bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Alzheimer's type dementia in an elderly Arab population
Authors: Bowirrat A. , Treves T. A. , Friedland R. P. , Korczyn A. D.
Published: March 2003

The aim of this study was to estimate the prevalence of dementia of the Alzheimer type (DAT) in an Arab Israeli community. Epidemiological studies of dementia have rarely been reported in Arab populations. The target population, aged 60 years or older, comprised 821 persons (362 males) who, on 1 October 1995, were residents of the rural area of Wadi Ara. These persons were examined for symptoms of dementia (DSM‐IV criteria), using a semistructured questionnaire for collection of demographic and medical data. Age, gender, and education‐specific prevalence rates were calculated for this population and compared to those obtained in other studies. DAT was diagnosed in 20.5% of this population. Its prevalence increased steeply with age, from 8% among those younger than 70 years to 33% among those aged 70–79 and 51% among those 80 years or older. Illiteracy was very common in this population, and strongly associated with higher prevalence of DAT (27% vs. 4%, P < 0.001). DAT was more prevalent among females than males (25% vs. 15%, P < 0.001). However, illiteracy was also significantly more frequent among women (96% vs. 42%, P < 0.001). After correction for illiteracy, the gender difference lost statistical significance. Few women smoked, but among men, the prevalence of DAT in those who smoked was lower as compared to non‐smokers (14% vs. 23%, a non‐significant difference). These results were confirmed by logistic regression wherein DAT was included as the dependent variable and age, illiteracy, gender and smoking as independent variables (OR=2.8, 2.8, 1.2 and 0.7, respectively; P < 0.005 for each, except for smoking). Our findings suggest that this population is unique because of extremely high rates of dementia. While the results support a protective effect of schooling against the development of dementia, other factors (e.g. genetic) must be sought to explain this high frequency.
Linking structural, metabolic and functional changes in multiple sclerosis
Authors: Filippi Massimo
Published: March 2003

In patients with multiple sclerosis (MS), conventional magnetic resonance imaging (MRI) has markedly improved our ability to detect the macroscopic abnormalities of the brain and spinal cord. New quantitative magnetic resonance (MR) approaches with increased sensitivity to subtle normal‐appearing white matter (NAWM) and grey matter changes and increased specificity to the heterogeneous pathological substrates of MS may give information complementary to conventional MRI. Magnetization transfer imaging (MTI) and diffusion‐weighted imaging (DWI) have the potential to provide important information on the structural changes occurring within and outside T2‐visible lesions. Magnetic resonance spectroscopy (MRS) adds information on the biochemical nature of such changes. Functional MRI might quantify the efficiency of brain plasticity in response to MS injury and improve our understanding of the link between structural damage and clinical manifestations. The present review summarizes how the application of these MR techniques to the study of MS is dramatically changing our understanding of how MS causes irreversible neurological deficits.
Review of the functional surgical treatment of dystonia
Authors: Krack Paul , Vercueil Laurent
Published: March 2003

A review of functional surgery for dystonia is presented. Recently renewed interest in stereotaxy for dystonia has followed the resurgence of pallidotomy and the introduction of deep brain stimulation (DBS) in Parkinson’s disease (PD) in the early 1990s. However, even since the 1950s, small series of patients treated with ablative surgery have been carefully studied, providing useful information, notably regarding the tolerability of surgery. In the setting of dystonia, thalamotomy was first performed with substantial benefits, but some authors outlined the great variability in outcome, and the high incidence of operative side‐effects. In the ‘modern’ era of functional surgery for movement disorders, the globus pallidus internus (GPi) has emerged to be currently the best target for dystonia, based on small series of patients published in the last few years. Both bilateral posteroventral pallidotomy (PVP) and bilateral pallidal stimulation, performed by several teams, have benefited a variety of patients with severe dystonia, the most dramatic improvements being seen in primary dystonia with a mutation in the DYT1 gene. Whereas patients with secondary dystonia have often shown a lesser degree of improvement, some publications have nevertheless reported major benefit. There is today a strong need for carefully controlled studies comparing secondary and primary dystonia, DYT1 and non‐DYT1 dystonia, ablative surgery and DBS, with additional assessment of neuropsychological changes, especially in children treated with bilateral pallidal procedures.
Hypoperfusion following encephalitis: SPECT with acetazolamide
Authors: Okamoto M. , Ashida K.‐I. , Imaizumi M.
Published: March 2003

At 4 weeks and 8 months following initial symptoms, we performed single‐photon emission computed tomography (SPECT) with acetazolamide (ACZ) testing in a patient recovering from acute encephalitis, possibly acute disseminated encephalomyelitis (ADEM). Both regional hypoperfusion at baseline and diminished cerebrovascular reserve were seen after focal hyperintensities had disappeared in magnetic resonance imaging (MRI). The time course of SPECT abnormalities reflected the clinical course more closely than the time course of MRI abnormalities. Thus, persistent cerebral circulatory impairment probably contributed to cognitive and language deficits observed at the subacute stage.
Post‐infectious ophtalmoparesis associated with anti‐GM1 but not with anti‐GQ1b antibodies
Authors: Lavallée P. , Vidailhet M. , Dussaule J. C. , Derkinderen P.
Published: March 2003

Acute paresis of extraocular muscles has been described following infection or immunization. It is usually associated with the presence of anti‐GQ1b antibodies. We report a case of post‐infectious ophtalmoparesis that was negative for anti‐GQ1b antibodies and positive for anti‐GM1 antibodies.
Effect of vitamin E supplementation in patients with ataxia with vitamin E deficiency
Authors: Gabsi S. , Gouider‐Khouja N. , Belal S. , Fki M. , Kefi M. , Turki I. , Hamida M. Ben , Kayden H. , Mebazaa R. , Hentati F.
Published: March 2003

Ataxia with vitamin E (Vit E) defciency (AVED) is an autosomal recessive disorder caused by mutations of the α tocopherol transfer protein gene. The Friedreich ataxia phenotype is the most frequent clinical presentation. In AVED patients, serum Vit E levels are very low in the absence of intestinal malabsorption. As Vit E is a major antioxidant agent, Vit E deficiency is supposed to be responsible for the pathological process. Twenty‐four AVED patients were fully investigated (electromyography, nerve conduction velocity (NVC) studies, somatosensory evoked potentials, cerebral computed tomography scan, sural nerve biopsy, genetic studies) and supplemented with Vit E (800 mg daily) during a 1‐year period. Clinical evaluation was mainly based on the Ataxia Rating Scale (ARS) for cerebellar ataxia assessment and serum Vit E levels were monitored. Serum Vit E levels normalized and ARS scores decreased moderately but significantly suggesting clinical improvement. Better results were noted with mean disease duration ≤ 15 years. Reflexes remained abolished and posterior column disturbances unchanged. Vitamin E supplementation in AVED patients stabilizes the neurological signs and can lead to mild improvement of cerebellar ataxia, especially in early stages of the disease.
Motor vehicle crashes and abnormal driving behaviours in patients with dementia in Mendoza, Argentina
Authors: Zuin D. , Ortiz H. , Boromei D. , Lopez O. L.
Published: March 2003

Studies conducted in industrialized countries have shown that elderly demented subjects have increased risk of car accidents. However, there is no information about the effect of dementia on driving habits in non‐industrialized countries.

The number of motor vehicle crashes (MVC) and abnormal driving behaviours (ADB) (e.g. not recognizing traffic lights, driving in the middle of the road, etc.) were assessed with a semi‐structured interview in 56 demented subjects and 31 elderly controls, all of whom were active drivers, at the Regional Registry of Dementia in Mendoza. Detailed neurological, psychiatric and neuropsychological examinations were also conducted on each subject.

The presence of dementia and sex (male) predicted ADB, MVC and number of MVC (two or more). Among demented patients, ADB and MVC were associated with sex (male) and number of MVC was associated with sex (male) and Blessed Dementia Rating Scale for activities of daily living scores. Neither ADB, MCV, or number of MVC were associated with education level, or with cognitive or psychiatric measures.

These findings showed that in developing countries, dementia has a significant contribution to MVC and ADB, as occurs in industrialized nations. Consequently, legislation to curb the risk of accidents caused by demented patients should be implemented. Furthermore, physicians must encourage demented patients (or their families) to discontinue driving, even those with mild dementia syndrome.
Clinical features and assessment of severe dementia. A review1
Authors: Boller F. , Verny M. , Hugonot‐Diener L. , Saxton J.
Published: March 2003

Sound understanding of the dementia syndrome requires adequate acquaintance with its entire spectrum, from the lightest to the most advanced stages. Most studies of dementia deal with light to moderate stages of the condition, while relatively little attention has been paid to its most severe stages. This review presents a clinical description of patients with severe dementia and of the tests currently available to evaluate their cognitive, behavioural, and functional status. Available instruments such as the Hierarchic Dementia Scale or the Severe Impairment Battery now allow quantification of the cognitive and behavioural status of patients with severe dementia. Experience with severe dementia shows that, far from being in a `vegetative state', as is commonly thought, late‐stage patients are in fact quite different from one another and in most cases continue to have an interaction with their environment. This ability to better define the characteristics of patients with severe dementia provides the basis for correlations between clinical data and data derived from neuroimaging, neurochemistry, or neuropathology. It also sets the stage for possible therapeutic trials involving these patients.
Electrophysiological study of vocal‐fold mobility disorders using a magnetic stimulator
Authors: Khedr E. M. , Aref E‐E. M.
Published: March 2003

In the field of neurolaryngology, there has been a great interest in neurophysiological studies, such as neurography, for the assessment of the integrity of the laryngeal neural pathway. Such tools provide an indication about the site and the nature of the nerve lesion. We have tried to use a magnetically evoked potential to assess the corticolaryngeal pathway in order to provide normative data on laryngeal nerve conductivity and to evaluate the integrity of the laryngeal neural system in patients with vocal‐fold mobility disorders. This study was conducted on 26 subjects (10 normal volunteers and 16 patients with vocal‐fold immobility) who were primarily selected on the basis of a comprehensive laryngeal evaluation including laryngo‐videostroboscopy assessment. Transcranial (cortical) and mastoid (peripheral) magnetic stimulations were performed to evoke muscle action potentials of the thyro‐arytenoid (TA) and cricothyroid muscles (CT). In normal volunteers, cortical stimulation leads to contralateral responses (cortical latency) after 10.9 and 11.3 ms and ipsilateral responses after 8.3 and 9.4 ms for right CT and TA muscles, respectively. There was a significant prolongation of cortical latency of the left TA compared with the right TA muscle, whilst no such significant difference was observed in the CT muscles. Peripheral stimulation evoked response (peripheral latency) after 2.8 and 2.7 ms in the right CT and TA, respectively, with the same significant prolongation of the left TA response compared with the right side. Amongst the patient groups, variable patterns of laryngeal muscle response latencies occurred, including normal response latency, lack of response of CT and TA muscles, prolonged peripheral latency with secondary prolonged cortical latency and prolonged cortical latency with normal peripheral latency. The results indicate that the magnetically evoked potential of laryngeal muscles offers an easy, non‐invasive technique and could have a role in the assessment of the integrity of corticolaryngeal pathways.
Measuring fatigue in patients with Parkinson's disease – the Fatigue Severity Scale
Authors: Herlofson K. , Larsen J. P.
Published: March 2003

The objective was to compare the prevalence and severity of fatigue in patients with Parkinson's disease (PD) with that in two control groups, one consisting of randomly chosen control subjects of the same age and sex distribution and the other consisting of patients with coxarthrosis waiting to receive total hip replacement. We also explored the possible correlation of demographic and clinical data to the presence and severity of fatigue. Sixty‐six patients with PD, 131 randomly chosen controls and 79 patients with coxarthrosis, waiting to receive total hip replacement, were evaluated for fatigue. Patients and controls with a depressive mood disorder or cognitive impairment had been excluded from the study. Fatigue was measured by the Fatigue Severity Scale (FSS). For the patients with PD the mean total FSS score was 4.1, compared with 2.7 amongst the randomly chosen control group and 2.9 in the group consisting of patients with coxarthrosis. Fifty per cent of the patients with PD had a mean total FSS score of 4 or higher, compared with 25% in both of the two control groups. There was no correlation between pain, presence of self‐reported nocturnal sleep disorders or duration of PD and fatigue. The patients with fatigue did have a more advanced disease, measured both by Unified Parkinson's Disease Rating Scale score and Hoehn and Yahr stage. Although the univariate analyses indicated that more severe parkinsonism was correlated to the symptom, the multivariate analysis showed that none of the studied variables were significant explanatory factors for fatigue. Fatigue is a common symptom in patients with PD without depression or dementia. The study indicates that fatigue is an independent symptom of the disease without relation to other motor or non‐motor symptoms.
Upregulated survivin expression in activated T lymphocytes correlates with disease activity in multiple sclerosis
Authors: Sharief M. K. , Noori M. A. , Douglas M. R. , Semra Y. K.
Published: March 2003

Programmed cell death (apoptosis) is critical for the normal development and homeostasis of the immune system. There is emerging evidence that failure of apoptosis to eliminate potentially pathogenic, autoreactive T lymphocytes may be involved in the pathogenesis of multiple sclerosis (MS). This failure is related to multiple abnormalities of apoptosis‐regulatory molecules that involve survivin, a recently described cell cycle‐regulated anti‐apoptosis protein. In this study, we investigated the relationship between survivin expression in peripheral T lymphocytes and clinical features of MS. We detected a significant over‐expression of survivin in mitogen stimulated T lymphocytes from patients with active MS when compared with corresponding expression in patients with stable MS or those with inflammatory and non‐inflammatory neurologic disorders. This over‐expression of survivin in patients with active MS correlated with cellular resistance to apoptosis and with features of disease activity, such as disease duration and the number of enhanced lesions on cranial magnetic resonance imaging. There was no correlation between cellular survivin levels and the expression of other apoptosis‐inhibitory proteins, such as Bcl‐2 and Fas‐associated death domain‐like interleukin‐1β‐converting enzyme inhibitory protein (FLIP). Our findings indicate that cellular over‐expression of the novel anti‐apoptosis protein survivin is a feature of clinically active MS.
Septo‐optic dysplasia with digital anomalies associated with maternal multidrug abuse during pregnancy
Authors: Orrico A. , Galli L. , Zappella M. , Monti L. , Vatti G. P. , Venturi C. , Hayek G.
Published: March 2003

We describe a 16‐year‐old female affected by septo‐optic dysplasia (SOD) with digital anomalies as additional feature. This rare developmental anomaly of midline brain structures can result from different pathogenetical events, including mutations of the homeo box gene HESX1, recently suggested as the etiological cause at least in a subset of patients. The absence of mutational involvement of this gene in our patient led us to consider, in alternative terms of pathogenesis, the maternal multidrug abuse occurring during pregnancy. Our report, in accord with previous experimental evidences, points out that illicit drug use might have played a causative role in brain development anomalies, thus our patient could represent an additional case of birth defects caused by a prenatal toxic exposure. The neurologic abnormalities and the clinical history of the patient are extensively reviewed. The need to include the SOD phenotype amongst the possible teratogenic effects of multidrug abuse is evidenced.
Mycophenolate in treatment‐resistant inflammatory neuropathies
Authors: Umapathi T. , Hughes R.
Published: March 2003

There has been an increasing interest in the use of mycophenolate as an immunomodulatory drug in neuromuscular diseases. We report five consecutive patients with treatment‐resistant chronic inflammatory demyelinating polyradiculoneuropathy or multifocal motor neuropathy who were treated with mycophenolate. None showed clinically significant benefit. The use of mycophenolate did not result in the reduction in the dose of corticosteroid or other immunosuppressive agents in any patient. Side‐effects, although not serious, were troubling enough for two patients to stop mycophenolate.
Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison
Authors: Werner C. , Bardeleben A. , Mauritz K‐H. , Kirker S. , Hesse S.
Published: March 2003

Treadmill training with partial body weight support can restore the gait ability of chronic non‐ambulatory hemiparetic subjects. A combination of physiotherapy and treadmill training may accelerate the rate of recovery. Therefore a randomized study was planned. Twenty‐eight non‐ambulatory hemiparetic patients were randomly assigned to group A or B. A 3‐week baseline of conventional therapy was followed by 15 sessions of physiotherapy and treadmill training in patients of group A and by 15 sessions of treadmill training in patients of group B over a period of 3 weeks. Follow‐up was 4 months later. The major outcome variables were gait ability and ground level walking velocity. Gait ability and velocity did not change during the baseline. In group B, five patients became independent walkers after the specific intervention, whereas 10 patients of group A regained independent walking ability in the same period (P < 0.05). Four months later group differences had waned. Three weeks of treadmill training plus physiotherapy accelerated the restoration of gait ability in hemiparetic subjects, however, the double amount of therapy in group A does not exclude a simple dose–response phenomenon.
Aneurysmal subarachnoid hemorrhage in Baltic population: experience from Latvia (1996–2000)
Authors: Keris V. , Buks M. , Macane I. , Kalnina Z. , Vetra A. , Jurjane N. , Mikelsone A.
Published: March 2003

Better knowledge of clinical epidemiology and course of aneurysmal subarachnoid hemorrhage (ASAH) is essential for dedicated planning of the need for services. The aim of the study was to obtain a picture of epidemiology and clinical course of ASAH in Riga City (the capital of Latvia). A retrospective population‐based study included residents of Riga City who suffered their first ASAH during a 5‐year period from the beginning of 1996 till the end of 2000. The total number of ASAH events in the population during the study period was 292, of which 56 (19%) were fatal before reaching the hospital. There was no significant difference between age‐specific incidence rates in men and women. The mean ASAH rates per 100 000 per year were 10.3 for age‐adjusted incidence (in the population aged 20–79 years) and 7.2 for crude incidence. The mean age‐adjusted case fatality rates were 57% for all ASAH events and 45% for those who survived admission. Our data suggest that incidence of ASAH in Baltic population can be recognized as average compared with other European regions. However, the case fatality rate of ASAH in the study population was higher than those of SAH reported from MONICA Collaborating Centers.
Gait training in hemiplegia
Authors: Mauritz K‐H.
Published: March 2003

Restoration of gait is a major goal in neurological rehabilitation. Before starting therapy, a comprehensive assessment is necessary to evaluate the deficits and remaining functions. A wide variety of therapeutic procedures are available and have to be adapted to the individual situation – different concepts of physiotherapy stress different features like: force exercise, reduction of spasticity, gait symmetry, utilization of equilibrium reflexes, stepping automation, endurance training, repetition of rhythmic movements, etc. The spectrum of available therapies was recently widened by treadmill training, with partial body‐weight support, locomotor pharmacotherapy, selective reduction of spasticity by botulinum toxin injections, and by musical biofeedback, which have each proved to be successful in the restoration of gait pattern. Treadmill training based on partial body weight support, combined with enforced stepping movements has proved to be successful in the restoration of gait pattern. A common problem in hemiparetic gait, is the spastic inversion of the foot. If spasticity is not severe, an ankle‐foot orthosis (AFO) is the appropriate technical aid. In other cases, botulinum toxin injection into spastic leg muscles has been successfully used to improve gait functions. In hemiparetic stroke patients, auditory (musical) rhythm, as a peripheral pacing signal, resulted in a significant increase in weight‐bearing stance time on the paretic side. In addition, there was an improved stride symmetry with rhythmic cueing and a normalizations of gait pattern. These methods directed to gait improvement should be combined and adapted to the individual patient's needs, in order to obtain the best results.
Yes/no reversals as neurobehavioral sequela: a disorder of language, praxis, or inhibitory control?
Authors: Frattali C. , Duffy J. R. , Litvan I. , Patsalides A. D. , Grafman J.
Published: March 2003

This study identifies a linguistic phenomenon suggestive of damage to fronto‐subcortical circuitry. Our objective was to determine the occurrence and neuroradiological/neurobehavioral correlates of yes/no reversals in corticobasal degeneration (CBD), and document occurrence of reversals in other neurological conditions. In a prospective study, we evaluated 34 CBD patients using a neuropsychologic battery and magnetic resonance imaging. Patients were subdivided into two groups: those with (n = 11) and without (n = 23) yes/no reversals. In a retrospective study conducted during the period of 1991–2001, we identified 33 patients for whom yes/no reversals occurred to compare correlates with prospective study findings. In the prospective study, 11 patients (32.3%) had yes/no reversals. Significant between‐group differences were found in scores of lexical fluency (P = 0.02) and prehension (P = 0.03). Prehension scores correlated with facial praxis (P < 0.0001) and upper limb praxis scores (P < 0.0001) in the yes/no reversal group only. In the retrospective study, nine CBD patients and 24 non‐CBD patients had yes/no reversals, with damage to fronto‐subcortical areas present in all patients. Results suggest an association with deficits in mental flexibility and inhibitory control. High within‐group correlations of lexical fluency and prehension with praxis scores suggest a relationship of yes/no reversals with multiple factors.
Restless legs syndrome
Authors: Odin P. , Mrowka M. , Shing M.
Published: March 2003

Restless legs syndrome (RLS), first described in 1672 and given its name in 1945, is one of the most common sleep and movement disorders. Modern population‐based studies demonstrate a prevalence between 5% and 15% in adult white populations. According to the diagnostic criteria, RLS is defined as an irresistable desire to move limbs, usually associated with paresthesias/dysesthesias and motor restlessness. The symptoms start or worsen at rest and improve with activity. Additionally, the symptoms worsen in the evenings and/or nights, which often results in disturbance of sleep with daytime tiredness. There is often a family history of RLS. Initially, the disease course is usually fluctuating and later may become continuous or chronic‐progressive. The diagnosis is based on the patient history and is supported by a normal neurological examination. RLS is confirmed by the finding of periodic limb movements (PLM) in polysomnographic investigations and by a response to dopaminergic medication. A large number of studies have confirmed the effect of levodopa (L‐dopa) in the treatment of RLS. A majority of the patients treated over a longer period of time with L‐dopa, however, develop problems with an effect called augmentation, where the RLS symptoms begin appearing earlier during the day and involve new parts of the body with increasing severity. A large number of studies have now confirmed that dopamine agonists can also be effective in RLS therapy, and that this treatment seems to involve less risk for augmentation. This paper provides a general review of RLS with a focus on current treatment options.
Methodological Aspects of Prophylactic Drug Trials in Migraine
Authors: Olesen Jes , Krabbe Annette Æbelholt , Tfelt-Hansen Peer
Published: March 2003

The purpose of this paper is to analyse methodological aspects of prophylactic drug trials in migraine. A study of ferrum quartz in 33 patients provided the necessary data base. Migraine definitions, relation between interval headache and migraine, and a number of other clinical problems are discussed. A headache diary is presented which to a certain extent allows a separation of interval headache and migraine attacks. Virtually all patients with frequent migraine attacks have interval headaches. A statistical model which allows a separation of time effects and treatment effects is presented. The inter-patient variability was much greater than intra-patient variability. This indicates that it will be difficult to obtain sufficient power with a non-crossover design. The relation between duration of treatment periods and the recessary number of patients is shown to be inversely related.
The Site of Pain Origin During Migraine Attacks
Authors: Blau J. N. , Dexter S. L.
Published: March 2003

Fifty patients were examined during a migraine attack to seek the site of origin of the headache. There being no single specific test for an intra- or extracranial source of head pain, we employed a series of manoeuvres: coughing, rapid side-to-side head rotation, and breath-holding for 30 seconds-indicative of an intracranial component. Digital compression of the superficial temporal artery, and a blood pressure cuff round the head to occlude the scalp circulation, were used as evidence of an extracranial component. Patients were asked to comment on the effect each of these procedures had on their headache. The observations suggest that in 49/50 an intracranial factor was operative, and in 21 of these no extracranial component was apparent. In 28/49 there seemed to be both intra- and extracranial contributions to the headache. One patient did not respond to any test. The evidence presented seems to implicate intracranial structures in the pathogenesis of migraine headaches.
Primary Headaches: Reduced Circulating β-Lipotropin and β-Endorphin Levels with Impaired Reactivity to Acupuncture
Authors: Facchinetti F. , Nappi G. , Savoldi F. , Genazzani A. R.
Published: March 2003

Eleven patients affected by common migraine (CM), eleven affected by daily chronic headache (DCH), and eight healthy volunteers were studied. Plasma levels of β-endorphin (βEP), β-lipotropin (βLPH), ACTH and cortisol were measured in basal conditions and after traditional Chinese acupuncture (TCA). Basal βLPH and βEP plasma levels (pg/ml) in the DCH patients (57.6 ± 9.5 and 16.8 ± 2.5, respectively; M ± SE) were lower than those found in the controls (83.6 ± 13.7 and 26.0 ± 6.1; p < 0.001), while those found in the CM cases showed intermediate values (75.3 ± 12.0 and 24.4 ± 5.8). ACTH and cortisol concentrations in both the CM and DCH patients were in the same range as those of the control group. TCA caused an increase in βLPH and βEP plasma concentrations in the control group (βLPH: 117 ± 16.9; βEF: 44.6 ± 6.7). Opioid plasma levels, however, remained unmodified after TCA in both the CM and DCH groups. ACTH plasma levels remained stable after TCA in all three subject groups. Patients suffering from primary headache are characterized by low βLPH and βEP plasma levels and by a poor reactivity of circulating opioids to non-stressful stimuli.
Cluster Headache: Severity and Temporal Profiles of Attacks and Patient Activity Prior to And During Attacks
Authors: Russell David
Published: March 2003

A detailed clinical study of 77 spontaneous cluster headache attacks has been carried out. The information was recorded during a period when patients were without medication and with the use of methods which were not dependent on the patients' memory of events. The findings stress the usual rapid onset and termination of attacks, and their short duration. There was a preponderance of attacks beginning during sleep and the majority of daytime attacks began when patients were physically relaxed. No significant difference between nocturnal and daytime attacks was found as regards severity or temporal profiles. A significant positive correlation was found between severity of maximal pain and both duration of maximal pain and total duration of attacks. “Abortive attacks” accounted for 16% of attacks. The apparent spontaneous arrest of these attacks does not appear to be due to special features of patient activity prior to or during attacks, nor are they restricted to a refractory period following more severe attacks.
Effects of 5-Hydroxytryptamine and Ergotamine on Human Superficial Temporal Artery
Authors: Østergaard J. R. , Mikkelsen E. , Voldby B.
Published: March 2003

Isometric tension was recorded in ring preparations of human superficial temporal arteries contracted by noradrenaline (NA), 5-hydroxytryptamine (5-HT), and ergotamine. In contrast to NA and 5-HT, ergotamine induced long-lasting contractions refractive to additional stimulations and resistant to repeated wash-out. When tested against 5-HT, ergotamine acted as a non-competitive antagonist. When repeating the 5-HT stimulations (4.7 x 10–5 M) the contractile response decreased indicating tachyphylaxis to this agent. As ergotamine revealed both a vasoconstrictive and a 5-HT-blocking activity, the beneficial effect in migraine may be by an interference during both the vasoconstrictory and vasodilatory phases.
Enkephalinase Inhibition Relieves Pain Syndromes of Central Dysnociception (Migraine and Related Headache)
Authors: Sicuteri Federigo
Published: March 2003

Normotensive and hypertensive headache sufferers were treated with D-phenylalanine, aprotinin or captopril-all inhibitors of endogenous opioid degradation. Inconsistent results were obtained using D-phenylalanine and aprotinin (acute administration at the start of a migraine attack). Satisfactory results were obtained by prophylactic treatment with captopril (an inhibitor of the angiotensin converting enzyme and of the dipeptidyl carboxypeptidase-an enkephalin inactivating enzyme) compared with conventional drugs such as methysergide, lisuride, pizotifen, clonidine and beta-blocking agents. Excellent results were obtained with captopril on patients suffering from headache and arterial hypertension who had experienced no relief from beta-blocking agents and clonidine. Captopril could thus be a drug of choice in the therapy of headache associated with essential hypertension.
Latent Dysautonomic Pupillary Lateralization in Cluster Headache. A Pupillometric Study
Authors: Fanciullacci Marcello , Pietrini Umberto , Gatto Gaetano , Boccuni Maria , Sicuteri Federigo
Published: March 2003

Forty-five patients with cluster headache in the asymptomatic phase were studied by electronic pupillography, testing autonomic function of both pupils pharmacologically. Topical sympathetically-acting mydriatics, tyramine and cocaine and the cholinoceptor blocker, homatropine, induced defective mydriatic responses on the symptomatic side, indicating latent impairment of sympathetic function. The abnormality was found in interattack intervals of the cluster period or during intercluster phases. The tyramine test can be proposed for objective diagnosis of cluster headache. We postulate that cluster attacks are triggered and lateralized by a permanent latent unilateral sympathetic dysfunction. Lithium reduced the mydriatic response to tyramine of the pupil contralateral to the pain, thus restoring the equilibrium between both pupils; this therapy may correct the asymmetric sympathetic function by attenuating the activity in the asymptomatic side.
Ergotamine in Plasma and CSF After i.m. and Rectal Administration to Humans
Authors: Hovdal Harald , Syversen Gaby B. , Rosenthaler Joachim
Published: March 2003

An attempt was made to study the kinetics of penetration of ergotamine across the blood-bran barrier. A single therapeutic dose of ergotamine was given to 18 hospitalized patients; eight patients received 0.5 mg i.m., three patients 4 mg rectally, and seven patients 2 mg rectally. Plasma samples were drawn between 0.25 and 72 h and one CSF sample was taken from each patient between 0.5 and 6.5 h after administration. The ergotamine concentrations were measured using a RIA method. The 0.5 mg intramuscular injection showed the highest plasma levels of ergotamine, with a mean peak concentration of 1.27 ng/ml reached at 0.5 h. The 4 mg rectal administration resulted in mean plasma ergotamine levels of 0.44 ng/ml in the time interval of 0.75–2 h. The 2 mg ergotamine rectally resulted in mean plasma levels of 0.15–0.17 ng/ml 1–8 h after administration of ergotamine. Neither the plasma samples taken after 10 h nor the CSF samples had ergotamine concentrations above the detection limit of the RIA method (0.1 ng ergotamine/ml).
Low Plasma Testosterone Levels in Cluster Headache*
Authors: Romiti Alfredo , Martelletti Paolo , Gallo Maria Francesca , Giacovazzo Mario
Published: March 2003

Serum levels of various hormones have been estimated in cluster headache and non-cluster headache controls. Cluster headache patients were studied prior to, during, and after attack. During the cluster phase, plasma testosterone levels were low, whereas levels were within the reference limits in the remission period of episodic cluster headache. LH levels were within reference limits. Normal values were also found in control patients with non-cluster headache. It is suggested that a decrease of plasma testosterone levels in episodic cluster headache should be viewed in context with disordered REM sleep in cluster headache.
Chronic Paroxysmal Hemicrania. VIII. The Sweating Pattern
Authors: Sjaastad Ottar , Russell David , Saunte Carsten
Published: March 2003

Evaporimeter measurements of forehead sweating during attack were carried out in six female patients with chronic paroxysmal hemicrania. The patients served as their own controls. Increased sweating on the symptomatic side was found in two patients. both when compared to the non-symptomatic side during attack and when compared with the symptomatic side outside attack. The remaining four patients, two of whom had only weak attacks at the time of study, showed sweat values within the control range. In one patient, attacks could be precipitated by head flexion and by pressure against certain circumscribed points in the neck (“mechanical” precipitation of attacks). These attacks were also associated with increased sweating on the symptomatic side. Increased forehead sweating does not seem to be a sine qua non in CPH.
So-Called “Tension Headache” — The Response to a 5-HT Uptake Inhibitor: Femoxetine
Authors: Sjaastad Ottar
Published: March 2003

Sixteen patients with a headache resembling the so-called “tension headache” and a clear response to doxepin (demonstrated in a previous work) were given femoxetine, 400 mg p.d., and placebo in a cross-over, double-blind fashion. Only single blindness was kept in the last third of the study. Placebo and femoxetine tablets were each given for four weeks. Whereas there was a daily or practically daily occurring headache untreated, placebo was associated with a headache frequency of 92%. The corresponding figures for doxepin and femoxetine were 27% and 41%, respectively. Femoxetine led to transitory nausea and gastrointestinal discomfort, but in contrast to doxepin, no weight gain and only slight, if any, sedation. Most patients preferred femoxetine to doxepin. Femoxetine, an antidepressant phenylpiperidine derivative with predominant serotonin re-uptake inhibition (little effect on noradrenaline), thus seems to counteract so-called “tension headache”.
Glossopharyngeal Neuralgia
Authors: Bruyn G. W.
Published: March 2003

A review is presented of the clinical features of glossopharyngeal neuralgia, as analysed from 304 reported instances. The sex-ratio of the condition is equal, the peak-age at onset is between 40 and 60 yrs, and left-side involvement predominates in females. The clinical features are detailed in 18 specific items. In a review of the aetiology it is argued that the so-called “idiopathic” type of IXth nerve neuralgia (which, upon careful analysis, may still rest upon either an obscure tumor or infection or elongated styloid process) should be primarily attributed to vascular elongation and looping (“Jannetta mechanism”). The cardiovascular type of the neuralgia, with bradycardia, or asystole and convulsions or coma, receives special emphasis. The differential diagnosis, particularly in view of the not-infrequently occurring combination with trigeminal neuralgia, is set out briefly.
Is Acute Tolerance to 5-Hydroxytryptamine Opioid Dependent? Its Absence in Migraine Sufferers
Authors: Sicuteri Federigo
Published: March 2003

The human dorsal hand vein, exhausted in vivo (tachyphylaxis) by repeated inoculations of 5-hydroxytryptamine, recovers its capacity to contract in response to the 5HT when naloxone ( per se ineffective) is inoculated into the same vein. It would seem, therefore, that in the 5HT tachyphylactic mechanism a role could be played by the progressive excitation of a local opioid modulator apparatus (silent in basal condition); naloxone's capacity for neutralizing the vein's fatigue could be indirect evidence of this. This postulation of an opioid role in the tachyphylactic mechanism differs from the conventional thesis, which explains tachyphylaxis as a progressive exhaustion of NA released from the sympathetic neuron by 5HT (see Table 1). Tachyphylaxis is poor, delayed or absent in migraine sufferers; this anomaly is present even in the period between attacks. The anomaly of inverted tachyphylaxis appears amplified during attacks. The loss or inversion of 5HT-tachyphylaxis is constantly observed in heroin addicts during acute abstinence. The fact that the clinical phenomena of acute heroin abstinence are comparable with those of a migraine attack could be a matter for further investigation.
Platelet Met-Enkephalin Immunoreactivity and 5–Hydroxytryptamine Concentrations in Migraine Patients: Effects of 5–Hydroxytryptophan, Amitriptyline and Chlorimipramine Treatment
Authors: Boiardi Amerigo , Picotti Giovanni B , Giulio Anna Maria Di , Bussone Gennaro , Galva Maria Donata , Mantia Loredana La , Mantegazza Paolo
Published: March 2003

In thirty patients with common migraine the platelet concentrations of met-enkephalin immunoreactivity (ME) (76 9 pg/mg protein) were similar to those in 23 healthy volunteers (77 5), suggesting that there is no alteration in the ME pool in this biochemical compartment in migraine. Chronic treatment (4 weeks) with drugs that interfere with 5–hydroxytryptamine (5–HT) synthesis or uptake induced the expected changes in platelet 5–HT levels, i.e. a rise following administration of the 5–HT precursor 5–hydroxytryptophan (daily dose: 300–500 mg, n = 9) and a decrease after amine uptake inhibition by amitryptyline (30–75 mg, n = 7) and even more by chlorimipramine (30–50 mg, n = 9). Platelet ME concentrations rose by up to ∼90% over the basal values after either 5–hydroxytryptophan (significantly from week 2) or amitriptyline (at week 2) and were unchanged after chlorimipramine, indicating that 5–HT and ME concentrations in platelets can vary independently. The high platelet ME levels following 5–hydroxytryptophan and amitriptyline cannot be explained at present. They might be due either to increased ME synthesis, possibly in the megakaryocyte, or to decreased utilization by platelets or both.
Mast Cells in Cluster Headache. Ultrastructure, Release Pattern and Possible Pathogenetic Significance
Authors: Liberski Pawl P , Mirecka Barbara
Published: March 2003

Cluster headache remains a disease with almost totally unknown etiology and poorly understood pathogenesis. Some evidence has been presented to suggest that histamine released from mast cells might possibly be responsible for the initiation of pain attack. The authors present ultrastructural data concerning cutaneous mast cells in the painful region in patients suffering from cluster headache. The biopsies were taken between attacks in a bout. The fine structure of the mast cells (namely swollen granules, zones of decreased density, membrane-bound vesicles and granular fusion) are consistent with the dissolution pattern of secretion. The possible role of antidromic-reflex activation of the mast cells is also discussed.
Cluster Headache-Like Pain Caused by an Upper Cervical Meningioma
Authors: Kuritzky Arieh
Published: March 2003

A 68-year-old man with chronic lung disease suffered from cluster headache (CH)-like pain associated with an upper cervical meningioma extending to compress the lower brain stem. The pain disappeared after tumour excision. We suggest that compression of the brain stem and hypoxemia associated with chronic lung disease might have caused the attacks. especially in the early morning when REM sleep hypoxia was prevalent. It is also suggested that in atypical resistant cases of CH-like pain where therapy fails. efforts should be made to rule
A Chronobiological Study of Melatonin, Cortisol Growth Hormone and Prolactin Secretion in Cluster Headache
Authors: Chazot Guy , Claustrat Bruno , Brun Jocelyne , Jordan Daniel , Sassolas Geneviève , Schott Bernard
Published: March 2003

The temporal organization of plasma melatonin. cortisol. growth hormone (GH) and prolactin secretion was examined in healthy rested controls and in patients suffering from episodic cluster headache. Eleven patients with typical cluster headache (10 men, 1 female) and 8 male controls were studied over a 24–h period: blood was collected at 2–h intervals during the day and at l-h intervals at night. Plasma melatonin. cortisol, GH and prolactin levels were determined by radioimmunoassay. Most of the cluster headache patients showed a decrease in nocturnal melatonin secretion and the melatonin rhythm was even completely abolished in one patient. Chronobiological analysis of the cluster headache patients' 24–h plasma melatonin profile showed a significant decrease in amplitude and mesor: these were 58.7 pg/ml and 34.4 pg/ml respectively in control subjects, versus 18.7 pg/ml and 17.6 pg/ml for the patients. In addition. patients showed a significant phase-advance in their melatonin rhythm For cortisol, the rhythm appeared slightly blunted in the cluster headache group and was significantly phase-advanced. The plasma prolactin profile showed no significant alteration, but for plasma GH the nocturnal peak was advanced in some patients: in the absence of sleep recording, however, no conclusion could be drawn. Results from this study suggest a neuroendocrine dysregulation in cluster headache in the endogenous clock which controls the pineal rhythmicity.
Flunarizine in The Prevention of Classical Migraine: A Placebo-Controlled Evaluation
Authors: Mendenopoulos G , Manafi Th , Logothetis I , Bostantjopoulou S
Published: March 2003

Pharmacological data and early clinical experience have suggested that the calcium entry blocker flunarizine may be a valuable gain in the prophylaxis of migraine. This was supported by a study in 20 patients with classical migraine who were, after a drug free run-in phase, orally treated with either placebo or flunarizine (10 mg at night) for 3 to 4 months. Flunarizine significantly reduced the frequency, duration and severity of the migraine attacks. A corrected migraine index, based on these 3 variables was reduced by 82% in the drug group but increased by 66% in the control patients. Only 1 patient did not clearly benefit from flunarizine. In some cases flunarizine should be administered for at least 4 months before judging its efficacy. No side-effects occurred.
Efficacy of Nimodipine in the Prophylaxis of Migraine
Authors: Havanka-Kanniainen H , Hokkanen E , Myllylä VV
Published: March 2003

The efficacy of nimodipine in the prophylaxis of migraine was assessed in a double-blind, placebo-controlled, cross-over study carried out on 33 patients, 20 of whom suffered from classic and 13 from common migraine. Four patients dropped out, but not as a result of the side effects of the drug. The duration of drug treatment was 8 weeks. The dosage used was 30 mg four times daily. Nimodipine proved to be better than placebo, the number of migraine attacks and severity of headache showing a significant reduction. The drug was well tolerated and no marked side effects were noted. The results suggest that nimodipine is a useful new prophylactic drug for migraine, but further studies are needed before its final value can be evaluated.