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.

Relationship between precipitating agents and neurophysiological abnormalities in migraine.

The particular mechanisms of migraine anticipation by different precipitating agents are still unknown. The contingent negative variation (CNV) was recorded in the premenstrual and ovulation phases of the cycle in both rest and stress conditions in 17 migraine and 15 healthy women. In migraineurs a significant increase of amplitude of the initial CNV component in the premenstrual phase compared with ovulation was observed. During both the ovulation and premenstrual phases both migraineurs and controls demonstrated a significant increase of the CNV amplitude on stress. The increase of the amplitude on stress in the premenstrual phase was more pronounced in migraineurs. This study shows that stress and menstrual cycle are associated with changes of the initial CNV amplitude, probably indicating a higher probability of migraine attacks.

[Evaluation of myocardial perfusion in patients with hypertrophic cardiomyopathy in comparison with clinical and echocardiographic data]. / Otsenka perfuzii miokarda u bol'nykh s gipertroficheskoi kardiomiopatiei v sopostavlenii s sospostavlenii s klinicheskimi i ékhokardiograficheskimi dannymi.

AIM: To study peculiarities of myocardial perfusion in patients with hypertrophic cardiomyopathy (HCMP) in correlation with clinical and echocardiographic data. MATERIAL AND METHODS: 62 patients with HCMP (23 females and 39 males, mean age 44.4 +/- 11.2 years, the disease duration 13.0 +/- 10.4 years) have undergone ECG, 24-h ECG monitoring, echocardiography, perfusion scintigraphy of the myocardium with 99m-TcMIBI at rest and in combination with bicycle ergometry. The patients were divided into two groups: 35 patients of group 1 had moderate left ventricular hypertrophy (the septal thickness in diastole under 20 mm; 27 patients of group 2 had severe hypertrophy (the thickness was over 20 mm). RESULTS: Dyspnea and syncopal states occurred more frequently in patients from group 2. They also had a higher functional class of heart failure (2.0 +/- 0.8 and 1.2 +/- 0.7 for group 1 and 2, respectively, p < 0.05). Cardiac performance was significantly higher in patients of group 1. The size of the left atrium, left ventricular myocardium mass, the septal thickness and thickness of posterior wall of the left ventricle, gradient of pressure in the outflow tract of the left ventricle proved higher in patients of group 2. Deep stable defects of myocardial perfusion were detected in 5 (15%) patients of group 1 and 10 (37%) patients of group 2. Transient defects of myocardial perfusion were found in 9 (26%) patients of group 1 and 12 (44%) patients of group 2. The index of myocardial ischemia in group 1 patients was significantly lower than in patients of group 2 (3.5 +/- 2.2 and 8.3 +/- 2.5, respectively, p < 0.05). CONCLUSION: Patients with severe hypertrophy of the left ventricle had severe clinical picture, low exercise tolerance, marked hemodynamic changes, more frequent defects of left ventricular perfusion defects compared to patients with moderate hypertrophy of the left ventricular myocardium.

[Therapy of autonomic disorders by xanax (alprazolam)]. / Lechenie vegetativnykh rasstroistv preparatom ksanaksom (al'prazolam).

The paper presents an open noncomparative investigation of 36 patients with different manifestations of the syndrome of autonomic dystonia. 20 patients (group 1) had permanent autonomic disorder in context of generalyzed anxious disorders, 16 patients (group 2) had panic attacks. The examination was performed before and 4 weeks after monotherapy with xanax (1.5-2.5 mg/day). Clinical-neurologic study estimated both presence and a degree of manifestations of the syndrome of autonomic dysfunction, hyperventilatory syndrome and sleep disorders. Psychologic investigation included estimation of anxiety according to Spilberg's test, depression according to Beck's scale; SCL Scale was also used. Algesic syndrome was estimated by complex algesic questionnaire. Neurophysiologic study determined a contingent negative deviation and nociceptive flexory reflex. A positive therapeutic activity of xanax was established. The highest therapeutic effect was achieved in group 1 (83%) using lower doses (1.5 mg/day). In group 2 higher doses were needed (2.5 mg/day). In this case the effect was achieved in 83% of the cases, but full absence of panic attacks was observed only in 25% of the patients. Predictors of the drug's efficiency appeared to be short duration of the disease, slight manifestation of depression and absence of the algesic syndrome.

[Psychological factors of chronic pain]. / Psikhologicheskie faktory pri khronicheskoi boli.

To investigate psychological factors, involved in formation of chronic algesic syndrome, 70 patients (50 women, 20 men, mean age--33.5 years) with panic disorder (PD) were examined. The patients were divided into 3 groups: with PD combined with chronic ache (CA) (26 patients); with PD combined with episodical ache (EA) (19 cases); PD without ache (25 individuals). Algesic phenomena were estimated according to "Algesic anamnesis of life" questionnaire; depression level was estimated according to Back's and Hamilton's Rating tests; the level of reactive and personality anxiety--according to Spilberger's inventory test. Severity of psychopathologic syndromes was estimated according to SCL Rating Scale. It was demonstrated that patients with CA and PD have a more significant role of depression in course of the disease as compared with anxiety; prevalence of functional-neurological symptoms in clinical pattern of PD (atypicalness); high level of somatization and a lot of algesic stresses in their life. Factors that prevent chronization of the ache were the following ones: degree of manifestation and the significance of phobic anxiety in the course of the disease, restricting behavior, atypical PD and less number of pain episodes in life.

[Algesic phenomena in panic disorders]. / Bolevye fenomeny pri panicheskikh rasstroistvakh.

There were examined 35 patients with panic disorders (PD) which were divided into 2 groups. In patients of the 1-st group there were observed headaches of tension type (17 individuals), meanwhile in the patients of the 2-nd group (18 cases) there weren't observed any algesic syndromes. A "saturation" of the life of a patient with the different algesic phenomena were estimated as well as the level of a depression according to Beck's scale and the manifestations of psychopathologic symptoms according to SCL scale were also studied. To estimate neurophysiologic parameters there were used a method of a contingent negative deviation (CND) and nociceptive flexor reflex. For the patients of the 1-st group there was quite characteristic a "saturation" of life with algesic events, an atypicity of the algesic attacks and more pronounced connection of PD debut with biologic but not with emotional factors. Psychometric observation revealed a significantly higher levels of both the depression according to Beck's and the somatization according to SCL scales as compared with the 2-nd group. Alterations in CND parameters (a decrease of the amplitude of the late wave, increase of postimperative negative wave) and an increase of a subjective algesic perception in the patients of the 1-st group had testified the pronounced desadaptive disorders. In the patients of the 2-nd group these indices were normal. Thus, on the PD model there were studied some psychophysiologic factors, which caused a formation of chronic algesic syndromes in the patients.