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Giagkou N, Spanou I, Mitsikostas DD. Current perspectives on the recognition and diagnosis of low CSF pressure headache syndromes. Expert Rev Neurother 2022; 22:815-827. [PMID: 36453212 DOI: 10.1080/14737175.2022.2152674] [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] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Headaches occur when cerebrospinal fluid (CSF) pressure drops following dural puncture or trauma or spontaneously. As the features of these headaches and their accompanying symptoms might not be typical, low CSF pressure headache syndromes, and spontaneous intracranial hypotension in particular, are often misdiagnosed and underdiagnosed. AREAS COVERED The aim of this narrative review is to summarize the most recent evidence regarding the clinical presentation and the diagnosis of low CSF pressure headache syndromes. EXPERT OPINION The clinical spectrum low CSF pressure headache syndromes varies significantly and key signs might be missing. Low CSF pressure headache syndromes should be included in the differential diagnosis of any case of refractory headache, even when the headache is not orthostatic, or there are normal neuroimaging findings, and/or lumbar puncture opening pressure is within normal limits. Future research should focus on controlled interventional studies on the treatment of low CSF pressure headache syndromes, which are currently lacking.
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Affiliation(s)
- Nikolaos Giagkou
- 1 Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Spanou
- 1 Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimos D Mitsikostas
- 1 Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Bougea A, Efthymiopoulou E, Spanou I, Zikos P. A Novel Machine Learning Algorithm Predicts Dementia With Lewy Bodies Versus Parkinson's Disease Dementia Based on Clinical and Neuropsychological Scores. J Geriatr Psychiatry Neurol 2022; 35:317-320. [PMID: 33550890 DOI: 10.1177/0891988721993556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Our aim was to develop a machine learning algorithm based only on non-invasively clinic collectable predictors, for the accurate diagnosis of these disorders. METHODS This is an ongoing prospective cohort study (ClinicalTrials.gov identifier NCT number NCT04448340) of 78 PDD and 62 DLB subjects whose diagnostic follow-up is available for at least 3 years after the baseline assessment. We used predictors such as clinico-demographic characteristics, 6 neuropsychological tests (mini mental, PD Cognitive Rating Scale, Brief Visuospatial Memory test, Symbol digit written, Wechsler adult intelligence scale, trail making A and B). We investigated logistic regression, K-Nearest Neighbors (K-NNs) Support Vector Machine (SVM), Naïve Bayes classifier, and Ensemble Model for their ability to predict successfully PDD or DLB diagnosis. RESULTS The K-NN classification model had an accuracy 91.2% of overall cases based on 15 best clinical and cognitive scores achieving 96.42% sensitivity and 81% specificity on discriminating between DLB and PDD. The binomial logistic regression classification model achieved an accuracy of 87.5% based on 15 best features, showing 93.93% sensitivity and 87% specificity. The SVM classification model had an accuracy 84.6% of overall cases based on 15 best features achieving 90.62% sensitivity and 78.58% specificity. A model created on Naïve Bayes classification had 82.05% accuracy, 93.10% sensitivity and 74.41% specificity. Finally, an Ensemble model, synthesized by the individual ones, achieved 89.74% accuracy, 93.75% sensitivity and 85.73% specificity. CONCLUSION Machine learning method predicted with high accuracy, sensitivity and specificity PDD or DLB diagnosis based on non-invasively and easily in-the-clinic and neuropsychological tests.
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Affiliation(s)
- Anastasia Bougea
- First Department of Neurology, National and Kapodistrian University, Aiginition Hospital, Athens, Greece
| | - Efthymia Efthymiopoulou
- First Department of Neurology, National and Kapodistrian University, Aiginition Hospital, Athens, Greece.,Maison Sofos Elderly Care Unit, Athens, Greece
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Bougea A, Anagnostouli M, Angelopoulou E, Spanou I, Chrousos G. Psychosocial and Trauma-Related Stress and Risk of Dementia: A Meta-Analytic Systematic Review of Longitudinal Studies. J Geriatr Psychiatry Neurol 2022; 35:24-37. [PMID: 33205677 DOI: 10.1177/0891988720973759] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Stress has deleterious effects on brain health and yet, the prognostic value of psychosocial stress regarding the most common types of dementias, including Alzheimer disease, is still unclear. The primary aim of this systematic review was to explore the association between psychosocial stress and late onset dementia. We classified 24articles from Medline, PsycINFO, CINAHL, and Web of Science, as pertaining toxic categories of psychosocial and trauma-related stress (low socio-economic status [SES] related inequalities, marital status, posttraumatic stress disorder, work stress, "vital exhaustion" [VE], and, combined stressors). Using the Quality of Prognosis Studies in Systematic Reviews tool, we judged the quality of evidence to be low. This systematic review provided some non-robust, yet suggestive evidence that the above psychosocial types of stress are associated with increased risk of dementia in later life. Future robust, longitudinal studies with repeated validated measures of psychosocial stress and dementiaare required to strengthen or refute these findings.
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Affiliation(s)
- Anastasia Bougea
- Memory & Movement Disorders Clinic, 1st Department of Neurology, 69078Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Anagnostouli
- Memory & Movement Disorders Clinic, 1st Department of Neurology, 69078Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Demyelinating Diseases Clinic, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Aeginition Hospital, Athens, Greece
| | - Efthalia Angelopoulou
- Memory & Movement Disorders Clinic, 1st Department of Neurology, 69078Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Spanou
- Memory & Movement Disorders Clinic, 1st Department of Neurology, 69078Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Bougea AM, Zikos P, Spanou I, Efthymiopoulou E. Clock-Drawing Tasks as Predictive Measurements for Disease Classification Among Patients With Parkinson's Disease and Essential Tremor. Cureus 2021; 13:e13239. [PMID: 33728188 PMCID: PMC7949632 DOI: 10.7759/cureus.13239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Accepted: 02/09/2021] [Indexed: 01/17/2023] Open
Abstract
Background Nonmotor cognitive symptoms are widely being recognized in both Parkinson's Disease (PD) and Essential Tremor (ET), the two most common movement disorders. Clock-drawing (CD) test seems to be impaired early in the process of cognitive (executive) decline in PD. However, the optimal measures for detecting cognitive changes in ET patients have not been established. Examining whether the CD test is a quick test could identify frontal and visuospatial deficits in patients with Parkinson's disease (PD) and essential tremor (ET). Methods Visuospatial performance was assessed in 58 consecutive patients with ET and 75 with PD and 22 healthy controls (HC) who visited two neurological clinics of Athens in Greece. The CD and copy (CC) items of the PD-Cognitive Rating Scale were used as a test of visuospatial function. Results Both CD and CC scores were lower for ET compared to PD patients and HC (p=<0.001 for both comparisons). A binomial logistic regression showed that both CD and CC items predict if participants had ET or PD with high sensitivity 94.7% and specificity 87.9% and an area under the curve (AUC) 0.980 (95% confidence interval, 0.962-0.997). The model explained 86.1% (Nagelkerke R2) of the variance in the disease variable (ET/PD) and correctly classified 91.7% of the cases. Conclusion Patients with ET have more visuospatial deficits compared to PD and HC. CD task may be an easy, useful tool to track cognitive changes in nondemented patients with ET in clinical practice.
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Affiliation(s)
- Anastasia M Bougea
- Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Ioanna Spanou
- Neurology, 251 Hellenic Air Force Hospital, Athens, GRC
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Spanou I, Christidi F, Liakakis G, Rizonaki K, Bougea A, Anagnostou E, Kararizou E. Primary headache subtypes and thyroid dysfunction: Is there any association? Arq Neuropsiquiatr 2020; 78:695-699. [PMID: 33146240 DOI: 10.1590/0004-282x20200070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/17/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Primary headaches, and particularly migraine and tension-type headache (TTH) as well as hypothyroidism are common medical conditions. To date, numerous studies have suggested a possible bidirectional relationship between migraine and hypothyroidism, although certain studies had contradictory results. OBJECTIVE To investigate whether there is any association between primary headache subtypes and thyroid disorders. METHODS A retrospective study of consecutive patients aged ≥18 years referred to the Headache Outpatient Clinic of Aeginition Hospital and diagnosed with primary headache and any thyroid disorder. RESULTS Out of 427 patients (males/females=76/351), 253 (59.3%) were diagnosed with migraine without aura, 53 (12.4%) with TTH, 49 (11.5%) with migraine with aura, 29 (6.8%) with medication-overuse headache, 23 (5.4%) with mixed-type headache (migraine with/without aura and TTH), nine (2.1%) with cluster headache, and 11 (2.6%) with other types of primary headaches. The prevalence of any type of thyroid disorder was 20.8% (89/427 patients). In the total sample, 27 patients (6.3%) reported hypothyroidism, 18 (4.2%) unspecified thyroidopathy, 14 (3.3%) thyroid nodules, 12 (2.8%) Hashimoto thyroiditis, 12 (2.8%) thyroidectomy, three (0.7%) thyroid goiter, and three (0.7%) hyperthyroidism. Further statistical analysis between categorical variables did not reveal any significant association between headache subtypes and thyroid dysfunction. CONCLUSIONS No specific association was found between primary headache subtypes and specific thyroid disorder. However, a high prevalence of thyroid dysfunction in general and specifically hypothyroidism was demonstrated among patients with primary headaches, which lays the foundation for further clarification in prospective longitudinal studies.
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Affiliation(s)
- Ioanna Spanou
- National and Kapodistrian University of Athens, Medical School, Aeginition Hospital, Athens, Greece
| | - Foteini Christidi
- National and Kapodistrian University of Athens, Medical School, Aeginition Hospital, Athens, Greece
| | - Georgios Liakakis
- National and Kapodistrian University of Athens, Medical School, Aeginition Hospital, Athens, Greece
| | - Konstantina Rizonaki
- National and Kapodistrian University of Athens, Medical School, Aeginition Hospital, Athens, Greece
| | - Anastasia Bougea
- National and Kapodistrian University of Athens, Medical School, Aeginition Hospital, Athens, Greece
| | - Evangelos Anagnostou
- National and Kapodistrian University of Athens, Medical School, Aeginition Hospital, Athens, Greece
| | - Evangelia Kararizou
- National and Kapodistrian University of Athens, Medical School, Aeginition Hospital, Athens, Greece
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Spanou I, Mavridis T, Mitsikostas DD. Nocebo in Biosimilars and Generics in Neurology: A Systematic Review. Front Pharmacol 2019; 10:809. [PMID: 31396084 PMCID: PMC6667943 DOI: 10.3389/fphar.2019.00809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/15/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Nocebo refers to adverse events related to patients’ negative expectations and previous experiences, mediated by several neurobiological pathways within the brain. It is common among neurological patients and affects adherence and treatment outcomes, representing a real clinical challenge. Methods: We conducted a systematic search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in MEDLINE database, using several keywords for studies that can be processed to investigate the magnitude of nocebo in generics and biosimilars used in the most common neurological diseases. The aim was to estimate its size and suggest strategies to minimize its prevalence in clinical trials and practice. Results: Of a total of 2,606 identified articles, after criteria-based selection, 35 studies were included for analysis. Overall, there was vast heterogeneity across the studies concerning population, study design, and outcomes. Nocebo response could be estimated only in one double-blind randomized trial of generic glatiramer acetate in relapsing remitting multiple sclerosis that included a placebo arm. In this trial, no significant differences observed between the three arms (innovator, bioequivalent, and placebo) in favorable and unfavorable outcomes. In the open-label phase of the trial, an increased withdrawal rate was recorded in patients switched from placebo to bioequivalent (8.4%) that may be related to nocebo. In other open-label and real-world studies evaluating biosimilars or generics for brain disorders, a similar indirect nocebo effect is assuming by several investigators. Also, knowledge gaps between health-care providers and patients exist towards generics and biosimilars. Conclusions: Despite its presence, the true burden of the nocebo response and effect cannot be accurately estimated in existing studies with generics and biosimilars in neurological diseases. Targeted strategies for clinical trials’ design are needed in order to measure the exact nocebo’s size.
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Affiliation(s)
- Ioanna Spanou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Mavridis
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimos D Mitsikostas
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Spanou I, Bougea A, Liakakis G, Rizonaki K, Anagnostou E, Duntas L, Kararizou E. Relationship of Migraine and Tension-Type Headache With Hypothyroidism: A Literature Review. Headache 2019; 59:1174-1186. [PMID: 31310335 DOI: 10.1111/head.13600] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Migraine, tension-type headache, and hypothyroidism constitute very common medical conditions. Headache is one of the most common symptoms of hypothyroidism, occurring in approximately one-third of the patients. To date, data about the relationship between migraine and tension-type headache and thyroid dysfunction, and in particular hypothyroidism have been contradictory, while the underlying pathophysiological basis explaining this association is still unclear. OBJECTIVE In this review, we investigated the association between primary headaches and hypothyroidism, with the aim of shedding light on its pathophysiological basis. METHODS We conducted a systematic search in the MEDLINE database using both subject headings and keywords for headache, migraine, tension-type headache, thyroid hormones, and hypothyroidism, and we also examined manually the reference lists of all articles that met the inclusion criteria. Included studies were related to headache and thyroid disease comorbidity, with emphasis on hypothyroidism (ideally demonstrated by hormonal measurements), and with the term headache including migraine, tension-type headache, and headache attributed to hypothyroidism (HAH) based on the International Classification of Headache Disorders IIIb. Quality of studies was assessed by the Newcastle-Ottawa scale. RESULTS Of a total of 640 identified articles, 9 studies were included. Overall, there was vast heterogeneity across the included studies concerning population, study design and outcomes. Two studies investigated the HAH, with emphasis on the clinical characteristics of headache (time of onset, localization, quality, intensity, and response to hormonal replacement treatment). Five studies investigated comorbidity between migraine and thyroid disorders, especially hypothyroidism, and in the majority of them a positive association was demonstrated. One study found that headache, and particularly migraine, may increase the risk of developing hypothyroidism. Finally, only 1 study on chronic tension-type headache found coexistence of migraine and hypoactivity of the hypothalamus-pituitary-thyroid axis. The strengths and limitations of these studies are analyzed and possible pathophysiological mechanisms are suggested. CONCLUSIONS The existing data are considered inadequate to answer with certainty the relationship between headaches and thyroid disorders. According to our analysis, it seems that suggestions for a possible bidirectional association between headaches and especially migraine and hypothyroidism could exist. It hence lays the foundation for further research into the aforementioned association and its pathogenesis via large prospective multicenter studies.
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Affiliation(s)
- Ioanna Spanou
- Department of Headache, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Anastasia Bougea
- Department of Headache, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - George Liakakis
- Department of Headache, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Konstantina Rizonaki
- Department of Headache, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Evangelos Anagnostou
- Department of Headache, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Leonidas Duntas
- Department of Headache, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Evangelia Kararizou
- Department of Headache, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
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Spanou I, Vassilopoulou S, Koroboki E, Tountopoulou A, Velonakis G, Mitsikostas DD. Convexity Subarachnoid Hemorrhage Due to Cardioembolic Stroke in a Woman with Thyrotoxicosis: Α Case Report. J Stroke Cerebrovasc Dis 2017; 26:e195-e196. [PMID: 28780251 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/27/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Non-traumatic convexity subarachnoid hemorrhage (cSAH) is a rarely reported condition with a wide spectrum of etiologies. Cerebral ischemia secondary to extracranial or intracranial atherosclerotic disease has been identified as a relatively uncommon cause of cSAH. CASE REPORT We report a case of cSAH caused by cardioembolic stroke. A 69-year old female patient developed suddenly left-sided face and body weakness and numbness and visual neglect on the left. She was newly detected with paroxysmal atrial fibrillation on the ground of thyrotoxicosis. Brain magnetic resonance imaging revealed ischemia of embolic pattern with cSAH. Further evaluation excluded other cause of hemorrhage. Dilation of leptomeningeal collateral vessels and rupture of pial vessels in distal cortical arteries may caused cSAH. Full anticoagulation was initiated. After one month, her condition improved significantly (NIHSS from 6 to 2). CONCLUSIONS cSAH may be a rare complication of cardioembolic stroke.
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Affiliation(s)
- Ioanna Spanou
- First Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Sophia Vassilopoulou
- First Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Koroboki
- First Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyro Tountopoulou
- First Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Research Unit of Radiology and Medical Imaging, University of Athens Medical School, Athens, Greece
| | - Dimos Dimitrios Mitsikostas
- First Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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