Alternate finger tapping test in patients with migraine

Neuropsychological Profile in Pediatric Migraine without Aura: A Pilot Study

Despite the high prevalence of headache in developmental age, current reports about its neuropsychological effects are still lacking. The aim of the present pilot study is to assess the neuropsychological skills among children affected by migraine without aura (MwoA). Fifteen children (7M/8F) (mean age 10.73 ± 2.13) with MwoA, consecutively referred to the Center for Childhood Headache at Università degli Studi della Campania “Luigi Vanvitelli”, underwent the Italian version of the NEPSY-2 after cognitive evaluation. Moreover, to assess the pain level and disability grade during daily activity, the VAS and PedMIDAS scales were used. MwoA children were comparable with the control group of 38 children with respect to age, gender, language, and education level. Written informed consent was obtained from all parents and from children directly, when appropriate. MwoA children differed from controls significantly among the NEPSY-2 subscales, with a relevant relationship between the frequency and intensity of the attacks. In conclusion, the results of the present pilot study may suggest that MwoA could impact significantly neuropsychological functioning in children.

Subjective cognitive decline in patients with migraine and its relationship with depression, anxiety, and sleep quality

Background

Cognitive decline is a major concern in patients with migraine. Depression, anxiety, and/or poor sleep quality are well-known comorbidities of migraine, but available evidence on the subjective cognitive decline (SCD) is limited. This study aimed to investigate the presence and frequency of SCD and its relationship with anxiety, depression and sleep quality in patients with migraine.

Methods

We enrolled patients with migraine who scored within the normal range of the Korean-Mini Mental State Examination and the Korean-Montreal Cognitive Assessment. Using the Subjective Cognitive Decline Questionnaire (SCD-Q), participants with ≥7 were assigned to the SCD group. The Headache Impact Test-6, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Pittsburgh Sleep Quality Index were used and analyzed between the two groups.

Results

A total of 188 patients with migraine, aged 38.1 ± 9.9 years, were enrolled. The mean SCD-Q score was 6.5 ± 5.5, and 44.7% of participants were identified as SCD. Migraineurs with SCD reported higher headache pain intensity and headache impact, as well as greater prevalence of anxiety, depression, reduced quality of sleep, and shorter sleep duration during weekdays compared to migraineurs without SCD. There were no significant differences in terms of age, sex, migraine type (chronic/episodic), medication, or sleep duration during weekends between the two groups. Upon multivariate logistic analysis adjusted for age, sex, headache characteristics, and psychological variables, depression was associated with increased risk of SCD (Odds ratio 1.31, 95% confidence interval 1.16–1.49) and sleep duration during weekdays was associated with decreased risk of SCD (Odds ratio 0.66, 95% confidence interval 0.44–0.97).

Conclusions

A non-negligible number of patients with migraine complained of SCD. Depression and short sleep duration during weekdays were related to SCD among adult migraineurs.

Sequential brief neuropsychological evaluation of migraineurs is identical to controls

BACKGROUND

Evidence of attack-related cognitive dysfunction in migraine is growing. Controversy exists on whether cognitive dysfunction, mainly executive, may persist between attacks. Measuring the impact of cognitive function is gaining importance in clinical and research settings in migraine.

OBJECTIVE

To compare the performance of interictal migraine patients to controls in an assembled neuropsychological battery focused on executive functions and to study the practice effect of its repeated applications.

METHOD

Assembly of the battery that was then applied twice within 6 weeks to interictal migraineurs and matched healthy controls.

RESULTS

Migraine patients (n = 24) and controls (n = 24) had similar performance in both applications of the battery. There was a slight practice effect between the first and second evaluation, significant in Stroop Interference test (P = 0.002, multiplicity corrected); a meaningful score change was determined for each raw test scores.

CONCLUSIONS

Interictal migraineurs and controls performance is identical in a brief cognitive battery focused on executive functions. Repeated applications produced a practice effect that was quantified.

Cognitive and Behavioural Effects of Migraine in Childhood and Adolescence

Since cognitive and behavioural characteristics of paediatric migraineurs have yet to be adequately defined, in this study we assessed the effect of migraine on the interictal functioning of children and adolescents by comparing the performance of two patient groups, 17 migraineurs with aura (MA) and 31 without aura (MoA) and by correlating the duration of the disorder, the frequency of attacks and interictal period with neuropsychological and behavioural findings. Both patient groups had cognitive performance within normal range except for a significant delay in the reaction time (RT) task. Both MA and MoA revealed a behavioural phenotype characterized by internalizing problems on Child Behaviour Check List (CBCL) scales. Slower RT to simple visual stimuli may be an early sign of a subclinical neuropsychological dysfunction, significantly correlated with the frequency of headache attacks and interictal period. The lack of a control group and other methodological limitations, such as patient selection bias and unadjusted P-value for multiple testing, make it difficult to give this finding a clearcut meaning. Further studies are needed on larger samples compared with a control group.

Interictal Executive Dysfunction in Migraineurs Without Aura: Relationship With Duration and Intensity of Attacks

Subjects with migraine are at increased risk of subcortical white matter lesions (WML). Reports of cognitive testing in adults with migraine have yielded inconsistent results. We performed a cross-sectional study to assess whether migraine without aura (MwA) is associated with impairment in executive functioning, a typical cognitive correlate of subcortical WML. Forty-five subjects with MwA and 90 controls, matched for age and education, underwent a cognitive battery of tests evaluating executive functions. The following migraine characteristics were collected: age at onset and length of migraine history, and frequency, duration and intensity of attacks. Subjects with MwA performed significantly lower than controls in tests evaluating complex, multifactorial executive functions. After multiple adjustments, the duration and intensity of migraine attacks significantly predicted cognitive disturbances. In the interictal phase of MwA there is evidence of mild executive dysfunction. The cumulative effects of repeated migraine attacks on prefronto-cerebellar loop probably account for our results.

Clinical Utility of the Mig-SCog

BACKGROUND

Mig-SCog is a 9-item questionnaire developed to quantify attack-related cognitive complaints in migraine (M). The items relate to executive function and language, and the total Mig-SCog score is the sum of those scales.

OBJECTIVE

To evaluate the Mig-SCog scores regarding cognitive symptoms during a variety of conditions.

METHODS

We conducted a prospective comparative study of the Mig-SCog scores (1) between migraine and tension-type headache (TTH) patients during a headache; (2) in migraine patients between migraine attacks, non-headache pain and pain-free status; (3) in migraine patients during and outside a migraine attack.

RESULTS

One hundred forty-nine patients (98 M and 51 TTHA). Total Mig-SCog score was higher in migraine patients than TTH (8.0 ± 4.1 vs 3.4 ± 3.2, P < .0001). Sixty-three patients took part in the next part of the study. Migraine patients rated the Mig-SCog higher for migraine (7.9 ± 4.6) than for non-headache pain (2.3 ± 2.9, P < .0006) or pain-free (1.6 ± 2.4, P < .0006). In the final phase of the study, 38 patients Mig-SCog scores were not significantly different whether obtained during or outside an M attack (P = .26).

CONCLUSIONS

Attack-related subjective cognitive symptoms, assessed by Mig-SCog scores, differed between migraine and TTH patients. The Mig-SCog scores from migraine patients were found to be higher during migraine than during non-headache pain or pain-free conditions. Patient scoring from memory for usual attacks was not significantly different to scoring within attacks, We believe this demonstrates negligible recall bias.

Resting state brain activity in patients with migraine: a magnetoencephalography study

Background

Recent advances in migraine research have shown that the cerebral cortex serves a primary role in the pathogenesis of migraine. Since aberrant brain activity in migraine can be noninvasively detected with magnetoencephalography (MEG), The object of this study was to investigate the resting state cortical activity differences between migraineurs and controls and its related clinical characteristics.

Methods

Twenty-two subjects with an acute migraine and twenty-two age- and gender-matched controls were studied using MEG. MEG recordings were recorded 120 seconds during the headache attack. Analyze MEG signals from low (1–4 Hz) to high (200–1000 Hz)-frequency ranges.

Results

In comparison with the controls, brain activity in migraine subjects was significantly different from that of the controls both in two frequency ranges (55–90 Hz, p < 0.001) and (90–200 Hz, p < 0.004). But the power value showed no significantly differences between control and migraines in all frequency ranges (p > 0.05). All the clinical characteristics had no significant correlation with aberrant brain activity.

Conclusions

The results demonstrated that migraine subjects in resting state had significantly aberrant ictal brain activity that can be measured with neuromagnetic imaging techniques. The findings may facilitate the development of new therapeutic strategies in migraine treatment via alterations in cortical excitability with TMS and other medications in the future.

Effects of eye dominance (left vs. right) and cannabis use on intermanual coordination and negative symptoms in schizophrenia patients

Based on the previous findings, it has been assumed that in schizophrenia patients, eye dominance and cannabis use will affect negative symptoms and intermanual coordination (IMC), an index of interhemispheric communication. But eye dominance, specifically the clinical findings for it, has been neglected in schizophrenia research. We therefore investigated its effects in 52 right-handed (36 right-eyed and 16 left-eyed) and 51 left-handed (35 left-eyed and 16 right-eyed) schizophrenia in-patients without and with drug use. Eye dominance affected IMC in all schizophrenia patients. When comparing right- and left-handers, we found that this result was only significant in the right-handed patients and in the smaller subgroup without drug use. In the right-handers, left eye dominance-like left-handedness-was associated with higher values in IMC and less pronounced manifestation of negative symptoms, right eye dominance was not. Thus, left-eyed right-handers may be more closely related to left-handers than to right-handers. In accordance with the results from the literature, we suggest that these findings are due to better interhemispheric connections and less impairment of white matter structures, especially in right-hemispheric regions. Moreover, cannabis use was related to higher scores in IMC and less pronounced negative symptoms, but only in the right-eyed and not in the left-eyed right-handers or in the left-handers. Hence, differences in eye dominance and handedness may be partially responsible for different results in interhemispheric connections among cannabis users. In conclusion, both eye dominance and use of cannabis should be taken into account when assessing clinical symptoms in schizophrenia patients.

Interactions between brain structure and behavior: the corpus callosum and bimanual coordination

Bimanual coordination skills are required for countless everyday activities, such as typing, preparing food, and driving. The corpus callosum (CC) is the major collection of white matter bundles connecting both hemispheres that enables the coordination between the two sides of the body. Principal evidence for this brain-behavior relationship in humans was first provided by research on callosotomy patients, showing that sectioning (parts of) the CC affected interactions between both hands directly. Later, new noninvasive in vivo imaging techniques, such as diffusion tensor imaging, have energized the study of the link between microstructural properties of the CC and bimanual performance in normal volunteers. Here we discuss the principal factors (such as age, pathology and training) that mediate the relationship between specific bimanual functions and distinct anatomical CC subdivisions. More specifically, the question is whether different bimanual task characteristics can be mapped onto functionally distinct CC subregions. We review the current status of this mapping endeavor, and propose future perspectives to inspire research on this unique link between brain structure and behavior.

Neuropsychology of migraine: present status and future directions

Migraine is recognized as a primarily neural condition. Changes in neural physiology have been consistently identified in migraineurs. Numerous studies are available that evaluate physical and functional differences between migraineurs and headache-free controls. The most prominent neuroimaging findings reported in migraine sufferers have been white matter changes. However, physical changes on neuroimaging have not been clearly correlated with functional impairment in migraineurs. The current literature addressing the neuropsychologic consequences of migraine has been far from conclusive, and reports of cognitive testing in adult migraineurs and controls has yielded inconsistent results. Neuropsychologic testing suggests that there may be some subtle but possibly significant changes in cognition that occur both during and between migraine episodes. A finding emerging with some consistency is that migraine patients with aura experience more neuropsychologic deficits than migraine patients without aura. The few studies that assess nonmigraine headache suggest that physical changes may not be unique to migraine, although neuropsychologic changes do appear to be limited to migraineurs. An examination of the unmet needs and priorities for future research addressing this important topic is provided.

Neuromagnetic abnormality of motor cortical activation and phases of headache attacks in childhood migraine

The cerebral cortex serves a primary role in the pathogenesis of migraine. This aberrant brain activation in migraine can be noninvasively detected with magnetoencephalography (MEG). The objective of this study was to investigate the differences in motor cortical activation between attacks (ictal) and pain free intervals (interictal) in children and adolescents with migraine using both low- and high-frequency neuromagnetic signals. Thirty subjects with an acute migraine and 30 subjects with a history of migraine, while pain free, were compared to age- and gender-matched controls using MEG. Motor cortical activation was elicited by a standardized, validated finger-tapping task. Low-frequency brain activation (1∼50 Hz) was analyzed with waveform measurements and high-frequency oscillations (65–150 Hz) were analyzed with wavelet-based beamforming. MEG waveforms showed that the ictal latency of low-frequency brain activation was significantly delayed as compared with controls, while the interictal latency of brain activation was similar to that of controls. The ictal amplitude of low-frequency brain activation was significantly increased as compared with controls, while the interictal amplitude of brain activation was similar to that of controls. The ictal source power of high-frequency oscillations was significantly stronger than that of the controls, while the interictal source power of high-frequency oscillations was significantly weaker than that of controls. The results suggest that aberrant low-frequency brain activation in migraine during a headache attack returned to normal interictally. However, high-frequency oscillations changed from ictal hyper-activation to interictal hypo-activation. Noninvasive assessment of cortical abnormality in migraine with MEG opens a new window for developing novel therapeutic strategies for childhood migraine by maintaining a balanced cortical excitability.

Psychophysiological mechanisms underlying spatial attention in children with primary headache

OBJECTIVE

Neurophysiological studies to evaluate spatial attention in children with primary headache are lacking. Tactile spatial attention modulates the N140 somatosensory evoked potential (SEP) amplitude. The aims of the study are: (1) to investigate the effect of spatial attention on the N140 amplitude in children with migraine and tension-type headache (TTH) and in healthy children, and (2) to correlate the neurophysiological results with a neuropsychological test for spatial attention.

METHODS

We studied 16 patients with migraine without aura (MoA), 12 TTH children and 10 healthy subjects. "Deux Barrage" test for spatial attention was administered. SEPs were recorded in a neutral condition (NC) and in a spatial attention condition (SAC).

RESULTS

No significant differences in neuropsychological measures were found between MoA, TTH and healthy subjects. The N140 amplitude increase during SAC, as compared to NC, was significantly higher in patients than in healthy controls. Migraineurs showed a positive correlation between the N140 amplitude increase during SAC and their neuropsychological performance.

CONCLUSIONS

Although spatial attention performances in children with headache are as good as in controls, the N140 amplitude increase during SAC in headache patients suggests that the psychophysiological mechanisms subtending spatial attention are different from those in healthy children.

Can headache impair intellectual abilities in children? An observational study

BACKGROUND

The purpose of this study was to assess the cognitive functioning of children affected by headache, pinpointing the differences in intelligence style between subjects affected by migraine without aura and subjects with tension-type headache.

METHODS

The study population consisted of 147 children (mean age 10.82 ± 2.17 years) with headache, recruited from the Headache Center for Developmental Age, Child and Adolescent Neuropsychiatry Clinic, Second University of Naples. Cognitive profiling was performed using Weschler Intelligence Scale for Children Third Edition throughout the sample. According to the International Classification of Headache Disorders II criteria for pediatric age, subjects were divided into a migraine without aura group (n = 75; 43 boys, 32 girls) and a tension-type headache group (n = 72; 49 boys, 23 girls). The results were compared with the findings obtained from a sample of 137 healthy control subjects recruited from schools in the Campania region, matched for age and gender.

RESULTS

No difference in full intelligence quotient was found between the groups, but the children with tension-type headache had a lower verbal intelligence quotient and a higher performance intelligence quotient than the healthy controls and children with migraine. Factor analysis data showed that the children with migraine seemed to have lower perceptual organization than the children affected by tension-type headache.

CONCLUSION

To our knowledge, studies on cognitive functioning in children affected by headache in the interictal phase are scarce, and our results suggest a new perspective in understanding of the neuropsychological aspects of young patients affected by headaches.

Neuropsychological functioning in migraine: clinical and research implications

AIM

We review the research literature examining neuropsychological performance in migraine. Findings were organized by neuropsychological construct assessed and results were reported using effect size conventions. Factors considered in explaining results included sample characteristics, migraine factors, and control for non-migraine variables.

FINDINGS

There is weak evidence for deficits in processing speed, attention, verbal memory, verbal skills, working memory, sustained attention, and inhibition in migraine relative to healthy controls. There are mixed results regarding deficits in visual memory, motor dexterity, visuospatial/constructional skills, visual reasoning, and mental flexibility in migraine relative to healthy controls. Mixed findings do not seem to be consistently related to study characteristics or presence of aura; other important migraine factors (such as migraine severity or presence of neuroradiological findings) remain understudied. Relative to non-healthy control groups, however, there is weak evidence for an effect of migraine in any cognitive domain. Longitudinal studies provide little evidence that neuropsychological functioning worsens over time in migraine or that migraine is a risk factor for Alzheimer's disease.

RESEARCH IMPLICATIONS

It remains possible that cognitive dysfunction is seen in only a subset of migraine sufferers, perhaps those with more severe illness or neurological involvement; however, more research is needed to examine this issue. Non-migraine differences among migraine sufferers, including medical and psychiatric comorbidities and variables associated with treatment seeking, may partially account for inconsistent findings and should be evaluated for in future research.

CLINICAL IMPLICATIONS

Clinicians should refer migraine patients for comprehensive neuropsychological evaluation only when there is sufficient evidence for concern. Such evaluations should include consideration of other psychological, neurological, and medical contributors to both migraine and cognitive status.

Attention in children and adolescents with headache

OBJECTIVE

The previous studies reporting consistent visual reaction times slowing in patients with migraine prompted us to verify if headache could be associated to a broader impairment of attention. This study aims to undertake a thorough investigation of attentional performance by extending the evaluation to children with primary headache of different types.

METHODS

We compared 62 children with headache (14 migraineurs with aura, 29 without aura and 19 with tension type headache) and 52 controls without headache, matched for age, sex, and intelligence using Conners' Continuous Performance Test.

RESULTS

The 3 clinical groups did not differ in attentional measures. The headache patients, collapsed in 1 single sample, had mean scores in Hit Reaction Time significantly different from those of controls and also had a higher percentage of atypical scores in 2 indices of the Conners' Continuous Performance Test (faster mean reaction time and more commissions).

CONCLUSIONS

Our results confirm the presence of an association between attentional problems and headache that may impact academic learning and daily activities on the long term. The finding that the 3 clinical groups did not show significant differences in attentional performance supports the hypothesis that migraine and tension headache form a continuum that may share the same pathophysiological mechanisms. These results are discussed considering that neurotransmitters and the cerebral circuits subserving headache, personality profile, and attention could overlap, thus predisposing these children to even mild attention malfunctioning.

Off-line memory consolidation impairments in multiple sclerosis patients receiving high-dose corticosteroid treatment mirror consolidation impairments in depression

BACKGROUND

Sleep supports the consolidation of procedural memory, however patients with major depression show impaired motor memory performance after a night of sleep. It was hypothesized that this impairment is related to hypothalamic-pituitary-adrenal (HPA) axis dysfunction. We tested if high-dose administration of corticosteroids impairs off-line motor memory consolidation in patients with multiple sclerosis (MS).

METHODS

Nine patients with MS receiving high-dose corticosteroid therapy (methylprednisolone) and nine MS patients receiving alternative therapy (mitoxantrone) were assessed using a sequential finger tapping task before and after a night with polysomnography. In addition, nine patients with major depression (MD) receiving antidepressants and nine healthy controls were assessed.

RESULTS

Although the four groups did not differ in practice-dependent learning, healthy subjects and MS patients receiving mitoxantrone showed markedly overnight-improvements in tapping performance of 17% and 24% while MS patients receiving high-dose corticosteroid therapy and depressed patients showed -9% and -10% overnight decrease. MS patients with and without corticosteroid therapy did not differ in their amount of REM sleep, nor did MD patients and healthy controls. In addition, we did not find any correlation between REM sleep and memory consolidation.

CONCLUSION

Our results show that a strong intervention into the HPA system like in MS high-dose corticosteroid therapy impairs off-line motor memory consolidation comparable to the impairments seen in depressed patients. We propose therefore that depression-related changes in plasma corticosteroid levels rather than in sleep per se underlie off-line memory consolidation impairments in MD.

Identification of abnormal neuromagnetic signatures in the motor cortex of adolescent migraine

OBJECTIVE

To investigate the functional abnormalities of the motor cortices in children with migraine using magnetoencephalography (MEG) and a finger-tapping task.

BACKGROUND

Cortical hyperexcitability has been reported in adults with migraine using MEG. Many children with migraine report difficulty with motor functioning. There is no report on motor-evoked magnetic activation in children with migraine using MEG and the latest signal processing methods.

METHODS

Ten children with migraine (all female, 9 right-handed and 1 left-handed, aged 13-17 years) and 10 age- and gender-matched healthy children were studied with a 275-channel MEG system. After hearing a unilateral, randomly presented sound cue (500 Hz, 30 milliseconds square tone), each subject immediately performed a brisk index finger tapping with either the right or the left index finger. The auditory stimuli consisted of 200 trials of square tone, 100 trials per ear, randomly distributed. The latency and amplitude of neuromagnetic responses were analyzed with averaged waveforms. Neuromagnetic sources were estimated using synthetic aperture magnetometry (SAM). SAM images were normalized for each participant for group comparison.

RESULTS

In comparison with healthy children, children with migraine had prolonged latency of motor-evoked magnetic response in the right hemispheres during left finger movement (62.33 +/- 34.55 milliseconds vs 34.9 +/- 17.29 milliseconds, P < .05). In addition, children with migraine had stronger activation in the motor cortex during right finger movement (8097.46 +/- 5168.99 vs 4697.54 +/- 3194.74, P < .05).

CONCLUSIONS

The results suggest that there are neurophysiological changes in the motor cortices of children with migraine that can be measured with neuromagnetic imaging techniques. The findings expand the ability to study the cerebral mechanisms of migraine using MEG and may facilitate the development of new therapeutic strategies in migraine treatment via alterations in cortical excitability.

Headache and cognitive profile in children: a cross-sectional controlled study

We investigated whether children affected by tension-type headache and migraine without aura, compared with a healthy control group that was matched by age, culturally and socioeconomically display a diverse intellectual functioning and have a separate “cognitive profile”. A cross-sectional study was conducted from January 2006 to November 2008 at “Sapienza University” in Rome. A total of 134 children were diagnosed as being affected by either migraine without aura (93) or tension-type headache (41). On the basis of our exclusion/inclusion criteria, we enrolled 82 of these 134 children, 63 of whom were affected by migraine without aura and 19 by tension-type headache. On entry, cognitive functions were assessed in both the affected subjects and the control group by the Wechsler Intelligence Scale for Children-revised. Significant differences were found between the headache and control groups in the mean total intelligence quotient and verbal intelligence quotient scores (p < 0.001). Significant negative correlations were found between the total intelligence quotient, verbal intelligence quotient, performance intelligence quotient and the frequency of attacks (r = −0.55 and p < 0.001, r = −0.61 and p < 0.001, r = −0.29 and p < 0.01, respectively), as well as between the total intelligence quotient score and the age at headache onset (r = 0.234, p < 0.05). Our results suggest that the cognitive profile of children affected by headache should be assessed at the first child neurology outpatient observation. From a therapeutic point of view, although within a normal range, the abilities most likely to be less brilliant in such children are verbal skills.

Brain lesions and cerebral functional impairment in migraine patients

Migraine is an independent risk factor for ischemic stroke, mainly in the subpopulation of women with migraine with aura who are younger than 45 years, particularly those that use estrogen containing oral contraceptives. Migraine however should be considered a benign condition as the absolute increase of stroke risk is small. Migraine is also associated with a high prevalence of cerebral white matter hyperintensities, occurring in the deep and periventricular white matter as well as infratentorial, mainly pontine. The pathogenesis and clinical significance of these hyperintensities is unclear. We do not know whether migraine may be considered a progressive disorder in a subset of patients because of accumulation of these hyperintensities over time. Studies on the relationship between migraine and cognitive functioning yielded conflicting results. Two recent studies have provided reassuring news for the migraine patient. A population-based twin study showed that a lifetime migraine diagnosis was not associated with cognitive deficits in middle-aged subjects. A long-term prospective study, assessing cognitive and memory changes in ageing individuals with and without a history of migraine, showed that migraineurs do not exhibit more decline on cognitive tests over time versus controls. Migraine is certainly not a recognized risk factor for (vascular) dementia.

Prolonged response times characterize cognitive performance in multiple sclerosis

Cognitive impairment is amongst the main symptoms affecting multiple sclerosis (MS) and should be comprehensively and accurately assessed. To study the added value of a computerized neuropsychological battery enabling the measurement of response times in the cognitive domains, 58 randomly selected MS patients and 71 age-, gender- and education-matched healthy subjects were evaluated. Construct and discriminant validity were assessed for the standard Neuropsychological Screening Battery for Multiple Sclerosis (NSBMS) and the Mindstreams Computerized Cognitive Battery (MCCB). The MCCB demonstrated good construct validity in comparison with the NSBMS in memory (P < 0.001), executive function (P < 0.001), attention (P < 0.05) and information processing (P < 0.05) domains. In addition, it showed high discriminant validity most prominently for executive function, attention and motor skills (P < 0.001). Response times measured by the computerized battery were longer in all cognitive domains and varied with cognitive load, demonstrating that response time deficits in MS are associated with particular task demands. We conclude that in MS prolonged response times on a range of cognitive tasks signify abnormal conduction within demyelinative tracts.

The Neuropsychology of Recurrent Headache

Headache is recognized as one of the most prevalent neurological disorders, and is the most frequently reported symptom following injury to the head, brain, or neck. Although studies of central nervous system abnormalities in headache sufferers have emerged in recent years, less is known about the associated functional impairments. The research literature addressing neuropsychological consequences of headache has been far from conclusive. Migraine has been most extensively studied, with some consistent evidence of subtle but potentially significant changes in cognition occurring during and between migraine episodes. It also appears likely that migraine patients with aura experience more neuropsychological deficits than those without aura. While the literature devoted to understanding the neurocognitive profile of migraine sufferers is growing, much less research has addressed the neuropsychology of tension-type headache and posttraumatic headache (PTHA). There is some suggestion of poorer neuropsychological function in tension-type headache than controls, but the evidence is inconclusive. The PTHA population is highly varied in degree and location of trauma, preexisting headache condition, and other injury-related variables, allowing little generalization across studies. This paper summarizes research regarding the cognitive symptoms associated with migraine, tension-type headache, and PTHA, provides an overview of the cognitive side effects of headache medications, and addresses clinical implications and priorities for future research.

Callosal function in multiple sclerosis: bimanual motor coordination

Evidence of callosal dysfunction in patients with multiple sclerosis (MS) was examined using a test of bimanual coordination. MS patients were slower than non-patients on the Bimanual Coordination Test (BCT) on both unimanual trials (simple motor speed) and bimanual trials (intermanual coordination). Further, when compared to normals, MS patients exhibited a substantially greater difference between bimanual and unimanual response time, suggesting a deficit in interhemispheric motor interactions. A subgroup of MS subjects who showed markedly inefficient callosal transmission had previously been identified on the basis of abnormal evoked potentials (low amplitude cross-callosal evoked potentials). In comparisons of MS subgroups, the deficit in bimanual motor coordination was found only in MS patients with EP evidence of inefficient callosal transmission. These data support the conclusion that deficits in bimanual motor coordination occur in MS and that these deficits are related to callosal dysfunction.

Memory disturbances in migraine with and without aura: a strategy problem?

Cognitive defects in migraine have been reported by several authors. These findings however, are controversial. In this study we carried out an investigation on 14 patients with migraine with aura and 16 with migraine without aura according to the International Headache Society criteria. They were submitted to a comprehensive battery of neuropsychological tests. The patients were compared with a control group not significantly different as to age, sex and education. Migraine subjects showed impaired neuropsychological performances only on some cognitive tests. Both groups of patients did worse than the control group on visuo-spatial memory tasks, while only migraineurs without aura showed significantly impaired verbal memory performances. The memory defects, both on visuo-spatial and on verbal cognitive tasks, could depend on an impaired recall mechanism. These memory difficulties seem related to strategically and organizationally defective aspects of learning.