Letter to the Editor
Consumption patterns of antiepileptic drugs among epileptic patients in the Western Málaga district
Perfil de consumo de antiepilépticos en los pacientes epilépticos del Área Oeste de Málaga
G. Garcia-Martina,
, M.I. Chamorro-Muñoza, G. Martin-Reyesb, M.S. Dawid-Milnerc, F. Perez-Errazquina, M. Romero-Acebala
Corresponding author
a Servicio de Neurología, Hospital Virgen de la Victoria, Málaga, Spain
b Departamento de Economía aplicada (Estadística y Econometría) 68, Facultad de Económicas, Universidad de Málaga, Málaga, Spain
c Departamento de Fisiología Humana y Educación Físico-Deportiva, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
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Garcia-Martin, M.I. Chamorro-Muñoz, G. Martin-Reyes, M.S. Dawid-Milner, F. Perez-Errazquin, M. Romero-Acebal" "autores" => array:6 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Garcia-Martin" "email" => array:1 [ 0 => "guillerminagmartin@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.I." "apellidos" => "Chamorro-Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Martin-Reyes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M.S." "apellidos" => "Dawid-Milner" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "F." "apellidos" => "Perez-Errazquin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Romero-Acebal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Virgen de la Victoria, Málaga, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Economía aplicada (Estadística y Econometría) 68, Facultad de Económicas, Universidad de Málaga, Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Fisiología Humana y Educación Físico-Deportiva, Facultad de Medicina, Universidad de Málaga, Málaga, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Perfil de consumo de antiepilépticos en los pacientes epilépticos del Área Oeste de Málaga" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Understanding the consumption patterns of antiepileptic drugs (AEDs) is important since epilepsy generates a large percentage of healthcare costs and the adverse effects of antiepileptic drugs may have a significant impact on the patients’ quality of life. This is why it may be beneficial to document consumption patterns among the epileptic population of the Western Málaga district.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Since the only neurology departments in Málaga province are found in the 2 public hospitals in the capital city, we believe that ascertaining AED consumption patterns in our hospital can provide an approximate idea of how they are consumed throughout the Western Málaga district. Data might also be extrapolatable to the province's total population.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We collected data from patients with a definite diagnosis of active epilepsy<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> who attended weekly follow-up visits at Hospital Virgen de la Victoria in Málaga for a year. Data were also collected from patients with inactive epilepsy but still taking antiepileptic drugs.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We obtained a sample of 515 patients, including 507 on treatment. Clinical characteristics of our patients resembled those of epileptic patients in Europe, as we amply described in an article published in 2012.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Of the total patients, 54.3% were on monotherapy, 30.87% were on double therapy, 12.2% received triple therapy, and only about 1% were treated with 4 drugs.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The most widely used drug in the whole sample, whether in monotherapy or combination therapy, was valproic acid (28.3%), followed by levetiracetam and lamotrigine (23% each). In monotherapy only, the most widely used drugs were valproic acid and lamotrigine (14% each), followed by carbamazepine, oxcarbazepine, and levetiracetam in smaller percentages (7%, 6%, and 7%, respectively). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the consumption data for each antiepileptic drug used by patients in our sample.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Whereas 12% of the patients stated that they were taking one or more generic drugs, 17% of the patients in the sample did not know the brand of the antiepileptic drug they were taking (reference brand, alternative brand, or generic). Of the total samples, 2.9% of the patients reported a recent seizure and suggested that it might have been caused by changing the brand of antiepileptic drug.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Only 28% of the 407 patients questioned about adverse drug events mentioned having experienced one. We should indicate that in order to list adverse events for each drug separately, we conducted the study only with those patients on monotherapy.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the total sample, the most frequently reported adverse events were those affecting the cognitive sphere (8.9%), followed by physical adverse events (6.4%), and dizziness of any kind (4.9%). Therefore, and in line with other authors’ findings,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> the most frequent adverse events are related to the nervous system. We also observed abnormalities in laboratory analyses in almost half of the patients (48.8%) tested at least once.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Considering only those patients on monotherapy, topiramate was the drug that caused the most adverse events. Among patients treated with topiramate monotherapy, 57% of those questioned reported adverse events, especially weight loss. Topiramate was followed by phenytoin (40% of patients treated in monotherapy and asked about adverse events) and oxcarbazepine (30.7%). These 2 drugs affected concentration and caused sleepiness. Valproic acid was responsible for adverse effects, especially alopecia and/or obesity, in 26.4% of the interviewed patients treated with that drug in monotherapy. Carbamazepine caused adverse events, mainly digestive, in 20% of patients on that treatment, some of whom also presented alterations in laboratory results that might have been related to that drug. A similar percentage presented levetiracetam-related adverse events, most of which affected mood. Lamotrigine (9.67%) was the drug causing the fewest adverse events.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Grouping antiepileptic drugs taken as monotherapy by generation did not show a statistically significant degree of association, although new drugs are associated with fewer adverse events than classic antiepileptic drugs are (18% vs 25%). Detailed data cannot be presented here because our article appears in the Letters to the Editor section, but they can be consulted in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Consumption patterns of antiepileptic drugs in our patient sample are similar to those reported in other studies.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,6</span></a> However, some changes have been observed: increased consumption of new drugs and decreased use of the classic AEDs phenytoin and phenobarbital. In our sample, 51% of the patients use new drugs and 49% remain on classic AEDs (expressed as percentages of the total sample, including monotherapy and combination therapy). In our study, the most widely used drug was valproic acid, but the literature contains only a few epidemiological studies reporting these data. According to Gallito et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> the most widely used drug in Italy is phenobarbital; the Russian study by Ghekht et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and the Icelandic study by Olaffson and Hauser<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>, cite carbamazepine as the most widely used drug (36%).</p><p id="par0065" class="elsevierStylePara elsevierViewall">The main limitation of our study is its double selection bias. On the one hand, selected patients represent only one hospital, meaning that we did not consider patients whose follow-up visits take place in private clinics or primary care centres. The population may also contain undiagnosed epileptics or patients who do not attend follow-up visits. On the other hand, the search for adverse events was conducted using a clinical interview and not a specific questionnaire. As a result, many events may go undetected even when doctors are specifically searching for them.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a> We should stress that this study was only able to measure adverse events from drugs that patients are currently taking. As a result, this study collected no information about cases in which adverse events (severe effects or drug intolerance) resulted in withdrawal of the drug in question.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In any case, we would like to highlight the high rate of adverse events related to topiramate, even though the significance of this tendency is questionable since only a few patients were taking this drug in monotherapy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7). Other authors, however, have presented similar findings.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> In our opinion, the most noteworthy finding from this study is that it does not identify fewer adverse events for new drugs than for classic drugs. It does show different ranges of adverse events for each of the two drug types, and this finding is consistent with results from other studies.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,14</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Our study is the first large-scale contribution to the knowledge of AED consumption patterns in the south of Spain. Consumption of classic drugs remains high and its pattern is similar to that of new drugs. Although the type of adverse events differs between classic and new drugs, we found no statistically significant differences between the two drug groups with regard to presence or absence of adverse events. Classic drugs therefore remain a feasible option. Furthermore, a small percentage of patients have associated a change in the brand of AED with the occurrence of an epileptic seizure. Considering all of the above, the type and brand of an antiepileptic drug should always be selected on a case-by-case basis, while seeking to ensure rational drug use.</p><p id="par0080" class="elsevierStylePara elsevierViewall">All data from this study are included in a doctoral thesis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Garcia-Martin G, Chamorro-Muñoz MI, Martin-Reyes G, Dawid-Milner MS, Perez-Errazquin F, Romero-Acebal M. Perfil de consumo de antiepilépticos en los pacientes epilépticos del Área Oeste de Málaga. Neurología. 2015;30:67–69.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Socio-epidemiological study of epilepsy. Western Málaga district. Healthcare management and quality of life.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">ADR: only patients taking the drug in monotherapy are included.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CBZ, carbamazepine; CLB, clobazam; CLN, clonazepam; AED, antiepileptic drug; GB, gabapentin; LEV, levetiracetam; LMT, lamotrigine; <span class="elsevierStyleItalic">n</span>, patients reporting use of brand name vs generic/patients reporting ADRs vs no ADRs; <span class="elsevierStyleItalic">N</span>, total patients in the sample; OXC, oxcarbazepine; PRG, pregabalin; PHT, phenytoin; PB, phenobarbital; ADR, adverse drug reactions; RUF, rufinamide; VPA, valproic acid; TPM, topiramate; ZNS, zonisamide.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AED \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Brand (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Generic (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Frequency (<span class="elsevierStyleItalic">N</span>) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ADR (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No ADR (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Monotherapy (<span class="elsevierStyleItalic">N</span>) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PHT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">VPA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">146 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">146 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">CBZ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">108 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">OXC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">CLB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">CLN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LMT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">117 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">TPM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LEV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">118 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">118 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">ZNS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">GB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PRG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RUF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1431797.png" ] ] ] ] 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 0 | 4 |
| 2024 October | 25 | 5 | 30 |
| 2024 September | 30 | 3 | 33 |
| 2024 August | 26 | 1 | 27 |
| 2024 July | 16 | 9 | 25 |
| 2024 June | 15 | 5 | 20 |
| 2024 May | 14 | 4 | 18 |
| 2024 April | 19 | 6 | 25 |
| 2024 March | 23 | 2 | 25 |
| 2024 February | 18 | 5 | 23 |
| 2024 January | 17 | 6 | 23 |
| 2023 December | 12 | 12 | 24 |
| 2023 November | 18 | 11 | 29 |
| 2023 October | 14 | 10 | 24 |
| 2023 September | 18 | 4 | 22 |
| 2023 August | 10 | 10 | 20 |
| 2023 July | 16 | 9 | 25 |
| 2023 June | 16 | 3 | 19 |
| 2023 May | 21 | 3 | 24 |
| 2023 April | 10 | 5 | 15 |
| 2023 March | 8 | 1 | 9 |
| 2023 February | 8 | 4 | 12 |
| 2023 January | 9 | 9 | 18 |
| 2022 December | 25 | 13 | 38 |
| 2022 November | 20 | 6 | 26 |
| 2022 October | 20 | 14 | 34 |
| 2022 September | 21 | 19 | 40 |
| 2022 August | 15 | 6 | 21 |
| 2022 July | 26 | 9 | 35 |
| 2022 June | 19 | 12 | 31 |
| 2022 May | 29 | 7 | 36 |
| 2022 April | 36 | 12 | 48 |
| 2022 March | 59 | 10 | 69 |
| 2022 February | 54 | 11 | 65 |
| 2022 January | 40 | 8 | 48 |
| 2021 December | 26 | 10 | 36 |
| 2021 November | 28 | 11 | 39 |
| 2021 October | 13 | 10 | 23 |
| 2021 September | 14 | 13 | 27 |
| 2021 August | 11 | 8 | 19 |
| 2021 July | 12 | 13 | 25 |
| 2021 June | 12 | 7 | 19 |
| 2021 May | 11 | 14 | 25 |
| 2021 April | 22 | 31 | 53 |
| 2021 March | 17 | 12 | 29 |
| 2021 February | 11 | 11 | 22 |
| 2021 January | 12 | 16 | 28 |
| 2020 December | 24 | 12 | 36 |
| 2020 November | 11 | 5 | 16 |
| 2020 October | 8 | 9 | 17 |
| 2020 September | 13 | 17 | 30 |
| 2020 August | 19 | 9 | 28 |
| 2020 July | 11 | 17 | 28 |
| 2020 June | 10 | 12 | 22 |
| 2020 May | 11 | 18 | 29 |
| 2020 April | 11 | 4 | 15 |
| 2020 March | 23 | 8 | 31 |
| 2020 February | 8 | 3 | 11 |
| 2020 January | 20 | 8 | 28 |
| 2019 December | 17 | 11 | 28 |
| 2019 November | 15 | 6 | 21 |
| 2019 October | 9 | 8 | 17 |
| 2019 September | 14 | 5 | 19 |
| 2019 August | 10 | 6 | 16 |
| 2019 July | 2 | 6 | 8 |
| 2019 June | 22 | 13 | 35 |
| 2019 May | 66 | 17 | 83 |
| 2019 April | 31 | 5 | 36 |
| 2019 March | 7 | 5 | 12 |
| 2019 February | 15 | 10 | 25 |
| 2019 January | 6 | 15 | 21 |
| 2018 December | 5 | 8 | 13 |
| 2018 November | 13 | 4 | 17 |
| 2018 October | 16 | 13 | 29 |
| 2018 September | 2 | 0 | 2 |
| 2018 August | 4 | 0 | 4 |
| 2018 July | 7 | 2 | 9 |
| 2018 June | 5 | 1 | 6 |
| 2018 May | 13 | 7 | 20 |
| 2018 April | 0 | 3 | 3 |
| 2018 March | 5 | 0 | 5 |
| 2018 February | 5 | 1 | 6 |
| 2018 January | 5 | 3 | 8 |
| 2017 December | 6 | 0 | 6 |
| 2017 November | 6 | 4 | 10 |
| 2017 October | 10 | 3 | 13 |
| 2017 September | 11 | 2 | 13 |
| 2017 August | 18 | 4 | 22 |
| 2017 July | 20 | 2 | 22 |
| 2017 June | 14 | 21 | 35 |
| 2017 May | 12 | 2 | 14 |
| 2017 April | 9 | 3 | 12 |
| 2017 March | 11 | 73 | 84 |
| 2017 February | 6 | 1 | 7 |
| 2017 January | 9 | 8 | 17 |
| 2016 December | 16 | 12 | 28 |
| 2016 November | 17 | 7 | 24 |
| 2016 October | 18 | 16 | 34 |
| 2016 September | 16 | 10 | 26 |
| 2016 August | 18 | 5 | 23 |
| 2016 July | 13 | 2 | 15 |
| 2016 June | 28 | 19 | 47 |
| 2016 May | 16 | 18 | 34 |
| 2016 April | 27 | 20 | 47 |
| 2016 March | 44 | 24 | 68 |
| 2016 February | 11 | 17 | 28 |
| 2016 January | 11 | 9 | 20 |
| 2015 December | 7 | 10 | 17 |
| 2015 November | 11 | 15 | 26 |
| 2015 October | 22 | 14 | 36 |
| 2015 September | 30 | 11 | 41 |
| 2015 August | 19 | 4 | 23 |
| 2015 July | 12 | 3 | 15 |
| 2015 June | 8 | 2 | 10 |
| 2015 May | 24 | 7 | 31 |
| 2015 April | 24 | 15 | 39 |
| 2015 March | 29 | 14 | 43 |
| 2015 February | 104 | 30 | 134 |
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