bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomized study of combined botulinum toxin type A and casting in the ambulant child with cerebral palsy using objective outcome measures
Authors: Desloovere K. , Molenaers G. , Jonkers I. , De Cat J. , De Borre L. , Nijs J. , Eyssen M. , Pauwels P. , De Cock P.
Published: March 2003

It is recognized that objective gait analysis is of great value in planning a multilevel botulinum toxin type A (BTX‐A) treatment. After BTX‐A treatment, objective outcome measures can provide new and interesting information for each individual child with cerebral palsy (CP). Moreover, by studying group results, we may evaluate our treatment hypotheses. The present prospective study attempts to document the effect of integrated multilevel BTX‐A treatment on objective gait parameters and to define the optimal strategy for the combined treatment of BTX‐A with casting in children with cerebral palsy. Objective three‐dimensional gait analysis (3DGA) data were collected pre‐ and 2 months post‐treatment, in two randomized patient groups: a first group of 17 children treated with lower leg casting prior to BTX‐A injections, and a second group of 17 patients who received casting immediately after injections. The present study demonstrates that improved gait can be achieved after a multilevel BTX‐A treatment, combined with casting, using a set of 90 gait parameters. The most pronounced improvement was seen at the ankle joint. The results in the knee, hip and pelvis imply that multilevel treatment of the child with CP should start at an early age, in order to prevent development of muscle contractures. Slightly more pronounced benefits, mainly in the proximal joints, were seen for the children who were casted after injections as compared to the children who were casted before injections.
Twelve‐month safety of entacapone in patients with Parkinson’s disease
Authors: Myllylä V. V. , Kultalahti E.‐R. , Haapaniemi H. , Leinonen M. ,   FILOMEN Study Group
Published: March 2003

The safety of entacapone combined with levodopa and a dopadecarboxylase (DDC) inhibitor was tested in a 12‐month double‐blind study of 326 patients with idiopathic Parkinson’s disease (PD). The study population represented ‘typical’ PD outpatients, including patients with varying disease severity and with various concomitant medications. Two‐thirds of the patients were randomized to receive 200 mg of entacapone with each of 2–10 daily levodopa doses, and one‐third to receive placebo. All entacapone patients were included in the safety evaluation of adverse events (AEs), vital signs, ECG, and laboratory parameters. Entacapone was well tolerated with a discontinuation rate due to AEs of 14% compared with 11% with placebo (NS). As expected, due to dopaminergic enhancement, dyskinesia was more frequent as an AE with entacapone than with placebo. Dryness of mouth, urine discoloration and diarrhoea were more frequent non‐dopaminergic AEs with entacapone than with placebo. Entacapone had no adverse effects on hepatic enzyme activity, ECG or haemodynamic parameters, and there was no evidence of any toxicity. As an indication of levodopa enhancement with entacapone, patients taking 5–10 doses of levodopa, most likely representing predominantly fluctuating patients, showed a significant decrease in their mean daily levodopa dose of 94 mg in the entacapone group compared with a decrease of 39 mg in the placebo group (P < 0.01). The interval between the first two morning doses of levodopa increased by 17% with entacapone, whereas with placebo no extension was observed (P < 0.05). Despite levodopa dose reduction, efficacy of entacapone was maintained. As further evidence of efficacy, Parkinsonian symptoms markedly worsened in all patients after withdrawal of entacapone. We conclude that entacapone is safe in optimizing levodopa in long‐term treatment of idiopathic Parkinson’s disease. Monitoring of liver or other safety parameters during entacapone treatment is not required.
Chronic polyneuropathies in Vest‐Agder, Norway
Authors: Mygland Å. , Monstad P.
Published: March 2003

Epidemiological data on chronic polyneuropathies, especially inflammatory types, is limited. The purpose of this study was to examine the spectrum of causes and estimated prevalence of various polyneuropathy types in Vest‐Agder, and to examine the clinical features of the Vest‐Agder population of chronic inflammatory demyelinating polyneuropathy (CIDP).

In Vest‐Agder county (population of 155 464), polyneuropathy patients are registered in a database and followed prospectively. We did a measure of the database on October 31 1999.

A total of 192 patients were registered. The prevalence for chronic inflammatory demyelinating polyneuropathy (CIDP) was 7.7 per 100 000 population. The course was relapsing in five of fifteen patients, progressive in four patients and slowly progressive in six of fifteen patients. Two of the fifteen patients had pure sensory symptoms. The mean Rankin disability score was 3.4 at maximal deficit and 2.1 at last follow‐up. The prevalence of paraproteinemic polyneuropathy was 5.1 per 100 000 population. None of the patients with paraproteinemic polyneuropathy were worse than slightly disabled (disability score ≤ 2). The prevalences for other polyneuropathies were as follows: polyneuropathy and RA, 1.3; polyneuropathy and Sjögren's syndrome or sicca complex, 4.5 (polyneuropathy was the presenting symptom in five of seven patients); sarcoidosis 1.9; polyneuropathy and chronic Lyme, 0.6; paraneoplastic polyneuropathy, 1.9; diabetic polyneuropathy 23.2; vitamin deficiency, 5.1; alcoholic and toxic polyneuropathy, 19.9; hereditary polyneuropathy, 14.8. Cryptogenic polyneuropathies made up 26% of all polyneuropathies. The mean disability score was 2.0 (SD 1.1).

In conclusion, prevalence of CIDP was significantly higher than previously reported, and the prognosis was good in the majority of patients. Patients with paraproteinemic polyneuropathy were not severely disabled. Polyneuropathy was the presenting symptom in the majority of patients with Sjögren's syndrome or sicca complex.
Multimodal P3 under different attentional states in mesial temporal lobe epilepsy
Authors: Trinka E. , Unterrainer J. , Luef G. , Ladurner G.
Published: March 2003

Background Several studies demonstrate that the P3 component of the event‐related potentials (ERP) is generated by mesial temporal structures. The P3 is considered as endogenous information processing component independent from modality.

Purpose The aim of this investigation was to study whether the P3 latency elicited by auditory and visual stimuli under different attentional states is influenced by the mesial temporal lobe epilepsy (mTLE).

Methods The event related P3 component of 10 right handed patients (7 m/3 f, mean age 31.3 years (SD 7.3), median 31.5, range 20–47) with unilateral mTLE were studied and compared with 10 age matched controls (5 m/5 f, mean age 36.6 years (SD 12.6), median 32.1, range 22–48). Diagnosis of mTLE was based on seizure description, clinical history and examination, prolonged video‐EEG monitoring, magnetic resonance imaging (MRI), interictal and ictal SPECT. P3 potentials were elicited with a visual and auditory three stimulus discrimination paradigm.

Results The latency of the P3 response to the auditory stimulus under automatic and effortful attention was delayed (423.3 ms (SD 60.4) and 436.9 ms (SD 83.4)) compared with a control group (359 ms (SD 42.4) and 354.2 ms (SD 39.7); P=0.039 and P=0.012, ANOVA), while the P3 latencies to visual stimuli under both tested attentional states (407.3 ms (SD 52.9) and 390.6 ms (SD 40.2)) did not differ from controls (378.2 ms (SD 48.6) and 378.2 ms (SD 55.4)). P3 latencies to auditory novel paradigm in patients with right sided mTLE, but not left sided mTLE, differed significantly from controls (P=0.01).

Conclusion The results suggest a modality dependence of the P3 component in patients with mTLE. The novelty processing of auditory stimuli is disturbed in patients with right sided mTLE.
Zolmitriptan versus sumatriptan for the acute oral treatment of migraine: a randomized, double‐blind, international study
Authors: Gruffyd‐Jones K. , Kies B. , Middleton A. , Mulder L. J. M. M. , Røsjø Ø. , Millson D. S.
Published: March 2003

This randomized, double‐blind, parallel‐group study compared the efficacy and tolerability of zolmitriptan (2.5 or 5 mg) and sumatriptan (50 mg) in the acute oral treatment of up to six moderate‐to‐severe migraine attacks. The intention to treat (ITT) population comprised of 1522 patients: 500 treated with zolmitriptan 2.5 mg (2671 attacks), 514 with zolmitriptan 5 mg (2744 attacks) and 508 with sumatriptan 50 mg (2693 attacks). Overall, the 2‐h headache response rates in these groups were 62.9, 65.7 and 66.6%, respectively. There were no statistically significant differences between sumatriptan 50 mg and zolmitriptan 2.5 mg (P=0.12) or 5 mg (P=0.80). Approximately 40% of patients in each group reported a 2‐h headache response in ≥ 80% of attacks. There were no statistically significant differences between the groups in the rates of headache response at 1 h (zolmitriptan 2.5 mg 36.9%, zolmitriptan 5 mg 39.5% and sumatriptan 50 mg 38.0%) or 4 h (70.3, 72.9 and 72.2%, respectively) or in the rates of meaningful migraine relief at 1, 2 or 4 h or sustained (24‐h) pain relief. All treatments were well tolerated. In conclusion, zolmitriptan (2.5 or 5 mg) proved similarly efficacious compared with sumatriptan (50 mg), both in terms of response rates and consistency across attacks.
Local insulin injection improves median nerve regeneration in NIDDM patients with carpal tunnel syndrome
Authors: Ozkul Y. , Sabuncu T. , Yazgan P. , Nazligul Y.
Published: March 2003

It has been suggested that insulin has an effect on nerve regeneration similar to that of nerve growth factor (NGF). Therefore, we aimed to evaluate the effectiveness of local insulin injection on median nerve in patients with non‐insulin‐dependent diabetes (NIDDM) mellitus who have mild‐to‐moderate carpal tunnel syndrome (TS). We carried out a prospective, randomized, double‐blind, placebo‐controlled study in these patients. At the baseline, 20 mg methylprednisolone was injected directly into the carpal tunnel in all patients [n=43 (62 hands)]. A week after prednisolone, the placebo or NPH insulin (12 U) was injected into the carpal tunnel weekly for 7 weeks. The patients were followed up for 23 weeks. A significant improvement in mean median nerve motor distal latency (MNMDL), median nerve sensory velocity (MNSV), and global symptom score (GSS) occurred in both groups (with the exception of mean MNMDL in the placebo group). A more significant improvement in the mean MNMDL, MNSV, and GSS was observed in the insulin group when compared with the placebo group. This study suggests that local insulin treatment may be of great potential benefit in the improvement of nerve functions in NIDDM patients with mild‐to‐moderate CTS who opt for conservative treatment.
Recent advances in the diagnosis and treatment of epilepsy
Authors: Stefan Hermann , Halász Péter , Gil‐Nagel Antonio , Shorvon Simon , Bauer Gerhard , Ben‐Menachem Elinor , Perucca Emilio , Wieser Heinz Gregor , Steinlein Ortrud
Published: March 2003

Recent advances in the diagnosis and treatment of epilepsies are discussed with special consideration of epidemiology and classification, progress in neuroimaging, electrophysiological studies using EEG and MEG, initiation of medical and surgical treatment, the role of new antiepileptic drugs and selected aspects of genetics of ideopathic epilepsies. In addition from conclusions obtained by the review of recent developments suggestions for future work in Europe are discussed. A constructive approach from multicenter studies requires homologous definitions, documentations and standardization of procedures of trials for Euorpean multicenter studies.
Low headache prevalence amongst women with high TSH values
Authors: Hagen K. , Bjøro T. , Zwart J.‐A. , Vatten L. , Stovner L. J. , Bovim G.
Published: March 2003

The aim of this large cross‐sectional population‐based study was to examine a possible positive or negative association between thyroid dysfunction and headache. Between 1995 and 1997, all 92 566 adults in Nord‐Trøndelag County in Norway were invited to participate in a health survey. A total of 51 383 (56%) responded to a headache questionnaire, whereof thyroid‐stimulating hormone (TSH) was measured in 28 058 individuals. These included 15 465 women and 8019 men above 40 years of age, 1767 randomly selected individuals between 20 and 40 years of age, and 2807 (97%) with thyroid dysfunction. Associations between thyroid dysfunction and headache were assessed in multivariate analyses, estimating prevalence odds ratios (OR) with 95% confidence intervals (CIs). High TSH values were associated with low prevalence of headache. This was most evident amongst women with no history of thyroid dysfunction. Amongst these, headache was less probable (OR=0.5, 95% CI 0.3–0.7) if TSH ≥ 10 mU/l than in women with normal TSH (0.2–4 mU/l). In all age groups between 40 and 80 years, TSH was lower amongst headache sufferers, especially migraineurs, than in those without headache complaints.
Spike‐and‐wave complexes and seizure exacerbation caused by carbamazepine
Authors: Kochen S. , Giagante B. , Oddo S.
Published: March 2003

The purpose of this research is to analyse patients in whom carbamazepine (CBZ) therapy adversely affected electroencephalogram (EEG) recordings leading to seizure exacerbation and to identify risk factors for these events. From a total number of 2191 patients (p.) included in the Municipal Epilepsy Center (MEC) database, 77 patients with spike‐and‐wave (SW) discharges while on CBZ treatment have been selected. Patient population was divided in two groups: (i) patients who were already receiving CBZ at the time of their first visit to the MEC; and (ii) patients to whom CBZ was prescribed during follow‐up at the MEC. CBZ was discontinued in all patients with confirmed evidence of an increase in seizure frequency, or with no improvement of epilepsy. During follow‐up, EEG findings as well as all clinical changes were duly recorded. Group 1: Carbamazepine was discontinued in 17 patients (p.) as a result of paradoxical reactions. This condition occurs when an antiepileptic drug (AED) appears to exacerbate a type of seizure against which it is usually effective, or when it leads to the onset of new types of seizures. Three p. were withdrawn because of inappropriate drug selection. Group 2: CBZ was discontinued in six patients (p.) as a result of paradoxical reactions. The paradoxical reaction was more frequent in patients with frontal epilepsy and generalized SW discharges on the EEG (P=0.09) and patients with benign rolandic epilepsy (BRE) with diffuse interictal sharp and slow‐wave discharges. In both groups, clinical and electrical changes returned to their initial status upon CBZ withdrawal. On the basis of this study, it may be concluded that EEGs might eventually help to screen high‐risk patients. If EEG recordings become substantially worse, with more frequent and longer generalized SW bursts after initiation of CBZ therapy, patients should be carefully monitored in order to detect any sign of clinical impairment.
Using simulated consultations to develop communications skills for neurology trainees*
Authors: Smith Philip E. M. , Fuller Geraint N. , Kinnersley Paul , Brigley Steve , Elwyn Glyn
Published: March 2003

Communication skills are essential for clinical medicine yet, unlike in general practice, trainees in specialist and general medicine are not formally trained in them. We have used videotaped recording of simulated consultations to evaluate their acceptability and usefulness for training neurology specialist registrars. Twelve specialist registrars in neurology participated; their perceptions of the method were assessed using quantified scales and focus groups. All but one of the 12 trainees found the exercise useful both for improving clinical skills and for the imparting of information. The median visual analogue scores (0=useless, 100=very useful) for history taking and for imparting information were 91 and 90%, respectively. The median scores [and interquartile range (IQR)] of perceived usefulness for communication skills increased before to after (for use of video) from 68 (58–78) to 88 (80–92)% (P < 0.02), and (for use of simulated patients) from 51 (40–71) to 86 (79–89)% (P < 0.02). The focus groups provided additional qualitative data supporting the technique. We conclude that videotaped consultations with simulated patients are valued by most neurology trainees, both for improving their history‐taking skills and for imparting information. The technique could be used more widely in neurology training, and may have a role in assessment.
CADASIL syndrome in a large Turkish kindred caused by the R90C mutation in the Notch3 receptor
Authors: Utku U. , Celik Y. , Uyguner O. , Yüksel‐Apak M. , Wollnik B.
Published: March 2003

Mutations in the Notch3 gene are the cause of the autosomal dominant disorder CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). The CADASIL is an adult‐onset neurologic disorder (average age of onset is 45 years) characterized by recurrent strokes and dementia. Clinical features combined with cerebral magnetic resonance imaging (MRI), showing a diffuse leukoencephalopathy with subcortical infarcts in the basal ganglia and white matter, are highly contributive to the diagnosis. We present a Turkish family with CADASIL, in which 12 individuals in four generations were affected showing the typical clinical features of recurrent strokes. Mutation analysis of the Notch3 receptor gene identified the recently described R90C mutation in the N‐terminal part of the gene in affected individuals. Interestingly, migraine without aura was found as an initial symptom of the disease in two young mutation carriers (22 and 25 years, respectively), who did not show any additional clinical features or any MRI abnormalities. This indicates that migraine without aura in the absence of MRI abnormalities may represent an early initial symptom of CADASIL, which is difficult to diagnose in the absence of molecular diagnosis. Therefore, the used molecular screening method for Notch3 mutations provides a rapid and accurate diagnostic tool in addition to the standard diagnostic procedures.
The medical management of spasticity
Authors: Abbruzzese G.
Published: March 2003

When spasticity produces a clinical disability by interfering with posture, motor capacity, nursing or daily living activities, medical treatment is recommended. It is mainly indicated when the muscle overactivity is diffusely distributed and should be implemented early, to prevent permanent musculoskeletal deformities or contractures. A pharmacological approach relies on the use of drugs which modulate neurotransmitters acting at the cortico‐spinal level (GABA, glycine, glutamate, noradrenaline, serotonin). The aim of this treatment is to decrease spinal reflex excitability by reducing the release of excitatory neurotransmitters, or by potentiating the activity of inhibitory inputs. Evaluation of the efficacy of these drugs is determined by the therapeutic objectives which may be biomechanical, or functional. Diazepam increases presynaptic inhibition by stimulating GABAA receptors in the brainstem and spinal cord. In double‐blind studies of patients with spinal cord lesions, antispastic efficacy has been shown, but side‐effects are common. Baclofen stimulates GABAB receptors inducing a suppression of excitatory neurotransmitter release. Antispastic efficacy is sufficiently documented, but no definite effects on ambulation or activities of daily living have been proved. Tizanidine has an α2‐agonist activity (at spinal and supraspinal level) and decreases the presynaptic activity of excitatory interneurones. The main clinical effects are a reduction in tonic stretch, polysynaptic reflexes, and co‐contraction, with fewer side‐effects but no definite functional change. The efficacy of several other antispastic drugs is documented in a few controlled studies, but the majority of information arises from open trials or anecdotal observations.
Parkinson's disease, smoking and family history: meta‐analysis
Authors: Allam M. F. , Del Castillo A. S. , Navajas R. F.‐C.
Published: March 2003

To estimate the pooled risk of tobacco smoking for Parkinson's disease (PD) in patients with and without PD family history. We conducted systematic searches of Medline, PsycLIT, Embase, Current contents, Best Evidence, Nisc Mexico Biblioline, previous reviews, examination of cited reference sources and personal contact and discussion with several investigators expert in the field. Studies in all languages were considered. Published observational studies on PD and cigarette smoking stratified by PD family history were reviewed. When two or more papers were based on an identical study, the paper that principally investigated the relationship between PD, smoking stratified by PD family history or the paper that was published last was used. Three case–control studies were carried out between 1996 and 2000, of which one reported risk estimates. The risk of ever smoker in patients with positive PD family history was 0.82 (95% confidence interval 0.44–1.53). There was an obvious protective effect in the pooled estimate in patients with negative PD family history [odds ratio 0.77 (95% confidence interval 0.59–1.01)]. Although our pooled estimates show that smoking is inversely associated with the risk of PD only in patients with negative PD family history, further studies evaluating the interaction between smoking and PD family history are strongly needed.
Olanzapine efficacy in the treatment of essential tremor
Authors: Yetimalar Y. , Irtman G. , Gürgör N. , Başoğlu M.
Published: March 2003

We investigated the anti‐tremor effect of olanzapine, a novel atypical antidopaminergic drug, in 37 patients with essential tremor (ET) in an open‐label and prospective study by clinical scoring and patient self‐evaluation. Olanzapine monotherapy appears to be efficacious for the treatment of ET. Further clinical trials with control groups are indicated to establish the efficacy of olanzapine in patients with ET.
The tolerability and efficacy of entacapone over 3 years in patients with Parkinson's disease
Authors: Larsen J. P. , Worm‐Petersen J. , Sidén Å. , Gordin A. , Reinikainen K. , Leinonen M. ,   the NOMESAFE Study Group
Published: March 2003

The long‐term safety and efficacy of the catechol‐O‐methyltransferase (COMT) inhibitor entacapone was investigated in a 3‐year open‐label extension of the 6‐month double‐blind placebo‐controlled Nordic (NOMECOMT) study. After a wash‐out following this study, 132 patients with Parkinson's disease (PD) experiencing motor fluctuations treated with levodopa/dopa decarboxylase (DDC) inhibitor received additional therapy with entacapone 200 mg, administered with each dose of levodopa. The most common adverse events (AEs) were insomnia (30%), dizziness (20%), nausea (20%), aggravated parkinsonism (17%) and hallucinations (14%). Only 19 (14%) patients discontinued because of AEs. Most dopaminergic AEs occurred shortly after initiation of entacapone, and these could be managed by levodopa down‐adjustment. The mean duration of benefit of a single dose of levodopa increased significantly from 2.1 to 2.8 h (P < 0.01) at 3 months and remained prolonged for the whole study. At the end of the study, the mean daily dose of levodopa was significantly decreased from baseline (from 737 to 696 mg; P < 0.05). The patients' global assessment indicated that 69% of patients improved when given entacapone and this proportion was maintained until the end of the study (64%). There was a significant worsening of disability upon withdrawal of entacapone. In conclusion, entacapone given in combination with levodopa, has a good long‐term safety profile and a sustained beneficial effect in patients with PD with motor fluctuations.
Effect of Histamine on Regional Cerebral Blood Flow in Man
Authors: Krabbe Annette Æbelholt , Olesen Jes
Published: March 2003

Regional cerebral blood flow (rCBF) was measured using the intra-arterial 133Xe technique in 35 or 256 areas of a hemisphere. In seven patients rCBF was measured in the resting state and following intracarotid (i.c.) infusion of histamine 10–50 μg/min. In four patients histamine was infused intravenously in a dose of 25–40 μg/min. Histamine caused no significant change in mean arterial blood pressure or arterial PCO2. There was no significant change in mean hemispheric blood flow during i.v. or i.c. histamine infusion. No change in the regional distribution of hemispheric blood flow was observed. Experimental histamine headache is most likely of extracranial origin.
Cluster Headache: Heart Rate and Blood Pressure Changes During Spontaneous Attacks
Authors: Russell David , Lippe Are von der
Published: March 2003

The ECG findings before, during and following 81 spontaneous attacks of cluster headache in 24 patients have been recorded using a Holter cardiography system. No significant change in mean heart rate was found during attacks, when all attacks were considered as a group. Attacks which began when patients were awake differed from those which began during sleep as regards changes in mean heart rate. The mean heart rate decreased during the majority (61%) of attacks which began when patients were awake, whereas it remained unchanged or increased during the majority (67.5%) of attacks which began during sleep. The attacks which began when patients were awake also had higher absolute mean heart rate values before, during and following attacks compared to similar values for those attacks which began during sleep. Blood pressure was measured during 11 attacks and showed a significant increase in both systolic and diastolic blood pressure. The heart rate and blood pressure in six patients usually increased during induced head pain.
Intermittent Hypoendorphinaemia in Migraine Attack
Authors: Baldi Elisabetta , Salmon Silvia , Anselmi Bruno , Spillantini Maria Grazia , Cappelli Gino , Brocchi Alessandro , Sicuteri Federigo
Published: March 2003

Beta-endorphin (RIA method, previous chromatographic extraction) was evaluated in plasma of migraine sufferers in free periods and during attacks. Decreased levels of the endogenous opicid peptide were found in plasma sampled during the attacks but not in free periods. Even chronic headache sufferers exhibited significantly lowered levels of beta-endorphin, when compared with control subjects with a negative personal and family history of head pains. The mechanism of the hypoendorphinaemia is unknown: lowered levels of the neuropeptide, which controls nociception, vegetative functions and hedonia, could be important in a syndrome such as migraine, characterized by pain, dysautonomia and anhedonia. The impairment of monoaminergic synapses (“empty neuron” condition) constantly present in sufferers from serious headaches, could be due to the fact that opioid neuropeptides, because of a receptoral or metabolic impairment, poorly modulate the respective monoaminergic neurons, resulting in inbalance of synaptic neurotransmission.
Headache Syndromes Suggested by Statistical Analysis of Headache Symptoms
Authors: Ziegler Dewey K. , Hassanein Ruth Stephenson , Couch James R.
Published: March 2003

Statistical study of the correlation between 49 variables concerning characteristics of headache and of headache patients was carried out on 1,198 sequential patients complaining of severe or disabling headaches and attending a headache clinic. Factor analysis was the statistical method employed, 17 factors accounting for 64% of total variation emerged. The most prominent factor contained descriptors of neurological dysfunction associated with headache. Another factor contained variables of nausea and vomiting, only associated with inability to work. Other factors, contained separately, the following variables: (a) Time of headache, (b) time of week of headache, (c) unilateral nature of headache, (d) visual phenomena associated with headache. Relation of these findings to headache taxonomy is discussed.
Relationships Among Migrainous, Vascular and Orthostatic Symptoms
Authors: Drummond Peter D.
Published: March 2003

A headache symptom questionnaire was filled out by 766 undergraduate university students and 258 reported one or more headaches per month. Headaches characterized by one or more of the main migrainous symptoms (unilateral pain, gastrointestinal disturbance and focal neurological symptoms) were reported to be more severe, pulsatile, of longer duration, and associated with facial pallor and signs of cerebral vascular instability more frequently than headaches accompanied by few or none of the major migrainous symptoms. Additionally, hunger was reported to trigger headaches associated with migrainous symptoms more frequently than non-migrainous headaches. The results are consistent with the proposal that vascular involvement is one of the factors underlying a continuum of headache with migraine as one extreme.
Non-Familial Hemiplegic Migraine Responsive to Naloxone
Authors: Centonze V. , Brucoli C. , Macinagrossa G. , Attolini E. , Campanozzi F. , Albano O.
Published: March 2003

Two cases of non-familial hemiplegic migraine are described. Naloxone reversed the neurological deficits accompanying attacks, whereas the pain was uninfluenced. The possibility that the opiate-antagonist naloxone facilitates regression of neurological symptoms associated with migraine attacks in general is voiced….
Quantification of Salivation, Nasal Secretion and Tearing in Man
Authors: Saunte Carsten
Published: March 2003

The purpose of this study has been to establish a battery of tests of autonomic functions: Quantification of submandibular/sublingual salivation, nasal secretion and tearing on both sides. The tests were performed in a control group of 20 healthy students. We used a parasympatomimetic drug, pilocarpine 0.1 mg/kg body weight, to stimulate the different secretory functions. Saliva was collected with a pair of dentistry spiral suctions. Tearing was assessed with Schirmer's test tapes. Nasal secretion was quantified using Schirmer's test tapes, too. Nasal secretion and salivation on average was fairly symmetrical, whereas there was some asymmetry in tearing (which may be artificial). In single individuals, there may be considerable asymmetry in salivation as well. This test battery will be used in the study of possible autonomic dysfunctions in patients with unilateral headache.
Chronic Paroxysmal Hemicrania: Salivation, Tearing and Nasal Secretion
Authors: Saunte C
Published: March 2003

Autonomic functions have been studied in seven patients with chronic paroxysmal hemicrania (CPH). A test battery comprising tearing, salivation and nasal secretion was employed. Under basal conditions these parameters did not differ significantly from those in a control group. After stimulation with pilocarpine the patients responded rather inhomogeneously. This test battery may therefore help find and classify subgroups of these types of patients. During attacks, there is a clear discrepancy between minimal salivation on the one hand and the marked increase in tearing, nasal secretion and sweating on the other. CPH attacks may be associated with an increased firing of sympathetic impulses to the different organs. In the event of a uniform type of autonomic firing taking place during attack, these findings may suggest a different innervation pattern for the salivary glands compared to the other glands involved. The innervation pattern of these secretory organs may seem to be more intricate and sophisticated than hitherto assumed.
Chronic Paroxysmal Hemicrania: Severity, Duration and Time of Occurrence of Attacks
Authors: Russell David
Published: March 2003

A detailed clinical study of 105 CPH attacks in five patients has been carried out. Data were recorded during periods when patients were without medication and with the use of methods which were not dependent on the patients' memory of events. When overall assessments of symptoms during the study period were mild or moderate the attack frequency was from 4 to 8, mean 6.5 attacks per 24 h. However, when overall assessments of symptoms were described as severe or extremely severe the attack frequency was from 13 to 38, mean 21.8 attacks per 24 h. The mean duration of attacks was 13.3 ± 7.6 min. No nocturnal preponderance of attacks was found.
Chorea and Migraine: “Hemicrania Choreatica”?
Authors: Bruyn GW , Ferrari MD
Published: March 2003

The migraine literature contains a number of anecdotal reports in which mention is made of involuntary movements associated with migraine attacks. For the migraine connoisseur, such an association is intriguing for two reasons: (1) might this combination constitute yet another clinical type of complicated migraine (“hemicrania choreatica”)? (2) to what extent does the combination imply a common denominator, potentially clarifying the pathogenesis of the migraine attack and the chorea? The rarity of the combination eo ipso militates against the feasibility of a common, systemic, denominator; if there was one, many migraine patients would also suffer from chorea, either during the migraine attacks or in a more protracted form. Also, one would observe a prevalence of migraine among choreatic patients which exceeds the prevalence of migraine among the population.

Because migrainous involuntary movements have never been the object of special study, a synoptic and critical analysis of the dispersed data is presented.
L-5HTP Treatment in Primary Headaches: An Attempt at Clinical Identification of Responsive Patients
Authors: Bono Giorgio , Micieli Giuseppe , Sances Grazia , Calvani Menotti , Nappi Giuseppe
Published: March 2003

The therapeutic response to L-5HTP, a serotonin precursor, was studied in an attempt to identify clinical subgroups of primary headache patients. The results at the 4th month control in 100 patients under L-5HTP treatment at the dose of 300 mg/day confirm previous observations on the activity profile of the drug, the effects of which are equally distributed between recurrent and daily forms as well as among clinical subtypes. The emerging profile of the responsive patients is characterized by such peculiar traits as prevalence of previous major mood disturbances and minor frequency of anxiety, longer duration of the illness and higher occurrence of some associated symptoms, lower incidence of exogenous and hormonal trigger factors, and previously positive response to pizotifen treatment.
The Prevalence of Diet-Induced Migraine
Authors: Peatfield RC , Glover V , Littlewood JT , Sandler M , Rose F Clifford
Published: March 2003

Nineteen percent of about 490 patients with classical or common migraine reported that headaches can be precipitated by chocolate, 18% by cheese and 11% by citrus fruit. and a highly significant majority of these patients were sensitive to all three foods. Twenty-nine percent of the patients reported sensitivity to alcohol; again this was significantly associated with sensitivity to the three food stuffs, though a substantial number of patients were sensitive to alcohol but not foods. Thirty-one percent of 331 female patients believed that oral contraceptives precipitated headaches, but this could not be related to any dietary response. Patients with affected relatives were significantly more likely to report sensitivity to alcohol and chocolate; sensitivity to cheese and citrus fruit was less strongly related, and there was no relationship at all for oral contraceptives. These correlations suggest that food induced headaches are mediated by chemical constituents common to these foods.
Tolfenamic Acid, Metoclopramide, Caffeine and Their Combinations in The Treatment of Migraine Attacks
Authors: Tokola Riitta A , Kangasniemi Pentti , Neuvonen Pertti J , Tokola Olavi
Published: March 2003

Tolfenamic acid is a fenamate which inhibits prostaglandin (PG) biosynthesis and may act as a PG antagonist as well. Caffeine and metoclopramide are used in combination with analgesics and ergotamine in the treatment of migraine attacks, but controlled clinical studies on fixed combinations with analgesics are rare. The effects of orally given tolfenamic acid (200 mg), caffeine (100 mg), metoclopramide (10 mg), tolfenamic acid + caffeine (200 mg + 100 mg), tolfenamic acid + metoclopramide (200 mg + 10 mg) and placebo were studied in 49 migraine patients (3 men, 46 women) in a double-blind randomized cross-over study comprising 482 migraine attacks. The patients were allowed to take either one or two capsules of each preparation for an attack. Additional drugs were allowed after 3 h. Parameters characterizing the effects and side-effects of the drugs were registered. Tolfenamic acid and its combinations were found to be effective in the treatment of acute migraine, but caffeine and metoclopramide alone did not differ from placebo. Combination with metoclopramide was better than tolfenamic acid alone as judged by the smaller dose needed and the intensity of attack. Between tolfenamic acid alone and its caffeine combination there were no statistically significant differences.
“Hemicrania Continua”. An Indomethacin Responsive Headache. II. Autonomic Function Studies
Authors: Sjaastad O , Spierings ELH , Saunte C , Bakowska Maria M Wysocka , Sulg I , Fredriksen TA
Published: March 2003

Various autonomic parameters have been studied in two patients with “hemicrania continua”, a newly described unilateral headache which is aborted by indomethacin. Striking findings were made on pupillometry: In both patients, isocoria was present when untreated. Bilateral instillation of tyramine in the conjunctival sac resulted in a late appearing anisocoria, with the smaller pupil on the symptomatic side. Indomethacin medication corrected this anomaly. These findings add further evidence to our firm belief that “hemicrania continua” differs fundamentally from chronic paroxysmal hemicrania, where such pupillometric changes are not found. There thus seem to be at least two different types of hemicranias with an absolute indomethacin effect.
Naproxen Sodium in the Treatment of Migraine
Authors: Johnson ES , Ratcliffe DM , Wilkinson M
Published: March 2003

Seventy patients with classical or common migraine were treated during their attacks with either naproxen sodium or placebo in a randomised, double-blind parallel group study. The initial dose of naproxen sodium was 825 mg followed one hour later by a further 550 mg, if symptoms were the same or had improved. If the migraine symptoms had worsened, patients were offered an escape analgesic combination of 1000 mg paracetamol and 10 mg metoclopramide. Patients were assessed at monthly intervals for changes in the severity and duration of headache, premonitory symptoms (mainly visual disturbances) and photophobia, nausea and vomiting associated with migraine attacks that had occurred since the previous visit. Patients were studied for a maximum of ten attacks and significant improvement was observed in the severity and duration of headache when the patients were on naproxen sodium. Also the premonitory symptoms and photophobia improved significantly on naproxen sodium and significantly less rescue analgesics were required. Patients suffering from common migraine had less severe headaches and photophobia when taking naproxen sodium than when taking placebo and the headaches were shorter in duration and patients took less rescue analgesic. No significant difference was observed between the treatment groups in patients with classical migraine. Ten patients in the placebo group and six in the naproxen sodium group reported side-effects but these were possibly related to the use of rescue medication. Naproxen sodium proved safe and effective in common migraine attacks, but in this study efficacy was not established for classical migraine.
Migraine Art
Authors: Wilkinson Marcia , Robinson Derek
Published: March 2003

An analysis is made of 207 drawings and paintings entered for a migraine art competition. All types of visual disturbances were depicted. One hundred and fifty-four of the paintings showed spectral appearances with fortification or teichopsia in 99. Sixty-two showed either a partial or complete hemianopic loss. Metamorphopsia was seen in 32 and pain was depicted in some form or another in 80. Situational or trigger factors were shown in 23.
β-Eddorphin and ACTH in Plasma During Attacks of Common and Classic Migraine
Authors: Bach Flemming Winther , Jensen Kai , Blegvad Niels , Fenger Mogens , Jordal Robert , Olesen Jes
Published: March 2003

Plasma levels of b-endorphin and ACTH were measured during and outside migraine attacks in 17 patients with common migraine and 11 patients with classic migraine. Specific radioimmunoassays for b-endorphin and ACTH were used. The b-endorphin assay did not cross-react with b-lipotropin. In common migraine, median plasma b-endorphin was 3.3 pmol/l (95% confidence limits: 2.5–4.0 pmol/1) during attacks and 2.9 (2.4–3.2) pmol/l in the headache-free period. In classic migraine, plasma b-endorphin was 3.2 (1.4–4.3) pmol/l during attacks and 2.4 (1.1–3.65) pmol/l outside attacks. ACTH plasma levels were 15 (10.5–20) pmol/l during and 15.7 (13.4–17) pmol/l outside attacks in common migraine. In classic migraine, plasma ACTH was 16 (7–36) pmol/l and 12.3 (8–28) pmol/l respectively. No significant differences were found between attacks and headache-free periods in common or classic migraine. Accordingly, we could not add evidence to the theory of a dysfunction of the endogenous opioid system in migraine.
Flunarizine, The Vestibular System and Migraine
Authors: Ansink BJJ , Danby M , Oosterveld WJ , Schimsheimer RJ , Caers LI , Amery WK
Published: March 2003

The vestibular function was extensively investigated in 75 patients suffering from migraine. Pathological findings were present in 62 patients (82.6%). With the exception of position nystagmus, vestibular abnormalities were not related to migraine characteristics. Fifty-six patients were treated with flunarizine 10 mg daily for three months. A favourable effect on headache was obtained in 44 patients (78.5%). Flunarizine therapy influenced significantly gaze nystagmus and position nystagmus. The latter tended to be related to antimigraine efficacy. Other electronystagmographic parameters were not substantially influenced. The authors assume that the vestibular abnormalities in migraine are side phenomena, the clinical relevance of which, at least during the headache-free phase, is not yet well understood.
Late Post-Traumatic Headache in Pediatric Age
Authors: Lanzi G , Balottin U , Borgatti R , Agostini G De , Pezzotta S , Spanu G
Published: March 2003

In this study we evaluate the incidence and clinical characteristics of headache which arise 12–18 months after a cranial trauma in a pediatric age group of subjects. We contacted 217 individuals who had been hospitalized for head injury to return for check-up; of the 138 who responded, there were 86 males and 52 females (mean 9.2 years). The responders were given a complete physical and neurological examination and, in the presence of at least one parent, asked to fill out a headache questionnaire. Twenty-nine per cent suffered from headache, and in 6.5% the headache was migrainous in nature. The 138 patients were split up into three sub-classes in accordance with the nature of the trauma and two sub-classes in accordance with the presence or absence of fractures. The results were then compared with those obtained from a control population (246 patients with a mean age of 8.8 years). An increased headache frequency was found in those patients with average to severe trauma. We conclude that cranial trauma is not likely to be followed by headache unless accompanied by loss of consciousness and/or focal neurological signs.
Reduced Testosterone Levels in Cluster Headache: A Stress-Related Phenomenon?
Authors: Facchinetti Fabio , Nappi Giuseppe , Cicoli Claudio , Micieli Giuseppe , Ruspa Michela , Bono Giorgio , Genazzani Andrea R
Published: March 2003

The circadian changes in testosterone (T) and cortisol secretion and morning luteinizing hormone (LH) levels were evaluated in nine episodic cluster headache (CH) patients in active phase and in seven healthy volunteers, with collection of blood samples every 2 h for 24 h. CH showed a significant reduction of the 24-h integrated mean T value (mesor) (4.4 + 1.1 ng/ml; x ± SD) in comparison with controls (6.6 ± 0.8 ng/ml) ( P < 0.0l). Both groups had plasma T circadian rhythm with peak values in early morning, but in CH single cosinor analysis showed its absence in three out of nine CH patients. The rhythm showed an acrophase delay of 101 min in CH. Both patients and controls had a significant circadian rhythm of plasma cortisol concentration. CH patients, however, showed an acrophase delay of 106 min and significantly increased concentrations from 1200 h to 2000 h. Morning LH values were similar in the two groups. The reduced secretion of plasma T in CH patients in the active phase coexisted with an acrophase delay of its circadian rhythm. A similar delay was found in 24-h plasma cortisol levels. We suggest that stress accompanying attack expectancy in the active phase is the mechanism behind the elevated plasma cortisol levels. This in turn could reduce T concentrations, acting at the testicular level. These disturbances in internal chronoorganization support the hypothesis that cluster headache is basically a dyschronic disorder.
A New Etiology for Visual Impairment and Chronic Headache: The Tolosa-Hunt Syndrome may be Only One Manifestation of Venous Vasculitis
Authors: Hannerz Jan , Ericson Kaj , Bergstrand Gustaf
Published: March 2003

The Tolosa-Hunt syndrome is characterized by recurrent periods of painful ophthalmoplegia, dramatically ameliorated by steroid treatment. In half of the cases orbital phlebography shows characteristic changes. Ninety-six patients with orbital pain characteristic of the Tolosa-Hunt syndrome were submitted to orbital phlebography regardless of the existence of other symptoms. A pathologic phlebogram with changes typical of the Tolosa-Hunt syndrome was found in 50 patients. In 17 of these 50 patients the symptoms consisted of orbital pain only and no ophthalmoplegia. Twenty patients had pain and ipsilateral decrease of vision but no ophthalmoplegia, and 13 had painful ophthalmoplegia. Of 41 patients treated with steroid medication 39 responded dramatically with regard to the pain. Earlier findings indicate that the phlebographic changes are due to venous vasculitis, which thus may cause irreversible visual impairment but also chronic headache without ophthalmoplegia. It is concluded that the Tolosa-Hunt syndrome may be only one manifestation of a not uncommon disease.
Dynorphin B-Containing Perivascular Axons and Sensory Neurotransmitter Mechanisms in Brain Blood Vessels
Authors: Moskowitz Michael A , Brezina Lisa R , Kuo Christine
Published: March 2003

This is the first report demonstrating the existence of opiate-containing nerve fibers surrounding brain blood vessels. Dynorphin B, a tridecapeptide and potent opiate analgesic, was visualized by immunohistochemistry in guinea pig cerebral arteries comprising the circle of Willis and was measured by radioimmunoassay in canine middle cerebral arteries. This peptide, reportedly present in dorsal root ganglion cells, was observed by others to decrease the depolarization-induced release of substance P from primary sensory axons and, by so doing, to retard the development of neurogenic inflammation in target tissues. Consistent with an indirect action of dynorphin B, this peptide did not relax precontracted canine middle cerebral or basilar artery segments when added in vitro, nor did it modulate receptor-mediated relaxation on the addition of substance P. The presence of opiate-containing axons in or near trigeminovascular nerve fibers suggests novel mechanisms related to the modulation of pain possibly emanating from cerebral vessels.