bluuebunny/crossref_metadata_2025 huggingface dataset:
Herpes simplex virus encephalitis: chronic progressive cerebral MRI changes despite good clinical recovery and low viral load ‐ an experimental mouse study
Authors: Meyding‐Lamadé Uta , Lamadé Wolfram , Kehm Roland , Oberlinner Christoph , Fäth Almut , Wildemann Brigitte , Haas Jürgen , Hacke Werner
Published: March 2003

Cranial magnetic resonance imaging (MRI) is a sensitive diagnostic tool for the in vivo detection of morphological abnormalities in herpes simplex virus encephalitis (HSVE). We performed a long‐term MRI study in a mouse model of HSVE. Cranial MRI findings were compared with the viral load within brain tissue, the presence of HSV DNA in the cerebrospinal fluid (CSF), a daily clinical assessment and post‐mortem neurohistopathological studies. A 1.5 T cranial MRI scanner with standard spin‐echo sequences was used. Viral load within the brain and the presence of HSV DNA in cerebrospinal fluid were determined by a polymerase chain reaction assay. Clinically, animals were severely affected within the first 2 weeks and recovered thereafter. Focal histopathological and MRI abnormalities involved predominantly limbic structures, a pattern that mimics human disease. Severity and extent of abnormalities had increased at 6 months despite clinical improvement. HSV DNA was present in CSF during the acute disease only. Brain viral load peaked at day 10 and declined thereafter. MRI as an in vivo monitoring approach may reveal chronic progressive changes in HSVE, despite clinical recovery and low viral load in the brain. Secondary, not directly virus‐mediated, mechanisms of tissue damage may contribute to tissue damage of HSVE.
Psychological approach of non‐epileptic to epileptic patients: the dynamics of attitude changes during hospitalization
Authors: Jȩdrzejczak Joanna , Owczarek Krzysztof , Majkowski Jerzy
Published: March 2003

Measures of interpersonal relations of non‐epileptic patients to epileptic were studied in search of answers to two questions: what is the initial attitude of non‐epileptic patients to epileptic patients; and, do any changes in attitude occur during time spent together in hospital? In order to study these personal relations, a formal analysis of preferences was carried out. Twenty‐two non‐epileptic patients admitted to the Neurology and Epileptology Department, Medical Centre for Postgraduate Education, Warsaw were studied. Subjects were asked to rank‐order (from 1 to 9 points) suggested ways of distributing the profits of a hypothetical joint (e.g., with a room‐mate) money‐earning venture. The experimental procedure for each patient was repeated for all three room‐mates. Preferences were assessed three times — the day after admission to hospital, after 11 days and after 21 days in hospital. Following this procedure, it was possible to trace the dynamics of the patients' interpersonal relations. The data were correlated (Spearman's rs) and submitted to analysis of variance (MANOVA) with repeated measures. Analysis of the attitudes of patients with non‐epileptic neurological disorders towards epileptic patients revealed a dynamic tendency — from negative (measures one and partly two) to positive attitudes after three weeks spent together in hospital (measure three).
Duane’s syndrome
Authors: Gutowski N. J.
Published: March 2003

Duane’s syndrome is an unusual congenital form of strabismus where there is paradoxical anomalous lateral rectus innervation of the affected eye due to misdirection of axons destined for the medial rectus. Three types of Duane’s syndrome are recognized. Most cases of Duane’s syndrome are sporadic but up to 10% are familial, usually with autosomal dominant inheritance. Several autosomal dominant syndromes with dysmorphic features are associated with Duane’s syndrome. Chromosomal loci for genes contributing to Duane’s syndrome have been suggested at 4q, 8q and 22q. Duane’s syndrome is heterogeneous at multiple levels with variations in its ocular manifestations, accompanying systemic manifestations and in the chromosomal loci with which it may be associated. The definition clinically and genetically of the various subgroups of Duane’s syndrome will provide a valuable insight into brainstem axonal guidance to the extraocular muscles during human development.
Apraxia of lid opening is alleviated by pallidal stimulation in a patient with Parkinson’s disease
Authors: Goto S. , Kihara K. , Hamasaki T. , Nishikawa S. , Hirata Y. , Ushio Y.
Published: March 2003

Apraxia of lid opening (ALO) is a syndrome characterized by a non‐paralytic inability to open the eyes at will in the absence of visible contraction of the orbicularis oculi muscle. Here we report that globus pallidus internus deep brain stimulation on the right side markedly alleviates ALO as well as gait freezing in a patient with Parkinson’s disease.
Similarities and differences in the phenotype, genotype and pathogenesis of different spinocerebellar ataxias
Authors: Schelhaas H. J. , Ippel P. F. , Beemer F. A. , Hageman G.
Published: March 2003

Historically, the differential diagnosis of the autosomal ataxias (ADCAs) has been difficult. In 1983 Harding proposed a useful clinical classification. Since 1983 ADCAs have been increasingly characterized in terms of their genetic locus and are referred to as spinocerebeller ataxia (SCA). The overlap between the SCA phenotypes and the high variability within SCA subgroups means that, for individual patients, the underlying mutation cannot be predicted reliable purely on the basis of clinical symptoms and so diagnosis should be made on the genotype. However, for executing DNA analyses in order of clinical likelihood, neurologists may try to deduce the underlying mutation by using a clinical algorithm. In this article we not only describe such an algorithm but also plot the pathway from clinical presentation, genetic classification and mutation, abnormal protein to common neuropathology in these disorders.
Increased T‐lymphocyte interleukin‐6 binding in patients with multiple sclerosis
Authors: Bongioanni P. , Mosti S. , Romano M. R. , Lombardo F. , Moscato G. , Meucci G.
Published: March 2003

Multiple sclerosis (MS) represents a T‐cell‐mediated autoimmune demyelinating disease of the central nervous system associated with altered immunoregulation. Interleukin (IL)‐6 is a cytokine that has several effects on the neuroimmune system. Specific IL‐6 receptors have been found in human lymphocytes and neuroglial cells. The aim of the present study was to assay IL‐6 binding on peripheral blood T lymphocytes in MS patients. We found that T cells from MS patients had significantly more IL‐6 receptors [Bmax: 279 ± 7 vs. 246 ± 8 (mean ± SEM) receptors/cell, in patients and controls, respectively], whereas Kd values were similar to those of healthy subjects [26.8 ± 0.7 vs. 25.4 ± 0.6 (mean ± SEM) pM, in patients and controls, respectively]. Significant (P < 0.05) differences in IL‐6 binding values were observed between stable patients and those relapsing (272 ± 9 vs. 300 ± 12 (mean ± SEM) receptors/cell, respectively). We found significantly (P < 0.001) higher amounts of IL‐6 receptors on CD4+ T cells from MS patients than on CD4+ lymphocytes from controls (434 ± 11 vs. 363 ± 9 (mean ± SEM) receptors/cell, respectively); CD8+ T cells showed very few IL‐6 receptors in both patients and controls. These data are discussed in terms of MS immune pathogenesis and pathophysiology, because T‐cell activation seems to be linked to increased IL‐6 binding. The upregulated IL‐6 system might be involved in antibody‐mediated demyelinating pathways, because IL‐6 is well known to enhance humoral immune response.
Pramipexole in the treatment of advanced Parkinson’s disease
Authors: Möller J. C. , Oertel W. H.
Published: March 2003

Pramipexole is a novel nonergoline dopamine agonist with a preference for the dopamine D3 receptor subtype. Its efficacy and safety in the treatment of advanced Parkinson’s disease has been investigated in several clinical studies. This review provides a summary of the data currently available, particularly in reference to the recent results of the European clinical phase III study and the potential tremorlytic activity of pramipexole. Interim analysis of the open‐label European clinical phase III study has provided evidence of long‐term efficacy and safety of pramipexole. In another study pramipexole has been shown to be significantly superior to placebo with an improvement in tremor score by 48% (vs. 13% in the placebo group). In addition to its likely usefulness in the treatment of rest tremor in Parkinson’s disease, data suggest that pramipexole is of interest due to its reported low frequency of cardiovascular and gastrointestinal side‐effects. However, studies comparing pramipexole with other antiparkinsonian agents would be useful to further define its benefits in the treatment of tremor‐dominant Parkinson’s disease and to further document its favourable adverse event profile.
Outcome measurement of effectiveness of botulinum toxin type A in children with cerebral palsy: an ICIDH‐2 approach
Authors: Boyd R. N. , Hays R. M.
Published: March 2003

The ICIDH‐2 serves as a useful framework for differentiating measurement by dimensions of the disabling process. Such differentiation is important to achieve more valid measurement of health related outcomes. We have attempted to examine one intervention, treatment with botulinum toxin type A, for one patient population, children with cerebral palsy, and to describe the outcome measures used in the evaluation of that intervention using this evolving classification system. This process supports the concept that measurement of health outcomes should focus on the nature and extent of functional limitations in physical, social and psychological domains. The selection of measurement outcomes must be determined not only by the requirements of the scientific process but also by the needs of the patients who are the intended beneficiaries of the intervention.
Central and peripheral nervous system complications following allogeneic bone marrow transplantation
Authors: Solaro C. , Murialdo A. , Giunti D. , Mancardi G. , Uccelli A.
Published: March 2003

Although graft vs. host disease (GvHD) is a frequent complication of allogeneic bone marrow transplantation (BMT), involvement of the central and peripheral nervous systems (CNS and PNS, respectively) has not been demonstrated conclusively. Here, we report of a patient who, following allogeneic BMT for lymphoblastic T‐cell lymphoma, suffered a syndrome characterized by self‐remitting cerebellar and pyramidal signs associated with a progressive involvement of the peripheral nervous system (PNS). Clinical course and laboratory findings correlated with relapses of systemic GvDH, thus suggesting the possibility that involvement of CNS and PNS may be sustained by a similar pathogenic mechanism.
Electrophysiological measures and dual‐task performance in Tourette syndrome indicate deficient divided attention mechanisms
Authors: Johannes S. , Wieringa B. M. , Nager W. , Müller‐Vahl K. R. , Dengler R. , Münte T. F.
Published: March 2003

Tourette syndrome has been associated with impairments of attentional functions such as distractability, even in subjects without co‐morbid attention deficit hyperactivity disorder. Based on the results of earlier research we hypothesized that Tourette syndrome patients might employ altered control mechanisms of attentional processes and have concurrent difficulties in allocating their attentional resources among competing tasks.

Event‐related brain potentials (ERPs) were recorded in a group of Tourette syndrome patients and in a matched control group during a dual task experiment. This experiment required the simultaneous detection of visual and auditory target stimuli which were manipulated to yield two different difficulty levels each of which were varied orthogonally. The behavioural parameters confirmed the intended performance differences between difficult‐to‐detect targets and easy‐to‐detect targets. This was paralleled by lower amplitudes and longer latencies of the corresponding P3b‐ERP subcomponents. Although Tourette syndrome patients were unimpaired in overall performance they showed an increased interference of visual task demands with auditory target perception. In parallel they also exhibited a reduced amplitude of the P3b component to auditory targets. The findings show that Tourette syndrome patients are not generally impaired in their dual task performance. The allocation of attentional resources to competing tasks however, is altered. We speculate that this may be related to deficient inhibitory functions.
Facial myokymia in brain death
Authors: Saposnik G. , Mauriño J. , Saizar R.
Published: March 2003

Background Brain death (BD) is the irreversible loss of all functions of the brain and brainstem. Spontaneous and reflex movements of the limbs have been described in this condition. However, facial myokymia (FM) in BD has not been previously reported. The origin of that motor phenomenon in alive patients is still uncertain, since supranuclear, nuclear and peripheral mechanisms have been proposed.

Objective We describe the presence of FM in a patient who fulfilled the criteria for BD. A 40‐year‐old‐man had right‐sided weakness and impaired consciousness. After 14 h admission, he fulfilled the criteria for BD. A CT scan of the head showed a large putaminal hemorrhage. The EEG was isoelectric. At that time, fine spontaneous twitches of the left cheek were noticed. They consisted of repetitive and rhythmic movements in groups of 3–5 lasting for <5 s. These movements appeared every 2–10 min during 6 h.

Discussion Spinal reflexes have been described in BD. The presence of any movements other than the recognized reflexes may question this diagnosis and limit organ procurement for transplantation. The recognition of FM as an accepted movement in BD patients has practical and legal implications.
Effects of hyperventilation on fast goal‐directed limb movements in spinocerebellar ataxia type 6
Authors: Manto M.‐U.
Published: March 2003

It has been shown previously that hyperventilation modifies the features of the nystagmus in cerebellar patients (Walker and Zee, 1999). It has been hypothesized that hyperventilation influences the oculomotor control through a metabolic effect on cerebellar calcium channels, which play a critical role in the firing behaviour of neuronal populations in the cerebellum. This hypothesis has been tested here by analysing fast goal‐directed limb movements before and after hyperventilation in spinocerebellar ataxia type 6 (SCA‐6), a disease associated with a polyglutamine expansion in the α 1‐A voltage‐dependent calcium channel. Cerebellar hypermetria associated with fast distal single‐joint movements was found to be increased following hyperventilation in patients presenting SCA‐6 but remained unchanged in patients with idiopathic late‐onset cerebellar degeneration (ILOCA). This is a new provocative test to enhance distal dysmetria in SCA‐6. The present results strengthen the hypothesis of Walker and Zee. It is suggested that hyperventilation enhances the defective calcium transfers in SCA‐6, resulting in an impairment of the calcium influx in particular into Purkinje cells involved in the control of fast goal‐directed voluntary movements.
Pulmonary function tests in Parkinson’s disease
Authors: Polatli M. , Akyol A. , Çildaǧ O. , Bayülkem K.
Published: March 2003

Morbidity and mortality are usually caused by respiratory disorders in Parkinson’s disease (PD) because of pulmonary functional impairments. The purpose of this study was to determine the effects of PD on ventilatory function and that the use of pulmonary function tests (PFT) may serve as an indicator of PD severity. PFT have been performed in 21 patients with PD (15 non‐smoker and six exsmoker with 36.17 ± 26.54 pack‐years of smoking history; mean age 64.67 ± 10.76 years) and 16 normal age‐matched control subjects who never smoked. The clinical disability was indicated by a Hoehn–Yahr (H–Y) scale. MEF25% [maximal flow rate at 25% of remaining forced vital capacity (FVC)] and FEV1 (the volume of air expired during the first second of the FVC) in exsmoker PD group was lower than non‐smoker PD group (P < 0.05). The two effort dependent variables’ peak expiratory flow (PEF) and the maximal flow rate at 75% of the remaining FVC (MEF75%) percent predicted values were 70.66 ± 24.15 and 69.05 ± 24.39 in non‐smoker PD group whereas 90.18 ± 17.24 and 90.00 ± 18.97% predicted were in control group, respectively (P < 0.05). The maximal voluntary ventilation (MVV) was found to be 52.83 ± 15.52 and 91.52 ± 13.80% in PD and control group, respectively (P < 0.0001). MVV was the most effected parameter that was inversely correlated with the PD severity (r=−0.87, P < 0.0001). We concluded that less coordinated and less explosive muscle force has contributed to decrease in PEF and MEF75% values, and MVV decreases in PD as a result of the impaired performance and reduced efficiency during repetitive motor tasks which in part reflects abnormal agonist–antagonist muscle activity. So, spirometric studies may serve as a useful indicator of patients’ neurophysiological conditions for the purpose of anticipating and preventing complications because of pulmonary impairment.
Effect of vagal nerve stimulation on auditory and visual event‐related potentials
Authors: Brázdil M. , Chadim P. , Daniel P. , Kuba R. , Rektor I. , Novák Z. , Chrastina J.
Published: March 2003

Chronic unilateral vagal nerve stimulation (VNS) has been recently introduced into the therapy for intractable epileptic seizures. Its effect on cognitive functions in VNS‐treated patients remains controversial. The aim of the present study was to evaluate the possible impact of therapeutic VNS on cognitive functions by means of event‐related potentials analysis. Ten patients with medically intractable epilepsy, who had been implanted with VNS devices, participated in the study. Auditory and visual event‐related potentials (ERPs) were repeatedly recorded, first just before the implantation of VNS devices, and then again 3–6 months after the device activation. The effect of lower intensity stimulation on the P3 component of ERPs was assessed. No significant differences were found in auditory ERPs; the latencies of P3 as well as N2/P3 peak‐to‐peak amplitudes were virtually identical. The same was true for mean P3 latencies of visual ERPs. However, higher visual N2/P3 peak‐to‐peak amplitudes were observed in the responses to targets that followed VNS, with a significant finding at the electrodes investigated. When comparing the effect of VNS on visual N2/P3 amplitude in each electrode separately, the most expressive differences were found in the frontal region. This observation supports the theory of a possible positive effect of low‐intensity VNS on the cognitive functions.
Hepatitis B vaccine related‐myelitis?*
Authors: Karaali‐Savrun F. , Altintaş A. , Saip S. , Siva A.
Published: March 2003

We present four incidental cases that developed partial myelitis following the administration of hepatitis B vaccine in 1998. The first two cases, a 33‐year‐old man and a 42‐year‐old woman developed progressive sensory symptoms without motor involvement within 4 weeks following the vaccination. Their magnetic resonance imaging (MRI) disclosed similar lesions consistent with myelitis at their cervical spinal cord. A comparable inflammatory lesion was seen at the T9–T10 levels of the spinal cord in the third case, who was a 40‐year‐old woman presenting with numbness in her legs and urinary retention following the vaccination. The fourth case who was a 42‐year‐old woman, presented with sensory symptoms in her left extremities, which developed 3 months after the vaccination. Her MRI showed a hyperintense lesion at C6. She also had two tiny lesions in her cranial MRI. In all cases, there was no history of preceding infections and no clinical evidence suggestive of any other disorders that may cause myelopathy. All patients recovered completely within 3 months with the exception of the third patient who developed new neurological symptoms after 12 months. Similar clinical and imaging presentation of myelitis following hepatitis B vaccination within a 1 year period with no other demonstrable clinical and laboratory evidence for any other disorder raise the probability of a causal link between these two events.
Cognitive response control in writer’s cramp
Authors: Berg D. , Herrmann M. J. , Müller T. J. , Strik W. K. , Aranda D. , Koenig T. , Naumann M. , Fallgatter A. J.
Published: March 2003

Disturbances of the motor and sensory system as well as an alteration of the preparation of movements have been reported to play a role in the pathogenesis of dystonias. However, it is unclear whether higher aspects of cortical – like cognitive – functions are also involved. Recently, the NoGo‐anteriorization (NGA) elicited with a visual continuous performance test (CPT) during recording of a 21‐channel electroencephalogram has been proposed as an electrophysiological standard‐index for cognitive response control. The NGA consists of a more anterior location of the positive area of the brain electrical field associated with the inhibition (NoGo‐condition) compared with that of the execution (Go‐condition) of a prepared motor response in the CPT. This response control paradigm was applied in 16 patients with writer’s cramp (WC) and 14 age matched healthy controls. Topographical analysis of the associated event‐related potentials revealed a significant (P < 0.05) NGA effect for both patients and controls. Moreover, patients with WC showed a significantly higher global field power value (P < 0.05) in the Go‐condition and a significantly higher difference‐amplitude (P < 0.05) in the NoGo‐condition. A source location analysis with the low resolution electromagnetic tomography (LORETA) method demonstrated a hypoactivity for the Go‐condition in the parietal cortex of the right hemisphere and a hyperactivity in the NoGo‐condition in the left parietal cortex in patients with WC compared with healthy controls. These results indicate an altered response control in patients with WC in widespread cortical brain areas and therefore support the hypothesis that the pathogenesis of WC is not restricted to a pure sensory‐motor dysfunction.
Association between seropositivity toChlamydia pneumoniaeand acute ischaemic stroke
Authors: Madre J. Gil , Garcia J. L. Rodriguez , Gonzalez R. Carranza , Montero J. Mendoza , Paniagua E. Botia , Escribano J. R. Garcia , Martinez J. Dominguez , Cenjor R. Fernandez
Published: March 2003

Recent studies suggest an association betweenChlamydia pneumoniaeinfection with atherosclerosis, including cerebrovascular disease. We investigated the prevalence of Chlamydial seropositivity in patients with acute ischaemic stroke syndrome compared with age‐ and sex‐matched control subjects. Specific antibodies (IgA) toC. pneumoniaewere measured by microimmunofluorescence in both the clinical group (n=91) and the control group (n=112). Forty patients (43.9%) and 34 controls (30.3%) had positive IgA titres (P < 0.05). The pooled data from this and previous series yielded 45% of seropositivity in cerebrovascular patients vs. 19% in control subjects (P < 0.001). In conclusion, we suggest an association between chronic infection byC. pneumoniaeand acute ischaemic stroke.
The surgical management of spasticity
Authors: Lazorthes Y. , Sol J‐C. , Sallerin B. , Verdié J‐C.
Published: March 2003

Neurosurgery is only considered for severe spasticity following the failure of noninvasive management (adequate medical and physical therapy). The patients are carefully selected, based on rigorous multidisciplinary clinical assessment. In this we evaluate the contribution of the spasticity to the disability and any residual voluntary motor function. The goals for each patient are: (a) improvement of function and autonomy; (b) control of pain; and (c) prevention of orthopaedic disorders. To achieve these objectives, the surgical procedure must be selective and reduce the excessive hypertonia without suppressing useful muscle tone and limb functions. The surgical procedures are: (1) Classical neuro‐ablative techniques (peripheral neurotomies, dorsal rhizotomies) and their modern modifications using microsurgery and intra‐operative neural stimulation (dorsal root entry zone: DREZotomy). These techniques are destructive and irreversible, with the reduced muscle tone reflecting the nerve topography. It is mainly indicated when patients have localized spasticity without useful mobility. (2) Conservative techniques based on a neurophysiological control mechanism. These procedures are totally reversible. The methods involve chronic neurostimulation of the spinal cord or the cerebellum. There are only a few patients for whom this is indicated. Conversely, chronic intrathecal administration of baclofen, using an implantable pump, is well established in the treatment of diffuse spasticity of spinal origin. From reports in the literature, we critically review the respective indications in terms of function, clinical progression and the topographic extent of the spasticity.
Eosinophilic major basic protein and interleukin‐5 in eosinophilic myositis
Authors: Murata K. , Sugie K. , Takamure M. , Fujimoto T. , Ueno S.
Published: March 2003

To determine whether eosinophils play a critical role in muscle fiber damage in patients with eosinophilic myositis (EM). We investigated expression of eosinophilic major basic protein (MBP) and interleukin (IL)‐5 at the protein and mRNA levels in muscle biopsies from three patients with idiopathic EM. MBP deposits were found on the surface of eosinophils and muscle fibers surrounded by the eosinophils. Reverse transcriptase‐polymerase chain reaction analysis showed increased IL‐5 expression in EM muscle but not in control muscle. These results suggest that IL‐5 induces local accumulation of eosinophils and their release of MBP. The secreted proteins adhere to the muscle fiber membrane, resulting in muscle damage.
On the outcome in stroke patients one year later: the role of atrial fibrillation
Authors: Cisternino M. D. , Giaquinto S. , Maiolo I. , Palma E. , Valeriani M. , Vittoria E.
Published: March 2003

The post‐stroke aftermath of patients suffering from atrial fibrillation (AF) is investigated. A total of 104 consecutive patients (80 with AF and 24 without AF) were referred to a rehabilitation centre and enrolled. They underwent a rehabilitative programme. Disability was assessed by using the Functional Independence Measure (FIM), at the time of admission, discharge and after 1 year. Death was more frequent over the 1‐year interval in AF group. Ten patients died (42%), whereas in the non‐AF group death occurred in 15 cases (19%). By using chi‐square test, the difference was significant (P < 0.02).

The logistic regression analysis indicated that the unique variable affecting the FIM at follow‐up was the FIM at discharge (P < 0.0001). AF was not a significant variable in the equation. The result can be attributed to subject attrition in the AF group, as the most severe patients died and survivors could benefit from a better functional status.
Photophobia and Phonophobia in Tension-Type and Cervicogenic Headache
Authors: Vingen J Vanagaite , Stovner LJ
Published: March 2003

Light and sound-induced discomfort and pain thresholds were measured in 26 patients with cervicogenic headache, in 40 patients with tension-type headache, and in 100 headache-free controls. Neither headache group was significantly different as to photophobia and phonophobia, but both were significantly more sensitive to light and sound than controls ( p<0.0001), even when patients were tested in the headache-free period ( p<0.05). Episodic and chronic tension-type headache had similar photo- and phonophobia thresholds ( p≥0.7). Tension-type headache patients were more photo- and phonophobic during headache than outside attack ( p<0.05), but this was not true for cervicogenic headache ( p>0.56). In cervicogenic headache patients, photophobia ( p<0.05) but not phonophobia ( p=0.28) was greater on the symptomatic side than on the non-symptomatic side.
Migraine in Childhood and Adolescence. A Critical Study of the Diagnostic Criteria and of the Influence of Age on Clinical Findings
Authors: Gherpelli JLD , Poetscher LM Nagae , Souza AMMH , Bosse EMB , Rabello GD , Diament A , Scaff M
Published: March 2003

We studied 253 children aged <15 years. Phase 1 included 193 children with migraine (1.1 and 1.2) divided into two groups (<10 and ≥10 years). We studied the relationship between age and migraine type, headache characteristics, and associated symptoms of the International Headache Society (IHS) definition. A higher frequency of migraine with aura, pulsatile quality, and unilateral location was observed in older children. In phase 2 we studied 176 children with headache (excluding migraine with aura), comparing diagnostic criteria, definition items, sensitivity, and specificity. The results showed that item B of the definition was the most frequent cause of exclusion in the 1.7 diagnostic group. Compared with Vahlquist and the IHS, the Prensky criteria were the most sensitive. Sensitivity was >70% for pain of moderate/severe intensity, duration between 2 and 48 h, isolated photophobia, isolated phonophobia, and aggravation with physical activity. Specificity was >70% for nausea, vomiting, phonophobia and photophobia, isolated photophobia, aggravation with physical activity, and isolated phonophobia. Based on three alternative definitions, each modifying one item of the IHS definition, the sensitivity and specificity of these alternative definitions were compared with the “extended” criteria (children with migraine without aura and migrainous disturbance, according to the IHS criteria, grouped together). Exclusion of headache duration increased sensitivity by 10%, compared to restrictive IHS criteria, without decreasing specificity.
Familial Occurrence of Chronic Tension-Type Headache
Authors: Russell MB , Østergaard S , Bendtsen L , Olesen J
Published: March 2003

Chronic tension-type headache (CTTH) assessed by proband report was evaluated in a family study of CTTH. A clinical interview of first-degree relatives by a physician was used as index of validity. Familial occurrence of CTTH in first-degree relatives was also investigated. Patterns of familial aggregation of CTTH were assessed by calculating the population relative risk. A neurological resident carried out all the interviews of probands and their first-degree relatives. The operational diagnostic criteria of the International Headache Society were used. The 122 probands had 377 first-degree relatives. Sensitivity, specificity, predictive values, and chance-corrected agreement rate for the diagnosis CTTH were 68%, 86%, 53% (PVpos), 92% (PVneg), and 0.48, respectively. The low sensitivity of CTTH assessed by proband report indicates that a clinical interview by a physician is necessary in family studies of CTTH. Clinically interviewed parents, siblings, and children had a 2.1 to 3.9-fold significantly increased risk of CTTH compared with the general population. The gender of the probands did not influence the risk of CTTH among first-degree relatives. The significantly increased familial risk of CTTH and no increased risk of CTTH in spouses suggest that a genetic factor is involved in CTTH.
Prospective Large-Scale Study of the Tolerability of Subcutaneous Sumatriptan Injection for Acute Treatment of Migraine
Authors: O'Quinn S , Davis RL , Gutterman DL , Pait GD , Fox AW
Published: March 2003

To investigate prospectively serious adverse events associated with sumatriptan injection, we studied 12,339 typical migraineurs for up to 12 months each. This study imitated the ordinary clinical use of sumatriptan injection except that: (a) a short, written informed consent was required, (b) there was a centralized, automated dispensing service that audited each patient's product use, (c) patients were sometimes reviewed by telephone, and (d) drug supply and medical consultation were without charge. All adverse events were recorded regardless of etiology. There were 25 fatalities during the study, none being attributable to sumatriptan injection. Of six strokes in the study, two occurred soon after treatment of a migraine attack with sumatriptan injection; whether these were migraine-related or drug-related is discussed. None of the three myocardial infarctions was due to sumatriptan injection use. We conclude that sumatriptan injection is well tolerated when used in accordance with labeling.
Migraine and Ocular Pain in “Glaucoma Suspect”
Authors: De Marinis M , Giraldi JP , de Feo A , Rinalduzzi S , De Benedetti G. , Mollicone A , Accornero N
Published: March 2003

A relationship between glaucoma and migraine has been hypothesized by some authors, but not confirmed by others. We studied the prevalence and features of migraine and ocular pain in 460 “glaucoma suspect” patients (with ocular hypertension, but without optic disc and visual field abnormalities) and 460 controls. A higher prevalence of migraine was found in patients (13%), particularly in women (17%), than in controls (7%). At the time of the interview, migraine was still active in 68% of the patients and had decreased in the remaining 32% (prevalently those not being treated for ocular hypertension), whereas it had ceased in 52% of controls. Attacks of “ocular pain” of mild and moderate intensity were found to occur in 51% of the patients with both “glaucoma suspect” and migraine, in almost all who were not taking treatment for ocular hypertension. “Ocular pain” was time-related to the history of glaucoma. Changes in intraocular pressure may play a role in the interaction between “glaucoma suspect”, migraine, and ocular pain.
Glyceryl Trinitrate Induces Attacks of Migraine Without Aura in Sufferers of Migraine with Aura
Authors: Christiansen I , Thomsen LL , Daugaard D , Ulrich V , Olesen J
Published: March 2003

Migraine with aura and migraine without aura have the same pain phase, thus indicating that migraine with aura and migraine without aura share a common pathway of nociception. In recent years, increasing evidence has suggested that the messenger molecule nitric oxide (NO) is involved in pain mechanisms of migraine without aura. In order to clarify whether the same is true for migraine with aura, in the present study we examined the headache response to intravenous infusion of glyceryl trinitrate (GTN) (0.5 μg/kg/min for 20 min) in 12 sufferers of migraine with aura. The specific aim was to elucidate whether an aura and/or an attack of migraine without aura could be induced. Fourteen healthy subjects served as controls. Aura symptoms were not elicited in any subject. Headache was more severe in migraineurs than in the controls during and immediately after GTN infusion ( p=0.037) as well as during the following 11 h ( p=0.008). In the controls, the GTN-induced headache gradually disappeared, whereas in migraineurs peak headache intensity occurred at a mean time of 240 min post-infusion. At this time the induced headache in 6 of 12 migraineurs fulfilled the diagnostic criteria for migraine without aura of the International Headache Society. The results therefore suggest that NO is involved in the pain mechanisms of migraine with aura. Since cortical spreading depression has been shown to liberate NO in animals, this finding may help our understanding of the coupling between cortical spreading depression and headache in migraine with aura.
Intravenous Metamizol (Dipyrone) in Acute Migraine Treatment and in Episodic Tension-Type Headache–A Placebo-Controlled Study
Authors: Bigal ME , Bordini CA , Speciali JG
Published: March 2003

Acute headache is a very frequent symptom, responsible for significant demand at primary care units and emergency rooms. In such sets in Brazil, metamizol is easily found but, on the other hand, neither ergotics nor triptans are available. The aim of this study is to compare intravenous metamizol with placebo in the acute treatment of migraine with aura, migraine without aura and episodic tension-type headache. Fifty-four migraine with aura patients, 95 migraine without aura patients and 30 tension-type headache patients were treated with metamizol. Ninety patients (30 migraine with aura, 30 migraine without aura and 30 tension-type headache patients) received placebo. Pain intensity, nausea, aura, photo- and phonophobia were investigated at 30 min and 60 min after the administration of the drug. Significant improvement of pain after 30 min and 60 min post-dosage was achieved from metamizol groups compared with placebo groups. Significant improvement of all other symptoms was achieved after 60 min post-dosage. Side-effects were mild and with small incidence. Metamizol is an effective, safe and low price drug. It may be regarded as a good alternative drug for the treatment of common acute primary headaches.
Cgrp May Play A Causative Role in Migraine
Authors: Lassen LH , Haderslev PA , Jacobsen VB , Iversen HK , Sperling B , Olesen J
Published: March 2003

Calcitonin gene-related peptide (CGRP) has been detected in increased amounts in external jugular venous blood during migraine attacks. However, it is unknown whether this is secondary to migraine or whether CGRP may cause headache. In a double-blind crossover study, the effect of human αCGRP (2 μg/min) or placebo infused intravenously for 20 min was studied in 12 patients suffering from migraine without aura. Headache intensity was scored on a scale from 0 to 10. Two patients were excluded due to severe hypotension and one because she had an infection. In the first hour median peak headache score was 1.0 in the hαCGRP group vs. 0 in the placebo group ( P < 0.01). During the following 11 h all patients experienced headaches after hαCGRP vs. one patient after placebo ( P = 0.0004). The median maximal headache score was 4 after CGRP and 0 after placebo ( P = 0.006). In three patients after hαCGRP, but in no patients after placebo, the delayed headache fulfilled the IHS criteria for migraine without aura. As intravenous administration of hαCGRP causes headache and migraine in migraineurs, our study suggests that the increase in CGRP observed during spontaneous migraine attacks may play a causative role.
Protective behaviours: a useful approach in working with people with learning disabilities
Authors: Harper Glynis , Hopkinson Peter , McAfee John G.
Published: March 2003

The purpose of this paper is to introduce people working in the field of learning disabilities to the concept of ‘protective behaviours’ (PBs). It suggests that the PBs approach is relevant to people with learning disabilities, particularly in relation to issues of vulnerability and empowerment. The paper briefly overviews the basic features of the PBs approach and provides examples of its application in clinical settings. It concludes that the PBs process is of fundamental importance to services for people with learning disabilities and recommends that professionals would benefit from attending any training opportunities that may arise.
Quartz recrystallization and fluid flow during contact metamorphism: a cathodoluminescence study
Authors: Holness M. B. , Watt G. R.
Published: March 2003

Cathodoluminescence (CL) images of quartz grains in the Appin Quartzite from the aureole of the Ballachulish Igneous Complex (Scotland) reveal a textural complexity that we interpret in the light of published models of the evolution of the contact aureole. Five distinct generations of quartz can be discriminated in CL. The oldest of these is a dark luminescing mottled quartz (Type 1 quartz) that occurs in the centres of pre‐existing grains, in samples collected from 210 m to 0.1 m from the contact. Dark mottled quartz is interpreted to be unrecrystallized material and has a regional metamorphic CL spectral signature. The onset of contact metamorphism resulted in grain growth visible in CL as a series of fine‐scale alternating bands of bright and dark luminescing material (Type 2 quartz), which we attribute to infiltration of repeated pulses of small amounts of H2O along grain boundaries. Close to the intrusion, a subgrain‐scale network of intragranular, bright luminescing features could have resulted from either intragranular microcrack‐controlled infiltration of H2O at high temperatures or intergranular cracking followed by grain growth (Type 3 quartz). Broad bands of bright material on grain boundaries in samples that are inferred to have undergone partial melting are interpreted as quartz crystallized from the melt phase (Type 4 quartz). The final stage in the textural development is marked by a series of aligned fractures, detected in CL by nonluminescing material (Type 5 quartz) and corresponding closely with trails of fluid inclusions. These fractures are interpreted as the pathways for late‐stage, low‐temperature, retrogressive fluids.
Retrograde P–T evolution and high temperature–low pressure fluid circulation in relation to late Hercynian intrusions: a mineralogical and fluid inclusion study of the Charroux‐Civray plutonic complex (north‐western Massif Central, France)
Authors: Freiberger R. , Boiron M.‐C. , Cathelineau M. , Cuney M. , Buschaert S.
Published: March 2003

The calc‐alkaline plutonic complex from Charroux‐Civray (north‐western part of the French Massif Central) displays multiphase hydrothermal alteration. Plutonic rocks, as well as early retrograde Ca–Al silicate assemblages, which have crystallized during cooling and uplifting of the plutonic series, are affected by multiphase chlorite–phengite–illite–carbonate alteration linked to intense pervasive fluid circulation through microfractures. The petrographic study of alteration sequences and their associated fluid inclusions in microfissures of the plutonic rocks, as well as in mineral fillings of the veins, yields a reconstruction of the P–T–X evolution of the Hercynian basement after the crystallization of the main calc‐alkaline plutonic bodies. This reconstruction covers the uplift of the basement to its exposure and the subsequent burial by Mesozoic sediments.

Cooling of the calc‐alkaline plutonic series started at solidus temperatures (∼650°C), at a pressure of about 4 kbar (1 bar = 105 N m−2), as indicated by magmatic epidote stability, hornblende barometry and fluid inclusion data. Cooling continued under slightly decreasing pressure during uplift down to 2–3 kbar at 200–280°C (prehnite–pumpellyite paragenesis). Then, a hot geothermal circulation of CO2‐bearing fluids was induced within the calc‐alkaline rocks leading to the formation of greisen‐like mineralizations. During this stage, temperatures around 400–450°C were still high for the inferred depths (∼2 kbar). They imply abnormal heat flows and thermal gradients of 60–80°C km−1. The hypothesis of the existence of one large or a succession of smaller peraluminous plutons at depth, supported by geophysical data, suggests that localized heat flows were linked to concealed leucogranite intrusions. As uplift continued, greisen mineralization was subsequently affected by the chlorite–phengite–dolomite assemblage, correlated with aqueous and nitrogen‐bearing fluid circulations in the temperature range of 400–450°C. In a later stage, a continuous temperature decrease at constant pressure (∼0.5 kbar) led to the alteration of the dolomite–illite–chlorite type in the 130–250°C temperature range.
Communication between overpressured compartments
Authors: Wangen M.
Published: March 2003

Overpressure build‐up in compartments, and communication between overpressured compartments across faults are studied with simple analytical and numerical models. It is shown that the excess pressure in a (vertical) one‐dimensional, one‐compartment model can be written as the sum of the excess pressure generated in the seal above the compartment, and a second part, which is due to the expulsion of fluid from the compartment and the rocks below. The one‐compartment model is generalized to a two‐compartment model, which accounts for the fluid communication between the compartments through a fault zone. The volume rates of flow through the seals and the fault zone are shown to be the weighted mean of the volume rates of the one‐dimensional, one‐compartment model. The normalized weights are given by dimensionless numbers, called fault–seal numbers, which control the communication between the compartments. A fault–seal number much less than unity implies that the fault is a stronger barrier for the fluid flow than the seal. A fault–seal number larger than unity implies the opposite: that the seal is a stronger barrier than the fault. The conditions for isolated compartments and other regimes are identified in terms of the fault–seal numbers. It is discussed how the compartment fault–seal numbers can be computed when the permeability is given in the fault zone. The results given by the analytical compartment models are demonstrated and validated with two‐dimensional numerical (finite element) simulations.
FT‐IR measurements of petroleum fluid inclusions: methane, n‐alkanes and carbon dioxide quantitative analysis
Authors: Pironon J. , Thiery R. , Ayt Ougougdal M. , Teinturier S. , Beaudoin G. , Walgenwitz F.
Published: March 2003

A recent advancement in petroleum geochemistry is to model fossil oil composition using microthermometric and volumetric data acquired from individual fluid inclusion analysis. Fourier transform infrared (FT‐IR) microspectroscopy can record compositional information related to gas (CH4 and CO2) and alkane contents of petroleum inclusions. In this study, a quantitative procedure for FT‐IR microspectrometry has been developed to obtain, from individual fluid inclusions, mol percentage concentrations of methane, alkanes and carbon dioxide as constraints to thermodynamic modelling. A petroleum inclusion in a sample from the Québec City Promontory nappe area was used as standard to record a reference spectrum of methane. The analytical procedure is based on the measurement of CH4/alkane and CH4/CO2 band area ratios. CH4/alkane infrared band area ratio is obtained after spectral subtraction of the reference methane spectrum. This area ratio, affected by absolute absorption intensities of methane, methyl and methylene, provides a molar CH4/alkane ratio. Methyl/methylene ratio (CH2/CH3) ratio is obtained following procedures established in previous work. CO2/CH4 concentration ratio is estimated from relative absolute absorption intensities. Application to natural inclusions from different environments shows good correlation between FT‐IR quantification and PIT (petroleum inclusion thermodynamic) modelling.
Fluids and halogens at the diagenetic–metamorphic boundary: evidence from veins in continental basins, western Norway
Authors: Svensen H. , Jamtveit B. , Banks D. A. , Karlsen D.
Published: March 2003

Seven vein types are recognized in three continental Devonian molasse basins (the Hornelen, Kvamshesten and Solund basins) in western Norway. These include calcite‐, quartz‐ and epidote‐dominated veins. The salinities of fluid inclusions from quartz‐dominated veins in the Hornelen and Kvamshesten basins are close to or slightly higher than those for modern seawater, whereas the fluids from quartz‐ and calcite‐dominated veins in the Solund basin range from seawater values to 20 wt % NaCl equivalent. Minerals such as biotite, amphibole, titanite, chlorite and epidote are abundant in the latter veins, and are important constituents of the authigenic mineral assemblages. A combination of fluid inclusion and petrological data suggest that at least some of the veins formed at depths around 12–14 km. The Cl/Br ratios and the salinity of the fluid inclusions can be explained by interactions with evaporites, implying that the sedimentary environment forming the basin fill had the strongest influence upon low‐grade metamorphic fluid Cl and Br contents. Differences in the Cl/I and Na/Br ratios between the Solund basin and the Hornelen and Kvamshesten basins are best explained by local mass transfer between pore fluids and the surrounding rock matrix during burial and increasing temperatures.