bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapid and Sensitive Paradigm for Screening Patients With Headache in Primary Care Settings
Authors: Maizels Morris , Burchette Raoul 
Published: May 2003

Objective.—To determine the sensitivity and specificity of a brief headache screening paradigm for primary care clinicians.Background.—Migraine and drug rebound headache are disabling primary headache disorders. Both are underdiagnosed and undertreated. A method for rapid screening of migraine, drug rebound headache, and other daily headache syndromes would be useful. The Brief Headache Screen uses 3 questions—the frequency of severe (disabling) headache, other (mild) headache, and use of symptomatic medication—to generate diagnoses.Methods.—The Brief Headache Screen was evaluated in an emergency department, a family practice department, and a referral headache clinic. Diagnoses from the Brief Headache Screen were compared to diagnoses of trained researchers and headache specialists.Results.—Three hundred ninety‐nine patients were screened and interviewed. The criterion of episodic severe (disabling) headache correctly identified migraine in 136 (93%) of 146 patients with episodic migraine and 154 (78%) of 197 patients with chronic migraine, with a specificity for any migraine (episodic or chronic) of 32 (63%) of 51. The inclusion of episodic or daily severe headache identified migraine in 100% of patients with chronic migraine. Only 6 (1.7%) of 343 patients with migraine were not identified by severe (disabling) headache. The combination of severe and mild headache frequency was sensitive to daily headache syndromes in 218 (94%) of 232 patients with a specificity of 87 (54%) of 162. Medication overuse was correctly identified in 146 (86%) of 169 patients with a specificity of 22 (79%) of 28.Conclusion.—The frequency of severe (disabling) and mild headaches and use of symptomatic medications, rapidly and sensitively screens for migraine, daily headache syndromes, and medication overuse. The use of this paradigm in primary care settings may improve the recognition of these important headache syndromes.
Normalization of High Interictal Cerebrovascular Reactivity in Migraine Without Aura by Treatment With Flunarizine
Authors: Dora Babür , Balkan Sevin , Tercan Evren 
Published: May 2003

Background.—Modification of migraine‐associated cerebrovascular reactivity may provide insight into the mechanism of action of a given therapeutic intervention.Methods.—With transcranial Doppler and a breath‐holding index, cerebrovascular reactivity to hypercapnia was evaluated in 20 patients with migraine without aura interictally and in 11 healthy controls. Patients were started on prophylactic treatment with flunarizine 10 mg per day, and measurements were repeated at the end of every month for 3 months. Headache status was evaluated clinically via a headache index. Headache index; breath‐holding index; systolic, diastolic, and mean blood flow velocities; and pulsatility index measurements were recorded at every session.Results.—The baseline breath‐holding index was significantly higher in the migraine group compared to the control group (P  =  .002). No difference in other parameters was found between the groups. The change in the headache index was significant (P<.001), indicating a beneficial effect from flunarizine. The breath‐holding index improved significantly after treatment (P<.001), and the baseline difference in the breath‐holding index between the pretreatment migraine group and the control group was no longer evident at 3 months. There was no significant change with treatment in the other transcranial Doppler parameters.Conclusion.—Our finding of unchanged blood flow velocities but normalized cerebrovascular reactivity after treatment suggests that the mechanism of action of flunarizine in migraine does not involve a vasodilatory effect on cerebral vessels. It may be instead that flunarizine modifies cerebrovascular reactivity through its action on centrally located structures that subserve autonomic vascular control.
Migraine Prevalence During Menopausal Transition
Authors: Wang Shuu‐Jiun , Fuh Jong‐Ling , Lu Shiang‐Ru , Juang Kai‐Dih , Wang Peng‐Hui 
Published: May 2003

Background.—The effect of menopausal transition on the frequency of migraine has never been the focus of a community‐based study.Methods.—A cross‐sectional community‐based survey was undertaken among Chinese women aged 40 to 54 years in Kinmen, Taiwan. Neurologists diagnosed migraine based on the 1988 International Headache Society classification criteria. Menstrual history including a past or current history of premenstrual syndrome was obtained. Serum levels of estradiol and follicle‐stimulating hormone were measured.Results.—The 1‐year prevalence of migraine was 16.5% in the 1436 participants. Among the women who had not had hysterectomies and did not report symptoms of premenstrual syndrome, migraine prevalence did not vary according to menopausal status. In contrast, in women with self‐reported premenstrual syndrome, menopausal status was a factor in migraine prevalence: the late perimenopausal group had the highest prevalence (31%) and the spontaneous menopausal group had the lowest (7%). Among all menopausal groups, women who had had hysterectomies reported the highest migraine prevalence (27%), with the highest occurring in those with premenstrual syndrome (44%). The presence of low estrogen (<50 pg/mL) and high follicle‐stimulating hormone levels (>30 mIU/mL) was associated with lower migraine prevalence, even in the premenopausal and early perimenopausal women.Conclusions.—Our data supported the clinical impression that migraine prevalence increases before menopause and declines after spontaneous menopause. However, in this study, this trend occurred only in women with increased vulnerability to hormonal change, such as those with premenstrual syndrome. The presence of low estrogen and high follicle‐stimulating hormone levels predicted lower migraine prevalence, whereas a history of hysterectomy was related to higher prevalence.
Naratriptan in the Preventive Treatment of Refractory Chronic Migraine: A Review of 27 Cases
Authors: Rapoport Alan M. , Bigal Marcelo E. , Volcy Michel , Sheftell Fred D. , Feleppa Michele , Tepper Stewart J. 
Published: May 2003

Objective.—To review the efficacy of naratriptan as preventive treatment in 27 patients with chronic migraine refractory to other commonly used preventive therapies.Background.—The treatment of chronic migraine often poses a major challenge to the clinician. Even when given expert care, patients with chronic migraine may continue to have daily or near‐daily headaches.Methods.—Clinical records and headache calendars were reviewed of 27 patients fulfilling the following inclusion criteria: (1) aged 18 to 65 years; (2) diagnosis of chronic migraine (formerly transformed migraine), according to the criteria proposed by Silberstein et al; (3) previous failure of at least 4 preventive medications prescribed as part of a management program that included nonpharmacological measures, preventive medication, acute care medication, and detoxification from overused medication; and (4) have used daily naratriptan for no less than 2 consecutive months. The dose of naratriptan prescribed was 2.5 mg twice daily. We considered the following outcomes: (1) frequency of headache, (2) intensity of pain, (3) number of days per month with severe headache, (4) headache index (frequency times intensity), and (5) proportion of patients who reverted to an episodic pattern of pain after 6 months of treatment.Results.—There was a statistically significant reduction in the frequency of headache days 2 months (15.3 days versus 24.1 days at baseline, P<.001), 6 months (9.1 days, P<.001), and 1 year (7.3 days, P<.001) after daily treatment with naratriptan was initiated. There was also a statistically significant reduction in the number of days per month of severe pain at 1 month (5.6 days versus 12.5 days at baseline, P<.01), 2 months (5.7 days, P<.01), 6 months (2.8 days, P<.01), and 1 year (2.6 days, P<.01). Similarly, there was a statistically significant reduction in the headache index at 2 months (33 versus 56.4 at baseline, P<.001), 6 months (19.5, P<.001), and 1 year (17.2, P<.001).Of the 20 patients who continued to use naratriptan daily for at least 6 months, 13 (65%) reverted to an episodic pattern of pain (migraine). At 1 year, 11 (55%) still continued to experience episodic headache, 1 (5%) relapsed to chronic migraine, and 2 (10%) were lost to follow‐up. No patients had intolerability to naratriptan during the treatment period, and no one stopped treatment due to adverse events.Conclusion.—Naratriptan may have a role in the preventive treatment of intractable chronic migraine. Prospective, controlled studies should be considered.
Transformation Into Daily Migraine With Aura Following Transcutaneous Atrial Septal Defect Closure
Authors: Yankovsky A. E. , Kuritzky A. 
Published: May 2003

A link between migraine with aura and cardiac right‐to‐left shunting has been previously reported. Abortion or decreased frequency of migraine with aura attacks after atrial septal defect closure has been reported in the literature. We report the first case of transformation of migraine with aura into a daily pattern after atrial septal defect closure.A 48‐year‐old male who had been suffering from rather infrequent attacks of migraine with sensory and visual aura underwent transcutaneous closure of an atrial septal defect. His migraine attacks changed into a daily pattern the day following the procedure and remained so for 6 months. This change in pattern may be related to a changed intra‐atrial pressure after the closure or some other unknown factor.
Seizure Characterization and Electroencephalographic Features in Glut‐1 Deficiency Syndrome
Authors: Leary Linda D. , Wang Dong , Nordli Douglas R. , Engelstad Kristin , De Vivo Darryl C. 
Published: May 2003

Summary: Purpose:To characterize seizure types and electroencephalographic features of glucose transporter type 1 deficiency syndrome (Glut‐1 DS).Methods:Twenty children with clinical and laboratory features of Glut‐1 DS were evaluated. Age at seizure diagnosis, seizure classification, and response to treatment were determined by chart review. Thirty‐two continuous 24‐h EEG monitoring sessions and reports of 42 routine EEG studies were assessed.Results:Age at seizure diagnosis was between 4 weeks and 18 months (mean, 5 months). Seizure types were generalized tonic or clonic(14), absence(10), partial (nine), myoclonic (six), or astatic (four). During 24‐h EEGs, background activity showed generalized 2.5‐ to 4‐Hz spike–wave discharges (41%), generalized slowing or attenuation (34%), no abnormalities (34%), focal epileptiform discharges (13%), or focal slowing or attenuation (9%). No seizures were captured during 69% of the studies; the remainder had absence (19%), myoclonic (9%), or partial seizures (3%). On evaluation of routine and 24‐h EEG studies, focal epileptiform discharges (24%) and slowing (11%) were more frequent in ages 0–24 months. In older children (2–8 years), generalized epileptiform discharges (37.5%) and slowing (21%) were more common.Conclusions:In all ages, a normal interictal EEG was the most common EEG finding. When abnormalities occurred, focal slowing or epileptiform discharges were more prevalent in the infant. In older children (2 years or older), a generalized 2.5‐ to 4‐Hz spike–wave pattern emerged. Seizure types observed included, absence, myoclonic, partial, and astatic.
Topiramate and Psychiatric Adverse Events in Patients with Epilepsy
Authors: Mula Marco , Trimble Michael R. , Lhatoo Samden D. , Sander Josemir W. A. S. 
Published: May 2003

Summary:  Purpose: The aim of this study was to determine the prevalence of psychiatric adverse events (PAEs) in patients with epilepsy treated with topiramate (TPM). Classification, relation to TPM dosing, and outcome were evaluated to identify a patient profile at risk of developing PAEs.Methods: We evaluated the data of the first consecutive and prospectively collected patients in therapy with TPM.Results: Follow‐up information was available for 431 patients. PAEs occurred in 103 (23.9%) patients; M/F ratio, 55:48; mean age (±SD), 36.5 ± 11.2. In 46 (10.7%) patients, an affective disorder developed; in 16 (3.7%), a psychotic disorder; in 24 (5.6%), aggressive behavior with or without irritability; in 17 (3.9%), other behavior abnormalities such as agitated behavior, anger/hostility behavior, or anxiety. High starting dose and rapid titration schedule were relevant for the development of PAEs. Family psychiatric history and family history of epilepsy, personal history of febrile convulsions, psychiatric history, and presence of tonic–atonic seizures were found to be significant risk factors. Low seizure frequency before starting TPM and TPM/lamotrigine coadministration had a protective effect for PAEs.Conclusions: We found that PAEs associated with TPM were related to the titration schedule of the drug and that a unique patient profile is suggested by the clinical history.
Effects of Valproic Acid, Carbamazepine, and Phenobarbitone on the Fatty Acid Composition of Erythrocyte Membranes in Children
Authors: König Stephan A. , Knolle Julia , Friedewald Steffen , Koelfen Wolfgang , Longin Elke , Lenz Tamara , Hannak Dieter 
Published: May 2003

Summary:  Purpose: To investigate a possible relation between antiepileptic drugs (AEDs) and the fatty acid composition of membranes.Methods: Fatty acid (FA) composition of erythrocytes was studied in children with epilepsy receiving AED monotherapy. Children taking valproate (VPA, n = 28), carbamazepine (CBZ, n = 17), or phenobarbitone (PB, n = 14) were compared with healthy controls (n = 25). FAs were measured by capillary‐gas chromatography (GC‐FID).Results: Significant changes (p < 0.05) in the FA composition of membranes were found. In children treated with VPA, C13:0 was decreased (8.2 ± 2% vs. 10.7 ± 4% in controls) and C14:0 increased (1.4 ± 0.5% vs.1 ± 0.5% in controls). C17:0 again was reduced (9.9 ± 4% vs. 13.2 ± 6% in controls), whereas the long‐chained acids were enhanced: C18:2n‐6 (6 ± 2.4% vs. 3.9 ± 2.5% in controls), and C20:4n‐6 (1.9 ± 1.7% vs. 1.4 ± 0.5% in controls). The nonidentified FAs also increased with VPA therapy: 2.5 ± 0.8% versus 1.7 ± 0.9% in controls. Children treated with CBZ showed only minimal changes of FA composition: C13:0 was decreased compared with controls (8 ± 2% vs. 10.7 ± 4%). No changes were seen in patients taking PB. The mean corpuscular volume (MCV) showed important differences between the study groups: MCV was 84.7 ± 6.0 fl during VPA therapy (p < 0.001) and 85.7 ± 4.1 fl with CBZ (p < 0.001). During PB, the MCV increased to 82.87 ± 3.29 fl compared with controls (78.73 ± 4.92 fl; p < 0.01).Conclusions: VPA therapy is associated with changes of the FA composition of membranes, which is not the case with PB therapy. The implications of this finding remain to be established.
Epileptic Spasms and Partial Seizures as a Single Ictal Event
Authors: Pachatz Christa , Fusco Lucia , Vigevano Federico 
Published: May 2003

Summary:  Purpose: To investigate the phenomenon of epileptic spasms (ESs) associated with other seizure types in a single ictal event and to study the predictive value of this phenomenon regarding etiology and prognosis.Methods: We selected retrospectively eight female and five male patients, who had ESs and other seizure types within a single seizure event and for whom a video‐EEG recording of the phenomenon was performed in at least one situation.Results: The seizure type associated with ESs was a partial seizure in all patients. We identified three groups with different seizure patterns regarding the temporal association of ES and partial seizures (PSs): (a) PS followed by ES; (b) PS appearing during a cluster of ESs without interrupting the cluster; and (c) complex seizure interaction with a succession of ESs and PSs in a close but variable temporal association. Underlying disorders included cortical dysplasia (three patients), complex cerebral malformations (two patients), and perinatal anoxic–ischemic injuries (two patients); four cases were classified as cryptogenic, and in two children, etiology was unknown, but prenatal origin was suspected. Outcome was poor in nine cases with intractable epilepsy; four cases had a favorable outcome, defined as complete cessation of epileptic seizures.Conclusions: The phenomenon of associated ESs and PSs as a single ictal event can be related to different etiologies and should not be considered distinctive for cortical malformations or severe brain damage. Different seizure patterns of associated ESs and PSs provide no hint for etiology or prognosis. Outcome is prevalently but not constantly unfavorable in patients with the phenomenon.
EEG‐related Functional MRI in Benign Childhood Epilepsy with Centrotemporal Spikes
Authors: Boor Stephan , Vucurevic Goran , Pfleiderer Christian , Stoeter Peter , Kutschke Georg , Boor Rainer 
Published: May 2003

Abstract:The localization of epileptic foci is an important issue in children with extratemporal epilepsies. However, the value of noninvasive methods such as the EEG‐assisted functional magnetic resonance imaging (fMRI) has not been sufficiently investigated in children.As a model of extratemporal epilepsies, we studied 7 patients aged 5 to 12 (median 10) years with benign childhood epilepsy and centrotemporal (rolandic) spikes. Interictal spikes were recorded during the fMRI acquisition on a MR‐compatible battery‐powered digital EEG system with 16 channels. The fMRI sequences were correlated off‐line with the EEG spikes and analyzed with the software Statistical Parametrical Mapping SPM99.The fMRI results demonstrated the spike‐related activation in the perisylvian central region in three patients; we could not demonstrate fMRI activation despite active spiking in 2 patients, and 2 patients did not produce sufficient spikes for fMRI analysis. We currently consider the spike‐related fMRI as a research tool that localizes epileptic activity in selected patients. Further improvements of the technique are necessary to allow a clinical application of this method.
A Retrospective Analysis of Hippocampal Pathology in Human Temporal Lobe Epilepsy: Evidence for Distinctive Patient Subcategories
Authors: De Lanerolle Nihal C. , Kim Jung H. , Williamson Anne , Spencer Susan S. , Zaveri Hitten P. , Eid Toye , Spencer Dennis D. 
Published: May 2003

Summary:  Purpose: This study is a retrospective analysis of the pathology of the hippocampus from patients with medically intractable temporal lobe epilepsy. We attempted to relate neuronal density, immunohistochemistry, electrophysiologic data, and surgical outcome.Methods: Immunostaining patterns for neuropeptide Y, somatostatin, substance P, and dynorphin defined the immunohistochemical characteristics of the hippocampi. Neuronal densities were determined by microscopic cell counts. Sharp electrode recordings from dentate granule cells determined measures of inhibition and excitation.Results: Patient hippocampi without evidence of sclerosis generally resembled autopsy controls on the basis of neuronal densities of hippocampal subfields and patterns of immunostaining. The nonsclerotic hippocampi were divisible into two subgroups on the basis of neuronal density correlations between hippocampal subfields, the excitability of dentate granule cells, etiology, and surgical outcome. Hippocampi with sclerosis were divisible into those with significant neuronal loss confined to area CA1 and those with neuronal loss throughout the hippocampus and dentate gyrus. In the former, the dentate gyrus resembled in morphology the nonsclerotic hippocampi but with slightly increased excitability of the dentate granule cells. The hippocampi with more extensive neuronal loss had changes in immunostaining patterns associated with the dentate gyrus, correlated with significant hyperexcitability of dentate granule cells. The surgical outcome, with the exception of one group, was good in ∼70–90%.Conclusions: Hippocampi from patients with intractable temporal lobe epilepsy can be assigned to several groups on the basis of pathophysiology. Different pathologies may represent differing causative mechanisms of intractable temporal lobe epilepsy and be predictive of surgical outcome.
Anticonvulsant Effect of Flutamide on Seizures Induced by Pentylenetetrazole: Involvement of Benzodiazepine Receptors
Authors: Ahmadiani Abolhassan , Mandgary Ali , Sayyah Mohammad 
Published: May 2003

Summary:  Purpose: There is some structural similarity between the androgen receptor antagonist, flutamide (Flut) and benzodiazepines (BZDs). We evaluated the possible anticonvulsant effect and interaction of Flut with BZD receptors in common seizure models.Methods: (a) Different groups of mice each were pretreated i.p. with Flut, and after 0.5 h, they received chemoconvulsants [pentylenetetrazole (PTZ), bicuculline, aminophylline, strychnine or kainic acid]. Latency and incidence of a clonic seizure were recorded. (b) Mice were pretreated i.p. with Flut, and after 0.5 h, transauricular electroshock was applied. Occurrence of a tonic seizure was observed. (c) Amygdala‐kindled rats were pretreated i.p. with Flut, and 0.5, 1, or 2 h later, they were stimulated at afterdischarge threshold. Then the seizure parameters (afterdischarge duration, seizure severity, and stage 5 duration) were recorded. (d) The effect of Flut on clonic seizure threshold was determined by i.v. infusion of bicuculline or PTZ to different groups of Flut‐receiving mice. To determine the possible interaction of Flut with BZD receptors, the flumazenil (FMZ)+Flut effect on clonic seizure threshold was compared with the effect of Flut. (e) Neurotoxicity of Flut was evaluated by rotarod test at 30 min after administration.Results: Flut produced a dose‐dependent anticonvulsant effect against PTZ‐induced seizures [median effective dose (ED50), 67.0 mg/kg]. Moreover, Flut elevated the clonic seizure threshold induced by bicuculline or PTZ. FMZ reversed the effect of Flut on the threshold of PTZ seizures. A median toxic dose (TD50) value of 124.8 mg/kg was obtained for Flut.Conclusions: Flut both blocks PTZ‐induced clonic seizures and elevates the threshold of PTZ or bicuculline‐induced clonic seizures, through interaction with BZD receptors.