Clinical guidance for choosing the right pharmacotherapy for migraine attacks

INTRODUCTION

Migraine as headache attacks with autonomic symptoms is a serious condition and it is important to treat a single attack effectively in order to improve not only the patient's quality of life at a given moment but also to prevent the migraine from becoming a chronic one.

AREA COVERED

The article briefly presents the guidance in selecting the most appropriate pharmacological treatment of migraine attack, indicating a personalized approach to migraine patient.

EXPERT OPINION

In this short paper, we show the implementation of new drugs into everyday clinical practice. Good cooperation between the physician and the patient and having the patient's trust is one of the elements of a personalized therapeutic approach and the key to achieving satisfaction of both the patient and the doctor.

Insulin-like growth factor 1 and its prognostic value in the course of acute ischemic cerebrovascular events

Introduction

The aim of the study was to evaluate insulin-like growth factor 1 (IGF-1) as a predictor of the course of an acute cerebral ischemic event (AICE). This polypeptide, by activating receptors that are present in most tissues, including the brain, mediates the anabolic activity of growth hormone (GH) and its impact on growth and maturation processes, as well as organisms' survival time. AICE can occur in the form of a transient ischemic attack (TIA) or an ischemic stroke (IS).

Material and methods

The study included 86 participants. The correlation between serum IGF-1 concentration and the clinical status of 56 patients on days 1 and 9 of AICE, as well as risk factors and the course of the disease, were prospectively analyzed. The control group consisted of 30 healthy volunteers.

Results

Patients with a minor baseline neurological syndrome had higher serum IGF-1 concentrations than patients with severe baseline neurological dysfunctions. Multidimensional analyses showed that high IGF-1 values independently determined the worse course of the disease, especially in patients with a severe neurological deficit present on the first day of AICE.

Conclusions

Our results indicate that the high level of circulating IGF-1 on the first day of AICE is an independent factor determining the unfavorable course of the stroke, and this relationship is proportional to the severity of the baseline neurological deficit. The study also revealed a positive correlation between the decreased plasma IGF-1 concentration on the first day of AICE and the severity of neurological symptoms.

Overactivity of the Less Affected Side as a Possible Pattern of Asymmetry in Sitting in Patients Suffering from First-Time Ischemic Stroke-An Observational Study

It has been observed that in some people in the acute phase of ischemic stroke (IS) there is a tendency to shift the body weight towards the side more affected by the disease and a tendency to spontaneous movements of the upper and/or lower limbs (not covered by the neurological syndrome). The purposes of this study were: to define the kind of behavior observed, and to select symptoms which can predict its occurrence. Participants (n = 222) hospitalized due to first-time IS were assigned to three groups. A: 78 patients with no lateralization of the neurological syndrome (lateralization of the neurological syndrome-LoNS); B: 109 patients with LoNS; O+ group: 35 patients, who at the beginning of hospitalization presented, apart from LoNS, characteristic motor symptoms performed by the less affected side. Patients underwent therapy depending on the neurological symptoms. If the patient showed potential symptoms of a new phenomenon, overactivity of the less affected side (OLAS), a trial therapy (focused on this behavior) was used to confirm it. The predictive symptoms, selected among these from the index day, for the occurrence of OLAS in sitting were distinguished: asymmetry in supine posture and simple, repetitive movements of the nonparetic upper extremity.

Is there a correlation between migraine and eating disorders? A systematic literature review

INTRODUCTION

Migraine is a common primary headache disorder, which affects mainly young females, usually those with some specific personality traits including neuroticism and obsessive-compulsive disorder. Among many factors that may trigger headache are to be found those associated with eating patterns and behaviours. Eating disorders are psychiatric disorders of abnormal eating or weight-control behaviours. According to the most up-to-date classification, six main types are identified, including anorexia nervosa, bulimia nervosa, and binge eating disorder. Similar to migraine, eating disorders are mainly diagnosed in young adults and, moreover, personality pattern, in at least some of the eating disorders, is also suggested to be consistent.

MATERIAL AND METHODS

This systematic review aimed to summarise the available literature related to this topic. We performed an electronic article search through the Embase, PubMed, and Cochrane databases and included 16 articles into analysis in accordance with PRISMA 2020 guidelines.

RESULTS

Most of the studies revealed the presence of a putative correlation between migraine and eating disorders, and these encourage further investigations. Moreover, apart from the clinical aspect, also the pathogenesis underlying both disorders is suggested to be similar. More frequent co-occurrence of other psychiatric disorders in migraineurs, such as depression and anxiety, was reported and should be considered in future research. Furthermore, adverse interactions between pharmacotherapy and symptoms of comorbid conditions underline the importance of this problem.

CONCLUSIONS

A correlation between migraine and eating disorders appears highly probable. However, further investigations are required focusing on diverse aspects such as clinical, psychological, and pathogenic.

The Role of MicroRNA in Migraine: A Systemic Literature Review

Migraine is a common primary headache disorder, affecting about 14% of the population. Importantly, it was indicated as the second cause of disability globally and the leading cause among young women. Despite the widespread prevalence, migraine remains underdiagnosed and undertreated. The possible solution may be microRNAs-small, non-coding molecules. Until now, multiple studies have shown the great value of microRNA in both the diagnosis and treatment of different human diseases. Furthermore, a significant role in neurological disorders has been suggested. Little research regarding the utility of microRNA in migraine has been conducted, however, the results so far appear to be promising. We performed an electronic article search through PubMed and Embase Database to further explore the topic. After the analysis, according to PRISMA 2020 guidelines, we included 21 studies. The dysregulation was observed in migraine in general, as well as in different types and phases; thus, miRNAs emerge as promising diagnostic biomarkers. Additionally, some studies showed the influence of the intervention with miRNA levels on neuroinflammation and the expression of peptides, which are crucial in migraine pathogenesis. This review aims to summarize the current knowledge about the role of miRNAs in migraine and encourage to further research in this field.Kindly check and confirm the edit made in the title.I checked and confirm.

Caffeine for Headaches: Helpful or Harmful? A Brief Review of the Literature

Consumption of caffeine in the diet, both daily and occasional, has a significant biological effect on the nervous system. Caffeine, through various and not yet fully investigated mechanisms, affects headaches. This is especially noticeable in migraine. In other headaches such as hypnic headache, post-dural puncture headache and spontaneous intracranial hypotension, caffeine is an important therapeutic agent. In turn, abrupt discontinuation of chronically used caffeine can cause caffeine-withdrawal headache. Caffeine can both relieve and trigger headaches.

Health-Related Quality of Life in Migraine: EQ-5D-5L-Based Study in Routine Clinical Practice

BACKGROUND

Migraine leads to moderate to severe disabilities and disrupts family life, interpersonal relationships, and professional life, and is the second leading cause of disability worldwide. Many people with migraine suffer prolonged headaches and frequent migraine attacks, transition to having chronic migraine, and have the highest number of disability-adjusted life-years. The aim of this study is to measure the quality of life in migraineurs based on the EQ-5D-5L questionnaire.

METHODS

We assessed 100 consecutive patients diagnosed with migraine: 70 with episodic migraine and 30 with chronic migraine. Migraineurs were asked to complete the EQ-5D-5L. The control group (n = 100), matched for sex and age group, was created based on the results of the population norms study for the EQ-5D-5L in the general population of Poland.

RESULTS

Patients with migraine had worse HRQoL than the matched general population control group for all three primary endpoints of the EQ-5D-5L questionnaire: dimensions, EQ-5D-5L Index and EQ VAS.

CONCLUSIONS

Migraine is a disease that disrupts daily function, and as a lifelong disease, plays a role in every aspect of it. Proving a negative impact on many aspects helps to make decisions about treatment, especially in the context of the design and reimbursement of drugs.

Botulinum Toxin—A Current Place in the Treatment of Chronic Migraine and Other Primary Headaches

Headaches are a very common condition that most people will experience many times during their lives. This article presents the primary headaches, which are a large group of diseases where the headache is not a symptom of another known disease. Tension-type headache affects approximately 80% of the general population, and the prevalence of migraine is estimated at 10–12%. Clinical data and experience to date have demonstrated that botulinum toxin may be an effective prophylactic treatment for chronic headache types. It has been used in neurology for the treatment of dystonia and blepharospasm. Now it has been approved to treat chronic migraine and has been shown to confer significant benefit in refractory cases. Based on clinical experience botulinum toxin has also been tried in other headache disorders. While it is intuitively attractive to think that due to its effect on pain by sensory modulation, there may also be efficacy in its use in chronic tension-type headache and cluster headache, so far, there is little evidence to support this. Botulinum toxin is effective in pain control through its interaction with the SNARE complex, which inhibits the release of neurotransmitters, such as glutamate, substance P and calcitonin gene-related peptide. OnabotulinumtoxinA is effective not only in headache frequency and pain intensity but in other parameters, including quality of life.

Susac's syndrome diagnostic difficulties - the neurological point of view

Susac's syndrome is a rare microangiopathy affecting small vessels of the retina, inner ear and brain. It is characterised by a triad of symptoms: encephalopathy, visual defects, and sensorineural hearing loss. The disease is probably caused by an autoimmune process. Diagnosis is based on the typical symptoms, brain MRI, and, most importantly, fluorescein angiography. It is important to distinguish between Susac's syndrome and multiple sclerosis or migraine with aura, because misdiagnosis leads to the wrong treatment. To date, no detailed guidelines for the treatment of Susac's syndrome have been developed. Immunosuppression seems to be effective. It must be remembered that early and aggressive treatment is crucial, and that delays in diagnosis, and as a result in treatment implementation, worsen the prognosis.

Dizziness as a first alarming symptom to neurological hospital admission: reasons and differentiation problem - a pilot study

Aim. This prospective study aimed to assess the diversity of diagnoses in patients hospitalized in the neurology department, in whom the occurrence of dizziness was the presenting complaint during qualification for hospitalization, based on a joint assessment performed by a doctor and a physiotherapist and the implementation of treatment, including physiotherapy. Material and Methods. The study included consecutive patients selected from 2155 individuals hospitalized between 2018 and 2020 in the Neurology Unit who reported dizziness as the presenting complaint. Results. 100 patients (the mean age 58.68±16.57) were qualified for the study: 53 men (the mean age 59.47±15.44) and 47 women (the mean age 57.79±17.88). In the overwhelming number of cases, dizziness was associated with a vascular incident. However, cases of vertigo were also reported. Conclusion. A variety of diagnoses were made in patients hospitalized in the neurological department in whom the occurrence of dizziness was the presenting complaint during qualification for hospitalization.

Headache Attributed to SARS-CoV-2 Infection or COVID-19 Related Headache-Not Migraine-like Problem-Original Research

BACKGROUND

Many studies have confirmed headache as one of the most common COVID-19-related neurological symptoms. There are some reports concerning migraine attacks during SARS-CoV-2 infection with an unusual course of migraine attack. Our aim was to recognize and characterize accurately the features of headaches accompanying this disease.

METHODS

Research based on questionnaire study gathered 100 randomly chosen medical healthcare employees who experienced symptoms associated with COVID-19 disease, 96 with confirmed COVID-19 (positive SARS-CoV-2 PCR laboratory test or positive rapid COVID-19 antigen test).

CONCLUSION

Headaches reported in the study did not fulfill criteria for migraine with/without aura, tension-type headache according to ICHD-3.

The Microbiota-Gut-Brain Axis as a Key to Neuropsychiatric Disorders: A Mini Review

The central nervous system (CNS) is closely related to the gastrointestinal tract, mainly through regulating its function and homeostasis. Simultaneously, the gut flora affects the CNS and plays an essential role in the pathogenesis of neurologic and neuropsychological disorders such as Parkinson’s and Alzheimer’s disease, multiple sclerosis, amyotrophic lateral sclerosis or autism spectrum disorder. The population of gut microorganisms contains more than one billion bacteria. The most common are six phyla: Proteobacteria, Actinomyces, Verucomicrobia, Fusobacteria, and dominant Bacteroides with Firmicutes. The microbiota–gut–brain axis is a bidirectional nervous, endocrine, and immune communication between these two organs. They are connected through a variety of pathways, including the vagus nerve, the immune system, microbial metabolites such as short-chain fatty acids (SCFAs), the enteric nervous system, and hormones. Age, diet, antibiotics influence the balance of gut microorganisms and probably lead to the development of neurodegenerative disorders. In this article, a review is presented and discussed, with a specific focus on the changes of gut microbiota, gut–brain axis, related disorders, and the factors that influence gut imbalance.

Onabotulinumtoxin A (ONA-BoNT/A) in the treatment of chronic migraine

Migraine is a common primary headache disease, which reduces quality of life. About 8% of migraineurs suffer from chronic migraine (CM), which is the most severe and troublesome type. It has been proven that onabotulinumtoxinA (ONA-BoNT/A) significantly improves CM, presumably inhibiting the release of calcitonin gene-related peptide (CGRP) and other neurotransmitters from c-fibres endings, and thus decreasing activation of nociceptive pathways and transmission of pain. The aim of this position paper was to assess the place of ONA-BoNT/A for the prophylaxis of CM in adults. The authors have compared the efficacy, safety and tolerance of the toxin to those of classical oral preventive therapies as well as to recently introduced anti-CGRP-pathway monoclonal antibodies. The results of randomised controlled studies of ONA-BoNT/A have been compared to open label (real world practice) trials.

Experts’ and national consultants’ recommendations regarding management of patients treated for migraine with comorbid depression. Diagnosis. Therapeutic strategies. Part 2

Depressive disorders are currently diagnosed based on the ICD-10 and DSM-5 diagnostic criteria and include axial depressive symptoms and additional symptoms that must coexist for at least two weeks. Migraine is diagnosed based on the International Classification of Headache Disorders. It is generally divided into migraine with and without aura, and with regard to the frequency of attacks into episodic and chronic migraine. The therapeutic strategy in the treatment of depression is pharmacotherapy combined with psychotherapy, whereas in the treatment of migraine the strategy depends on the frequency of headache attacks (episodic migraine vs. chronic migraine) and comorbidities. A novelty is the introduction of monoclonal antibodies directed against CGRP or the receptor of CGRP. There are numerous reports which indicate specific usefulness of monoclonal antibodies that modify the action of CGRP in the treatment of migraine in people suffering from depression.

Experts’ and national consultants’ recommendations regarding management of patients treated for migraine with comorbid depression. Epidemiology. Pathomechanism. Comorbidity. Part 1

Coexistence of migraine and depression is a significant clinical problem. Health examination surveys indicate that patients who suffer from migraine are more likely to develop depression than the general population. The inverse relationship is also observed. The etiopathogenesis of both migraine and depression is not fully understood and is probably multifactorial and complex. Neurotransmission disorders, the immune system, and genetic predisposition are considered in the literature. The authors present etiopathogenetic theories of both diseases and their prevalence. They analyze data on the comorbidity of these conditions and discuss likely underlying factors. They describe clinical predictors of depression onset in people with migraine.

Migraine diagnosis and treatment in Poland: survey of primary care practitioners

AIM OF THE STUDY

This study aimed to analyze the daily clinical practice of primary care practitioners (PCPs) in Poland concerning migraine patients.

CLINICAL RATIONALE FOR THE STUDY

Migraine is a common chronic primary headache disease, which can be disabling if insufficiently managed. Numerous studies suggest that migraine remains underdiagnosed and undertreated. The first consultation of migraine patients is usually undertaken by a PCP.

MATERIALS AND METHODS

This study was conducted in June and July 2019 in Poland using a computer-assisted web interview with 51 PCPs. The interview questions concerned knowledge of diagnostic criteria and methods of migraine treatment.

RESULTS

On average, each PCP consulted 12 patients with migraine per month. More than half of PCPs (63%) listed partial diagnostic criteria for migraine without aura or mentioned aura in their responses. Only 10% of PCPs listed all diagnostic criteria for migraine without aura. Although 55% of PCPs said that they distinguished between episodic and chronic migraine, 18% provided the wrong definition. The most commonly prescribed drugs were triptans (66%), paracetamol, metamizole, or non-steroidal anti-inflammatory drugs (42%).

CONCLUSIONS AND CLINICAL IMPLICATIONS

PCPs play a critical role in diagnosing, treating, and monitoring migraine; however, many of them have insufficient knowledge about its diagnosis and correct differentiation between chronic and episodic forms.

Neurological manifestations of SARS-CoV-2 - a systematic review

INTRODUCTION

Following two coronaviral epidemics in 2002 and 2012, December 2019 saw the emergence of a potentially fatal coronavirus - SARS-CoV-2, which originated in Wuhan, China. While most coronaviruses are responsible for mild respiratory infections, they have been demonstrated to be neuroinvasive and neurotropic for over three decades. In this review, we assess whether SARS-CoV-2 follows this trend and if the neuroinvasive potential of this novel coronavirus is worthy of further investigation.

METHODS

To obtain sources for this study, we performed an online search through Pubmed, Researchgate and Google Scholar, finding 537 articles. After analysing them according to PRISMA, we included 14 in this review.

DISCUSSION

Data regarding neurological manifestations of SARS-CoV-2 is scarce and mostly inconsistent. There are however identifiable trends which might provide a basis for future research. There is strong evidence that this novel coronavirus may be neuroinvasive and could cause a wide array of neurological symptoms and complications. Cerebrospinal fluid testing may shed more light on the occurrence of SARS-CoV-2 in the central nervous system. Clarification of the respiratory failure mechanisms requires post mortem examinations and brain tissue analysis, and further research is of the utmost importance. However, we strongly believe that the existing evidence is enough to raise awareness among clinicians and help guide them through the diagnosis and optimal therapy of COVID-19 patients.

Cerebral venous and sinus thrombosis diagnosis: preliminary study of clinical picture and D-dimer concentration correlation

AIM OF THE STUDY

We investigated whether D-dimer (DD) concentration is elevated in cerebral venous and sinus thrombosis (CVST), as has been reported in the literature.

CLINICAL RATIONALE FOR THE STUDY

CVST is a disease with variable clinical presentations and a challenging diagnosis. We looked into whether D-dimer concentration might be an indicator of CVST, and the need for neuroimaging tests correlated with clinical factors.

MATERIALS AND METHODS

We included all consecutive patients (mean age 41.6 years) with CVST treated in our neurology department from 2014 to 2018 whose DD levels had been measured. DD concentrations were categorised as normal (≤ 0.5 μg/ml) or elevated ( > 0.5 μg/ml). Appropriate imaging confirmed the diagnosis of CVST. The results were compared to those of a control group consisting of 22 age- and sex-matched patients (mean age 40 years) with a diagnosis of primary headache (tension type or migraine) hospitalised to exclude secondary causes.

RESULTS

In 20 patients in the CVST study group, median level of DD was 1.0 + 0.57 μg/ml (range 0.19-2.45 μg/ml), compared to the control group's mean DD level of 0.50 + 0.45 μg/ml (range 0.15-1.73 μg/ml), with p < 0.005. Higher DD levels were associated with complications of the disease and fatal course (p < 0.005). One female and one male patient died because of CVST with DD levels of (respectively) 2.45 and 1.80 μg/ml - the two highest concentrations in our study group.

CONCLUSIONS AND CLINICAL IMPLICATIONS

DD concentration, especially in headache patients, may be a factor to predict CVST and an indicator for further diagnostic procedures with venography. But in clinical practice, low levels of DD cannot be taken to exclude CVST.

Clinical features and risk factors of angiography headache and evaluation of its relationship to primary headaches - an important but neglected problem

INTRODUCTION

The authors of the article published in the current edition a single-centre prospective cohort study featuring patients who had undergone a diagnostic cerebral angiography procedure and who had experienced a headache associated with the procedure [1]. The authors of 'Clinical features and risk factors of angiography headache and evaluation of its relationship to primary headaches' have addressed a common, but rarely discussed, problem of a headache associated with a cerebral angiography procedure - the angiography headache (AH).

CLINICAL REFLECTIONS

AH was found in almost a quarter of the patients who had undergone angiography, and was found to be associated with female gender, higher education level, and a history of primary headache.

CLINICAL IMPLICATIONS

It is worth remembering that migraine and tension type headaches are common predisposing factors to headache during and after this procedure.

Virtual reality in the diagnostics and therapy of neurological diseases

Introduction: The use of Virtual Reality (VR) in neurology mainly concerns motor solutions. Such an approach is cost-effective and resource-effective. The aim of this work is to review and assess the effectiveness of proposed VR systems in order to diagnose and rehabilitate neurological patients with cognitive disorders.Areas covered: The existing analog neuropsychological tests lack ecological validity. The literature review revealed that VR solutions' biggest advantage is the possibility of assessing patients in everyday situations. Specific tasks (e.g. spatial, verbal, adaptive) could be focused on examining the exact types of memory disabilities in the heterogeneous group of cognitive impairments. There is a visible promise for further development in this area and a good basis for personalized and remote use. While different methodology is set in the analyzed articles the improvement in neurological functions is seen in all of them.Expert opinion: VR is still a relatively new and understudied solution, but there is a visible progress in its research. This trend could lead to more specific and tailored methods for therapy and diagnostics.

Migraine headache facilitators in a population of Polish women and their association with migraine occurrence - preliminary results

AIM OF THE STUDY

. The occurrence of migraine is linked with some common lifestyle activities and conditions preceding the attack. Our study presents known and presumptive lifestyle factors and activities related to migraine, and compares them to the frequency of headache attacks.

MATERIAL AND METHODS

40 female patients of the Headache Outpatient Clinic in Warsaw, Poland, diagnosed with migraine, mean age 44.6 years, and 40 female participants from the control group, mean age 39.5 years, were included in the study. The study employed questionnaires reporting the presence of lifestyle factors and socioeconomic predispositions as well as the Migraine Disability Assessment Test (MIDAS) as data collection methods.

RESULTS

Correlations between some of the lifestyle factors and the frequency of migraines occurred statistically significantly.

CONCLUSIONS

Some factors and lifestyle activities such as stress, relaxation, specific dietary products, fasting, fatigue, bright light, noise, weather changes or menstruation may have an influence on migraine frequency and severity in female patients, which can have an impact on migraine prevention.

Altered functional brain imaging in migraine patients: BOLD preliminary study in migraine with and without aura

DESIGN

Migraine is regarded as a complex brain dysfunction of sensory and modulatory networks with the secondary sensitisation of the trigeminal system as well as the affected brain area's activities. The particular role of the hippocampus and the brainstem in the first phase of the attack, the disrupted cognitive network, and the activation of the limbic and visual systems, are the main discoveries in the field of migraine imaging that have been achieved using functional techniques. Thus advanced neuroimaging has been widely employed to study the pathogenesis of migraine.

OBJECTIVE

The evaluation of fMRI BOLD images of migraine patients with or without aura, with particular attention to the interictal phase.

SUBJECTS AND METHODS

The aim of this study was to compare brain activity during visual stimuli by fMRI BOLD in the interictal phase (black and white checkerboard tests, static or flickering) of 16 migraine patients, eight with aura and eight without.

RESULTS

We demonstrated differences in the right part of the brainstem, the left part of the cerebellum, and in the right middle temporal gyrus. However, the bilateral brain activation in the occipital and frontal lobe remained similar.

CONCLUSIONS

Results of our preliminary study suggest that migraine with aura and migraine without aura might be separate disorders, and this requires further investigation.

Are antimigraine drugs that influence CGRP levels justified?

Migraine is one of the most common disorders found in everyday clinical practice. Although migraines are not directly life-threatening or permanently disabling, the severity of the pain and symptoms that characterize a migraine attack often prevent normal work and cause difficulties in everyday life. Migraines also affect the patient's family, who often experience stress and depression in response to the patient's condition. Available therapy, used in both acute and chronic treatments, might not provide sufficient improvement. Due to problems like therapy inefficacy, side effects, and intolerance, patients often stop treatments. Recent studies have indicated that drugs that act through calcitonin gene-related peptide (CGRP) can significantly improve migraine therapy. Here, we review results from currently available clinical trials on CGRP receptor antagonists and anti-CGRP monoclonal antibodies.

A single-fibre EMG Study of Neuromuscular Transmission in Migraine Patients

It is known that mutations of CACNA1A, which encodes a neuronal P/Q Ca2+ channel, are present in patients with familial hemiplegic migraine, and possibly in other types of migraine as well. This calcium channel is also involved in neuromuscular transmission. To assess if the single-fibre EMG (SFEMG) method can demonstrate a neuromuscular transmission deficit in migraine, a group of 26 patients with different types of migraine and 20 healthy control subjects were studied. The migraine patients were divided into three groups: 8 patients with migraine without aura (MoA), 12 with migraine with aura excluding visual aura (MA) and 6 with visual aura (VA). A SFEMG of the voluntarily activated extensor digitorum communis muscle was performed. The SFEMG results were normal in the healthy controls and the MoA group (migraine without aura). Slight neuromuscular transmission disturbances were present in 6/12 (50%) of patients with MA and in 1/6 (17%) of patients with VA. We suggest that abnormal neuromuscular transmission detectable by SFEMG may reflect a genetically determined dysfunction of the P/Q Ca2+ channels in a subgroup of migraineurs with aura.

Genetic studies of Polish migraine patients: screening for causative mutations in four migraine-associated genes

BACKGROUND AND AIM

Migraine is the most common neurological disorder, affecting approximately 12 % of the adult population worldwide, caused by both environmental and genetic factors. Three causative genes have been identified in familial hemiplegic migraine (FHM) families: CACNA1A, ATP1A2, and SCNA1A. Recently, several mutations in KCNK18 have also been found as causative factors in migraine development. The aim of our study was to identify the genetic background of migraine in the Polish population.

MATERIAL AND METHODS

Sixty patients with migraine without aura (MO) or with different types of migraine with aura (MA), including sporadic hemiplegic, familial hemiplegic, and probable familial hemiplegic, were screened for mutations in the four genes previously linked with different types of migraine (ATP1A2, CACNA1A, SCN1A, and KCNK18).

RESULTS

Two missense mutations were found. One novel mutation in SCN1A, encoding α subunit of sodium channel, causing amino acid change M1500V localized to a region encoding inactivation loop between transmembrane domains III and IV of the channel, was detected in a female FHM patient. The M1500V mutation was absent in a group of 62 controls, as well as in the ExAC database. The second, already known missense mutation S231P in KCNK18 was found in a female MA patient. Additionally, a novel intronic polymorphism possibly affecting alternative splicing of SCN1A, at chr2:16685249, g.77659T>C, and c.4581+32A>G, located between exons 24 and 25, in a region encoding the inactivation loop of the sodium channel was found in a female MO patient. No mutations in ATP1A2 or CACNA1A were found in the study group.

CONCLUSIONS

The presence of SCN1A mutations and absence of mutations in ATP1A2 or CACNA1A suggest that the Polish patients represent FHM type 3. On the other hand, the presence of KCNK18 mutation indicated another FHM subtype. It could be speculated that contrary to other European populations, the genetic basis of migraine in the Polish population involves mutations in genes not included in the study. Next-generation sequencing methods should be implemented to identify other migraine-associated variants.

The Application of Timing in Therapy of Children and Adults with Language Disorders

A number of evidence revealed a link between temporal information processing (TIP) and language. Both literature data and results of our studies indicated an overlapping of deficient TIP and disordered language, pointing to the existence of an association between these two functions. On this background the new approach is to apply such knowledge in therapy of patients suffering from language disorders. In two studies we asked the following questions: (1) can the temporal training reduce language deficits in aphasic patients (Study 1) or in children with specific language impairment (SLI, Study 2)? (2) can such training ameliorate also the other cognitive functions? Each of these studies employed pre-training assessment, training application, post-training and follow-up assessment. In Study 1 we tested 28 patients suffering from post-stroke aphasia. They were assigned either to the temporal training (Group A, n = 15) in milliseconds range, or to the non-temporal training (Group B, n = 13). Following the training we found only in Group A improved TIP, accompanied by a transfer of improvement to language and working memory functions. In Study 2 we tested 32 children aged from 5 to 8 years, affected by SLI who were classified into the temporal training (Group A, n = 17) or non-temporal training (Group B, n = 15). Group A underwent the multileveled audio-visual computer training Dr. Neuronowski^®, recently developed in our laboratory. Group B performed the computer speech therapy exercises extended by playing computer games. Similarly as in Study 1, in Group A we found significant improvements of TIP, auditory comprehension and working memory. These results indicated benefits of temporal training for amelioration of language and other cognitive functions in both aphasic patients and children with SLI. The novel powerful therapy tools provide evidence for future promising clinical applications.

Changes in Serum Amino Acids in Migraine Patients without and with Aura and their Possible Usefulness in the Study of Migraine Pathogenesis

BACKGROUND

Results of several studies suggest that serum amino acids monitoring in migraine might be useful as an objective measurement of the disease status.

OBJECTIVE

The aim of the present work was to analyze the profile of aliphatic and aromatic amino acids in blood serum of migraine patients without and with aura between attacks.

METHODS

A total number of 37 migraine patients (26 with migraine without aura and 11 with migraine with aura), mean age 39±12 years, and 40 age-matched healthy subjects as the control group, mean age 38±14 years, were included into the study. The levels of glutamic acid, glutamine, histidine (His), valine (Val), isoleucine, leucine (Leu), phenyloalanine, lysine were evaluated.

RESULTS

The level of His was significantly higher in both groups of migraine patients (without and with aura) compared to the control group (F(2,74)=10.17, p=0.00). The levels of Val and Leu were significantly different in migraine without but not with aura, when compared with the control group (F(2,74)=4.70, p=0.01 and F(2,74)=4.39, p=0.02, respectively).

CONCLUSION

We found higher level of His in migraine patients without and with aura and lower level of Val and Leu in patients with migraine without aura.

Impairment of neuromuscular transmission in transient global amnesia - does it really exist?

BACKGROUND

The main hypotheses regarding mechanisms of transient global amnesia (TGA) are ischemia in hippocampal structures, epileptic genesis, and migraine. In accordance with the hypothesis of a shared, common pathophysiological mechanism in both TGA and migraine, neuromuscular transmission (NMT) abnormalities previously found in migraine were also suspected in TGA.

OBJECTIVE

The aim of our study was to analyze NMT in TGA patients to reveal a subclinical impairment of neuromuscular transmission as a possible indicator of underlying channelopathy, which would point to a shared etiology with migraine.

MATERIALS AND METHODS

The study group consisted of 15 patients (6 males) with TGA (mean age 69.5±7.4yrs). The duration of amnesia ranged from 1 to 6h (mean 4.4h). Single fiber electromyography (SFEMG), the most sensitive tool for NMT assessment, of the voluntarily activated frontal muscle was performed 1-5 days after a TGA incident.

RESULTS

Abnormal SFEMG was found in 1 patient (6.6%). In all other patients, SFEMG was in the normal range.

CONCLUSION

Our neurophysiological study does not confirm NMT defects in TGA. The role of channelopathy with NMT dysfunction in the pathogenesis of TGA is rather unlikely, whereas subclinical NMT abnormalities were certainly proven in migraine.

Internal jugular vein valve insufficiency is not increased in migraine: an ultrasound study in migraine patients and control participants

Background

Migraine is a common neurological disorder of unclear pathogenesis. Recently incompetence of internal jugular vein valve (IJVVI) was found to be associated with some neurological conditions of unknown etiology such as benign cough headache, primary exertional headache or transient global amnesia. Common vascular mechanism linking transiently increased cerebral venous pressure with the above mentioned conditions was then postulated. Therefore we decided to investigate whether IJVVI may be associated with migraine.

Aim and methods

The aim of our study was to evaluate the occurrence of IJVVI and retrograde flow duration in 70 (56 females) migraine patients by color Doppler ultrasound during Valsalva maneuver.

We assessed internal jugular vein valve in 44 patients with migraine without aura (39 female); mean age 37 ± 9 yrs. and in 26 patients with migraine with typical aura (17 female); mean age 34 ± 9 yrs. Age- and sex-matched control group consisted of 42 healthy persons (33 female); mean age 32 ± 1 yrs.

Results

Frequency of the internal jugular vein valve insufficiency was similar in patients with migraine and in the healthy subjects (51% v. 40%, p = 0.26). Also mean values of retrograde flow duration were similar in both groups (2.4 ± 0.8 sec in migraine group and 2.2 ± 1.2 sec in controls, p = 0.14).

Conclusion

The results of our study show no evidence for an increased prevalence of IJVVI in migraine patients.

[Psychotic symptoms and cognitive impairment in neurosarcoidosis. Case report and review of literature]

Clinical involvement of the nervous system occurs in about 5% of patients with sarcoidosis. We describe a fatal case of a young patient with neurosarcoidosis with a relatively rare psychotic syndrome in the course of neurosarcoidosis, presenting itself as a depressive syndrome with delusions. The neurological manifestations consisted of cerebellar symptoms, peripheral neuropathy and general epileptic seizures. Cerebrospinal fluid examination, serum angiotensin-converting enzyme level, magnetic resonance imaging, chest radiography, gallium isotope scanning and other tests were used as diagnostic tools. He was treated with steroids, methotrexate and neuroleptics ineffectively. The patient died because of complications related to neurosarcoidosis. The diagnosis of neurosarcoidosis was confirmed by autopsy.

Dementia means number of things - the overlap of neurodegeneration with brain iron accumulation (NBIA) and Alzheimer changes: an autopsy case

In humans overlap between various neurodegenerative disorders is a well known phenomenon. We reported a case of a 77-year-old woman with parkinsonism, dystonia, psychiatric symptoms and progressing dementia misdiagnosed at the age of 51 years as Parkinson's disease. Histopathological examination of the patient's brain performed 26 years after the disease onset revealed numerous axonal spheroids and iron deposits in structures of the nigro-pallido-striatal system that enabled to diagnose neurodegeneration with brain iron accumulation (NBIA) (former Hallervorden-Spatz syndrome), and changes characteristic for Alzheimer's disease (AD). NBIA is a group of rare clinically and genetically heterogeneous diseases of the extrapyramidal system which common feature is abnormal iron storage in the basal ganglia. Disturbed iron metabolism is also one of the hypothetical patho-mechanisms of AD. A coexistence of morphological changes characteristic for AD and NBIA in our patient suggests that similar molecular mechanisms may be involved in pathogenesis of various neurodegenerative processes, especially in disorders with iron dyshomeostasis. This case contributes also to the increasing evidence of NBIA heterogeneity.

[Primary progressive aphasia: primary nonfluent aphasia or logopedic aphasia? A case report]

We present a case of a 58-year-old female suffering from progressive language difficulties with characteristic symptoms of primary progressive aphasia (PPA) who was finally diagnosed as having progressive nonfluent aphasia variant (PNFA). The differential diagnosis was made between a variant of PNFA and logopenic variant of PPA occurring often in the course of Alzheimer's disease.

[Chronic daily headache--history, epidemiology, clinic and future]

Chronic daily headache (CDH) is not a diagnosis but a category that contains many disorders representing primary and secondary headaches. CDH is defined as headaches which occur more often than 15 days per month for at least 3 months. Approximately 3 to 5 percent of the population worldwide has daily or near-daily headaches. Primary CDH of long duration includes transformed migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua. Transformed migraine and medication-overuse headaches are among the most common and challenging of the CDH disorders. Treatment of CDH focuses on reduction of headache triggers and use of preventive medications such as antidepressants, antiepileptic drugs and beta-blockers. Antidepressants are the most common preventive medications for all types of CDH, which suggests that central serotoninergic neurotransmission can be an important factor in the pathophysiology of chronic pain syndromes.

[Migraine with visual aura: visual aura pictured by the patient]

The most frequent type of migraine aura is the typical one in which the most frequently occurring aura type are visual phenomena. Types of visual aura may be different. Scintillating scotoma, fortification zigzags (teichopsiae), fragmentation of the visual image are typical illusions in visual aura. The visual illusion of a typical corona phenomenon was represented as a visual migraine aura symptom. The extra edges of the corona phenomenon are commonly seen around the perceptual images of objects. The corona phenomenon is strongly associated with visual loss and the presence of elementary geometric illusions. It is surrounding a person's head, shoulders, hands, or body. Illusory splitting can be differentiated from the fragmentation of visual images and from the geometric illusion or mosaic illusion. The pathogenesis of migraine aura remains unclear. The probable cause of migraine aura may be cortical spreading depression (CSD) and cerebral hypoperfusion. Ionic changes, activation of trigeminal nerve and release of neuropeptides seem to be secondary to CSD during the attack of migraine aura. In present article the pictures of visual aura experienced by migraine patient are presented and discussed.

[Current views on the pathogenesis of migraine aura]

The pathogenesis of migraine aura, like migraine, remains unclear. The probable cause of migraine aura may be cortical spreading depression (CSD) and cerebral hypoperfusion. Ion changes, activation of the trigeminal nerve and release of neuropeptides seem to be secondary to CSD during an attack of migraine aura. There are many hypotheses of migraine pathogenesis. The focal symptoms during migraine aura may be due to transient constriction of a cerebral artery and headache can result from a sterile inflammatory reaction around the walls of dilated cranial vessels. The development of aura makes a vascular origin a remote possibility, while a primary disturbance of cortical neuron function, probably CSD and activation of the trigeminovascular system, is a more reasonable explanation.

[Headaches in women]

Headaches are the most frequent condition in humans. Some of the primary headaches e.g. migraine, tension type headache and chronic paroxysmal hemicrania are more prevalent in women than in men. Pregnancy, lactation, breast feeding, withdrawal, intensify some of the primary headaches. These periods supply to some diseases such as eclampsia or cerebral venous thrombosis, in which headache is one of the main symptoms. Differential diagnosis of those headaches are very important, because the pharmaceutical treatment is restricted. Menstruation and menopause periods also cause headaches.