Introduction: There is great interest in using hyperbaric oxygen (HBO) to treat neurological disease. The exquisite sensitivity of neural tissue to hypoxia makes increased oxygenation attractive as a ...therapy for disease processes that induce ischemia, edema, and, more recently, apoptosis. Four things specifically exist as targets for future projects and clinical trials: (1) stroke (2) traumatic brain injury (3) radiation induced necrosis and (4) status migrainosus. Methods: Specific aims: Stroke: determine if the use of HBO in the treatment of acute ischemic stroke is effective at improving outcomes. TBI: determine whether use of HBO in the acute state after traumatic brain injury is effective at improving outcomes and reducing elevated ICP. RIN: determine whether HBO treatment of radiation necrosis of brain results in improvement of neurological function and reduction of necrosis. Migraine: determine whether use of HBO will relieve headache pain in status migrainosus. Results: Stroke: there is evidence from animal studies that focal cerebral ischemia may improve after HBO treatment. TBI: the interest in using HBO to treat TBI is based upon the premise that hypoxia, edema and apoptosis play significant roles in the pathophysiology of the disease. RIN: the evidence suggests that in cases where either the patient is not improving on medical therapies or when surgical resection is not possible, HBO should be considered as a treatment option. Migraine: there is some evidence looking at HBO as an effective treatment of acute migraine attack. Summary: Each is discussed further with proposed study design and justification for their respective parameters. As our action plan moving forward, it is our goal to investigate in each area with multidisciplinary, multi-centered, case controlled double blind crossover studies.
Zawroty głowy należą do najczęstszych problemów w praktyce lekarskiej i stanowią bardzo niejednorodną grupą objawów o interdyscyplinarnym charakterze. Główne przyczyny zawrotów mogą mieć podłoże ...laryngologiczne, neurologiczne, internistyczne, okulistyczne czy psychiatryczne. Bardzo ważne w ich różnicowaniu jest dokładne opisanie przez chorego charakteru dolegliwości. Zasadniczo zawroty głowy można podzielić na zawroty układowe (vertigo) i nieukładowe (lightheadedness, disequilibrium). Jedną z najczęstszych przyczyn zawrotów głowy są łagodne położeniowe zawroty głowy (ŁPZG). Wśród innych głównych przyczyn wymienia się: zawroty psychogenne, migrenę (wtym migrenę podstawną i migrenę przedsionkową), chorobę Ménière’a, zapalenie nerwu przedsionkowego, wieloprzyczynowe zawroty wieku podeszłego (prezbiastazja) oraz zawroty naczyniopochodne. Te ostatnie są w Polsce nadrozpoznawane, natomiast zbyt rzadko stwierdza się pozostałe przyczyny zawrotów, a zwłaszcza ŁPZG, które łatwo zdiagnozować za pomocą niemal patognomonicznej próby Dix-Hallpike’a i w których można wdrożyć wysoce skuteczne leczenie manewrem repozycyjnym (Epleya) lub uwalniającym (Semonta). Kluczowe znaczenie w rozpoznawaniu przyczyny zawrotów głowy mają badania neuroobrazujące, a w szczególności badanie głowy rezonansem magnetycznym (MRI). Ponadto bardzo przydatne są badania laryngologiczne, głównie badanie elektronystagmograficzne (ENG), umożliwiające różnicowanie zawrotów ośrodkowych i obwodowych. Poza wymienionymi zabiegami w leczeniu zawrotów głowy przydatna jest farmakoterapia, w któ- rej wiodącą rolę odgrywa obecnie betahistyna. W niniejszej pracy omówiono najczęściej spotykane przyczyny zawrotów głowy, ze szczególnym uwzględnieniem ich diagnostyki różnicowej przy łóżku chorego.
Preparations from rhizomes of Petasites hybridus (L.) Gaertn., B. Mey. & Scherb. (common butterbur) have a long history of use in folk medicine in treatment of several diseases as anti-inflammatory ...and spasmolytic drugs. Extracts from this species are of interest to researchers in the field of phytopharmacology due to their biologically active compounds, particularly two eremophilane sesquiterpenes (petasin and isopetasin), which are contained not only in rhizomes and roots, but also in leaves. Moreover, P. hybridusa contains pyrrolizidine alkaloids, which showed hepatotoxic, carcinogenic and mutagenic properties. Hence, special extracts devoid of alkaloids obtained by sub- and super-critic carbon dioxide extraction were used in the preclinical, clinical studies and phytotherapy. Our review aims to provide a literature survey of pharmacological as well as clinical trials of P. hybridus, carried out in 2000-2013. Also several studies of other species used in non-European countries have been included. Besides, the botanical description of Petasites genus and phytochemical characteristic of P. hybridus and toxicological studies of pyrrolizidine alkaloids as well as chemical profile of patented commercial extracts from rhizomes, roots and leaves of this species used in European phytotherapy have been performed. In this review, attention has also been paid to the promising and potential application of special extracts of P. hybridus not only in the prevention of migraine, treatment of allergic rhinitis symptoms, asthma and hypertension, but also in prevention and slowing the progression of neurodegenerative diseases developing with the inflammatory process in the CNS as a new therapeutic strategy. In fact, there is already an evidence of promising properties of P. hybridus extracts and sesquiterpens - decrease in the prostaglandins and leukotrienes release, inhibition of COX-1 and COX-2 activity, as well as antagonism of L-type voltage-gated calcium channels. In order to explain the new mechanisms of action of P. hybridus extracts in the CNS and their future application in phytotherapy of diseases with neuroinflammatory process, further studies should be performed.
Przetwory z kłączy lepiężnika różowego (Petasites hybridus (L.) P. Gaertn., B. Mey. & Scherb.) mają długą historię stosowania w medycynie ludowej jako środki o działaniu przeciwzapalnym i spazmolitycznym w leczeniu różnych chorób. Ekstrakty uzyskane z omawianego gatunku są interesujące z punktu widzenia badań fitofarmakologicznych ze względu na obecność licznych związków biologicznie czynnych, głównie seskwiterpenów z grupy eremofilanów: petazyny i izopetazyny. Wspomniane substancje występują nie tylko w kłączach i korzeniach, ale także w liściach lepiężnika różowego. Ponadto, P. hybridus zawiera alkaloidy pirolizydynowe, które wykazują właściwości hepatotoksyczne, karcinogenne oraz mutagenne. Dlatego w badaniach przedklinicznych i klinicznych oraz fitoterapii są stosowane ekstrakty specjalne pozbawione tych związków, które otrzymuje się metodami ekstrakcji dwutlenkiem węgla w stanie podkrytycznym lub nadkrytycznym. Celem niniejszej pracy był przegląd danych bibliograficznych, z zakresu badań farmakologicznych, toksykologicznych oraz klinicznych lepiężnika różowego, przeprowadzonych w latach 2000-2013. Uwzględniono również kilka prac dotyczących gatunków stosowanych poza Europą. Dokonano opisu botanicznego rodzaju Petasites oraz charakterystyki fitochemicznej P. hybridus, a także przedstawiono profil chemiczny opatentowanych komercyjnych ekstraktów z kłączy, korzeni i liści lepiężnika różowego, stosowanych w europejskiej fitoterapii. W pracy przeglądowej zwrócono uwagę na możliwość zastosowania specjalnych ekstraktów z P. hybridus nie tylko w prewencji migreny, leczeniu objawów kataru alergicznego, astmy czy nadciśnienia, lecz także w zapobieganiu lub spowalnianiu postępu chorób neurodegeneracyjnych, przebiegających ze stanem zapalnym w OUN. Istnieją już dowody na obiecujące właściwości seskwiterpenów i ekstraktów z lepiężnika różowego - zmniejszanie uwalniania prostaglandyn i leukotrienów, hamowanie aktywności COX-1 i COX-2 oraz antagonizm wobec kanałów wapniowych bramkowanych napięciem typu L. Konieczne jest jednak przeprowadzenie dalszych badań farmakologicznych ekstraktów P. hybridus, celem wyjaśnienia nowych mechanizmów działania w OUN oraz ich przyszłego zastosowania w fitoterapii chorób ośrodkowego układu nerwowego przebiegających z procesem zapalnym.
Stroke in patients with migraine De Reuck, Jacques; Paemeleire, Koen; Van Maele, Georges
Neurologia i neurochirurgia polska,
2010, Letnik:
44, Številka:
2
Journal Article
Recenzirano
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Migraine with aura (MA) is considered as a risk factor for ischaemic stroke. The present observational retrospective study compares migraine patients admitted for a documented stroke with those ...presenting focal neurological symptoms and headache without a demonstrable lesion and in which the final diagnosis was a migraine attack with aura.
The study included 14 migraine patients with a stroke and 37 without a stroke. The clinical characteristics, the vascular risk factors and the results of the technical examinations were compared.
Stroke occurred in migraine patients with aura as well as without aura. Classical vascular risk factors were rather rare. Patent foramen ovale (PFO) with or without atrial septum aneurysm appeared to be the main risk factor for stroke in patients with a history of migraine. Infarcts were mainly located in the supratentorial territory of the posterior cerebral circulation. Also some lobar haematomas were observed, but their aetiology remained uncertain. The strokes were generally mildly severe with good outcome. Hyperintense signals in the cerebral white matter and cerebellum, on T2-weighted magnetic resonance imaging, were more frequent in the migraine patients with stroke.
The presence of PFO, rather than of MA, appeared to be the main risk factor for stroke patients with migraine. No direct relation between migraine and stroke could be demonstrated.
The aim of our study was to evaluate the frequency of the C677T variant in the methylenetetrahydrofolate reductase (MTHFR) gene in patients with migraine with or without aura and to find an ...association between this variant and vascular lesions in magnetic resonance imaging of the head, presence of patent foramen ovale (PFO) and increased level of homocysteine.
Ninety-one patients with migraine, aged 19-57, were investigated in this study. The MTHFR C677T variant was genotyped in this group and levels of homocysteine, folic acid and vitamin B12 were measured. Transcranial Doppler sonography with test for PFO detection by injection of air contrast during the Valsalva manoeuvre was performed in each patient.
Frequency of the C677T variant in the MTHFR gene was similar in patients and controls. Hyperhomocysteinaemia was significantly more frequent in migraine patients with the C677T variant. The prevalence of PFO was significantly higher in migraine patients with aura and the homozygous variant of the MTHFR gene.
Frequency of the C677T variant in the MTHFR gene was similar in patients and controls. Significantly more frequent prevalence of PFO in migraine patients with aura (with homozygous recessive genotype of MTHFR probably suggests their common genetic basis. Hyperhomocysteinaemia was significantly more frequent in migraine patients with the C677T variant, which could be an additional risk factor of this disease.
Migraine is a frequent form of head-ache. Although many mechanisms describing onset of migraine with and without visual aura have been suggested, the aetiology of migraine headaches is still not ...clear. Neurogenic inflammation may play a key role in the development of migraine headaches. We evaluated the discriminative power of serum levels of C-reactive protein (CRP) and transforming growth factor beta 1 (TGF-β1) in patients who presented to our clinic with migraine headaches with or without visual aura.
We designed a prospective case-control study of 51 patients with migraine (27 with migraine with aura and 24 with migraine without aura; all had headache) and compared them with 27 healthy subjects during the study period. Demographic and clinical characteristics recorded were age, sex, marital status, occupation, characteristics of headache, laboratory values, and serum CRP and TGF-β1 levels. Statistical analyses used Student t-test, the χ2 test, and ANOVA followed by the post-hoc Bonferroni test for multiple comparisons. Receiver operator characteristic (ROC)-curve analysis for CRP and TGF-β1 was also conducted.
There was no difference between the groups in terms of demographic characteristics, marital status, and socioeconomic status. Statistically, white blood cell levels, serum glucose levels, triglyceride levels, high-density lipoprotein levels, and serum CRP and TGF-β1 were significantly higher in patients with migraine (p < 0.05). The ROC curve results in this study identified that CRP and TGF-β1 may discriminate patients who have different types of migraine headache.
This study suggests that serum CRP and TGF-β1 levels may be diagnostic factors to differentiate migraine patients with and without aura. These findings show that neurogenic inflammation may have a role in the aetiology of migraines.
PROFILAKSA MIGRENE – PRIKAZ LITERATURE ĆURKOVIĆ KATIĆ, ANA; MIHALJ, MARIO; REPIĆ BULIČIĆ, ANA ...
Acta medica Croatica,
04/2020, Letnik:
74, Številka:
1
Paper
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Cilj ovog prikaza literature je procijeniti mogućnosti profi lakse migrene. Prema preporukama International Headache Society (IHS) profi laksa migrene provodi se u bolesnika koji imaju ≥4 dana ...migrensku glavobolju na mjesec bilo da se radi o epizodičnoj ili kroničnoj migreni. Učinkovitim liječenjem smatra se smanjenje učestalosti migrenskih ataka za ≥50 %. Učinkovitima su se pokazali β-blokatori, kalcijski antagonisti, antiepileptici kao što su topiramat i valproat kao i gabapentin i pregabalin, te fl unarizin i antidepresivi. Učinkovitost levatiracetama, cervikalne miofascijalne anestezije te kožne elektrostimulacije i muskularne stimulacije još je u ispitivanju. Dvojben je učinak botulinum toksina. Istražuje se moguća primjena histamina, zatvaranje foramena ovale te primjena akupunkture, supraorbitalne i vagalne nervne stimulacije te transkranijske magnetske stimulacije. Istražuje se utjecaj kateholamina i melatonina te kontraceptiva, ribofl avina, dekstrometorfi na u nastanku migrenskih glavobolja. Potrebna je adekvatna procjena mogućih učinaka u profi laksi primjenom probiotika, koenzima Q10 i magnezija. Klinička istraživanja su pokazala da primjena humanih monoklonskih protutijela erenumaba, fremanezumaba i galkanezumaba pokazuju statistički značajnu učinkovitost (≥50 % učinkovitosti) u profi laksi migrene što je potrebno potvrditi u kliničkoj praksi.
Mutations of CACNA1A, which encodes a neuronal P/Q Ca2+ channel, are present in patients with familial hemiplegic migraine, and possibly in other types of migraine as well. This calcium channel is ...also involved in neuromuscular transmission. In our previous study we confirmed that the single-fibre electromyography (SFEMG) method can demonstrate a neuromuscular transmission deficit in migraine with aura. The aim of our present study was to estimate the neurotransmitter dysfunction in cluster headache and to compare the results between patients with cluster headache and those with migraine with aura.
We selected 6 patients with cluster headache and 6 patients with migraine with typical aura. SFEMG of the voluntarily activated extensor digitorum communis muscle was performed.
The SFEMG results were in the normal range in the cluster headache group and in the healthy controls. Slight neuromuscular transmission disturbances were present in patients with migraine with aura.
The abnormal neuromuscular transmission detectable by SFEMG may reflect a genetically determined dysfunction of the P/Q Ca2+ channels in a group of migraineurs with aura. Conversely, absence of neuromuscular abnormalities in cluster headache patients could be explained by different aetiology not resulting in channelopathy. Single-fibre electromyography could be a helpful tool in clinically questionable cases in differentiating between cluster headache and migraine with aura.
Nakon što im je propisana profilaktička terapija pacijenti mogu dobiti knjižicu s osnovnim informacijama o bolesti i mogućnostima liječenja kao i detaljnom opisu načina primjene lijeka Ajovy, ...djelovanju lijeka te svemu što može doprinijeti uspjehu liječenja. Pacijentima je na raspolaganju i
Dnevnik migrene kao pomoć u praćenju bolesti.
Glavobolja uzrokovana prekomjernom upotrebom lijekova (GUPUL) kronična je sekundarna glavobolja uzrokovana prekomjernom i redovitom upotrebom bilo kojeg od lijekova za akutnu simptomatsku terapiju ...glavobolje u bolesnika s primarnom glavoboljom. Iako je prevalencija GUPUL-a u općoj populaciji do 1,7%, ona vrlo negativno utječe na kvalitetu života bolesnika i tako stvara ekonomski teret cijelom društvu. Treće izdanje Međunarodne klasifikacije glavobolja (The International Classification of Headache Disorders, 3rd edition – ICHD-3) definira GUPUL i klasificira ga u 8 podtipova ovisno o vrsti prekomjerno upotrebljavanih lijekova. Kronična migrena i tenzijska glavobolja najčešće su primarne glavobolje uz koje se GUPUL javlja. Komorbiditeti GUPUL-a uključuju ponajprije afektivne poremećaje te je u tih bolesnika potreban interdisciplinarni terapijski pristup. Prekid uzimanja uzročnog lijeka – detoksikacija jest condicio sine qua non u liječenju GUPUL-a koji zatim često rekurira. Detoksikacija se može provesti postupno ili naglo, ambulantno ili hospitalno. Profilaktička terapija GUPUL-a temelji se na profilaksi primarne glavobolje u podlozi. Pravodobnim prepoznavanjem kronifikacije primarne glavobolje i započinjanjem profilaktičke terapije može se prevenirati razvoj GUPUL-a.
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