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Title: Science at work. Post by cluster on May 18th, 2007, 7:03pm 1: Neurol Sci. 2007 May;28 Suppl 2:S94-6. Related Articles Biochemistry of neuromodulation in primary headaches: focus on anomalies of tyrosine metabolism. D'Andrea G, Nordera GP, Perini F, Allais G, Granella F. Headach e Center, Neurology Clinic "Villa Margherita", Via Costacolonna 6, I-36057, Arcugnano, Italy. Recent studies have suggested that abnormalities of dopamine and trace amines (tyramine, octopamine, and synephrine), products of tyrosine metabolism, may constitute the metabolic events that predispose to the occurrence of cluster headache (CH) and migraine attacks. This hypothesis is supported by the following evidences: the discovery of trace amine associated receptors (TAARs), expressed on the olfactory epithelium, amigdala, hypothalamus, periacqueductal gray, and the biochemical anomalies of dopamine and trace amines. The possible effects of these biochemical abnormalities on TAARs and dopamine receptors, located in different areas of CNS, may explain the behaviour (restlessness, anxiety and, at times, hypersexuality) and the autonomic signs during the painful attacks of CH, and the premonitory symptoms of migraine crisis (thirst, craving, yawning, alteration of smell, depression etc.). PMID: 17508188 [PubMed - in process] 2: Neurol Sci. 2007 May;28 Suppl 2:S229-31. Related Articles Two symptomatic cases of cluster headache associated with internal carotid artery dissection. Rigamonti A, Iurlaro S, Zelioli A, Agostoni E. Department of Neurology, Ospedale A. Manzoni, Via Dell'Eremo 9/11, I-23900, Lecco, Italy, rig74@libero.it. Cluster headache is a clinical entity characterised by strictly unilateral head pain attacks accompanied by ipsilateral autonomic phenomena. We report two patients who had pain episodes mimicking cluster headache attacks, and who experienced a total or partial Horner's syndrome ipsilaterally to pain, persisting for 48 h after the last attack. A dissection of the ipsilateral internal carotid artery at the extra-intracranial passage was present in both cases. These cases highlight the need for extensive neuroradiological investigation in cluster headache patients when atypical features are present. PMID: 17508178 [PubMed - in process] 3: Neurol Sci. 2007 May;28 Suppl 2:S188-97. Related Articles Antiepileptic drugs in the prophylaxis of migraine, chronic headache forms and cluster headache: a review of their efficacy and tolerability. D'Amico D. Fondazione IRCCS Istituto Neurologico C. Besta, Via Celoria 11, I-20123, Milan, Italy, damicodo@tiscali.it. The studies of different antiepileptic drugs (AEDs) in the prophylaxis of episodic migraine, cluster headache (CH) and chronic headache forms (chronic daily headache, transformed or chronic migraine, chronic tension-type headache) are reviewed. The main results from published trials are summarised - focusing on responder rates as reported in placebo-controlled, double-blind studies. Most common adverse events are also discussed. This review indicated that robust evidence supports the use of sodium valproate-divalproex and of topiramate (TPM) in the prophylaxis of migraine, while definitive conclusions about the real effects of other AEDs in migraine cannot be drawn. Overall, evidence of efficacy of different AEDs in chronic headache forms and in CH is still lacking, most studies being open-label, small-sample trials. Nevertheless, encouraging data from controlled trials are emerging for TPM in the treatment of chronic headache forms. PMID: 17508169 [PubMed - in process] 4: Neurol Sci. 2007 May;28 Suppl 2:S166-78. Related Articles The future of acute care and prevention in headache. Krymchantowski AV, Rapoport AM, Jevoux CC. , Rua Siqueira Campos 43/1002 Copacabana, Rio de Janeiro, Brazil. Migraine is a chronic neurological disease with heterogeneous characteristics resulting in a range of symptom profiles, burden and disability. It affects nearly 12% of the adult population in Western countries and up to 22% of the Brazilian population, imposing considerable suffering as well as personal, economic and social losses. The pharmacological treatment of migraine is divided into preventive and acute treatment. A better comprehension of migraine pathophysiology, as well as the finding of novel molecular targets, has led to a growing number of upcoming therapeutic opportunities. The same is true of cluster headache, which affects only about 0.07%-0.4% of most populations. This review focuses on current and emerging agents and procedures for the treatment of migraine and cluster headache. PMID: 17508166 [PubMed - in process] |
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Title: Re: Science at work. continued. Post by cluster on May 18th, 2007, 7:05pm Neurol Sci. 2007 May;28 Suppl 2:S146-9. Related Articles Deep brain stimulation in craniofacial pain: seven years' experience. Bussone G, Franzini A, Proietti Cecchini A, Mea E, Curone M, Tullo V, Broggi G, Casucci G, Bonavita V, Leone M. Headache Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, I-20133, Milan, Italy, leone@istituto-besta.it. Cluster headache (CH) is a primary headache with excru ciatingly painful attacks that are strictly unilateral. About 10% of cases experience no significant remission, and about 15% of these do not respond to medication, so surgery is considered. Neuroimaging studies show that the posterior inferior hypothalamus is activated during CH attacks and is plausibly the CH generator. We report on 16 chronic CH patients, with headaches refractory to all medication, who received long-term hypothalamic stimulation following electrode implant to the posterior inferior hypothalamus. After a mean follow-up of 23 months, a persistent pain-free to almost pain-free state was achieved in 13/16 patients (15/18 implants; 83.3%) a mean of 42 days (range 1-86 days) after monopolar stimulation initiation. Ten patients (11 implants) are completely pain-free. A common side effect was transient diplopia, which limited stimulation amplitude. In one patient, a small non-symptomatic haemorrhage into the 3rd ventricle occurred following implant, but regressed 24 h later. Persistent side effects are absent except in one patient with bilateral stimulation, in whom stimulation was stopped to resolve vertigo and worsened bradycardia, but was resumed later without further problems. Hypothalamic stimulation is an effective, safe and well tolerated treatment for chronic drug-refractory CH. It appears as a valid alternative to destructive surgical modalities, and has the additional advantage of being reversible. PMID: 17508162 [PubMed - in process] |
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Title: Re: Science at work. Post by Phil L on May 18th, 2007, 10:23pm Perhaps in English next time. |
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Title: Re: Science at work. Post by ClusterChris on May 18th, 2007, 10:48pm Wow, That second article just got me excited! I am going to e-mail that doctor and see if he is willing to speak to me about this! Awsome post! Chris |
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Title: Re: Science at work. Post by cluster on May 19th, 2007, 1:57pm Hello Phil, Whats wrong with Italian? ;-) I forgot two cluster headache related abstracts from the same supplement (Volume 28, Supplement 2 / Mai 2007) of the Journal "Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology": Neurol Sci. 2007 May;28 Suppl 2:S138-45. Related Articles Update on neurosurgical treatment of chronic trigeminal autonomic cephalalgias and atypical facial pain with deep brain stimulation of posterior hypothalamus: results and comments. Broggi G, Franzini A, Leone M, Bussone G. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, I-20133, Milan, Italy, gbroggi@istituto-besta.it. The objective of this study is to describe the therapeutic effect and the technical and surgical problems of deep brain stimulation (DBS) of the posterior hypothalamus over seven years, for treatment of chronic trigeminal autonomic cephalalgias and atypical facial pain. We report a surgical series of 20 patients that underwent DBS of the posterior hypothalamus. This series includes 16 patients with chronic cluster headache (CH), one patient with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and three patients with atypical facial pain. All patients of this series were resistant to any pharmacological and conservative treatment. The stimulated target was the same in the whole series even though stereotactic coordinates of the target referred to the midcommissural point differ slight in the Y anteroposterior value due to individual anatomical variability. The commissures based reference system was adapted to individual anatomical landmarks of the brainstem adding to the registration a third reference point below the commissural plane. The stimulation parameters of unipolar stimulation were similar in the whole series: 180 Hz, 60 mus, 1-3 V. In the CH series, at five years follow-up the percentage of total number of days free from pain attacks improved from 1%-2% to 71%. Ten patients of this series had a complete and persistent pain-free state at 18 months follow-up and the patient with SUNCT has complete pain relief. In the three patients with atypical facial pain, the neurostimulation procedure was absolutely unsuccessful. DBS of the posterior hypothalamus produced a significant and marked reduction of pain bouts in CH patients and in the SUNCT patient. The attempts to treat atypical facial pain in three patients failed. PMID: 17508161 [PubMed - in process] 2: Neurol Sci. 2007 May;28 Suppl 2:S108-13. Related Articles Functional neuroimaging and headache pathophysiology: new findings and new prospects. Leone M, Proietti Cecchini A, Mea E, Curone M, Tullo V, Casucci G, Bonavita V, Bussone G. Headache Centre, Fondazione IRCCS, Istituto Nazionale Neurologico Carlo Besta, Via Celoria 11, I-20133, Milan, Italy, leone@istituto-besta.it. In the last ten years pathophysiology of primary headaches has received new insights from neuroimaging studies. Positron emission tomography (PET) showed activation of specific brain structures, brainstem in migraine and hypothalamic grey in trigeminal autonomic cephalalgias. This brain activation suggests it may intervene both in a permissive or triggering manner and as a response to pain driven by the first division of the trigeminal nerve. Voxel-based morphometry has suggested that there is a correlation between the brain area activated specifically in acute cluster headache - the posterior hypothalamic grey matter - and an increase in grey matter in the same region. New insights into mechanisms of head pain have emerged thanks to neuroimaging obtained in experimentally induced headaches, and during peripheral and central neurostimulation. PMID: 17508155 [PubMed - in process] pf wishes Friedrich |
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