Expression of fibrinogen receptors in platelets of migraine patients--correlation with platelet GPIIb content and plasma cholesterol.

Binding of fibrinogen to platelets washed from blood of migraine patients (n = 30) and control donors (n = 24) was compared. In addition, contents of platelet glycoprotein IIb and platelet fibrinogen were determined in both groups by radioimmunoassay. The receptor capacity for fibrinogen in platelets activated by ADP was significantly higher (p less than 0.01) in migraine patients (52,505 +/- 4,925) than in controls (33,881 +/- 3,965). The mean contents of GPIIb (3.51 +/- 0.34 micrograms/10(8) platelets) and fibrinogen (37.26 +/- 4.05 micrograms/10(8) platelets) in migraine platelets were also markedly increased (p less than 0.01 and p less than 0.001, respectively) when compared to controls (2.21 +/- 0.18 micrograms of GPIIb and 18.75 +/- 2.29 micrograms of fibrinogen per 10(8) platelets, respectively). There was a high correlation between the number of fibrinogen receptors exposed by ADP and the total amount of platelet GPIIb both in migraine patients (R = 0.69, p less than 0.01) and controls (R = 0.62 p less than 0.01), as well as plasma cholesterol in the case of migraine patients (R = 0.82, p less than 0.001).

Suloctidil therapy in migraine: an open pilot study.

An open pilot study was carried out in 27 patients with severe and frequent migraine attacks who had failed to respond adequately to other drug therapy, to assess the effectiveness and tolerance of prophylactic treatment with suloctidil. Patients received 600 mg suloctidil daily for 6 weeks. Response, assessed on the reduction in frequency of attacks, was considered as good in 7 patients and as significant improvement in 11 patients. Treatment was rated as of doubtful value or as ineffective in the other 9 patients. One patient stopped treatment because of adverse reactions and 10 others reported mild side-effects.

[Sumatriptan and its use in treatment of migraine and cluster headaches]. / Sumatriptan i jego zastosowanie w leczeniu napadów migreny i klasterowego bólu glowy.

The methods used presently for abortion of the attacks of migraine and cluster headache are not fully satisfactory which causes that the search for new therapies is continuing. Although the mechanism of migraine attacks remains unexplained, it is thought that an important role in it is played by serotonin receptors, vasodilation in certain regions and opening of arteriovenous communications in the head. Sumatriptan is an agonist of 5-HT1 -like receptors and exerts a selective vasoconstricting effect on the arteries of the head, particularly in the rami of the carotid artery. In 1988 the first reports appeared on the effectiveness of the drug in migraine attacks. In the following years extensive, multicentre and international studies of the drug were carried out on over 600 healthy volunteers and nearly 6000 patients with migraine. The studies demonstrated that Sumatriptan was effective in abortion of migraine attacks. After oral administration of 100 mg or subcutaneous injection of 6 mg in nearly 70% of cases the attack regressed or was greatly alleviated, similarly as other symptoms accompanying the headache such as photophobia, nausea, vomiting. Studies were undertaken also on the effectiveness of Sumatriptan in emergency treatment of cluster headache, and good results were again achieved. The tolerance of the drug is good, although in some cases side effects develop, usually transient and mild, among them tingling, feeling of pressure, heat or heaviness of the head or chest, taste change and burning sensation at the site of injection. Sumatriptan, similarly as all novel drugs, requires caution in its use, particularly in patients with coronary heart disease and hypertension, and also in old patients. As yet, the use of the drug in paediatric migraine or in pregnancy is not recommended.

[Current views on pathophysiology of migraine. Part IV: autonomic disturbances. Central neural hypothesis. Conclusions]. / Wspólczesne poglady na patogeneze migreny. Czesc IV: Zaburzenia autonomiczne. Hipotezy osrodkowe. Podsumowanie.

The last part of the article concerns the role of the disturbances of autonomic system and central neural hypothesis of migraine pathogenesis. The author presents the results of studies on pupillometry and autonomic heart regulation, that seem to indicate hypofunction of the autonomic system in migraine. The views on "neurogenic inflammation", as the basic pathologic phenomenon in migraine attack are also discussed, as well as the hypothesis of cortical spreading depression. In the conclusions the author find that neither theory can convincingly explain the pathogenesis of migraine. The updated studies seem to indicate both vascular, autonomic and central neural factors in, possibly multifactorial, pathogenesis of migraine.

[Current views on pathophysiology of migraine: Part I. Genetics of migraine. Genesis of the vascular theory]. / Wspólczesne poglady na patogeneze migreny Czesc I: Wprowadzenie. Genetyka migreny. Rozwój teorii naczyniowej.

The studies on the pathogenesis of migraine have developed into a vast scientific movement in last years. The author discusses throughly the results of these studies. In the first part of the paper the genesis and development of the vascular theory of migraine pathogenesis is presented.

[Possibility of timolol use for immediate alleviation of Horton's cluster headache. Preliminary report]. / O mozliwosci zastosowania timololu do doraznego lagodzenia napadów bólu glowy Hortona. Doniesienie wstepne.

The author gave timolol to 4 patients with cluster headaches instilling it in the form of a 0.5% solution into the conjunctival sac during attacks. Usually the attacks were significantly shortened and alleviated. Trials with placebo gave negative results. The method requires verification in a larger material but even now it appears to be worth of recommendiation.

[Present problems of migraine and similar headaches]. / Aktualne problemy migreny i pokrewnych bólów glowy.

Headaches belong to the most frequent sufferings. According to certain most modern epidemiological studies about 20% of adults have recurrent headaches, among them particularly migraine and tension headache. In recent years the interest in these conditions had increased resulting in a great number of research works. A great role is played by the International Headache Society, and the newly formed European Federation of Headaches. In 1988 a universally accepted classification, and diagnostic criterias were elaborated and have been accepted by the Polish neurologists. Tens or research centres are studying the problems in this field. The main directions of studies are-the role of neurotransmitters, the vascular system of the head, the mechanisms of autonomic regulation, the role of neurogenic bland inflammation in the generation of pain, and the psycho-emotional factors. A number of new clinical forms of headache have been described. Therapeutic possibilities have also increased (beta-blockers, calcium blockers, serotonin receptor drugs, eg. sumatriptan, microsurgery of neuralgias etc). This opens a new period for satisfactory advances in that rather marginal, as yet, area.

[Drug rebound headaches]. / Polekowe bóle glowy "z odbicia".

The term "drug rebound headache" refers to headaches occurring every day in patients with migraine and tension headaches as a consequence of taking analgesics or ergotamine every day. Their cause is a vicious circle mechanism. This form of headache has been discovered in recent years and it is supposed that about 20% of patients with chronic headaches belong to that category. The only way to disrupt this vicious circle is immediate complete abandoning of these drugs. The abstinence period with associated troublesome symptoms lasts several to up to 20 days. Antidepressants are given for their alleviation. The author prescribes opipramol /Pramolan/ which is taken by increments from half tablet up to three in 6 days and the treatment is then continued for 4-6 weeks. From the 6th day on the patient should completely discontinue taking of analgesics. The material observed by the author comprises 47 patients /45 women/ aged 19-57 years, mean age 41 years, with these headaches continuing since 1-12 years /mean 3.0 years/. The above described method gave good results in 32 cases. In 10 cases complete withdrawal of analgesics was not possible by this method was abandoned accepting that their headaches were not due to drug abuse.

[Emergency treatment of migraine attacks with particular reference to agonists of 5-HT1B/1D receptor]. / Dorazne leczenie napadów migreny ze szczególnym uwzglednieniem agonistów receptora 5-HT1B/1D.

The author discusses the modern methods of emergency controlling of migraine attacks, especially the recently introduced drugs agonists of the 5-HT 1B/1D receptor /Sumatriptan, Zolmitriptan/ and prophylactic treatment. In light and moderately severe attacks analgesics are usually effective as well as non-steroid antiinflammatory drugs /paracetamol, acetylsalicylic acid, naproxen, diclofenac, ibuprofen, ketoprofen etc./ with or without addition of caffeine and codeine, and metoclopramide /for suppression of nausea and vomiting/ or Torecan. Ergotamine is still in use, although it can produce serious adverse effects. An essential advance in the treatment of more severe attacks was achieved with the introduction of Sumatriptan, a selective 5-HT1D receptor agonist in 1988. In pursuing this direction further indole derivatives /so called triptans/ were introduced. Zolmitriptan introduced in 1994 is an agonists of 5-HT 1B/1D receptor, is active both peripherally and centrally, is well absorbed from the digestive tract and has a good bioavailability index /40%/. In 2.5 mg doses it causes regression or marked alleviation of migraine attack within 2 hours in 70% of cases. Administration of a second dose after that time increases the percentage of successes. Adverse effects are usually mild, coronary complication have not yet been described. Prophylactic treatment is given to patients with attack frequency over 2 in a month. For that treatment usually dihydroergotamine, pisotifen, propranolol, metoprolol, flunarizin, valproic acid, iprasochrom and oxetoron are given.

[Selected problems for discussion of procedures in epilepsy]. / Wybrane dyskusyjne problemy postepowania w padaczce.

In neurological practice epilepsy treatment has a special place. Among the problems encountered by us in this connection every day the following are worth mentioning: Differential diagnosis of epileptic seizure against psychogenic fits and fainting. Management of the first seizure /treatment starting?/. How EEG tracings should be related to clinical status? Should imaging examination be suggested? Treatment programme /doses, mono- or polytherapy, new generation drugs/ Can anticonvulsants worsen epilepsy? Indications to surgical treatment. Whether and when anticonvulsants should be withdrawn in case of remission? Should treatment be given prophylactically after injury or stroke? How to deal with late onset epilepsy? What is the significance of concomitant diseases? The purpose of this lecture is to incite personal consideration of these matters and discussion on these problems in which it is difficult to take optimal decision.

[Insomnia and its treatment]. / Bezsennosc i jej leczenie.

Insomnia is a very frequent complaint /periodically or permanently it affects about 35% of the population/ and is a serious sociological problem. This term covers at least four types of sleep disorders: difficult falling asleep, frequent awakening, too early awakening and impairment of sleep quality--sleep quantitatively sufficient but failing to produce a feeling of rest. Insomnia may be sporadic, short-lasting and chronic. The last type requires particularly medical assistance since impairment of sleep quality can lead to drug dependence. In every case of insomnia it should be tried to explain its cause /neurosis, depression, somatic diseases with symptoms leading to sleep disturbances, toxic factors such as alcohol, drugs, inappropriate sleep hygiene etc./. In the treatment the basic role is played by removal of causes and better observation of sleep hygiene. Hypnotic drugs are indicated in sporadic and short-lasting insomnia, but in chronic insomnia they should be used cautiously and not continuously. Barbiturates have been abandoned recently and benzodiazepines have replaced them. They are, however, fraught with numerous faults. Cyclopyrolones /Zolpidem, Zopiklon/ are the new generation of hypnotic drugs in which the negative features of benzodiazepines have been partly excluded. Their half-life is short, they cause no rebound effect, adverse effects are better tolerated and are less frequent, drug dependence is not produced.

[Clinical trial of suloctidil (sulocton) for the treatment of migraine (preliminary report)]. / Próba zastosowania preparatu suloctidil (sulocton) w leczeniu migreny (doniesienie wstepne).

Suloctidil, a new vasoactive drug, shows certain properties which make it particularly suitable for using in migraine. The author administered Suloctidil in daily doses of 600 mg to 12 patients with migraine during 6 weeks. In 9 cases good results were obtained. Although further investigations are necessary, it seems already now that Suloctidil will enrich the armamentarium of antimigrainous drugs.

[A case of status epilepticus with psychomotor seizures]. / Przypadek stanu padaczkowego napadów psychoruchowych.

The authors describe in the light of an own case the clinical manifestations and electroencephalographic findings in status epilepticus with psychomotor seizures.

[Atypical facial pain]. / Atypowy ból twarzy.

The term "atypical facial pain" describes chronic pain syndrome involving the face. The syndrome consists of continuous mostly burning bouts of pain, localized in one half of the face. The authors review the literature of the topic, discuss also the historical aspects of terminology. The clinical symptoms and signs, course, and therapeutic attempts are also discussed.

[Sodium valproate versus propranolol in the prophylactic treatment of migraine]. / Porównanie dzialania soli sodowej kwasu walproinowego i propranololu w leczeniu profilaktycznym migreny. Doniesienie wstepne.

In the recent years sodium valproate (SV) has been proposed as a prophylactic drug in migraine. Several reports documented a positive effect of SV in migrainous patients. The authors present the results of the open study in 35 women with migraine without aura treated with the daily dose of 1000-1500 mg of SV, during 10 weeks. The results were compared with the effect of propranolol administered to the same patients, in daily dose of 120-160 mg during 10 weeks. The effects were similar: in both methods more than 50% reduction of frequency and severity of attacks was obtained. The side effects were generally mild; in no case the treatment was stopped. The authors conclude that in the future SV might be administered in migraine prophylaxis as the first choice drug.

[The comparison of sodium valproate and ergotamine titrate plus caffeine in the abortive treatment of migraine attacks]. / Porównanie dzialania soli sodowej kwasu walproinowego i winianu ergotaminy z kofeina w doraznym leczeniu napadów migreny. Doniesienie wstepne.

The contemporary measures against migraine attacks are not fully satisfying, thus the migraine episode is still a challenge in treatment. In 1993 Hering and Steiner proposed valproic acid for the interruption of migraine attacks. The authors present the results of their own study comparing the effects of sodium valproate (SV) and ergotamine plus caffeine (Coffecorn) in this respect. 82 attacks in 20 patients were treated altogether. The effectiveness of SV was statistically not different from that of ergotamine--the drug recognized formerly as the first choice one in the abortion of migraine attacks.

[Current views on pathophysiology of migraine. Part II: Further development and current status of the vascular theory. Migraine and allergy]. / Wspólczesne poglady na patogeneze migreny. Czesc II: Dalszy rozwój i stan obecny teorii naczyniowej. Migrena i alergia.

In this part further arguments advocating the vascular theory are discussed, among others: the influence of drugs (ergotamine, sumatriptan), so called "migrainous stroke", and the results of the last neuroimaging studies on the migraine. The authors state in summary that vascular disturbances do take place in migraine attack, but they should be regarded in connection with biochemical and central neuronal disorders. In the end the authors discusse the current views on the impact of allergy in the pathophysiology of migraine.

[Current views on pathophysiology of migraine. Part III: Biochemical hypothesis. The role of blood platelets]. / Wspólczesne poglady na patogeneze migreny. Czesc III: Hipotezy biochemiczne. Rola plytek krwi.

Systematic studies on the biochemistry of migraine were first undertaken in early 1960s; they initially concerned serotonin metabolism. The studies were next extended, covering catecholamines, histamine, free fatty acids, selected peptides and hormones. The results were mostly disappointing and such studies were mostly given up. In the last years we have been witnessing the come back of the study on the role of serotonin in migraine as the neurotransmitter involved in the antinociception and vascular innervation. In the 1970s a great deal of studies on blood platelets as serotonin reservoir were undertaken in migraine patients.

[Controlled study of iprazochrome effectiveness (Divascan) in prophylactic treatment of migraine]. / Kontrolowane badania skutecznosci iprazochromu (Divascan) w profilaktycznym leczeniu migreny.

The study was designed as double blind, placebo controlled. The patients were treated with 15 mg of iprazochrome daily in three equal doses for eight weeks, or--with equal amount of placebo tablets. The effectiveness was calculated with the use of Migraine Score (MS) by Couch et. al. 44 patients completed the study. In 21 the therapy was positive: 16 out of them were treated with iprazochrome, 5--with placebo. In 23 patients the treatment was negative: 19 out of them took placebo, 4--iprazochrome. Statistical analysis showed significant influence (chi 2 test: p < 0.001; Youle coeff. = 0.88). In iprazochrome group mean decrease of MS was significant after treatment (p < 0.01), but not significantly changed in the placebo group. According to our results iprazochrome was found effective in the prophylaxis of migraine.

[Use of tryptophan in the treatment of epilepsy of the Lennox-Gastaut type]. / Próba zastosowania tryptofanu w leczeniu padaczki typu Lennoxa-Gastaut.

The authors describe a positive but transient effect of additional administration of tryptophan in 3 children with Lennox-Gastaut epilepsy in whom anticonvulsants alone failed to control the attacks. Further observations are necessary, especially for studying the correlation of doses with blood drug level.