[Personality changes in chronic daily headache: a study in the general population]

BACKGROUND AND AIMS

The prevalence and type of personality disorders in unselected patients with chronic daily headache (CDH) are unknown. The aim of this study was to analyze the personality profile of patients with CHD is the general population.

PATIENTS AND METHODS

Eighty-nine patients with CDH taken from a sample of 1,883 unselected subjects from the general population completed the EPQ-A (Eysenck Personality Questionnaire-Adult).

RESULTS

Sixty percent of the patients with CDH presented a personality profile with high values in the scales measuring both the neurotic component (N scales) and the psychotic component (P scale). No significant differences were observed in the percentage of patients with high scores in these scales according to the diagnoses of transformed migraine (TM) or chronic tension headache (CTH). However, the percentage of questionnaires with high or not adapted scores was significantly greater in the patients abusing of analgesic drugs than is the non-abusers (82% versus 53%). With regard to the personality profile, we found a greater, but not significant, percentage of patients with CDH with a high grade of neuroticism in comparison with psychoticism (52% versus 36%). There were no significant differences in the personality profile between the two main subgroups of CCH, TM and CTC: 56% of the patients with TM showed high grade of neuroticism and 47% psychoticism versus 52% and 30%, respectively in the case of the patients with CTC. Sixty-eight percent of the analgesic abusers presented neurotic features and 50% psychotic features versus 47% and 32%, respectively, for the non abusers.

CONCLUSIONS

There is a high percentage of subjects with CDH in the general population who present high scores in the scales measuring the two basic components of the personality, such as neuroticism and psychoticism. This personality profile is still found more frequently in patients presenting symptomatic medication abuse.

Explicit and implicit memory biases in depression and panic disorder

The purpose of the present study was to investigate the presence of a bias for emotional information (panic-related, depression-related, positive and neutral) in explicit memory and implicit memory (by means of free recall and word-stem completion tasks, respectively) among depressed (N=20) and panic (N=20) patients. Three different encoding conditions (graphemic, semantic and self-reference) were used. The results of this study failed to show the existence of a mood-congruent memory bias for both implicit and explicit memory in these emotional disorders. According to the correlational analyses performed, differences among categories of emotional words meant less than the difference among various types of encoding and memory bias in order to differentiate among groups.

Almotriptan: pharmacological differences and clinical results

In this manuscript we review the key basic and clinical data of almotriptan, the new selective 5-HT(1B/D) agonist developed for the symptomatc treatment of migraine. Among triptans, almotriptan has the highest oral bioavailability, with more than two-thirds of the administered dose absorbed within the first hourboth inside and outside a migraine attack. Gender or the presence of food in the stomach do not influence this pharmacokinetic profile, and its clean metabolism results in no relevant interactions with other medications. The dose exhibiting the best efficacy/ tolerability ratio is 12.5 mg. Efficacy parameters with this dose are very comparable to those of sumatriptan 100 mg, with a recurrence rate in the lower range. The tolerability of almotriptan is similar to that for placebo. The incidence of chest symptoms is very low (<1%), even though this drug remains contraindicated in patients with ischaemic cardiomyopathy. In summary, almotriptan's promising basic profile together with its excellent tolerability/safety profile and good efficacy confirm this new 5-HT(1B/D) agonist as a drug of choice for the symptomatic treatment of migraine attacks.

Structure of the PHD zinc finger from human Williams-Beuren syndrome transcription factor

The PHD (plant homeo domain) is a approximately 50-residue motif found mainly in proteins involved in eukaryotic transcription regulation. The characteristic sequence feature is a conserved Cys(4)-HisCys(3) zinc binding motif. We have determined the solution structure of the PHD motif from the human Williams-Beuren syndrome transcription factor (WSTF) protein. The domain folds into an interleaved zinc finger which binds two Zn(2+) in a similar manner to that of the RING and FYVE domains. The structure reveals a conserved zinc-binding core, together with two variable loops that are likely candidates for interactions between the various PHD domains and their specific ligands.

Alternating hemiplegia of childhood: no mutations in the familial hemiplegic migraine CACNA1A gene

INTRODUCTION

Alternating hemiplegia of childhood (AHC) is a rare disorder mainly characterized by attacks of hemiplegia and mental retardation. It has been often associated with migraine. The CACNA1A gene on chromosome 19 is involved in familial hemiplegic migraine and other episodic cerebral disorders, but also with progressive neuronal damage.

METHODS

We performed mutation analysis in this gene in four AHC patients, using single strand conformation polymorphism analysis.

RESULTS

We found nine polymorphisms, but no mutations in any of the 47 exons.

CONCLUSIONS

Other cerebral ion channel genes remain candidate genes for AHC.

Non-seasonality of births in Tierra del Fuego (Chile)

Tierra del Fuego is situated at the southern tip of the American continent, which conditions its environmental and climatic characteristics. The colonizing population arrived, at the end of the 19th century, from other Chilean regions (particularly from Chiloé) and diverse European countries, especially Britain and Croatia, but also Germany, Spain and Italy. In the present study, the existence of a seasonal pattern in 5430 births registered in the Chilean population of Tierra del Fuego from 1890 to 1995 was analysed. The analysis showed no seasonal distribution of births in the periods 1890-1920 and from 1946 to the present day, a phenomenon rarely reported in the literature. The absence of seasonality in birth distribution could be related to the great diversity in the origins of the population's families, the constant renovation of this and the declining importance of the administrative capital of the province of Tierra del Fuego, Porvenir, in favour of Punta Arenas, capital of the Magellanic region. In the period of maximum development of the capital of the province, a seasonal pattern was detected with a peak in April and a trough in October, which corresponds with a maximum of conceptions in July and, in general, during the early southern winter and a decline in births from late spring to mid-summer, with a trough in January. This birth distribution is interpreted as a subordination of activity and social life to the annual sheep cycle. In addition to temporal trends, the influence on the observed patterns of environmental parameters, father's occupation, seasonality of marriage and the origin of the parents were analysed.

Birth seasonality in the early Spanish-Mexican colonists of California (1769-1898)

The pattern of birth seasonality in California's early Spanish-Mexican colonists between 1769 and 1898 was reconstructed using genealogical data for progeny of 657 marriages. The monthly distribution of the 3,824 births in this sample shows a strong seasonal pattern, with spring and fall peaks (corresponding to peaks in conceptions during July and February) and a low point in October. This seasonal reproductive pattern is the result of a complicated set of interactions among environmental, physiological, and cultural variables. California's strongly developed winter rainfall pattern and the 19th-century agricultural cycle clearly influenced the seasonal pattern of marriages and births in this agrarian society. Several historical processes interacted with these environmental and economic factors to transform the seasonal birth pattern of the early colonists. Through time the birth pattern becomes less variable and the birth maximum shifts from spring to early winter. This appears to be, at least in part, a result of changes in labor patterns and an increase in average parity. These data suggest a multifactorial explanation for birth seasonality, in which the timing of conceptions and births is influenced by both environmental and socioeconomic factors.

Patterns of sulfadiazine acute nephrotoxicity

Sulfadiazine acute nephrotoxicity is reviving specially because of its use in toxoplasmosis in HIV-positive patients. We report 4 cases, one of them in a previously healthy person. Under treatment with sulfadiazine they developed oliguria, abdominal pain, renal failure and showed multiple radiolucent renal calculi in echography. All patients recovered their previous normal renal function after adequate hydration and alcalinization. A nephrostomy tube had to be placed in one of the patients for ureteral lithiasis in a single functional kidney. None of them needed dialysis or a renal biopsy because of a typical benign course. Treatment with sulfadiazine requires exquisite control of renal function, an increase in water ingestion and possibly the alcalinization of the urine. We communicate a case in a previously healthy person, a fact not found in the recent literature. Probably many more cases are not detected. We think that a prospective study would be useful.

Consistent efficacy and tolerability of almotriptan in the acute treatment of multiple migraine attacks: results of a large, randomized, double-blind, placebo-controlled study

In this double-blind study, the efficacy and tolerability of a single dose of almotriptan (6.25 or 12.5 mg) was compared with placebo in the treatment of three consecutive migraine attacks of moderate or severe intensity. Of 1013 randomized patients, 722 evaluable patients completed the study. The total number of attacks relieved (severe or moderate pain reduced to mild or no pain) at 2 h post-dose was significantly higher (P < 0.001) after treatment with almotriptan 6.25 or 12.5 mg compared with placebo (60% and 70% vs. 38%, respectively). Moreover, a consistent response was achieved across and within patients for almotriptan 6.25 or 12.5 mg compared with placebo (pain relief in at least two out of three attacks within 2 h for 64% and 75% vs. 36%, respectively) and less than one-third of the patients relapsed within 24 h. Almotriptan was well tolerated with no significant differences between the almotriptan and placebo treatment groups in the percentage of patients reporting adverse events. Overall, the 12.5-mg dose was associated with the most favourable efficacy/tolerability ratio and is, therefore, the recommended dose.

Comparison of rizatriptan 10 mg vs. zolmitriptan 2.5 mg in the acute treatment of migraine. Rizatriptan-Zolmitriptan Study Group

The efficacy and tolerability of rizatriptan (MAXALT) and zolmitriptan (ZOMIG) were compared in a randomized, double-blind, double-dummy, stratified (on prior use of rizatriptan and/or zolmitriptan), placebo-controlled, single attack study in 766 patients. Rizatriptan tended to provide freedom from pain sooner than zolmitriptan (hazard ratio 1.26, P = 0.075), acting within 60 min following dosing. More patients were pain free at 2 h on rizatriptan than on zolmitriptan (43.2% vs. 35.6%, P=0.041), while headache relief at 2 h was similar (70.5% vs. 66.8%). At 2 h, fewer patients on rizatriptan had symptoms of photophobia (35.6% vs. 43.5%, P = 0.029) and nausea (25.2% vs. 32.5%, P=0.046), and more patients on rizatriptan had normal function (45.4% vs. 37.0%, P=0.025) than zolmitriptan. Headache recurred in 28% of patients taking rizatriptan, 29% taking zolmitriptan and 26% taking placebo. Both active treatments were effective compared to placebo and were well tolerated. The most common side-effects with rizatriptan were asthenia/fatigue, somnolence and dizziness, while the most common side-effects with zolmitriptan were asthenia/fatigue and dizziness.

Modeling cyclooxygenase inhibition. Implication of active site hydration on the selectivity of ketoprofen analogues

Molecular modeling studies performed on the two cyclooxygenase isozymes (COXs) suggest that active site hydration is crucial for understanding inhibitor selectivity. In this work, models have been constructed considering some implicit water molecules, placed in the position suggested by GRID, that participate in the dynamic hydrogen-bonding network at the polar active site entrance together with protein residues 355, 524, 120, and 513. The selectivity observed for ketoprofen (1) and the structural analogues 2 and 3 may be rationalized in terms of such implicit hydration.

Synthesis and pharmacological evaluation of new 4-2-(7-heterocyclemethoxynaftalen-2-ylmethoxy)ethylbenzoic acids as LTD(4)-antagonists

A group of new 4-[2-(7-heterocyclemethoxynaftalen-2-ylmethoxy)ethyl]benzoic acids have been synthesized and pharmacologically evaluated as LTD(4)-antagonists. Thiazole derivatives, especially 4-[2-[7-(4-cyclobutylthiazole-2-ylmethoxyl)naphthalen- 2-ylmetho-xy]et hyl]benzoic acid, present considerable activity and improved pharmacokinetic profiles in comparison with our quinoline containing lead molecule confirming the interest of our compounds as potentially oral antiasthmatics and that the 4-alkylthiazole system can be considered as bioisosteric of the quinoline ring at least in our series of compounds.

Derivation of pharmacophore and CoMFA models for leukotriene D(4) receptor antagonists of the quinolinyl(bridged)aryl series

The present work focuses on the study of the three-dimensional (3D) structural requirements for the leukotriene D(4) (LTD(4)) antagonistic activity of compounds having the basic quinolinyl(bridged)aryl framework. An approach combining pharmacophore mapping, molecule alignment, and CoMFA models was used to derive a hypothesis for a series of LTD(4) antagonists having the basic diaryl-bridged framework. In this compound series, the produced pharmacophore hypotheses have shown to yield molecule alignments suitable to derive valuable CoMFA models. Model selection focused on (1) obtention of coherent modeling results, (2) consistency with the available SAR data, and (3) ability to predict the activity of an independent set of congeneric molecules. This approach resulted in a combined pharmacophore and CoMFA model that can generally represent the antagonistic activity within a log unit of the measured value for compounds of the series. The resulting pharmacophore (model C) consists of an acidic or negative ionizable function (AC), a hydrogen-bond acceptor (HBA), and three hydrophobic regions (HY) and produces chemically meaningful alignments with the most active compounds of the series mapping the pharmacophore in a extended energetically favorable conformation.

Loss of dopamine uptake sites and dopamine D2 receptors in striatonigral degeneration

To explore the mechanisms underlying L-dopa response, we studied, by postmortem autoradiography, selective makers of dopamine presynaptic terminals, [3H]WIN 35428, and dopamine D2 receptors, [3H]nemonapride, in the putamen of four Parkinson's disease (PD) and one striatonigral degeneration (SND) neuropathologically confirmed brains as compared with six matched control brains. Dopamine uptake transporter was dramatically decreased (> 90%) both in PD and SND striatum. Dopamine D2 receptors were preserved in PD, but clearly reduced (> 76%) in the SND putamen. These data confirm that L-dopa response is closely associated with the preservation of striatal dopamine D2 receptors.

Ergotamine in the acute treatment of migraine: a review and European consensus

Ergotamine has been used in clinical practice for the acute treatment of migraine for over 50 years, but there has been little agreement on its place in clinical practice. An expert group from Europe reviewed the pre-clinical and clinical data on ergotamine as it relates to the treatment of migraine. From this review, specific suggestions for the patient groups and appropriate use of ergotamine have been agreed. In essence, ergotamine, from a medical perspective, is the drug of choice in a limited number of migraine sufferers who have infrequent or long duration headaches and are likely to comply with dosing restrictions. For most migraine sufferers requiring a specific anti-migraine treatment, a triptan is generally a better option from both an efficacy and side-effect perspective.

Hypertension control in the elderly with amlodipine

Treatment of hypertension in the elderly reduces the incidence of cardiovascular events. Some classes of antihypertensive drugs, including long-acting dihydropyridine calcium channel blockers such as amlodipine, can be prescribed in the presence of comorbid conditions. The results of clinical trials support the use of long-acting dihydropyridine calcium channel blockers in the elderly; amlodipine has been shown to be effective and well tolerated in the elderly population.

Antiproteinuric effect of calcium antagonists on puromycin-induced experimental nephrosis

Calcium antagonists have a potential for beneficial effects on kidney function unrelated to their antihypertensive action. In this study we have investigated the efficacy of calcium antagonists compounds (verapamil, nifedipine and diltiazem) on reversible acute renal insufficiency, proteinuria and interstitial nephritis induced by the puromycin ammonucleoside (PAN). An increase in blood pressure (BP) was detected on day 14, with no statistical differences in the response to calcium antagonists. Serum creatinine concentration increased to 1.2 mg/dL on day 7 after PAN and decreased to 0.7 mg/dL at 14 days, calcium antagonists shortened the time required to reach baseline or control levels. Calcium antagonists also reduced proteinuria in the PAN-treated animals, in both day 7 and day 14. Differential effects of the antagonists were observed. Verapamil caused a greater reduction (p < 0.01) in proteinuria than nifedipine or diltiazem in day 7. Moreover, verapamil (p < 0.01) and nifedipine (p < 0.01) reduced the total number of interstitial infiltrating leukocytes from 690 to 120 and 425 positive cells/20 high power fields (x63) respectively, by contrast, diltiazem had no effect. We conclude that in this model of PAN nephropathy verapamil is more effective in reducing both proteinuria and the severity of acute interstitial nephritis than either nifedipine or diltiazem. The possible clinical implications of these results remain to be elucidated.