Migraine and sleep disorders: a systematic review.

Migraine and sleep disorders are common and often burdensome chronic conditions with a high prevalence in the general population, and with considerable socio-economic impact and costs.The existence of a relationship between migraine and sleep disorders has been recognized from centuries by clinicians and epidemiological studies. Nevertheless, the exact nature of this association, the underlying mechanisms and interactions are complex and not completely understood. Recent biochemical and functional imaging studies identified central nervous system structures and neurotransmitters involved in the pathophysiology of migraine and also important for the regulation of normal sleep architecture, suggesting a possible causative role, in the pathogenesis of both disorders, of a dysregulation in these common nervous system pathways.This systematic review summarizes the existing data on migraine and sleep disorders with the aim to evaluate the existence of a causal relationship and to assess the presence of influencing factors. The identification of specific sleep disorders associated with migraine should induce clinicians to systematically assess their presence in migraine patients and to adopt combined treatment strategies.

Tropomyosin receptor kinase B-mediated signaling in integration of neuropathic pain and obesity in diabetic polyneuropathy.

OBJECTIVE: To assess the quantitative serum levels of tropomyosin receptor kinase receptor B, and to estimate its association with serum concentration of brain-derived neurotrophic factor and obesity in patients with painful and painless forms of diabetic polyneuropathy. METHODS: We examined 70 patients with diabetic polyneuropathy with confirming peripheral nerve dysfunction by electroneuromyography and measuring of serum levels tropomyosin receptor kinase receptor B and brain-derived neurotrophic factor by enzyme immunoassay. Diabetic polyneuropathy was diagnosed using the modified Toronto Consensus (2011) criteria, while neuropathic pain was assessed using an 11-point Numerical Pain Rating Scale. The patients were divided into two groups according to presence or absence of neuropathic pain. Control Group consisted of 14 healthy persons. RESULTS: The serum levels of tropomyosin receptor kinase receptor B and brain-derived neurotrophic factor in patients with diabetic polyneuropathy are significantly higher than healthy controls (p=0.000). Hyperexpression of brain-derived neurotrophic factor in serum was associated with painful form of diabetic polyneuropathy (R=0.392, p=0.012) and obesity (R=0.412, p=0.001). On the contrary high concentration of tropomyosin receptor kinase receptor B in serum associated with painless diabetic polyneuropathy by Pain DETECT (R=-0.354, p=0.015), low body weight (R=-0.354, p=0.015) and severe demyelization of nerve fibers (R=-0.574, p=0.001), indicated "non-working" receptor detected in serum. CONCLUSION: Tropomyosin receptor kinase receptor B signaling is involved in the modulation of neuropathic pain and obesity in diabetic polyneuropathy.

Tropomyosin receptor kinase B-mediated signaling in integration of neuropathic pain and obesity in diabetic polyneuropathy / Sinalização mediada pelo receptor de tropomiosina quinase tipo B na integração de dor neuropática e obesidade na polineuropatia diabética

ABSTRACT Objective: To assess the quantitative serum levels of tropomyosin receptor kinase receptor B, and to estimate its association with serum concentration of brain-derived neurotrophic factor and obesity in patients with painful and painless forms of diabetic polyneuropathy. Methods: We examined 70 patients with diabetic polyneuropathy with confirming peripheral nerve dysfunction by electroneuromyography and measuring of serum levels tropomyosin receptor kinase receptor B and brain-derived neurotrophic factor by enzyme immunoassay. Diabetic polyneuropathy was diagnosed using the modified Toronto Consensus (2011) criteria, while neuropathic pain was assessed using an 11-point Numerical Pain Rating Scale. The patients were divided into two groups according to presence or absence of neuropathic pain. Control Group consisted of 14 healthy persons. Results: The serum levels of tropomyosin receptor kinase receptor B and brain-derived neurotrophic factor in patients with diabetic polyneuropathy are significantly higher than healthy controls (p=0.000). Hyperexpression of brain-derived neurotrophic factor in serum was associated with painful form of diabetic polyneuropathy (R=0.392, p=0.012) and obesity (R=0.412, p=0.001). On the contrary high concentration of tropomyosin receptor kinase receptor B in serum associated with painless diabetic polyneuropathy by Pain DETECT (R=-0.354, p=0.015), low body weight (R=-0.354, p=0.015) and severe demyelization of nerve fibers (R=-0.574, p=0.001), indicated "non-working" receptor detected in serum. Conclusion: Tropomyosin receptor kinase receptor B signaling is involved in the modulation of neuropathic pain and obesity in diabetic polyneuropathy.

RESUMO Objetivo: Avaliar os níveis séricos quantitativos do receptor da tropomiosina quinase B, e estimar sua associação com os níveis séricos do fator neurotrófico derivado do cérebro e a obesidade, em pacientes com formas dolorosas e indolores de polineuropatia. Métodos: Examinamos 70 pacientes com polineuropatia diabética, com disfunção de nervo periférico confirmada por eletroneuromiografia e medida de níveis séricos do receptor da tropomiosina quinase B e do fator neurotrófico derivado do cérebro, por imunoensaio enzimático. Polineuropatia diabética foi diagnosticada através dos critérios modificados do Consenso de Toronto (2011), e a dor neuropática foi avaliada pela escala Numerical Pain Rating com 11 pontos. Os pacientes foram divididos em dois grupos, conforme presença ou ausência de dor neuropática. O Grupo Controle tinha 14 indivíduos saudáveis. Resultados: Os níveis séricos do receptor da tropomiosina quinase B e do fator neurotrófico derivado do cérebro em pacientes com polineuropatia diabética são significativamente mais elevados do que controles saudáveis (p=0,000). Hiperexpresssão do fator neurotrófico derivado do cérebro no soro foi associada à forma dolorosa da polineuropatia diabética (R=0,392, p=0,012) e obesidade (R=0,412, p=0,001). Por outro lado, alta concentração sérica de receptor da tropomiosina quinase B, associada à polineuropatia diabética indolor por PainDETECT (R=-0,354, p=0,015), baixo peso corporal (R=-0,354, p=0,015) e grave desmielização de fibras nervosas (R=-0,574, p=0,001), indicaram receptor "não funcionante" detectado no soro. Conclusão: A sinalização do receptor da tropomiosina quinase B está envolvida na modulação da dor neuropática e obesidade na polineuropatia diabética.