RESUMEN
Chronic migraine is a neurological disorder characterized by 15 or more headache days per month of which at least 8 days show typical migraine features. The process that describes the development from episodic migraine into chronic migraine is commonly referred to as migraine transformation or chronification. Ample studies have attempted to identify factors associated with migraine transformation from different perspectives. Understanding CM as a pathological brain state with trigeminovascular participation where biological changes occur, we have completed a comprehensive review on the clinical, epidemiological, genetic, molecular, structural, functional, physiological and preclinical evidence available.
Asunto(s)
Progresión de la Enfermedad , Trastornos Migrañosos/diagnóstico por imagen , Trastornos Migrañosos/fisiopatología , Enfermedad Crónica , Epigénesis Genética/fisiología , Humanos , Trastornos Migrañosos/genética , Neuroimagen/tendenciasRESUMEN
In joint initiatives, the European Headache Federation and Lifting The Burden have described a model of structured headache services (with their basis in primary care), defined service quality in this context, and developed practical methods for its evaluation.Here, in a continuation of the service quality evaluation programme, we set out ten suggested role- and performance-defining standards for specialized headache centres operating as an integral component of these services. Verifiable criteria for evaluation accompany each standard. The purposes are five-fold: (i) to inspire and promote, or stimulate the establishment of, specialized headache centres as centres of excellence; (ii) to define the role of such centres within optimally structured and organized national headache services; (iii) to set out criteria by which such centres may be recognized as exemplary in their fulfilment of this role; (iv) to provide the basis for, and to initiate and motivate, collaboration and networking between such centres both nationally and internationally; (v) ultimately to improve the delivery and quality of health care for headache.
Asunto(s)
Trastornos de Cefalalgia/diagnóstico , Trastornos de Cefalalgia/terapia , Clínicas de Dolor/normas , Calidad de la Atención de Salud/normas , Atención a la Salud/normas , Atención a la Salud/tendencias , Cefalea/diagnóstico , Cefalea/terapia , Humanos , Clínicas de Dolor/tendencias , Atención Primaria de Salud/normas , Atención Primaria de Salud/tendencias , Calidad de la Atención de Salud/tendenciasRESUMEN
PURPOSE: The aim of this retrospective study was to evaluate survival outcomes in well-performing, mainly, young patients receiving a sequence of all available therapeutic options for relapsed glioblastoma, including re-irradiation. METHODS: We performed a retrospective analysis of 27 patients irradiated twice for glioblastoma between 2008 and 2016. In the first line, all had surgical treatment of the tumor followed by radiotherapy with a total dose of 60 Gy and temozolomide. All re-irradiated patients were treated with a total dose of 36 Gy in 12 fractions. The endpoints were death from glioblastoma or any cause, and toxicity after re-irradiation. RESULTS: The median follow-up of survivors was 35.6 months. At the time of analysis, 25 patients had died. The median time between first and second radiotherapy was 18.9 months (6.1-58.4). Re-irradiation was performed at different time points of first, second and third progression. The median overall survival after first diagnosis was 39.2 months. Five years after first surgery, nearly 20% of the patients were alive. CONCLUSION: Carefully planned re-irradiation of the brain is a safe therapy for recurrent glioblastoma. Younger and well-performing patients benefit from all available therapy options. Every patient should be discussed in a multidisciplinary setting at each time point of tumor progression. Further prospective studies are needed to define the optimal time, dose and volume of re-irradiation.
Asunto(s)
Neoplasias Encefálicas/mortalidad , Glioblastoma/mortalidad , Recurrencia Local de Neoplasia/mortalidad , Reirradiación/mortalidad , Adulto , Anciano , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/terapia , Terapia Combinada , Femenino , Estudios de Seguimiento , Glioblastoma/patología , Glioblastoma/radioterapia , Glioblastoma/terapia , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/radioterapia , Recurrencia Local de Neoplasia/terapia , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
The diagnosis of primary headache disorders is clinical and based on the diagnostic criteria of the International Headache Society (ICHD-3-beta). However several brain conditions may mimic primary headache disorders and laboratory investigation may be needed. This necessity occurs when the treating physician doubts for the primary origin of headache. Features that represent a warning for a possible underlying disorder causing the headache are new onset headache, change in previously stable headache pattern, headache that abruptly reaches the peak level, headache that changes with posture, headache awakening the patient, or precipitated by physical activity or Valsalva manoeuvre, first onset of headache ≥50 years of age, neurological symptoms or signs, trauma, fever, seizures, history of malignancy, history of HIV or active infections, and prior history of stroke or intracranial bleeding. All national headache societies and the European Headache Alliance invited to review and comment the consensus before the final draft. The consensus recommends brain MRI for the case of migraine with aura that persists on one side or in brainstem aura. Persistent aura without infarction and migrainous infarction require brain MRI, MRA and MRV. Brain MRI with detailed study of the pituitary area and cavernous sinus, is recommended for all TACs. For primary cough headache, exercise headache, headache associated with sexual activity, thunderclap headache and hypnic headache apart from brain MRI additional tests may be required. Because there is little and no good evidence the committee constructed a consensus based on the opinion of experts, and should be treated as imperfect.
Asunto(s)
Cefaleas Primarias/diagnóstico , Imagen por Resonancia Magnética , Consenso , Humanos , Neuroimagen , Examen FísicoRESUMEN
Metamizole (dipyrone) is a nonsteroidal compound with strong analgesic as well as antipyretic and spasmolytic properties. Based on a small number of cases of agranulocytosis, metamizole was withdrawn from the market in some countries. Other countries restricted its use. This paper discusses the safety aspects of metamizole and compares it with other compounds used for similar indications.
Asunto(s)
Agranulocitosis/inducido químicamente , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Dipirona/efectos adversos , Dipirona/uso terapéutico , Interacciones Farmacológicas , Humanos , Riesgo , Retirada de Medicamento por SeguridadRESUMEN
Chronic migraine (CM) was first defined in the second edition of the International Headache Society (IHS) classification in 2004. The definition currently used (IHS 2006) requires the patient to have headache on more than 15 days/month for longer than 3 months and a migraine headache on at least 8 of these monthly headache days and that there is no medication overuse. In daily practice the majority of the patients with CM also report medication overuse but it is difficult to determine whether the use is the cause or the consequence of CM. Most the patients also have other comorbidities, such as depression, anxiety and chronic pain at other locations. Therapy has to take this complexity into consideration and is generally multimodal with behavioral therapy, aerobic training and pharmacotherapy. The use of analgesics should be limited to fewer than 15 days per month and use of triptans to fewer than 10 days per month. Drug treatment should be started with topiramate, the drug with the best scientific evidence. If there is no benefit, onabotulinum toxin A (155-195 Units) should be used. There is also some limited evidence that valproic acid and amitriptyline might be beneficial. Neuromodulation by stimulation of the greater occipital nerve or vagal nerve is being tested in studies and is so far an experimental procedure only.
Asunto(s)
Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/terapia , Neurología/normas , Austria , Enfermedad Crónica , Alemania , Humanos , SuizaRESUMEN
BACKGROUND: Efficacy and safety data have not previously been compiled for intramuscular interferon beta-1a (IM IFNß-1a) in patients with multiple sclerosis (MS) ≥ 50 years of age. We investigated the efficacy and safety of IM IFNß-1a in patients segregated by 50 and 40 years of age in separate meta-analyses. METHODS: The MS Clinical Research Group Study, the Controlled High-Risk Subjects AVONEX(®) (IM IFNß-1a) MS Prevention Study, the IFNß-1a European Dose-Comparison Study, and a multicenter, open-label antigenicity and safety study of human serum albumin-free IM IFNß-1a were analyzed. RESULTS: Overall, 906 patients (68 aged ≥ 50 years and 838 aged <50 years, or 323 aged ≥ 40 years and 583 aged <40 years) received IM IFNß-1a for ≥ 24 months. At baseline, patients ≥ 50 years had significantly higher Expanded Disability Status Scale scores than patients <50 years (3.4 vs. 2.8; P < 0.001), but fewer relapses in the three preceding years (2.6 vs. 3.4; P < 0.001); patients ≥ 40 years and <40 years exhibited similar differences. After 2 years of treatment, there were no significant differences in annualized relapse rate, sustained disability progression, time to sustained disability progression, or number of MRI-identified gadolinium-enhanced lesions between age groups in either analysis. The cumulative probability of relapse was significantly lower in patients ≥ 40 years versus patients <40 years (0.601 vs. 0.702; P < 0.001). Adverse event incidence did not differ significantly between age groups in either analysis. CONCLUSIONS: IM IFNß-1a is effective and well tolerated in patients with MS ≥ 40 and ≥ 50 years as well as younger patients.
Asunto(s)
Adyuvantes Inmunológicos/administración & dosificación , Interferón beta/administración & dosificación , Esclerosis Múltiple/tratamiento farmacológico , Adolescente , Adulto , Anciano , Ensayos Clínicos Fase II como Asunto , Ensayos Clínicos Fase III como Asunto , Humanos , Inyecciones Intramusculares , Interferón beta-1a , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: Headache disorders are very common, but their monetary costs in Europe are unknown. We performed the first comprehensive estimation of how economic resources are lost to headache in Europe. METHODS: From November 2008 to August 2009, a cross-sectional survey was conducted in eight countries representing 55% of the adult EU population. Participation rates varied between 11% and 59%. In total, 8412 questionnaires contributed to this analysis. Using bottom-up methodology, we estimated direct (medications, outpatient health care, hospitalization and investigations) and indirect (work absenteeism and reduced productivity at work) annual per-person costs. Prevalence data, simultaneously collected and, for migraine, also derived from a systematic review, were used to impute national costs. RESULTS: Mean per-person annual costs were 1222 for migraine (95% CI 1055-1389; indirect costs 93%), 303 for tension-type headache (TTH, 95% CI 230-376; indirect costs 92%), 3561 for medication-overuse headache (MOH, 95% CI 2487-4635; indirect costs 92%), and 253 for other headaches (95% CI 99-407; indirect costs 82%). In the EU, the total annual cost of headache amongst adults aged 18-65 years was calculated, according to our prevalence estimates, at 173 billion, apportioned to migraine (111 billion; 64%), TTH (21 billion; 12%), MOH (37 billion; 21%) and other headaches (3 billion; 2%). Using the 15% systematic review prevalence of migraine, calculated costs were somewhat lower (migraine 50 billion, all headache 112 billion annually). CONCLUSIONS: Headache disorders are prominent health-related drivers of immense economic losses for the EU. This has immediate implications for healthcare policy. Health care for headache can be both improved and cost saving.
Asunto(s)
Costo de Enfermedad , Trastornos de Cefalalgia/economía , Costos de la Atención en Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Costos y Análisis de Costo , Estudios Transversales , Europa (Continente)/epidemiología , Femenino , Trastornos de Cefalalgia/diagnóstico , Trastornos de Cefalalgia/epidemiología , Trastornos de Cefalalgia/terapia , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
The Eurolight project is the first at European Union level to assess the impact of headache disorders, and also the first of its scale performed by collaboration between professional and lay organizations and individuals. Here are reported the methods developed for it. The project took the form of surveys, by structured questionnaire, conducted in ten countries of Europe which together represented 60% of the adult population of the European Union. In Lithuania, the survey was population-based. Elsewhere, truly population-based studies were impractical for reasons of cost, and various compromises were developed. Closest to being population-based were the surveys in Germany, Luxembourg, the Netherlands, Italy and Spain. In Austria, France and UK, samples were taken from health-care settings. In addition in the Netherlands, Spain and Ireland, samples were drawn from members of national headache patient organizations and their relatives. Independent double data-entry was performed prior to analysis. Returned questionnaires from 9,269 respondents showed a moderate female bias (58%); of respondents from patients' organizations (n = 992), 61% were female. Mean age of all respondents was 44 years; samples from patients' organizations were slightly older (mean 47 years). The different sampling methods worked with differing degrees of effectiveness, as evidenced by the responder-rates, which varied from 10.8 to 90.7%. In the more population-based surveys, responder-rates varied from 11.3 to 58.8%. We conclude that the methodology, although with differences born of necessity in the ten countries, was sound overall, and will provide robust data on the public ill-health that results from headache in Europe.
Asunto(s)
Costo de Enfermedad , Cefalea/epidemiología , Proyectos de Investigación , Adulto , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
The Austrian Alzheimer Society developed evidence-based guidelines based on a systematic literature search and criteria-guided assessment with subsequent transparent determination of grades of clinical recommendation. The authors evaluated currently available therapeutic approaches for the most common forms of dementia and focused on diagnosis and pharmacological intervention, taking into consideration the situation in Austria. The purpose of these guidelines is the rational and cost-effective use of diagnostic and therapeutic measures in dementing illnesses. Users are physicians and all other providers of care for patients with dementia in Austria.
Asunto(s)
Demencia/diagnóstico , Demencia/tratamiento farmacológico , Medicina Basada en la Evidencia , Nootrópicos/uso terapéutico , Anciano , Anciano de 80 o más Años , Aminoácidos/efectos adversos , Aminoácidos/uso terapéutico , Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Inhibidores de la Colinesterasa/efectos adversos , Inhibidores de la Colinesterasa/uso terapéutico , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/tratamiento farmacológico , Estudios Transversales , Demencia/epidemiología , Demencia/etiología , Quimioterapia Combinada , Femenino , Ginkgo biloba , Humanos , Incidencia , Estilo de Vida , Cuidados a Largo Plazo , Masculino , Cumplimiento de la Medicación , Memantina/efectos adversos , Memantina/uso terapéutico , Persona de Mediana Edad , Extractos Vegetales/efectos adversos , Extractos Vegetales/uso terapéutico , Dinámica Poblacional , Psicotrópicos/efectos adversos , Psicotrópicos/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
The Clinical Trials Subcommittee of the International Headache Society published its first edition of the guidelines on controlled trials of drugs in tension-type headache in 1995. These aimed 'to improve the quality of controlled clinical trials in tension-type headache', because 'good quality controlled trials are the only way to convincingly demonstrate the efficacy of a drug, and form the basis for international agreement on drug therapy'. The Committee published similar guidelines for clinical trials in migraine and cluster headache. Since 1995 several studies on the treatment of episodic and chronic tension-type headache have been published, providing new information on trial methodology for this disorder. Furthermore, the classification of the headaches, including tension-type headache, has been revised. These developments support the need for also revising the guidelines for drug treatments in tension-type headache. These Guidelines are intended to assist in the design of well-controlled clinical trials in tension-type headache.
Asunto(s)
Ensayos Clínicos Controlados como Asunto/normas , Guías de Práctica Clínica como Asunto , Sociedades Médicas/normas , Cefalea de Tipo Tensional/tratamiento farmacológico , Cefalea de Tipo Tensional/prevención & control , HumanosRESUMEN
BACKGROUND AND PURPOSE: The rationale for our study was to examine the prophylactic benefit of two doses of amitriptyline over a 6-month observational period in patients with migraine. We aimed at evaluating whether 50 mg of amitryptiline extended release was more effective than 25 mg in reducing the number of migraine days. METHODS: Primary outcome measure was the reduction of migraine days in time course (i.e., 3 and 6 months after patient enrolment). As secondary analyses, predictors of treatment response were evaluated. Treatment response was defined as reduction of > or =30% and > or =50% in migraine headache days in time course. RESULTS: The intent-to-treat population comprised 132 patients (female 96; male 36) with migraine. Median migraine days per month were reduced from 7 days (range: 6-15) at baseline, to 6 days (range: 4-12; P < 0.001) at 3 months, and to 6 days (range: 3-12; P < 0.001) at 6 months, respectively. However, no statistically significant difference in the number of migraine days was seen between the two treatment groups at 3 and 6 months. As a result of secondary analyses, the number of migraine days per month at baseline was the only independent predictor of response to amitriptyline treatment (for both definitions of treatment response, i.e., response rate > or =30% and response rate > or =50%) at 6 months. CONCLUSIONS: The prophylactic effect of amitriptyline seen in our study was rather weak and did not differ between the two treatment groups. The results of this 6-month, prospective, open-label clinical observation are therefore not encouraging.
Asunto(s)
Amitriptilina/administración & dosificación , Analgésicos no Narcóticos/administración & dosificación , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/prevención & control , Adulto , Amitriptilina/uso terapéutico , Analgésicos no Narcóticos/uso terapéutico , Preparaciones de Acción Retardada , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
The aim of this study was to determine whether in migraine patients with and without aura early treatment with various triptans leads to differences in pain reduction after 1 h and in modulating cutaneous allodynia. Thirty-six patients with early manifestation of a clinically recognizable allodynia of the face and non-responders to earlier treatment with sumatriptan 100 mg were included. Patients were randomized to six triptan treatment groups. Significant pain reduction was seen only in the group receiving zolmitriptan nasal spray 5 mg with a mean visual analogue scale (VAS) score of 3.8 (s.d. 1.2) at baseline and 2.4 (s.d. 1.3; P = 0.015) at 1 h after using the triptan and was thus a predictor of a VAS score 3 within 1 h. The study results indicate that migraine headache intensity can be reduced within 1 h by using zolmitriptan 5 mg nasal spray in spite of the presence of early cutaneous allodynia.
Asunto(s)
Migraña con Aura/tratamiento farmacológico , Migraña sin Aura/tratamiento farmacológico , Agonistas de Receptores de Serotonina/administración & dosificación , Trastornos Somatosensoriales/tratamiento farmacológico , Sumatriptán/administración & dosificación , Administración Intranasal , Administración Oral , Adolescente , Adulto , Cara/inervación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oxazolidinonas/administración & dosificación , Oxazolidinonas/efectos adversos , Dimensión del Dolor , Agonistas de Receptores de Serotonina/efectos adversos , Piel/inervación , Sumatriptán/efectos adversos , Resultado del Tratamiento , Nervio Trigémino , Triptaminas/administración & dosificación , Triptaminas/efectos adversosRESUMEN
The criteria of the International Headache Society (IHS) define four different primary headache syndromes with daily chronic headaches: chronic migraine, episodic and chronic tension type headache, hemicrania continua, new daily persisting headache. A further important differential diagnosis is medication overuse headache (previously known as analgesia headache). The German, Austrian, and Swiss headache societies now present the first joint guidelines for therapy of these headache syndromes. The current literature was reviewed and a summary is presented. The therapy recommendations do not only include the scientific evidence but also the practical relevance.
Asunto(s)
Analgésicos/uso terapéutico , Trastornos de Cefalalgia/tratamiento farmacológico , Acupuntura , Adulto , Analgésicos/efectos adversos , Terapia Conductista , Biorretroalimentación Psicológica , Niño , Terapia Combinada , Diagnóstico Diferencial , Medicina Basada en la Evidencia , Trastornos de Cefalalgia/diagnóstico , Trastornos de Cefalalgia/etiología , Cefaleas Secundarias/diagnóstico , Cefaleas Secundarias/tratamiento farmacológico , Cefaleas Secundarias/etiología , Humanos , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/etiología , Guías de Práctica Clínica como Asunto , Cefalea de Tipo Tensional/tratamiento farmacológico , Cefalea de Tipo Tensional/etiologíaRESUMEN
This open study evaluates the effectiveness and safety of topiramate for the prophylaxis of chronic tension-type headache. Fifty-one patients were enrolled, of whom 46 completed 24 weeks of treatment with topiramate. Daily dosing was titrated from 25 mg to 100 mg by treatment week 4. The primary efficacy parameter was headache frequency at weeks 13-24 compared with baseline. Headache frequency declined from 23.50 +/- 5.32 days (baseline, mean, SD) to 12.58 +/- 6.28 days at weeks 13-24 (P < 0.0001), with frequency of severe headaches dropping from 8.18 to 3.14 days (P < 0.0001). The average headache intensity dropped from 6.13 to 2.07 on the visual analogue scale (P < 0.0001). These parameters were not significantly reduced at weeks 5-12. A 50% reduction in headache frequency was achieved in 73% of patients at weeks 13-24. Also improved were mood, sleep, quality of life (all parameters, P < 0.0001) as well as the Beck Depression Inventory-II (P < 0.0001). In addition, a highly significant weight loss of 2.14 kg (mean) was observed between baseline (71.64 +/- 10.65 kg) and week 24 [69.50 +/- 10.04 kg (SD)] (P < 0.0001). There were only few side-effects, none of these rated severe. The results provide preliminary confirmation of the efficacy and tolerability of topiramate in the prophylaxis of chronic tension-type headache.
Asunto(s)
Anticonvulsivantes/administración & dosificación , Fructosa/análogos & derivados , Cefalea de Tipo Tensional/tratamiento farmacológico , Cefalea de Tipo Tensional/prevención & control , Adolescente , Adulto , Afecto/efectos de los fármacos , Analgésicos/administración & dosificación , Anticonvulsivantes/efectos adversos , Enfermedad Crónica , Depresión/tratamiento farmacológico , Femenino , Fructosa/administración & dosificación , Fructosa/efectos adversos , Humanos , Masculino , Registros Médicos , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Calidad de Vida , Sueño/efectos de los fármacos , Cefalea de Tipo Tensional/psicología , Topiramato , Resultado del TratamientoRESUMEN
Data from observational studies suggest that migraine may be a risk factor for stroke. Furthermore, a significant association between migraine and ischemic stroke (IS) has been demonstrated in population and case-control studies. The risk of IS appears to be higher for migraine with aura than for migraine without aura. The pathogenesis is not known but several studies report some common biochemical mechanisms in the two diseases. Meta-analysis also demonstrates that subjects with migraine are at higher risk of showing white matter abnormalities on magnetic resonance images than are those without migraine.
Asunto(s)
Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/epidemiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Lesiones Encefálicas/complicaciones , Coagulantes/efectos adversos , Anticonceptivos Orales/efectos adversos , Predisposición Genética a la Enfermedad , Humanos , Trastornos Migrañosos/etiología , Trastornos Migrañosos/genética , Factores de RiesgoRESUMEN
This study examined the efficacy of lamotrigine in the prevention of migraine aura. Fifty nine patients suffering from migraine with aura received lamotrigine in a controlled three year prospective open study. Treatment response was defined as a reduction of aura frequency each month by at least 50%. Primary endpoint was reached by three quarters of the patients. Lamotrigine significantly reduced both frequency of migraine aura (mean, 1.5 (SD, 0.6) each month before v 0.4 (0.7) after treatment; p < 0.001) and aura duration (mean, 27 (SD, 11) minutes before v 8 (14) after treatment; p < 0.001). Furthermore, more than three quarters of those patients with a reduction of aura symptoms experienced a significant reduction of frequency of migraine attacks (mean, 2.1 (SD, 1.0) each month before v 1.2 (1.1) after treatment; p < 0.001). Lamotrigine was highly effective in reducing migraine aura and migraine attacks. The strong correlation between reduction of aura symptoms and migraine attacks stresses the potential role of aura-like events and possibly cortical spreading depression as a trigger for trigeminal vascular activation, and subsequently the development of migraine headaches.
Asunto(s)
Analgésicos/uso terapéutico , Migraña con Aura/tratamiento farmacológico , Triazinas/uso terapéutico , Adulto , Femenino , Humanos , Lamotrigina , Masculino , Persona de Mediana Edad , Migraña con Aura/patología , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Patients with symptomatic > or = 60% (n = 134), asymptomatic > or = 80% (n = 143), and asymptomatic progressive > or = 60% (n = 25) internal carotid artery stenosis underwent stenting and were followed clinically and by Doppler-assisted duplex imaging for 27.1 +/- 15.6 months. Stroke and death from stroke occurred within 30 days after stenting in 4.7% of the symptomatic and in 3.0% of the asymptomatic patients and in the follow-up period in 2.3% of the symptomatic and in 1.2% of the asymptomatic patients.
Asunto(s)
Arteria Carótida Interna/cirugía , Estenosis Carotídea/cirugía , Embolia Intracraneal/etiología , Stents/efectos adversos , Accidente Cerebrovascular/prevención & control , Procedimientos Quirúrgicos Vasculares/efectos adversos , Factores de Edad , Anciano , Anciano de 80 o más Años , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Causalidad , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular , Humanos , Embolia Intracraneal/prevención & control , Masculino , Persona de Mediana Edad , Selección de Paciente , Complicaciones Posoperatorias , Reoperación/estadística & datos numéricos , Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler DúplexRESUMEN
The authors analyzed whether nondemented (PD) and demented Parkinson patients (PDD) and patients with dementia with Lewy bodies (DLB) respond similarly in the levodopa test (LDT). Percentage of motor improvement was similar in the three groups; the proportion of patients with 10% and more improvement was greater in PD than in PDD and DLB. Positive LDT was predictive for favorable response in chronic levodopa treatment, but also some nonresponsive demented patients profited from chronic levodopa therapy.
Asunto(s)
Demencia/fisiopatología , Agonistas de Dopamina , Levodopa , Enfermedad por Cuerpos de Lewy/fisiopatología , Enfermedad de Parkinson/fisiopatología , Anciano , Anciano de 80 o más Años , Demencia/etiología , Agonistas de Dopamina/uso terapéutico , Femenino , Humanos , Levodopa/uso terapéutico , Enfermedad por Cuerpos de Lewy/tratamiento farmacológico , Masculino , Enfermedad de Parkinson/tratamiento farmacológico , Enfermedad de Parkinson/psicología , Valor Predictivo de las Pruebas , Estudios ProspectivosRESUMEN
This study presents the first nation-wide survey of migraine in Austria. A sample of 997 Austrian > or = 15 years old were interviewed personally (face-to-face) in a random sample in the whole country. Diagnosis of migraine was based on the International Headache Society (IHS) classification. Of the Austrian adult population 10.2% were identified to suffer from IHS migraine, 5.6% from migraine without aura, 2.3% from migraine with aura and 2.3% from borderline migraine. Another 8.5% have possible migraine. Other primary headaches were reported in 30.7%. Sex, age, working status and region were found to be the main demographic influencing factors. Further influences were stress, spinal column problems or weather changes. The most used acute medications were over-the-counter drugs, doctor attendance rate was very low. Working people with migraine dropped out of work 14 days per year, which adds up to 6.8 million working days per year. This remains a substantial economic factor. The findings indicate that migraine sufferers in Austria need to be more informed about their illness and what to do against it, especially encouraging doctor visits.