Effects of Topically Applied Contractubex® on Epidural Fibrosis and Axonal Regeneration in Injured Rat Sciatic Nerve.

AIM: To investigate the effects of Contractubex® (Cx) on peripheral nerve regeneration and scar formation. MATERIAL AND METHODS: A surgical procedure involving sciatic nerve incision in 24 adult male Sprague-Dawley rats followed by epineural suturing was performed. In weeks 4 and 12 following surgery, macroscopic, histological, functional, and electromyographic examinations of the sciatic nerve were conducted. RESULTS: No significant difference was found between the Cx group and the control group in terms of sciatic function index (SFI) and distal latency results at week 4 (p > 0.05). However, significant improvements in the Cx group were observed in SFI amplitudes and nerve action potentials at week 12 (p < 0.001 and p < 0.001, respectively). Significant improvements were found in the amplitudes of nerve action potentials in the treatment group after weeks 4 and 12 (p < 0.05 and p < 0.001, respectively). Macroscopically and histopathologically, epidural fibrosis decreased (p < 0.05 and p < 0.001, respectively). For both measurement times, the treatment group had significantly higher numbers of axons (week 4, p < 0.05; week 12, p < 0.001), and the treatment group had better results regarding its axon area (weeks 4 and 12, p < 0.001) and myelin thickness (weeks 4 and 12, p < 0.05). CONCLUSION: Cx, which is applied topically in peripheral nerve injury, affects axonal regeneration and axonal maturation positively and reduces the functional loss.

Prolactin and oxytocin: potential targets for migraine treatment.

Migraine is a severe neurovascular disorder of which the pathophysiology is not yet fully understood. Besides the role of inflammatory mediators that interact with the trigeminovascular system, cyclic fluctuations in sex steroid hormones are involved in the sex dimorphism of migraine attacks. In addition, the pituitary-derived hormone prolactin and the hypothalamic neuropeptide oxytocin have been reported to play a modulating role in migraine and contribute to its sex-dependent differences. The current narrative review explores the relationship between these two hormones and the pathophysiology of migraine. We describe the physiological role of prolactin and oxytocin, its relationship to migraine and pain, and potential therapies targeting these hormones or their receptors.In summary, oxytocin and prolactin are involved in nociception in opposite ways. Both operate at peripheral and central levels, however, prolactin has a pronociceptive effect, while oxytocin appears to have an antinociceptive effect. Therefore, migraine treatment targeting prolactin should aim to block its effects using prolactin receptor antagonists or monoclonal antibodies specifically acting at migraine-pain related structures. This action should be local in order to avoid a decrease in prolactin levels throughout the body and associated adverse effects. In contrast, treatment targeting oxytocin should enhance its signalling and antinociceptive effects, for example using intranasal administration of oxytocin, or possibly other oxytocin receptor agonists. Interestingly, the prolactin receptor and oxytocin receptor are co-localized with estrogen receptors as well as calcitonin gene-related peptide and its receptor, providing a positive perspective on the possibilities for an adequate pharmacological treatment of these nociceptive pathways. Nevertheless, many questions remain to be answered. More particularly, there is insufficient data on the role of sex hormones in men and the correct dosing according to sex differences, hormonal changes and comorbidities. The above remains a major challenge for future development.

Welder's lung and brain MRI findings in manganese-exposed welders.

BACKGROUND: Biomarkers of manganese (Mn) exposure and manganism are poorly understood. Blood Mn levels are often used to assess exposure, while brain Mn accumulation may be demonstrated by pallidal hyperintensity at magnetic resonance imaging (MRI). Mn-containing electrodes used in manual metal arc welding may be associated with the welder's lungs. METHODS: A cross-sectional study was set up to compare T1 intensity in basal ganglia at MRI and Mn blood levels in subjects with or without pneumoconiosis. Clinical, radiological, pulmonary function and laboratory parameters were assessed among 154 welders referred to our hospital for suspected pulmonary pathology. RESULTS: The study group included 123 male welders with pneumoconiosis (79.9%) and 31 welders without pulmonary damage (20.1%). The cases without pneumoconiosis were younger (38.5±6.6 vs 42.1±7.1, p=0.012). Cases with pneumoconiosis had blood lower Mn levels [13.5 (10-21)] as compared to those without pneumoconiosis [18.5 (7.8- 34)], p=0.035. In the same groups, the cases with high blood Mn levels were 49 (39.8%) and 18 (58.1%) p= 0.052, respectively. Brain MRI hyperintensity was found in 86 (55.8%) subjects with welder's lung 63 (51.2) but also in 23 (74.2) individuals without welder's lung. MRI hyperintensity in basal ganglia was significantly related to high blood Mn (p<0.005). CONCLUSION: This is the first study evaluating blood Mn levels of welders and their correlation with pulmonary and neurological effects. Poor working conditions may be associated with exposure to Mn and fibrogenic fumes leading to chronic lung diseases and hyperintensity in brain MRI suggesting Mn accumulation.

Impact of occupational lead exposure on nerve conduction study data.

INTRODUCTION: To investigate nerve conduction data of lead exposed workers. METHODS: A total of 287 subjects, consisting of 197 lead exposed workers and 90 healthy controls were included. Nerve conduction study of motor (median, ulnar, peroneal and tibial) and sensory (median, ulnar and sural) nerves were performed. The data were analyzed as two and three groups. RESULTS: The median blood lead level was 40.90 µg/dl. Median sensory, ulnar motor, and ulnar sensory conduction velocity were lower; distal latency of median motor, median sensory and sural sensory were longer than the controls (p < 0.05). There was no difference between the groups in terms of amplitudes. DISCUSSION: This study was indicated the neurotoxic effect of lead exposure may occur in the peripheral nerves, while the mean blood lead level is 40 µg/dl.

Measurement of the facial nerve thickness and its correlation with freezing phenomenon and hypomimia in Parkinson's disease.

OBJECTIVE: Hypomimia is one of the diagnostic features in Parkinson's disease, and freezing blocks may also occur with the degenerative process. We investigated that the thickness of the cranial facial nerve that innervates facial expressions, and the relationship between bradymimia and freezing phenomena in these patients. METHODS: We included 70 patients and healthy participants in this cross-sectional study. Clinical characteristics, modified Hoehn and Yahr (mHY) stages, Unified Parkinson's Disease Rating Scale (UPDRS) scores and Freezing of Gait Questionnaire (FOG-Q) scores of Parkinson's patients were recorded. FOG-Q was scored between 1 and 4 points. The thickness of the facial nerve and its neighborhoods of numerically equal groups were measured radiologically in the internal acoustic channel (IAC) with magnetic resonance imaging of temporal lobe. Right and left facial nerve thicknesses were compared. RESULTS: The right facial nerve thicknesses of the patient and control groups were measured as 0.97 ± 0.12 mm and 1.20 ± 0.10 mm at the proximal level and 0.71 (0.69-0.81) mm and 1.21 (1.13-1.24) mm at the distal level, respectively (P < 0.001). Notably, the facial nerve was more atrophied on the right than on the left (P < 0.001). Facial nerve to IAC ratio (%) was significantly lower and cerebrospinal fluid thickness distance (%) measurement was significantly higher (P < 0.001). Also, the FOG-Q and facial nerve to IAC ratio were negatively correlated (P = 0.049, rho = -0.335). CONCLUSIONS: Our study provides new information about the facial nerve and its neighborhoods and clinical relationships in individuals with PD. In studies investigating hypomimia and FOG in Parkinson's, neuroimaging of the facial nerve can also be used. These results need to be proven with more comprehensive studies.

Clinical success of greater occipital nerve blockade in improving sleep quality of chronic migraineurs: a prospective observational study.

BACKGROUND: The success of various therapy methods in the treatment of insomnia and poor quality sleep, both of which play an active role in the chronicization process of migraine, has been the subject of investigation. The aim of this research was to evaluate the success, acceptability, and efficacy of greater occipital nerve block (GON-B) therapy in chronic migraine (CM) patients in improving their sleep quality and developing their beliefs about sleep . METHODS: The study included 40 patients with CM from the general population who agreed to receive blockade therapy. Before the injection treatment, 1-week sleep diaries as well as depression and anxiety symptoms were examined. The Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Pre-Sleep Arousal Scale (PSAS), Epworth Sleepiness Scale (ESS), and Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scales were measured and evaluated both before and after the completion of 3 months of treatment. RESULTS: Thirty-seven patients with CM successfully completed our 12-week treatment period. The anxiety and depression scales of the patients decreased after 3 months (p < 0.001). PSQI and its subgroups ratings significantly improved after treatment (p < 0.001). Similarly, ISI, ESS, PSAS, and DBAS test scores also improved after treatment (p < 0.001). CONCLUSIONS: This study provides evidence as to the applicability and acceptability of GON-B in CM treatment in terms of increased sleep quality; improved sleep beliefs, attitudes, and behaviors; and arousals and decreased insomnia findings.

Association of freezing of gait and clinical features in patients with Parkinson's disease.

Freezing of gait (FOG) is a disabling symptom that affects the quality of life of patients with Parkinson's disease (PD) and its pathophysiology is not fully understood yet. The aim of the present study is to evaluate the relationship between FOG and other clinical characteristics in patients with PD. The clinical characteristics, modified Hoehn and Yahr (mHY) stages, Unified Parkinson's Disease Rating Scale (UPDRS) scores, and total Freezing of Gait Questionnaire (FOG-Q) scores of the patients with PD were recorded. FOG-Q item 1.3 was used to evaluate patients with or without FOG. A total of 65 patients with PD (32 with FOG and 33 without FOG) were included to the study. Disease duration was longer, mHY stages were higher, bradykinesia and dyskinesia were more common in patients with FOG compared to patients without (p = 0.001, p = 0.036, p = 0.019 and p = 0.021; respectively). Patients with FOG had lower UPDRS part III tremor subscores (p = 0.020), although gait, postural balance subscores and part IV motor fluctuations scores were higher (p = 0.003, p = 0.023 and p < 0.001; respectively). A positive correlation was found between FOG-Q scores and mHY stages (p < 0.001), UPDRS part II and III total scores (p = 0.020 and p = 0.001) and part III bradykinesia, and gait and postural balance subscores (p = 0.003, p = 0.036 and p = 0.003, respectively), and part IV motor fluctuation scores (p = 0.006). The results of the present study point to an association between FOG and bradykinesia rather than tremor, prolonged disease duration and advanced disease stage reflecting its association with more severe and extensive neurodegenerative processes.

Validity and reliability of the Turkish version of Public Attitudes Toward Epilepsy scale.

OBJECTIVE: This study was conducted to test the validity and reliability of the Turkish version of the Public Attitudes Toward Epilepsy (PATE) scale, which aims to understand public perceptions of seizures and epilepsy. METHODS: The scale was translated following the standard procedures. For psychometric validation, the Turkish version of the PATE scale was administered to 201 native Turkish speakers above the age of 18 who had no history of seizures or epilepsy. It was found that the respondents were able to fill out the scale quickly and without difficulty in understanding the translated items on the scale. RESULTS: Cronbach's alpha coefficient was found to be 0.843 for the overall scale and above 0.7 for each individual item. Cronbach's alpha was 0.78 for the general domain and 0.792 for the personal domain. Exploratory and confirmatory factor analyses were carried out and showed that the scale had a structure similar to that of the original scale, with the 14 items grouped under two dimensions, similar to the original scale. CONCLUSION: The Turkish version of the PATE scale was a valid and reliable tool to measure the attitudes toward epilepsy in Turkish society.

Evaluation of sleep-related respiratory disorders in patients with multiple sclerosis.

Patients with multiple sclerosis (MS) often report fatigue, poor sleep and complaint of sleep disorders. Neurofilament light chain (NF-L) has been identified as a potential biomarker for disease progression in MS patients. In this study, we aimed to evaluate sleep characteristics in MS patients and its relationship with the level of serum NF-L. In the present study carried out as a prospective and cross-sectional study, 32 relapsing-remitting MS (RRMS) patients and 32 control subjects were included. Epworth Sleepiness Scale and Fatigue Severity Scale tests were applied to the groups and the full night polysomnography was performed. Serum samples were obtained for NF-L analysis. Apnea-hypopnea index (AHI), AHI in rapid eye movement sleep (AHI REM), percentage of NonREM stage 1 (N1) and NonREM stage 3 (N3) values were significantly different in RRMS patients (p < 0.05). There was correlation between AHI and Expanded Disability Status Scale indicating a negative directed moderate relationship (r = - 0.343 p = 0.055). Serum NF-L correlations with sleep efficiency and percentage of NonREM stage 2 (N2) were showed mild significant correlation (r = - 0.342 as - 0.535, p < 0.05). We found that sleep disorders are prevalent in RRMS patients and it has a negative effect on the clinical outcome of disease. In clinical practice, the association of these two diseases should be taken into consideration because sleep disturbances increase the disability of MS disease especially presenting with fatigue.

The prevalence of papilledema in patients with migraine: a crucial cooccurrence of migraine and idiopathic intracranial hypertension.

OBJECTIVE: We aimed to investigate the prevalence of idiopathic intracranial hypertension (IIH) in patients with migraine by screening for papilledema. MATERIALS AND METHODS: We have included all the patients with migraine who applied to our neurology clinic during December 2019 and accepted to participate in the study. The demographic and clinical characteristics including migraine subtype (episodic/chronic), headache frequency per month, and headache characteristics of all patients were interrogated. Besides, the presence of fibromyalgia (FM) and chronic fatigue syndrome (CFS) was noted. Fundus examination was performed in all of the patients and the presence of papilledema was noted. RESULTS: Overall, 158 consecutive migraineurs were included in this study. The mean age of the group was 35.9 ± 9.9 and the female/male ratio was 134/24. Papilledema was determined in 10 (6%) patients. There was a past medical history of having IIH in one of these patients. In four of the patients, the diagnosis of IIH was newly established. Comparative analyses between episodic migraineurs and chronic migraineurs revealed that female gender was more prevalent in chronic migraineurs (p = 0.00) and the comorbidities of FM and CFS were more common in chronic migraineurs. Remarkably, papilledema was found to be more common in chronic migraineurs. The results of the logistic regression analyses revealed that obesity was the only predictor for the presence of papilledema (p = 0.014). CONCLUSION: Our results may suggest that IIH should be kept in mind as a notable comorbidity in migraineurs, particularly in the subgroup of obese patients with chronic migraine.

Electrophysiological evaluation of carpal tunnel syndrome female patients after vitamin D replacement.

OBJECTIVE: The effects of vitamin D on the central and peripheral nervous system continue to be investigated today. In the present study, we aimed to evaluate pain and electrophysiologic response in patients with carpal tunnel syndrome (CTS) who have undergone replacement therapy due to vitamin D deficiency. METHODS: Fifty female patients diagnosed with mild and moderate CTS and accompanied by vitamin D deficiency were included in this study. Nerve conduction study (NCS) was performed before and after vitamin D replacement, and the patient's pain was evaluated with Visual Analogue Scale (VAS). RESULTS: When NCS were compared before and after treatment, there was a statistically significant improvement in the median distal sensory onset latency (DSOL) and sensory conduction velocity (CV) and motor distal latencies (DML) values (p=0.001; p<0.001; p=0.001, respectively). At the same time, there was a decrease in the VAS values in patients (p<0.001). When the two groups were compared there was an improvement in DSOL and sensory CV in both groups, but in DML only in moderate CTS group. CONCLUSION: In this study, it was shown that mild and moderate CTS patients had an improvement in pain and electrophysiological parameters after vitamin D replacement. Replacing vitamin D in early stages of CTS may be beneficial.

Impact of dissociative experiences in migraine and its close relationship with osmophobia.

OBJECTIVE: Migraine is a complex episodic disease manifested by dysfunction of the sympathetic nervous system along with numerous neuropsychiatric symptoms. The aim of this study was to identify the dissociative symptoms with neurobiological similarities in episodic and chronic migraine patients and to evaluate their correlation with migraine frequency and severity of attacks. METHODS: The study included 61 episodic, 45 chronic migraine patients diagnosed using the criteria of the International Headache Society and 54 healthy control subjects. Dissociative Experiences Scale, Beck Anxiety Scale and Beck Depression Inventory were filled with the interviews. Demographic, clinical and headache characteristics of the patients were recorded according to migraine types. Results were analyzed by Kruskal-Wallis method and Spearman's correlation tests. RESULTS: Dissociative symptoms were more common in the patients with chronic migraine, and there was a statistically significant difference between the chronic migraine group and the episodic migraine and control groups (p = 0.001, p < 0.001). Dissociative experiences were correlated with depression and anxiety findings, and in both groups, there was a significant correlation between clinical characteristics of migraine and osmophobia in the controlled partial correlation analysis (p < 0.05). CONCLUSION: This study revealed that dissociative symptoms are more common especially in patients with chronic migraine and there is a significant association with osmophobia in both migraine groups. According to these data, we think that dissociative symptoms in chronic migraine patients will be questioned and osmophobia may be a guide in this regard.

Electrophysiological evaluation of carpal tunnel syndrome female patients after vitamin D replacement / Avaliação eletrofisiológica de pacientes do sexo feminino com síndrome do túnel do carpo após reposição de vitamina D

Abstract Objective: The effects of vitamin D on the central and peripheral nervous system continue to be investigated today. In the present study, we aimed to evaluate pain and electrophysiologic response in patients with carpal tunnel syndrome (CTS) who have undergone replacement therapy due to vitamin D deficiency. Methods: Fifty female patients diagnosed with mild and moderate CTS and accompanied by vitamin D deficiency were included in this study. Nerve conduction study (NCS) was performed before and after vitamin D replacement, and the patient's pain was evaluated with Visual Analogue Scale (VAS). Results: When NCS were compared before and after treatment, there was a statistically significant improvement in the median distal sensory onset latency (DSOL) and sensory conduction velocity (CV) and motor distal latencies (DML) values (p=0.001; p<0.001; p=0.001, respectively). At the same time, there was a decrease in the VAS values in patients (p<0.001). When the two groups were compared there was an improvement in DSOL and sensory CV in both groups, but in DML only in moderate CTS group. Conclusion: In this study, it was shown that mild and moderate CTS patients had an improvement in pain and electrophysiological parameters after vitamin D replacement. Replacing vitamin D in early stages of CTS may be beneficial.

Resumo Objetivo: Os efeitos da vitamina D no sistema nervoso central e periférico continuam sendo investigados atualmente. Neste estudo, objetivamos avaliar a dor e a resposta eletrofisiológica em pacientes com síndrome do túnel do carpo (STC) submetidos a terapia de reposição devido à deficiência de vitamina D. Métodos: Cinquenta pacientes do sexo feminino diagnosticadas com STC leve e moderada e acompanhadas de deficiência de vitamina D foram incluídas neste estudo. O estudo da condução nervosa (ECN) foi realizado antes e após a reposição da vitamina D, e a dor do paciente foi avaliada com a Escala Visual Analógica (EVA). Resultados: Quando a ECN foi comparada antes e após o tratamento, houve uma melhora estatisticamente significativa na latência mediana do início sensorial distal (DSOL) e nos valores de velocidade de condução sensorial (VC) e latência distal motora (LDM) (p=0,001; p<0,001; p=0,001, respectivamente). Ao mesmo tempo, houve uma diminuição dos valores da EVA nos pacientes (p<0,001). Quando os dois grupos foram comparados, houve uma melhora no DSOL e no VC sensorial em ambos, mas no LDM apenas no grupo STC moderado. Conclusão: Neste estudo, foi demonstrado que pacientes com STC leve e moderada apresentaram melhora da dor e parâmetros eletrofisiológicos após a reposição de vitamina D. A substituição da vitamina D nos estágios iniciais da STC pode ser benéfica.

The relationship between exposure to hot/cold weather and the clinical features of headaches in patients with migraine and tension-type headaches.

Background and purpose: This study investigates the relationship between exposure to hot/cold weather and the characteristic clinical features of headaches in patients with migraine and tension-type headaches.Methods: This cross-sectional study was conducted with the participation of 190 patients with migraine, and 140 patients with tension-type headaches. The patients were evaluated using a form that collected data on their sociodemographic profile, the clinical features of their headaches, any accompanying symptoms and their relationships with changes in the weather (hot/cold). The headaches of all the participants in the study were thought to be triggered by exposure to hot/cold weather.Results: In the patients with migraine, the exposure to hot/cold weather as a trigger was not found to have a significant relationship with age, body mass index or the characteristic clinical features of headaches (p > 0.05). In patients with tension-type headaches, exposure to hot/cold weather as a trigger was found to have a significant relationship with body mass index (p = 0.019), but not with age or the characteristic clinical features of headaches (p > 0.05).Conclusions: In obese patients with tension-type headache, it was found that hot weather triggered headache more than cold weather. In patients with migraine and tension-type headaches, no relationship was found between exposure to hot/cold weather as a trigger and the clinical features of headaches. The accurate identification of the factors precipitating headaches by both clinicians and patients can help lower the frequency of headaches.

Anger and impulsiveness in migraine patients with and without aura.

Background and purpose: Migraine is a common primary headache disorder triggered by internal or external stimuli. Impulsitivity and anger are associated with many neurological and psychiatric disorders. The aim of this study was to investigate the anger and impulsivity in migraine patients with or without aura.Methods: A total of 55 patients aged between 18 and 55, who were diagnosed with episodic migraine (31 with aura and 24 without aura) and 40 healthy controls were enrolled in this prospective cross-sectional study.Migraine diagnosis and classification were based on criteria from the International Classification of Headache Disorders, 3rd edition (beta version). Multidimensional Anger Scale and Barratt Impulsivity Scale-11 were administered to the patient and control groups.Results:Migraine patients with aura, migraine patients without aura and control groups were compared, anger symptoms were significantly higher in migraine patients with aura (p < 0.001), but between these groups there was no significant difference in terms of impulsivity (p = 0.711).Conclusions: It was found that anger symptoms were more common in migraine patients with aura compared to migraine patients without aura and control group, but in impulsitivity there was no difference between groups.Further studies in future investigating the relation between migraine with aura and anger may pave the way for different and more specified treatment approach.

Comparison of patients with migraine and tension-type headache in terms of somatosensory amplification and health anxiety.

INTRODUCTION: Although it is known that anxiety and depressive disorders frequently accompany migraine and TTH, the role of somatic amplification (SSA) and health anxiety in these diseases is not adequately known. OBJECTIVE: The aim of this study is to compare SSA and health anxiety in patients with migraine or TTH, and healthy controls and to investigate the relationships between SSA, health anxiety, headache characteristics, anxiety and depressive symptoms. METHODS: Fifty-four migraine, 50 TTH patients from the outpatient unit of the neurology department and 53 healthy volunteers were recruited for the study. The somatosensory amplification scale (SSAS), health anxiety inventory, Beck depression (BDI) and anxiety inventory (BAI) were administered to all participants. RESULTS: The SSAS scores were significantly higher in migraineurs compared with the healthy controls. The health anxiety scores were significantly higher in both migraine and TTH groups. The BDI and BAI scores were also significantly higher in migraine and TTH groups compared with the controls. A significant positive correlation was found between headache frequency and BAI scores, the visual analogue scale scores and SSAS and BDI scores in migraineurs. The SSAS scores were also significantly correlated with the BDI and BAI scores in both of the headache groups. A similar correlation was determined with the health anxiety scores. CONCLUSIONS: While patients with migraine and TTH evalute, taking into account the SSA and health anxiety may contribute to the prognosis and treatment of these diseases.

Vitamin D, vitamin D binding protein, vitamin D receptor levels and cardiac dysautonomia in patients with multiple sclerosis: a cross-sectional study / Vitamina D, proteína de ligação à vitamina D, níveis de receptores de vitamina D e disautonomia cardíaca em pacientes com esclerose múltipla: um estudo transversal

ABSTRACT Vitamin D is a pleiotropic steroid hormone that modulates the autonomic balance. Its deficiency has been described as an environmental risk factor for multiple sclerosis (MS). The aim of this study was to investigate the serum levels of vitamin D, vitamin D binding protein (VDBP) and vitamin D receptors (VDR) and to evaluate cardiac dysautonomia in MS patients due to bidirectional interaction between vitamin D and the autonomic nervous system. Methods: The current cross-sectional study was conducted on 26 patients with relapsing-remitting MS and on 24 healthy controls. Twenty-four-hour ambulatory blood pressure variability (BPV) was calculated and the participants were evaluated for orthostatic hypotension and supine hypertension. Serum levels of vitamin D, VDBP and VDR were measured. Results: The mean serum vitamin D level was significantly lower in MS patients than in controls (p = 0.044); however there was no significant difference in terms of VDR and VDBP levels between the groups. Supine hypertension and orthostatic hypotension were significant and the 24-hour systolic BPV was significantly decreased in patients with MS (p < 0.05) compared to controls. No correlation was found between vitamin D, VDBP and VDR with supine hypertension, orthostatic hypotension and systolic BPV values (p > 0.05). Also, there was a negative correlation between VDBP and the EDSS (p = 0.039, r = −0.406). Conclusion: There was no correlation between orthostatic hypotension, supine hypertension and systolic BPV values and serum vitamin D, VDBP and VDR in MS patients. Future prospective studies with large number of patients may help us to better understand the relationship between vitamin D and the autonomic nervous system.

RESUMO A vitamina D é um hormônio esteroide pleiotrópico que modula o equilíbrio autonômico. Sua deficiência tem sido descrita como fator de risco ambiental para esclerose múltipla (EM). O objetivo deste estudo foi investigar os níveis séricos de vitamina D, proteína de ligação à vitamina D (VDBP) e receptor de vitamina D (VDR) e avaliar a disautonomia cardíaca em pacientes com EM devida à interação bidirecional entre vitamina D e sistema nervoso autônomo. Métodos: O presente estudo transversal foi realizado em 26 pacientes com EM remitente-recorrente e em 24 controles saudáveis. A variabilidade da pressão arterial ambulatorial (BPV) por 24 horas foi calculada e os participantes foram avaliados quanto à hipotensão ortostática e hipertensão supina. Os níveis séricos de vitamina D, VDBP e VDR foram medidos. Resultados: O nível sérico médio de vitamina D foi significativamente menor nos pacientes com EM do que nos controles (p = 0,044); no entanto, não houve diferença significativa em termos de níveis de VDR e VDBP entre os grupos. Hipertensão supina e hipotensão ortostática foram significativas e a BPV sistólica de 24 horas diminuiu significativamente em pacientes com EM (p < 0,05) em comparação aos controles. Não foi encontrada correlação entre vitamina D, VDBP e VDR com hipertensão supina, hipotensão ortostática e BPV sistólica (p > 0,05). Também houve correlação negativa entre VDBP e EDSS (p = 0,039, r = −0,406). Conclusão: Não houve correlação entre hipotensão ortostática, hipertensão supina e valores de BPV sistólica e vitamina D sérica, VDBP e VDR em pacientes com EM. Futuros estudos prospectivos com grande número de pacientes podem nos ajudar a entender melhor a relação entre vitamina D e sistema nervoso autônomo.

Comparison of patients with migraine and tension-type headache in terms of somatosensory amplification and health anxiety / Estudo comparativo de pacientes com enxaqueca e cefaleia do tipo tensional em relação à amplificação somatossensorial e à ansiedade associada à saúde

ABSTRACT Although it is known that anxiety and depressive disorders frequently accompany migraine and TTH, the role of somatic amplification (SSA) and health anxiety in these diseases is not adequately known. Objective: The aim of this study is to compare SSA and health anxiety in patients with migraine or TTH, and healthy controls and to investigate the relationships between SSA, health anxiety, headache characteristics, anxiety and depressive symptoms. Methods: Fifty-four migraine, 50 TTH patients from the outpatient unit of the neurology department and 53 healthy volunteers were recruited for the study. The somatosensory amplification scale (SSAS), health anxiety inventory, Beck depression (BDI) and anxiety inventory (BAI) were administered to all participants. Results: The SSAS scores were significantly higher in migraineurs compared with the healthy controls. The health anxiety scores were significantly higher in both migraine and TTH groups. The BDI and BAI scores were also significantly higher in migraine and TTH groups compared with the controls. A significant positive correlation was found between headache frequency and BAI scores, the visual analogue scale scores and SSAS and BDI scores in migraineurs. The SSAS scores were also significantly correlated with the BDI and BAI scores in both of the headache groups. A similar correlation was determined with the health anxiety scores. Conclusions: While patients with migraine and TTH evalute, taking into account the SSA and health anxiety may contribute to the prognosis and treatment of these diseases.

RESUMO Embora se saiba que os distúrbios de ansiedade e depressão frequentemente acompanhem a enxaqueca e a TTH, o papel da amplificação somatossensorial (somatosensory amplification, SSA) e da hipocondria nessas doenças ainda não é bem conhecido. Objetivo: O presente estudo faz uma comparação entre pacientes que sofrem de enxaqueca e TTH com um grupo de controle saudável em termos de SSA e hipocondria e investiga a relação entre os achados e as características da cefaleia, a ansiedade e os sintomas depressivos. Métodos: O estudo incluiu 54 pacientes com enxaqueca, 50 pacientes com TTH e 53 voluntários saudáveis que se cadastraram na clínica de neurologia. A escala de amplificação somatossensorial (somatosensory amplification scale, SSAS), o inventário de hipocondria, o Inventário de Depressão de Beck (Beck Depression Inventory, BDI) e o Inventário de Ansiedade de Beck (Beck Anxiety Inventory, BAI) foram aplicados aos participantes. Resultados: Quando comparados com os controles saudáveis, as pontuações da SSAS dos pacientes com enxaqueca foram significativamente maiores, enquanto as pontuações de hipocondria foram significativamente maiores em ambos os grupos de enxaqueca e TTH. As pontuações do BAI e do BDI foram significativamente maiores em ambos os grupos de pacientes que no grupo de controle. No grupo da enxaqueca, foi identificada uma correlação positiva entre frequência de cefaleia e ansiedade, bem como entre a Escala Analógica Visual (EVA), a SSAS e a depressão. Em ambos os grupos de pacientes, a SSA foi correlacionada positivamente com a depressão e a ansiedade, e uma correlação semelhante foi encontrada entre a SSA e a hipocondria. Conclusão: Em avaliações dessas doenças, a hipocondria e a SSA devem ser levadas em consideração, pois se acredita que essa abordagem possa contribuir positivamente para o prognóstico e tratamento da doença.

Vitamin D, vitamin D binding protein, vitamin D receptor levels and cardiac dysautonomia in patients with multiple sclerosis: a cross-sectional study.

OBJECTIVES: Vitamin D is a pleiotropic steroid hormone that modulates the autonomic balance. Its deficiency has been described as an environmental risk factor for multiple sclerosis (MS). The aim of this study was to investigate the serum levels of vitamin D, vitamin D binding protein (VDBP) and vitamin D receptors (VDR) and to evaluate cardiac dysautonomia in MS patients due to bidirectional interaction between vitamin D and the autonomic nervous system. METHODS: The current cross-sectional study was conducted on 26 patients with relapsing-remitting MS and on 24 healthy controls. Twenty-four-hour ambulatory blood pressure variability (BPV) was calculated and the participants were evaluated for orthostatic hypotension and supine hypertension. Serum levels of vitamin D, VDBP and VDR were measured. RESULTS: The mean serum vitamin D level was significantly lower in MS patients than in controls (p = 0.044); however there was no significant difference in terms of VDR and VDBP levels between the groups. Supine hypertension and orthostatic hypotension were significant and the 24-hour systolic BPV was significantly decreased in patients with MS (p < 0.05) compared to controls. No correlation was found between vitamin D, VDBP and VDR with supine hypertension, orthostatic hypotension and systolic BPV values (p > 0.05). Also, there was a negative correlation between VDBP and the EDSS (p = 0.039, r = -0.406). CONCLUSION: There was no correlation between orthostatic hypotension, supine hypertension and systolic BPV values and serum vitamin D, VDBP and VDR in MS patients. Future prospective studies with large number of patients may help us to better understand the relationship between vitamin D and the autonomic nervous system.