bluuebunny/crossref_metadata_2025 huggingface dataset:
Discrepancies between patient and professionals recall and perception of an outpatient consultation
Authors: Parkin T. , Skinner T. C.
Published: October 2003

Aims  To explore the degree of agreement between patient and health care professional's perceptions of consultations.

Methods  Immediately after 141 dietitian/nurse specialist consultations, patients and professional's completed the Health Care Climate questionnaire (HCC), Medical Interview Satisfaction Scale (MISS) and the Treatment Self‐Regulation Questionnaire (TSRQ) In addition, both parties were asked about any key points or issues discussed in the consultation; any decisions that were made about their diabetes treatment today; any goals that were set as a result of today's consultation.

Results  Patient and professional's scores on the HCC and MISS were not correlated (r = 0.3 and 0.16). Patient and professionals disagreed on the issues discussed 19.6% of the time, on the decisions made 20.7% of the time and goals set 44.3% of the time. More autonomy support in the consultation was associated with greater autonomous motivation for self‐care (r = 0.31; P < 0.001) more controlled motivation was associated with less agreement on issues discussed and goals set (r = −0.20; r = −0.24; P < 0.05).

Conclusion  There is significant disagreement between patients and professionals perceptions and recollection of the content of consultations. Professional's communications skills need to be developed to ensure these discrepancies are minimized. Skills to provide greater autonomy support in the consultation would help to enhance this process and improve outcomes.
Plasma interleukin‐6 is associated with coagulation in poorly controlled patients with Type 2 diabetes
Authors: Aso Y. , Okumura K. , Yoshida N. , Tayama K. , Kanda T. , Kobayashi I. , Takemura Y. , Inukai T.
Published: October 2003

Aims  We investigated the relationship between interleukin (IL)‐6 and coagulation, i.e. whether changes in the plasma IL‐6 are associated with those in coagulation markers (D dimer and fibrinogen) after glycaemic control with sulphonylurea or insulin in poorly controlled patients with Type 2 diabetes.

Methods  We studied 42 patients with Type 2 diabetes, including 19 subsequently treated with sulphonylurea, 23 treated with insulin and 48 control subjects. All patients were in poor glycaemic control and were hospitalized for 3 weeks. At the beginning and end of treatment, we measured plasma concentrations of IL‐6, fibrinogen, and D dimer.

Results  Plasma concentrations of IL‐6 and D dimer were significantly higher in diabetic patients than in controls (P < 0.0001 for both). In all patients with diabetes, the plasma concentration of IL‐6 decreased significantly (P < 0.001) after treatment. Changes in the plasma IL‐6 during hospitalization were positively correlated with those in plasma D dimer and fibrinogen (r = 0.664, P < 0.0001; r = 0.472, P = 0.0042, respectively). Treatment with sulphonylurea or insulin caused a similar fall in the plasma IL‐6 concentration with a concomitant decrease in the BMI and an equal improvement in glycaemia.

Conclusions  In poorly controlled patients with Type 2 diabetes, plasma IL‐6 concentrations were reduced significantly even by short‐term metabolic control. As changes in the plasma concentrations of D dimer are related to plasma IL‐6, plasma IL‐6 may reflect a pro‐coagulant as well as an inflammatory state in patients with Type 2 diabetes.
Gender differences in the prevalence of impaired fasting glycaemia and impaired glucose tolerance in Mauritius. Does sex matter?
Authors: Williams J. W. , Zimmet P. Z. , Shaw J. E. , De Courten M. P. , Cameron A. J. , Chitson P. , Tuomilehto J. , Alberti K. G. M. M.
Published: October 2003

Objective  To examine gender differences in the characteristics and prevalence of various categories of glucose tolerance in a population study in Mauritius.

Research design and methods  In 1998, a community‐based cross‐sectional survey was conducted in Mauritius. Categories of glucose metabolism were determined in 5388 adults, with an oral glucose tolerance test given to those who did not have previously diagnosed diabetes (n = 4036). Other cardiovascular risk factors were assessed among those without known diabetes.

Results  For men and women the prevalence of diabetes (22.0 vs. 21.8%, respectively) and the prevalence of coexisting impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) (3.2 vs. 2.9%) were similar. However, men were twice as likely as women to have isolated IFG [5.1% (4.2–6.0) vs. 2.9% (2.3–3.5)], despite being younger, thinner and with lower plasma insulin but higher lipids. Conversely, the prevalence of isolated IGT was lower in men [9.0% (7.9–10.2) vs. 13.9% (12.6–15.1)]. Among non‐diabetic individuals, fasting glucose was higher in men than women, whereas 2‐h glucose was higher in women. In people without diabetes, women had significantly higher body mass index, beta cell function (HOMA‐B), fasting and 2‐h insulin than men and significantly lower waist‐hip ratios, waist circumference, insulin sensitivity (HOMA‐S) and triglycerides.

Conclusion  In Mauritius, the distribution of impaired glucose metabolism differs by sex. The observation that IFG is more prevalent in men and IGT more prevalent in women raises important questions about their underlying aetiology and the ability of the current glucose thresholds to equally identify men and women at high‐risk of developing diabetes. IFG should be seen as a complimentary category of abnormal glucose tolerance, rather than a replacement for IGT.
Alternative routes of insulin delivery
Authors: Owens D. R. , Zinman B. , Bolli G.
Published: October 2003

Attempts at replicating physiological insulin secretion, as a means of restoring the normal metabolic milieu and thereby minimizing the risk of diabetic complications, has become an essential feature of insulin treatment. However, despite advances in the production, purification, formulation and methods of delivery of insulin which have occurred in recent years, this has met with limited success. The current advocacy of intensive insulin therapy regimens involving multiple daily subcutaneous injection places a heavy burden of compliance on patients and has prompted interest in developing alternative, less invasive routes of delivery. To date, attempts to exploit the nasal, oral, gastrointestinal and transdermal routes have been mainly unsuccessful. The respiratory tree, with a large surface area, offers the greatest potential for the delivery of polypeptide drugs and there is renewed interest in administrating insulin by the intrapulmonary route. Current pulmonary drug delivery systems include a variety of pressurized metered dose inhalers, dry powder inhalers, nebulizers and aqueous mist inhalers. Recent clinical studies suggest a possible role for inhaled insulin in fulfilling meal‐related insulin requirements in persons with Type 1 and Type 2 diabetes. Most experience with inhaled insulin has been obtained using either dry powder formulation in the Nektar Pulmonary Inhaler/Exubera device (Nektar Therapeutics Inc., San Carlos, CA, Aventis, Bridgewater, NJ, Pfizer, NY) or a liquid aerosol formulation in the AERx® Insulin Diabetes Management System (Aradigm Corp., Hayward, CA, NovoNordisk A/S, Copenhagen, Denmark). If long‐term safety and efficacy is confirmed, inhalation may become the first non‐subcutaneous route of insulin administration for widespread clinical use. Despite overwhelming interest and investment in administering insulin via the oral route, success is not expected in the short term. Attempts at utilizing the buccal mucosa and skin are also continuing. Pancreatic transplantation will remain limited to those patients receiving a kidney transplant and immunotherapy. Islet cell transplantation is at an early though encouraging stage following the availability of new less toxic immunosuppressive agents. True insulin independence will require further advances in the combined fields of cell biology and genetics to ensure freedom from both the need for lifelong administration of insulin and the complications of diabetes.
A 75% insulin lispro/25% NPL mixture provides a longer duration of insulin activity compared with insulin lispro alone in patients with Type 1 diabetes
Authors: Roach P. , Woodworth J. , Gudat U. , Cerimele B. , Diebler F. , Pein M. , Dreyer M.
Published: October 2003

Aims  To compare a new insulin formulation, high mix (HM) [75% lispro (LP) and 25% neutral protamine lispro (NPL)], to regular human insulin (HR) and LP with respect to glucose response and pharmacokinetics following a test meal in patients with Type 1 diabetes.

Methods  After fasting overnight, patients received an intravenous insulin infusion to standardize blood glucose (BG) to 7.5 mmol/l (135 mg/dl). In a randomised, three‐way crossover study, HR was injected 30 min before, and LP or HM was injected immediately before the test meal on three separate occasions. For each patient, LP and HR were administered at identical doses; the HM dose was one and one third times that of HR and LP to maintain the same dose of short or rapid‐acting insulin. The insulin infusion was stopped 15 min after the insulin injection. Free insulin and BG concentrations were measured frequently for 7 h following the test meal.

Results  HM and LP resulted in better glycaemic control than HR during the observation period. BG concentrations during the first 4–5 h did not differ between HM and LP. However, HM exhibited prolonged insulin activity relative to LP beyond 5 h, extending the duration of action by approximately 1 h, and resulting in lower overall BG concentrations when the 0–6‐ and 0–7‐h intervals were considered.

Conclusions  Compared with LP, HM provided similar glycaemic control for up to 5 h and superior glycaemic control from 5 to 7 h following a standard test meal
Volumetric quantitation by MRI in primary progressive multiple sclerosis: volumes of plaques and atrophy correlated with neurological disability
Authors: Ukkonen M. , Dastidar P. , Heinonen T. , Laasonen E. , Elovaara I.
Published: October 2003

In primary progressive multiple sclerosis (PPMS) abnormalities in brain magnetic resonance imaging (MRI) differ from abnormalities in other subtypes of multiple sclerosis (MS). It was investigated whether the extent of brain and spinal cord MRI abnormalities is reflected in the neurological disability in PPMS. Focal and diffuse changes and atrophy in central nervous system (CNS) in patients with PPMS (n = 28) and healthy controls (n = 20) were assessed by semi‐automatic MRI segmentation and volumetric analysis. The measurements were related to neurological disability as expressed by the expanded disability status scale (EDSS), the regional functional scoring system (RFSS), the arm index and the ambulation index. Plaques in T1‐ and/or T2‐weighted images were seen in all brains, while spinal plaques were detected in 23 of 28 patients (82%). The total volumes of brain and spinal cord were significantly smaller in patients than in controls (P = 0.001 and 0.000, respectively). The volumes of T1 or T2 lesions in the brain correlated to the ambulation index (r = 0.51, P = 0.005 and r = 0.53, P = 0.004, respectively). No correlations were detected between MRI measurements and total EDSS score, but relative brain atrophy correlated inversely with the total RFSS scores, poor arm index and higher cerebral disturbances (r = −0.53, P = 0.004; r = −0.53, P = 0.004; and r = −0.52, P = 0.005, respectively). Although the number of spinal T2 lesions correlated with sensory disturbances (r = 0.60, P = 0.001), no correlations were found between EDSS subscores and spinal cord atrophy. These findings show that marked atrophy of brain and spinal cord detected by volumetric quantitation correlates with neurological disability. This observation indicates the importance of neurodegenerative events in PPMS.
Human African trypanosomiasis: quantitative and qualitative assessment of intrathecal immune response
Authors: Lejon V. , Sindic C. J. M. , Van Antwerpen M.‐P. , Doua F. , Djé N. , Solano P. , Jamonneau V. , Wouters I. , Büscher P.
Published: October 2003

Quantitative and qualitative techniques for assessment of the intrathecal humoral immune response in human African trypanosomiasis were compared, and their diagnostic potential for detection of the meningo‐encephalitic stage of the disease was evaluated. Total and trypanosome specific immunoglobulin G (IgG) and IgM intrathecal synthesis were studied in paired cerebrospinal fluid (CSF) and blood samples of 38 trypanosomiasis patients and in three controls using Reiber's formulae. The presence of CSF‐specific oligoclonal IgG and of trypanosome‐specific antibodies was determined using iso‐electric focusing followed by immunoblotting and antigen‐driven immunoblots. The intrathecal IgG fraction (16% positive) and oligoclonal IgG detection (24% positive) were insensitive for detection of an intrathecal humoral immune response. Trypanosome‐specific IgG synthesis, reflected by the IgG antibody index (AI) (26% positive), was confirmed by the presence of oligoclonal specific IgG (47% positive), but the latter was more sensitive. Although the detection technique failed for oligoclonal IgM, the intrathecal IgM fraction (42% positive) and the IgM AI (32% positive) indicated that the meningo‐encephalitic stage of the disease is characterized by a dominant intrathecal IgM response, which was higher than the IgG response. The highest combination of diagnostic sensitivity and specificity for the meningo‐encephalitic stage of trypanosomiasis was observed for quantitative IgM determinations.
Left internal carotid artery dissection presenting with headache, Collet‐Sicard syndrome and sustained hypertension
Authors: Walker S. , McCarron M. O. , Flynn P. A. , Watt M.
Published: October 2003

The baroreflex maintains blood pressure through the glossopharyngeal (IX) cranial nerve. We report a 54‐year‐old man who developed a left sided headache, hoarseness, dysarthria, dysphagia, and sustained hypertension from a left internal carotid artery dissection. We hypothesise that interruption of the left IX nerve caused hypertension in this patient.
Results of carpal tunnel release
Authors: Prick J. J. W. , Blaauw G. , Vredeveld J. W. , Oosterloo S. J.
Published: October 2003

We evaluated, by means of a prospective study, the results of carpal tunnel release both clinically and electrophysiologically in 188 patients with a carpal tunnel syndrome. A questionnaire was completed by patient and surgeon pre‐ and post‐operatively (6 and 12 months after operation), when physical examination, electromyography and nerve conduction tests were also performed. Full pre‐ and post‐operative results were available for 136 patients and 82% of the patients were satisfied with the results of the operation. Symptoms caused by median nerve compression showed the greatest improvement and no fixed patterns with regard to unsatisfactory results were found. If pain persisted in the wrist, many patients considered the operation to have been unsuccessful. Electrophysiological improvement occurred in all patients and at 12 months follow‐up, median nerve conduction was normal in 21% of cases. Thus distal sensory latency remained abnormal in 79% of the patients, emphasizing the need for caution when recurrence of carpal tunnel syndrome is diagnosed in such cases.
Reduced jaw opening from paradoxical activity of mandibular elevator muscles treated with botulinum toxin
Authors: Bakke M. , Werdelin L. M. , Dalager T. , Fuglsang‐Frederiksen A. , Prytz S. , Møller E.
Published: October 2003

The aim of the study was the effect of injections with botulinum toxin A (BTX‐A) on reduced jaw opening, caused by paradoxical, antagonistic activity of jaw elevator muscles after brain stem lesions. The study included a male (51 years) and a female (69 years) patient. Subjective assessment, clinical recordings, muscle blocks and electromyography (EMG) were used to diagnose paradoxical activity, and to plan, guide and evaluate the treatment. The paradoxical innervation pattern was unilateral in the male and bilateral in the female. The paradoxical activity during jaw opening amounted to 24–109% of the level during maximum biting, and bursts of paradoxical activity were also present during chewing. EMG‐guided blocks and later BTX‐A injections of the affected muscles increased the opening by 9–23 mm from pre‐treatment values of 15–18 mm, and normalized chewing. The study proved BTX‐A to be an effective treatment for reduced jaw opening caused by paradoxical activity. Treatment was optimized by EMG evaluation of the current activity of the jaw elevator muscles, permitting individual treatment plans with longer intervals between BTX‐A injections and lower doses than with conventional treatment for oromandibular dystonia. Thus the treatment only had to be repeated one to two times per year to maintain acceptable jaw mobility.
Cost of a recurrent vs. cost of first‐ever stroke over an 18‐month period
Authors: Spieler J.‐F. , de Pouvourville G. , Amarenco P.
Published: October 2003

When assessing the cost‐effectiveness of the secondary prevention of stroke, it is not well known whether the cost of a recurrent brain infarction (BI) is different from a first‐ever BI. In a cohort of 435 consecutive prevalent cases of BI (including both recurrent and first‐ever BI) we collected medical and socio‐economic variables. Handicap was measured with the Rankin scale. Only the direct medical costs were considered over an 18‐month period from a societal perspective. We compared first‐ever to recurrent BI. Of the 435 patients 20.5% had a recurrent BI. The length of the initial hospitalization and the distribution of the patients into the three classes of handicap (Rankin 0–2, 3, and 4–5) were similar in the first‐ever and recurrent BI groups. The average total cost of a first‐ever BI was €19 725 (95% CI, 17 950–21 501) and €18 560 (95% CI, 15 798–21 322) for a recurrent BI (P = 0.48). There were no differences between the two groups when the costs were compared by handicap levels (P = 0.17) or when the costs were compared for each type of expenditure (initial hospitalization, rehabilitation, ambulatory services) except for long‐term care, because of the small number of cases. This study suggests that the costs of recurrent BI are roughly similar to the costs of first‐ever BI, which may be helpful when studying the cost‐effectiveness of secondary stroke prevention trials.
Cortical lesions associated with transient neurological symptoms – not always a matter of cause and effect
Authors: Kipervasser S. , Fried I. , Korczyn A. D. , Segev Y. , Neufeld M. Y.
Published: October 2003

The occurrence of transient recurrent stereotypical neurological events mandates the exclusion of an underlying brain lesion. When imaging studies demonstrate the presence of a structural brain lesion, a cause and effect relationship between the two entities is assumed, and the decision for surgical intervention may then follow almost automatically. We describe five patients with transient neurological events suspected as being seizures that were referred for surgery because of an associated structural brain lesion. Video electroencephalographic recordings revealed that the events that brought these patients to neurosurgical attention were non‐epileptic seizures. None of these patients underwent surgical intervention, and all were referred for behavioral therapy. Therefore, even in the presence of a confirmed brain lesion, the presenting paroxysmal events may be of a non‐organic origin and should not necessarily be assumed to be caused by the concomitantly existing structural abnormality.
Jaw‐opening dystonia (Brueghel's syndrome) associated with cavum septi pellucidi and Verga's ventricle – a case report
Authors: Miyaoka T. , Miura S. , Seno H. , Inagaki T. , Horiguchi J.
Published: October 2003

Jaw‐opening dystonia (oromandibular dystonia with jaw‐opening; Brueghel's syndrome) is a rare condition, and only a limited number of cases have been reported in the literature. However, many patients may remain undiscovered or misdiagnosed, like a patient described previously. A case (40‐year‐old man) of jaw‐opening dystonia (oromandibular dystonia with jaw‐opening; Brueghel's syndrome) is reported. In this case, brain anomalies, cavum septi pellucidi and Verga's ventricle, were observed on magnetic resonance imaging of the brain. This case and a review of the literature indicate the presence of organic factors in the etiology of Brueghel's syndrome. The etiological relationship of brain anomalies in Bruegel's syndrome is discussed.
A retrospective, observational study comparing the four available immunomodulatory treatments for relapsing–remitting multiple sclerosis
Authors: Carrá A. , Onaha P. , Sinay V. , Alvarez F. , Luetic G. , Bettinelli R. , San Pedro E. , Rodríguez L.
Published: October 2003

We performed an observational, retrospective analysis of outcome in a sequential cohort of patients with relapsing–remitting multiple sclerosis (RRMS) in Argentina. Patients treated for 16 months with interferon β‐1a (Avonex®; 30 μg intramuscularly, once a week), interferon β‐1a (Rebif®; 44 μg subcutaneously, thrice weekly), interferon β‐1b (Betaferon®; 250 μg subcutaneously, every other day) or glatiramer acetate (Copaxone®; 20 mg subcutaneously daily) were compared with a non‐treated group of patients. The different treatment groups were similar in baseline demographic and clinical variables. A significant fall in the annual relapse rate was observed for all four treatments, with the largest effect observed with glatiramer acetate (81% reduction in relapse rate, compared with pre‐treatment values). The proportion of patients remaining relapse‐free for the entire 16‐month treatment period varied from 37% in untreated patients to 83% in the glatiramer acetate treated group. No statistically significant changes in disability scores were observed over the treatment period. This first such comparative study in Latin America shows that treatment of multiple sclerosis patients with immunomodulatory therapies in the context of current standards of care in Argentina provides clinically important benefit, and suggest that some of these therapies may be better than others.
MRI correlates of executive dysfunction in patients with ischaemic stroke
Authors: Vataja R. , Pohjasvaara T. , Mäntylä R. , Ylikoski R. , Leppävuori A. , Leskelä M. , Kalska H. , Hietanen M. , Aronen H. J. , Salonen O. , Kaste M. , Erkinjuntti T.
Published: October 2003

Executive dysfunction (ED) may lead to problem behaviour and impaired activities of daily living in many neuropsychiatric disorders, but the neuroanatomical correlates of ED are still not well known. Different aspects of executive functions were studied by widely used neuropsychological tests in 214 elderly patients 3 months after ischaemic stroke, and a sum score of eight different measures was counted in each patient. The number and site of brain infarcts as well as severity and location of white matter lesions (WMLs) and brain atrophy on magnetic resonance imaging were recorded and compared between patients with and without ED. ED was present in 73 (34.1%) of the 214 patients. The mean frequency of brain infarcts in the brain and in the left hemisphere was higher in the patients with ED. Lesions affecting the frontal‐subcortical circuits (e.g. pallidum, corona radiata or centrum semiovale) were more frequent in patients with ED than in those without. Also, patients with pontine brain infarcts frequently had ED, but this may have been due to more extensive ischaemic changes in these patients in general. Mean number of brain infarcts affecting the pons and posterior centrum semiovale on the left side, moderate to severe medial temporal atrophy, the Fazekas white matter score, the Mini‐Mental State Examination score and low education were independent correlates of ED. Brain infarcts and WML affecting the frontal‐subcortical circuits or the pons may increase risk for ED in stroke patients.
Long‐term safety and cognitive effects of galantamine in the treatment of probable vascular dementia or Alzheimer's disease with cerebrovascular disease
Authors: Kurz A. F. , Erkinjuntti T. , Small G. W. , Lilienfeld S. , Damaraju C. R. Venkata
Published: October 2003

The relationship between cholinergic dysfunction and cognitive and functional impairment in patients with vascular dementia (VaD) and Alzheimer's disease (AD) with cerebrovascular disease (CVD) suggests a potential role for cholinomimetic therapy. Initial studies of galantamine demonstrated cognitive, behavioral, and functional benefits in these populations. 326 patients with VaD or AD with CVD who completed an initial 12‐month trial were treated with galantamine 24 mg/day in a 24‐month, open‐label extension. This interim analysis was performed at month 12 of the open‐label extension (248 completed the trial). Galantamine (up to 24 months total) was well tolerated in both groups. The most frequently reported adverse events, characteristic of older dementia patients, included depression, agitation, and insomnia. Gastrointestinal adverse events were less common than initially, indicating declining incidence with long‐term therapy. Patients taking galantamine for the entire study demonstrated the least cognitive decline on AD Assessment Scale‐cog/11: 2.7 points vs. 3.1 points in those given placebo initially (P < 0.001 and P = 0.003, respectively). The long‐term benefits of galantamine were evident in both groups; cognitive baseline levels were maintained for approximaely 21 months in VaD patients and for 12 months in patients with AD with CVD. Long‐term (up to 24 months) galantamine therapy in patients with VaD and AD with CVD is well tolerated and associated with prolonged maintenance of cognitive function.
Disease severity and outcome in thymoma myasthenia gravis: a long‐term observation study
Authors: Romi F. , Gilhus N. E. , Varhaug J. E. , Myking A. , Aarli J. A.
Published: October 2003

Thymomas occurring in myasthenia gravis (MG) are usually of the cortical subtype and are usually treated by thymectomy. However, the factors that influence MG outcome in thymoma MG patients are not known. In a long‐term study, MG severity and treatment was observed in 24 thymoma and 24 non‐thymoma MG patients for up to 30 years, and the occurrence of muscle autoantibodies was assayed. The rate of complete stable remission was low and did not differ between the two groups. There was no significant difference in MG severity between thymoma and non‐thymoma MG patients at any time during the study. Titin and ryanodine receptor (RyR) antibody occurrence was significantly higher in thymoma MG patients. Four thymoma (all titin and RyR antibody positive) and two non‐thymoma (both titin and one RyR antibody positive) MG patients died from MG‐related respiratory insufficiency. Seventy percent of thymoma and 75% of non‐thymoma MG patients were treated with immunosuppressive drugs. The number of patients who received plasmapheresis did not differ in those who were treated because of acute MG deterioration, irrespective of planned surgery.This study shows equal MG severity and outcome in thymoma and non‐thymoma MG, but the presence of RyR antibodies in thymoma MG and titin/RyR in non‐thymoma MG indicates a less favorable prognosis.
A C77G point mutation in CD45 exon 4, which is associated with the development of multiple sclerosis and increased susceptibility to HIV‐1 infection, is undetectable in Japanese population
Authors: Sabouri A. H. , Saito M. , Matsumoto W. , Kodama D. , Farid R. , Izumo S. , Usuku K. , Osame M.
Published: October 2003

HTLV‐1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) is one outcome of Human T‐cell lymphotropic virus type 1 (HTLV‐1) infection. It remains unknown why the majority of infected people remain healthy whereas only approximately 2–3% develop disease. Recently, heterozygous state of CD45 exon 4 mutation (C77C wild type and C77G mutant) was reported to be associated with development of multiple sclerosis in German patients and increased susceptibility to HIV‐1 infection in the United Kingdom. To investigate whether this mutation is associated with the development of HAM/TSP, we studied a group of 164 HAM/TSP patients and 108 asymptomatic HTLV‐1 carriers in Kagoshima (HTLV‐1 endemic area in Southern Japan) by using PCR‐RFLP and subsequent direct sequencing analysis. All 272 subjects showed homozygosity in the CD45 exon 4, suggesting that this mutation is absent or very rare in Japanese population.
Guillain–Barré syndrome in southern Taiwan: clinical features, prognostic factors and therapeutic outcomes
Authors: Cheng B.‐C. , Chang W.‐N. , Chang C.‐S. , Chee C.‐Y. , Huang C.‐R. , Chen J.‐B. , Chang C.‐J. , Hung P.‐L. , Wang K.‐W. , Chang H.‐W. , Lu C.‐H.
Published: October 2003

To determine the clinical features, prognostic factors, and therapeutic results of Guillain–Barré syndrome (GBS) in order to improve the therapeutic strategy for this disease. We retrospectively reviewed the electrodiagnostic study and medical records of patients with GBS admitted to Chang Gung Memorial Hospital, Kaohsiung, between January 1986 and December 2000. Outcomes and prognosis were followed‐up after 1 year. Ninety‐six patients were enrolled in this study. According to the clinical and electrophysiological findings, 77 patients were acute inflammatory demyelinating polyradiculoneuropathy, seven were Miller Fisher syndrome, and six were axonal forms, and six were unclassified. At a follow‐up of 1 year, 61 patients (64%) recovered, 30 (31%) had residua and five (5%) died. Amongst these 30 had residua, including unassisted gait in 19, assisted gait in four, and wheel/bed bound in seven. According to the statistical analysis, disabilities at the nadir (P < 0.0001) and at admission (P = 0.014) were significant prognostic factors. Variables used for the stepwise logistic regression, and the results revealed that after analysis for all the above variables, only disability at the nadir (P < 0.0001) was independently associated with the treatment failure rate. Our study revealed 27% of cases in need of respiratory support during hospitalization, and 5% of hospital‐treated patients die from the complications. Furthermore, 31% had residua at a follow‐up of 1 year or more. If prognostic factors are considered, disability at the nadir during hospitalization demonstrates consistently poor therapeutic outcomes. Therefore, early diagnosis, choice of appropriate treatment, and preventing complications during acute stages are essential to maximize the potential for survival.
Ictal limb dystonia in temporal lobe epilepsy. An invasive video‐EEG finding
Authors: Kuba R. , Rektor I. , Brázdil M.
Published: October 2003

The aim of the investigation was to evaluate the ictal EEG in the putamen and the temporal and frontal lobes during contralateral ictal limb dystonia (ID). Ten epilepsy surgery candidates participated in the study. All of them were investigated using intracerebral and/or subdural electrodes. In four of the patients, the putamen was investigated with diagonal depth electrodes (patients 1–4), in six of the patients, both the temporal and frontal lobes were investigated (patients 5–10). All of the investigated contacts were located contralateral to the side of the ictal dystonia. All of the patients suffered from temporal lobe epilepsy (TLE); in patient 10, both temporal and frontal seizure types were recorded. A total of 20 complex partial seizures (CPS) were analysed. ID was never an early symptom in the course of CPS. Slow activity was recorded in the putamen in all 10 seizures of the four patients in whom the putamen was investigated (patients 1–4). In five of these seizures, there was a time‐locked change in the ictal EEG in relation to the ID (slowing of activity in three seizures; acceleration in two seizures). At the time of the onset of ID, several cortical regions were involved in the ictal discharge, within both the contralateral temporal and frontal lobes. In all 10 seizures of the six patients in whom both the temporal and frontal lobes on the contralateral side were evaluated (patients 5–10), the ictal paroxysmal discharge was noted in both lobes (i.e. frontal and temporal) at the time of ID onset. We can conclude that ID is a late symptom in TLE. Widespread activation of the contralateral temporal and frontal lobes is needed for the appearance of ID; however, the critical region responsible for the genesis of ID was not revealed. Although there are some non‐specific changes in the putamen contralateral to ID, the changes were never epileptic in type. The putamen probably collaborates in the genesis of ID, but it does not generate the epileptic discharge during its course.
Anomia for people's names, a restricted form of transient epileptic amnesia
Authors: Ghika‐Schmid F. , Nater B.
Published: October 2003

A 37‐year‐old man consulted after two episodes of transient anomia for people's names over a period of 6 months. The first episode lasted about 10 min and was restricted to an inability to remember his 2‐year‐old son's first name. The second, was limited to an inability to recall his daughter's first name for 5 min with clear abnormal experiential quality. Witnessed descriptions of the attacks confirmed the absence of any other cognitive impairment or motor automatisms. The neurological examination was normal except for hyposmia. Inter‐ictal cognitive evaluation was normal apart from the anomia for people's names or retrieval of names of familiar people in his childhood on definition and on famous faces naming test. A wake electroencephalograph showed left temporal epileptiform abnormalities, following hyperpnea. On magnetic resonance imaging, quantitative analysis revealed a mildly decreased volume of the left hippocampus. The diagnosis of transient epileptic amnesia (TEA) was considered and the patient did not recur for 6 months under lamotriginum. Thus anomia for people's names may be the sole clinical manifestation of TEA. Such a clinical presentation may easily be overlooked. Treatment may prevent further recurrence and the installation of more important and permanent autobiographical memory impairment. Our observation may suggest an isolated system not only for people's knowledge, but for people's naming. It is consistent with the notion of proper name as pure referring expression.
HLA class II genotypes in Mexican Mestizo patients with myasthenia gravis
Authors: García‐Ramos G , Téllez‐Zenteno J. F. , Zapata‐Zúñiga M. , Yamamoto‐Furusho J. K. , Ruiz‐Morales J. A. , Villarreal‐Garza C. , Vargas‐Alarcón G. , Estañol B. , Llorente L. , Granados J.
Published: October 2003

Myasthenia gravis is an autoimmune, heterogeneous disorder, characterized by the presence of antibodies against acetylcholine receptors at the neuromuscular junction. There is a strong evidence that an individual's genetic composition is an important predisposing factor for the development of the disease. To correlate HLA class II genotypes with thymic pathology in Mexican Mestizo patients who had been subjected to thymectomy. HLA class II genes were analyzed in 60 patients and in 99 healthy ethnically matched controls. Thymic hyperplasia, atrophy, thymoma, and normal histology were encountered in 56, 33, 8 and 2% of patients, respectively. HLA‐DR11 was significantly increased in patients with thymoma compared with healthy controls (pC = 0.001, OR = 13.35, 95% CI 3.5–51.3), compared with the subgroup of hyperplasia patients (pC = 0.005, OR = 15.5, 95% CI 2.78–95.58) and with the atrophy subgroup (pC = 0.04, OR = 10.5, 95% CI 1.75–70.95). This study provides the evidence of an association between HLA class II alleles with clinical and genetic heterogeneity in myasthenia gravis, particularly in those with thymoma (HLA‐DR11).
Polyneuropathy associated with IgG/IgA monoclonal gammopathy: a clinical and electrophysiological study of 15 cases
Authors: Magy L. , Chassande B. , Maisonobe T. , Bouche P. , Vallat J.‐M. , Léger J.‐M.
Published: October 2003

Peripheral neuropathy has been widely reported in patients with monoclonal gammopathy (MG), more frequently immunoglobulin M (IgM) or IgG than IgA. Nevertheless, it remains unclear whether this association has clinical or pathogenic relevance. In order to clarify the possible role of IgG/IgA MG in neuropathy, we studied the clinical and electrophysiological features of 15 consecutive patients with polyneuropathy and IgG/IgA‐MG, and compared them to those of 40 patients with polyneuropathy associated with IgM‐MG, previously reported. Nine middle‐aged patients (60%) had a chronic progressive or relapsing demyelinating polyneuropathy (DP) that was clinically and electrophysiologically indistinguishable from classic chronic inflammatory demyelinating polyneuropathy (CIDP) and frequently responded to immunosuppressive treatments, both characteristics supporting a dysimmune process. Six older patients (40%) had a chronic axonal distal polyneuropathy similar to the so‐called chronic cryptogenic sensory polyneuropathy: there was no clear relationship with the MG in these patients and the response to immunosuppressive treatments was poor. Several features allowed us to distinguish between polyneuropathies associated with IgG/IgA‐MG (IgG/IgA‐PN) considered together and polyneuropathies associated with IgM‐MG (IgM‐PN). In the first group, the proportion of patients with a predominantly sensory clinical picture (27%) was less than that in the second group (75%), and there were fewer changes in nerve conduction studies. In addition, we found that the nine patients with DP associated with IgG/IgA‐MG (IgG/IgA‐DP) differed from the 31 with DP associated with IgM‐MG (IgM‐DP): clinical and electrophysiological studies clearly showed that the demyelinating pattern was more heterogeneous in IgG/IgA‐DP than in IgM‐DP. The spectrum of polyneuropathies associated with IgG/IgA‐MG is heterogeneous, including DP, which is similar to classic CIDP, and axonal polyneuropathy, in which the pathogenic role of the MG remains elusive. In addition, IgG/IgA‐DP differ from IgM‐DP on clinical and electrophysiological grounds, suggesting probable different physiopathological mechanisms.
Choreoathetosis related to lithium intoxication
Authors: Stemper B. , Thürauf N. , Neundörfer B. , Heckmann J. G.
Published: October 2003

A 76‐year old woman was admitted because of severe gait ataxia and dysarthric speech that had worsened over the last 24 h. The patient was initially suspected of having repeated transitory ischemic attacks (TIAs) as her daughter reported a similar episode that had happened 3 weeks prior to admission. The onset of spontaneous twisting, choreoathetotic movements of both hands and arms and worsening of symptoms one hour after admission together with a history of lithium therapy lead to the correct diagnosis and appropriate treatment.
The Effect of Nitric Oxide Synthase Inhibition on Histamine Induced Headache and Arterial Dilatation in Migraineurs
Authors: Lassen LH , Christiansen I , Iversen HK , Jansen-Olesen I , Olesen J
Published: October 2003

We have previously proposed that histamine causes migraine via increased NO production. To test this hypothesis, we here examined if the NOS inhibitor, L-NG methylarginine hydrochloride (L-NMMA:546C88), could block or attenuate histamine induced migraine attacks and responses of the middle cerebral, temporal and radial arteries. In a double blind crossover design 12 patients were randomized to receive pretreatment with L-NMMA (6 mg/kg) or placebo i.v. over 15 min followed on both study days by histamine (0.5 μg/kg/min) i.v. for 20 min. Headache scores, mean maximal blood velocity (Vmean) in the middle cerebral artery (MCA) (transcranial doppler) and diameters of temporal and radial arteries (high resolution ultrasound) were repeatedly measured. Pre-treatment with L-NMMA, had no effect on histamine induced headache or migraine, but also had no effect on the magnitude of histamine induced – decrease in MCA blood velocity, or dilatation of neither the temporal nor the radial artery. L-NMMA constricted the temporal artery by 8% before histamine infusion, whereas the radial artery was unaffected. The temporal artery dilated 4-5 times more than the radial artery during histamine infusion. In conclusion the use of a NOS inhibitor in the highest possible dose did not block the histamine-induced headache response or arterial dilatation. Either the concentration of L-NMMA reaching the smooth muscle cell was insufficient or, histamine dilates arteries and causes headache via NO independent mechanisms. Our results showed for the first time a craniospecificity for the vasodilating effect of histamine and for the arterial effects of NOS inhibition.
Comparative Efficacy of Eletriptan vs. Naratriptan in the Acute Treatment of Migraine
Authors: Garcia-Ramos G , MacGregor EA , Hilliard B , Bordini CA , Leston J , Hettiarachchi J
Published: October 2003

This was a randomized, double-blind study designed to evaluate the comparative efficacy and tolerability of the 40-mg dose of eletriptan and the 2.5-mg dose of naratriptan. Patients ( n = 548) meeting International Headache Society (IHS) criteria for migraine were randomized to treat a single migraine attack with either eletriptan 40 mg, naratriptan 2.5 mg, or placebo. Headache response rates at 2 h and 4 h, respectively, were 56% and 80% for eletriptan, 42% and 67% for naratriptan ( P < 0.01 for both time-points vs. eletriptan), and 31% and 44% for placebo ( P < 0.0001 vs. both active drugs at both time-points). Eletriptan also showed a significantly greater pain-free response at 2 h (35% vs. 18%; P < 0.001) as well as lower use of rescue medication (15% vs. 27%; P < 0.01) and higher sustained headache response at 24 h (38%) compared with naratriptan (27%; P < 0.05) and placebo (19%; P < 0.01). Both eletriptan and naratriptan were well tolerated. The results confirm previous meta-analyses that have suggested the superiority of eletriptan vs. naratriptan in the acute treatment of migraine.
Hemicrania Continua with Contralateral Episodic Cluster Headache: A Case Report
Authors: Lisotto C , Mainardi F , Maggioni F , Zanchin G
Published: October 2003

The trigeminal autonomic cephalgias (TACs) are characterized by short-lasting unilateral headaches with autonomic features (1). They include four headache disorders, cluster headache (CH), paroxysmal hemicrania (PH), SUNCT syndrome and hemicrania continua (HC). The coexistence of different ipsilateral TACs in the same patient has been previously reported in six published cases (2-6). In five of these patients an association of CH and PH was noted (2-5). The two varieties of attacks occurred separately in three patients, while their simultaneous occurrence was observed in two cases. In another patient the successive occurrence of trigeminal neuralgia, SUNCT syndrome, PH and CH in one active headache period was noted (6). All the reported cases concerned male patients. We describe what we believe to be the first case of coexistence of two different contralateral TACs.
Quality of Life in Migraine Patients: A Qualitative Study
Authors: Ruiz de Velasco I , González N , Etxeberria Y , Garcia-Monco JC
Published: October 2003

The impact of migraine on quality of life has been traditionally evaluated by quantitative analysis, but diverse aspects remain insufficiently assessed, so a complementary qualitative approach may have advantages. The aim of this study was to assess the impact of migraine on the quality of life of migraineurs through the perception of patients and their relatives, and healthcare professionals. Qualitative methods were used, including six focus groups and nine personal interviews with 33 migraine patients under physician-directed treatment, five self-medicated patients, five relatives of migraine patients and seven healthcare professionals. Migraine has a negative affect on the quality of life, including physical, emotional and social aspects of daily life such as family, work and social relationships. Family environment and psychological well-being of patients were the aspects most affected according to patients and relatives. Health professionals emphasized work impairment and focused on pharmacological management and on the need for adequate information about migraine for non-medicated patients and patients' relatives. Qualitative methods, such as focus groups and interviews, are a valuable resource for assessing quality of life and well-being of migraine patients. These techniques open up new areas for further research.
Are Vascular Disorders More Prevalent in the Relatives of Children and Adolescents with Migraine?
Authors: Lanzi G , Termine C , Rossi M , Ferrari Ginevra O , D'Arrigo S , Amica I , Mongelli A , Avantaggiato P , Beghi E
Published: October 2003

The objective of the study was to assess whether a family history of vascular disorders is more common in children and adolescents with migraine than in the general population. Family history of stroke, arterial hypertension, myocardial infarction and diabetes was investigated by history taking in relatives of ambulatory children and young adults with migraine and in a control group. The odds ratios (ORs) with 95% confidence intervals (95% CI) were used as a risk measure. Using univariate and multivariate (logistic regression) analysis, family history was assessed in the whole sample and in subgroups by sex and age, degree of relationship (parents and grandparents vs. relatives), disease type (migraine with and without aura), and type of vascular disorder. The sample included 143 cases (migraine with aura 35, migraine without aura 108) and 164 controls aged 324 years (mean 12 ± 3.8 years). Patients with migraine were at increased risk of vascular disorders in parents and grandparents but not in all relatives. Multivariate analysis indicated family history of stroke as most common only in boys. In conclusion, our study provides some clues to the assumption that migraine and vascular disorders have common pathogenic mechanisms and that genetic susceptibility plays a role in increasing the risk of migraine in the offspring of families with one or more cerebrovascular or cardiovascular conditions.
Bathing Headache: A Variant of Idiopathic Thunderclap Headache
Authors: Liao Yi-Chu , Fuh Jong-Ling , Lirng Jiing-Feng , Lu Shiang-Ru , Wu Zin-An , Wang Shuu-Jiun
Published: October 2003

Bathing headache is rarely described in literature. We report four middle-aged Taiwanese women who developed severe throbbing headache with maximum intensity of onset during bathing. Diffuse cerebral vasospasm was demonstrated in one of them. All their headaches resolved spontaneously ( n = 1) or after nimodipine treatment ( n = 3). Except for one patient with vasospasm in whom reversible posterior leukoencephalopathy and an asymptomatic cerebellar infarction developed, the others recovered without any complications. The clinical profile of bathing headache points to idiopathic thunderclap headache. It may not be as benign as previously reported. Nimodipine might be effective in treatment of this special headache syndrome.
Enhanced Interictal Responsiveness of the Migraineous Visual Cortex to Incongruent Bar Stimulation: A Functional MRI Visual Activation Study
Authors: Vincent M , Pedra E , Mourão-Miranda J , Bramati IE , Henrique AR , Moll J
Published: October 2003

Since visual aura is usually described as expanding zigzag lines, neurones involved with the perception of line orientation may initiate this phenomenon. A visual incongruent line stimulation protocol was developed to obtain functional magnetic resonance images (fMRI) interictally in 5 female migraine patients with typical fortification spectra and in 5 normal matched controls. Activation in the visual cortex was present contralateral to the side of stimulation in 4 of 5 patients, notably in the extrastriate visual cortex. In 4 of 5 controls activation was observed in the medial and anterior orbitofrontal cortex. In one of them additional activation at the right nucleus accumbens/ventral striatum and right ventral pallidum was present. In the remaining control subject activation was present in the left primary visual cortex. The enhanced interictal reactivity of the visual cortex in migraineurs supports the hypothesis of abnormal cortical excitability as an important pathophysiological mechanism in migraine aura, though the role of specific regions of the visual cortex remains to be explored.