Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Pharmacological prophylaxis of chronic migraine: a review of double-blind placebo-controlled trials.
Chronic migraine is an important public health problem. The aim of treatment should be to reduce migraine frequency and its negative impact on functioning, as well as to limit the use of acute medications. ⋯ The results of the review indicate that tizanidine, gabapentin, valproic acid, and particularly topiramate are effective prophylactics against chronic migraine, with improvements in several endpoints that were significantly superior to those achieved by placebo. However, the different results found by different trials, as well as several methodological problems inherent in the trials, suggest the need for further research to provide clear indications from large, multicentre, controlled trials with homogeneous inclusion criteria and adequate endpoints.
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Obsessive compulsive disorder is a highly disabling pathological condition which in the most severe and drug-resistant form can severely impair social, cognitive and interpersonal functioning. Deep-brain stimulation has been demonstrated to be an effective and safe interventional procedure in such refractory forms in selected cases. We here report the first Italian experience in the treatment of this pathology by means of nucleus accumbens stimulation, pointing out to some technical data which could be of help in localization of the target.
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The transesophageal echocardiography (TEE) and contrast-enhanced transcranial Doppler/Duplex ultrasonography (ceTCD) are complementary methods for diagnosing a right to left shunt across a patent foramen ovale. We report on a case of paradoxical embolism across a subclavian arterial-venous fistula. This case underlines the necessity of performing the ceTCD, as in this condition the right to left shunt could be detected by means of ceTCD, whereas the TEE reveals regular findings.
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The needle contact test (NCT) is a diagnostic technique useful to identify, through the contact of the needle on the skin of the ear, the most efficacious points for reducing pain during a migraine attack. The aim of this study was to identify the most important auricular zones for pain control by applying the NCT in a group of 15 women during a unilateral attack of migraine without aura. ⋯ The insertion of a semi-permanent needle in these zones allowed stable control of the migraine pain, which occurred within 30 min and persisted at the same levels 24 h later (ANOVA for repeated measures: p < 0.01). Pain was tested by using a visual analogue scale; the values recorded were the following: 7.6 +/- 1.6 at baseline and 4.3 +/- 1.7; 4.1 +/- 1.9; 3.9 +/- 1.8; 3.4 +/- 1.8; 2.3 +/- 1.6 after, respectively, 15, 30, 60, 120 min and 24 h.
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The aim of this study is to identify the pathophysiology of migraine attack with prolonged aura (between 1 h and 7 days) not clearly understood. We studied cortical cerebral microcirculation by an innovative near infrared spectroscopy system (NIRS) and cerebral macrocirculation by transcranial Doppler (TCD) in eight subjects (3 M and 5 F, age range 21-41 years) during spontaneous prolonged migraine aura and after 1, 2, 4, 6, 12 and 24 h since the end of aura and compared the results with the headache-free periods. During aura NIRS showed a significant decrease of the arterial pulse wave of cerebral microcirculation (APWCM) amplitude (-35%), p < 0.002, and an increase of cerebral tissue oxygen saturation (SctO(2)) (+15%), p < 0.008 ipsilateral to the headache pain and contralateral to the symptoms of aura compared with the headache-free periods; TCD showed a significant increase of pulsatility index (+38%), p < 0.001 and a significant decrease of the diastolic velocity in the posterior and middle cerebral artery ipsilateral to the headache pain and contralateral to the symptoms of aura compared with the headache-free periods. During prolonged migraine aura we found areas of cortical hypoperfusion corresponding to the topography of aura symptoms that were the result of a decreased metabolic demand rather than ischemic mechanism.