical variability means that ischemic lesions can occur bilaterally in both thalamus due to the obstruction of a single artery, characterizing this picture. We present a case with acute ischemic lesions in both thalamus and anterior midbrain, compatible with the obstruction of the Percheron artery.

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Palabras clave: Arteria Percherón, Infarto talámico bilateral,

Keywords: Bilateral thalamic infraction, Percheron artery,

Adrenoleucodistrofia Ligada al Cromosoma X: Patrón de Desmielinización Mesencéfalo-Ponto-Cerebelosa. X-Linked Adrenoleukodystrophy: Mesencephalon-Pons.cerebellum Demyelinating Pattern.

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Palabras clave: Adrenoleucodistrofia,

Keywords: Adrenoleukodystrophy,

Infiltración dural metastásica. Metastatic dural infiltration.

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Palabras clave: Infiltración dural metastásica,

Bioética, Epidemias y Derechos Humanos. Bioethics, Epidemics and Human Rights

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Palabras clave: Bioética, Derechos Humanos, Epidemias,

Estudio COVID-EC: ¿Por Qué se Justifica Investigar Las Características Clínicas de Los Pacientes COVID-19 En Guayaquil, Ecuador? COVID-EC Study: Why Is It Justified To Research The Clinical Characteristics Of COVID-19 Patients In Guayaquil, Ecuador?

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Palabras clave: Coronavirus, COVID-19,

Recomendaciones Ecuatorianas Para Pacientes con Esclerosis Múltiple en Relación a Pandemia Por Coronavirus (COVID-19). Ecuadorian Recommendations For Patients With Multiple Sclerosis In Relation To A Coronavirus Pandemic (COVID-19)

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Palabras clave: esclerosis múltiple,

Enfermedad Por Coronavirus 2019 (COVID-19): Importancia de Sus Potenciales Efectos Neurológicos. Coronavirus Disease 2019 (COVID-19): The Importance Of Its Potencial Neurological Effects

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Palabras clave: Coronavirus, COVID-19,

Profilaxis en la Migraña: Descripción de la Prescripción en un Primer Nivel de Colombia. Migraine Prophylaxis: Description Of The Prescription In A First Level Of Colombia

Introduction: Migraine is a prevalent disease, crisis can be prevented with medication for not less than 6 months.

Objective: To identify the drugs used for the prophylactic treatment of migraine, inappropriate prescriptions and associated variables.

Materials and methods. Cross-sectional study, in patients of legal age, diagnosed with migraine and prescribed with prophylactic medications. Sociodemographic, comedication, comorbidities and drugs variables were included. Univariate, bivariate and binary logistic regression analysis was performed. Inappropriate prescription was defined by the formulation of drugs without evidence of effectiveness for prophylaxis or by the use of drugs at doses or subtherapeutic times.

Results: 241 patients were included, 87.1% were women. 87.6% of patients received effective drugs, 10.8% probably effective, 2.5% possibly effective and 10.4% drugs without evidence. Propranolol was the most commonly used drug for prophylaxis, on average for 69.1±57.2 days, followed by valproic acid (53.2±55.3 days) and amitriptyline (45.7±39.6 days). 99.6% of patients presented an inappropriate prescription.

Conclusions: A high inadequate prescription of medications for the prophylactic treatment of migraine was identified due to not complying with the recommended dose and duration, as well as an important use of drugs without evidence.

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Palabras clave: Cefalea, Farmacoepidemiología, Prescripciones de Medicamentos, Propranolol, Trastornos migrañosos,

Keywords: headache, Migraine Disorders, Pharmacoepidemiology, Prescription Drugs, Propranololr,

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