A comparison of the clinical efficacy of GON block at the C2 level and GON block at the classical distal occipital level in the treatment of migraine.

PURPOSE: The aim of this retrospective study was to compare the efficacy and complications of ultrasound-guided block (C2GON) at the level of C2 and block performed from the distal occiput level (DOGON) as the greater occipital nerve progresses superficially to the obliquus capitis inferior muscle in migraine patients. METHODS: 63 patients were included in this retrospective study. For C2GON blockade, 2 units of 4 ml 0.5% bupivacaine were prepared for bilateral administration to 32 patients. For DOGON, two 1.5 ml 0.5% bupivacaine was prepared bilaterally for each patient. The patients were evaluated in terms of pain intensity and frequency, analgesic use, and any side effects before the injection and at the 1st and 3rd months after the last treatment. RESULTS: When we compared C2GON block and DOGON block in our study, we found that both blocks were effective for 3 months. The reduction rates in the C2GON and DOGON groups were 75.3% and 59% in the number of severe attacks, 63.9% and 59.1% in the total analgesic use, 71.1% and 56.25% in the triptan use, 78% and 60% in the number of days with severe headache, 63.4% and 50.3% in the duration of headache. The decrease in the highest VAS score was 48.1% in the group with C2GON, while it was 53% in the group with DOGON. CONCLUSIONS: Current findings have shown that both C2GON and DOGON blockades are effective in the treatment of migraine for 3 months.

Apilarnil: A Novel Neuroprotective Candidate.

PURPOSE: This study was designed to investigate the effect of apilarnil on neuronal damage and related mechanisms in a sepsis model in order to demonstrate whether or not apilarnil has neuroprotective effect. METHODS: In this study, 64 adult male Sprague-Dawley species rats were randomly divided into eight groups. The rats were administered apilarnil and/or lipopolysaccharide (LPS). Superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), xanthine oxidase (XOD) and testican-1 levels were measured in the brain tissue. Proinflammatory cytokines (tumor necrosis factor alpha [TNF-α], interleukin 1 beta [IL-1ß], interleukin 6 [IL-6]) were measured in brain tissue. Histological examinations were performed on hippocampus and cortex tissues in all groups. Apoptotic cell count was estimated using the Tunel method to observe the apilarnil's effect on apoptosis. Purkinje cells were counted in the hippocampus to measure the protective effect of apilarnil on the hippocampus. RESULTS: Apilarnil reduced the decrease in SOD and CAT levels in the brain developing sepsis. Apilarnil reduced the increase in MDA, XOD, and testican-1 levels in the septic brain. It was observed that the number of degenerated neurons due to sepsis decreased as apilarnil dose increased. Apilarnil reduced the elevated levels of proinflammatory cytokines (IL-6, TNF-α, IL-1ß) induced by sepsis. Apilarnil prevented sepsis-related apoptosis in the brain. CONCLUSION: The neuroprotective potential of apilarnil against brain damage in the sepsis model was demonstrated and suggested that it has the potential to contribute to new therapeutic targets against various neurological disorders.

Vitamin D, vitamin D binding protein, vitamin D receptor levels and cardiac dysautonomia in patients with multiple sclerosis: a cross-sectional study / Vitamina D, proteína de ligação à vitamina D, níveis de receptores de vitamina D e disautonomia cardíaca em pacientes com esclerose múltipla: um estudo transversal

ABSTRACT Vitamin D is a pleiotropic steroid hormone that modulates the autonomic balance. Its deficiency has been described as an environmental risk factor for multiple sclerosis (MS). The aim of this study was to investigate the serum levels of vitamin D, vitamin D binding protein (VDBP) and vitamin D receptors (VDR) and to evaluate cardiac dysautonomia in MS patients due to bidirectional interaction between vitamin D and the autonomic nervous system. Methods: The current cross-sectional study was conducted on 26 patients with relapsing-remitting MS and on 24 healthy controls. Twenty-four-hour ambulatory blood pressure variability (BPV) was calculated and the participants were evaluated for orthostatic hypotension and supine hypertension. Serum levels of vitamin D, VDBP and VDR were measured. Results: The mean serum vitamin D level was significantly lower in MS patients than in controls (p = 0.044); however there was no significant difference in terms of VDR and VDBP levels between the groups. Supine hypertension and orthostatic hypotension were significant and the 24-hour systolic BPV was significantly decreased in patients with MS (p < 0.05) compared to controls. No correlation was found between vitamin D, VDBP and VDR with supine hypertension, orthostatic hypotension and systolic BPV values (p > 0.05). Also, there was a negative correlation between VDBP and the EDSS (p = 0.039, r = −0.406). Conclusion: There was no correlation between orthostatic hypotension, supine hypertension and systolic BPV values and serum vitamin D, VDBP and VDR in MS patients. Future prospective studies with large number of patients may help us to better understand the relationship between vitamin D and the autonomic nervous system.

RESUMO A vitamina D é um hormônio esteroide pleiotrópico que modula o equilíbrio autonômico. Sua deficiência tem sido descrita como fator de risco ambiental para esclerose múltipla (EM). O objetivo deste estudo foi investigar os níveis séricos de vitamina D, proteína de ligação à vitamina D (VDBP) e receptor de vitamina D (VDR) e avaliar a disautonomia cardíaca em pacientes com EM devida à interação bidirecional entre vitamina D e sistema nervoso autônomo. Métodos: O presente estudo transversal foi realizado em 26 pacientes com EM remitente-recorrente e em 24 controles saudáveis. A variabilidade da pressão arterial ambulatorial (BPV) por 24 horas foi calculada e os participantes foram avaliados quanto à hipotensão ortostática e hipertensão supina. Os níveis séricos de vitamina D, VDBP e VDR foram medidos. Resultados: O nível sérico médio de vitamina D foi significativamente menor nos pacientes com EM do que nos controles (p = 0,044); no entanto, não houve diferença significativa em termos de níveis de VDR e VDBP entre os grupos. Hipertensão supina e hipotensão ortostática foram significativas e a BPV sistólica de 24 horas diminuiu significativamente em pacientes com EM (p < 0,05) em comparação aos controles. Não foi encontrada correlação entre vitamina D, VDBP e VDR com hipertensão supina, hipotensão ortostática e BPV sistólica (p > 0,05). Também houve correlação negativa entre VDBP e EDSS (p = 0,039, r = −0,406). Conclusão: Não houve correlação entre hipotensão ortostática, hipertensão supina e valores de BPV sistólica e vitamina D sérica, VDBP e VDR em pacientes com EM. Futuros estudos prospectivos com grande número de pacientes podem nos ajudar a entender melhor a relação entre vitamina D e sistema nervoso autônomo.

Constipation is associated with tension type headache in women / Constipação está associada à cefaleia do tipo tensional em mulheres

ABSTRACT Tension-type headaches (TTH) and irritable bowel syndrome (IBS) are comorbid diseases affecting, especially, women. One of the underlying mechanisms for both is autonomic dysfunction in the brain-gut axis. We aimed to evaluate the factors accompanying TTH and their relation to functional gastrointestinal disorders. Methods: Women diagnosed with TTH were questioned about headache pattern and severity, and accompanying factors, as well as being screened for IBS according to the Rome III criteria. The participants were divided into two groups: constipation-dominant IBS (IBS-C) group and "others", with a total of 115 individuals included in the study. Results: Of the 115 patients; 48 (41.8%) of the women had IBS-C criteria while 67 (58.2%) described mixed-type IBS or diarrhea-dominant IBS. There were no significant differences in terms of mean age (p = 0.290), body mass index (p = 0.212), visual analog scale (p = 0.965), duration of attacks (p = 0.692), and episodic/chronic type (p = 0.553). Osmophobia was seen in 43.5%; phonophobia in 68.7%, and photophobia in 47.0% of the patients, and only osmophobia was significantly associated in women in the IBS-C group (p = 0.001). Conclusion: In female patients with TTH, a higher level of constipation was detected. The relationship of these two diseases suggests that they may share common mechanisms. This is the first study showing the relationship of osmophobia with constipation.

RESUMO As cefaléias do tipo tensional (TTH) e a síndrome do intestino irritável (IBS) são comorbidades que afetam especialmente as mulheres. O mecanismo subjacente para ambas é a disfunção autonômica no eixo cérebro-intestino. Nosso objetivo foi avaliar os fatores que acompanham as TTH e sua relação com distúrbios gastrointestinais funcionais (FGID). Métodos: Mulheres com diagnóstico de TTH foram questionadas quanto ao padrão e gravidade da cefaleia, fatores acompanhantes e triadas para IBS de acordo com os critérios de Roma III e foram divididas em dois grupos: grupo com IBS com predominância de constipação (IBS-C) e as demais. Um total de 115 mulheres foram incluídas no estudo. Resultados: Do total de 115 pacientes; 48 (41,8%) das mulheres tiveram os critérios da IBS-C, enquanto 67 (58,2%) tiveram IBS do tipo misto ou IBS com predominância de diarreia. Não houve diferenças significativas em termos de idade média (p = 0,290), índice de massa corporal (IMC) (p = 0,212), escala visual analógica (VAS) (p = 0,965), duração dos ataques (p = 0,692), e tipo episódico / crônico (p = 0,553). Osmofobia foi observada em 43,5% das pacientes; fonofobia em 68,7% e fotofobia em 47,0%, e apenas osmofobia foi significativamente associada no grupo de mulheres com predominância de constipação (p = 0,001). Conclusão: Em pacientes do sexo feminino com TTH, encontra-se uma maior constipação. A relação dessas duas doenças sugere que elas podem compartilhar mecanismos comuns. Além disso, este é o primeiro estudo mostrando a relação da osmofobia com a constipação.

Paresthesia frequency in fibromyalgia and its effects on personality traits.

AIM: Paresthesia and personality disorders are common conditions among patients with fibromyalgia. However, no previous study has examined a possible relation of paresthesia with personality traits in fibromyalgia. This study investigates the frequency of paresthesia in fibromyalgia patients and its relation with personality traits. METHOD: Female patients with fibromyalgia (n = 101) were divided into two groups according to the presence (n = 49; mean age 40.63 ± 7.62 years; range 23-55 years) or absence (n = 52; mean age 40.50 ± 7.12 years; range 27-53 years) of paresthesia. Also, a healthy control group (n = 53; mean age 39.34 ± 5.26 years; range 23-55 years) was included. The groups were evaluated by the Temperament and Character Inventory. Accordingly, temperament includes four dimensions: harm avoidance, novelty seeking, persistence, reward dependence; and character consists of three dimensions: cooperativeness, self-transcendence, self-directedness. RESULTS: There were no significant differences among the three groups in the scores of novelty seeking, persistence, reward dependence and cooperativeness (for all P > 0.05). Both fibromyalgia groups had significantly higher scores in harm avoidance and had lower scores in self-directedness compared to the control group (P < 0.001). Also, fibromyalgia patients with paresthesia had significantly higher harm avoidance and self-directedness scores than those in patients without paresthesia (P < 0.001). In both fibromyalgia groups, self-transcendence scores were similar (P = 0.465) but significantly higher than in the control group (P < 0.001). CONCLUSION: This is the first study evaluating the association of paresthesia and personality traits in fibromyalgia. These results suggest that psychological distress associated with high harm avoidance and low self-directedness scores are more prominent in fibromyalgia patients, and especially of those who have paresthesia.

Pain, depression and sleep disorders in patients with diabetic and nondiabetic carpal tunnel syndrome: a vicious cycle / Dor, depressão e distúrbios do sono em pacientes diabéticos e não diabéticos com síndrome do tumor do carpo: um ciclo vicioso

ABSTRACT Carpal tunnel syndrome (CTS) is a condition involving nerve entrapment that often leads to chronic neuropathic pain. We aimed to evaluate sleep quality and related parameters in diabetic and non-diabetic CTS patients. Method This study included a total of 366 patients with chronic CTS. These patients’ sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) and depression using the Beck Depression Inventory (BDI). The severity of neuropathic pain was evaluated using the Douleur Neuropathique-4 (DN4) questionnaire and a visual analogue scale (VAS). Results In the non-diabetic patient group, the total PSQI score was found to affect BDI and VAS, while in the diabetic patient group, the duration of symptoms affected VAS, BDI and fasting glucose levels. Conclusion For diabetic patients, hyperglycemia depression and chronification of neuropathic pain may lead to deterioration of sleep quality. Therefore, consideration of these parameters in the treatment may break a vicious cycle.

RESUMO A síndrome do túnel do carpo (STC) é uma condição que envolve compressão do nervo frequentemente determinando dor neuropática crônica. Procuramos avaliar a qualidade do sono e parâmetros correlatos em pacientes diabéticos e não-diabéticos com STC. Método Este estudo incluiu 366 pacientes com STC crônica. A qualidade de sono destes pacientes foi avaliada pelo Pittsburgh Sleep Quality Index (PSQI) e a depressão foi avaliada usando Beck Depression Inventory (BDI). A gravidade da dor neuropática foi avaliada usando o questionário Douleur Neuropathique-4 (DN4) e a escala visual analógica (EVA). Resultados No grupo de pacientes não-diabéticos, o valor total do PSQI afetou BDI e VAS, enquanto no grupo de diabéticos a duração dos sintomas afetou VAS, BDI e níveis de glicemia de jejum. Conclusão Em pacientes diabéticos, depressão e cronificação da dor neuropática podem levar à deterioração da qualidade do sono. Assim, considerar todos estes parâmetros no tratamento pode quebrar este círculo vicioso.

Retinol-binding protein-4 and hs-CRP levels in patients with migraine.

Retinol-binding protein-4 (RBP4) and high-sensitivity C-reactive protein (hs-CRP) levels are associated with inflammation in patients with migraine. The release of proinflammatory cytokines during migraine results in recurrent sterile neurogenic inflammation. This study aimed to determine the correlation between RBP4 and hs-CRP levels, and migraine, which is considered an inflammatory disease. The study included 48 migraine patients and 40 age- and gender-matched controls. Migraine was diagnosed according to International Classification of Headache Disorders-II. The serum RBP4 level was measured using a commercial ELISA kit and hs-CRP was measured using an enzyme immunoassay test kit. The serum RBP4 level was significantly lower in the migraine patients than in the controls (P < 0.001), whereas the hs-CRP level was significantly higher in the migraine patients (P < 0.001). RBP4 and hs-CRP levels did not differ between the migraine patients with and without aura (P > 0.05). Migraine headache severity, frequency and duration were not correlated with serum RBP or hs-CRP levels (P > 0.05). The observed high hs-CRP level and low RBP4 level in migraine patients suggest that vitamin A might play a major role in the pathogenesis of migraine. It is known that inflammation is a key factor in many diseases. Additional research might result in a better understanding of the anti-inflammatory effects of vitamin A.