Predictors of cardiopulmonary fitness in cancer-affected and -unaffected women with a pathogenic germline variant in the genes BRCA1/2 (LIBRE-1).

Physical activity (PA) helps prevention and aftercare of sporadic breast cancer (BC), cardiopulmonary fitness (CPF) being an age-independent predictor of tumor-specific mortality. Therefore, we wanted to identify predictors of CPF (represented by peak oxygen uptake: VO2peak) in BRCA1/2 mutation carriers whose risk of developing BC is high. We used cross-sectional data from 68 BRCA1/2 germline mutation carrying women participating in the randomized, prospective, controlled clinical study LIBRE-1. Assessments included cardiopulmonary exercise testing, medical and lifestyle history plus socioeconomic status. Additionally, the participants completed a psychological questionnaire regarding their attitude, subjective norms, perceived behavior control and intention towards PA. A multivariate logistic regression model was used to identify predictors for participants reaching their age- and sex-adjusted VO2peak reference values. 22 participants (median age: 40 years, interquartile range (IQR) 33-46) were cancer-unaffected and 46 cancer-affected (median age: 44 years, IQR 35-50). The strongest predictor for reaching the reference VO2peak value was attitude towards PA (Odds Ratio 3.0; 95% Confidence Interval 1.3-8.4; p = 0.021). None of the other predictors showed a significant association. A positive attitude towards PA seems to be associated with VO2peak, which should be considered in developing therapeutic and preventive strategies.Trial registrations: NCT02087592; DRKS00005736.

[Relaxation techniques and behavioural therapy for the treatment of migraine : Guidelines from the German Migraine and Headache Society]. / Entspannungsverfahren und verhaltenstherapeutische Interventionen zur Behandlung der Migräne : Leitlinie der Deutschen Migräne- und Kopfschmerzgesellschaft.

Besides pharmacological and interventional possibilities nonpharmacological options, deriving from behavioural approaches may be helpful in the treatment of migraine. Already consulting a patient reduces frequency of attacks. Relaxation (especially progressive muscle relaxation), endurance sports, and biofeedback as well as cognitive behavioural therapy are effective in treatment of migraine. The combination of these treatment options also with pharmacological treatment increase the positive effects.

[Psychological therapy of migraine: systematic review]. / Psychologische Therapie der Migräne: Systematische Übersicht.

This review summarizes the various forms of behavioral treatment of migraine which could demonstrate empirical efficacy. The main unimodal kinds of treatment are thermal and electromyography (EMG) biofeedback training and progressive muscle relaxation. The various relaxation techniques do not differ in their efficacy in treating migraine. On average a reduction in migraine frequency of 35-45 % is achieved. The mean effect sizes (ES) of various biofeedback techniques are between 0.4 and 0.6. Cognitive-behavioral treatment is applied as a multimodal treatment and on average achieves an improvement in migraine activity by 39 % and an ES of 0.54. All behavioral procedures can be used in combination or as an alternative to drug prophylaxis with comparable success. A combination of pharmacological and behavioral treatment can achieve additional success. There is strong evidence for the clinically significant efficacy of all forms of behavioral treatment in childhood and adolescence. There are no signs of differential indications.

Influence of acute psychological trauma on time estimation behaviour: a prospective pilot study.

In addition to the symptom triad of intrusions, avoidance behaviour and hyperarousal, typical and frequent characteristics of acute and chronic posttraumatic disorders are neuropsychological disturbances of working memory and executive functions. So far, however, only a very limited number of studies have dealt with their effects on the capability to assess time-related information. The purpose of this prospective study therefore was to compare persons after an acute traumatic experience with healthy controls in the course of 12 months, focusing on their ability to estimate time as a measure of their readiness of attention. 39 participants aged 17-59 years (mean age = 35.1 years, who had experienced a traumatic event and exhibited symptoms of acute stress disorder) were compared with 38 healthy controls (mean age = 36.1 years) at eight times of measurement within a period of 12 months. Performance was determined by means of a prospective time estimation task. The participants had to estimate a time interval of 5 s, once with and once without feedback about the quality of the estimates. The time estimates by the traumatised persons were significantly less precise than those by the control group. Progress analyses have shown that trauma patients exhibit larger deviations from the defined time interval, both under feedback conditions and without feedback. Psychological traumatisation leads to both an acute and long-term, demonstrable impairment of time estimation ability. The recognizable disturbance of information processing may both be a cause and a result of clinical trauma symptoms.

Aerobic exercise as a therapy option for migraine: a pilot study.

Exercise is assumed to have a positive effect on migraine. However, none of the few studies on this topic can prove the expected positive influence of exercise. Therefore, the aim of this pilot study was to develop a training program suitable for migraine patients and to examine its effect on migraine. 16 patients were examined. 8 migraine patients completed a 10-week aerobic running exercise program consisting of 3 workouts per week. The program was developed by sports scientists especially to increase the fitness level. Physical fitness, i. e., physical working capacity, was assessed using a PWC 150 test. There was also a control group of 8 patients without any special physical training. Migraine patients of the exercise group showed both a reduction in the number of migraine days per month (p=0.048) and the intensity of the attacks (p=0.028). An increase in fitness level resulted in a lowered stress level. Stress strategies like "displacement activity" (r=-0.715; p=0.046), "looking for self-affirmation" (r=-0.742; p=0.035) and "feelings of aggression" (r=-0.802; p=0.017) were reduced. Increasing the level of fitness (PWC 150) is one predictor for migraine improvement (r=0.409, p=0.031). Aerobic exercise which leads to a better fitness level is an alternative therapy method for migraine.

[Biofeedback for headaches]. / Biofeedback bei Kopfschmerzen.

Biofeedback is a direct feedback of a physiological function. The aim of biofeedback is to change the physiological function into a required direction. To manage this, the physiological function has to be fed back visually or acoustically and it has to be perceived consciously. Biofeedback as a therapeutic practice derives from behavioural therapy and can be used in the context of behavioural interventions. Biofeedback has proved to be successful in non-medical treatment of pain. According to more recent meta-analyses biofeedback reveals high evidence in the treatment of migraine or tension-type headache. In these headaches biofeedback procedures are considered highly effective.

Effects of pregnancy on slow cortical potentials in migraine patients and healthy controls.

Increased negative amplitudes and lack of habituation of contingent negative variation (CNV) in migraine are well established and are supposed to reflect an altered cortical excitability level. Migraine attacks occur less during pregnancy but often relapse after delivery. We investigated the effect of pregnancy on slow cortical potentials and reaction time in migraine patients and healthy controls. Four groups were examined: 14 pregnant migraine patients, 12 non-pregnant migraine patients, 15 pregnant healthy women and 16 non-pregnant healthy women aged 19-38 years. Two recordings were performed in the pregnant subjects: in the 36th week of gestation and 4 weeks after delivery. The non-pregnant subjects were recorded at the same time interval of 8 weeks. Pregnant migraine patients showed significantly fewer migraine days during the third trimester of pregnancy and returned to nearly the former level 4 weeks post delivery. Non-pregnant migraine patients demonstrated a significant reduction of migraine days at the second measurement. There was no effect of pregnancy on CNV amplitudes, but there was an effect of pregnancy on the habituation coefficient and reaction time of migraine patients. Faster habituation from a higher preactivation level was found. As an explanation for the changed habituation level we favour the model of correlation between preactivation level and habituation level, the so-called law of initial value. We found a correlation between preactivation level and habituation. Our study confirms a specific effect of pregnancy on slow cortical potentials in migraine patients.

Central mechanisms of controlled-release metoprolol in migraine: a double-blind, placebo-controlled study.

beta-Blockers are widely used in the prophylaxis of migraine and have been described as very effective drugs in many studies. Some investigators have demonstrated that the clinical improvement of migraine corresponds to the normalization of the contingent negative variation (CNV), a slow cortical potential measuring cortical information processing. However, most of these studies have contained a variety of methodological pitfalls, which we attempted to address in the current study. Twenty patients suffering from migraine without aura were randomly divided into two groups. The groups were treated either with controlled-release metoprolol or placebo for 3 months, using a double-blind design. Twice before and once after each month of the treatment the CNV was recorded. After 3 months, a significant reduction of migraine frequency, duration and intensity was demonstrated for the metoprolol compared with the placebo group. The CNV was characterized by a marked reduction of the amplitude of the total CNV and postimperative negative variation and normalization of the eartly CNV habituation following treatment. Therefore, metoprolol may exert its prophylactic effect in migraine through the influence on cortical information processing and excitability represented by the CNV.

Efficacy of phenazone in the treatment of acute migraine attacks: a double-blind, placebo-controlled, randomized study.

In this study we compared the efficacy of 1000 mg phenazone with that of placebo in the treatment of acute migraine attacks in a randomized double-blind, placebo-controlled study of 208 patients. The main target criterion was the number of patients with a pain reduction from severe or moderate to slight or no pain 2 h after taking the pain medication. The percentage of patients satisfying the main target criterion was 48.6% for phenazone and 27.2% (P < 0.05) for placebo. Freedom from pain after 2 h was reported by 27.6% with phenazone treatment and 13.6% (P < 0.05) with placebo. Compared with placebo, the phenazone treatment also resulted in a significant improvement in the associated migraine symptoms of nausea, phonophobia and photophobia. Of patients treated with phenazone 11.4%, and 5.8% of those treated with placebo reported adverse events. There was no significant difference between the groups with regard to numbers of patients with adverse events. No serious adverse events occurred. The results show that phenazone at a dosage of 1000 mg is effective and well tolerated in the treatment of acute migraine attacks.

[Non pharmacological treatment of migraine]. / Die nichtmedikamentöse Behandlung der Migräne.

Actual recommendations for treatment of migraine consist both of pharmacological and non-pharmacological treatment. The latter enables the patient higher responsibility and self-efficacy in coping with migraine. Therefore, the active involvement in the treatment of the patients is obligatory in all psychological pain therapy methods. Focus of therapy are emotional, cognitive, behavioural and social factors of migraine illness, with the aim to modify unfavourable habits and migraine attack-inducing factors. As non-pharmacological methods counselling, relaxation training, biofeedback and cognitive-behavioural treatments are employed. The long-term effects are comparable with those of pharmacological treatment, combination of pharmacological and non-pharmacological treatment lead to even higher efficacy and is often indicated. In case of headache in children, behavioural therapy should be the method of first choice. In the text, empirically proven methods of psychological pain therapy in migraine will be explained.

Contingent negative variation and attentional performance in humans.

The relation between a paper-pencil test of sustained attention (d2-letter cancellation test, d2-LCT) and the contingent negative variation (CNV) as a cortical slow potential was calculated in 23 healthy undergraduate students. Both d2-LCT and CNV reflect selective, focussed attention. There was a Pearson correlation coefficient of r = -0.670 between the early component of the CNV and the number of checked letters in d2-LCT, indicating significant differences in early CNV between low and high performance in d2-LCT. The results showed a linear relationship between paper-pencil registered attentional properties and the cortically recorded early component of CNV.

Non-linear electroencephalogram dynamics in patients with spontaneous nocturnal migraine attacks.

The present study was conducted to examine non-linear electroencephalogram (EEG) measures during the development of a spontaneous migraine attack. We investigated the sleep EEG of five patients with migraine without aura in the pain-free interval and at the onset of a nocturnal attack. Sleep EEG recordings were analysed using the method of global dimensional complexity compared to conventional sleep scoring techniques. We found no divergence between classical sleep architecture and the estimated dimensional course nor any relevant short-term changes related to the onset of headache. There was, however, a loss of dimensional complexity in the first two non-rapid eye movement sleep states in the migraine night, with statistical significance during the second sleep cycle. For the first time, these results provide evidence of a global dimension decrease that is related to cortical network changes during a migraine attack.

Polysomnographic findings in nights preceding a migraine attack.

Sleep recordings were performed in eight patients to analyse sleep alterations preceding migraine attacks. Polysomnographic recordings from nights before an attack were compared with nights without following migraine. We analysed standard sleep parameters and electroencephalogram (EEG) power spectra. The main findings preceding migraine attacks were a significant decrease in the number of arousals, a decrease in rapid eye movement (REM) density, a significant decrease of beta power in the slow wave sleep, and a decrease of alpha power during the first REM period. The results suggest a decrease in cortical activation during sleep preceding migraine attacks. According to the models of sleep regulation, alterations in the function of aminergic or cholinergic brainstem nuclei have to be discussed.

[Effects of Harpagophytum procumbens LI 174 (devil's claw) on sensory, motor und vascular muscle reagibility in the treatment of unspecific back pain]. / Harpagophytum-Extrakt LI 174 (Teufelskralle) bei der Behandlung unspezifischer Rückenschmerzen - Effekte auf die sensible, motorische und vaskuläre Muskelreagibilität.

PROBLEM: This randomised, double-blind, placebo controlled study was intended to investigate the effects of Harpagophytum procumbens (Devil's Claw) on sensory, motor and vascular mechanisms of muscle pain. In addition to clinical efficacy and tolerability, possible action mechanisms were analysed by means of experimental algesimetric methods. METHODOLOGY: The study was performed on patients with slight to moderate muscular tension or slight muscular pain of the back, shoulder and neck. On a double-blind randomised basis the verum group received 2x1 film tablets per day, i. e. 2x480 mg/day, of Harpagophytum extract LI 174 (Rivoltan(R)) at 8.00 a.m. and 8.00 p.m. over a certain period. The duration of the therapy was 4 weeks. Data recording at 14-day intervals was made using a visual analogue scale, pressure algometer test, recording of antinociceptive muscular reflexes, muscle stiffness test, EMG surface activity, muscular ischaemia test, clinical global score and subjective patient and physician ratings. RESULTS: A total of 31 patients in the verum group and 32 in the placebo group were treated. After four weeks of treatment there was found to be a clear clinical efficacy of the verum on the clinical global score and in the patient and physician ratings. Highly significant effects were found in the visual analogue scale, the pressure algometer test, the muscle stiffness test and the muscular ischaemia test. No difference from placebo was found in the recording of antinociceptive muscular reflexes or in the EMG surface activity. Tolerability was good; no serious adverse effects occurred. CONCLUSIONS: A highly significant clinical efficacy was achieved with a monotherapy of Harpagophytum dry extract LI 174 after four weeks' treatment at a dosage of 2x480 mg/day in cases of slight to moderate muscular pain. With regard to the action mechanisms investigated, it may be concluded that treatment with Harpagophytum extract LI 174 may be expected to have a significant influence on sensory and vascular muscular response and bring about a reduction in muscle stiffness. No central nervous effects were discovered.

[Prediction of verbal and numerical comprehension in patients with cochlear implants]. / Zur Vorhersage von Sprach- und Zahlenverständnis bei Patienten mit Cochlear-Implantat.

BACKGROUND: Cognitive abilities determine the outcome of cochlear implantation. Neuropsychological tests of intellectual, memory, attentional and emotional functions were applied pre-operatively in 33 deaf patients receiving a cochlear implant. The outcome of verbal and numerical comprehension was measured in a subgroup of 14 patients post-operatively and correlated with pre-operative neuropsychological performance. METHODS: Neuropsychological performance was recorded using standardized tests for intellectual abilities (abbreviated Wechsler Adult Intelligence Scale [WAIS], crystallized intelligence scale), memory performance (Benton Visual Retention Test), attentional functions (d2 letter-cancellation-test), reaction time (Vienna Reaction Test) and emotional state (personality inventories). Verbal and numerical comprehension was measured post-operatively following adaptation of the speech processor. Performance and comprehension data were correlated. RESULTS: Cognitive performance parameters did not differ significantly from those of a healthy group. There was a correlation of r = +0.65 between numerical comprehension and the "mosaic-test", a subtest of the WAIS and of r = +0.78 between numerical comprehension and the crystallized intelligence scale. CONCLUSIONS: Pre-operative cognitive parameters may predict the outcome of cochlear implants.

[Sleeping behavior and migraine. An evaluation by daily self-reports]. / Migräne und Schlaf. Retrospektive und prospektive Analyse anhand von Kopfschmerz- und Schlafprotokollen.

PROBLEM: Regarding the coherence of sleeping behavior and the occurrence of migraine attacks, we conducted a study based on migraine and sleeping diaries. METHODS: Besides the daily recording of times of falling asleep and waking up, duration of sleep, sleep disruption and quality of sleep, clinical migraine parameters like occurrence of migraine attacks, headache intensity and duration and the daily mood rating were registered over periods of at least 6 weeks. In the analyses, we defined two classes of events: (1) nights not followed by a migraine attack; (2) nights followed by migraine. We examined a retrospective sample (23 patients with altogether 580 attacks) and a prospective sample (16 patients with altogether 96 attacks). RESULTS: In both samples, we found that the duration of sleep was significantly reduced in nights followed by migraine (6.8 vs. 8.1 h and 6.4 vs. 7.2 h respectively) due to earlier awakening, with unchanged time of falling asleep. Up to two thirds of the observed migraine attacks were reported to be present directly after awakening. Quality of sleep was markedly reduced in nights followed by a migraine attack (i.e. sleep disruptions, feeling exhausted/no feeling of restedness when wakening up). We found only weak and insignificant correlations between the foregoing daily mood rating and the quantitative parameters of sleeping behavior on nights followed by migraine; somewhat more pronounced correlations were observable between the mood rating and the qualitative sleep parameters. CONCLUSIONS: Overall, we conclude that the observed changes in sleeping behavior are largely part of the migraine attack, with the possibility that REM sleep functions as a migraine trigger. In clinical application, we strongly recommend the use of daily self-observations of patients' sleep-related behaviors in the migraine diary, identifying migraine-prone sleeping habits and evaluating their potency for triggering migraine attacks.

Behavioral treatment in migraine. Cognitive-behavioral therapy and blood-volume-pulse biofeedback: a cross-over study with a two-year follow-up.

The aim of the present study was to ascertain the effects of two behavioral medicine approaches to the treatment of migraine. We also evaluated the specific effect of the sequence of the two treatments. Thirty-eight patients, suffering from migraine without aura, either obtained treatment in the following sequence: blood-volume-pulse biofeedback followed by cognitive behavioral therapy (Group I) or were given the treatment in reverse order (Group II). The effects of treatment in Group I were significantly better than those in Group II. We conclude that the application of biofeedback helps the patient to recognize the influence of thoughts and emotions on bodily reactions and therefore prepares the way for successful cognitive treatment.

Effects of nicotine gum on F waves in non-smokers.

The effects of chewing gum, containing 0 and 4 mg nicotine, on F waves were studied in healthy volunteers in a repeated measure design. F responses were recorded from the abductor pollicis brevis muscle following stimulation of the median nerve at the wrist. The persistence and various amplitude measures were analysed. Chewing a 4 mg nicotine gum, with a considerable rise in systemic nicotine (6.4-37.4 ng/ml), failed to produce significant effects on F wave parameters in relation to the placebo baseline. The analysis of different F wave amplitude ranges, however, revealed significant nicotine-induced changes: a dose-related decrease of F responses > or = 500 microV and an increase of F waves between 200-290 microV. This may be due to an activation of Renshaw cells in the spinal cord.

Exteroceptive silent period of masseter muscle activity evoked by electrical mental nerve stimulation: relation to non-pain and pain sensations.

Exteroceptive silent periods (ESPs) of masseter muscle activity evoked by electrical stimulation of the mental nerve were studied over a large range of prepain intensities and at pain threshold in 44 normal subjects. Seven levels of stimulus intensity, based on individual sensory and pain thresholds, were applied and the relationship between ESPs, stimulus intensity and perception, as manifested by the subjective verbal response, was investigated. The analysis revealed that the occurrence of ESPs was not related to the stimulus intensity at the pain threshold. There were individually different patterns of progressive response to increasing current intensities within the pre-pain range in many cases. On the other hand, almost half of all the subjects investigated showed no or only occasional ESPs. In view of this variability the concept of ESPs being a nociceptive behavioural response has to be questioned.