bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac Risk Factors and the Use of Triptans: A Survey Study
Authors: Young William B. , Mannix Lisa , Adelman James U. , Shechter Aaron L. 
Published: March 2003

Objective.—To describe current practice in triptan use. Background.—Triptans are effective migraine treatments that cause chest symptoms in some patients. True cardiac ischemia is rare. Design.—Headache specialists and family practitioners completed questionnaires regarding the times when triptans are contraindicated, obtaining electrocardiograms (ECGs), and giving the first dose in the office. Results.—Sixty‐five headache specialists and 67 family practitioners responded. Headache specialists saw an average of 36.3 patients with headache per week. Family practitioners saw an average of 7.2. Family practitioners and headache specialists had similar opinions regarding the age at which triptans were contraindicated with various numbers of risk factors. Sixty‐one percent of headache specialists and 50% of family practitioners would not use a triptan at any age for patients with more than three risk factors (P = NS). Ten percent of headache specialists obtained an ECG for all patients being prescribed triptans, while no family practitioners did (P = .008). Ten percent of both family practitioners and headache specialists never obtained an ECG, even with multiple cardiac risk factors. Headache specialists obtained ECGs more often than family practitioners (P < .002 for one to three risk factors). Family practitioners were more likely to give the first dose of the triptan in the office regardless of cardiovascular risk (58% versus 20%, P < .001). Forty‐five percent of headache specialists and 2% of family practitioners never gave the first dose in the office (P < .001). Family practitioners gave the first dose in the office more readily than headache specialists in patients with no risk factors (P = .001), but not for one or more risk factors. Conclusions.—No consensus exists among family practitioners or headache specialists about when to avoid using a triptan due to excessive cardiac risk factors, when to obtain an ECG prior to using a triptan, and when to give the first dose of a triptan in the office. Headache specialists are more likely to obtain ECGs, whereas family practitioners are more likely to give the first dose of a triptan in the office.
Triptans in the Treatment of Basilar Migraine and Migraine With Prolonged Aura
Authors: Klapper J. , Mathew N. , Nett R. 
Published: March 2003

Objective.—To report on the use of triptans in migraine with prominent neurologic symptoms.Background.—As stated in their package inserts, the triptans are contraindicated in patients with basilar or familial hemiplegic migraine, and physicians are reluctant to prescribe these drugs to other patients with prominent or prolonged aura.Methods.—We evaluated 13 patients with basilar migraine, familial hemiplegic migraine, or migraine with prominent or prolonged aura who had received triptans.Results.—Excellent; no adverse events.Conclusion.—The contraindication of triptans in basilar migraine should be reconsidered. Similarly, prominent or prolonged aura may not represent a reasonable contraindication to triptan therapy.
Visual Cortex Excitability in Migraine With and Without Aura
Authors: Mulleners Wim M. , Chronicle Edward P. , Palmer Joanne E. , Koehler Peter J. , Vredeveld Jan‐Willem 
Published: March 2003

Objectives.—Previous research using transcranial magnetic stimulation has produced equivocal findings concerning thresholds for the generation of visual phosphenes in migraine with aura. These studies were methodologically varied and did not systematically address cortical excitability in migraine without aura. We therefore studied magnetophosphene thresholds in both migraine with aura and migraine without aura compared with headache‐free controls.Methods.—Sixteen subjects with migraine with aura and 12 subjects with migraine without aura were studied and compared with 16 sex‐ and age‐matched controls. Using a standardized transcranial magnetic stimulation protocol of the occipital cortex, we assessed the threshold stimulation intensity at which subjects just perceived phosphenes via a method of alternating course and fine‐tuning of stimulator output.Results.—There were no significant differences across groups in the proportion of subjects seeing phosphenes. However, the mean threshold at which phosphenes were reported was significantly lower in both migraine groups (migraine with aura=47%, migraine without aura=46%) than in controls (66%). Moreover, there was no significant correlation between individual phosphene threshold and the time interval to the closest migraine attack.Conclusion.—Our findings confirm that the occipital cortex is hyperexcitable in the migraine interictum, both in migraine with and without aura.
Migraine With Aura After Administration of Sublingual Nitroglycerin Tablets
Authors: Bánk J. 
Published: March 2003

As a nitric oxide donor, nitroglycerin can trigger migraine in migraineurs. The headache is not characteristically accompanied by an aura.A patient with no personal or family history of migraine reported the development of a typical visual aura and a throbbing headache while using nitroglycerin for angina pectoris.The possible mechanisms are discussed.
Migraine with Aura Versus Migraine Without Aura: Pain Intensity and Associated Symptom Intensities After Placebo
Authors: Bigal Marcelo E. , Bordini Carlos A. , Sheftell Fred D. , Speciali José G. , Bigal Janaína O. M. 
Published: March 2003

Objective.—To compare the intensity of pain and associated symptoms after placebo administration in patients with migraine with aura and migraine without aura.Background.—Studies that evaluate drugs used in the acute treatment of migraine ideally should include a placebo arm. The International Headache Society also recommends stratification according to age and sex but not by the presence versus absence of aura.Methods.—The study was conducted as part of a placebo controlled randomized survey comparing four active drugs against placebo in the acute treatment of migraine. Patients were blinded as to treatment received. Placebo consisted of 10 mL of normal saline (0.9%) intravenously. Pain intensity was evaluated by a 10‐point analogical‐verbal scale. Nausea, photophobia, and phonophobia were evaluated by a four‐point analogical‐verbal scale. For statistical analysis, unpaired t‐test with Welch correction was used.Results.—After placebo administration, reduction of symptom intensity (pain, nausea, photophobia, and phonophobia) in patients with migraine without aura was significantly greater than that observed in patients with migraine with aura.Conclusions.—Our findings suggest that studies comparing placebo against an active drug should use stratification according to the presence versus absence of aura.
Almotriptan Increases Pain‐Free Status in Patients With Acute Migraine Treated in Placebo‐Controlled Clinical Trials
Authors: Mathew Ninan T. 
Published: March 2003

Objectives.—Evaluate the efficacy of a single oral dose of almotriptan in achieving pain‐free status during treatment of acute migraine attacks.Methods.—This pooled analysis (N=1321) used data from two randomized, placebo‐controlled, phase III trials (studies A and B) to determine the proportion of patients with migraine achieving pain‐free status 2 hours after a single oral dose of study medication (almotriptan or placebo). Pain was assessed using a 4‐point integer scale (0=no headache, 3=severe headache), and recorded in a patient self‐assessment booklet.Results.—The proportion of patients pain‐free at 2 hours after study medication was significantly greater with almotriptan 6.25 mg (both studies P≤.002) and almotriptan 12.5 mg (both studies P≤.001) than with placebo. In study A, 11.6% of patients taking almotriptan 12.5 mg versus 2.5% of patients receiving placebo were pain‐free at 1 hour (P=.016). At 1.5 hours, 26.8% of patients taking almotriptan 12.5 mg versus 8.8% receiving placebo (P=.001) were pain‐free, and at 2 hours, 38.4% on almotriptan versus 11.3% on placebo were pain‐free (P<.001). In study B, 23.8% of patients taking almotriptan 12.5 mg were free from pain at 1.5 hours versus 10.2% receiving placebo (P<.001). At 2 hours, 39.2% taking almotriptan 12.5 mg versus 15.3% receiving placebo were pain‐free (P<.001). Increases in pain‐free status with almotriptan generally occurred in a dose‐dependent manner.Conclusion.—Compared with placebo, almotriptan 12.5 mg significantly increases the proportion of patients who are pain‐free by as early as 1 hour, and consistently by 1.5 hours, after a single dose.
Status Epilepticus and Tiagabine Therapy: Review of Safety Data and Epidemiologic Comparisons
Authors: Shinnar Shlomo , Berg Anne T. , Treiman David M. , Hauser W. Allen , Hesdorffer Dale C. , Sackellares J. Chris , Leppik Ilo , Sillanpaa Matti , Sommerville Kenneth W. 
Published: March 2003

Summary:  Purpose: To determine whether an increased risk of status epilepticus (SE) and complex partial status epilepticus (CPSE) is associated with tiagabine (TGB) therapy.Methods: Thirteen cases in which an EEG, performed on patients with altered mental status taking TGB, was reported to demonstrate spike‐and‐wave discharges (SWDs) were reviewed by a panel of experts. In addition, all cases of suspected SE from TGB clinical trials were reviewed. The occurrence of SE in four epidemiologic cohorts from Rochester, Minnesota, Turku, Finland, Bronx, New York, and New Haven, Connecticut was analyzed as an external comparison.Results: Review of the 13 cases with reported SWDs found that the majority had had prior EEGs with similar findings, and only three were thought to have electrographic evidence of SE. There was no difference in the frequency of SE or CPSE in the placebo‐controlled clinical trials between the TGB‐treated (1.0% SE, 0.8% CPSE) and placebo‐treated (1.5% SE, 1.5% CPSE) groups. The 5% frequency of SE and 3% frequency of CPSE in the TGB‐treated patients in the long‐term safety studies, which included 2,248 patients, were very similar to the rates of occurrence of SE and CPSE in the four external cohorts. The major risk factor for the occurrence of SE and CPSE in all groups was a prior episode of SE (p < 0.0001).Conclusions: Over a 3‐year period, SE will occur in 5–10% of patients with epilepsy not in remission. At highest risk are those who have had a prior episode of SE. Treatment with TGB in recommended doses does not increase the risk of SE in patients with partial seizures.
Absence Seizures Aggravated by Valproic Acid
Authors: Lerman‐Sagie Tally , Watemberg Nathan , Kramer Uri , Shahar Eli , Lerman Pinchas 
Published: March 2003

Summary: Purpose:To report on pediatric patients with absence epilepsy who experienced absence seizure aggravation while receiving valproic acid (VPA).Methods:The charts of all children from four pediatric epilepsy clinics receiving VPA for absence epilepsy were reviewed. Patients were evaluated and followed up between 1994 and 2000.Results:Eight cases (six boys) of absence seizure aggravation were detected. Mean age at seizure onset was 5.8 years (range, 3–12 years). Six patients had simple absence seizures, one had myoclonic absences, and one had absences with automatisms. The electroencephalogram in all cases depicted generalized 3‐Hz spike‐and‐wave activities. All eight patients experienced an increase in the frequency of absence seizures within days of VPA introduction. Dose increments resulted in further seizure aggravation. Serum levels of VPA were within therapeutic range in all patients. No case was attributed to VPA‐induced encephalopathy. All patients improved on VPA discontinuation. In five children, VPA was reintroduced, resulting in further seizure aggravation.Conclusions:VPA can occasionally provoke absence seizure aggravation in patients with absence epilepsy.
Remission of Seizures in a Population‐Based Adult Cohort with a Newly Diagnosed Unprovoked Epileptic Seizure
Authors: Lindsten Hans , Stenlund Hans , Forsgren Lars 
Published: March 2003

Summary: Purpose: To investigate the probability of achieving remission of seizures after a newly diagnosed unprovoked epileptic seizure in an adult population‐based cohort.Methods: 107 patients aged 17 years or older with a newly diagnosed unprovoked epileptic seizure (index seizure) in 1985 through 1987 were followed up until the date of death or to the end of 1996. The proportion of cases during follow‐up that attained a 1‐year, 3‐year, 5‐year remission was calculated by actuarial analyses. Variables for stratification were age at diagnosis, seizure type, etiology, EEG, and the occurrence of seizures within 1 year of initiation of antiepileptic drug (AED) therapy.Results: Cumulative 1‐, 3‐ and 5‐year remission rates were 68, 64, and 58%. There was no statistically significant difference regarding time points of achieving a 1‐year remission after epilepsy diagnosis and the subsequent probability during follow‐up of attaining a 5‐year remission. Having seizures within 1 year after beginning with an AED was a statistically significant predictor of never achieving 1‐year remission of seizures during follow‐up (refractory seizures). Other stratified variables were not statistically significant predictors.Conclusions: Seizure prognosis for the majority of patients with newly diagnosed epilepsy is good. The time required after epilepsy diagnosis to achieve a 1‐year remission of seizures does not affect the probability of additionally achieving a 5‐year remission. Patients with refractory seizures can be identified within a few years from diagnosis of epilepsy. These patients must be targeted early for optimization of pharmacologic treatment, possible surgery, and psychosocial intervention.
Psychosocial Adjustment of People with Epilepsy in Hong Kong
Authors: Lau Vanessa W. Y. , Lee Tatia M. C. , Ng Philip K. K. , Wong Virginia C. N. 
Published: March 2003

Summary:  Purpose: In light of the issues associated with the psychosocial adjustment of people with epilepsy that have been widely reported, this study examined these issues within a Chinese cultural context.Methods: Fifty patients with epilepsy completed The Washington Psychosocial Inventory, the Coping Inventory for Stressful Situations, and a questionnaire that assessed their psychosocial difficulties and coping styles. Multiple regression procedure was used to examine the strength of various medical and social factors in predicting the psychosocial adjustment problems of these participants.Results: Social factors, such as self‐perception and coping strategies, were more powerful predictors of psychosocial adjustment in people with epilepsy than the medical factors associated with epilepsy.Conclusions: These findings showed that psychosocial maladjustment is a significant issue for people with epilepsy in Hong Kong. The emerging importance of social factors as predictors of psychosocial adjustment in epilepsy, as compared with medical factors, highlights the need for developing tailored counseling therapy and social support groups for people with epilepsy.
Circulating Levels of Allopregnanolone, an Anticonvulsant Metabolite of Progesterone, in Women with Partial Epilepsy in the Postcritical Phase
Authors: Galli Renato , Luisi Michele , Pizzanelli Chiara , Monteleone Patrizia , Casarosa Elena , Iudice Alfonso , Murri Luigi 
Published: March 2003

Summary:  Purpose: Several lines of evidence indicate that there exists a relation between ovarian hormones and epilepsy. Estrogens decrease seizure threshold and increase brain excitability, whereas progesterone has an inhibitory effect and reduces epileptiform activity. Recently considerable interest has turned to neuroactive steroids, a group of progesterone metabolites, as endogenous modulators of excitability of the central nervous system (CNS). Their ability to alter neuronal firing rapidly occurs through interaction with γ‐aminobutyric acid (GABA) A receptor complex. In a previous experience, serum allopregnanolone (3α‐OH‐5α‐pregnan‐20‐one) levels were measured in 15 women with partial epilepsy in the intercritical phase, and no significant differences were found between patients and control subjects.Methods: To find out if there are changes in serum allopregnanolone levels after epileptic seizure, blood samples were drawn immediately, 15 min, and 6 h after a seizure in seven fertile females with partial epilepsy.Results: The most interesting finding is that allopregnanolone increases in serum during the first 15 min after partial seizures (p < 0.05) and decreases after 6 h.Conclusions: These data are consistent with a role for allopregnanolone in the control of neuronal excitability and seizures.
Transplacental Passage of Oxcarbazepine and Its Metabolites In Vivo
Authors: Myllynen P. , Pienimäki P. , Jouppila P. , Vähäkangas K. 
Published: March 2003

Summary:  Purpose: The purpose of this study was to investigate human fetal exposure to oxcarbazepine (OCBZ) in vivo.Methods: Transplacental passage and placental tissue concentrations of OCBZ and its metabolites were determined. Maternal venous blood, cord blood, and placental tissue samples from 12 mothers using OCBZ during pregnancy alone or in combination with other antiepileptic drugs were collected. Samples were analyzed with high‐performance liquid chromatography.Results: Maternal venous concentrations of OCBZ and its major metabolites were at same range as cord blood concentrations (OCBZ in maternal serum, 0.19 ± 0.16 μg/ml, and in cord serum, 0.21 ± 0.19 μg/ml; 10‐hydroxy‐10,11‐dihydrocarbamazepine (10‐OH‐CBZ) in maternal serum, 5.69 ± 2.49 μg/ml, and in cord serum, 5.23 ± 1.44 μg/ml; 10,11‐trans‐dihydroxy‐10,11‐dihydrocarbamazepine (10,11‐D) in maternal serum, 0.29 ± 0.22 μg/ml, and in cord serum, 0.28 ± 0.14 μg/ml). OCBZ (0.17 ± 0.16 μg/g placental tissue), 10‐OH‐CBZ (3.49 ± 1.34 μg/g placental tissue) and 10,11‐D (0.25 ± 0.11 μg/g placental tissue) were detected in the placental tissue. The amount of OCBZ detected from placental tissue was 0.01% of the daily dose.Conclusions: OCBZ, like other antiepileptic drugss, is transferred significantly through the placenta in humans.
Pharyngeal Dysesthesias as an Aura in Temporal Lobe Epilepsy Associated with Amygdalar Pathology
Authors: Garganis K. , Papadimitriou C. , Gymnopoulos K. , Milonas J. 
Published: March 2003

Summary:  Purpose: Pharyngeal dysesthetic auras are typically described with centrotemporal and opercular seizure‐onset localizations. In this report we describe the fourth case in literature with temporal lobe seizures, apparently secondary to an amygdalar lesion on magnetic resonance imaging (MRI), presenting with prominent pharyngeal dysesthesias as the initial, or only, seizure manifestation.Methods: Because of diagnostic uncertainty regarding the nature of the pharyngeal sensations, our case underwent prolonged extracranial video‐EEG monitoring.Results: Video‐EEG information documented the epileptic origin of the dysesthesias and was concordant with the side and location of the amygdalar lesion.Conclusions: Pharyngeal dysesthetic auras may be produced by epileptic activity originating from the amygdala, and perhaps other mediotemporal structures. The underlying topography of this aura is not known with certainty, and it may reflect seizure spread from the amygdala and adjacent areas to the closely interconnected insular and opercular cortex, whose secondary activation could elicit similar sensations.
Hot Water Epilepsy: Clinical and Electrophysiologic Findings Based on 21 Cases
Authors: Bebek Nerses , Gürses Candan , Gokyigit Aysen , Baykan Betul , Ozkara Cigdem , Dervent Aysin 
Published: March 2003

Summary:  Purpose: Our aim is to outline the clinical and electroencephalographic (EEG) features of patients with hot water epilepsy (HWE), a rare and unique form of reflex epilepsy.Methods: Twenty‐one patients with HWE, seen in our clinic until 1999, were studied. Male outnumbered female subjects in a ratio of 3:1. The age at the onset of seizures ranged from 19 months to 27 years (mean age at onset, 12 years).Results: The main factors precipitating seizures were bathing with hot water and/or pouring water over the head. Six patients reported self‐induction, either by increasing the heat or the amount of water and/or recalling earlier bathing experiences. Nine patients expressed feeling pleasure during the seizures. Twenty patients had partial seizures, eight of whom also had secondarily generalized seizures. One patient had apparent generalized seizures only. Spontaneous seizures were present in 62% of the cases. Interictal epileptogenic abnormalities were documented in the EEGs of eight patients; the other eight had normal EEGs. The major sites of epileptogenic activity were over the unilateral temporal regions (in 40% of patients). Neuroimaging studies available for 12 patients (four cranial computed tomography and eight cranial magnetic resonance imaging scans) revealed normal findings. Seizure control in patients who were followed up was achieved by reducing the temperature or the duration of the bath or shower; several of the patients required medication.Conclusions: The major findings of this study are that HWE has a male preponderance, can be self‐induced, is often done for pleasure, has complex triggering factors, and shows temporally located abnormalities in the EEGs. Although HWE is generally known to be self‐limited, antiepileptic drug treatment may sometimes be necessary to control seizures. Hot water epilepsy should be classified separately among the epileptic syndromes.
Acetazolamide in Women with Catamenial Epilepsy
Authors: Lim Li‐Ling , Foldvary Nancy , Mascha Ed , Lee Julia 
Published: March 2003

Summary:  Purpose: Catamenial epilepsy is a condition characterized by an increase in seizures during particular phases of the menstrual cycle. The incidence of catamenial epilepsy varies widely, partly because of a lack of a universally adopted definition. Specific treatment options for these patients are limited. The use of acetazolamide (AZ) has been based largely on anecdotal reports demonstrating efficacy in small or poorly characterized populations. The purpose of this study was to analyze retrospectively the efficacy, safety profile, and tolerability of AZ in women with catamenial epilepsy.Methods: Women with catamenial epilepsy identified from 1990 through 1999 were invited to participate in a retrospective telephone questionnaire addressing the relationship of seizures and the menstrual cycle and the use, efficacy, and adverse effects of AZ. Seizure outcome was classified as: seizure free (SF), significantly improved (SI), or not significantly improved (NSI). Responses to AZ were compared in women with different types of epilepsy and comparing continuous versus intermittent dosing using Fisher's exact tests.Results: Twenty women were identified who had received or were currently taking AZ. The drug was given continuously in 55% and intermittently in 45% of patients. A ≥50% decrease in the seizure frequency was reported by 40% of subjects. Response rates were similar in generalized and focal epilepsy and in temporal and extratemporal epilepsy. There was no significant difference in effectiveness comparing continuous with intermittent dosing. A loss of efficacy over 6–24 months was reported by 15% of women.Conclusions: Despite our small sample and retrospective design, AZ appears to demonstrate efficacy for catamenial epilepsy.