Are more nerve injections in the same session more effective in migraine treatment? 3-month follow-up results.

Background and purpose: Peripheral nerve blockade techniques have been developed for both acute and prophylactic treatment of migraine. Our aim was to compare pain parameters between the groups of patients who only had greater occipital nerve blockade (GON), and those who also had blockade to the supraorbital nerve (SON) and infraorbital nerve (ION) together with greater occipital nerve blockade, in order to reduce pain more effectively in migraine patients. Methods: 50 patients diagnosed with migraine were included in our study. 22 patients underwent only bilateral GON blockade (GONB), and 28 patients underwent bila-teral GON blockade and bilateral SON and ION blocka-des (MCNB). In both groups, the number of headache days and visual analog scale scores of the patients were noted in the first month before the injection, in the first, second and third months after the injections (injections were applied to patients 3 times with one-month intervals). Results: While the number of headache days before injection was 9.6 days/month in the GONB group and 9.3 days/month in the MCNB group, it was 6.2 days/month and 5.2 days/month after the first injection, 5.3 days/month and 3.8 days/month after the second injection, and 3.9 days/month and 2.8 days/month after the third injection, respectively (p < 0.01). While the visual analog scale scores of both groups were 8.1 before injection, it decreased to 5.9 and 6.0, respectively, after the third injection. Conclusion: There was no significant difference in the reduction of pain parameters between only GON blockade and SON and ION blockades in addition to GON blockade.

Botulinum toxin type A wear-off phenomenon in chronic migraine patients: how long does the maximum efficiency last? / O fenômeno do encurtamento do efeito da toxina botulínica tipo A em pacientes com migrânea crônica: quanto tempo dura a eficiência máxima?

ABSTRACT Background: Botulinum toxin Type A (BoNTA) is a successful treatment for chronic migraine prophylaxis. Objective: We aimed to evaluate the monthly change of effectiveness of BoNTA treatment. Methods: A total of 80 patients (70 females and 10 males) with chronic migraine were included. In our study protocol, we applied to 155 U across 31 fixed-sites and if the patient had pain, 40 U dose injections were applied across 8 specific head/neck muscle areas. Headache days and analgesic intake were noted before the BoNTA injection and during the interviews at the first, second, and third months after the BoNTA injection. Results: The mean age was 37.59 ± 7.60 and 87.5% of the patients were female. The mean number of headache days/month before BoNTA was 18.95±2.69, decreasing to 10.55±3.15 days/month in the first month (p<0.001), 9.31±2.43 days/month in the second month (p<0.001), and increased to 11.97±3.27 days/month in the third month (p<0.001). The mean analgesic intake before BoNTA was 11.48±4.68 tablets/month, while it decreased to 6.53±2.72 tablets/month in the first month (p<0.001) and 5.40±2.46 tablets/month in the second month (p<0.001). In the third month, it was 5.85±2.59 tablets/month (p<0.001). There was a significant increase in pain medication use from the second to the third month (p<0.001). Conclusion: In our study, there was a significant reduction in analgesic intake and headache days in the first and second months after BoNTA injection, and an increase was observed in the third month.

RESUMO Antecedentes: A toxina botulínica Tipo A (BoNTA) é um tratamento de sucesso para a profilaxia da migrânea crônica. Objetivo: Nosso objetivo foi avaliar a mudança mensal da eficácia do tratamento com BoNTA. Métodos: Um total de 80 pacientes (70 mulheres e 10 homens) com migrânea crônica foi incluído. Em nosso protocolo de estudo, aplicamos 155 U em 31 locais fixos e, se o paciente sentisse dor, injeções de dose de 40 U foram aplicadas em 8 áreas musculares específicas da cabeça/pescoço. Dias de cefaleia e ingestão de analgésicos foram anotados antes da injeção de BoNTA e durante as entrevistas no primeiro, segundo e terceiro meses após a injeção de BoNTA. Resultados: A média de idade foi 37,59±7,60 e 87,5% dos pacientes eram do sexo feminino. O número médio de cefaleias dias/mês antes da BoNTA foi de 18,95±2,69 dias/mês, diminuindo para 10,55±3,15 dias/mês no primeiro mês (p<0,001), 9,31±2,43 dias/mês no segundo mês (p<0,001), e aumentou para 11,97±3,27 dias/mês no terceiro mês (p<0,001). A ingestão média de analgésicos antes da BoNTA foi de 11,48±4,68 comprimidos/mês, enquanto diminuiu para 6,53±2,72 comprimidos/mês no primeiro mês (p<0,001) e 5,40±2,46 comprimidos/mês no segundo mês (p<0,001). No terceiro mês, era de 5,85±2,59 comprimidos/mês (p<0,001). Quando comparados o segundo e o terceiro mês, observou-se aumento significativo do uso de analgésicos do segundo para o terceiro mês (p<0,001). Conclusão: Em nosso estudo, houve redução significativa da ingestão de analgésicos e dos dias de cefaleia no primeiro e segundo meses após a injeção de BoNTA, e aumento no terceiro mês.

Botulinum toxin type A wear-off phenomenon in chronic migraine patients: how long does the maximum efficiency last?

BACKGROUND: Botulinum toxin Type A (BoNTA) is a successful treatment for chronic migraine prophylaxis. OBJECTIVE: We aimed to evaluate the monthly change of effectiveness of BoNTA treatment. METHODS: A total of 80 patients (70 females and 10 males) with chronic migraine were included. In our study protocol, we applied to 155 U across 31 fixed-sites and if the patient had pain, 40 U dose injections were applied across 8 specific head/neck muscle areas. Headache days and analgesic intake were noted before the BoNTA injection and during the interviews at the first, second, and third months after the BoNTA injection. RESULTS: The mean age was 37.59 ± 7.60 and 87.5% of the patients were female. The mean number of headache days/month before BoNTA was 18.95±2.69, decreasing to 10.55±3.15 days/month in the first month (p<0.001), 9.31±2.43 days/month in the second month (p<0.001), and increased to 11.97±3.27 days/month in the third month (p<0.001). The mean analgesic intake before BoNTA was 11.48±4.68 tablets/month, while it decreased to 6.53±2.72 tablets/month in the first month (p<0.001) and 5.40±2.46 tablets/month in the second month (p<0.001). In the third month, it was 5.85±2.59 tablets/month (p<0.001). There was a significant increase in pain medication use from the second to the third month (p<0.001). CONCLUSION: In our study, there was a significant reduction in analgesic intake and headache days in the first and second months after BoNTA injection, and an increase was observed in the third month.

Alexithymia is a non motor symptom of essential tremor regardless of the presence of depression and anxiety.

OBJECTIVE: Essential tremor (ET) is one of the most common movement disorders. Aside from tremor, patients may exhibit other motor features as well as non-motor features, including neuropsychiatric symptoms. The cerebellum and cerebellar connections are thought to play a key role in the pathophysiology of ET. Cognitive and affective disturbances can occur in the context of cerebellar disease. Our aim was to study the prevalence and clinical correlates of alexithymia and its relationship to depression and anxiety in ET patients and control subjects (CS). METHOD: We enrolled 100 ET patients and 100 age- and gender-matched CS. The Toronto Alexithymia Scale-20 (TAS-20), the Beck depression inventory-II and the Beck anxiety inventory were administered. RESULTS: Alexithymia levels were significantly higher in ET patients than CS (respective mean TAS-20 scores = 50.63 ± 9.79 vs. 44.05 ± 12.51, p < 0.001).  There were robust associations between alexithymia, depressive symptoms, and anxiety but, after excluding the ET patients and the CS who had moderate or severe depression or who had moderate or severe anxiety, the total alexithymia score remained significantly higher in the ET than the CS group (46.78 ± 9.19 vs. 41.18 ± 11.79, p ≤ 0.01). CONCLUSION: This study suggests that prevalence of alexithymia is significantly higher in ET patients. Alexithymia might be another non-motor neuropsychiatric symptom of the disease.  Further studies are needed to confirm and expand upon our findings.

Alexithymia is associated with cognitive impairment in patients with Parkinson's disease.

Background and purpose: Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson's disease (PD). Alexithy-mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com-mon pathology of neuroanatomical structures. We hypo-thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective - The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Methods: Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale-20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Results: Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet-ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01). Conclusion: Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Neuroimaging depression and anxiety in essential tremor: A diffusion tensor imaging study.

OBJECTIVE: Patients with essential tremor (ET) may exhibit non-motor features, including those that are neuropsychiatric. Depression and anxiety are the most common among these. This study aims to investigate the possible relationship between microstructural brain changes and symptoms of depression and anxiety in ET. METHODS: We assessed 62 ET patients (40 women and 22 men, mean age 46.0 ±â€¯20.4) for symptoms of depression and anxiety using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Thirty-two patients had severe or moderate symptoms of anxiety, and 15 patients had severe or moderate depressive symptoms. Microstructural brain changes were evaluated using diffusion tensor imaging (DTI), which was reported using fractional anisotropy (FA), mean diffusivity (MD), apparent diffusion coefficient (ADC), radial diffusivity (RD), and axial diffusivity (AD) values calculated for 17 regions of interest including the prefrontal cortex, paralimbic and limbic structures and cerebellar peduncles. We evaluated the relationship between observed changes in brain regions and symptoms of depression and anxiety. RESULTS: Decreased left amygdala FA (p = 0.003) and increased left amygdala RD (p = 0.04) were detected in depressed vs. non-depressed ET patients. Left ventrolateral prefrontal cortex (VLPFC) FA (p = 0.02) and left precuneus FA (p = 0.02) values differed between anxious patients vs. non-anxious ET patients. BDI scores were correlated with left amygdala FA and left RD, while BAI scores were correlated with left VLPFC FA and left precuneus FA. DISCUSSION: Our results provide evidence that symptoms of depression and anxiety could be based in structural brain changes observed in patients with ET.