Clinical Neuroscience

[Sumatriptan autoinjection in the acute treatment of migraine attack]

ERTSEY Csaba1, JELENCSIK Ilona1, ÁFRA Judit1, BOZSIK György1

JANUARY 20, 1996

Clinical Neuroscience - 1996;49(01-02)

[The authors report the results of the first Hungarian trial of 5-HT1 receptor agonist sumatriptan autoinjector in the acute treatment of migraine. During the treatment of 400 attacks in 67 patients a significant headache relief was reported in 41% after 30 minutes p. i. and 80.5% after 120 minutes p. i., respectively. In the same time frame complete dissolution of the headache was reported in 39.5% and 72%. The majority of the accompanying symptoms disappeared before the headache relief. Migraine recurrence was frequently noted (45.1% of all attacks). Slight side-effects were experienced in 36% of the attacks treated; in one case skin rash and in another one a temporary chest pain was reported. Using the autoinjector device did not pose serious problems to the patients.]

AFFILIATIONS

  1. Semmelweis Orvostudományi Egyetem, Neurológiai Klinika, Budapest

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Clinical Neuroscience

[Differential diagnosis of Parkinson's syndrome]

FERENC Fornádi

[The fundamental improvement of therapy in Parkinson's disease during the last 25 years also led to specific requirements in differential diagnosis of Parkinson-like diseases. It has become rapidly apparent that the idiopathic Parkinson's syndrome can be treated by a substitutional levodopa therapy very well in the beginning. Considering this fact especially in the case of a so-called "primary levodopa failure" a profound differential diagnosis is necessary. On the other hand an initially diagnosed Parkinson's disease can change its character and develops a widening if symptoms secondary to a reduced levodopa responsiveness. This process can be explained bz a spread of affected cerebral systems known as multy system atrophy (MSA). In former times the differentiation of Parkinson-like diseases could only be done by clinical examination and with regard to a missing levodopa responsiveness. In the last decade diagnostic availabilities became more and more. In addition to MRI and SPECT the 18-FDG- and 18-F-levodopa-PET-scan is very helpful in the cases mentioned above. The following presentation of differential diagnosis in Parkinson-like diseases outlines especially the possibilities of PET-screening.]

Clinical Neuroscience

[Vasoreactivity changes of healthy volunteers investigated by transcranial doppler]

VALIKOVICS Atilla, OLÁH László, FÜLESDI Béla, MUNKÁCSY Csaba, CSIBA László

[Transcranial Doppler (TCD) was used to measure the effect of 1 g acetazolamide (Diamox, Lederle) on blood flow velocity in the middle cerebral artery of 50 healthy volunteers (aged 20-70 years). Parameters of blood flow, blood pressure, heart rate and blood gas values were determined before and after intravenous administration of Diamox. The reserve capacity was expressed as a percentage change of baseline values. The acetazolamide did not result in significant blood pressure and blood gas changes. The mean velocity of blood flow before Diamox administration was 59.8+14.4 cm/s. The velocity of flow significantly increased after acetazolamide, peaking after 10 minutes. The extent of reserve capacity was the greatest in the age group of 31-40 years and the smallest in the 61-70 years group. The reaction was longer lasting in age groups over 50 years. Significantly higher flow parameters and greater reserve capacity was found in women than in men at each measuring time point. The reserve capacity depended on age and gender.]

Clinical Neuroscience

[Distant neuromuscular effect of locally injected botulinum toxin]

DIÓSZEGHY Péter, GLAUB Teodóra, MECHLER Ferenc

[Distant neuromuscular effect of locally infiltrated botulinum toxin was studied. The extensor digitorum communis muscle far from the place of injection was sampled with single-fiber EMG in patients treated for spasmodic torticollis. In 2 and 8–16 weeks after the infiltration the mean jitter values increased significantly compared to that of the results before the treatment. Extremely increased jitter values and blocks were found, too. The fiber density was also higher after the botulinum toxin infiltration. The electrophysiological changes may be a consequence of presynaptic blockade, the botulinum toxin induced terminal sprouting of motor axons and formation of new neuromuscular junctions. Parallel with the electrophysiological abnormalities no remote clinical effects were found. The single-fiber EMG proved to be a sensitive method to control the remote neuromuscular effect of botulinum toxin.]

Clinical Neuroscience

[Schizophrenia-like psychotic episode in Multiple sclerosis]

SIMÓ Magdolna, RÓZSA Csilla, BODROGI László, TAKÁTS Annamária

[A case is presented of a twenty-year-old female with multiple sclerosis. In 1990 the patient had three exacerbations with cerebellar, optic and pyramidal symptoms. After a four-year period of remission she was hospitalized with acute schizophrenia-like psychosis. Acute psychosis is an uncommon manifestation of multiple sclerosis which may cause difficulties in differential diagnosis.]

Clinical Neuroscience

[MIET headache section II. Continuing Education Conference, Abstracts]

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Clinical Neuroscience

Evaluation of anxiety, depression and marital relationships in patients with migraine

DEMIR Fıgen Ulku, BOZKURT Oya

Aim - The aim of this study was to evaluate the frequency and characteristics of attacks in patients with migraine, to determine the effects of anxiety or depressive symptoms, and to evaluate the marital relationships of patients with migraine. Method - Thirty patients who were admitted to the neurology outpatient clinic of our hospital between July 2018 and October 2018 and were diagnosed with migraine according to the 2013 International Headache Society (IHS) diagnostic criteria were included in this cross-sectional study. Age, sex, headache frequency and severity, depressive traits, marital satisfaction and anxiety status were examined. We used the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maudsley Marital Questionnaire (MMQ) and Visual Analogue Scale (VAS) for measuring relevant parameters. Results - The mean severity of migraine pain according to VAS scale was 6.93 ± 1.41 and the mean number of migraine attacks was 4.50 ± 4.24. The mean BDI score of the patients was 12.66 ± 8.98, the mean MMQ-M score was 19.80 ± 12.52, the mean MMQ-S score was 13.20 ± 9.53, the mean STAI-state score was 39.93 ± 10.87 and the mean STAI-trait score was 45.73 ± 8.96. No significant correlation was found between age, number of migraine attacks, migraine duration, migraine headache intensity, and BDI, STAI and MMQ scores (p>0.05). But there was a positive correlation between MMQ-S and scores obtained from the BDI and STAI-state scales (p<0.05). Conclusion - In this study more than half of the migraine patients had mild, moderate or severe depression. A positive correlation was found between sexual dissatisfaction and scale scores of depression and anxiety.

Clinical Neuroscience

To handle the HaNDL syndrome through a case: The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis

ÇOBAN Eda, TEKER Ruken Serap, SERİNDAĞ Helin, SAKALLI Nazan, SOYSAL Aysun

The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL) is a rare entity. This disease has been related to migrainous headaches. It is a benign, self-limited disorder, which is characterized by fluctuating neurological symptoms and cerebrospinal fluid lymphocytosis. We describe a case of a 47 years old man with acute onset of headache and aphasia. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis (25 cells/μl, 100% lymphocytes). Electroencephalogram showed moderate slow rhythm in the left hemisphere, with temporoparietal predominance, and without epileptiform activity. His blood tests as well as magnetic resonance imaging (MRI) results were normal. With the diagnosis of HaNDL syndrome the patient was accepted in the Department of Neurology and discharged with full recovery.

Clinical Neuroscience

[Examining the psychometric properties of a new quality of life questionnaire in migraineurs]

MANHALTER Nóra, PALÁSTI Ágnes, BOZSIK György, ÁFRA Judit, ERTSEY Csaba

[Background - The deleterious effect of primary headaches on the sufferers’ quality of life (QOL) has been abundantly documented using both generic and headache-specific instruments. The currently used questionnaires focus on a limited number of factors and therefore may not be sensitive enough to detect the effect of headache type and headache characteristics on QOL, despite the obvious clinical differences. We have devised a comprehensive questionnaire that may be more sensitive to the burden of headache. Objective - To assess the psychometric properties of the new questionnaire on a group of migraineurs. Patients and method - We studied 117 migraineurs who completed the validated Hungarian version of the SF-36 generic QOL measure and our new, 25-item questionnaire. Reliability was assessed by internal consistency, measured by Cronbach’s a of all items. Content validity was exam- ined by calculating the correlation of the items with subscales of the SF-36 measure. The correlation of the patients’ migraine characteristics with the questionnaire’s items was used to assess criterion validity. Results - The questionnaire was quick and easy to administer. The questionnaire demonstrated good reliability, with Cronbach’s alpha being 0.893. Content validity was adequate; most “physical” items of the new questionnaire showed significant correlations with the bodily pain and role physical SF-36 subscales and most “psychical” and “social” items were correlated with mental health and social functioning SF-36 subscales. Criterion validity was adequate, with headache severity being correlated with most of the items. Discussion - In this study the new headache-specific quality of life instrument showed adequate psychometric properties.]

Clinical Neuroscience

Hyperhomocysteinemia in female migraineurs of childbearing ages

ALEMDAR Murat, SELEKLER Macit Hamit

Background and purpose - Migraine is a risk factor for ischemic stroke in women of childbearing ages. Previous researches revealed a higher prevalence of hyperhomocysteinemia in migraineurs. Possible differences on the frequencies of hyperhomocysteinemia between migraine with aura and migraine without aura could contribute the established variances in stroke risk between these migraine types. Therefore, we aimed to search if the frequency of hyperhomocysteinemia was different between these subtypes of migraine or not. Methods - We analyzed the findings of serum homocysteine levels in female migraineurs of 16-49 years old who admitted to our outpatient clinic. Results - Homocysteine level was elevated in 13.3% of study population. There were not any significant differences on median serum homocysteine levels between migraine with aura (8.0 mikromol/L) and without aura (8.5 mikromol/L). (p=0.426) The frequencies of hyperhomocysteinemia were also similar (9.1% versus 16.7%, respectively; p=0.373). Correlation analyses did not reveal any linear correlation between ages and homocysteine levels either in group of migraine with aura or in group of migraine without aura (p=0.417 and p=0.647, respectively). Similarly, any linear correlation between disease ages and homocysteine levels either in group of migraine with aura or in group of migraine without aura was not detected (p=0.359 and p=0.849, respectively). Conclusion - The median serum homocysteine levels and the frequencies of hyperhomocysteinemia are similar between migraine with aura and without aura in women of childbearing ages. Therefore, the variances on stroke risk ratios between these types of migraine are probably not originated from the differences of serum homocysteine status.

Lege Artis Medicinae

[Illness representation of patiens with migraine and tension headache]

AMANDA Illés, NAGY Beáta Erika

[It’s been proven by many scientific observation that patients describe their diseases both in progression and adaptation in a different manner even though having a similar origin. The reason behind is the various cognitive background. The investigation of this cognitive function may help us understand patients personal reactions better. In 2007 I investigated the effect of three factors (type, understanding and duration of the disease) on illness representation in patients suffering from headache. The patients included were the following three groups: having migraine with aura, migraine without aura and patients with tension headache. I was looking for correlations and differences in disease representations. For this investigation I have used illness representation questionnaires translated and adapted to Hungarian population. The data were obtained in the waiting hall of two headache centres in Debrecen. Although there were no significant correlations in most of the cases, certain tendencies were observed. Understanding of disease representation could be very useful tool in psychological support, psychotherapy for the patients and it could improve their quality of life.]