Propranolol plasma levels and relief of migraine. Relationship between plasma propranolol and 4-hydroxypropranolol concentrations and clinical effects.

The relationship between propranolol and 4-hydroxypropranolol plasma concentrations and relief of migraine was assessed in 17 patients during treatment with oral racemic propranolol hydrochloride in doses of 40 to 240 mg/day. Propranolol decreased the migraine index more than 70% in 13 patients: five patients at a dosage of 40 mg/day, five patients at a dosage of 120 mg/day, and three patients at a dosage of 240 mg/day. Three patients did not achieve a good improvement of migraine at any of the doses used. The relief of migraine was not directly related to the propranolol and 4-hydroxypropranolol plasma concentrations.

Binswanger's disease and normal-pressure hydrocephalus. Clinical and neuropsychological comparison.

We investigated the clinical and cognitive aspects of patients with normal-pressure hydrocephalus and possible Binswanger's disease. We studied 19 patients with normal-pressure hydrocephalus and 19 patients with Binswanger's disease, comparing them with the same number of matched controls. The patients with normal-pressure hydrocephalus had a later age and more frequent gait disturbance at the onset, shorter duration of the illness, rare signs of vascular disturbances, and more frequent severe mental deterioration. Ventricular enlargement may play a role in determining the more rapid and worse clinical course of normal-pressure hydrocephalus.

Electroencephalogram and HIV infection: a prospective study in 100 patients.

In order to study the correlation between central nervous system (CNS) involvement and EEG abnormalities in HIV infection we studied 100 consecutive HIV patients. Patients were divided into 4 groups; Group I: 42 neurologically asymptomatic subjects; Group II: 6 patients with peripheral neuropathies; Group III: 28 patients with AIDS Dementia Complex; Group IV: 24 patients with secondary CNS involvement. The results of this study emphasize that abnormal EEGs are correlated with CNS involvement. Neurologically asymptomatic patients showed no abnormal tracings, but the presence of borderline EEGs (33%) in asymptomatic patients should be evaluated prospectively.

Impairment of memory and consciousness in migraine: clinical and EEG study.

We report the clinical and EEG study of three migraine patients who presented with peculiar clinical phenomena related to migraine attack. The first case is a transient global amnesia that followed a classic migraine status. The second is a confusional state that complicated a classic migraine attack. The third is a complex attack with combined features of migraine and epilepsy.

Cardiovascular and biochemical assessment in migraine patients submitted to tilt test.

Ten migraine patients underwent a tilt test both during migraine attack and headache-free interval, and the following parameters were assessed: plasma levels of norepinephrine (NE), and serum dopamine beta hydroxylase (D beta H), systolic and diastolic blood pressure and heart rate (SBP, DBP, HR). SBP during the tilt test showed a fall greater than 30 mmHg in 2 cases in the headache-free interval and in 4 cases during migraine attack. In migraine patients in headache-free interval, tilt test increased NE and D beta H as it did in the control group, while in migraine attack tilt test increased NE and D beta H less than in the control group. This impairment of the sympathetic nervous system during the migraine attack is discussed.

Classic migraine attack complicated by confusional state: EEG and CT study.

We report electroencephalographic and clinical observations in one attack of classic migraine, accompanied by a confusional state. The ictal EEG showed slow waves over the left hemisphere, the abnormality gradually clearing up during the four days following the attack. A brain CT scan was normal during the attack and also a few days later. A possible relationship between impairment of consciousness during the attack and left hemispheric metabolic dysfunction is discussed.

Migraine with aura and photosensitive epileptic seizures: a case report.

An 18-year-old female presented with two seizures induced by photic stimulation. She had a positive family history for migraine and a history of febrile convulsions. Since the age of 13 she had suffered from migraine attacks with aura. A brain computerized tomography with contrast enhancement was negative and several electroencephalograms showed a photoparoxysmal response. At the age of 18 she had a partial secondary generalized seizure after photic stimulation during routine electroencephalogram. The onset of seizure was in the occipital region. Two days later, the patient presented with a typical migrainous attack with aura. Interictal apomorphine test (1.5 mg s.c.) blocked the photoparoxysmal response. According to Quesnay, dopaminergic failure of the occipital cortex may account for both epileptic and migraine features.

Menstrual migraine: intermittent prophylaxis with a timed-release pharmacological formulation of dihydroergotamine.

An open study was performed on 20 women between 20 and 40 years of age in order to assess the effectiveness of a slow-release pharmacological formulation of dihydroergotamine in the prevention of menstrual migraine. Therapy was started two days prior to the expected date of menstruation and continued for five days after the onset of menstrual flow. Trial lasted for five months, four patients suspended the treatment: one because of side effects and three because of "ineffectiveness of drug". In the 16 patients who completed the study, there was a significant reduction both in intensity and duration of migraine compared to the month prior to treatment.

Complicated migraine studied by phosphorus magnetic resonance spectroscopy.

The brain and skeletal muscle of eight adult patients with migraine with prolonged auras or migraine strokes leaving a permanent hemianopic defect were studied by phosphorus magnetic resonance spectroscopy. Biochemical assays performed on muscle biopsy and platelets had revealed abnormal mitochondrial enzyme activities. Brain magnetic resonance spectroscopy showed an abnormally low phosphocreatine to inorganic phosphate ratio in all patients, apparently due to decreased phosphocreatine and increased inorganic phosphate contents. Muscle phosphorus magnetic resonance spectroscopy showed low recovery from exercise in seven patients. Three patients had an increased phosphocreatine/inorganic phosphate ratio at rest, and the exercise transfer characteristics were abnormal in four patients for relatively low levels of exercise. The mitochondrial metabolic defects present in platelets and muscle of complicated migraine patients are therefore also expressed in the brain.

Neuroleptic malignant syndrome in an AIDS patient: clinical and pathological findings.

Neuroleptic malignant syndrome (NMS) has been recently described following therapy with non strictly neuroleptic drugs that alter dopaminergic function, such as sulpiride and metoclopramide, and might occur more easily in patients with functional or organic brain disorders. We observed an AIDS patient who suffered from NMS following treatment with clotiapine for insomnia and agitation. Two months later, he presented with a similar syndrome following antiemetic treatment with alizapride. On both occasions, the symptoms completely regressed after the administration of dopaminergic and muscle relaxant drugs. The patient died of pneumonia one month after the last episode. The present paper describes the clinical and pathological findings.

L-5-hydroxytryptophan versus placebo in childhood migraine prophylaxis: a double-blind crossover study.

L-5HTP was tested versus placebo in a double-blind crossover study of 27 migraine children aged 6-12 years, who recorded their headaches in a headache diary for 1 month. Twenty-one patients subsequently started the trial. The mean daily dose of L-5HTP was 5 mg/kg body weight, and each treatment period with either L-5HTP or placebo lasted 12 weeks. In group A (L-5HTP-placebo; 10 patients) and group B (placebo-L-5HTP; 11 patients) both L-5HTP and placebo led to a significant reduction of the migraine index and frequency of migraine attacks during the 3rd month of each treatment period. However, we found a treatment X period interaction because the efficacy determinants decreased significantly during the first and the second treatment periods in both groups irrespective of the sequence of treatments. No differences were found between L-5HTP (first period of group A) and placebo (first period of group B).

Segregation analysis of migraine in 128 families.

To test the existence of inherited liability to migraine, formal segregation analysis of family data collected from 128 patients has been performed. Patients were subdivided into three groups in accordance with the presence or absence of migraine in their parents. The results obtained in each group were then compared with those expected on the basis of two different modes of simple Mendelian inheritance, namely autosomal dominant and autosomal recessive transmission. Our data show that neither of the two hypotheses can be accepted, thus suggesting the existence of a possible genetic heterogeneity of liability to migraine.

Veralipride-induced tardive dystonia in a patient with bipolar psychosis.

Veralipride is a benzamide derivative effective in the treatment of menopausal syndrome. Despite its antidopaminergic action, extrapyramidal side effects seem to be very uncommon. We observed a patient with bipolar psychosis, who developed segmental dystonia after taking the drug. The disorder slowly receded in 14 months, but reappeared during neuroleptic therapy a few months later. To the best of our knowledge, this is the first case of veralipride-induced tardive dystonia, and the affective disorder might have predisposed our patient to the development of this tardive side effect.

Transient abnormalities on magnetic resonance imaging after partial status epilepticus.

We report two patients who developed focal abnormalities on MRI after partial status epilepticus. Maximum radiological modification occurred in the area of maximal epileptic discharge. Subsequent MRI failed to demonstrate persistent abnormalities. These transient abnormalities on MRI could be an expression of cerebral edema caused by focal epileptic status.

Normal muscle mitochondrial function in Ramsay-Hunt syndrome.

Mitochondrial encephalomyopathies may display clinical features similar to Ramsay-Hunt syndrome (RHS). We studied muscles mitochondrial function in 2 patients with RHS. Histochemical and ultrastructural studies of muscle biopsies and biochemical analysis of muscle mitochondrial enzymes were normal. There is no evidence for a disturbance of muscle mitochondrial function in RHS.