bluuebunny/crossref_metadata_2025 huggingface dataset:
Phenytoin dosage adjustment in Saudi epileptics: utilization of steady‐state pharmacokinetic parameters
Authors: Abduljabbar Mohammed , Al‐Khamis Khalil , Ogunniyi Adesola , Daif Abdul Kader , Al‐Yamani Mohammed
Published: March 2003

We determined the Michaelis‐Menten parameters (Vmax and Km) in 271 Saudi epileptic patients having generalized tonicclonic seizures and who were treated with phenytoin (PHT) using high pressure liquid chromatography (HPLC). The patients comprised 150 (55.4%) males and 121 (44.6%) females, with a mean age of 31.7 years (SD = 18.5). The mean Vmax, for subjects less than 16 years of age was 10.35 mg/kg/day (SD = 0.73, range = 3.77‐17.01), while for those above 16 years, the mean value was 7.99 mg/kg/day (SD = 0.15, range = 3.68–15.95). The difference was statistically significant (P < 0.001). Vmax was positively correlated with weight (r= 0.953), but negative with age (r= 0.903). Km values ranged from 1.01‐20.87 mg/litre. The adult Km mean of 6.52 mg/l (SD = 0.24) was significantly higher than the mean of 4.79 mg/l (SD = 0.40) for pediatric patients (P < 0.01), but Km was correlated neither with age nor with weight. Our results showed no difference between the predicted and observed serum PHT concentrations in both the pediatric and adult patients when the respective, age group Km and Vmax values were used to adjust PHT doses. The pediatric cases, however, required 30% more PHT per kilogram of body weight than the adults for the achievement of similar serum concentrations.
Does selegiline modify the progression of early Parkinson's disease? Results from a five‐year study
Authors: Larsen Jan P. , Boas Jette , Erdal John Erik ,   Norwegian‐Danish Study Group
Published: March 2003

The objective of this study was to examine the effect of long‐term treatment with selegiline on the progression of Parkinson's disease (PD). One hundred and sixty‐three patients with early PD were treated with levodopa and benserazide, combined with selegiline or placebo in a five‐year randomized, placebo‐controlled, double‐blind, parallel group study followed by a one‐month wash‐out of selegiline or placebo. The main outcome measures were assessments of the severity of parkinsonism, levodopa requirements and the development of end‐of‐dose motor fluctuations over time and after wash‐out at the end of the study period. Results indicated that patients treated with the combination of selegiline and levodopa developed markedly less severe parkinsonism and required lower doses of levodopa during the five‐year study period than patients treated with levodopa and placebo. There was no trend towards worsening during wash‐out among patients previously treated with selegiline. The results cannot easily be explained by a symptomatic effect of selegiline.
Adhesion of mononuclear cells from multiple sclerosis patients to cerebral vessels in cryostat sections of normal human brain
Authors: Zaffaroni Mauro , Martinazzi Silvia , Crivelli Filippo , Ghezzi Angelo , Zampieri Antonella , Martinazzi Massimo , Zibetti Adelio , Canal Nicola
Published: March 2003

Leukocyte extravasation across the blood—brain barrier is a critical event in the pathogenesis of multiple sclerosis (MS). This complex multistep process includes the adhesion of leukocytes to the endothelial cells of the central nervous system microvasculature. To investigate this phenomenon in MS, we developed a modified version of the frozen‐section assay. Peripheral blood mononuclear cells (PBM) from 26 MS patients, 26 healthy controls and 10 patients with other inflammatory non‐neurological diseases (OIND) were co‐incubated with cryostat sections of normal brain white matter, immunohistochemically labelled with anti‐CD45 antibody and counterstained with Giemsa stain. CD45‐positive PBM adherent to transected microvasculature were counted with an automated image analyzer. MS patients showed an increased number of vessel‐bound PBM (48.8 ± 36.4) with respect to healthy controls (27.4 ± 20.7, P= 0.01) and OIND patients (22.6 ± 7.8, P= 0.01). Significant differences were also obtained counting the number of vessel‐bound PBM as a percent of total vascular cells between MS patients (12.7 ± 7.2%) and healthy controls (6.9 ± 5.4%, P= 0.002) or OIND patients (7.4 ± 4.4%, P= 0.03). We confirm that PBM from MS patients show an increased potential of binding to cerebral vessels. The frozen‐section assay provides a unique tool to study in situ the molecular interactions of leukocytes with brain vascular structures.
Executive functions and speed of mental processing in elderly patients with frontal or nonfrontal ischemic stroke
Authors: Leskelä Maarit , Hietanen Marja , Kalska Hely , Ylikoski Raija , Pohjasvaara Tarja , Mäntylä Riitta , Erkinjuntti Timo
Published: March 2003

Impairments in executive functions have been related to aging and frontal lobe lesions. Aging also causes slowing of mental processing. We examined whether ischemic stroke in the frontal brain area results in dysexecutive syndrome, or whether the frontal stroke causes increased slowing of mental processing. Neurological, radiological and neuropsychological examinations were carried out 3 months post‐stroke on 250 ischemic stroke patients (55–85 years) and on 39 healthy control subjects. Of the patients, 62 had frontal and 188 had nonfrontal lesions. The neuropsychological examination comprised several cognitive domains, including tests considered to measure executive functions. The frontal group was slower than the nonfrontal group in tasks measuring speed of mental processing which were time‐limited (Trail Making A, Stroop dots and fluency). They were also inferior in the Digit Span backwards task. There were no differences between the groups in other cognitive domains, nor in some tests which are considered to be measures of executive functions (e.g. WCST). Impairments in executive functions were evident in both the frontal and the nonfrontal groups compared with the controls, but no dysexecutive syndrome specifically related to frontal lesions was found. Frontal stroke related mainly to the slowing of mental processing.
Hepatic metastasis of thymoma
Authors: Moretti R. , Nasuelli D. , Torre P. , Antonello R. M. , Cazzato G. , Stanta G.
Published: March 2003

The natural history of thymoma remains unpredictable because of the possibility of recurrence not infrequent after resection, but generally confined to the mediastinum Rufini et al. (1997)
.
Idiopathic intracranial hypertension without papilledema after epidural anaesthesia: a casual or causal association?
Authors: Porta‐Etessam J. , Martínez‐Salio A. , Berbel A. , Pérez Martínez D. A.
Published: March 2003

To the Editor,
Effects of sex hormones on experimental autoimmune myasthenia gravis
Authors: Leker R. R. , Karni A. , Brenner T. , Weidenfeld J. , Abramsky O.
Published: March 2003

To examine whether exacerbation of myasthenia gravis (MG) can be induced by changes in sex hormone levels we immunized 20 female Lewis rats with torpedo antigen to induce experimental autoimmune MG (EAMG). Ten of the animals underwent surgical ovariectomy prior to the induction of EAMG and 10 served as controls. Anti‐acetylcholine receptor antibody (AChR‐ab) titres and the degree of decrement on repetitive stimulation electromyography (REMG) at 3 Hz were obtained at base line and compared between rats with and without ovariectomy and a second control group of naïve rats. Three rats in each group were then injected with excess oestrogen and progesterone for one week, and three of the remaining rats in each group were given sham injections, and the degree of decrement on REMG and AchR‐ab titres were re‐evaluated. Immune reactivity of peripheral lymphocytes and splenic lymphocytes from all groups and controls was also determined. A comparable number of animals with and without ovariectomy developed clinical and electromyographic EAMG. The extent of decrement on REMG and AChR‐ab titres did not change following hormonal replacement. Lymphocyte reactivity was similar for rats with and without ovariectomy. In conclusion, sex hormones do not appear to have an influence on the susceptibility to and the severity of MG.
Progressive muscle pain, weight gain, fatique and unusual body shape change
Authors: Heckmann J. G. , Kraus B. , Stefan H. , Neundörfer B.
Published: March 2003

Multiple symmetrical lipomatosis (MSL) is a rare syndrome characterized by symmetric unencapsulated lipomas around the axial region and frequently associated with neurological involvement, particularly myopathy and neuropathy ( Klopstock et al., 1994
). Here we present a typical image of a patient with MSL, explaining this disease for neurologists who might care for these patients in an average day at the neuromuscular consultation unit.
Treatment of functional limitations at the knee in ambulatory children with cerebral palsy
Authors: Chambers H. G.
Published: March 2003

The gait of ambulatory children with cerebral palsy frequently involves abnormal knee motion. Spasticity, muscle contracture formation, impairments of motor control, weakness, balance deficits, and extrapyramidal motions can all contribute to the functional limitations imposed at the knee. Careful clinical evaluation of the child and their gait must be performed in order to determine the best individual course of treatment. Often, three‐dimensional motion analysis with assessment of muscle activity and force is necessary to completely assess the complexities of gait. Several typical gait patterns have been described involving the knee, including ‘jump knee’, ‘crouch’, ‘true equinus’, ‘apparent equinus’, ‘recurvatum’ and ‘stiff knee’ gait. Each of these gait patterns is defined here and discussed using case examples. These typical gait patterns are usually accompanied by involvement at the hip and ankle and may be combined with transverse plane rotational abnormalities. Treatment options such as rehabilitation (physiotherapy, casting, strengthening, and/or orthoses), spasticity management (intramuscular injections of phenol, alcohol, and botulinum toxin type A) and orthopaedic approaches are discussed for each entity.
Proportional change: an additional method of reporting technical and functional outcomes following clinical interventions
Authors: Blair E. M. , Love S. C. , Valentine J. P.
Published: March 2003

One of the major challenges in disability management research is to express results in a manner that can be generalized to subjects with varying degrees of disability. Absolute measurements of change are often dependent on initial characteristics, in which case they can only be generalized to subjects with the same characteristics. We define proportional change as the ratio of change to the maximum possible or targeted change. It can be assessed in any situation where a maximum possible or targeted change is definable. Its estimated value will be sensitive to the choice of denominator. Subjective assessments, such as those measured with Likert scales, are naturally expressed as proportional change with the denominator being set by the subject. Denominators may also be determined objectively by physical limitations or, less desirably, by the measurement tool. Where there is no readily or objectively determinable denominator, they should be chosen for each subject in advance of the intervention according to carefully specified criteria. Proportional change is proposed, as an adjunct to the reporting of absolute measures of change following therapeutic interventions, as a means of expressing change in a manner that is both individualized and generalizable.
A randomized, double‐blind, placebo‐controlled study of the efficacy and safety of botulinum toxin type A in upper limb spasticity in patients with stroke
Authors: Bakheit A. M. O. , Pittock S. , Moore A. P. , Wurker M. , Otto S. , Erbguth F. , Coxon L.
Published: March 2003

Objective. To study the efficacy and safety of botulinum toxin type A (BtxA) in the treatment of upper limb muscle spasticity, caused by stroke.

Methods. This was a randomized, controlled trial. Patients received either placebo injections or a total of 1000 IU of BtxA (Dysport) into five muscles of the affected arm. Muscle tone was assessed using the Modified Ashworth Scale (MAS). Other outcome measures were the change in the joint range of motion (ROM), the Barthel index, pain score, goal attainment and the subjective evaluation of benefit by patients and investigators. The patients were assessed blind to randomization at baseline and 4, 8, 12 and 16 weeks after treatment.

Results. Fifty nine patients were recruited and received treatment. One patient was lost to follow‐up before the last scheduled visit of the study. The group of patients who received BtxA had a significant reduction in the summed MAS score at week 4 compared with the placebo group (P=0.004). The magnitude of benefit over the 16 week follow‐up period was significantly reduced for the BtxA group in the wrist (P=0.004) and the finger joints (P=0.001) when compared with the placebo.

There was no statistically significant difference between the groups in the joint ROM, muscle pain, goal‐attainment or the Barthel index scores at week 4 of the study. At week 16, the BtxA group showed significantly greater improvement in the passive ROM at the elbow (P=0.036). The patients’ global assessment of benefit at the end of the study showed that 16 (50%) patients in the placebo group had ‘much improved’ or had ‘some improvement’ compared with 24 (92.3%) patients in the BtxA group (P=0.007). The investigators’ rating for the same item was 16 (50%) and 23 (88.4%) patients, respectively (P=0.002).

Sixteen and twenty patients in the BtxA and placebo groups, respectively, had an adverse event. The most frequently reported adverse events were accidental injury, respiratory and urinary tract infections and muscle pain.

Conclusion. The findings of the present study suggest that treatment with BtxA in a dose of 1000 units reduces muscle tone in patients with post‐stroke upper limb spasticity. This effect is sustained for at least 16 weeks. BtxA is safe in the dose used in this study.

Important note. The authors wish to emphasize that the botulinum toxin preparation used in this study was Dysport (Ipsen Ltd) which has a different therapeutic equivalence from other commercially available product, Botox (Allergan Inc.).
Effects of closed traumatic brain injury and genetic factors on the development of Alzheimer’s disease
Authors: Jellinger K. A. , Paulus W. , Wrocklage C. , Litvan I.
Published: March 2003

In order to assess the impact of traumatic brain injury (TBI) and Apolipoprotein E (ApoE) allele frequency on the development of Alzheimer’s disease (AD), we examined: (i) the incidence of AD pathology in 55 consecutive autopsy cases (mean age ± SD 77.6 ± 7.3 years) with residual closed TBI lesions and (ii) the frequency of TBI residuals in 53 age‐matched autopsy proven AD cases. In both series, ApoE was evaluated from archival paraffin‐embedded brain material. The results were as follows: (i) In the TBI series, 12.7% showed Consortium to Establish a Registry for Alzheimer’s disease (CERAD) definite and 9.1% probable AD, only one with ApoEɛ4. From the remaining 43 non‐AD cases, three had ApoEɛ4. The prevalence of 21.8% AD in this small autopsy cohort was significantly higher than 3.3% in a recent large clinical series and 14% in the general population over the age of 70. (ii) In the AD cohort with ApoEɛ4 allele frequency of 30% similar to other AD series, residuals of TBI were seen in 4 brains (7.5%), all lacking the ApoEɛ4 allele. TBI incidence was slightly higher than 8.5% in the clinical MIRAGE study. The results of this first retrospective autopsy study of TBI, ApoE allele frequency, and AD confirms clinical studies suggesting severe TBI to be a risk factor for the development of AD particularly in subjects lacking ApoEɛ4.
Epidemiological aspects of headache in a workplace setting and the impact on the economic loss
Authors: Pop P. H. M. , Gierveld C. M. , Karis H. A. M. , Tiedink H. G. M.
Published: March 2003

The objective of this study was to assess the epidemiological aspects of headache in a workplace setting and the economical impact. By sending a questionnaire to 1781 employees of a Dutch manufacturing company we tried to assess the prevalence of headache and headache subtype within this working place. Besides the personal view of each responder regarding his/her headache subtype, the International Headache Society (IHS) criteria were used to classify headaches on the basis of reported features. Moreover the missing labour days, as a result of headache, during the previous 4 weeks were measured, as well as the loss of productivity at the working place during an episode of headache; from this an estimate of the economic loss could be calculated. The response rate of the questionnaire was 60.8%. The lifetime prevalence of headache amongst the responders was 53.3%. Of these, 34.5% thought their headache was tension‐type headache, 10.6% thought it was migraine, 5.4% mentioned daily headache, and 18.2% mentioned another type of headache. According to the IHS criteria the differentiation was somewhat different: 26.2% of the headache could be classified as tension‐type headache and 15% as migraine. When the costs for lost labour days and loss of productivity as a result of all types of headache were accumulated, the economic loss was estimated at 18.933 US$ in 4 weeks (for the group of responders). In conclusion, headache is related to a substantial economic loss; migraine is probably underestimated in a workplace setting.
Atherogenic progression of carotid stenosis associates selectively with monocyte fraction in circulating leukocytes
Authors: Boyajian R. A. , Otis S. M.
Published: March 2003

Humoral biomarkers of inflammation appear to correlate with future cardiovascular events warranting investigation of more specific associations between phenotypic subclasses of circulating cellular immunity and atherogenic progression of carotid stenosis. Retrospective study of carotid stenosis progression based on archived serial carotid duplex ultrasonography examinations in 100 patients. Predictors of atherogenic progression of carotid stenosis were sought using univariate and multivariate analysis of age, gender, hypertension, diabetes mellitus, smoking, peripheral blood leukocyte count and leukocyte differential profile, platelets, diastolic and systolic and mean arterial blood pressure, pulse pressure, creatinine, glucose, total‐, HDL‐, and LDL‐cholesterol, triglycerides, and body mass index. Atherogenic progression of carotid stenosis was limited to patients with carotid stenosis at baseline (41/100) and exhibited a sporadic episodic temporal course. Univariate predictors of stenosis progression were diabetes mellitus, smoking, percent monocytes, and absolute monocyte count. Logistic regression demonstrated that monocytes as a percentage of circulating leukocytes [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.06–1.47, P=0.0093] and smoking (OR 7.09, 95% CI 1.97–25.43, P=0.0027) were independently associated with atherogenic epochs. A selective association between the fraction of monocytes among leukocytes in peripheral blood and atherogenic progression of carotid stenosis is described.
The recognition, diagnosis and management of cerebral vasculitis: a European survey
Authors: Scolding N. J. , Wilson H. , Hohlfeld R. , Polman C. , Leite I. , Gilhus N. ,   (The EFNS Cerebral Vasculitis Task Force)
Published: March 2003

We have completed a survey of European neurological practice concerning cerebral vasculitis. Twenty‐nine respondents from 15 countries provided information concerning the diagnosis and management. The results confirmed the anticipated low frequency of the disease, but also illustrated the power of any putative collaborative effort. Interestingly, there was a wide variation in clinical practice, in particular concerning the perceived importance of cerebral angiography as a diagnostic test and the very common use of steroids as first‐line treatment, rather than more potent immunosuppressive agents. This variation is probably to be explained at least, in part, by the absence of any firm evidence base to inform clinical practice. A European collaborative effort – in which there has emerged considerable interest – offers a realistic opportunity to generate sound clinical evidence and thence scientifically robust practical guidelines.
Health‐related quality of life and its relationship to cognitive and emotional functioning in multiple sclerosis patients
Authors: Benito‐León J. , Morales J. M. , Rivera‐Navarro J.
Published: March 2003

The existing knowledge about the health‐related quality of life (HRQoL) and its relationship to cognitive and/or emotional functioning in multiple sclerosis (MS) is scarce. We assessed differences between subgroups of MS outpatients (n = 209) on one HRQoL instrument: a version of the Functional Assessment of Multiple Sclerosis quality of life instrument; on two cognitive functioning tests: the Mini‐Mental State Examination and the clock drawing test; and on two emotional functioning tests: the Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety. Three disease‐related characteristics were assessed: physical disability, duration of the illness, and clinical course. The results showed that each of these has an effect on at least one dimension of HRQoL and on one mental functioning test. Thus, the more severe, the more progressive, and the longer the illness duration, the lower the HRQoL. Likewise, cognitive mean scores decreased and emotional mean scores increased with greater illness severity and progressive the MS. Furthermore, we also found significant correlations between cognitive and emotional functioning tests and HRQoL dimensions. Thus, the worse cognitive functioning and the higher depressive and anxiety symptoms score the lower the HRQoL.
No change in the structure of the brain in migraine: a voxel‐based morphometric study
Authors: Matharu M. S. , Good C. D. , May A. , Bahra A. , Goadsby P. J.
Published: March 2003

Migraine is a common, disabling form of primary neurovascular headache. For most of the twentieth century it was regarded as a vascular headache whose primary pathophysiology lay in the cranial vasculature. Functional brain imaging using positron emission tomography has demonstrated activation of the rostral brain stem in acute migraine. Voxel‐based morphometry is a new fully automated whole brain technique that is sensitive to subtle macroscopic and mesoscopic structural differences between groups of subjects. In this study 11 patients suffering from migraine with aura (10 females, one male: 23–52 years, mean 31); 11 controls (10 females, one male: 23–52, mean 31); 17 patients with migraine without aura (16 females, one male: 24–57, mean 34); 17 controls (16 females, one male: 24–57, mean 34) were imaged with high resolution volumetric magnetic resonance imaging. There was no significant difference in global grey or white matter volumes between either patients with migraine and controls, or patients with aura and without aura. This study did not show any global or regional macroscopic structural difference between patients with migraine and controls, with migraine sufferers taken as homogenous groups. If structural changes are to be found, other methods of phenotyping migraine, such as by genotype or perhaps treatment response, may be required to resolve completely whether there is some subtle structural change in the brain of patients with migraine.
Cerebral venous thrombosis in four patients with multiple sclerosis
Authors: Vandenberghe N. , Debouverie M. , Anxionnat R. , Clavelou P. , Bouly S. , Weber M.
Published: March 2003

We report four new cases of cerebral venous thrombosis (CVT) occurring in patients with multiple sclerosis (MS). Each patient had undergone lumbar puncture at varying times prior to clinical presentation (4 days to over 1 year). Only two of the patients had received intravenous (i.v.) methylprednisolone 48 h prior to CVT and were under oral contraception, a risk factor for cerebral thrombophlebitis. The other two patients had not undergone recent lumbar puncture, were not taking corticosteroids and did not present vascular risk factors. The patients all had normal routine blood work‐ups and none had thrombophilia. All patients dramatically improved with full systemic heparinization. Minor sequelae were noticed in two patients. The pathogenesis underlying the occurrence of CVT in MS patients remains unclear and we discuss the relationship between lumbar puncture, steroid treatment and CVT.
Adrenergic, Cholinergic and Peptidergic Nerve Fibres in Dura Mater Involvement in Headache?
Authors: Edvinsson Lars , Uddman Rolf
Published: March 2003

Nerve fibres containing noradrenaline, acetylcholinesterase, vasoactive intestinal polypeptide and substance P were demonstrated in the dura mater of guinea-pigs using histochemical and immunohistochemical methods. These fibres accompanied blood vessels of all size, indicating a vasomotor role. In addition, some nerve fibres were observed without any obvious relation to the blood vessels. The rich supply of nerve fibres to the various parts of the dura mater may possibly be of importance in the pathogenesis of some types of headache.
A Case of Pre-Chronic Paroxysmal Hemicrania
Authors: Pelz Margaret , Merskey Harold
Published: March 2003

We describe a patient with neck pain of twelve years' duration whom we believe to have an early form of chronic paroxysmal hemicrania. Her pain was severe, frequent and brief and was greatly relieved by Indomethacin. There were two atypical features in this case—predominance of pain in the neck, and a change of pain from the right to the left side.
Platelet Serotonin Uptake and Migraine
Authors: Launay J. M. , Pradalier A. , Dreux C. , Dry J.
Published: March 2003

Platelet serotonin uptake characm, max, y) were determined in platelet-rich plasma for 11 common migraineurs and 15 healthy volunteers. All three parameters decreased only for the three patients having a migraine collection. Migrainous platelets isolated on dextran or resuspended in control plasma exhibited normal serotonin uptake. This finding suggests that plasmatic factor(s) may be responsible for the decrease of platelet serotonin uptake observed during migraine attack.
Brain Hypoxia: The Turning-Point in the Genesis of the Migraine Attack?
Authors: Amery Willem K.
Published: March 2003

The hypothesis postulates that a brief episode of focal cerebral hypoxia occurs in every attack of migraine. Clinical, biochemical and technical (EEG and CT scans) evidence is summarized suggesting that cerebral hypoxia may indeed occur in the course of a migraine attack. Focal hypoxia is seen as the turning-point in the pathogenesis of the attack. It may be provoked by different mechanisms in different patients; the potential role of decreased oxygen supply and of increased oxygen need are reviewed and excess sympathetic drive is considered a potential key mechanism in a majority of patients. Whether or not focal hypoxia leads to a genuine migraine attack, depends largely upon the quality of the whirlpool of biochemical, vascular and hematological changes that follow the hypoxic episode. These changes are discussed and it is concluded that those which have been reported to occur during migraine attacks could be due to a preceding hypoxic event. Finally, the hypoxia viewpoint is confronted with some popular theories about the pathogenesis of migraine. It is found that the other points of view are compatible with the hypoxia hypothesis.
Foods, and Food and Drug Combinations, Responsible for Head and Neck Pain
Authors: Seltzer Samuel
Published: March 2003

The literature has been reviewed to uncover the existence of head and neck pain syndromes caused by foods and food and drug combinations. Knowledge of the etiology of such syndromes may help in their treatment. At least twenty-five syndromes have been described. These include those induced by coloring and flavoring agents, alcoholic products, chocolate, coffee and tea, foods containing tyramine, vitamins, minerals, pesticides, and several others. Where possible, the active ingredients and the minimal amounts responsible for the induction of pain have been identified.
Cluster Headache — Clinical Findings in 180 Patients
Authors: Manzoni Gian Camillo , Terzano Mario Giovanni , Bono Giorgio , Micieli Giuseppe , Martucci Nicola , Nappi Giuseppe
Published: March 2003

Anamnestic data and clinical features were accurately investigated in 180 patients with cluster headache; 161 were episodic sufferers and 19 were chronic. A significantly high familial incidence of coronary heart disease was found. The patients' medical history revealed a significantly high incidence of peptic ulcer disease and head injury with brain concussion. It is stressed that the side on which head injury took place is very frequently the same side on which cluster headache is located, although the latency between the two events appears to be a long one. The study of timing of cluster periods suggests, for some patients, a constant, typical temporal pattern not necessarily related to seasons or the months of the year. Cluster attacks frequently occur during certain periods of the day (onset being most frequent between 1 and 3 p.m.). Cluster headache cannot be considered as a nocturnal headache.
Cyclic Vomiting and Recurrent Abdominal Pains as Migraine or Epileptic Equivalents*
Authors: Lanzi G. , Balottin U. , Ottolini A. , Burgio F. Rosano , Fazzi E. , Arisi D.
Published: March 2003

A retrospective method was used to estimate the incidence of recurring motion-sickness, cyclic vomiting and abdominal pain considered as different manifestations of a so-called periodic syndrome in 100 migraine sufferers, 100 epileptics and 100 control subjects in the pediatric age group. Such recurrent symptoms are significantly more frequent in those suffering from migraine than in the other two groups. Examination of subgroups of patients affected by particular forms of migraine (classical and common) and of epilepsy (generalized seizures, simple partial seizures, complex partial seizures) contributed little new to our understanding of the nature of periodic syndrome. It is concluded that the above symptoms of periodic syndrome should generally be considered as manifestations of a migrainous rather than of an epileptic disorder.
Immunoglobulins and Complement in Migraine
Authors: Jerzmanowski Antoni , Klimek Andrzej
Published: March 2003

In 54 patients with migraine and 70 persons comprising the control group, the total complement level (CH50) was evaluated together with its C3 and C4 fraction level and the level of IgG, IgA and IgM immunoglobulins. It was found that the average C3 fraction level was significantly decreased, while the C4 fraction level and total complement activity remained in the normal range. The immunoglobulin level did not show any statistically significant alterations except for the IgA level, which was lowered in migraine patients. On this basis, i.e. lowering of the C3 fraction level with normal C4 fraction level and total complement activity and lack of elevation of IgA, it is felt that the alternative pathway of complement system may be activated in migraine.
Total IgE, Specific IgE and Prick-Tests Against Foods in Common Migraine—A Prospective Study
Authors: Pradalier A. , Weinman S. , Launay J. M. , Baron J. F. , Dry J.
Published: March 2003

A prospective study of total IgE, specific IgE against 12 common foods, and prick-tests with 11 common food allergens was performed on 50 consecutive migraine sufferers. Total IgE levels were found above 100 kU/I for seven patients, but five of them were atopic. Prick-tests and PAST were positive for four and six patients (class 1), respectively. Food challenge on these six patients did not cause any migraine attacks. This study thus indicates a very low frequency of allergic dietary migraine to common foods.
Tomographic Determination of Cerebral Blood Flow During Attacks of Cluster Headache
Authors: Krabbe Annette Æbelholt , Henriksen Leif , Olesen Jes
Published: March 2003

A rapidly rotating single-photon emission tomograph was used to study regional cerebral blood flow (rCBF) by 133-Xenon inhalation in 18 patients with cluster headache. Measurements were performed in all patients in the resting state. The patients were given alcohol and/or nitroglycerin to provoke an attack of cluster headache. In eight patients it was possible to obtain satisfactory measurements during their cluster headache attack. All patients had a normal resting CBF with a normal age regression. During the headache phase, no significant changes of mean CBF from baseline occurred. There were no focal changes in the individual patient, but the mean rCBF in all eight patients showed significantly increased rCBF in the central, basal region and a small part of the right parietotemporal region. These changes we interpret as pain activation. It may be concluded that changes in rCBF are not likely to play a pathophysiological role in the development of cluster headache attacks.
Kinetics and Thermolability of Platelet Monoamine Oxidase in Cluster Headache and Migraine
Authors: Waldenlind Elisabet , Sääf Jan , Ekbom Karl , Ross Svante , Wahlund Lars-Olof , Wetterberg Lennart
Published: March 2003

Platelet monoamine oxidase activity (MAO) from 33 cluster headache patients (17 males, 16 females) and 34 migraine patients (16 males, 18 females) was assayed. The kinetic constants (apparent V max and apparent K m ) and the thermolability, measured as the ratio of the platelet MAO activity after and before heat treatment (+52°C, 30 min), were determined. The MAO activity and V max values were significantly lower in cluster headache than in migraine and in both headache disorders compared to a control group (62 males, 66 females). When comparing all groups, K m was not significantly different except for migraine females, who had lower K m values compared to control females. Thermolability was significantly higher in cluster headache than in migraine and in both headache disorders compared to the control group. Smokers of five cigarettes or more per day had significantly lower Vmax values but similar K m and thermolability values compared to those smoking less or nothing. The findings of low maximal velocities and high thermolability of platelet MAO in cluster headache and migraine are suggested to represent constitutionally different enzyme properties.
Reversible Cerebral Arteriopathy Associated with the Administration of Ergot Derivatives
Authors: Henry PY , Larre P , Aupy M , Lafforgue JL , Orgogozo JM
Published: March 2003

Three cases of intracranial arteriopathy associated with the administration of ergot derivatives are reported. In the first case, excessive doses of dihydroergotamine and of ergotamine tartrate seemed to be the cause, but simultaneous treatment with an antibiotic and the existence of a cytomegalovirus infection could have favoured the arteriopathic process. The second patient also received excessive doses of these two drugs, but in addition she was taking oestrogen and progesteron containing contraceptives. In the third case, an intravenous injection of methylergometrine in a dose of 0.2 mg seemed to have initiated the arteriopathy. Arteriograms were comparable in all three cases, with segmental stenosis of several cerebral arteries, whereas internal carotid and vertebral arteries remained normal. In the first case a control cerebral arteriography was normal one month later. These findings suggest that widespread cerebral arteriopathy can appear in subjects who chronically abuse ergotamine tartrate.
Chronic Paroxysmal Hemicrania: Lack of Pre-Chronic Stage
Authors: Bogucki Andrzej , Szymanska Róza , Braciak Wieslaw
Published: March 2003

Two cases of chronic paroxysmal hemicrania are presented, both with atypical late onset of illness and lack of pre-CPH stage. In one patient the pain attacks were unusually short, and no associated symptoms during the pain attack were observed. However, the positive reaction to indomethacin substantiates the diagnosis of CPH.
Trigeminal Control of Cranio-Facial Vasomotor Response: I. Histamine Test in Patients with Unilateral Gasserian Ganglion Lesions
Authors: Marinis Milena De , Martucci Nicola , Gagliardi Franco Maria , Feliciani Massimo , Agnoli Alessandro
Published: March 2003

It has been hypothesized that the trigeminal system may control vasomotor changes and pain in vascular headaches. In this study, headache was induced by an intravenous injection of histamine in 37 patients with trigeminal rhizotomy and in 12 controls. The vasomotor response to histamine was studied with facial telethermography. The headache in patients with trigeminal lesions differed, in a prevalence of unilateral localization contralaterally to the operated side (21 patients), from that in controls. No relationship was found between the hypoesthesia caused by the operation and the prevalence of unilateral headache. A statistically significant correlation ( p < 0.001) was found between unilateral absence of headache and decreased vasomotor response on the operated side. These reactions occurred more in patients who underwent thermocoagulation than in patients who underwent retro-gasserian rhizotomy. Thus the gasserian ganglion seems to control the cranio-facial vasomotor response and the headache through a vascular pathway, acting on cerebral arteries, which differs from the sensory pathway.
Platelet α-Adrenergic Receptor Activity and Pizotifen in Migrainous Children
Authors: Bond Peter A , Salmon Michael A
Published: March 2003

Adrenoceptors have been measured in the platelets from migrainous children, using (3H) yohimbine. Maximum binding (Bmax) was not significantly different in migrainous children and controls, 259 ± 21 and 265 ± 19 f moles per mg of protein respectively. Dissociation constants (KD) were significantly higher in the migraine group than in the controls 2.62 ± 0.18 and 2.17 ± 0.07 respectively ( p < 0.02). Bmax values were lower in 6 out of 9 cases following treatment with pizotifen. In 8 out of 9 cases KD values were lower following pizotifen treatment; in one case there was no change.
Clinical Trial of Nimodipine for Single Attacks of Classic Migraine
Authors: Jensen Kai , Tfelt-Hansen Peer , Lauritzen Martin , Olesen Jes
Published: March 2003

In a randomized, double-blind cross-over study, 43 patients with classic migraine received 40 mg Nimodipine and placebo as sublingual capsules. There was no significant effect on patients' preference, development of headache, need for escape medicine, duration of headache, severity of headache or headache index. Considerable methodological problems were encountered. Only 54% of the 79 patients selected for the trial could be evaluated. Suggestions for future trials are made.
Acupuncture Treatment of Chronic Tension Headache – A Controlled Cross-Over Trial
Authors: Hansen Per Evald , Hansen John Hersted
Published: March 2003

In a controlled trial the effect of traditional Chinese acupuncture v. placebo acupuncture was evaluated in 18 patients with chronic tension headache (mean disease duration 15 years). All patients suffered from daily or frequently recurring headache, the intensity of which was recorded by the patient over a period of 15 weeks. Each patient was treated by traditional Chinese acupuncture as well as by placebo acupuncture in a cross-over design following randomization. Each period of treatment comprised six treatments. Traditional Chinese acupuncture was found to be significantly more pain-relieving than placebo acupuncture, according to the pain registration of the patients themselves. The pain reduction was 31%. Acupuncture is therefore found to be a reasonable treatment for chronic tension headache.
Methylergometrine, an Active Metabolite of Methysergide
Authors: Müller-Schweinitzer Else , Tapparelli Carlo
Published: March 2003

In conscious dogs methysergide (MS) caused constriction of the saphenous vein at about 3000 times lower doses than methylergometrine (MT) when infused locally, but it elicited only a short-lasting venoconstrictor response when injected systemically intravenously. MS and MT proved to be equally active venoconstrictor agents when administered orally. Analysis of canine plasma by high-performance liquid chromatography showed that after both oral and intravenous administration of MS large amounts of MT appeared in the plasma whereas only low and transient levels of MS could be detected. It is suggested that one of the first steps in metabolism of MS is demethylation at position 1 of the indole, leading to the formation of MT, which may be a main active principle of the therapeutic effectiveness of MS in the interval treatment of migraine headache.
Chronic Paroxysmal Hemicrania: The First Possible Bilateral Case
Authors: Pöllmann Walter , Pfaffenrath Volker
Published: March 2003

There are three headaches syndromes that are typically characterized by strictly unilateral and always same-sided attacks: cluster headache, “cervicogenic” headache, and chronic paroxysmal hemicrania (CPH). In rare cases, cluster headache also occurs bilaterally; “cervicogenic” headaches probably as well. We present a patient with a probable bilateral CPH. To our knowledge no such case has previously been described.
The Utilization of The Rorschach Test in A Case-Controlled Study
Authors: Guidetti Vincenzo , Mazzei Gastone , Ottaviano Salvatore , Pagliarini Marina , Paolella Anna , Seri Stefano
Published: March 2003

The Rorschach test was administered to 58 children of normal intelligence aged 7–14 years with a history of common migraine of at least 12 months and to a group of controls matched for age, sex, and IO. The Rorschach test was scored blindly. The migraine group was characterized by marked intellectual inhibition with poor school performance and low response rates; inhibition of psychomotor activity and aggressiveness, shown by content analysis and by the presence of kinesthetic shock; inhibition of affect (ratio M/sum C); ineffective use of mechanisms of defence against anxiety (F-); prevalence of phobic features and massive use of repression, indicated by the high rejection rate and shock at red colour. The differences from the controls were significant at the 0.01 level with regard to all items in the preadolescent age group and with regard to all items except kinesthetic shock in the migraine group as a whole. There was thus a definite difference between the migraine group and the controls, a difference that might depend on impairment of ego function and on recurrent experience of pain.
Abnormal Membrane Composition and Membrane-Dependent Transduction Mechanisms in Cluster Headache
Authors: Belleroche J de , Kilfeather S , Das I , Rose F Clifford
Published: March 2003

Previous studies have indicated that membrane structure and function may be abnormal in cluster headache. This has been further investigated by analysis of membrane phosphatidylcholine, total phospholipids, and cholesterol in erythrocytes and by assay of receptor-mediated transduction. The stimulation of lymphocyte adenylate cyclase with isoprenaline and prostacyclin was used as the test system. A significant increase in the ratio of membrane phosphatidylcholine to cholesterol without change in cholesterol was found in cluster headache patients as compared with control subjects. This indicated a reduced turnover of phosphatidylcholine, since erythrocyte choline is significantly reduced in this condition. Abnormal membrane function was also indicated from the significant depression of high-affinity prostaglandin receptor stimulation of lymphocyte adenylate cyclase and the similar trend in the β-adrenoceptor response. Since no change in agonist affinity and β-adrenoceptor density occurred, this depression indicates a generalized defect in coupling of receptors to adenylate cyclase. It is hypothesized that the impaired function that would result might contribute to the aetiology of cluster headache.
Tizanidine in the Management of Trigeminal Neuralgia
Authors: Vilming Steinar T , Lyberg Torstein , Lataste Xavier
Published: March 2003

In a double-blind study the efficacy and tolerability of tizanidine was compared with those of carbamazepine in the management of trigeminal neuralgia. Six patients were allocated to treatment with tizanidine and six to carbamazepine. After individual titration the maximum daily doses were 18 mg and 900 mg, respectively. Among the efficacy factors used, the visual analog scale (VAS) and the overall efficacy as assessed by patients and investigator turned out to be the most appropriate. The results indicate that tizanidine was well tolerated, but the effects, if any, were inferior to those of carbamazepine.
Effects of Extracellular Calcium and of the Calcium Entry Blockers Flunarizine and Nimodipine on Contractile Responses in Human Temporal Arteries
Authors: Jansen I , Edvinsson L
Published: March 2003

Contraction induced by 124 mM potassium followed the depolarization of smooth-muscle cells and activation of potential-operated calcium channels in human temporal arteries. The contraction elicited consisted of two phases, one rapid and one slowly developing stable phase; both were affected by the two calcium entry blockers flunarizine and nimodipine but at significantly different concentrations. In calcium-free medium 124 mM potassium resulted in a weak contraction. Addition of calcium caused a concentration-dependent contraction that was attenuated by the calcium entry blockers at concentrations comparable to those inhibiting the second phase. The results suggested that in human temporal arteries flunarizine and nimodipine act as calcium entry blockers; there was good correlation with the therapeutic plasma concentration for nimodipine but not for flunarizine.
Headache and Dysfunction of the Masticatory System in Adolescents
Authors: Wänman Anders , Agerberg Göran
Published: March 2003

An epidemiologic group of 285 17–year-old adolescents was studied with the aid of a questionnaire for frequency and intensity of headache and for symptoms of dysfunction of the masticatory system. They were also subjected to a functional examination of the masticatory system. Recurrent headaches occurred significantly more often among the girls (18%) than the boys (6%). Girls also reported significantly more intense headaches than boys. Fatigue in the jaws and difficulties in chewing were commoner in those with frequent and more intensive headaches. Tenderness to palpation of the masticatory muscles and impaired mandibular mobility were significantly commoner findings among those with recurrent headaches and those with more intense headaches. Tooth-grinding and clenching were related to frequency but not to intensity of headache. The investigation showed a significant relationship between frequency and intensity of headaches and signs and symptoms of dysfunction of the masticatory system.
“Hemicrania Continua”: A Third Norwegian Case
Authors: Sjaastad Ottar , Tjørstad Knut
Published: March 2003

Another case of hemicrania continua is described–that of a 54-year-old woman, who for the past 3 years has had continuous, left-sided headache. Before this period she had non-continuous headache, otherwise resembling the present one, for 3–4 years. In the chronic stage, the headache fluctuates considerably. Indomethacin in a dosage of 150 mg/day abolishes the headache completely. In hemicrania continua, there may thus, as in chronic paroxysmal hemicrania, be a non-chronic stage, antedating the chronic one. The relative importance of the two stages cannot be assessed at present.
Chronic Paroxysmal Hemicrania: Orbital Phlebography and Steroid Treatment: A Case Report
Authors: Hannerz Jan , Ericson Kaj , Bergstrand Gustaf
Published: March 2003

A 62-year-old man with ankylosing spondylitis and with a 3-year history of chronic paroxysmal hemicrania is presented. Because of his ankylosing spondylitis naproxen was prescribed; this decreased the attacks of headache to about 50%. However, treatment with indomethacin and steroids eliminated the attacks completely, the former drug in 24 h but only when the drug was taken; the latter drug was completely effective after a week but with an effect that lasted half a year after the medication was stopped. Orbital phlebography showed changes similar to those previously observed in patients with Tolosa-Hunt syndrome and cluster headache. Venous vasculitis thus seems to be associated with all three disorders and may be a factor of etiologic significance.