bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bilateral GPi DBS is useful to reduce abnormal involuntary movements in advanced Parkinson’s disease patients, but its action is related to modality and site of stimulation
Authors: Peppe A. , Pierantozzi M. , Altibrandi M. G. , Giacomini P. , Stefani A. , Bassi A. , Mazzone P. , Bernardi G. , Stanzione P. 
Published: March 2003

In Parkinson’s disease (PD) patients, internal globus pallidus (GPi) stimulation has been reported to produce good effects on abnormal involuntary movements (AIM); less improvement has been observed in extrapyramidal symptoms. We assessed the effect of monopolar dorsal (uppermost), ventral (lowest) and bipolar (uppermost vs. lowest) bilateral globus pallidus stimulation by quadripolar electrode on extrapyramidal symptoms and AIM induced by a dose of apomorphine. Six PD patients were studied in OFF therapy condition after surgery without stimulation (STIM OFF) and during stimulation (STIM ON) with the three different modalities. All patients were evaluated by the unified Parkinson’s disease rating scale, section III (UPDRS) and by the AIM. Our results show that all three bilateral GPi stimulation modalities reduce the UPDRS score (between 49.7 and 31.5%), although the bipolar and lowest stimulation are the most effective. Similarly, bipolar and lowest stimulation were also the most effective in reducing the occurrence and intensity of the apomorphine‐induced AIM. On the contrary, uppermost stimulation (UP ON) produced an AIM occurrence similar to that observed in the OFF stimulus condition.We suggest that bilateral GPi stimulation is an useful procedure to ameliorate extrapyramidal signs of advanced PD patients; however, it produces an antidyskinetic effect only if the ventral or the entire GPi is stimulated. On the contrary, the UP ON, most probably located in the external globus pallidus (GPe), does not modify the AIM occurrence.
Myotonic dystrophy type 2
Authors: Finsterer J. 
Published: March 2003

Myotonic dystrophy type 2 (DM2) is a clinically but not genetically heterogeneous, multisystem disorder, that is clinically similar to, but distinct from myotonic dystrophy type 1 (DM1). Initially, different phenotypes of DM2 were described by Ricker (proximal myotonic myopathy, PROMM), Ranum (myotonic dystrophy 2, DM2) and Udd (proximal myotonic dystrophy, PDM). Clinical features these three phenotypes had in common were diffuse, proximal or distal weakness, wasting, myotonia, cataract, cerebral, endocrine and cardiac abnormalities. Initially, the clinical differences between DM1 and PROMM seemed unmistakable, but meanwhile it has become apparent that the clinical differences between these entities are blurring. In 1999, Day et al., Meola et al. and Ricker et al. mapped the mutated gene of all three phenotypes to chromosome 3q. In 2001, the three different phenotypes were found to rely on the same mutation in the ZNF9 gene on chromosome 3q21.3. Although DM2 may be clinically heterogeneous, it is by result of a mutation in a single gene. The mutation responsible for DM2 is a CCTG‐repeat expansion of 75–11 000 repeats in intron 1 of the ZNF9 gene on chromosome 3q21.3. Because of the clinical heterogeneity, the diagnosis of DM2 should rely on DNA analysis alone.
Effects of vigabatrin on brain GABA+/Cr signals in focus‐distant and focus‐near brain regions monitored by 1H‐NMR spectroscopy
Authors: Mueller S. G. , Weber O. M. , Duc C. O. , Meier D. , Russ W. , Boesiger P. , Wieser H. G. 
Published: March 2003

The new antiepileptic drug vigabatrin (VGB) increases gamma‐aminobutyric acid (GABA) in the brain. We compared GABA+/Cr signals measured focus‐near and focus‐distant and correlated it with the degree of response to VGB.Brain GABA+/Cr signals were measured in 17 epileptic patients in structurally normal appearing tissue by nuclear proton magnetic resonance (1H‐NMR) spectroscopy using a special editing sequence for GABA. In 11 patients the measurements were done in brain areas distant to focus and in six near to focus.Full‐responders (seizure reduction of ≥50% at the end of the treatment phase) and partial‐responders (seizure reduction of ≥50% at the end of the first month of treatment but ≤50% at end of treatment) had lower GABA+/Cr signals in the hemisphere with the epileptogenic focus and increases of the GABA+/Cr signals with VGB. Non‐responders (seizure reduction of ≤50%) had no side difference in the GABA+/Cr signals before treatment and no increase during treatment. These observations were made in structurally normal appearing tissue near to the focus and distant to the focus.A side difference in brain GABA+/Cr signal between the epileptogenic and non‐epileptogenic hemisphere before VGB treatment correlates with an improved seizure control under VGB treatment regardless whether the measurement is done focus‐near or focus‐distant.
Visual System Dysfunction in Migraine
Authors: Chronicle EP , Mulleners WM 
Published: March 2003

This paper reviews both clinical and experimental literature relating to visual dysfunction in migraine, starting with the eye and progressing via the retina and visual pathways to the visual cortex. Migraine is associated with (i) a pupillary sympathetic hypofunction, and (ii) a cortical hypersensitivity to visual stimuli (perhaps only in migraine with aura), the pathogenesis of which remains to be determined. Various hypotheses are discussed, and it is proposed that the methods of visual psychophysics may represent a useful approach in the future study of cortical hyperexcitability in migraine. Paradoxically, little research has been directed towards understanding (i) the photophobia of migraine attacks, and (ii) how migraine may be triggered by visual stimuli. Research aimed at elucidating the mechanisms of these phenomena may enhance understanding of the pathogenes is of migraine. The clinical and psychophysical findings reviewed above reveal a broad agreement that migraine is associated with (i) a pupillary sympathetic hypofunction, and (ii) a cortical hypersensitivity to visual stimuli (perhaps only in migraine with aura). Evidence for other dysfunctionality in the eye, retina or visual pathways is, in our view, equivocal. In spite of the research effort thus far, visual phenomena which are integral to migraine symptomatology are very poorly understood. We would contend that research aimed at understanding the neurological basis of the visual triggering of migraine and of photophobia would assist a more complete understanding of the disorder, and perhaps shed light on processes occurring at the very initiation of an attack. We suggest also that further investigations into the nature and cause of the dysfunction of the visual cortex in migraine with aura may assist the development of general pathophysiological theories.
Preventive Treatment of Migraine
Authors: Silberstein SD 
Published: March 2003

The pharmacologic treatment of migraine may be acute (abortive, symptomatic) or preventive (prophylactic). Most migraine preventive medications were designed to treat other disorders (e.g., propranolol for hypertension, valproate for epilepsy, etc.). Preventive medication is usually given daily for months or years; however, treatment can be episodic, subacute, or chronic. The medications can be divided into two major categories: (i) Alternatives of high efficacy, which include β- blockers, tricyclic antidepressants, and divalproex, and of lower efficacy, which include selective serotonin reuptake inhibitors, calcium channel antagonists, and non-steroidal antiinflammatory drugs and (ii) second-line choices of high efficacy, which include methysergide and monoamine oxidase inhibitors. The choice of preventive treatment depends on the individual drug's efficacy and side effects, the patient's wants, needs, and response to prior treatment, and the presence of any comorbid or coexistent disease. Most patients require acute headache treatment. Some require preventive treatment. Patients on preventive medication still require acute treatment for breakthrough attacks. Many patients find that their acute attacks are more manageable if they are on a preventive medication. The choice of preventive treatment depends on the individual drug's efficacy and side effects, the patient's wants, needs, and response to prior treatment, and the presence of any comorbid or coexistent disease.
Myogenic Cerebrovascular Autoregulation in Migraine Measured by Stress Transcranial Doppler Sonography
Authors: Heckmann JG , Hilz MJ , Katalinic A , Marthol H , Mück-Weymann M , Neundörfer B 
Published: March 2003

Background and purpose: Transcranial Doppler sonography (TCD) studies may help to elucidate the nature and role of vascular abnormalities in migraine. Our aim in this study was to evaluate cerebrovascular autoregulative response in migraine patients with and without aura to blood pressure increase using stress TCD. Patients and methods: Using transcranial Doppler ultrasound at rest and during ergometer stress (stress TCD), we studied the changes in mean flow velocities and resistance index (RI) in relation to physical stress in the middle cerebral artery. Fifteen migraine patients without aura, 15 migraine patients with aura, and 15 healthy control subjects were examined. Patients suffered from predominantly unilateral headache and were studied during an attack-free period. The Pourcelof's RI as a measure of cerebrovascular reactivity was calculated by dividing the difference between systolic and diastolic velocity by the systolic velocity. Results: None of the subgroups showed any difference during ergometer exercise with regard to blood pressure, endtidal CO2, heart rate, or mean flow velocity. In all subgroups, sufficient physical stress was achieved. With respect to RI change, migraine patients without aura and healthy controls did not differ ( p>0.05). However, the RI change of migraine patients with aura was significantly lower than the RI change of migraine patients without aura or healthy subjects ( p>0.05). The discrimination analysis showed in addition that RI change (absolute and as a percentage) and mean flow velocity change (as a percentage) could be used as diagnostic variables to detect patients with aura symptoms. Conclusion: Differences exist in cerebrovascular reactivity in migraine patients with aura that may contribute to the neurologic disturbances in these patients during attack. We propose that there is disorder of myogenic cerebrovascular autoregulation in migraine patients with aura during headache-free intervals.
Structural and Neurochemical Markers of Brain Injury in the Migraine Diathesis of Systemic Lupus Erythematosus
Authors: Rozell CL , Sibbitt WL , Brooks WM 
Published: March 2003

Objective: To determine whether migraine in systemic lupus erythematosus (SLE) is associated with accentuated brain injury and disease activity. Methods: Forty SLE patients (11 without headache, 11 with non-migraine headache, and 18 with migraine) underwent clinical evaluation, magnetic resonance imaging (MRI), and spectroscopy (MRS). Results: Recurrent headache occurred in 75% of SLE patients. MRI abnormalities and reduced N-acetylaspartate were common. However, migraine in SLE was not associated with increased disease activity or severity, neuropsychiatrie manifestations, or end-organ involvement compared to patients without migraine ( p>0.05). There were no differences in the prevalence or severity of MRI or MRS abnormalities between SLE patients with migraine, with non-migraine headache, or without headache ( p>0.05). Conclusions: Headache does not identify SLE patients at risk for brain injury, increased disease activity, or increased end-organ involvement. Aggressive immunosuppressive therapy for headache alone is not indicated in SLE.
Reliability of the Migraine Disability Assessment Score in A Population-Based Sample of Headache Sufferers
Authors: Stewart WF , Lipton RB , Kolodner K , Liberman J , Sawyer J 
Published: March 2003

Background. The Migraine Disability Assessment (MIDAS) score is used to quantify headache-related disability. In a previous study, we showed that the MIDAS score was highly reliable in population-based samples of migraine headache sufferers in two countries. Objectives. To examine the test–retest reliability and internal consistency of the five items comprising the MIDAS score and the overall MIDAS score in a population-based sample of both migraine and nonmigraine headache sufferers. Methods. Using a clinically validated telephone interview, a population-based sample of migraine and nonmigraine headache sufferers was identified in Baltimore, Maryland, USA. A total of 97 migraine cases and 80 nonmigraine subjects completed the MIDAS questionnaire on two occasions an average of 3 weeks apart. The MIDAS score is derived from five questions about missed time from work (or school) and household work (one question each about missed days and days with at least 50% reduced productivity) and missed days of nonwork activities. Results. Among all headache sufferers die test–retest Spearman's correlations of individual MIDAS questions ranged from 0.67 to 0.73. The Spearman's correlation for the MIDAS score (i.e., sum of lost days and reduced effectiveness days in each domain) was 0.84. Cronbach's alpha, a measure of internal consistency, was 0.83. Mean and median item values and the overall MIDAS scores differed between migraine and nonmigraine cases. Even after adjusting for differences in headache frequency, the mean MIDAS scores differed substantially (i.e., 10.3 points) between migraine cases and nonmigraine cases. Conclusions. The reliability and internal consistency of the MIDAS score are high, as tested in a population-based sample of headache sufferers. MIDAS scores are substantially higher in migraine cases than in nonmigraine cases, supporting the validity of the measure.
The Cortical Silent Period is Shortened in Migraine with Aura
Authors: Aurora SK , Al-Sayeed F , Welch KMA 
Published: March 2003

Objectives: Central neuronal hyperexcitability may be the physiological disturbance that predisposes subjects to migraine attacks. To test this hypothesis, we studied the cortical stimulation silent period (CSSP) elicited by transcranial magnetic stimulation (TMS), which is in part a measure of central inhibition of motor pathways in migraine with aura (MwA) patients and normal controls. Methods: In nine MwA patients (mean age 35.9 ± 7) and 9 controls (mean age 37.6 ± 7), we carried out transcranial stimulation using a 95 mm circular coil and Caldwell MES 10 stimulator to determine resting motor threshold (MT) for bilateral FDI muscles. All subjects performed isometric voluntary contraction of bilateral FDI maintained at 20% of maximal effort, during which we measured bilateral CSSP at (i) the stimulus intensity (SI) determined for the MT and (ii) an SI of 1.5 x MT. Results: Although the mean MT was higher in MwA compared with controls (63.1 ± 14.4 vs 58.1 ± 8.9), the difference was not significant. At an SI of 1.5 x MT the mean CSSP did not differ between the groups (MwA 141.7 ± 31.9 vs controls 162.4 ± 36.6). At the SI of the MT, however, the CSSP was shorter in MwA patients than in controls (62.9 ± 27.3 vs 106.3 ± 19.6, p=0.001). There was an inverse correlation between the duration of CSSP and an increased frequency of headache ( p=0.02). Conclusions: The shortened CSSP that we measured in MWA patients compared to normal with low intensity magnetic stimulation suggests reduced central inhibition resulting in increased excitability of cortical neurons in migraine subjects. The association of CSSP reduction with increased frequency of migraine is further suggestive that brain excitability is the basis of susceptibility to migraine attacks.
Are the Periodic Changes of Neurophysiological Parameters During the Pain-Free Interval in Migraine Related to Abnormal Orienting Activity?
Authors: Siniatchkin M , Gerber W-D , Kropp P , Voznesenskaya T , Vein AM 
Published: March 2003

Objective and methods Migraine patients are characterized by increased amplitude and reduced habituation of contingent negative variation (CNV). Furthermore, the CNV underlies periodic changes during the pain-free interval, being maximal before attack. The periodicity of CNV is related to periodic changes in habituation, probably due to variation of orienting activity during the pain-free interval. CNV and orienting response (OR) were studied in 20 females suffering from migraine without aura and in 12 matched healthy females. The neurophysiological recordings in the group of patients were performed 1–4 days before and 4 days after a migraine attack. The amplitudes and habituation of early and late components and total CNV were calculated. The OR was assessed using the habituation of the skin conductance response (SCR) and alpha blocking (AB). The non-parametric tests were employed for statistical analysis. Results There were no differences between the two groups for habituation of all CNV components and of SCR following an attack. However, the habituation of AB was significantly reduced in migraine. Before attack we observed a significantly reduced habituation of the early and total CNV and of the AB compared to controls and recordings performed after an attack. The habituation of the late component and of SCR remained unchanged. Conclusions The abnormal habituation could be explained by the periodic changes of physiological parameters during the pain-free interval. The impaired habituation of early CNV in migraine is associated with increased orienting activity seen only in the central component (AB) of OR.
Oral Contraceptives and Stroke
Authors: Bousser M-G , Kittner S J 
Published: March 2003

Since 1962, more than 25 studies have been devoted to the relationship between oral contraceptives and stroke. They are all case-control or cohort epidemiological studies and thus contain the difficulties and biases that are inherent in these types of studies. The following conclusions can be drawn from these studies: High oestrogen content (≥ 50 μg) increases the risk of stroke, all stroke subtypes, and stroke death. Low oestrogen content (< 50 μg) carries a very low or no risk of stroke. There are no data on progestogen only oral contraceptives. Stroke risk is greatly increased if associated risk factors are present, in particular hypertension, cigarette smoking and migraine. Oral contraceptives, even at low doses, significantly increase the risk of cerebral venous thrombosis, which is further enhanced if congenital thrombophilia is present. The attributable risk of stroke in young women using oral contraceptives is about 1 per 200 000 woman-years. The contraceptive and non-contraceptive benefits of low dose oral contraceptives vastly outweigh their risks provided that other risk factors are absent or well controlled.
The health log: developing a health monitoring tool for people with learning disabilities within a community support agency
Authors: Curtice Lisa , Long Linda 
Published: March 2003

SummaryThe health log developed by Sense Scotland is a confidential hand‐held record of personal health information. It aims to assist the individual with complex communication difficulties to achieve improvements in health and well‐being. A secondary aim is to provide good information for healthcare professionals. The present paper describes the development of the log as part of a process to identify and respond to health needs as an integral part of person‐centred planning within a community support agency. Changes to the log, training, and plans for sharing and disseminating information about health management have been developed in response to feedback from staff. There is a need to increase awareness of the shared responsibility to promote good health throughout the networks of support providers in the community, to develop health monitoring systems to share information between health and social care providers, and to exchange good practice.
Makaton peer tutoring evaluation: 10 years on
Authors: Hooper Helen , Walker Margaret 
Published: March 2003

SummaryThe present paper describes an audit of the work of 164 Makaton peer tutors working in 23 establishments in England, Scotland and Wales. Questionnaires were sent to managers, Makaton peer tutors and facilitators (i.e. day centre staff, speech and language therapists, and teachers). The purpose of this study was to examine the effect of the Makaton peer tutoring scheme on the communication skills of all those involved. In addition, information was obtained from all participants about how the scheme had affected them, and what they thought had contributed to its success or failure. Sixteen establishments reported that the scheme had not only contributed to an increase in communication and the effectiveness of interaction, but that it had also resulted in an increase in self‐esteem, confidence and assertiveness. Out of those establishments which had stopped using the Makaton peer tutoring scheme, the loss of the facilitator was the most common cause.
Attention deficit hyperactivity disorder and mild learning disabilities: a case study
Authors: Young Susan , Newland John 
Published: March 2003

SummaryThe pervasive use of ‘challenging behaviour’ as an explanatory concept has precluded the development of alternative ways of construing the actions of people with learning disabilities. Moreover, possession of a challenging behaviour label has facilitated the segregation of individuals into specialist service provision. The present case study illustrates how an inclusive account can be developed using concepts from mainstream psychological activity. The development of alternative accounts also has implications for the design of interventions. It is argued that the process of developing alternative accounts may ultimately result in the redundancy of ‘challenging behaviour’ as an explanatory concept.
Thermodynamic study of capillary pressure curves based on free energy minimization
Authors: Deng Y. , Lake L. W. 
Published: March 2003

AbstractThis paper presents a new method for pore level network simulation of the distribution of two immiscible phases in a permeable medium. The method requires that the Helmholtz free energy of the system — the medium and the two phases contained within the pore space — be a minimum at all saturation states. We describe the method here and show some typical results from a computer algorithm that implements it. The results include (i) an explanation of the ‘scanning’ behaviour of capillary pressure curves based wholly on the free energy minimization, (ii) predictions of capillary pressure at arbitrary wetting states, including negative capillary pressures, and (iii) illustrations of how the minimized free energy changes along the scanning curves. The method also predicts the known dependency of the capillary pressure on the pore size distribution and interfacial tension. The current work is restricted to two‐dimensional networks, but the free energy minimization appears to be generalizable to three dimensions and to more than two fluid phases. Moreover, functions generated through the minimization, specifically contact areas between the medium surface and the phases, appear to have applications predicting other multiphase petrophysical properties.