Choroid plexus imaging in multiple sclerosis management - a systematic review.

INTRODUCTION: Multiple sclerosis (MS) is a central nervous system (CNS) disease associated with inflammation, demyelination, and neurodegeneration. It affects more than 2 million people globally, and usually occurs in young adults, three-quarters of whom are women. Importantly, accurate diagnosis and treatment are essential, as this disease can lead to the rapid development of disability. The choroid plexus (CP) is a structure widely known as the main cerebrospinal fluid source. However, it is also involved in immune cell trafficking to the cerebrospinal fluid, which is increased in different neurological disorders, particularly those associated with neuroinflammation. As MS is generally thought to be caused by an autoimmune process, it has been suggested that the choroid plexus may play a significant role in its pathogenesis, manifesting via changes in imaging characteristics. MATERIAL AND METHODS: Although research regarding this topic has been very limited, the results of the available studies appear promising. To further investigate this subject, we performed a systematic literature review according to the PRISMA 2020 guidelines. The PubMed and Embase databases were searched for relevant articles, and after thorough analysis, 16 studies were included in our review. RESULTS: CP volume was significantly increased in MS patients compared to healthy individuals. Furthermore, some studies found that CP enlargement occurs even before a definite diagnosis. Moreover, a few articles reported correlations between CP volume and brain atrophy, or even disease severity. CONCLUSIONS: Our findings show that CP imaging has the potential to become a novel and valuable tool in multiple sclerosis management.

The Role of MicroRNA in Migraine: A Systemic Literature Review.

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

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

INTRODUCTION: Migraine is a common primary headache disorder, which affects mainly young females, usually those with some specific personality traits including neuroticism and obsessive-compulsive disorder. Among many factors that may trigger headache are to be found those associated with eating patterns and behaviours. Eating disorders are psychiatric disorders of abnormal eating or weight-control behaviours. According to the most up-to-date classification, six main types are identified, including anorexia nervosa, bulimia nervosa, and binge eating disorder. Similar to migraine, eating disorders are mainly diagnosed in young adults and, moreover, personality pattern, in at least some of the eating disorders, is also suggested to be consistent. MATERIAL AND METHODS: This systematic review aimed to summarise the available literature related to this topic. We performed an electronic article search through the Embase, PubMed, and Cochrane databases and included 16 articles into analysis in accordance with PRISMA 2020 guidelines. RESULTS: Most of the studies revealed the presence of a putative correlation between migraine and eating disorders, and these encourage further investigations. Moreover, apart from the clinical aspect, also the pathogenesis underlying both disorders is suggested to be similar. More frequent co-occurrence of other psychiatric disorders in migraineurs, such as depression and anxiety, was reported and should be considered in future research. Furthermore, adverse interactions between pharmacotherapy and symptoms of comorbid conditions underline the importance of this problem. CONCLUSIONS: A correlation between migraine and eating disorders appears highly probable. However, further investigations are required focusing on diverse aspects such as clinical, psychological, and pathogenic.

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

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

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

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

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

AIM OF THE STUDY: This study aimed to analyze the daily clinical practice of primary care practitioners (PCPs) in Poland concerning migraine patients. CLINICAL RATIONALE FOR THE STUDY: Migraine is a common chronic primary headache disease, which can be disabling if insufficiently managed. Numerous studies suggest that migraine remains underdiagnosed and undertreated. The first consultation of migraine patients is usually undertaken by a PCP. MATERIALS AND METHODS: This study was conducted in June and July 2019 in Poland using a computer-assisted web interview with 51 PCPs. The interview questions concerned knowledge of diagnostic criteria and methods of migraine treatment. RESULTS: On average, each PCP consulted 12 patients with migraine per month. More than half of PCPs (63%) listed partial diagnostic criteria for migraine without aura or mentioned aura in their responses. Only 10% of PCPs listed all diagnostic criteria for migraine without aura. Although 55% of PCPs said that they distinguished between episodic and chronic migraine, 18% provided the wrong definition. The most commonly prescribed drugs were triptans (66%), paracetamol, metamizole, or non-steroidal anti-inflammatory drugs (42%). CONCLUSIONS AND CLINICAL IMPLICATIONS: PCPs play a critical role in diagnosing, treating, and monitoring migraine; however, many of them have insufficient knowledge about its diagnosis and correct differentiation between chronic and episodic forms.

Stimulation-induced side effects after deep brain stimulation - a systematic review.

OBJECTIVE: Deep brain stimulation (DBS) was approved by Food and Drug Administration for Parkinson's disease, essential tremor, primary generalised or segmental dystonia and obsessive-compulsive disorder (OCD) treatment. The exact mechanism of DBS remains unclear which causes side effects. The aim of this review was to assess variables causing stimulation-induced chronic psychiatric/personality-changing side effects. METHODS: The analysis of scientific database (PubMed, Cochrane Library, EMBASE) was conducted. The included articles had to be research study or case report and DBS to be conducted in therapeutic purposes. The researches with mental disorders in patients' medical histories were excluded. RESULTS: Seventeen articles were used in the review. In the group of movement disorders the characteristic of side effects was strongly related to the placement of the electrode implantation. Tiredness/fatigue was correlated with DBS in thalamus. Implantations in subthalamic nucleus were mostly followed by affective side effects such as depression or suicide. The higher voltage of electrode was connected with more severe depression after implantation. The analysis of affective disorder contained only three articles - two about OCD and one about depression. Forgetfulness and word-finding problems as activities connected with cognition may be an inevitable side effect if obsessive thoughts are to be inhibited. CONCLUSION: DBS of subthalamic nucleus should be seen as the most hazardous place of implantation. As a result there is a strong need of 'gold standards' based on the connectivity research and closer cooperation of scientists and clinicians.

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

INTRODUCTION: Following two coronaviral epidemics in 2002 and 2012, December 2019 saw the emergence of a potentially fatal coronavirus - SARS-CoV-2, which originated in Wuhan, China. While most coronaviruses are responsible for mild respiratory infections, they have been demonstrated to be neuroinvasive and neurotropic for over three decades. In this review, we assess whether SARS-CoV-2 follows this trend and if the neuroinvasive potential of this novel coronavirus is worthy of further investigation. METHODS: To obtain sources for this study, we performed an online search through Pubmed, Researchgate and Google Scholar, finding 537 articles. After analysing them according to PRISMA, we included 14 in this review. DISCUSSION: Data regarding neurological manifestations of SARS-CoV-2 is scarce and mostly inconsistent. There are however identifiable trends which might provide a basis for future research. There is strong evidence that this novel coronavirus may be neuroinvasive and could cause a wide array of neurological symptoms and complications. Cerebrospinal fluid testing may shed more light on the occurrence of SARS-CoV-2 in the central nervous system. Clarification of the respiratory failure mechanisms requires post mortem examinations and brain tissue analysis, and further research is of the utmost importance. However, we strongly believe that the existing evidence is enough to raise awareness among clinicians and help guide them through the diagnosis and optimal therapy of COVID-19 patients.

Treatment and management of migraine in neurological ambulatory practice in Poland by indicating therapy with monoclonal anti-CGRP antibodies.

AIM OF STUDY: To analyse Polish neurologists' familiarity with the diagnostic criteria for migraine, and how their methods of management of migraine work in daily practice. CLINICAL RATIONALE FOR STUDY: Migraine is a common primary headache disease that causes substantial disability and reduces quality of life. Many migraine patients remain undiagnosed and deprived of treatment. Migraine treatment is problematic, and many patients discontinue preventive treatment, mainly because of a lack of efficacy or adverse effects. Antibodies targeting calcitonin gene-related peptide and its receptor seem to be effective and well-tolerated agents in migraine prevention. MATERIAL AND METHODS: This study was conducted using a computer-assisted web interview conducted with 51 neurologists in Poland, who agreed to participate in the study during a phone call. The questionnaire mainly assessed methods of treatment of migraine patients and diagnostic criteria used in neurological practice. RESULTS: Only one neurologist listed all of the diagnostic criteria for migraine, and 80% of physicians in their practice used only a part of the migraine diagnostic criteria, usually the migraine without aura criteria. On average, each neurologist had 55 patients under continuous care, seeing roughly 18 patients per month. On average, neurologists estimated that 77% of all patients with migraine had episodic migraine, whereas the rest had the chronic form. Importantly, 40% of patients with chronic migraine received all available preventive treatments without a satisfactory effect. Neurologists could offer monoclonal antibodies that target the CGRP-pathway (i.e. anti-CGRP and anti-CGRP receptor monoclonal antibodies) for the prevention of chronic migraine to about one in three patients with a chronic form of the disease. CONCLUSIONS AND CLINICAL IMPLICATIONS: Migraine is underdiagnosed and undertreated in Poland. Understanding of the diagnostic criteria for migraine among neurologists is insufficient. Most neurologists in Poland see patients in whom anti-CGRP/R-targeting treatment is indicated.

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

AIM OF THE STUDY: We investigated whether D-dimer (DD) concentration is elevated in cerebral venous and sinus thrombosis (CVST), as has been reported in the literature. CLINICAL RATIONALE FOR THE STUDY: CVST is a disease with variable clinical presentations and a challenging diagnosis. We looked into whether D-dimer concentration might be an indicator of CVST, and the need for neuroimaging tests correlated with clinical factors. MATERIALS AND METHODS: We included all consecutive patients (mean age 41.6 years) with CVST treated in our neurology department from 2014 to 2018 whose DD levels had been measured. DD concentrations were categorised as normal (≤ 0.5 µg/ml) or elevated ( > 0.5 µg/ml). Appropriate imaging confirmed the diagnosis of CVST. The results were compared to those of a control group consisting of 22 age- and sex-matched patients (mean age 40 years) with a diagnosis of primary headache (tension type or migraine) hospitalised to exclude secondary causes. RESULTS: In 20 patients in the CVST study group, median level of DD was 1.0 + 0.57 µg/ml (range 0.19-2.45 µg/ml), compared to the control group's mean DD level of 0.50 + 0.45 µg/ml (range 0.15-1.73 µg/ml), with p < 0.005. Higher DD levels were associated with complications of the disease and fatal course (p < 0.005). One female and one male patient died because of CVST with DD levels of (respectively) 2.45 and 1.80 µg/ml - the two highest concentrations in our study group. CONCLUSIONS AND CLINICAL IMPLICATIONS: DD concentration, especially in headache patients, may be a factor to predict CVST and an indicator for further diagnostic procedures with venography. But in clinical practice, low levels of DD cannot be taken to exclude CVST.

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

INTRODUCTION: The authors of the article published in the current edition a single-centre prospective cohort study featuring patients who had undergone a diagnostic cerebral angiography procedure and who had experienced a headache associated with the procedure [1]. The authors of 'Clinical features and risk factors of angiography headache and evaluation of its relationship to primary headaches' have addressed a common, but rarely discussed, problem of a headache associated with a cerebral angiography procedure - the angiography headache (AH). CLINICAL REFLECTIONS: AH was found in almost a quarter of the patients who had undergone angiography, and was found to be associated with female gender, higher education level, and a history of primary headache. CLINICAL IMPLICATIONS: It is worth remembering that migraine and tension type headaches are common predisposing factors to headache during and after this procedure.

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

AIM OF THE STUDY: . The occurrence of migraine is linked with some common lifestyle activities and conditions preceding the attack. Our study presents known and presumptive lifestyle factors and activities related to migraine, and compares them to the frequency of headache attacks. MATERIAL AND METHODS: 40 female patients of the Headache Outpatient Clinic in Warsaw, Poland, diagnosed with migraine, mean age 44.6 years, and 40 female participants from the control group, mean age 39.5 years, were included in the study. The study employed questionnaires reporting the presence of lifestyle factors and socioeconomic predispositions as well as the Migraine Disability Assessment Test (MIDAS) as data collection methods. RESULTS: Correlations between some of the lifestyle factors and the frequency of migraines occurred statistically significantly. CONCLUSIONS: Some factors and lifestyle activities such as stress, relaxation, specific dietary products, fasting, fatigue, bright light, noise, weather changes or menstruation may have an influence on migraine frequency and severity in female patients, which can have an impact on migraine prevention.

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

DESIGN: Migraine is regarded as a complex brain dysfunction of sensory and modulatory networks with the secondary sensitisation of the trigeminal system as well as the affected brain area's activities. The particular role of the hippocampus and the brainstem in the first phase of the attack, the disrupted cognitive network, and the activation of the limbic and visual systems, are the main discoveries in the field of migraine imaging that have been achieved using functional techniques. Thus advanced neuroimaging has been widely employed to study the pathogenesis of migraine. OBJECTIVE: The evaluation of fMRI BOLD images of migraine patients with or without aura, with particular attention to the interictal phase. SUBJECTS AND METHODS: The aim of this study was to compare brain activity during visual stimuli by fMRI BOLD in the interictal phase (black and white checkerboard tests, static or flickering) of 16 migraine patients, eight with aura and eight without. RESULTS: We demonstrated differences in the right part of the brainstem, the left part of the cerebellum, and in the right middle temporal gyrus. However, the bilateral brain activation in the occipital and frontal lobe remained similar. CONCLUSIONS: Results of our preliminary study suggest that migraine with aura and migraine without aura might be separate disorders, and this requires further investigation.

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

BACKGROUND AND AIM: Migraine is the most common neurological disorder, affecting approximately 12 % of the adult population worldwide, caused by both environmental and genetic factors. Three causative genes have been identified in familial hemiplegic migraine (FHM) families: CACNA1A, ATP1A2, and SCNA1A. Recently, several mutations in KCNK18 have also been found as causative factors in migraine development. The aim of our study was to identify the genetic background of migraine in the Polish population. MATERIAL AND METHODS: Sixty patients with migraine without aura (MO) or with different types of migraine with aura (MA), including sporadic hemiplegic, familial hemiplegic, and probable familial hemiplegic, were screened for mutations in the four genes previously linked with different types of migraine (ATP1A2, CACNA1A, SCN1A, and KCNK18). RESULTS: Two missense mutations were found. One novel mutation in SCN1A, encoding α subunit of sodium channel, causing amino acid change M1500V localized to a region encoding inactivation loop between transmembrane domains III and IV of the channel, was detected in a female FHM patient. The M1500V mutation was absent in a group of 62 controls, as well as in the ExAC database. The second, already known missense mutation S231P in KCNK18 was found in a female MA patient. Additionally, a novel intronic polymorphism possibly affecting alternative splicing of SCN1A, at chr2:16685249, g.77659T>C, and c.4581+32A>G, located between exons 24 and 25, in a region encoding the inactivation loop of the sodium channel was found in a female MO patient. No mutations in ATP1A2 or CACNA1A were found in the study group. CONCLUSIONS: The presence of SCN1A mutations and absence of mutations in ATP1A2 or CACNA1A suggest that the Polish patients represent FHM type 3. On the other hand, the presence of KCNK18 mutation indicated another FHM subtype. It could be speculated that contrary to other European populations, the genetic basis of migraine in the Polish population involves mutations in genes not included in the study. Next-generation sequencing methods should be implemented to identify other migraine-associated variants.

Migraine frequency and its association with dyslipidemia in women.

BACKGROUND: Some studies have shown a higher occurrence of unfavorable lipid profile in women with migraine as compared to the general population. AIM: The aim of our study was to assess the link between lipid profile and the frequency of migraine attacks. PATIENTS AND METHODS: 64 female migraine patients, mean age 40 ± 10.84 years and mean duration of the disease 18.52 ± 7.57 years, were included into the study. Lipid profile (total cholesterol, TC; low-density lipoprotein cholesterol, LDL-C; high-density lipoprotein cholesterol, HDL-C; triglycerides, TG) was evaluated in all migraine patients. Frequency of migraine attacks was calculated from the amount of migraine episodes within the last 3 months. RESULTS: The correlation between TC and TG and the frequency of the migraine attacks were statistically significant. CONCLUSION: TC and TG values may have an influence on migraine severity and also contribute to the increased risk of cardiovascular diseases, especially in women.

An association between migraines and heart anomalies-true or false? A heart ultrasound study using cTTE in migraine patients and control participants.

DESIGN: A migraine is a common neurological disorder that often coexists with other illnesses including heart abnormalities, such as patent foramen ovale (PFO), atrial septal aneurysm (ASA), and mitral valve prolapse (MVP). OBJECTIVE: The aim of our study was to evaluate the occurrence of some heart abnormalities in migraine patients by routine and contrast transthoracic echocardiography. SUBJECTS AND METHODS: We assessed the occurrence of PFO, ASA, and MVP in 96 patients with migraine without aura (87 females), in 62 patients with migraine with aura (41 females) and in 53 healthy persons (40 females). RESULTS: In comparison with our control group, only the prevalence of PFO was statistically higher in patients with migraine (P = 0.03) and especially with aura (P = 0.01). We did not find any statistically significant differences between the occurrence of ASA or MVP in migraine and control groups. CONCLUSION: The results of our study raise the question of the heart's role in the mechanism of migraine attacks. If the occurrence of migraine with aura had been related to some heart abnormalities, the pathophysiology of migraine attacks may have some connection to some heart dysfunction. Resolving the association between migraine and comorbid cardiac conditions might shed light on the underlying mechanisms of migraines and even result in a different treatment strategy. However, we do not find any clear connection between PFP, ASA, and MVP, and migraine occurrence.