Alexithymic characteristics in pediatric patients with primary headache: a comparison between migraine and tension-type headache.

BACKGROUND: Alexithymia is a personality construct characterized by difficulties in verbal emotional expression and a limited ability to use one's imagination. Evidence of alexithymic characteristics was found in adults suffering from headache, while little is known about children. The aim of this study was to establish the prevalence of alexithymia in two different subgroups of children and adolescents suffering from primary headache. We also looked for correlation between alexithymia in children and in their mothers. METHODS: This study involved 89 participants: 47 (11 males, 36 females, aged 8 to 17 years) suffering from tension-type headache (TTH), and 42 (18 males, 24 females, aged 8 to 17 years) suffering from migraine (M), based on the International Classification of Headache Disorders (ICHD 2013). A control group of 32 headache-free subjects (26 females and 6 males, aged 8 to 17 years) was also considered. Two questionnaires were administered to measure alexithymia: the Alexithymia Questionnaire for Children to young patients and controls, and the Toronto Alexithymia Scale (TAS-20) to the mothers. RESULTS: Higher rates of alexithymia emerged in the TTH group compared to the M group. In particular, TTH sufferers had difficulty identifying their feelings. The mothers of children with headaches didn't score higher in alexithymia compared to other mothers. In the M and in the control group, there was a significant correlation between the rates of alexithymia in young people and in their mothers. CONCLUSIONS: To date no other study has investigated alexithymia in subgroups of primary headaches in developmental age. Our results suggest that patients suffering from TTH are more alexithymic than M patients. This pave the way to etiopathogenetic and clinical considerations, calling for a comprehensive and multidisciplinary approach to tackle the problem of headache.

Spontaneous involution of diffuse fibrous dysplasia of paranasal sinuses.

We report the case of a 25-year-old patient, diagnosed at age 10, with diffuse fibrous dysplasia of the paranasal sinuses, an extremely rare idiopathic condition. This diagnosis is possible only by cerebral computed tomography (CT), cerebral and anterior skull base magnetic resonance imaging (MRI), and histopathology. Surgical treatment is common. This boy had mild symptoms: moderate headache in the morning that did not affect his daily activity, and rhinitis, partially responsive to medication. The neurologic examination was abnormal. Radiographs, CT, and MRI showed a diffuse mass in the paranasal sinuses which had a histopathological diagnosis of fibrous dysplasias. The family refused to refer the patient to surgery. The boy has been monitored annually for 15 years. He has remained asymptomatic without headache since age 11, with normal, general and neurologic examinations. Serial MRIs showed a spontaneous partial involution of the mass.

Impact of a weight loss program on migraine in obese adolescents.

BACKGROUND AND PURPOSE: Increased headache frequency and severity have been observed in obese populations, but the real impact of a weight loss treatment on headache has not been studied. We investigated this issue in a sample of obese adolescents. METHODS: In all, 135 migraineurs, aged 14-18 years, with body mass index (BMI) ≥ 97 th percentile, participating in a 12-month-long program, were studied before and after treatment. The program included dietary education, specific physical training, and behavioral treatment. RESULTS: Decreases in weight (P < 0.01), BMI (P < 0.01), waist circumference (P < 0.01), headache frequency (P < 0.01) and intensity (P < 0.01), use of acute medications (P < 0.05), and disability (P < 0.05) were observed at the end of the first 6-month period and were maintained through the second 6 months. Both lower baseline BMI and excess change in BMI were significantly associated with better migraine outcomes 12 months after the intervention program. CONCLUSIONS: Significant improvements in both adiposity and headache data were observed in obese adolescents with migraine who participated in a 12-month-long interdisciplinary intervention program for weight loss. Initial body weight and amount of weight loss may be useful for clinicians to predict migraine outcomes.

Norovirus gastroenteritis and seizures: an atypical case with neuroradiological abnormalities.

We describe an 8-year-old boy admitted because of prolonged seizures during norovirus gastroenteritis without any signs of encephalopathy. Blood tests were normal and cerebrospinal fluid examination resulted negative for both bacteria and viruses. A reverse transcriptase polymerase chain reaction revealed norovirus RNA in a stool sample. A cerebral computed tomography turned out to be normal whereas subsequent cerebral magnetic resonance imaging showed transitory signal abnormalities consistent with vasogenic edema. The post-ictal electroencephalogram revealed normal background activity with sporadic left posterior delta waves. The child was discharged after 10 days with an unremarkable physical examination. A cerebral magnetic resonance imaging and an electroencephalogram after 1 month were both negative. We report a new case of benign infantile convulsions due to norovirus gastroenteritis with neuroradiological abnormalities to the pertinent literature in order to improve knowledge about this disorder and increase the possibility of clarifying its pathogenesis.

Osmophobia in migraine classification: a multicentre study in juvenile patients.

AIMS: This study was planned to investigate the diagnostic utility of osmophobia as criterion for migraine without aura (MO) as proposed in the Appendix (A1.1) of the International Classification of Headache Disorders (ICHD-II, 2004). METHODS: We analysed 1020 patients presenting at 10 Italian juvenile headache centres, 622 affected by migraine (M) and 328 by tension-type headache (TTH); 70 were affected by headache not elsewhere classified (NEC) in ICHD-II. By using a semi-structured questionnaire, the prevalence of osmophobia was 26.9%, significantly higher in M than TTH patients (34.6% vs 14.3%). RESULTS: Osmophobia was correlated with: (i) family history of M and osmophobia; and (ii) other accompanying symptoms of M. By applying these 'new' criteria, we found an agreement with the current criteria for the diagnosis of migraine without aura (MO) in 96.2% of cases; 54.3% of previously unclassifiable patients received a 'new' diagnosis. CONCLUSIONS: In conclusion, this study demonstrates that this new approach, proposed in the Appendix (A1.1), appears easy to apply and should improve the diagnostic standard of ICHD-II in young patients too.

Clinical and diagnostic aspects of multiple sclerosis and acute monophasic encephalomyelitis in pediatric patients: a single centre prospective study.

OBJECTIVE: The purpose of the study was to compare and contrast the initial presenting demographic, clinical, neuroimaging, and laboratory features in a cohort of children affected from multiple sclerosis (MS) or acute disseminated encephalomyelitis (ADEM). METHODS: A 12-year prospective study was conducted in 68 pediatric patients (age

Osmophobia in juvenile primary headaches.

This study was planned to investigate the prevalence of osmophobia in juvenile headache sufferers and to analyse the diagnostic utility of osmophobia in order to distinguish migraine without aura from episodic tension-type headache. We examined 305 consecutive patients presenting at our Paediatric Headache Centre. A semistructured questionnaire was given to 275 selected patients affected by migraine or tension-type headache. The prevalence of osmophobia during attacks was 18.5%, mainly in migraine patients (25.1%) vs. those with tension-type headache (8.3%). Osmophobia showed more specificity than phonophobia or photophobia in the differential diagnosis between migraine and tension-type headache. In conclusion, this study demonstrates that osmophobia resulted in a symptom with poor sensitivity (27.1%) but high specificity (92%) that could become a supportive diagnostic criterion even in children for the differential diagnosis between migraine without aura and tension-type headache.

Primary headaches in preschool age children: clinical study and follow-up in 163 patients.

Although headache frequency is increasing in preschool age children, an extensive evaluation of the clinical features in affected patients has yet to be achieved. This retrospective study examined 243 patients who were separately analysed in two distinct groups according to the age of onset and the age of first clinical evaluation. Group 1 included preschool age children, while Group 2 consisted of pubertal age patients. In all the patients the importance of a positive family history for headache as a risk factor was confirmed. In addition, when compared with Group 2, Group 1 showed greater male gender prevalence and earlier onset of the attacks. Regarding clinical features, in Group 1, compared with Group 2, the attack duration was shorter with lower symptom association such as photo- or phonophobia, nausea and no pain increase during physical activity. In the same group, tension-type headache was the predominant diagnosis, in contrast to the high migraine prevalence of Group 2. This study also showed that the International Headache Society 1988 classification criteria are not fully adequate for juvenile headaches. In fact, the headaches of more than 10% of patients in Group 1 still remained unclassifiable, while those of all the subjects in Group 2 were properly classifiable.

Quality of life in young Italian patients with epilepsy.

The objective was to evaluate the quality of life of young Italian patients with epilepsy and to investigate the influence of epilepsy medical variables on patients' quality of life. The settings were the Department of Paediatrics, University of Padua; Children's Hospital Giovanni XXIII, Bari; and three schools of South Italy. A sample of 285 subjects was selected: 140 subjects affected by idiopathic and cryptogenic epilepsy (classified according to the International League Against Epilepsy criteria) and 145 control subjects. Data derived from the comparison between the two groups throughout "Epilepsy and children questionnaire" confirmed the negative epilepsy impact on the young patients' quality of life: in fact they scored significantly lower on psychological and social domains (p

Auditory event-related potentials and reaction times in migraine children.

Cognitive processing was investigated interictally in 18 children with migraine without aura and 18 age-matched controls by measuring event-related potentials (ERPs) and reaction times (RTs) during an acoustic oddball paradigm. Results showed that N100 amplitude evoked by frequent stimuli was significantly smaller in patients compared with controls. Habituation of target P300 amplitude was observed in patients but not in controls. Mean RTs were equivalent in the two groups, but migraine children made more errors than controls.

Quality of life in young Italian patients with primary headache.

OBJECTIVE: To compare the quality of life of young Italian patients with headache with that of the juvenile Italian population free of chronic disease. METHODS: The Quality of Life Headache in Youth (QLH-Y) Questionnaire developed by Dutch investigators was translated into Italian and validated in a young Italian population. The forward/backward translation and, for psychometric testing, the factor analysis and Cronbach coefficient alpha were used. A new instrument (Questionnaire for Young Subjects Affected by Primary Headache) was developed to assess psychological, physical, and social functioning and functional status and was used to compare the quality of life of the patients with headache with that of headache-free controls. For psychometric testing (via the questionnaire), we selected a sample of 394 subjects (178 males and 216 females, aged 10 to 18 years): 320 subjects from three schools of North Italy and 74 patients with headache from the Paediatric Headache Center of Padua. In the latter group, 48 patients had tension-type headache and 26 had migraine without aura, according to the International Headache Society diagnostic criteria. RESULTS: The data derived from the comparison of 84 headache-free subjects (control group) and the 74 young patients with headache confirmed that primary headache negatively influenced the latter's quality of life: patients scored significantly (P<.05) lower on psychological, physical, and social functioning than the headache-free controls. CONCLUSIONS: Quality of life is compromised significantly in young patients with primary headache disorders. The questionnaire used in this study is a valid and reliable self-administered instrument that may facilitate clinical research in headache.

Coeliac disease associated with peripheral neuropathy in a child: a case report.

Clinical features and pathological findings of sural nerve biopsy are reported of a 3-year-old child affected with coeliac disease who developed a progressive polyneuropathy, unresponsive to a gluten-free diet, nor to vitamin E and folic acid supply. There was no evidence of malabsorption, nor of blood factor deficiency, nor of metabolic abnormalities which might account for the neuropathy. A sural nerve biopsy showed marked loss of myelinated fibres without evidence of regenerative phenomena. Distal involvement and features of nerve pathology are consistent with a "dying-back" mechanism to underlie the nerve damage. The lack of response to a gluten-free diet suggests that direct toxicity of gliadin is not implicated.

[Anxiety and memory in hospitalized adolescents; effect of the projection of a film]. / Ansia e ricordo in adolescenti ricoverati: influenza della proiezione di un film.

The purpose of our study was the evaluation of the effects of a film on the anxiety and memory of cronically ill adolescents (n. 25) versus healthy adolescents (n. 25). The chronic illness was: renal failure, renal transplantation (6 months before), scoliosis and Crohn's disease. The S.T.A.I.-Y test was administered before and after the film to evaluate the state-anxiety before and after the vision, only the trait-anxiety was evaluated before. The state and trait-anxiety was not abnormal, although the state anxiety was increased in the hospitalized adolescents before the vision (mean S.T.A.I.-Y = 43.2) and was decreasing (mean S.T.A.I.-Y = 37.32) after it. This result confirms the needs of a global paediatric health-care in order to minimise psychosocial traumas, associated with hospitalisation. The second goal of our research was the mood and memory correlation and the mood-congruency. We administered two memory tests (free and guided) using a recorder and a questionnaire. Our study presents a better free-memory in healthy subjects (16.6% vs. 5.16% in the hospitalized adolescents) and a better guided-memory in the healthy subjects (13.7% vs. 7.08% in the hospitalized adolescents). Our results can't confirm the mood-congruency theory, although the study conclusion is concerning a general decreasing of memory competence, following the repeated hospital admissions and the chronic illness.

Optic atrophy as the first symptom in Hallervorden-Spatz syndrome.

A 16-year-old boy with the classic or postinfantile type of Hallervorden-Spatz syndrome is described. Bilateral optic atrophy with visual loss but without retinal changes was the only presenting symptom. Mild cognitive impairment, behavioural disturbances and insidious extrapyramidal involvement appeared later. MRI showed marked symmetrical hypointensity of the globi pallidi and substantia nigra. This new observation suggests that the occurrence of optic atrophy in a patient with Hallervorden-Spatz syndrome should be regarded as noncoincidental and stresses the importance of an accurate neurological work-up in all adolescents with any unusual form of progressive optic atrophy.

[Intraorbital tumors in children. Two cases and review of the literature]. / Neoplasie endorbitarie in età evolutiva. Due casi e revisione della letteratura.

Also in childhood, the orbital cavity is a possible place for different kinds of lesions. The recent contribution of magnetic risonance imaging (MRI) enables a more accurate differential diagnosis of intraorbital pathology. The clinical and neuroradiological data of two new patients affected respectively by intraorbital meningioma and schwannoma are presented. Both patients showed exophthalmos without pain and were treated with surgery. The different etiologies of intraorbital lesions, i.e. vascular, neoplastic, inflammatory, cystic and malformative are analyzed. Sometimes the case history and neuroradiological assessment alone enable a correct diagnosis. More often, however, only surgery reveals the exact nature of the disease. The age of the patient too can represent a criteria for a possible differential diagnosis.

Clinical and neuroradiological findings of moyamoya disease in Italy.

A total of 34 Italian patients (15 males and 19 females) suffering from Moyamoya disease (MMD) and selected by a questionnaire survey in 12 neuropediatric and neuroradiologic departments were studied in a multicentric study. The onset of the disease appeared either in childhood (27 patients, aged 0-16 years, mean 5.4 years) or in adulthood (seven patients, aged 25-55 years, mean 35 years). The early clinical symptoms consisted of transient ischemic attacks and/or stroke (20 cases), recurrent migraine-like headaches (seven cases), seizures (six cases) and hemorrhage (one case). A total of four familial cases were found. The final diagnosis was based in all cases on the conventional angiographic findings and more recently also on the magnetic resonance angiography (ten patients). The mean lag time between the first clinical manifestation and the angiographic diagnosis was about 2 years. A medical treatment (vasodilators, antiplatelet agents, calcium channel blockers) was followed by 21 patients, while five cases underwent a surgical revascularization. The follow-up ranges from 1 to 15 years (mean 6 years): A motor (16 cases) and/or mental impairment (14 cases) was detected especially in the childhood onset MMD; only one patient died. In nine cases the long-term outcome persisted without neurological deficit.

Interictal and ictal phase study with Tc 99m HMPAO brain SPECT in juvenile migraine with aura.

Single photon emission computed tomography (SPECT) was performed on 30 juvenile patients suffering from different types of migraine with aura. SPECT was carried out only during the pain-free interval in 11 patients. The other 19 patients underwent SPECT ictally and 9 of them also interictally. During the pain-free interval, the investigation was normal in 16 of 20 cases and revealed hypoperfused areas in 4 of 20 cases. Ictally, regional cerebral blood flow (rCBF) abnormalities were found in 14 of 19 cases; hypoperfusion in 11 patients and hyperperfusion in 3 patients. In most cases, rCBF abnormalities corresponded to the topography of neurologic symptoms. Our interictal period results do not agree with the previous studies in juvenile migraineurs, while during the ictal phase we demonstrated, for the first time, significant rCBF abnormalities in juvenile patients suffering from migraine with aura.

Juvenile idiopathic stabbing headache.

We report on 83 juvenile patients with idiopathic stabbing headache, subjectively perceived as lasting from a fraction of a second to a few minutes. This sample was selected from among 2543 outpatients referred because of recurrent headache to the Paediatric Neurology Services of Ferrara and Padua (Italy). Other painful syndromes were excluded by clinical examination and appropriate tests. Idiopathic stabbing headache in the pediatric age group, contrary to the adult form, is usually not associated with other primary headache syndromes. We suggest that this clinical picture should be more clearly defined in the future, in order to better understand its relationships with other primary headaches.

Neurofibromatosis type 1 and type I Chiari malformation: an unusual association.

We report an 11-year-old boy with neurofibromatosis type 1 (NF1) and asymptomatic type I Chiari malformation. This association may be considered a pure coincidence, due to the relative frequency of the two conditions, but recent reports describing the same association suggest that type I Chiari malformation probably should be added to the list of abnormalities of the central nervous system reported in patients affected by NF1.