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Coelho T, Marques W, Dasgupta NR, Chao CC, Parman Y, França MC, Guo YC, Wixner J, Ro LS, Calandra CR, Kowacs PA, Berk JL, Obici L, Barroso FA, Weiler M, Conceição I, Jung SW, Buchele G, Brambatti M, Chen J, Hughes SG, Schneider E, Viney NJ, Masri A, Gertz MR, Ando Y, Gillmore JD, Khella S, Dyck PJB, Waddington Cruz M. Eplontersen for Hereditary Transthyretin Amyloidosis With Polyneuropathy. JAMA 2023; 330:1448-1458. [PMID: 37768671 PMCID: PMC10540057 DOI: 10.1001/jama.2023.18688] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
Importance Transthyretin gene silencing is an emerging treatment strategy for hereditary transthyretin (ATTRv) amyloidosis. Objective To evaluate eplontersen, an investigational ligand-conjugated antisense oligonucleotide, in ATTRv polyneuropathy. Design, Setting, and Participants NEURO-TTRansform was an open-label, single-group, phase 3 trial conducted at 40 sites across 15 countries (December 2019-April 2023) in 168 adults with Coutinho stage 1 or 2 ATTRv polyneuropathy, Neuropathy Impairment Score 10-130, and a documented TTR variant. Patients treated with placebo from NEURO-TTR (NCT01737398; March 2013-November 2017), an inotersen trial with similar eligibility criteria and end points, served as a historical placebo ("placebo") group. Interventions Subcutaneous eplontersen (45 mg every 4 weeks; n = 144); a small reference group received subcutaneous inotersen (300 mg weekly; n = 24); subcutaneous placebo weekly (in NEURO-TTR; n = 60). Main Outcomes and Measures Primary efficacy end points at week 65/66 were changes from baseline in serum transthyretin concentration, modified Neuropathy Impairment Score +7 (mNIS+7) composite score (scoring range, -22.3 to 346.3; higher scores indicate poorer function), and Norfolk Quality of Life Questionnaire-Diabetic Neuropathy (Norfolk QoL-DN) total score (scoring range, -4 to 136; higher scores indicate poorer quality of life). Analyses of efficacy end points were based on a mixed-effects model with repeated measures adjusted by propensity score weights. Results Among 144 eplontersen-treated patients (mean age, 53.0 years; 69% male), 136 (94.4%) completed week-66 follow-up; among 60 placebo patients (mean age, 59.5 years; 68% male), 52 (86.7%) completed week-66 follow-up. At week 65, adjusted mean percentage reduction in serum transthyretin was -81.7% with eplontersen and -11.2% with placebo (difference, -70.4% [95% CI, -75.2% to -65.7%]; P < .001). Adjusted mean change from baseline to week 66 was lower (better) with eplontersen vs placebo for mNIS+7 composite score (0.3 vs 25.1; difference, -24.8 [95% CI, -31.0 to -18.6; P < .001) and for Norfolk QoL-DN (-5.5 vs 14.2; difference, -19.7 [95% CI, -25.6 to -13.8]; P < .001). Adverse events by week 66 that led to study drug discontinuation occurred in 6 patients (4%) in the eplontersen group vs 2 (3%) in the placebo group. Through week 66, there were 2 deaths in the eplontersen group consistent with known disease-related sequelae (cardiac arrhythmia; intracerebral hemorrhage); there were no deaths in the placebo group. Conclusions and Relevance In patients with ATTRv polyneuropathy, the eplontersen treatment group demonstrated changes consistent with significantly lowered serum transthyretin concentration, less neuropathy impairment, and better quality of life compared with a historical placebo. Trial Registration ClinicalTrials.gov Identifier: NCT04136184; EU Clinical Trials Register: EudraCT 2019-001698-10.
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Affiliation(s)
- Teresa Coelho
- Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Wilson Marques
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil
| | | | | | - Yeşim Parman
- İstanbul Üniversitesi–Istanbul Tıp Fakültesi, Istanbul, Turkey
| | | | | | - Jonas Wixner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Long-Sun Ro
- Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | | | - Pedro A. Kowacs
- Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
| | - John L. Berk
- Boston University School of Medicine, Boston, Massachusetts
| | - Laura Obici
- Amyloidosis Research and Treatment Centre, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Markus Weiler
- Amyloidosis Center and Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Isabel Conceição
- Centro Hospitalar Universitário Lisboa-Norte, Hospital de Santa Maria, Lisbon, Portugal
| | | | | | | | - Jersey Chen
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland
| | | | | | | | - Ahmad Masri
- OHSU Center for Hypertrophic Cardiomyopathy and Amyloidosis, Portland, Oregon
| | | | - Yukio Ando
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Julian D. Gillmore
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Sami Khella
- University of Pennsylvania School of Medicine, Philadelphia
| | | | - Márcia Waddington Cruz
- Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Vieira KR, Folchini CM, Heyde MD, Stuginski-Barbosa J, Kowacs PA, Piovesan EJ. Wake‐Up Headache Is Associated With Sleep Bruxism. Headache 2020; 60:974-980. [DOI: 10.1111/head.13816] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/30/2019] [Accepted: 12/30/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Katia R.M. Vieira
- Internal Medicine Postgraduate ProgramHospital de Clínicas da Universidade Federal do Paraná Curitiba Brazil
- Pain and Headache ClinicDivision of NeurologyNeurology and Psychiatry UnitHospital de Clínicas da Universidade Federal do Paraná Curitiba Brazil
| | - Caroline M. Folchini
- Internal Medicine Postgraduate ProgramHospital de Clínicas da Universidade Federal do Paraná Curitiba Brazil
- Pain and Headache ClinicDivision of NeurologyNeurology and Psychiatry UnitHospital de Clínicas da Universidade Federal do Paraná Curitiba Brazil
| | - Marcelo D.V.D. Heyde
- Internal Medicine Postgraduate ProgramHospital de Clínicas da Universidade Federal do Paraná Curitiba Brazil
- Pain and Headache ClinicDivision of NeurologyNeurology and Psychiatry UnitHospital de Clínicas da Universidade Federal do Paraná Curitiba Brazil
| | | | - Pedro A. Kowacs
- Internal Medicine Postgraduate ProgramHospital de Clínicas da Universidade Federal do Paraná Curitiba Brazil
- Pain and Headache ClinicDivision of NeurologyNeurology and Psychiatry UnitHospital de Clínicas da Universidade Federal do Paraná Curitiba Brazil
| | - Elcio J. Piovesan
- Department of Internal Medicine Hospital de Clínicas da Universidade Federal do Paraná Curitiba Brazil
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Trinka E, Ben-Menachem E, Kowacs PA, Elger C, Keller B, Löffler K, Rocha JF, Soares-da-Silva P. Efficacy and safety of eslicarbazepine acetate versus controlled-release carbamazepine monotherapy in newly diagnosed epilepsy: A phase III double-blind, randomized, parallel-group, multicenter study. Epilepsia 2018; 59:479-491. [DOI: 10.1111/epi.13993] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Eugen Trinka
- Department of Neurology; Christian Doppler Medical Center; Paracelsus Medical University Salzburg; Salzburg Austria
- Center for Cognitive Neuroscience; Salzburg Austria
- Department of Public Health and Health Technology Assessment; University for Health Sciences, Medical Informatics, and Technology; Hall in Tirol Austria
| | - Elinor Ben-Menachem
- Institute for Clinical Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | | | - Christian Elger
- Department of Epileptology; University of Bonn; Bonn Germany
| | | | | | - José Francisco Rocha
- Department of Research and Development; BIAL-Portela & C S.A.; S. Mamede do Coronado Portugal
| | - Patrício Soares-da-Silva
- Department of Research and Development; BIAL-Portela & C S.A.; S. Mamede do Coronado Portugal
- Pharmacology and Therapeutics Unit, Department of Biomedicine; Faculty of Medicine; University of Porto; Porto Portugal
- MedInUP; Center for Drug Discovery and Innovative Medicines; University of Porto; Porto Portugal
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Elger C, Koepp M, Trinka E, Villanueva V, Chaves J, Ben-Menachen E, Kowacs PA, Gil-Nagel A, Moreira J, Gama H, Rocha JF, Soares-da-Silva P. Pooled efficacy and safety of eslicarbazepine acetate as add-on treatment in patients with focal-onset seizures: Data from four double-blind placebo-controlled pivotal phase III clinical studies. CNS Neurosci Ther 2017; 23:961-972. [PMID: 29030894 PMCID: PMC5813188 DOI: 10.1111/cns.12765] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 08/02/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 11/28/2022] Open
Abstract
Purpose Pooled evaluation of the key efficacy and safety profile of eslicarbazepine acetate (ESL) added‐on to stable antiepileptic therapy in adults with focal‐onset seizures. Methods Data from 1703 patients enrolled in four phase III double‐blind, randomized, placebo‐controlled studies were pooled and analyzed. Following a 2 week titration period, ESL was administered at 400 mg, 800 mg, and 1200 mg once‐daily doses for 12 weeks (maintenance period). Pooled efficacy variable was standardized (/4 weeks) seizure frequency (SSF) analyzed over the maintenance period as reduction in absolute and relative SSF and proportion of responders (≥50% reduction in SSF). Pooled safety was analyzed by means of adverse events and clinical laboratory assessments. Results SSF was significantly reduced with ESL 800 mg (P < 0.0001) and 1200 mg (P < 0.0001) compared to placebo. Median relative reduction in SSF was 33.4% for ESL 800 mg and 37.8% for 1200 mg (placebo: 17.6%), and responder rate was 33.8% and 43.1% (placebo: 22.2%). ESL was more efficacious than placebo regardless of gender, geographical region, epilepsy duration, age at time of diagnosis, seizure type, and type of concomitant antiepileptic drugs (AED). Incidence of adverse events (AEs) and AEs leading to discontinuation was dose dependent. Most common AEs (>10% patients) were dizziness, somnolence, and nausea. The incidence of treatment‐emergent AEs (dizziness, somnolence, ataxia, vomiting, and nausea) was lower in patients who began taking ESL 400 mg (followed by 400 mg increments to 800 or 1200 mg) than in those who began taking ESL 600 mg or 800 mg. Conclusions Once‐daily ESL 800 mg and 1200 mg showed consistent results across all efficacy and safety endpoints, independent of study population characteristics and type of concomitant AEDs. Treatment initiated with ESL 400 mg followed by 400 mg increments to 800 or 1200 mg provides optimal balance of efficacy and tolerability.
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Affiliation(s)
- Christian Elger
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Mathias Koepp
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, London, UK
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Vicente Villanueva
- Unidad Multidisciplinar de Epilepsia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - João Chaves
- Serviço de Neurologia, Hospital S. António, Centro Hospitalar do Porto, Porto, Portugal
| | - Elinor Ben-Menachen
- Department of Clinical Neuroscience and Physiology, Sahlgren Academy, Sahlgren University Hospital, Göteborg, Sweden
| | | | | | - Joana Moreira
- Department of Research and Development, BIAL - Portela & Cª, S.A., S. Mamede do Coronado, Portugal
| | - Helena Gama
- Department of Research and Development, BIAL - Portela & Cª, S.A., S. Mamede do Coronado, Portugal
| | - José-Francisco Rocha
- Department of Research and Development, BIAL - Portela & Cª, S.A., S. Mamede do Coronado, Portugal
| | - Patrício Soares-da-Silva
- Department of Research and Development, BIAL - Portela & Cª, S.A., S. Mamede do Coronado, Portugal.,Department of Biomedicine, Faculty of Medicine, Unit of Pharmacology and Therapeutics, University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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Teive HAG, Germiniani FMB, Kowacs PA, Munhoz RP. Charcot, Mitchell and Lees: neurology free thinkers and their experiences of psychoactive drugs. Arq Neuropsiquiatr 2016; 74:1035-1038. [PMID: 27992004 DOI: 10.1590/0004-282x20160160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 09/05/2016] [Indexed: 11/22/2022]
Abstract
Three world-famous neurologists, Charcot and Mitchell, in the 19th century, and Lees, in this century, all of whom had great scientific curiosity, experimented with the psychoactive drugs hashish, mescal and yagé, respectively, in an attempt to increase their knowledge of neurological diseases and how the brain works.
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Affiliation(s)
- Hélio A G Teive
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Unidade de Distúrbios dos Movimentos, Curitiba PR, Brasil
| | - Francisco M B Germiniani
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Unidade de Distúrbios dos Movimentos, Curitiba PR, Brasil
| | - Pedro A Kowacs
- Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Neurologia, Unidade de Dor de Cabeça, Curitiba PR, Brasil
| | - Renato P Munhoz
- University Health Network, Toronto Western Hospital, Gloria and Morton Shulman Movement Disorders, Toronto, ON, Canada
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Abstract
The case of a 25-year-old white male, who had migrainous headaches each time he sat in front of his personal computer screen, is described. Changing the screen frequency from 60 to 75 Hz through a Windows command could abolish the headaches. In several surveys, computer screens have been reported to be a migraine trigger. We hypothesize that this environmental trigger may be related to the abnormal flicker fusion thresholds that have been described in migraineurs. It may be that modifying the frequencies of light sources, such as computer screens, could become a non-pharmacological approach to prevent migraine attacks.
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Affiliation(s)
- P A Kowacs
- Headache Unit, Neurology Division, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil.
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Abstract
A randomized double-controlled trial involving 22 patients with Noonan syndrome (NS) and 22 normal individuals (control group) was carried out to determine the prevalence of migraine in patients with NS. The NS group consisted of 11 males aged 19.55 ± 6.11 years and 11 females aged 18.81 ± 5.47 years. The control group consisted of 11 males aged 19.55 ± 6.6 years and 11 females aged 18.81 ± 5.47 years. Seven NS-group patients reported migraine without aura (MO), and three reported probable MO (PMO). Taken together, these represent a prevalence of migraine in the NS group of 45.5%. Two control-group patients reported MO, a prevalence of 9.09%. The prevalence of migraine was significantly higher in the NS-group patients than in the controls ( P < 0.005), suggesting a positive association between NS and migraine. Nevertheless, further studies are needed to confirm our findings.
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Affiliation(s)
- E J Piovesan
- Headache Unit, Neurology Division, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil.
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Abstract
There are a significant number of famous people who suffered from frequent headaches during their lifetime while also exerting an influence of some kind on politics or the course of history. One such person was Anneliese Marie Frank, the German-born Jewish teenager better known as Anne Frank, who was forced into hiding during World War II. When she turned 13, she received a diary as a present, named it ‘Kitty’ and started to record her experiences and feelings. She kept the diary during her period in hiding, describing her daily life, including the feeling of isolation, her fear of being discovered, her admiration for her father and her opinion about women's role in society, as well as the discovery of her own sexuality. She sometimes reported a headache that disturbed her tremendously. The ‘bad’ to ‘terrifying’ and ‘pounding’ headache attacks, which were accompanied by vomiting and during which she felt like screaming to be left alone, matched the International Headache Society criteria for probable migraine, whereas the ‘more frequent headaches’ described by Anne's father are more likely to have been tension-type headaches than headaches secondary to ocular or other disorders.
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Affiliation(s)
- R F de Almeida
- Headache Outpatient Unit, Hospital da Polícia Militar, Belo Horizonte, Minas Gerais, Brazil.
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Kowacs PA, Piovesan EJ, Werneck LC, Fameli H, Zani AC, da Silva HP. Critical Flicker Frequency in Migraine. A Controlled Study in Patients without Prophylactic Therapy. Cephalalgia 2016; 25:339-43. [PMID: 15839848 DOI: 10.1111/j.1468-2982.2004.00861.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The critical flicker frequencies (CFF) of individuals with migraine with and without aura were determined and compared to those of normal controls. Twenty-six migraine patients, 12 with aura and 14 without aura and 30 healthy controls were included. Migraineurs were tested during a migraine-free period, through both the continuous flicker method (CFM) and the forced choice method (FCM). Migraineurs presented a mean flickering fusion threshold lower than healthy controls with the CFM (40.45 vs. 44.33, respectively; P = 0.019) and with the FCM (34.16 Hz vs. 38.5 Hz, respectively, P = 0.019). Both groups of migraineurs had significantly lower thresholds as compared to controls, migraineurs with aura presenting the lowest thresholds for the fusion of flickering ( P = 0.008 and P = 0.0001 with the CFM and the FCM, respectively). Results confirmed and extended previous observations of abnormal flicker fusion thresholds in migraineurs. We hypothesize that this finding might be related to a shorter cortical stimulation silent period.
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Affiliation(s)
- P A Kowacs
- Headache Unit, Neurology Division, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil.
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Nascimento FA, Takeshita BT, Kowacs PA. Phenytoin-induced isolated chronic, nocturnal dry cough. Epilepsy Behav Case Rep 2016; 5:44-5. [PMID: 27330990 PMCID: PMC4907895 DOI: 10.1016/j.ebcr.2016.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 02/27/2016] [Accepted: 03/04/2016] [Indexed: 11/28/2022]
Abstract
We report a 72-year-old man with a four-year history of dyscognitive seizures (with occasional secondary generalization) who developed isolated, nocturnal dry cough immediately after being started on PO phenytoin. The cough was not accompanied by any other symptom or sign as his physical exam was completely normal. Further investigation with chest CT and spirometry was unremarkable. This symptom persisted for six months and did not resolve until we weaned him off of phenytoin. According to the Naranjo Adverse Drug Reaction Probability Scale, his cough was classified as being probably (score + 6) related to the use of this antiepileptic drug. To our knowledge, there has been only one study that reported phenytoin-triggered cough. It described a postoperative patient who developed cough and bronchospasm after receiving IV phenytoin. By reporting our case and discussing the literature on this specific topic, we have essentially two goals. First, we intend to remind clinicians that isolated persistent cough can be an adverse reaction to phenytoin. Second, we hope to encourage further studies that will be able to elucidate the association presented herein.
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Affiliation(s)
- Fábio A Nascimento
- Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Pedro A Kowacs
- Neurological Institute of Curitiba (INC), Curitiba, Paraná, Brazil
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Kowacs PA, Utiumi MAT, Nascimento FA, Piovesan EJ, Teive HAG. OnabotulinumtoxinA for trigeminal neuralgia: a review of the available data. Arq Neuropsiquiatr 2015; 73:877-84. [PMID: 26291995 DOI: 10.1590/0004-282x20150109] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/12/2015] [Indexed: 11/21/2022]
Abstract
Trigeminal neuralgia (TN) patients may develop side effects from centrally acting drugs, have contraindications for neurosurgical procedures, or experience relapse during conventional therapies. OnabotulinumtoxinA (BoNT/A) has been reported to be effective for TN, although this finding has been challenged. An overview of the available evidence based on a narrative/qualitative analysis of the literature is presented. About 90% of patients who receive BoNT/A show an improvement, a higher figure than that reported for the placebo effect of BoNT/A for other headaches. Tolerability of BoNT/A is good, and its few side-effects are transient. The articles reviewed were mainly case reports, case series and open-label trials; however, randomized controlled trials have endorsed the efficacy of BoNT/A for TN. This evidence, together with a better understanding of the analgesic mechanisms of BoNT/A and its proven efficacy in treating other pain syndromes, supports the use of this toxin as a therapeutic option for TN.
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Affiliation(s)
| | - Marco A T Utiumi
- Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, BR
| | - Fábio A Nascimento
- Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, GD
| | - Elcio J Piovesan
- Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, BR
| | - Helio A G Teive
- Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, BR
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Abstract
BACKGROUND Throughout history, migraine-associated visual symptoms have puzzled patients, doctors, and neuroscientists. The visual aspects of migraine extend far beyond the aura phenomena, and have several clinical implications. METHODS A narrative review was conducted, beginning with migraine mechanisms, then followed by pertinent aspects of the anatomy of visual pathways, clinical features, implications of the visual system on therapy, migraine on visually impaired populations, treatment of visual auras and ocular (retinal) migraine, effect of prophylactic migraine treatments on visual aura, visual symptoms induced by anti-migraine or anti-headache drugs, and differential diagnosis. RESULTS A comprehensive narrative review from both basic and clinical standpoints on the visual aspects of migraine was attained; however, the results were biased to provide any useful information for the clinician. CONCLUSION This paper achieved its goals of addressing and condensing information on the pathophysiology of the visual aspects of migraine and its clinical aspects, especially with regards to therapy, making it useful not only for those unfamiliar to the theme but to experienced physicians as well.
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Affiliation(s)
- Pedro A Kowacs
- Neurological Institute of Curitiba (INC), Curitiba, Brazil; Neurology Section, Hospital Clinics of the Federal University at Paraná (HC-UFPR), Curitiba, Brazil
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Sperling MR, Abou-Khalil B, Harvey J, Rogin JB, Biraben A, Galimberti CA, Kowacs PA, Hong SB, Cheng H, Blum D, Nunes T, Soares-da-Silva P. Eslicarbazepine acetate as adjunctive therapy in patients with uncontrolled partial-onset seizures: Results of a phase III, double-blind, randomized, placebo-controlled trial. Epilepsia 2014; 56:244-53. [PMID: 25528898 PMCID: PMC4354260 DOI: 10.1111/epi.12894] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [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] [Accepted: 11/12/2014] [Indexed: 11/28/2022]
Abstract
Objective To evaluate the efficacy and safety of adjunctive eslicarbazepine acetate (ESL) in patients with refractory partial-onset seizures. Methods This randomized, placebo-controlled, double-blind, parallel-group, phase III study was conducted at 173 centers in 19 countries, including the United States and Canada. Eligible patients were aged ≥16 years and had uncontrolled partial-onset seizures despite treatment with 1–2 antiepileptic drugs (AEDs). After an 8-week baseline period, patients were randomized to once-daily placebo (n = 226), ESL 800 mg (n = 216), or ESL 1,200 mg (n = 211). Following a 2-week titration period, patients received ESL 800 or 1,200 mg once-daily for 12 weeks. Seizure data were captured and documented using event-entry or daily entry diaries. Results Standardized seizure frequency (SSF) during the maintenance period (primary end point) was reduced with ESL 1,200 mg (p = 0.004), and there was a trend toward improvement with ESL 800 mg (p = 0.06), compared with placebo. When data for titration and maintenance periods were combined, ESL 800 mg (p = 0.001) and 1,200 mg (p < 0.001) both reduced SSF. There were no statistically significant interactions between treatment response and geographical region (p = 0.38) or diary version (p = 0.76). Responder rate (≥50% reduction in SSF) was significantly higher with ESL 1,200 mg (42.6%, p < 0.001) but not ESL 800 mg (30.5%, p = 0.07) than placebo (23.1%). Incidence of treatment-emergent adverse events (TEAEs) and TEAEs leading to discontinuation increased with ESL dose. The most common TEAEs were dizziness, somnolence, nausea, headache, and diplopia. Significance Adjunctive ESL 1,200 mg once-daily was more efficacious than placebo in adult patients with refractory partial-onset seizures. The once-daily 800 mg dose showed a marginal effect on SSF, but did not reach statistical significance. Both doses were well tolerated. Efficacy assessment was not affected by diary format used.
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Meneses MS, Rocha SFB, Simão C, Santos HNHLD, Pereira C, Kowacs PA. Vagus nerve stimulation may be a sound therapeutic option in the treatment of refractory epilepsy. Arq Neuro-Psiquiatr 2013; 71:25-30. [DOI: 10.1590/s0004-282x2013000100006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 10/08/2012] [Indexed: 11/21/2022]
Abstract
INTRODUCTION: Refractory epilepsy accounts for 20 to 30% of epilepsy cases and remains a challenge for neurologists. Vagus nerve stimulation (VNS) is an option for palliative treatment. OBJECTIVE: It was to study the efficacy and tolerability of VNS in patients implanted with a stimulator at the Curitiba Institute of Neurology (INC). METHODS: A case study of six patients with refractory epilepsy submitted to a VNS procedure at the INC in the last four years was described and discussed. RESULTS: Mean age at time of implantation was 29 years. Mean follow-up was 26.6 months. Seizure frequency decreased in all patients (40-50% (n=2) and >80% (n=4)). Three patients no longer required frequent hospitalizations. Two patients previously restricted to wheelchairs started to walk, probably because of improved mood. CONCLUSION: In this population, VNS proved to be a sound therapeutic option for treating refractory epilepsy.
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15
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Ducci RD, Cirino RH, de Oliveira RA, Twardowschy CA, Chomatas ER, Kowacs PA. Analysis of 621 death certificates issued from 1998 to 2007 in Curitiba, Brazil, mentioning epilepsy, epileptic seizures and/or status epilepticus. Seizure 2011; 20:406-8. [DOI: 10.1016/j.seizure.2011.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 01/18/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022] Open
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16
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17
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18
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Lorenzoni PJ, Scola RH, Lang B, Kay CSK, Teive HAG, Kowacs PA, Werneck LC. Cerebellar ataxia in non-paraneoplastic Lambert-Eaton myasthenic syndrome. J Neurol Sci 2008; 270:194-6. [PMID: 18374949 DOI: 10.1016/j.jns.2008.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 02/05/2008] [Accepted: 02/07/2008] [Indexed: 11/29/2022]
Abstract
Lambert-Eaton myasthenic syndrome (LEMS) is an immune-mediated disorder of the neuromuscular junction that rarely is associated with cerebellar ataxia (CA). We describe two patients with non-paraneoplastic LEMS associated with CA who showed high levels of anti-P/Q-type voltage-gated calcium channels antibodies in the serum and cerebrospinal fluid, and reduced CMAP with increment after brief maximum voluntary contraction in electrophysiological studies. We suggest that LEMS should be considered in the differential diagnosis of patients with CA.
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Affiliation(s)
- Paulo J Lorenzoni
- Department of Internal Medicine, Universidade Federal do Paraná, Curitiba, Brazil
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19
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Kowacs PA, Teive HAG, Piovesan EJ, Zavala JA, Werneck LC. Botulinum-A toxin in the treatment of painful post-stroke nocturnal paroxysmal dystonia triggered by periodic limb movements of sleep: case report. Arq Neuro-Psiquiatr 2006; 64:1027-9. [PMID: 17221018 DOI: 10.1590/s0004-282x2006000600028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 08/07/2006] [Indexed: 11/22/2022]
Abstract
INTRODUCTION: Sleep disorders presenting involuntary movements may be very annoying to patients, apart from their negative influence on sleep. OBJECTIVE: To report the use of botulinum type-A toxin (BoNT-A) to manage the case of a patient whose sleep was severely disrupted by episodes of dystonic posturing of the right lower limb triggered by periodic limb movements of sleep (PLMS). METHOD: A 79-year-old woman with mild post-stroke right hemiparesis presented with recurrent painful episodes of dystonia of the right lower limb, which disrupted her sleep. The dystonic episodes could also be voluntarily triggered by extension of the right hallux. Polysomnography confirmed that the dystonic episodes were triggered by PLMS. Twenty units of BoNT-A (20U/500U vial) were injected into her right extensor hallucis longus. RESULTS: Shortly after BoNT-A was injected, the dystonic symptoms abated, and the patient achieved better sleep efficiency. CONCLUSION: The PLMS-related involuntary extension of the hallux was probably triggering the nocturnal post-stroke lower limb dystonic paroxysms. BoNT-A injection into the right extensor hallucis longus was effective in managing this condition and thus resolved the associated disruption of sleep.
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Affiliation(s)
- Pedro A Kowacs
- Serviço de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brasil.
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20
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Meneses MS, Hertz A, Gruetzmacher C, Blattes SF, Silva Júnior EBD, Vosgerau RA, Laroca H, Kowacs PA. Epilepsia e desordens de malformação do desenvolvimento cortical. ACTA ACUST UNITED AC 2006. [DOI: 10.1590/s1676-26492006000500007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVOS: As desordens do desenvolvimento cortical (DDC) constituem a segunda causa de epilepsia refratária. Diversas patologias estão incluídas nas DDC. Seu diagnóstico foi facilitado com o desenvolvimento na neuroimagem. MÉTODOS: No presente artigo, apresentamos sete casos divididos em três grupos, de acordo com o mecanismo de produção das DDC: 1) anormalidades da proliferação e diferenciação de neurônios da glia; 2) anormalidades de migração neuronal; 3) anormalidades na organização neuronal. A investigação consistiu em história mais exame neurológico, avaliação neuropsicológica, ressonância magnética e eletrencefalograma. RESULTADOS E CONCLUSÕES: Três pacientes apresentaram displasia cortical focal, dois apresentaram heterotopia em banda, um paciente apresentava lisencefalia e uma apresentava esquizencefalia. Todos os pacientes apresentavam epilepsia de difícil controle. Malformações corticais constituem um grupo heterogêneo de causas de epilepsia de difícil controle. É importante para o manejo médico que as diversas formas de malformações corticais sejam conhecidas e diagnosticadas, o que foi facilitado pelo advento da ressonância magnética.
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21
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Piovesan EJ, Teive HG, Kowacs PA, Della Coletta MV, Werneck LC, Silberstein SD. An open study of botulinum-A toxin treatment of trigeminal neuralgia. Neurology 2006; 65:1306-8. [PMID: 16247065 DOI: 10.1212/01.wnl.0000180940.98815.74] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thirteen subjects with trigeminal neuralgia were treated with botulinum-A neurotoxin (BoNT/A) in an open-label pilot study. After BoNT/A, visual analog scale score, surface area of pain, and therapeutic coefficient were reduced in all patients and for all branch trigeminal nerves studied. Therefore, BoNT/A is an efficient treatment. There were no major side effects. A placebo-controlled clinical trial is needed to confirm these findings.
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Affiliation(s)
- E J Piovesan
- Neurology Division, Internal Medicine Department, Hospital de Clinicas, Universidade Federal do Parana, Curitiba, Brazil.
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22
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Abstract
Cortical spreading depression was described in 1943 by Aristides Leão, a Brazilian neurophysiologist. Initially considered to be a mysterious event as it was discovered serendipitously, its nature has become progressively better known. Cortical spreading depression is now accepted as the mechanism underlying migraine aura and has became known as either Leão's spreading depression or cortical spreading depression. Recent studies have suggested a role for Leão's cortical spreading depression in the pathogenesis and symptomatology of neurologic disorders such as transient global amnesia, head injury, and cerebrovascular diseases.
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Affiliation(s)
- H A G Teive
- Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.
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23
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Meneses MS, Rocha SB, Kowacs PA, Andrade NO, Santos HL, Narata AP, Bacchi AP, Silva EB, Simão C, Hunhevicz SC. Tratamento cirúrgico da epilepsia do lobo temporal: análise de 43 casos consecutivos. Arq Neuro-Psiquiatr 2005; 63:618-24. [PMID: 16172711 DOI: 10.1590/s0004-282x2005000400012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Quarenta e três pacientes com epilepsia refratária ao tratamento medicamentoso foram submetidos à cirurgia de epilepsia do lobo temporal no Instituto de Neurologia de Curitiba, entre os anos de 1998 a 2003. Trinta e nove (90,6%) pacientes apresentavam esclerose mesial temporal, e quatro (9,4%), tumores cerebrais. Dos trinta e sete pacientes que possuíam avaliação pós-operatória completa, 83,7% apresentaram classificação I, segundo Engel (livres de crises incapacitantes). Complicações pós-operatórias ocorreram em 18,6%: uma infecção da ferida operatória, um caso de hidrocefalia, um de fístula liquórica, dois casos de paralisia transitória do IV nervo craniano e um de hemiparesia transitória. Não houve nenhum óbito relacionado à cirurgia de epilepsia no presente estudo.
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Affiliation(s)
- Murilo S Meneses
- Instituto de Neurologia de Curitiba, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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24
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Kowacs PA, Piovesan EJ, de Campos RWGR, Lange MC, Zetola VF, Werneck LC. Warfarin as a therapeutic option in the control of chronic cluster headache: a report of three cases. J Headache Pain 2005; 6:417-9. [PMID: 16362716 PMCID: PMC3452071 DOI: 10.1007/s10194-005-0234-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2005] [Accepted: 06/08/2005] [Indexed: 11/26/2022] Open
Abstract
Chronic cluster headache
remains refractory to medical therapy
in at least 30% of those who suffer
from this condition. The lack of
alternative medical therapies that
are as effective as, or more effective
than, lithium carbonate makes
new therapies necessary for this
highly disabling condition. Based
on a previous report, we gave oral
anticoagulants to three patients with
chronic cluster headache. Two of
them remained cluster headachefree
while taking warfarin. In the
third patient, the use of warfarin for
three weeks initially increased the
frequency and intensity of cluster
headache attacks but subsequently
induced a prolonged remission. In
spite of the paucity of data available,
oral anticoagulation appears to
be a promising therapy for chronic
cluster headache.
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Affiliation(s)
- Pedro A Kowacs
- Headache Section, Neurology Division, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Rua General Carneiro 181/1236, 80060-900 Curitiba, Brazil.
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25
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Kowacs PA, Marchioro IJM, Silva EBD, Rocha SFBD, Simão CA, Meneses MS. "Hot-water epilepsy ", "warm-water epilepsy", or bathing epilepsy? Report of three cases and considerations regarding an old theme. Arq Neuro-Psiquiatr 2005; 63:399-401. [PMID: 16059587 DOI: 10.1590/s0004-282x2005000300006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Partial and generalized tonic-clonic reflex seizures related to hot water bathing have been described as temperature-related. We describe three cases of bathing epilepsy: a 28 year-old white male and a 30 year-old white female with spells triggered either by warm or hot water, and a 32 year-old female with spells triggered by hot water. The later two of the three cases presented localized epilepsy and a familial history of epilepsy. A complex tactile stimuli might play the most relevant role on seizure triggering, as well as water temperature with an additive effect over cutaneous stimulation.
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Affiliation(s)
- Pedro A Kowacs
- Epilepsy Unit, Instituto de Neurologia de Curitiba, Curitiba, PR, Brazil.
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26
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Affiliation(s)
- Pedro A. Kowacs
- Headache Section, Neurology Division, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, Rua General Carneiro 181, Sala 1236, 80060-900 Curitiba, Brazil
| | - Elcio J. Piovesan
- Headache Section, Neurology Division, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, Rua General Carneiro 181, Sala 1236, 80060-900 Curitiba, Brazil
| | - Lineu C. Werneck
- Headache Section, Neurology Division, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, Rua General Carneiro 181, Sala 1236, 80060-900 Curitiba, Brazil
| | - Hudson Fameli
- Headache Section, Neurology Division, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, Rua General Carneiro 181, Sala 1236, 80060-900 Curitiba, Brazil
| | - Marcos C. Lange
- Headache Section, Neurology Division, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, Rua General Carneiro 181, Sala 1236, 80060-900 Curitiba, Brazil
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27
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Kowacs PA, Troiano AR, Mendonça CT, Teive HAG, Werneck LC. Carotid transient ischemic attacks presenting as limb-shaking syndrome: report of two cases. Arq Neuropsiquiatr 2004; 62:339-41. [PMID: 15235742 DOI: 10.1590/s0004-282x2004000200027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Limb shaking syndrome (LSS) is a rare presentation of transient ischemic attacks (TIAs), usually secondary to a critical carotid stenosis compromising intracranial circulation, first described 40 years ago. Two additional cases are described herein, aiming to add on to previous descriptions, and to warn physicians about this potentially harming and rather uncommon condition.
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Affiliation(s)
- Pedro A Kowacs
- Neurology Division, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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28
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Kowacs PA, Monteiro de Almeida S, Pinheiro RL, Fameli H, Piovesan EJ, Correia A, Werneck LC. Central nervous system Aspergillus fumigatus infection after near drowning. J Clin Pathol 2004; 57:202-4. [PMID: 14747452 PMCID: PMC1770214 DOI: 10.1136/jcp.2003.010066] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To report the case of a 26 year old white man, who developed chronic meningitis and intracerebral granulomata 15 days after an episode of near drowning in a swamp. METHODS Aspergillus fumigatus was isolated from cerebrospinal fluid cultures. RESULTS The patient died 70 days after the symptoms were first noticed, and seven days after a subarachnoid haemorrhage. Aspergillus has never been reported before as a cause of intracranial infection after near drowning. CONCLUSIONS Physicians must be aware of this possibility when confronted with such a situation, because there are now effective therapeutic options for systemic aspergillosis.
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Affiliation(s)
- P A Kowacs
- Neurology Division, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, 80060-900, Curitiba, Brazil.
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Kowacs PA, Soares Silvado CE, Monteiro de Almeida S, Ramos M, Abrão K, Madaloso LE, Pinheiro RL, Werneck LC. Infection of the CNS by Scedosporium apiospermum after near drowning. Report of a fatal case and analysis of its confounding factors. J Clin Pathol 2004; 57:205-7. [PMID: 14747453 PMCID: PMC1770198 DOI: 10.1136/jcp.2003.8680] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This report describes a fatal case of central nervous system pseudallescheriasis. A 32 year old white man presented with headache and meningismus 15 days after nearly drowning in a swine sewage reservoir. Computerised tomography and magnetic resonance imaging of the head revealed multiple brain granulomata, which vanished when steroid and broad spectrum antimicrobial and antifungal agents, in addition to dexamethasone, were started. Cerebrospinal fluid analysis disclosed a neutrophilic meningitis. Treatment with antibiotics and amphotericin B, together with fluconazole and later itraconazole, was ineffective. Miconazole was added through an Ommaya reservoir, but was insufficient to halt the infection. Pseudallescheria boydii was finally isolated and identified in cerebrospinal fluid cultures, a few days before death, three and a half months after the symptoms began. Diagnosis was delayed because of a reduction in the lesions after partial treatment, which prevented a stereotactic biopsy. Physicians should be aware of this condition, and provide prompt stereotactic biopsy. Confirmed cases should perhaps be treated with voriconazole, probably the most effective, currently available treatment for this agent.
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Affiliation(s)
- P A Kowacs
- Division of Neurology, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, 80060-900 Curitiba, Brazil.
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Abstract
Cranial nociceptive perception shows a distinct topographic distribution, with the trigeminal nerve receiving sensory information from the anterior portions of the head, the greater occipital nerve, and branches of the upper cervical roots in the posterior regions. However, this distribution is not respected during headache attacks, even if the etiology of the headache is specific for only one nerve. Nociceptive information from the trigeminal and cervical territories activates the neurons in the trigeminal nucleus caudalis that extend to the C2 spinal segment and lateral cervical nucleus in the dorsolateral cervical area. These neurons are classified as multimodal because they receive sensory information from more than one afferent type. Clinically, trigeminal activation produces symptoms in the trigeminal and cervical territory and cervical activation produces symptoms in the cervical and trigeminal territory. The overlap between the trigeminal nerve and cervical is known as a convergence mechanism. For some time, convergence mechanisms were thought to be secondary to clinical observations. However, animal studies and clinical evidence have expanded our knowledge of convergence mechanisms. In this paper, the role of convergence mechanisms in nociceptive physiology, physiopathology of the headaches, clinical diagnosis, and therapeutic conduct are reviewed.
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Affiliation(s)
- Elcio J Piovesan
- Jorge Manços do Nascimento Teixeira 868, São José dos Pinhais, 83005-500 Brazil.
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Piovesan EJ, Young BW, Werneck LC, Kowacs PA, Oshinsky ML, Silberstein SD. Recurrent extratrigeminal stabbing and burning sensation with allodynia in a migraine patient. Cephalalgia 2003; 23:231-4. [PMID: 12662193 DOI: 10.1046/j.1468-2982.2003.00541.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- E J Piovesan
- Setor de Cefaléias, Especialidade de Neurologia, Departamento de Clínica Médica do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
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Abstract
The idiopathic stabbing headache (ISH) is characterized by a stabbing pain of short duration, variable localization and an errant evolution pattern. As its biological mechanisms are unknown and the treatment options are little effective, this disorder shows a strong impact on the patient's life. Two females and one male, aged 76, 66 and 72 years, respectively, started presenting ISH within 20 days after the onset of a stroke. All the patients were treated for the ISH with celecoxib, a COX-2 specific inhibitor, with full recovery from ISH up to 6 days after it was first administered. The interruption of the drug 60 days after the treatment with celecoxib induced again the appearance of algic symptoms in two patients. We concluded that cerebrovascular diseases (CD) can lead to ISH and that the COX-2 inhibitor can be an effective prophylactic drug for ISH after CD.
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Affiliation(s)
- E J Piovesan
- Headache Section, Neurology Unit, Internal Medicine Department, Hospital de Clinicas da Universidade Federal do Paraná, Curitiba, Brazil.
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Kowacs PA, Piovesan EJ, Tatsui CE, Lange MC, Werneck LC, Vincent M. Symptomatic trigeminal-autonomic cephalalgia evolving to trigeminal neuralgia: report of a case associated with dual pathology. Cephalalgia 2001; 21:917-20. [PMID: 11903287 DOI: 10.1046/j.1468-2982.2001.00253.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- P A Kowacs
- Serviço de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal de Paraná, Curitiba, Brazil.
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Kowacs PA, Piovesan EJ, Lange MC, Werneck LC, Tatsui CE, Ribas LC, Scapucin L, Marques LE, Moreira AT. Prevalence and clinical features of migraine in a population of visually impaired subjects in Curitiba, Brazil. Cephalalgia 2001; 21:900-5. [PMID: 11903284 DOI: 10.1046/j.1468-2982.2001.00286.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To investigate the relevance of lacking or diminished visual input on the expression of migraine, we evaluated its prevalence and clinical features in a population of visually impaired subjects. Between September 1999 and April 2000, 203 visually impaired subjects with a headache inventory were surveyed. Those with headache were assessed according to IHS criteria for the presence of migraine. Migraineurs had their symptoms further detailed through an interview and a headache diary. Of the 104 subjects reporting headaches during the last 6 months, 29 had migraine (14.2%). The prevalence of migraine was not influenced by whether the visual impairment was complete or partial. Mean frequency of migraine attacks was 2.7/month. Most subjects (96%) reported severe and/or moderate attacks. Nausea, vomiting, aggravation by activity and phonophobia were reported by 62%, 37.9%, 86.2% and 96.6% of the subjects, respectively. Visual impairment does not seem to influence prevalence of migraine or its clinical features.
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Affiliation(s)
- P A Kowacs
- Division of Neurology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil.
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35
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Affiliation(s)
- E J Piovesan
- Headache Unit, Neurology Section, Internal Medicine Department, Hospital de Clínicas da UFPR, Brazil.
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36
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Piovesan EJ, Lange MC, Kowacs PA, Pacheco C, Werneck LC. Evaluation of headache intensity in migrainous patients with visual handicap through the tactile analogical scale (TAS). Arq Neuropsiquiatr 2001; 59:702-7. [PMID: 11593268 DOI: 10.1590/s0004-282x2001000500009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The tactile analogue scale (TAS) was elaborated to be used in blind subjects or those who can not use the vision during their crises. The objective of this study was to characterize, from TAS, the architecture of migraine attacks in subjects with visual disability. For that, 11 migrainous with visual disturb (MVD) subjects were studied and 22 migrainous subjects with no visual disability as a control group. All patients fulfilled the criteria for migraine and the patients of the group studied showed visual acuteness less than 20/200. To evaluate the results, the patients of the group MVD were subdivide within two groups, according to their visual acuteness: subgroup A subjects with subnormal vision and subgroup B amaurotic ones. In subgroup A measurement 46 attacks with average of the migraine attacks of the 56.50 mm, in the subgroup B 45 attacks with average of the 59.58 mm and in the control group 92 attacks with average of the 49.88 mm. When subgroup B and control group were compared there was a significant statistic difference (p=0.022). Through these outcomes we can observe that the migrainous subjects with no visual afference show a higher pain intensity during the migraine crises comparing to those subjects with no visual handicap. The study suggests that, as in other forms of sensibility, the total visual loss can also interfere in the nociceptive control of the pain during the migraine attacks.
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Affiliation(s)
- E J Piovesan
- Unidade de Cefaléia, Especialidade de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brasil.
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37
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Piovesan EJ, Werneck LC, Kowacs PA, Tatsui CE, Lange MC, Vincent M. [Anesthetic blockade of the greater occipital nerve in migraine prophylaxis]. Arq Neuropsiquiatr 2001; 59:545-51. [PMID: 11588633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Migraine comprises a great many encephalic structures in its pathophysiology with the trigeminal nerve (TN) type being one of the main ones. For the purpose of determining a possible influence of the greater occipital nerve (GON) on migraine behavior, 37 patients who showed this pathology were studied. Using a double blind "cross over" group and submitting those patients to a GON infiltration with bupivacaina 0.5% (BP) and physiological serum 0.9% (PS), the clinical effects were evaluated: subjectively, through a pain analytical visual scale; objectively, by determining the threshold of pain perception (algometry). The comparison between the two groups (BP-PS) and (PS-BP) has shown that the number and duration of the attacks did not show significant statistical differences during the study. The intensity of the attacks was lower in group (BP-PS) only after the second infiltration (p=0.020), in the other moments no differences have been observed between the groups. The conclusion is that the anesthetic blockage with BP on the GON does not change the number of crises and their duration, but it does provokes an intensity reduction after 60 days from the infiltration. The results shown here suggest that GON participates in the cranial nociceptive modulation during crises of migraine without aura.
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Affiliation(s)
- E J Piovesan
- Unidade de Cefaléias, Especialidade e Serviço de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brasil.
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Piovesan EJ, Kowacs PA, Lange MC, Pacheco C, Piovesan LR, Werneck LC. [Prevalence and semiologic aspects of the idiopathic stabbing headache in a migraine population]. Arq Neuropsiquiatr 2001; 59:201-5. [PMID: 11400025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Idiopathic stabbing headache is a quite unknown disorder. Its main features consist of brief stabbing pains, lasting few seconds. In most cases, idiopathic stabbing headache is underdiagnosed. We have followed up migraine patients during a period of 12 months, aiming to determine the prevalence and main features of idiopathic stabbing headache while occurring apart from migraine attacks. Two hundred and thirty-three of the 280 patients initially surveyed were included in the analysis of the results. Ninety-four patients presented idiopathic stabbing headaches (40.4%), being 72 of them females (76.5%). For migraine with idiopathic stabbing headaches, mean age, age of beginning of migraine and years with migraine were 33, 22.5 and 10.6 years, respectively. Mean duration of the idiopathic stabbing headaches was reported to be 1.42 seconds [ 1 second by 68 patients (72.4%), 2 seconds by 17 (18.1%), 3 seconds by 6 (6.3%), 4 seconds by 1 (1.05%) and 5 seconds by 2 (2.15%)]. Pain paroxysms were reported to be unilateral by 86 (91.4%) and bilateral by 8 (8.6%) of the cases. They were reported to be temporal by 56 patients (60%), occipital by 15 (15.6%), frontal by 8 (8.5%), temporo-occipital by 7 (7.4%), parietal by 5 (5.3%), fronto-temporal by 1 (1.06%), cervical by 1 (1.06%) and ocular by 1 patient (1.06%). The study confirms a high prevalence of idiopathic stabbing headaches in migraineurs. Its main clinical features could be well determined during the interval between migraine attacks.
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Affiliation(s)
- E J Piovesan
- Unidade de Cefaléias, Serviço de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná.
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Piovesan EJ, Lange MC, Piovesan LM, Kowacs PA, Werneck LC. [Pseudomigraine with CSF pleocytosis: intermittent measurement of the intracranial pressure. Case report]. Arq Neuropsiquiatr 2001; 59:449-53. [PMID: 11460197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Pseudomigraine with pleocytosis is a self-limited and rather benign disorder, characterized by recurrent bouts of migrainous headaches, associated to focal neurological symptoms and to cerebrospinal fluid abnormalities. We have submitted an individual with pseudomigraine to three lumbar punctures. The first and the third lumbar punctures, carried out during symptomatic periods, revealed a cerebrospinal fluid with aseptic lymphomonocytic pleocytosis, and an opening pressure of 400 and 440 mmH2O, respectively. The cerebrospinal fluid pressure measured during an asymptomatic period was normal (190 mmH20). Although the underlying mechanisms of this disorder remain elusive, there is some evidence that suggests an involvement of autoimmune mechanisms leading to a reduction of the cerebral blood flow, similar to that seen in the cortical spreading depression. In this report, we raise the possibility of a contributory role to be played by the elevated cerebrospinal fluid pressure on the pathophysiology of this disorder.
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Affiliation(s)
- E J Piovesan
- Ambulatório de Cefaléias, Especialidade de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brasil.
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Kowacs PA, Piovesan EJ, Werneck LC, Tatsui CE, Lange MC, Ribas LC, da Silva HP. Influence of intense light stimulation on trigeminal and cervical pain perception thresholds. Cephalalgia 2001; 21:184-8. [PMID: 11442552 DOI: 10.1046/j.1468-2982.2001.00178.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thirty-three migraineurs and 23 healthy controls were submitted to pressure algometry before and after light-induced discomfort was elicited by progressive light stimulation in a monoblind fashion. Pressure algometries were performed on the emergence of the supraorbital, infraorbital, mental and greater occipital nerves, and over the temporal muscles, always throughout the same sequence and from right to left. Measurements were carried out before and immediately after light stimulation and after 10 min of the second algometry. The final result for each site measured at each time-point was the mean of the three measurements. Light stimulation was carried out progressively until light-induced discomfort was reported, to a maximum of 20,000 lux. A heat-blocking glass protected patients' eyes. Migraineurs presented significant and persistent drops in pain perception thresholds after light stimulation, at all sites tested (P = 0.002 to < 0.0001). These drops were not seen in controls, in whom, conversely, a less significant increase was seen on right infraorbital and left temporal muscle sites. Our results indicate that in migraineurs, light may have a relevant role in trigeminal and cervical pain perception thresholds.
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Affiliation(s)
- P A Kowacs
- Neurology Division, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
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Piovesan EJ, Tatsui CE, Kowacs PA, Lange MC, Pacheco C, Werneck LC. [Using algometry of pressure measuring the threshold of trigeminal pain perception in normal volunteers: a new protocol of studies]. Arq Neuropsiquiatr 2001; 59:92-6. [PMID: 11299439 DOI: 10.1590/s0004-282x2001000100019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Algometry of pressure is a technique that measures the physiology of the nociceptive system. Acting directly on the responsive peripheral nociceptors to pressure stimuli, this technique allows the study on nociceptive integrity in normal subjects or having different algic syndromes. Utilizing 29 asymptomatic volunteers, the threshold of the painful perception was studied, measuring them in a direct way over the emergence of the supra-orbital, infra-orbital and mental nerves. The following algometric average were recorded: right mental nerve 46.2 Kg/cm2 and left 48.6 Kg/cm2; right supra-orbital nerve 47.7 Kg/cm2 and left 45.2 Kg/cm2; right infra-orbital nerve 53.9 Kg/cm2 and left 55.4 Kg/cm2. After reviewing the principles of the algometry utilization, we have validated this protocol, showing the average values obtained by measuring the trigeminal system, afterwards comparing them with an inervated region by cervical branches (major occipital nerve) and the temporal muscle.
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Affiliation(s)
- E J Piovesan
- Setor de Cefaléias, Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Brazil.
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Piovesan EJ, Kowacs PA, Tatsui CE, Lange MC, Ribas LC, Werneck LC. Referred pain after painful stimulation of the greater occipital nerve in humans: evidence of convergence of cervical afferences on trigeminal nuclei. Cephalalgia 2001; 21:107-9. [PMID: 11422092 DOI: 10.1046/j.1468-2982.2001.00166.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cranial sensory innervation is supplied mainly by the trigeminal nerves and by the first cervical nerves. Excitatory and inhibitory interactions among those nerve roots may occur in a mechanism called nociceptive convergence, leading to loss of somato-sensory spatial specificity. Three volunteers in an experimental trial had sterile water injected over their greater occipital nerve on one side of the neck. Pain intensity was evaluated 10, 30 and 120 s after the injection. Two of the patients reported intense pain. Trigeminal autonomic features, suggestive of parasympathetic activation, were seen associated with trigeminally distributed pain. These data add to and reinforce previous evidence of convergence of cervical afferents on the trigeminal sensory circuit.
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Affiliation(s)
- E J Piovesan
- Setor de Cefaléias, Especialidade de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
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Piovesan EJ, Tatsui CE, Kowacs PA, Prazeres RF, Lange MC, Antoniuk SA, Werneck LC. [Lipoma of the corpus callosum associated with the hypertrophy of the corpus callosum: case report]. Arq Neuropsiquiatr 2000; 58:947-51. [PMID: 11018839 DOI: 10.1590/s0004-282x2000000500027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite the lipomas are the tumors that more commonly occur in the corpus callosum (CC), its incidence in the population is not common. We report on a 5-year old boy, with history of retardation in the psychomotor development and disturbs in the gait, secondary to generalized hypotony. Magnetic resonance imaging showed a curvilinear lipoma of the CC related to its hypertrophy. In the literature patients with CC lipoma usually have agenesis or hypotrophy of the CC, but in the reported case we have seen, by the first time, a hypertrophy of the CC. We made embryologic, genetic, clinical, radiographic and therapeutic considerations about the patients that have CC lipoma comparing to findings in the case we report.
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Affiliation(s)
- E J Piovesan
- Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, 80069-900, Brasil.
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Abstract
Two cases of Lafora's disease with prominent movement disorders portraying rare initial manifestations are reported. In both patients, the first manifestations were cerebellar ataxia, dysartria and startle phenomenon. These symptoms occurred before seizures, myoclonic and progressive dementia, which are more well known as manifestations of Lafora's disease. The diagnosis was confirmed by the identification of PAS positive inclusion bodies in deep skin biopsy samples. Our patients presented an unexpected slow progression of the disease, with longer survival. Lafora's disease should be remembered among diseases causing slowly progressive ataxia associated with epileptic seizures.
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Affiliation(s)
- A de Quadros
- Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná
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Piovesan EJ, Lange MC, Teive HA, Tatsui CE, Kowacs PA, Piovesan LM, Werneck LC. [Change in the biological pattern of migraine with aura after the use of tetrabenazine: case report]. Arq Neuropsiquiatr 2000; 58:566-71. [PMID: 10920424 DOI: 10.1590/s0004-282x2000000300027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The influence of the dopaminergic system on the pathophysiology of migraine has been suggested as a result of recent genetic discoveries. A possible hyper-reactivity of the dopaminergic receptors DRD2 reinforced the evidence regarding this. We describe a 31 years-old male patient affected by a generalized dystonia secondary to perinatal hypoxia. At age 16, the patient started having headache crises that met the criteria for migraine with aura. After three years of treatment for dystonia with tetrabenazine, a clear reduction in the frequency, intensity and duration of the crises was perceived. During two periods longer than two months, the interruption of the treatment with tetrabenazine brought about an aggravation of the migraine crises. We present this case as being the first description in the literature showing the beneficial effects of tetrabenazine, a blocker of dopaminergic receptors, on the behavior of migraine with aura.
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Affiliation(s)
- E J Piovesan
- Setor de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Brazil
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Piovesan EJ, Kowacs PA, Lange MC, Tatsui CE, Werneck LC. [Can the biologic pattern of cervicogenic headache change after overuse or withdrawal of ergotamine derivatives?]. Arq Neuropsiquiatr 2000; 58:336-41. [PMID: 10849637 DOI: 10.1590/s0004-282x2000000200022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The transformation of a primary headache into a chronic daily headache (CDH) may or may not be related to the overuse of pain-killers, as their influence on the pathophysiological mechanisms remain inconclusive. We describe three patients (female, aged 65 and 39 years, and male, 46) affected by cervicogenic headache (CH) and CDH linked to the overuse of pain-killers (ergotamine derivatives) that were submitted to the infiltration of the greater occipital nerve (GON). At the end of three days of treatment, a total improvement of the pain symptoms was recorded, which allowed for the withdrawal of the ergotamine derivatives. The CH cannot be ranked with the CDHs, since it presents an organic etiology; however, if the pain is daily and the diagnosis is belated, the indiscriminate and excessive use pain-killers may occur. In the cases described, the overuse of pain-killers did not affect the natural evolution of this headache after treatment with the infiltration of the GON, as all the patients who underwent infiltration showed a total improvement of their painful symptoms, without headache resulting from the withdrawal of pain-killers, nor did they show any pharmacological dependence. This is an evidence that the CH presents and organic etiology, not being influenced in its pathophysiology by the overuse of ergotamine derivatives.
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Affiliation(s)
- E J Piovesan
- Setor de Cefaléias, Especialidade de Neurologia, Departamento de Clínica Médica, Hospital de Clinicas, Universidade Federal do Paraná (UFPR), Curitaba PR, Brasil.
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Kowacs PA, Piovesan EJ, Tatsui CE, Lange MC, Ribas LC, Werneck LC. Prolonged migraine aura without headache arrested by sumatriptan. A case report with further considerations. Cephalalgia 1999; 19:241-2. [PMID: 10376169 DOI: 10.1046/j.1468-2982.1999.019004241.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The case of a 42-year-old woman with prolonged migraine visual aura without headache, whose long-lasting episodes of visual aura were successfully controlled by oral sumatriptan, is reported. Effectiveness of sumatriptan was unequivocal, since, after taking sumatriptan, duration of aura would drop from 1.5 h to approximately 20 min. This case suggests that sumatriptan may cross the blood-brain barrier and block spreading depression.
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Affiliation(s)
- P A Kowacs
- Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil.
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Piovesan EJ, Werneck LC, Kowacs PA, Tatsui C, Lange MC, Carraro Júnior H, Wittig EO. [Greater occipital neuralgia associated with occipital osteolytic lesion. Case report]. Arq Neuropsiquiatr 1999; 57:114-9. [PMID: 10347737 DOI: 10.1590/s0004-282x1999000100023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The anatomic distribution of the greater occipital nerve during its path permits a close relationship with muscular structures, tendons, vessels and bones. The rupture of this relationship can origin its irritation and headache. We describe an uncommon association between an osteolytic lesion on occipital bone and greater occipital nerve. The patient, female 50, has been presenting headache for two years on the right occipital region spreading to the hemicranic and ipsilateral supraorbital region. The symptoms started spontaneously or by pressure on the trapezius tendon. The pain lasted about 30 minutes, compressive, mild intensity, with no autonomic symptoms and no improvement after the infiltration in the greater occipital nerve. The total improvement of the symptoms after releasing the nerve has allowed us to associate this lesion to the presence of algic symptoms.
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Affiliation(s)
- E J Piovesan
- Unidade de Cefaléias, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, Brasil.
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Urban CD, Piovesan EJ, De Almeida SM, Kowacs PA, Minguetti G, Werneck LC. [Acute schistosomiasis with brain involvement. Case report]. Arq Neuropsiquiatr 1996; 54:677-82. [PMID: 9201353 DOI: 10.1590/s0004-282x1996000400021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A case of acute schistosomiasis with magnetic resonance images (MRI) of the brain suggestive of demyelinating lesions, pyramidal disorder in the lower limbs and normal cerebrospinal fluid is presented. Diagnosis could be established by detection of antibodies on blood and cerebrospinal fluid. Schistosoma mansoni involves the spinal cord more often than the brain. Praziquantel associated to prednisolone was effective in this case. There are few reports of brain involvement with S. mansoni, but its prevalence is probably greater. Due to the paucity of studies, its pathophysiology and therapeutics remain to be better clarified. The immune and MRI aspects are emphasized.
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Affiliation(s)
- C D Urban
- Departamento de Clínica Médica, Hospital de Clínicas da Universidade, Federal do Paraná (UFPR), Curitiba, Brasil
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Abstract
The migrainous syndrome secondary to a parieto-occipital arteriovenous malformation usually presents as unilateral headache with visual aura of progressive severity. We report successful prevention by atenolol of migraine with visual aura associated with an occipital vascular malformation. Effectively preventing migraine delayed specific therapeutic measures, thereby exposing the patient to the risk of an intracranial hemorrhage. The authors consider that prophylactic therapy should not be started whenever such an association is suspected.
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Affiliation(s)
- P A Kowacs
- Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
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