bluuebunny/crossref_metadata_2025_split huggingface dataset:
Almotriptan Versus Rizatriptan in Patients With Migraine in Spain
Authors: Leira Rogelio , Dualde Elena , Del Barrio Horacio , Machuca Manuel , López‐Gil Arturo ,   Spanish Group for the Study of Triptan Consumption in Community Pharmacies
Published: July 2003

Objectives.—To compare patient‐reported use of rizatriptan 10 mg with that of almotriptan 12.5 mg per migraine attack (24 hours) in a Spanish population.Methods.—One hundred twenty Spanish community pharmacies recruited patients with migraine to whom they had dispensed almotriptan and rizatriptan. No other selection criteria were used. Patients kept diaries for baseline pain intensity, the number of triptan tablets used, additional medication taken per attack, and their degree of satisfaction with the medication 2 hours after the initial dose. Patients recorded details for a maximum of 3 attacks. Analysis of variance or the Student t test and chi‐squared or Fisher exact tests were used for univariate comparisons. A generalized estimating equation method was used to correct for within‐subject variability. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.Results.—One hundred twenty‐six patients (85% women) recorded data for 318 migraine attacks. Rizatriptan was used to treat 122 attacks, almotriptan was used to treat 110 attacks, and a nontriptan medication was used in the initial treatment of 86 attacks. Triptan use (adjusted mean, 95% CI) per attack in this study was lower for rizatriptan (1.19 tablets; 95% CI, 1.06 to 1.32) than for almotriptan (1.43 tablets; 95% CI, 1.30 to 1.56; P= .003). The use of a triptan and additional medication per attack increased with baseline pain severity. Rizatriptan was used to treat more attacks with only one tablet (78%) than almotriptan (58%). Treatment of attacks with almotriptan was more than twice as likely to involve the use of more than one tablet per attack (24 hours) than those treated with rizatriptan (adjusted OR, 2.42; 95% CI, 1.37 to 4.30; P= .003). Patient satisfaction with treatment response at 2 hours was more than 2‐fold greater for rizatriptan (85%) than for almotriptan (68%) (adjusted OR, 2.55; 95% CI, 1.11 to 5.87; P= .03).Conclusions.—In this prescription‐selected Spanish population, a significantly lower number of rizatriptan tablets were required to treat migraine attacks compared with almotriptan. Further, patients were more than twice as likely to use more than one tablet or additional medication (or both) for attacks treated with almotriptan than for those treated with rizatriptan. Although these data suggest that rizatriptan may be a more effective treatment for migraine than almotriptan, further randomized studies are required to confirm this conclusion.
Burden of Migraine in Brazil: Estimate of Cost of Migraine to the Public Health System and an Analytical Study of the Cost‐Effectiveness of a Stratified Model of Care
Authors: Bigal Marcelo E. , Rapoport Alan M. , Bordini Carlos A. , Tepper Stewart J. , Sheftell Fred D. , Speciali José G. 
Published: July 2003

Background.—The search for rationality in health expenses in developing countries collides with the lack of effectively conducted epidemiologic studies.Purpose.—To present an estimate of the impact and costs of migraine in the Brazilian public health system and to estimate the impact on these costs and the effectiveness of a model of stratified care in the management of migraine.Methods.—An analytical model of utilization of the Brazilian public health system was constructed. Data refer to 1999 and were obtained in accordance with the following steps: (1) Brazilian demographic characteristics; (2) characteristics of the public health system related to its 3 hierarchical levels—primary, secondary, and tertiary care, the last being subdivided into emergency department and hospital care; and (3) estimation of the number of migraine consultations at each complexity level. In Brazil, migraineurs seen in the public health system are most often discharged with an acute treatment, usually a nonspecific medication. We compared this treatment with a proposed stratified care model that uses a triptan as an acute care medication.We have made the following assumptions: (1) 15% of the patients would fall into the Migraine Disability Assessment (MIDAS) grade I category, 25% would fall into the MIDAS grade II category, 30% into the grade III category, and 30% into the MIDAS grade IV category; (2) the mean number of migraine attacks per year are: MIDAS I, 7.49; MIDAS II, 8.02; MIDAS III, 12.22; and MIDAS IV, 27.01. The annual costs of the treatment were calculated according to the following equation: AC = P × N × C + P × Cp + P × Cat × AMA, where P is the number of patients; N, the number of consultations per patient; C, the cost of consultation per level; Cp, the cost of preventive drugs; Cat, the cost of acute therapy drugs; and AMA is the number of migraine attacks per year.Results.—The public health system resources included 55 735 ambulatory units (primary and secondary) and 6453 emergency department and public hospital units, with a corresponding budget of US $2 820 899 621.26. The estimated cost of a consultation on the primary care level was US $11.53; on the secondary care level, US $22.18; in the emergency department, $34.82; and for hospitalization, US $217.93. The total estimated public health system expenses for migraine were US $140 388 469.60. The proposed model would imply a cost reduction of 6.2% (US $7 514 604.40) with an improvement in the quality of the public health system from the actual 18.2% to an estimated 84.5%.Conclusion.—Migraine seems to pose a huge burden on the Brazilian public health system. The implementation of a stratified care model of treatment that would include specific acute migraine therapies could result in a dramatic increase in the quality of migraine care and a significant reduction in cost.
Posttraumatic Headache: Biopsychosocial Comparisons With Multiple Control Groups
Authors: Tatrow Kristin , Blanchard Edward B. , Hickling Edward J. , Silverman Daniel J. 
Published: July 2003

Objective.—This study examined somatic, psychological, and cognitive functioning of subjects with posttraumatic headache in comparison with multiple control groups.Background.—Posttraumatic headache is not as widely studied as other forms of headache (eg, tension‐type, migraine). Previous research has suggested poor psychological functioning in patients with posttraumatic headache in comparison with other groups of patients with pain; however, this group has yet to be compared with a group of persons who have experienced trauma but are headache‐free.Design and Methods.—Nineteen subjects with posttraumatic headache were studied, with full assessments available for 14 participants. Comparison groups, containing 16 participants each, included another headache group, a nonheadache group, and a trauma (motor vehicle accident) survivor nonheadache group. Participants completed several measures assessing somatic, psychological, and cognitive functioning.Results.—Findings revealed that the posttraumatic headache group exhibited significantly poorer functioning than the comparison groups on several measures including the Psychosomatic Symptom Checklist, Postconcussion Syndrome Checklist, axis II psychiatric diagnoses, Minnesota Multiphasic Personality Inventory, and the Daily Hassles Scale (frequency and total). Additionally, they scored higher on the following: number of axis I psychiatric diagnoses, the Daily Hassles Scale (intensity), Beck Depression Inventory, State‐Trait Anxiety Inventory, and State‐Trait Anger Expression Inventory. The posttraumatic headache group was similar to the other trauma group on the Posttraumatic Stress Disorder Symptom Checklist and the Life‐Trauma Checklist.Conclusions.—This study confirmed the distress seen in this understudied population of persons with headache and highlights areas of focus for proper assessment and treatment of those with headache and who have had an accident.
Use of the Migraine Disability Assessment Questionnaire in Children and Adolescents With Headache: An Italian Pilot Study
Authors: D'Amico D. , Grazzi L. , Usai S. , Andrasik F. , Leone M. , Rigamonti A. , Bussone G. 
Published: July 2003

Objectives.—To determine the suitability of the Migraine Disability Assessment (MIDAS) Questionnaire for assessing disability in children and adolescents with headache and to obtain preliminary information about disability in different primary headaches.Background.—During the last decade, researchers have begun to employ standardized methodologies to investigate the global impact of primary headaches. Disease‐specific instruments have been developed to measure headache‐related disability. The MIDAS Questionnaire, which is the most extensively studied of these instruments, was designed to assess the overall impact of headaches over the 3 months before compilation. The MIDAS Questionnaire is an optimal tool to assess headache‐related disability in adults.Methods.—Ninety‐five patients aged 7 to 17 years with tension‐type headache, migraine, or both completed the validated Italian form of the MIDAS questionnaire on 2 occasions. Test‐retest reliability was assessed by the Spearman rank correlation test. The Cronbach α assessed internal consistency. The patients answered questions about the adequacy of the questionnaire.Results.—The Cronbach α was .8. Correlation coefficients were generally high for the overall MIDAS score and for the items investigating disability in school and in family/leisure activities; they were lower for the items about housework. Most patients thought that the MIDAS Questionnaire was useful (98.9%) and that it captured the impact of their headaches (58.9%); 41% thought that questions about disability in housework were useless, 44.2% suggested adding questions regarding inability to do homework. All primary headaches had a considerable impact on daily activities, but patients with migraine tended to have lower headache frequencies and lower total disability time; those with tension‐type headache suffered more days in which activities, although performed, were substantially impaired.Conclusions.—The MIDAS Questionnaire is useful for assessing disability in children and adolescents with different primary headaches. Minimal changes in the phrasing and content of the items would be sufficient to render the MIDAS specific for the younger population with headache.
Prevalence of Headache in Puerto Rico
Authors: Miranda Héctor , Ortiz Gilberto , Figueroa Sandra , Peña Diana , Guzmán Josué 
Published: July 2003

Background.—Headache is one of the most frequently reported disorders in the general adult population. Despite the fact that this disorder is common, no official estimate of the prevalence of headache exists in Puerto Rico.Purpose.—To examine the prevalence of headache and migraine, specifically, in Puerto Rico.Methods.—A telephone survey of 1610 individuals was conducted. The telephone calls were distributed using the 1990 census adjusted to the population of Puerto Rico in 1998, and according to gender, geographical area, and age.Results.—The prevalence of headache in Puerto Rico was 35.9% and migraine, in particular, 13.0%. When prevalence was fractionated by age, gender, and geographical areas, the prevalence of headache was similar for all ages, with females exhibiting a 2:1 preponderance over males. In the younger population (between 20 and 50 years of age), the female‐male ratio for migraine was 3:1, and the prevalence for migraine was lower in the Metropolitan area.Conclusion.—This study, the first of its type in Puerto Rico, demonstrates that headache (and migraine specifically) is a common disorder in this country.
Aspects of Referral Care for Headache Associated With Improvement
Authors: Salvesen Rolf , Bekkelund Svein Ivar 
Published: July 2003

Objective.—To assess which aspects of referral care for headache are associated with improvement of pain and subjective quality of life.Background.—In managed care, referrals to a specialist are sometimes kept to a minimum. It has been questioned whether patients with headache do better after consultation with a specialist.Methods.—We mailed a questionnaire to all patients referred for headache to a neurologic center in northern Norway during a 2‐year period (n = 1403). The questionnaire included items concerning diagnosis and treatment, along with simple visual analog scales to assess whether the patient's headache syndrome and self‐perceived quality of life had changed after seeing the specialist.Results.—There were 1052 responders (75%). Headache generally decreased after consultation with a specialist; it decreased significantly more in the 527 patients who were assigned a diagnosis compared to the 344 patients who claimed they were not. Reduction of headache also was significantly more obvious in the 483 patients who had treatment prescribed, as compared to the 385 patients not receiving any therapeutic measure. Self‐perceived quality of life was generally improved, significantly more when the patient was given a diagnosis, and even when the diagnosis did not lead to treatment.Conclusions.—Patients referred to a neurologic center for evaluation of headache generally experience a significantly greater improvement in their headache syndrome and quality of life. This appears particularly so when they receive a diagnosis, even if no treatment is prescribed.
Topiramate in the Prophylactic Treatment of Cluster Headache
Authors: Láinez Miguel J. A. , Pascual Julio , Pascual Ana M. , Santonja Jose M. , Ponz Alejandro , Salvador Antonio 
Published: July 2003

Objective.—The role of topiramate in the prophylactic treatment of cluster headache is still unclear. The aim of this study was to evaluate the effectiveness of topiramate in a group of patients with refractory episodic or chronic cluster headache.Background.—Proof of efficacy of preventive treatment of cluster headache is limited, especially for the chronic form of the disorder. There are very few randomized clinical trials on this condition with topiramate or other new anticonvulsant agents. Recent case reports and series involving topiramate have shown good results. The mechanism of action of topiramate is unknown, but is presumably mediated by γ‐aminobutyric acid.Methods.—Twenty‐six patients with episodic (n = 12) or chronic (n = 14) cluster headache were studied prospectively. All patients had been treated with some preventive treatment, with poor or no response. Treatment with topiramate was initiated with 25 mg once a day, and the dose was titrated every 3 to 7 days to a maximum of 200 mg, according to clinical response and tolerability.Results.—Topiramate rapidly induced cluster remission in 15 patients, reduced the number of attacks more than 50% in 6 patients, and reduced the cluster period duration in 12. The mean time to remission was 14 days (range, 1 to 27), but in 7 patients remission was obtained within the first days of treatment with very low doses (25 to 75 mg a day). Tolerability was good within the lower range of doses used. Six patients discontinued treatment due to side effects (all with daily doses over 100 mg) or lack of efficacy.Conclusions.—Our results confirm that topiramate can be an effective option for the preventive treatment of episodic and chronic cluster headache.
Software Reuse Reference Model Approach in Developing an Automated Medical Information System (AMIS) for Improving Health Care Practice
Authors: Khatri Anil , Rine David C. , Khatri Sadhna 
Published: July 2003

Objective.—To evaluate patient acceptance of an automated medical information system specific to headache.Background.—Studies suggest that automated tools may help health care delivery systems to be efficient and effective, but patient satisfaction remains a major concern.Methods.—We adapted our software reuse reference model and Unified Modeling Language to apply the domain model to the headache population. Patients with headache were tested both to validate the system and to evaluate patient satisfaction and headache management with an automated system.Results.—The mean age of all study participants was 44 years. Over 95% of the participants were satisfied or strongly satisfied with the Automated Medical Information System.Conclusions.—The results strongly suggest that patients are willing and able to use nontraditional sources, such as the Automated Medical Information System, to learn about their illnesses.
Dental Status and Oral Health of Patients with Epilepsy: An Epidemiologic Study
Authors: Károlyházy Katalin , Kovács Eszter , Kivovics Péter , Fejérdy Pál , Arányi Zsuzsanna 
Published: July 2003

Summary:  Purpose: We performed a dental survey of epilepsy patients to examine their oral health by statistical means and to provide a guide for the dental treatment of these patients. Methods: We first set up four “dental” subgroups of epilepsy patients, based on the types of seizures, seizure frequency, and mental state. One hundred one patients underwent a survey concerning their dental, medical, and epilepsy histories, followed by a dental examination. Indexes quantifying oral hygiene, the number and condition of the remaining teeth, periodontium, and the degree of prosthetic treatment were measured. An age‐matched control group of general (nonepilepsy) population underwent an identical dental examination. Statistical comparison was performed between the patient and the control groups and between subgroups of epilepsy patients. Results: In almost all aspects of oral health and dental status, patients with epilepsy showed a significantly worse condition compared with the control group. Comparison of the subgroups of epilepsy patients revealed that the most severe findings concern patients who have poorly controlled epilepsy, especially those who have frequent generalized tonic–clonic seizures. Conclusions: The observed difference probably results from a combination of factors such as the effect of the seizures themselves, socioeconomic conditions, and the negative attitude of dentists. We recommend that the planning of dental treatment of such patients should start with the assessment of their disease and determination of the “dental” subgroup to which they belong. For each subgroup, specific recommendations for interventions are given.
Confirmation of Nonconvulsive Limbic Status Epilepticus with the Sodium Amytal Test
Authors: Burneo Jorge G. , Knowlton Robert C. , Gomez Camilo , Martin Roy , Kuzniecky Ruben I. 
Published: July 2003

Summary:  Is it a seizure? This question can be difficult for a clinician to answer, and it may be more critical if the possible seizure lasts >30 min. Long‐duration questionable seizure activity changes the question to, “Is it status epilepticus?”Status epilepticus (SE) can be divided into convulsive and nonconvulsive types. Convulsive SE is the most easily recognized, whereas nonconvulsive SE is more clinically variable and controversial. The term nonconvulsive SE is more often applied to patients who are severely obtunded or comatose with minimal or no motor movements, or in a stupor of altered consciousness reflecting generalized ictal activity. Nonconvulsive SE also can be caused by focal seizure activity, sometimes restricted to deep small volumes of brain in which scalp EEG may not be diagnostic.We present the case of a patient who had dominant limbic hippocampal SE, but in whom the diagnosis could not be confirmed until a modified novel use of the sodium amytal test was performed.
Outcome of Surgical Treatment in Familial Mesial Temporal Lobe Epilepsy
Authors: Kobayashi Eliane , D'Agostino Maria Daniela , Lopes‐Cendes Iscia , Andermann Eva , Dubeau François , Guerreiro Carlos A. M. , Schenka André A. , Queiroz Luciano S. , Olivier André , Cendes Fernando , Andermann Frederick 
Published: July 2003

Summary:  Purpose: To describe postoperative outcome in patients with familial mesial temporal lobe epilepsy (FMTLE). Methods: We studied FMTLE patients who underwent surgical treatment for refractory seizures. FMTLE was defined when at least two individuals in a family had a clinical EEG diagnosis of MTLE. Preoperative investigation included magnetic resonance imaging (MRI), interictal/ictal EEGs, and neuropsychological evaluation. We used Engel's classification for postoperative outcome. Results: To date, 20 FMTLE patients have been operated on, with 1.6 to 9.8 years of follow‐up (mean, 5.5 years). Hippocampal atrophy (HA) and other signs of mesial temporal sclerosis (MTS) were present in 18 patients (15 unilateral). Seizures were recorded in 19 patients. Seventeen (85%) patients are in class I. Two patients had normal hippocampal volumes (HcV): one (5%) is in class II and the other (5%) in class IV (extratemporal seizures developed after surgery). One (5%) patient had bilateral HA and is in class III. Qualitative histopathology showed MTS with different degrees of severity. Conclusions: Refractory FMTLE patients have good surgical outcome when unilateral or clearly asymmetric HA is identified. Preoperative investigation should be the same as that in patients with sporadic refractory MTLE.
Evidence for S284L Mutation of the CHRNA4 in a White Family with Autosomal Dominant Nocturnal Frontal Lobe Epilepsy
Authors: Rozycka Agata , Skorupska Elzbieta , Kostyrko Andrzej , Trzeciak Wieslaw H. 
Published: July 2003

Summary:  Purpose: To identify mutations of the neuronal nicotinic acetylcholine receptor α4 subunit gene (CHRNA4) responsible for autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) in a group of white patients. Methods: A group of 47 patients from 21 unrelated families with ADNFLE were screened for mutations in CHRNA4. Clinical features and EEG findings in the patients were consistent with those reported in the literature for other affected families. The entire gene was amplified from genomic DNA by polymerase chain reaction (PCR) followed by multitemperature single‐strand conformation polymorphism analysis (MSSCP) and sequencing. Results: A c.851C>T transition in exon 5 of CHRNA4 was identified in three affected individuals from two generations of the same family, but not in the remaining patients or in 100 healthy volunteers. This mutation caused an S284L substitution in the transmembrane domain M2 segment of the α4 subunit of the neuronal nicotinic acetylcholine receptor. The same mutation had previously been detected in a single Japanese family with ADNFLE, and in an Australian woman with a sporadic form of NFLE. Conclusions: This is the first report of an occurrence of c.851C>T transition in a white family with ADNFLE.
Expressed Emotion in the Relatives of People with Epileptic or Nonepileptic Seizures
Authors: Stanhope Nicola , Goldstein Laura H. , Kuipers Elizabeth 
Published: July 2003

Summary:  Purpose: This study investigated Expressed Emotion (EE) in relatives of people with epileptic or nonepileptic seizures (NES). Methods: In a cross‐sectional study, we used the Five‐Minute Speech Sample to explore EE in the key relative of people with epilepsy (n = 36) and those with NESs (n = 21), as well as levels of anxiety and depression and use of coping strategies. Results: A significantly greater proportion of relatives of NES than epilepsy patients were rated as high EE. Hostility was evident in more high‐EE epilepsy than high‐EE NES relatives, whereas emotional overinvolvement and positive relationship ratings tended to be more common in high‐EE NES relatives. High‐ and low‐EE epilepsy relatives used problem‐focused as opposed to emotion‐focused coping strategies significantly more than half the time. High EE and seizure frequency were not associated. Age at onset of the disorder was higher in epilepsy patients with high‐ than with low‐EE relatives. Conclusions: Irrespective of etiology, carers for people with seizure disorders may find it hard to adjust to the difficulties these disorders create. Interventions that encourage problem‐solving, reappraisals of “loss” and education regarding the causes of some of the patients' behavioral and mood problems seem likely to be beneficial.