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Cristillo V, Pilotto A, Piccinelli SC, Libri I, Locatelli M, Giunta M, Mazzoleni V, Pezzini D, Arici D, Gipponi S, di Cola FS, Cottini E, Gamba M, Magoni M, Padovani A. Neurological disorders throughout acute SARS-CoV2 infection: A comparative study between vaccinated and non-vaccinated patients. J Neurol Sci 2024; 457:122898. [PMID: 38281402 DOI: 10.1016/j.jns.2024.122898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/30/2023] [Accepted: 01/21/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND The role of vaccination on Covid-19 severity in neurological patients is still unknown. We aim at describing clinical characteristics and outcomes of breakthrough and unvaccinated Covid-19 patients hospitalized for neurological disorders. METHODS Two hundred thirty-two Covid-19 patients were admitted to a neuro-Covid Unit form March 1st 2021 to February 28th 2022. Out of the total sample, 74 (32%) were full vaccinated. The prevalence, clinical characteristics, disease severity, expressed by Brescia-COVID Respiratory Severity Scale (BCRSS) and National Early Warning Score 2 (NEWS2), and final outcomes of neurological syndromes were compared between vaccinated and unvaccinated cases. Cox regression analysis was implemented in order to investigate the combined effect of predictors of mortality. RESULTS Breakthrough vaccinated cases were older (years 72.4 ± 16.3 vs 67.0 ± 18.9 years, p = 0.029), showed higher pre-admission comorbidity score and Clinical Frailty scale score (4.46 ± 1.6 vs 3.75 ± 2.0, p = 0.008) with no differences in terms of disease progression or mortality rate (16.2% vs 15.2%), compared to full-dose vaccinated patients. Cox-regression analysis showed age and NEWS2 score as the variables with a significant relation to mortality between the two groups, independently from pre-morbid conditions and inflammatory response. CONCLUSION This study on breakthrough COVID-19 infection could help identify vulnerable neurological patients with higher risk of poor outcomes.
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Affiliation(s)
- Viviana Cristillo
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy.
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | | | - Ilenia Libri
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Martina Locatelli
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Marcello Giunta
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Valentina Mazzoleni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Debora Pezzini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Davide Arici
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Stefano Gipponi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | | | - Elisabetta Cottini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Massimo Gamba
- Stroke Unit, Azienda Socio Sanitaria Territoriale Spedali Civili, Spedali Civili Hospital, Brescia, Italy
| | - Mauro Magoni
- Stroke Unit, Azienda Socio Sanitaria Territoriale Spedali Civili, Spedali Civili Hospital, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
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Ceccardi G, Schiano di Cola F, Caratozzolo S, Di Pasquale M, Bolchini M, Padovani A, Rao R. Onabotulinumtoxin-A: Previous Prophylactic Treatment Might Improve Subsequent Anti-CGRP Monoclonal Antibodies Response in Patients with Chronic Migraine. Toxins (Basel) 2023; 15:677. [PMID: 38133181 PMCID: PMC10747467 DOI: 10.3390/toxins15120677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of the present study was to evaluate whether previous preventive treatment with onabotulinumtoxin-A might influence subsequent clinical response following a switch to anti-CGRP monoclonal antibodies (mAbs). The present retrospective study was conducted at the Headache Centre-Neurology Clinic at the Spedali Civili Hospital of Brescia between November 2018 and May 2023. The primary objective was to assess clinical outcome (monthly headache days (MHDs), monthly migraine days (MMDs), mean analgesics consumption, and clinical disability according to Migraine Disability Assessment (MIDAS)) following three months (T3) of preventive treatment with anti-CGRP mAbs comparing patients who did and those who did not previously receive treatment with Onabotulinumtoxin-A. Moreover, we aimed to evaluate whether the clinical response to anti-CGRP mAbs was affected by the number of previous Onabotulinumtoxin-A administrations. At T3, compared to Onabotulinumtoxin-A naïve patients, patients who previously received Onabotulinumtoxin-A documented fewer MMDs (3.3 ± 3.7 versus 5.2 ± 5.0; p = 0.017) and a lower MIDAS score (23.2 ± 20.9 versus 37.4 ± 39.6; p = 0.013). Patients who received at least 3 onabotulinumtoxin-A administrations documented, at T3, lower MMDs compared to those who received fewer cycles (respectively, 2.1 ± 2.7 vs. 6.5 ± 4.4; p = 0.024). In conclusion, according to our data, previous treatment with onabotulinumtoxin-A might improve subsequent response to anti-CGRP mAbs preventive treatment.
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Affiliation(s)
| | - Francesca Schiano di Cola
- Department of Care Continuity and Frialty, Neurology Unit, University of Brescia, 25128 Brescia, Italy; (G.C.); (A.P.); (R.R.)
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Vernieri F, Brunelli N, Guerzoni S, Iannone LF, Baraldi C, Rao R, Schiano di Cola F, Ornello R, Cevoli S, Lovati C, Albanese M, Perrotta A, Cetta I, Rossi SS, Taranta V, Filippi M, Geppetti P, Sacco S, Altamura C. Retreating migraine patients in the second year with monoclonal antibodies anti-CGRP pathway: the multicenter prospective cohort RE-DO study. J Neurol 2023; 270:5436-5448. [PMID: 37468621 DOI: 10.1007/s00415-023-11872-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The outcome of migraine patients retreated with monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (anti-CGRP) or its receptor (anti-CGRPr) is not completely known. METHODS This multicentric prospective observational cohort study assessed monthly migraine days (MMDs), migraine acute medication intake (MAMI), and HIT-6 at baseline, after 90-112 days (Rev-1), after 84-90 days since Rev-1 (Rev-2) and 30 days after the last injection of anti-CGRP/CGRPr mAbs (Year-end), in the first and the second year after a discontinuation period. RESULTS We enrolled 226 patients (79.6% with chronic migraine; 55.3% on erenumab and 44.7% on galcanezumab or fremanezumab). MMDs, MAMI, and HIT-6-did not differ at the respective first and second-year evaluations in the entire cohort, and comparing anti-CGRP with anti-CGRPr Abs. MMDs (18.1 ± 7.8 vs. 3.4 ± 7.8), MAMI (26.7 ± 28.3 vs.17.7 ± 17.2), and HIT-6 scores (63.1 ± 5.9 vs. 67.1 ± 10.3) were lower in the second year than in the pre-treatment baseline (consistently, p < 0.0001). Second-year baseline MMDs were lower in patients on anti-CGRP mAbs (p = 0.001) and with lower pre-treatment baseline MMDs (p ≤ 0.001). CONCLUSION Anti-CGRP/CGRPr mAbs are effective in the second as in the first year. The use of anti-CGRP or CGRPr mAbs influenced the second-year baseline MMDs, but their effectiveness did not differ during the two treatment years.
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Affiliation(s)
- Fabrizio Vernieri
- Unità Cefalee e Neurosonologia, Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
- Neurologia, Dipartimento di Medicina e Chirurgia, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Nicoletta Brunelli
- Unità Cefalee e Neurosonologia, Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Simona Guerzoni
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology, Headache Center and Drug Abuse, Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy
| | - Luigi Francesco Iannone
- Headache Center, Section of Clinical Pharmacology and Oncology, Department of Health Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - Carlo Baraldi
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology, Headache Center and Drug Abuse, Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy
| | - Renata Rao
- Headache Center, ASST Spedali Civili of Brescia, Department Continuity of Care and Fragility, Department of Clinical and Experimental Sciences, Neurological Clinic, University of Brescia, Brescia, Italy
| | - Francesca Schiano di Cola
- Headache Center, ASST Spedali Civili of Brescia, Department Continuity of Care and Fragility, Department of Clinical and Experimental Sciences, Neurological Clinic, University of Brescia, Brescia, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Carlo Lovati
- Headache Center, Neurology Unit, L. Sacco University Hospital, Milan, Italy
| | - Maria Albanese
- Neurology Unit, Headache Center, Tor Vergata University Hospital, Rome, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Ilaria Cetta
- Neuroimaging Research Unit, Division of Neuroscience; Neurology Unit and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Sergio Soeren Rossi
- Neurologia, Dipartimento di Medicina e Chirurgia, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Valentina Taranta
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience; Neurology Unit and Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Pierangelo Geppetti
- Headache Center, Section of Clinical Pharmacology and Oncology, Department of Health Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudia Altamura
- Unità Cefalee e Neurosonologia, Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Neurologia, Dipartimento di Medicina e Chirurgia, Università Campus Bio-Medico di Roma, Rome, Italy
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Schiano di Cola F, Bolchini M, Ceccardi G, Caratozzolo S, Liberini P, Rao R, Padovani A. An observational study on monoclonal antibodies against calcitonin-gene-related peptide and its receptor. Eur J Neurol 2023; 30:1764-1773. [PMID: 36856538 DOI: 10.1111/ene.15761] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND AND PURPOSE Based on their pharmacological target, two classes of calcitonin-gene-related peptide (CGRP) monoclonal antibodies (mAbs) have been identified: antibodies against the CGRP ligand-galcanezumab, fremanezumab, eptinezumab-and antibodies against the CGRP receptor (CGRP-R), erenumab. The aim of the present study was to compare anti-CGRP versus anti-CGRP-R mAbs in patients with high frequency episodic and chronic migraine. METHODS All patients on monthly treatment with anti-CGRP mAbs with an available 6 months' follow-up at January 2022 were included. Data on efficacy outcome were collected following one (T1), three (T3) and six (T6) months of treatment, and included monthly headache/migraine days, the Migraine Disability Assessment Scale (MIDAS) and Headache Impact Test 6 (HIT-6) scores, pain intensity, analgesics consumption and response rates (>50% headache days reduction compared to baseline). RESULTS In all, 152 patients were enrolled, of whom 68 were in treatment with anti-CGRP mAbs (49 galcanezumab, 19 fremanezumab) and 84 with the anti-CGRP-R (erenumab). MIDAS scores were significantly lower in the anti-CGRP group at T1 and T3 (respectively p < 0.02 and p < 0.03) as well as the number of mean migraine days at T3 (p < 0.01). At T3 and T6 outcome measures were comparable, although a significantly higher percentage of super-responders was found in the anti-CGRP group (respectively p < 0.04 and p < 0.05), with a similar overall percentage of responders. CONCLUSIONS The present study on a real-world sample confirms the beneficial effect of both anti-CGRP and anti-CGRP-R mAbs, with a more favorable outcome for anti-CGRP antibodies.
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Affiliation(s)
- Francesca Schiano di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Marco Bolchini
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Giulia Ceccardi
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Salvatore Caratozzolo
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Paolo Liberini
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Renata Rao
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
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di Cola FS, Bolchini M, Caratozzolo S, Ceccardi G, Cortinovis M, Liberini P, Rao R, Padovani A. Migraine Disability Improvement during Treatment with Galcanezumab in Patients with Chronic and High Frequency Episodic Migraine. Neurol Int 2023; 15:273-284. [PMID: 36810472 PMCID: PMC9944445 DOI: 10.3390/neurolint15010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The aim of the present study was to assess the migraine outcome, in particular migraine disability, in chronic (CM) and high frequency episodic migraine (HFEM) patients in treatment with galcanezumab. METHODS The present study was conducted at the Headache Centre of Spedali Civili of Brescia. Patients were treated with galcanezumab 120 mg monthly. Clinical and demographical information were collected at the baseline (T0). Data about outcome, analgesics consumption and disability (MIDAS and HIT-6 scores) were collected quarterly. RESULTS Fifty-four consecutive patients were enrolled. Thirty-seven patients had a diagnosis of CM, 17 of HFEM. During treatment, patients reported a significant reduction in terms of mean headache/migraine days (p < 0.001), the attacks' pain intensity (p = 0.001) and monthly consumed analgesics (p < 0.001). The MIDAS and HIT-6 scores also documented a significant improvement (p < 0.001). At the baseline, all patients documented a severe degree of disability (MIDAS score ≥ 21). Following six months of treatment, only 29.2% of patients still documented a MIDAS score ≥ 21, with one third of patients documenting little or no disability. A > 50% MIDAS reduction, compared to baseline, was observed in up to 94.6% of patients, following the first three months of treatment. A similar outcome was found for HIT-6 scores. A significant positive correlation was found between headache days and MIDAS at T3 and T6 (T6 > T3), but not baseline. DISCUSSION Monthly prophylactic treatment with galcanezumab was found to be effective in both CM and HFEM, especially in reducing migraine burden and disability.
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Affiliation(s)
- Francesca Schiano di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25122 Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
- Correspondence: ; Tel.: +39-0303995632
| | - Marco Bolchini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25122 Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
| | - Salvatore Caratozzolo
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
| | - Giulia Ceccardi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25122 Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
| | - Matteo Cortinovis
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25122 Brescia, Italy
| | - Paolo Liberini
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
| | - Renata Rao
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25122 Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
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Schiano di Cola F, Ceccardi G, Bolchini M, Caratozzolo S, Liberini P, Padovani A, Rao R. Photophobia and migraine outcome during treatment with galcanezumab. Front Neurol 2023; 13:1088036. [PMID: 36742057 PMCID: PMC9889984 DOI: 10.3389/fneur.2022.1088036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023] Open
Abstract
Background Calcitonin gene-related peptide (CGRP) plays a pivotal role in migraine physiology, not only regarding migraine pain but also associated symptoms such as photophobia. The aim of the present study was to assess monoclonal antibodies targeting CGRP efficacy not only in terms of headache and migraine frequency and disability but also in reducing ictal photophobia. Material and methods This is a retrospective observational study, conducted at the Headache Center-ASST Spedali Civili Brescia. All patients in monthly treatment with galcanezumab with at least a 6-month follow-up in September 2022 with reported severe photophobia during migraine attacks were included. Data regarding headache frequency, analgesics consumption, and migraine disability were collected quarterly. Moreover, patients were asked the following information regarding photophobia: (1) whether they noticed an improvement in photophobia during migraine attacks since galcanezumab introduction; (2) the degree of photophobia improvement (low, moderate, and high); and (3) timing photophobia improvement. Results Forty-seven patients were enrolled in the present study as they met the inclusion criteria. Seventeen patients had a diagnosis of high-frequency episodic migraine and 30 of chronic migraine. From baseline to T3 and T6, a significant improvement in terms of headache days (19.2 ± 7.6 vs. 8.6 ± 6.8 vs. 7.7 ± 5.7; p < 0.0001), migraine days (10.4 ± 6.7 vs. 2.9 ± 4.3 vs. 3.6 ± 2.8; p < 0.0001), analgesics consumption (25.1 ± 28.2 vs. 7.6 ± 7.5 vs. 7.6 ± 8.1; p < 0.0001), MIDAS score (82.1 ± 48.4 vs. 21.6 ± 17.6 vs. 18.1 ± 20.5; p < 0.0001), and HIT-6 score (66.2 ± 6.2 vs. 57.2 ± 8.6 vs. 56.6 ± 7.6; p < 0.0001) was found. Thirty-two patients (68.1%) reported a significant improvement in ictal photophobia, with over half of the patients reporting it within the first month of treatment. Photophobia improvement was more frequent in patients with episodic migraine (p = 0.02) and triptans responders (p = 0.03). Conclusions The present study confirms previous reports regarding galcanezumab efficacy beyond migraine frequency. In particular, over 60% of patients, in our cohort, documented a significant improvement also in reducing ictal photophobia. This improvement was, in most patients, moderate to high, and within the first 6 months of treatment, regardless of the clinical response on migraine frequency.
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Bolchini M, Schiano di Cola F, Ceccardi G, Caratozzolo S, Liberini P, Rao R, Padovani A. Migraine Disability and Severity Improvement during Long-Term Treatment with Erenumab. Eur Neurol 2023; 86:135-139. [PMID: 36538908 DOI: 10.1159/000527674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022]
Abstract
The aim of the present study was to assess erenumab efficacy in migraine disability and intensity throughout the first treatment cycle, discontinuation, and the first 6 months of re-treatment in patients with high-frequency episodic migraine. The study design was retrospective and observational. Inclusion criteria were the following: diagnosis of high-frequency episodic migraine and ongoing treatment with erenumab 140 mg currently at their second treatment cycle. Data regarding migraine frequency, disability (MIDAS score), and severity of attacks (NRS score) were collected quarterly. Twenty-five patients were enrolled. At the end of the first treatment cycle, compared to baseline, a significant improvement of MIDAS scores was found (13.5 ± 11.1 vs. 72.5 ± 32.1; p = 0.005), with a subsequent worsening during treatment suspension (30.1 ± 26.9; p = 0.03). Pain intensity remained unmodified during the first treatment cycle (NRS score baseline: 7.6 ± 0.9 vs. 12 months: 7.5 ± 0.7; p = 0.13). During re-treatment, MIDAS scores documented a new significant improvement, reaching the same level at 6 months of re-treatment as at the end of the first cycle (30.1 ± 26.9 vs. 12.9 ± 5.4; p = 0.03). A significant improvement, compared to baseline, was observed for pain intensity during re-treatment (6.8 ± 2.2 vs. 5.6 ± 0.9 at RT3 vs. 5.2 ± 1.4 at RT6; p = 0.05). In conclusion, during re-treatment with erenumab 140 mg, migraine pain intensity and disability documented a significant and progressive improvement. Our data confirm the long-term efficacy, although in a very limited case series, of monoclonal antibodies targeting CGRP beyond headache frequency reduction.
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Affiliation(s)
- Marco Bolchini
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Francesca Schiano di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Giulia Ceccardi
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Salvatore Caratozzolo
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Paolo Liberini
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Renata Rao
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, Università degli Studi di Brescia and ASST Spedali Civili Brescia, Brescia, Italy
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Ceccardi G, Schiano di Cola F, Di Cesare M, Liberini P, Magoni M, Perani C, Gasparotti R, Rao R, Padovani A. Post COVID-19 vaccination headache: A clinical and epidemiological evaluation. Front Pain Res (Lausanne) 2022; 3:994140. [PMID: 36425358 PMCID: PMC9679518 DOI: 10.3389/fpain.2022.994140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/17/2022] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION This study aimed to assess the prevalence and clinical characteristics of headaches, in particular secondary headaches. MATERIALS AND METHODS This observational study was performed at the ASST Spedali Civili of Brescia, Italy. Visits to the Emergency Department (ED) and subsequent hospitalizations regarding a new or worsening headache in the 16 days following the administration of the COVID-19 vaccine between January 2021 and January 2022 were recorded and compared with those of January 2019-January 2020. RESULTS The ratio between ED admissions due to headaches and total ED admissions was significantly higher in 2021 compared with 2019 (4.84% vs. 4.27%; p < 0.0001). Two-hundred and eighty-nine ED headache admissions (10.8% of all ED headache admissions) were time-correlated to the COVID-19 vaccination, of which 40 were hospitalized in order to exclude a symptomatic etiology. At discharge, 32 patients had a diagnosis of benign headache not attributed to any cranial/extracranial disorder and eight patients of secondary headache, whose diagnoses were the following: Headache attributed to cranial and/or cervical vascular disorder (n = 4); headache attributed to nonvascular intracranial disorder (n = 2); headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure (n = 1); and painful lesions of the cranial nerves (n = 1). The headache most frequently reported by patients had migraine-like characteristics: the localization was predominantly frontal or temporal, the pain was described as throbbing and severe in intensity and it was frequently accompanied by nausea/vomit, and photo-phonophobia. Over half-regardless of the final diagnosis-of hospitalized patients had a history of primary headaches. CONCLUSIONS Following the spread of COVID-19 vaccination, the number of ED admissions due to headaches significantly increased. However, less than 14% of all the ED visits due to a headache time-correlated to the COVID-19 vaccination were actually hospitalized, with most patients documenting a benign headache, possibly related to the generic side effects of the vaccination. Only 8/40 hospitalized patients were diagnosed with a secondary headache. These benign headaches would actually fulfill diagnostic criteria for 8.1 Headaches attributed to the use of or exposure to a substance (ICHD-3), although, at the time being, it does not include vaccines as possible substances.The headache migraine-like characteristics' reported by most patients could suggest activation of the trigeminovascular pathway by all the cytokines and other pro-inflammatory molecules released following the vaccination.
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Affiliation(s)
- Giulia Ceccardi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - Francesca Schiano di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - Marco Di Cesare
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - Paolo Liberini
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - Mauro Magoni
- Stroke Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | | | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Renata Rao
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
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9
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Schiano di Cola F, Caratozzolo S, Venturelli E, Balducci U, Sidoti V, Pari E, Costanzi C, di Summa A, Sixt GJ, D'Adda E, Liberini P, Rao R, Padovani A. Erenumab Discontinuation After 12-Month Treatment: A Multicentric, Observational Real-Life Study. Neurol Clin Pract 2022; 11:e834-e839. [PMID: 34992966 DOI: 10.1212/cpj.0000000000001112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/10/2021] [Indexed: 11/15/2022]
Abstract
Objective To assess migraine outcome after 12-month treatment with erenumab and compare patients who underwent 3-month erenumab discontinuation following the first treatment cycle with those who continued monthly administrations. Methods This is a multicentric observational study in patients with migraine in treatment with erenumab. After a full 12-month treatment cycle (T12), patients could either continue or discontinue erenumab for at least 3 months. Patients who underwent treatment discontinuation were assessed after 3 months (T15) to decide whether to start retreatment. Patients were then assessed following at T16 and T18. Results Thirty consecutive patients were enrolled. Nineteen patients underwent treatment suspension at T12 up to T15, whereas 11 continued prophylaxis. At T15, patients who discontinued treatment documented significantly more migraine days (17.06 ± 6.5 vs 4.8 ± 2.5; p < 0.0001) and analgesics consumption (14.8 ± 9.2 vs 4.6 ± 2.5; p = 0.002), compared with those who continued treatment. After retreatment, at T16, patients who had previously undergone discontinuation documented a significant improvement in terms of migraine days (9.01 ± 4.4 vs 17.06 ± 6.5; p < 0.0001) and analgesics consumption (9.6 ± 7.3 vs 14.8 ± 9.2; p = 0.004). Such improvement was even greater at T18, comparable with T12. Conclusion After treatment discontinuation, a rapid migraine worsening was found, despite the high clinical response during treatment and at retreatment, which might be secondary to an untimely interruption of a potentially disease-modifying pharmacologic intervention. Although clinical improvement was documented after retreatment, given the high frequency and degree of worsening during discontinuation, it seems plausible-even ethical-to re-evaluate current timing of discontinuation. Classification of Evidence This study provides Class III evidence that people with migraine discontinuing erenumab migraine prophylaxis after 12 months were more likely to have an increase in nonresponder status and migraine days than those who continued treatment.
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Affiliation(s)
- Francesca Schiano di Cola
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
| | - Salvatore Caratozzolo
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
| | - Elisabetta Venturelli
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
| | - Ubaldo Balducci
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
| | - Vincenzo Sidoti
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
| | - Elisa Pari
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
| | - Chiara Costanzi
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
| | - Alfonsina di Summa
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
| | - Gabriele Johanna Sixt
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
| | - Elisabetta D'Adda
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
| | - Paolo Liberini
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
| | - Renata Rao
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
| | - Alessandro Padovani
- Neurology Unit, Clinical and Experimental Sciences Department (FSC, SC, PL, RR, AP), University and Spedali Civili, Brescia; Neurology Unit (EV), ASST Papa Giovanni XXIII, Bergamo; Neurology Unit (UB, VS), ASST Franciacorta, P.O. Chiari; Neurology Unit (EP, CC), Ospedale di Cremona, ASST Cremona; Neurology Unit (AS, GJS), Ospedale Centrale di Bolzano, Azienda Sanitaria dell'Alto Adige; and Neurology Unit (EDA), Ospedale Maggiore di Crema, ASST Crema, Italy
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Schiano di Cola F, Caratozzolo S, Liberini P, Padovani A, Rao R. CGRP-monoclonal antibodies and SARS-CoV-2 vaccination. J Neurol 2022; 269:2848-2849. [PMID: 34999961 PMCID: PMC8742562 DOI: 10.1007/s00415-021-10946-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Francesca Schiano di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, BS, Italy.
| | - Salvatore Caratozzolo
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, BS, Italy
| | - Paolo Liberini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, BS, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, BS, Italy
| | - Renata Rao
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, BS, Italy
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Cristillo V, Pilotto A, Cotti Piccinelli S, Bonzi G, Canale A, Gipponi S, Bezzi M, Leonardi M, Padovani A, Libri I, Giunta M, Cortinovis M, Locatelli M, Risi B, di Cola FS, Zoppi N. Premorbid vulnerability and disease severity impact on Long-COVID cognitive impairment. Aging Clin Exp Res 2022; 34:257-260. [PMID: 35014002 PMCID: PMC8747881 DOI: 10.1007/s40520-021-02042-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/21/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Cognitive deficits have been increasingly reported as possible long-term manifestations after SARS-CoV-2 infection. AIMS In this study we aimed at evaluating the factors associated with cognitive deficits 6 months after hospitalization for Coronavirus Disease 2019 (COVID-19). METHODS One hundred and six patients, discharged from a pneumology COVID-19 unit between March 1 and May 30 2020, accepted to be evaluated at 6 months according to an extensive neurological protocol, including the Montreal Cognitive Assessment (MoCA). RESULTS Abnormal MoCA scores at 6 months follow-up were associated with higher pre-hospitalization National Health System (NHS) score (Duca et al. in Emerg Med Pract 22:1-2, 2020) (OR 1.27; 95% CI 1.05-1.6; p = 0.029) and more severe pulmonary disease expressed by the Brescia-COVID Respiratory Severity Scale (Duca et al. in Emerg Med Pract 22:1-2, 2020) (BCRSS > 1OR 4.73; 95% CI 1.53-14.63; p = 0.003) during the acute phase of the disease. DISCUSSION This longitudinal study showed that the severity of COVID-19, indicated by BCRSS, and a complex score given by age and premorbid medical conditions, expressed by NHS, play a major role in modulating the long-term cognitive consequences of COVID-19 disease. CONCLUSIONS These findings indicate that the association of age and premorbid factors might identify people at risk for long-term neurological consequences of COVID-19 disease, thus deserving longer and proper follow-up.
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12
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di Cola FS, Caratozzolo S, Di Cesare M, Liberini P, Rao R, Padovani A. MIGRAINE MONITORING IN THE TIME OF COVID-19: TRIGGERS AND PROTECTORS DURING A PANDEMIC. Pain Med 2021; 22:2728-2738. [PMID: 34181002 DOI: 10.1093/pm/pnab202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Aim of the present observational study was to assess the impact of COVID-19 quarantine on migraine and evaluate potential influencing factors. Previous studies reported mixed results regarding clinical outcome during quarantine in patients with migraine. In particular, data from areas strongly affetcted by COVID-19 pandemic are missing. METHODS One-hundred and seventy patients, previously assessed at the Headache Centre - ASST Spedali Civili Brescia, underwent a telephonic interview regarding migraine features and clinical, occupational and lifestyle variables. RESULTS Compared to baseline, during quarantine, we found a significant overall reduction in migraine days (14.7±0.6 vs 12.3±0.7, p <0.001), with 47.1% patients reporting a clinical improvement. Outdoor living spaces (OR 2.3, 95% CI 1.7-3.07, p = 0.009), a positive attitude throughout quarantine (OR 4.12, 95% CI 2.3-7.1, p = 0.03), working full-time (OR 1.03, 95% CI 0.5-1.9, p < 0.001) and a baseline diagnosis of chronic migraine (OR 1.4, 95% CI 1.1-2.02, p = 0.002) were associated with an increased chance of migraine improvement. Being single (OR 1.5, 95% CI 1.1-2.01, p = 0.05) and physical inactivity (OR 1.3, 95% CI 1.1-1.6, p = 0.02) were associated with an increased risk of worsening. CONCLUSIONS Quarantine had an overall positive impact on migraine. Based on our results, we hypothesize the reduction of daily hassles and challenges might be the main reason for such improvement.
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Affiliation(s)
- Francesca Schiano di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Salvatore Caratozzolo
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Di Cesare
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Liberini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Renata Rao
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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13
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Labastida-Ramírez A, Benemei S, Albanese M, D’Amico A, Grillo G, Grosu O, Ertem DH, Mecklenburg J, Fedorova EP, Řehulka P, di Cola FS, Lopez JT, Vashchenko N, MaassenVanDenBrink A, Martelletti P. Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence. J Headache Pain 2020; 21:55. [PMID: 32448142 PMCID: PMC7245945 DOI: 10.1186/s10194-020-01122-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Headache is a common complication of traumatic brain injury. The International Headache Society defines post-traumatic headache as a secondary headache attributed to trauma or injury to the head that develops within seven days following trauma. Acute post-traumatic headache resolves after 3 months, but persistent post-traumatic headache usually lasts much longer and accounts for 4% of all secondary headache disorders. MAIN BODY The clinical features of post-traumatic headache after traumatic brain injury resemble various types of primary headaches and the most frequent are migraine-like or tension-type-like phenotypes. The neuroimaging studies that have compared persistent post-traumatic headache and migraine found different structural and functional brain changes, although migraine and post-traumatic headache may be clinically similar. Therapy of various clinical phenotypes of post-traumatic headache almost entirely mirrors the therapy of the corresponding primary headache and are currently based on expert opinion rather than scientific evidence. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, especially impaired sleep and post-traumatic disorder. There are also effective options for non-pharmacologic therapy of post-traumatic headache, including cognitive-behavioral approaches, onabotulinum toxin injections, life-style considerations, etc. CONCLUSION: Notwithstanding some phenotypic similarities, persistent post-traumatic headache after traumatic brain injury, is considered a separate phenomenon from migraine but available data is inconclusive. High-quality studies are further required to investigate the pathophysiological mechanisms of this secondary headache, in order to identify new targets for treatment and to prevent disability.
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Affiliation(s)
- Alejandro Labastida-Ramírez
- Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Silvia Benemei
- Health Sciences Department, University of Florence, and Headache Centre, Careggi University Hospital, Florence, Italy
| | - Maria Albanese
- Department of Systems Medicine, Neurology Unit, University of Rome “Tor Vergata”, “Tor Vergata” Hospital, Rome, Italy
| | - Antonina D’Amico
- Department of Child Neuropsychiatry, University of Palermo, Palermo, Italy
| | - Giovanni Grillo
- Department of Child Neuropsychiatry, A.R.N.A.S. Civico, P.O. Giovanni di Cristina Ospedale dei Bambini, Palermo, Italy
| | - Oxana Grosu
- Diomid Gherman Institute of Neurology and Neurosurgery, Headache Centre and Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| | - Devrimsel Harika Ertem
- Department of Neurology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Jasper Mecklenburg
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Pavel Řehulka
- Department of Neurology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Francesca Schiano di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Javier Trigo Lopez
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Nina Vashchenko
- University Clinic of Nervous Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - On behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)
- Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Health Sciences Department, University of Florence, and Headache Centre, Careggi University Hospital, Florence, Italy
- Department of Systems Medicine, Neurology Unit, University of Rome “Tor Vergata”, “Tor Vergata” Hospital, Rome, Italy
- Department of Child Neuropsychiatry, University of Palermo, Palermo, Italy
- Department of Child Neuropsychiatry, A.R.N.A.S. Civico, P.O. Giovanni di Cristina Ospedale dei Bambini, Palermo, Italy
- Diomid Gherman Institute of Neurology and Neurosurgery, Headache Centre and Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
- Department of Neurology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Zdorovie Clinic, Tomsk, Russia
- Department of Neurology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- University Clinic of Nervous Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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14
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Benussi A, Pilotto A, Premi E, Libri I, Giunta M, Agosti C, Alberici A, Baldelli E, Benini M, Bonacina S, Brambilla L, Caratozzolo S, Cortinovis M, Costa A, Cotti Piccinelli S, Cottini E, Cristillo V, Delrio I, Filosto M, Gamba M, Gazzina S, Gilberti N, Gipponi S, Imarisio A, Invernizzi P, Leggio U, Leonardi M, Liberini P, Locatelli M, Masciocchi S, Poli L, Rao R, Risi B, Rozzini L, Scalvini A, Schiano di Cola F, Spezi R, Vergani V, Volonghi I, Zoppi N, Borroni B, Magoni M, Pezzini A, Padovani A. Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy. Neurology 2020; 95:e910-e920. [DOI: 10.1212/wnl.0000000000009848] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/13/2020] [Indexed: 01/16/2023] Open
Abstract
ObjectiveTo report clinical and laboratory characteristics, treatment, and clinical outcomes of patients admitted for neurologic diseases with and without coronavirus disease 2019 (COVID-19).MethodsIn this retrospective, single-center cohort study, we included all adult inpatients with confirmed COVID-19 admitted to a neuro-COVID unit beginning February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (false discovery rate corrected) to those of neurologic patients without COVID-19 admitted in the same period.ResultsOne hundred seventy-three patients were included in this study, of whom 56 were positive and 117 were negative for COVID-19. Patients with COVID-19 were older (77.0 years, interquartile range [IQR] 67.0–83.8 years vs 70.1 years, IQR 52.9–78.6 years, p = 0.006), had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n = 43, 76.8% vs n = 68, 58.1%), and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.9, IQR 0.7–1.1 vs 0.5, IQR 0.4–0.6, p = 0.006). In-hospital mortality rates (n = 21, 37.5% vs n = 5, 4.3%, p < 0.001) and incident delirium (n = 15, 26.8% vs n = 9, 7.7%, p = 0.003) were significantly higher in the COVID-19 group. Patients with COVID-19 and without COVID with stroke had similar baseline characteristics, but patients with COVID-19 had higher modified Rankin Scale scores at discharge (5.0, IQR 2.0–6.0 vs 2.0, IQR 1.0–3.0, p < 0.001), with a significantly lower number of patients with a good outcome (n = 11, 25.6% vs n = 48, 70.6%, p < 0.001). In patients with COVID-19, multivariable regressions showed increasing odds of in-hospital death associated with higher qSOFA scores (odds ratio [OR] 4.47, 95% confidence interval [CI] 1.21–16.5, p = 0.025), lower platelet count (OR 0.98, 95% CI 0.97–0.99, p = 0.005), and higher lactate dehydrogenase (OR 1.01, 95% CI 1.00–1.03, p = 0.009) on admission.ConclusionsPatients with COVID-19 admitted with neurologic disease, including stroke, have a significantly higher in-hospital mortality and incident delirium and higher disability than patients without COVID-19.
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Schiano di Cola F, Caratozzolo S, Liberini P, Rao R, Padovani A. Response Predictors in Chronic Migraine: Medication Overuse and Depressive Symptoms Negatively Impact Onabotulinumtoxin-A Treatment. Front Neurol 2019; 10:678. [PMID: 31354606 PMCID: PMC6635602 DOI: 10.3389/fneur.2019.00678] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/10/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Despite numerous studies that have investigated clinical, radiological, and biochemical response predictors, the clinical profile of those patients who might benefit from OnabotulinumtoxinA is still missing. The aim of the present study was to identify potential OnabotulinumtoxinA response predictors among several clinical characteristics and confirm OnabotulinumtoxinA efficacy and safety in chronic migraine (CM) prevention. Methods: The study was conducted at the Headache Center—Neurology Clinic—Spedali Civili Hospital of Brescia. Eighty-four consecutive CM patients were enrolled, with a mean age of 48 years (SD 9.7) and a mean disease duration of 10.1 years (SD 6.6). The mean reported headache-days frequency was 22.5 (SD 5.9) per month, while the mean number of severe headache-days was 15.2 (SD 8.9) with a mean monthly medication intake of 33.2 (SD 5.6). The clinical characteristics analyzed as potential response predictors were: gender, disease duration, migraine characteristics (location, side constancy, unilateral autonomic and neurovegetative symptoms), previous prophylactic treatments, add-on therapies, withdrawal therapies, psychiatric (anxiety and depression symptoms) comorbidities and medication overuse. Results: A significant reduction from baseline to 3, 6, 9, and 12 month treatment cycles in total headache days, high intensity headache days and triptans consumption per month was found. Depressive symptoms and medication overuse negatively predicted OnabotulinumtoxinA outcome. Conclusions: Our results confirm the efficacy and safety of OnabotulinumtoxinA in CM. Depressive comorbidity and medication overuse, among all clinical variables, were the only significant response predictors. Such findings provide interesting insights regarding patients selection for OnabotulinumtoxinA treatment as, with the introduction of anti calcitonin gene-related (CGRP) monoclonal antibodies, clinicians will have to thoroughly judge and tailor among the many available therapeutic options now available. Future research might be needed to confirm our findings, in particular for its therapeutic implications.
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Affiliation(s)
- Francesca Schiano di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Renata Rao
- Neurology Unit, Spedali Civili Hospital, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Pilotto A, Schiano di Cola F, Premi E, Grasso R, Turrone R, Gipponi S, Scalvini A, Cottini E, Paghera B, Garibotto V, Rizzetti MC, Bonanni L, Borroni B, Morbelli S, Nobili F, Guerra UP, Perani D, Padovani A. Extrastriatal dopaminergic and serotonergic pathways in Parkinson’s disease and in dementia with Lewy bodies: a 123I-FP-CIT SPECT study. Eur J Nucl Med Mol Imaging 2019; 46:1642-1651. [DOI: 10.1007/s00259-019-04324-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/31/2019] [Indexed: 02/07/2023]
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Pietroboni AM, Schiano di Cola F, Scarioni M, Fenoglio C, Spanò B, Arighi A, Cioffi SM, Oldoni E, De Riz MA, Basilico P, Calvi A, Fumagalli GG, Triulzi F, Galimberti D, Bozzali M, Scarpini E. CSF β-amyloid as a putative biomarker of disease progression in multiple sclerosis. Mult Scler 2016; 23:1085-1091. [PMID: 27754941 DOI: 10.1177/1352458516674566] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurodegeneration plays a major role in determining disability in multiple sclerosis (MS) patients. Hence, there is increasing need to identify reliable biomarkers, which could serve as prognostic measure of disease progression. OBJECTIVES To assess whether cerebrospinal fluid (CSF) tau and β-amyloid (Aβ) levels were altered in newly diagnosed MS patients and correlated with disability. Moreover, we investigated whether these CSF biomarkers associate with macroscopic brain tissue damage measures. METHODS CSF Aβ and tau levels were determined by enzyme-linked immunosorbent assay in CSF samples from 48 newly diagnosed MS patients, followed-up clinically for 3 years by recording their Expanded Disability Status Scale score at 6-month intervals, and 45 controls. All patients underwent magnetic resonance imaging at baseline and at the end of follow-up to quantify their lesion load (LL). RESULTS CSF Aβ levels were significantly reduced in patients compared to controls ( p < 0.001). Lower CSF Aβ levels at baseline were a disability predictor at 3-year follow-up ( p = 0.009). CSF tau levels correlated with T2- and T1-LL ( p < 0.001). CONCLUSION CSF Aβ reduction is a promising biomarker of neurodegeneration and may predict patients' clinical outcome. Therefore, CSF Aβ should be considered as a potential biomarker of prognostic value.
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Affiliation(s)
- Anna M Pietroboni
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Schiano di Cola
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Scarioni
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Fenoglio
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Spanò
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Andrea Arighi
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Mg Cioffi
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuela Oldoni
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Milena A De Riz
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Basilico
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Calvi
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio G Fumagalli
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Triulzi
- Neuroradiology Unit, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Galimberti
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Bozzali
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Elio Scarpini
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, "Dino Ferrari" Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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