Cost of Chronic and Episodic Migraine. A pilot study from a tertiary headache centre in northern Italy.

BACKGROUND: Chronic migraine (CM) has a high impact on functional performance and quality of life (QoL). CM also has a relevant burden on the National Health Service (NHS), however precise figures are lacking. In this pilot study we compared the impact in terms of costs of CM and episodic migraine (EM) on the individual and on the National Health System (NHS). Furthermore, we comparatively evaluated the impact of CM and EM on functional capability and on QoL of sufferers. METHODS: We enrolled 92 consecutive patients attending the Pavia headache centre: 51 subjects with CM and 41 with episodic migraine (EM). Patients were tested with disability scales (MIDAS, HIT-6, SF-36) and with an ad hoc semi-structured questionnaire. RESULTS: The direct mean annual cost (in euro) per patient suffering from CM was €2250.0 ± 1796.1, against €523.6 ± 825.8 per patient with EM. The cost loaded on NHS was €2110.4 ± 1756.9 for CM, €468.3 ± 801.8 for EM. The total economic load and the different sub-items were significantly different between groups (CM vs. EM p = 0.001 for each value). CM subjects had higher scores than EM for MIDAS (98.4 ± 72,3 vs 15.5 ± 17.7, p = 0.001) and for HIT-6 (66.1 ± 8.4 vs 58.7 ± 10.1, p = 0.001). The SF-36 score was 39.9 ± 14,74 for CM and 66.2 ± 18.2 for EM (p = 0.001). CONCLUSIONS: CM is a disabling condition with a huge impact on the QoL of sufferers and a significant economic impact on the NHS. The adequate management of CM, reverting it back to EM, will provide a dual benefit: on the individual and on the society.

Anodal transcranial direct current stimulation in chronic migraine and medication overuse headache: A pilot double-blind randomized sham-controlled trial.

OBJECTIVES: Little evidence is available on the role of transcranial direct current stimulation (tDCS) in patients affected by chronic migraine (CM) and medication overuse headache (MOH). We aim to investigate the effects of tDCS in patients with CM and MOH as well as its role on brain activity. METHODS: Twenty patients with CM and MOH were hospitalized for a 7-day detoxification treatment. Upon admission, patients were randomly assigned to anodal tDCS or sham stimulation delivered over the primary motor cortex contralateral to the prevalent migraine pain side every day for 5 days. Clinical data were recorded at baseline (T0), after 1 month (T2) and 6 months (T3). EEG recording was performed at T0, at the end of the tDCS/Sham treatment, and at T2. RESULTS: At T2 and T3, we found a significant reduction in monthly migraine days (p = 0.001), which were more pronounced in the tDCS group when compared to the sham group (p = 0.016). At T2, we found a significant increase of alpha rhythm in occipital leads, which was significantly higher in tDCS group when compared to sham group. CONCLUSIONS: tDCS showed adjuvant effects to detoxification in the management of patients with CM and MOH. The EEG recording showed a significant potentiation of alpha rhythm, which may represent a correlate of the underlying changes in cortico-thalamic connections. SIGNIFICANCE: This study suggests a possible role for tDCS in the treatment of CM and MOH. The observed clinical improvement is coupled with a potentiation of EEG alpha rhythm.

[The effectiveness of anthropometric indicators in the nutritional diagnosis of well-nourished and undernourished pregnant women ]. / Efectividad de dos indicadores antropométricos en el diagnóstico nutricional de gestantes eutróficas y desnutridas.

The objective was to evaluate the effectiveness of the indicators prepregnancy weight and prepregnancy body mass index in the categorization of the nutritional state of the pregnant woman. The study group was formed by 109 pregnant women. They were evaluated in the first trimester of the pregnancy, at the "Centro de Atención Nutricional Infantil Antímano". In each one of them the nutritional state was classified according to three criteria: integral nutritional diagnosis, prepregnancy weight and prepregnancy body mass index. For the evaluation of the effectiveness of the diagnostic criteria, the other two approaches were compared with the integral nutritional diagnosis. The analysis of the frequency, sensibility, specificity and predictive values were applied. The integral nutritional diagnosis showed: 75.2% (n = 82) well-nourished and 14.8% (n = 27) undernourished. The sensibility of the prepregnancy weight was 0.93 and of the prepregnancy body mass index was 0.52, with a positive predictive value of 0.60 and 0.82 respectively. The specificity of the first indicator was 0.79 and of the second was 0.96, with negative predictive value of 0.97 and 0.86 respectively. The pregnancy weight demonstrated to be effective to diagnosis undernourished women.

[Changes of the anthropometric variables during gestation in well-nourished women]. / Cambios en las variables antropométricas durante la gestación en mujeres eutróficas.

To analyze the behavior of the anthropometric measures during gestation in teenagers and adults pregnant women. The study group was formed by 81 well nourished, healthy pregnant women, 14 teenagers and 67 adults. They were evaluated at Centro de Atención Nutricional Infantil "Antímano". The anthropometric criteria included at least five anthropometric evaluations: one in the first trimester of pregnancy, two in the second and two in the third. The anthropometric variable mean was obtained from each one of the pregnant women in each of their corresponding visits during the first, second and third trimester. The descriptive statistics of the studied anthropometric variables were calculated. Student' t test was applied. There were significant changes during pregnancy in weight, wrist, waist, abdomen, waist-hip, hip-gluteal, thigh and calf circumferences and body mass index in teenagers and adults. There were significant changes during gestation in a lying down position height in teenagers and mid-arm circumference in adults. There was significant difference in change from the first to the third trimester of gestation, between teenagers and adults in the calf circumference. The studied anthropometric variables presented the same behavior during gestation in adolescents and adults, unless the mid-upper arm circumference.

Botulinum toxin type A potentiates the effect of neuromotor rehabilitation of Pisa syndrome in Parkinson disease: a placebo controlled study.

INTRODUCTION: Pisa syndrome (PS) is a tonic lateral flexion of trunk that represents a disabling complication of advanced Parkinson disease (PD). Conventional rehabilitation treatment (CT) ameliorates axial posture and trunk mobility in PD patients, but the improvement tends to wane in 4-6 months. Botulin toxin (BT) may reduce muscle hyperactivity, therefore improving CT effectiveness. We evaluated whether the injection of incabotulinum toxin type A (iBTA) into the hyperactive trunk muscles might improve the effectiveness of rehabilitation in a group of PD patients with PS. METHODS: Twenty-six PD patients were enrolled in a randomized placebo-controlled trial. Group A was treated with iBTA before undergoing CT (a 4-week intensive programme), while Group B received saline before the 4-week CT treatment. Patients were evaluated at baseline, at the end of the rehabilitative period, 3 and 6 months with kinematic analysis of movement, UPDRS, Functional Independence Measure and Visual Analog Scale for pain. RESULTS: At the end of the rehabilitation period, both groups improved significantly in terms of static postural alignment and of range of motion. Group A showed a significantly more marked reduction in pain score as compared with Group B and a more prolonged efficacy on several clinical and kinematic variables. CONCLUSIONS: Our preliminary data suggest that BT may be considered an important addition to the rehabilitation programme for PD subjects with PS for improving axial posture and trunk mobility, as well as for a better control of pain.