Beamline simulations using monochromators with high d-spacing crystals.

Monochromators for synchrotron radiation beamlines typically use perfect crystals for the hard X-ray regime and gratings for soft X-rays. There is an intermediate range, typically 1-3 keV (tender X-rays), which common perfect crystals have difficulties covering and gratings have low efficiency, although some less common crystals with high d-spacing could be suitable. To evaluate the suitability of these crystals for a particular beamline, it is useful to evaluate the crystals' performance using tools such as ray-tracing. However, simulations for double-crystal monochromators are only available for the most used crystals such as Si, Ge or diamond. Here, an upgrade of the SHADOW ray-tracing code and complementary tools in the OASYS suite are presented to simulate high d-spacing crystals with arbitrary, and sometimes complex, structures such as beryl, YB66, muscovite, etc. Isotropic and anisotropic temperature factors are also considered. The YB66 crystal with 1936 atomic sites in the unit cell is simulated, and its applicability for tender X-ray monochromators is discussed in the context of new low-emittance storage rings.

Calcitonin gene-related peptide in migraine: from pathophysiology to treatment.

INTRODUCTION: It has been observed in recent years that levels of such molecules as calcitonin gene-related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase-activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients' migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity. DEVELOPMENT: The Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics. CONCLUSIONS: The clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.

1st Post-European Headache Federation Meeting: a review of the latest developments presented at the 2020 European Headache Federation Congress. / I Reunión Post-European Headache Federation: revisión de las novedades presentadas en el Congreso de la European Headache Federation de 2020.

INTRODUCTION: After the European Headache Federation (EHF) Congress, renowned Spanish neurologists specialised in migraine presented the most significant latest developments in research in this field at the Post-EHF Meeting. DEVELOPMENT: The main data presented concerning the treatment of chronic and episodic migraine were addressed, with attention paid more specifically to those related to preventive treatments and real-life experience in the management of the disease. An important review was carried out of the new therapeutic targets and the possibilities they offer in terms of understanding the pathophysiology of migraine and its treatment. An update was also presented of the latest developments in the treatment of migraine with fremanezumab, a monoclonal antibody recently authorised by the European Medicines Agency. Participants were also given an update on the latest developments in basic research on the pathology, as well as an overview of the symptoms of migraine and COVID-19. Finally, the repercussions of migraine in terms of its burden on the care and economic resources of the health system were addressed, along with its impact on society. CONCLUSIONS: The meeting summarised the content presented at the 14th EHF Congress, which took place in late June/early July 2020.

TITLE: I Reunión Post-European Headache Federation: revisión de las novedades presentadas en el Congreso de la European Headache Federation de 2020.Introducción. Tras la celebración del congreso de la European Headache Federation (EHF), reconocidos neurólogos españoles expertos en el tratamiento de la migraña expusieron en la Reunión Post-EHF las principales novedades presentadas en el congreso y relacionadas con ese ámbito. Desarrollo. Se abordan los principales datos presentados relacionados con el tratamiento de la migraña crónica y episódica; concretamente, los relacionados con los tratamientos preventivos y la experiencia en vida real en el manejo de la enfermedad. Se hizo una importante revisión de las nuevas dianas terapéuticas y las posibilidades que ofrecen en cuanto al conocimiento de la fisiopatología de la migraña y su tratamiento. Asimismo, se hizo una actualización de las novedades presentadas en el tratamiento de la migraña con fremanezumab, anticuerpo monoclonal recientemente autorizado por la Agencia Europea de Medicamentos. Se hizo una actualización de las novedades en investigación básica en la patología, así como una relación de los síntomas de migraña y COVID-19. Finalmente, se abordaron las implicaciones de la migraña en la carga sanitaria asistencial y económica, y su impacto en la sociedad. Conclusiones. En la reunión se hizo un resumen del contenido presentado en el 14 Congreso de la EHF, que tuvo lugar a finales de junio y principios de julio de 2020.

Document of revision and updating of medication overuse headache (MOH). / Documento de revisión y actualización de la cefalea por uso excesivo de medicación (CUEM).

INTRODUCTION: Medication overuse headache is a secondary headache in which the regular or frequent use of analgesics can increase the frequency of the episodes, causing the transition from episodic to chronic headache. The prevalence of medication overuse headache is approximately 1-2%, with higher rates among women aged 30-50 years and with comorbid psychiatric disorders such as depression or anxiety, or other chronic pain disorders. It is important to be familiar with the management of this disease. To this end, the Spanish Society of Neurology's Headache Study Group has prepared a consensus document addressing this disorder. DEVELOPMENT: These guidelines were prepared by a group of neurologists specialising in headache after a systematic literature review and provides consensus recommendations on the proper management and treatment of medication overuse headache. The treatment of medication overuse headache is often complex, and is based on 4 fundamental pillars: education and information about the condition, preventive treatment, discontinuation of the drug being overused, and treatment for withdrawal symptoms. Follow-up of patients at risk of recurrence is important. CONCLUSIONS: We hope that this document will be useful in daily clinical practice and that it will update and improve understanding of medication overuse headache management.

Evidencia y experiencia del uso de onabotulinumtoxinA en neuralgia del trigémino y cefaleas primarias distintas de la migraña crónica / Evidence of and experience with the use of onabotulinumtoxinA in trigeminal neuralgia and primary headaches other than chronic migraine

INTRODUCCIÓN: En el campo de las cefaleas, onabotulinumtoxinA (onabotA) tiene indicación bien establecida en la migraña crónica (MC). Además, en los últimos años su uso se está extendiendo a otras cefaleas primarias (migraña episódica de alta frecuencia, cefaleas trigémino-autonómicas, cefalea numular) y a la neuralgia del trigémino. Al ser una opción terapéutica que se va a ir incorporando de forma progresiva en el manejo de estas entidades, creemos que es necesario reflejar con un carácter eminentemente práctico cuáles son las posibles indicaciones de onabotA, más allá de la MC, así como su protocolo de administración, que diferirá en función del tipo de cefalea y/o neuralgia. DESARROLLO: A partir de una revisión de la bibliografía existente y de nuestra propia experiencia clínica, se ha elaborado este documento de consenso cuyo objetivo es servir de guía a aquellos profesionales que quieran aplicar estas técnicas en su actividad asistencial. En la primera parte se abordará el mecanismo de acción de onabotA y la razón de su utilización en diversas cefaleas distintas de la MC desde un punto de vista fisiopatológico y clínico. En la segunda parte se hará una revisión de la evidencia disponible y los estudios publicados en los últimos años. Para cada una de estas entidades, se añadirá una «recomendación de experto», basada en la propia experiencia clínica, que refleje el perfil de paciente que puede ser candidato a este tratamiento, las dosis y el protocolo de administración de onabotA. CONCLUSIÓN: El tratamiento con onabotA en entidades distintas a la MC debe ser siempre individualizado y se planteará en pacientes seleccionados que no hayan respondido a la terapia convencional

INTRODUCTION: In the field of headaches, onabotulinumtoxinA (onabotA) is well established as a treatment for chronic migraine (CM). In recent years, it has been used increasingly to treat other primary headaches (high-frequency episodic migraine, trigeminal-autonomic cephalalgias, nummular headache) and trigeminal neuralgia. As this treatment will progressively be incorporated in the management of these patients, we consider it necessary to reflect, with a fundamentally practical approach, on the possible indications of onabotA, beyond CM, as well as its administration protocol, which will differ according to the type of headache and/or neuralgia. DEVELOPMENT: This consensus document was drafted based on a thorough review and analysis of the existing literature and our own clinical experience. The aim of the document is to serve as guidelines for professionals administering onabotA treatment. The first part will address onabotA's mechanism of action, and reasons for its use in other types of headache, from a physiopathological and clinical perspective. In the second part, we will review the available evidence and studies published in recent years. We will add an "expert recommendation" based on our own clinical experience, showing the best patient profile for this treatment and the most adequate dose and administration protocol. CONCLUSION: Treatment with onabotA should always be individualised and considered in selected patients who have not responded to conventional therapy

Evaluation of the concomitant use of oral preventive treatments and onabotulinumtoxinA in chronic migraine: the PREVENBOX study.

BACKGROUND AND PURPOSE: OnabotulinumtoxinA is an effective preventive treatment for chronic migraine (CM). In CM, in addition to a reduction in headache frequency, a decreased reliance on oral prophylactics is also indicative of treatment effectiveness. This study aimed to quantify the change in the use of oral prophylactics after treatment with onabotulinumtoxinA in patients with CM. METHODS: This was a retrospective, multicentric, cross-sectional study. Patients with CM (International Classification of Headache Disorders-3beta) that had been treated with onabotulinumtoxinA were enrolled consecutively. We collected parameters related to each patient's pre-treatment situation, as well as their current situation, focusing on frequency and intensity of migraine, number of oral prophylactics and the respective cycle of onabotulinumtoxinA. Univariate and logistic regression analyses were performed. RESULTS: We included 542 patients, 90.0% of whom were taking oral preventive treatments. During treatment with onabotulinumtoxinA, 47.8% withdrew at least one prophylactic and 41.6% stopped using oral prophylactics altogether. Factors associated with a reduction or cessation of oral prophylactics were >50% improvement in frequency and intensity, remission to episodic migraine, use of topiramate as an initial treatment, increased number of infiltrations and shorter chronification period (P < 0.05). The multivariate analysis showed that a chronification period <20 months, more than five cycles of onabotulinumtoxinA, >50% improvement in pain intensity and topiramate as an initial treatment were predictors of a reduction in oral prophylactics (area under the curve, 70.3%; P < 0.001). CONCLUSIONS: Our study demonstrated the efficacy and safety of onabotulinumtoxinA. This treatment reduced the use of oral prophylactics. Withdrawal of oral prophylactics was most likely to occur after five cycles of treatment.

Evidence of and experience with the use of onabotulinumtoxinA in trigeminal neuralgia and primary headaches other than chronic migraine. / Evidencia y experiencia del uso de onabotulinumtoxinA en neuralgia del trigémino y cefaleas primarias distintas de la migraña crónica.

INTRODUCTION: In the field of headaches, onabotulinumtoxinA (onabotA) is well established as a treatment for chronic migraine (CM). In recent years, it has been used increasingly to treat other primary headaches (high-frequency episodic migraine, trigeminal-autonomic cephalalgias, nummular headache) and trigeminal neuralgia. As this treatment will progressively be incorporated in the management of these patients, we consider it necessary to reflect, with a fundamentally practical approach, on the possible indications of onabotA, beyond CM, as well as its administration protocol, which will differ according to the type of headache and/or neuralgia. DEVELOPMENT: This consensus document was drafted based on a thorough review and analysis of the existing literature and our own clinical experience. The aim of the document is to serve as guidelines for professionals administering onabotA treatment. The first part will address onabotA's mechanism of action, and reasons for its use in other types of headache, from a physiopathological and clinical perspective. In the second part, we will review the available evidence and studies published in recent years. We will add an "expert recommendation" based on our own clinical experience, showing the best patient profile for this treatment and the most adequate dose and administration protocol. CONCLUSION: Treatment with onabotA should always be individualised and considered in selected patients who have not responded to conventional therapy.

Evidencia y experiencia de bótox en migraña crónica: Recomendaciones para la práctica clínica diaria / Evidence and experience with onabotulinumtoxinA in chronic migraine: Recommendations for daily clinical practice

OnabotulinumtoxinA ha demostrado ser eficaz como tratamiento preventivo en pacientes con migraña crónica (MC). El Grupo de Estudio de Cefalea de la Sociedad Española de Neurología ha considerado que sería de interés, a los 5 años de la aprobación en España de la onabotulinumtoxinA, reunir a un grupo de expertos en el tratamiento de pacientes con MC para elaborar con la evidencia actual y nuestra experiencia unas recomendaciones dirigidas a facilitar su uso en la práctica clínica diaria. Con este fin planteamos 12 preguntas que nos hacemos como médicos y que también nos realizan nuestros pacientes. Cada autor ha contestado una pregunta y luego el documento ha sido revisado por todos. Esperamos que esta revisión constituya una herramienta práctica para ayudar a los neurólogos que tratan a pacientes con MC

OnabotulinumtoxinA has been demonstrated to be effective as a preventive treatment in patients with chronic migraine (CM). Five years after the approval of onabotulinumtoxinA in Spain, the Headache Study Group of the Spanish Society of Neurology considered it worthwhile to gather a group of experts in treating patients with CM in order to draw up, based on current evidence and our own experience, a series of guidelines aimed at facilitating the use of the drug in daily clinical practice. For this purpose, we posed 12 questions that we ask ourselves as doctors, and which we are also asked by our patients. Each author responded to one question, and the document was then reviewed by everyone. We hope that this review will constitute a practical tool to help neurologists treating patients with CM

Calcitonin gene-related peptide in migraine: from pathophysiology to treatment. / CGRP en migraña: de la fisiopatología a la terapéutica.

INTRODUCTION: It has been observed in recent years that levels of such molecules as calcitonin gene-related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase-activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients' migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity. DEVELOPMENT: The Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics. CONCLUSIONS: The clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.

Evidence and experience with onabotulinumtoxinA in chronic migraine: Recommendations for daily clinical practice. / Evidencia y experiencia de bótox en migraña crónica: Recomendaciones para la práctica clínica diaria.

OnabotulinumtoxinA has been demonstrated to be effective as a preventive treatment in patients with chronic migraine (CM). Five years after the approval of onabotulinumtoxinA in Spain, the Headache Study Group of the Spanish Society of Neurology considered it worthwhile to gather a group of experts in treating patients with CM in order to draw up, based on current evidence and our own experience, a series of guidelines aimed at facilitating the use of the drug in daily clinical practice. For this purpose, we posed 12 questions that we ask ourselves as doctors, and which we are also asked by our patients. Each author responded to one question, and the document was then reviewed by everyone. We hope that this review will constitute a practical tool to help neurologists treating patients with CM.

Utilidad del campo magnético y el láser en el tratamiento de la parálisis facial periférica idiopática / Usefulness of magnetic field and laser for the treatment of idiopathic peripheral facial palsy

Objetivos: Determinar si la terapia combinada de campo magnético (CM) y láser con la terapia convencional (TC) es más beneficiosa para el proceso de recuperación de una parálisis facial periférica idiopática (PFPI) que la aplicación de cada uno de estos 2 agentes físicos por separado con la TC. Métodos Se realizó un estudio prospectivo, aleatorizado y controlado a simple ciego. Fueron incluidos 153 pacientes con PFPI que tuvieran menos de una semana de evolución desde la instalación de los síntomas y que no hubieran recibido tratamiento fisioterapéutico previo. Los pacientes se distribuyeron al azar en 4 grupos de estudio según el tratamiento: grupo A: TC; grupo B: láser + TC; grupo C: CM + TC, y grupo D: CT + láser + CM. La variable de salida que se utilizó para evaluar los resultados del tratamiento fue la escala de Sunnybrook. Los pacientes se evaluaron antes del tratamiento, al mes y a los 3 meses. Resultados Los pacientes de los grupos C y D mostraron una mejor recuperación que aquellos de los grupos A y B (mayor valor en la escala de Sunnybrook y menos sincinesias). Específicamente, los pacientes del grupo D tuvieron resultados más ventajosos en el proceso de recuperación a los 3 meses. Conclusiones La aplicación del tratamiento combinado de TC, láser y CM resultó más beneficiosa que la combinación de cada uno de estos 2 agentes físicos por separado con la TC (AU)

Objectives: To evaluate if the combination of magnetic field (MF) and laser therapy with conventional therapy (CT) is more beneficial for the recovery process of idiopathic peripheral facial palsy (IPFP) than the separate application of each one of these two physical agents with CT. Methods: A prospective, randomized and controlled simple blinded study was conducted. The study included 153 patients with IPFP having less than one week of evolution from symptom onset and no previous physiotherapy treatment. The patients were randomly distributed into4 study groups according to treatment: A) CT, B) laser + CT, C) MF + CT, and D) CT + laser+ MF. Outcome variable used to evaluate treatment was the Sunnybrook scale. Patients were evaluated before initiating treatment, and at one and 3 months after treatment. Results: Patients in groups C and D displayed a better outcome than those in groups A and B(higher Sunnybrook score and less syncinesia). Specifically, patients in group D exhibited the best overall recovery at 3 months. Conclusions: Combined treatment with CT+laser+MF was more beneficial than the separate combination of each one of these two physical agents with CT (AU)

Application of spatially resolved high resolution crystal spectrometry to inertial confinement fusion plasmas.

High resolution (λ∕Δλ ∼ 10 000) 1D imaging x-ray spectroscopy using a spherically bent crystal and a 2D hybrid pixel array detector is used world wide for Doppler measurements of ion-temperature and plasma flow-velocity profiles in magnetic confinement fusion plasmas. Meter sized plasmas are diagnosed with cm spatial resolution and 10 ms time resolution. This concept can also be used as a diagnostic of small sources, such as inertial confinement fusion plasmas and targets on x-ray light source beam lines, with spatial resolution of micrometers, as demonstrated by laboratory experiments using a 250-µm (55)Fe source, and by ray-tracing calculations. Throughput calculations agree with measurements, and predict detector counts in the range 10(-8)-10(-6) times source x-rays, depending on crystal reflectivity and spectrometer geometry. Results of the lab demonstrations, application of the technique to the National Ignition Facility (NIF), and predictions of performance on NIF will be presented.

Tratamiento combinado de campo magnético, láser, masaje y ejercicio en la parálisis facial periférica idiopática / Combined treatment of magnetic field, laser, massage and exercise in idiopathic peripheral facial paralysis

Introducción Las diferencias de criterios en cuanto a la utilización de agentes físicos en la parálisis facial periférica ha fomentado la realización de diversas investigaciones que permiten proponer nuevas alternativas de tratamiento, como son el uso de nuevos agentes físicos que han probado su eficacia en otras patologías con similitud de fisiopatogenia. Los tratamientos actuales buscan acelerar la mejoría y aumentar el porcentaje de personas recuperadas. Objetivos Evaluar la efectividad que tendría el tratamiento con campo magnético y láser en pacientes con parálisis facial periférica idiopática con menos de una semana de evolución, desde la instalación de los síntomas, sin tratamiento fisioterapéutico previo. Métodos Se realizó un estudio prospectivo, experimental, aleatorizado y controlado a simple ciego en el Servicio de Terapia Física y Rehabilitación del Instituto de Neurología y Neurocirugía (INN) en La Habana, en un periodo comprendido entre enero de 2009 y enero de 2011.ResultadosLos pacientes fueron evaluados al inicio, al mes y a los 3 meses del tratamiento, después de lo cual se comprobó una recuperación más rápida en el grupo experimental con respecto al grupo control, al mes (p=0,004075) y (Z=2,87232) y a los 3 meses (p=0,007859) y (Z=2,65810).Conclusiones Los pacientes que recibieron la terapia combinada de campo magnético, láser, masaje y ejercicios tuvieron una recuperación más rápida respecto al grupo que solo recibió masaje y ejercicio, lo cual corrobora que la terapia propuesta es efectiva en los pacientes con parálisis facial periférica idiopática(AU)

Introduction The different criteria regarding the use of physical agents in peripheral facial paralysis has fostered the performance of various investigations that make it possible to propose new treatment alternatives, such as the use of new physical agents that have proven effective in other conditions with similarity to pathogenesis. Current treatments are aimed at accelerating improvement and increasing the number of people who recovered. Objectives To evaluate the effectiveness that the low frequency electromagnetic field and low level laser therapy would have in patients with idiopathic peripheral facial paralysis with less than one week's evolution from the initiation of the symptoms, without previous physiotherapy. Methods A prospective, experimental, randomized, controlled single blind study was conducted in the Department of Physiotherapy and Rehabilitation, Institute of Neurology and Neurosurgery (INN) in Havana, in a period between January 2009 and January 2011.ResultsPatients were evaluated at baseline, one month and three months of treatment, after which faster recovery was verified in the experimental group compared to the control group at one month (P=.004075) and (Z=2.87232) and at three months (P=.007859) and (Z=2.65810).Conclusions The patients who received combined therapy, magnetic field, laser, massage and exercise had a faster recovery than the group that received massage and exercise alone. This collaborates that the proposed therapy is effective in patients with idiopathic peripheral facial paralysis (AU)

A novel zirconium Kα imager for high energy density physics research.

We report on the development and characterization of a zirconium Kα imager for high energy density physics research. The imager consists of a spherically bent quartz crystal operating at 15.7 keV photon energy. We compare the performance of the imager in terms of integrated reflectivity (R(int)) and temperature dependent collection efficiency (η(Te)) to that of the widely used Cu Kα imager. Our collisional-radiative simulations show that the new imager can be reliably used up to 250 eV plasma temperature. Monte Carlo simulations show that for a 25 µm thick tracer layer of zirconium, the contribution to Kα production from photo-pumping is only 2%. We present, for the first time, 2D spatially resolved images of zirconium plasmas generated by a high intensity short pulse laser interacting with Zr solid targets.

Neurophysiological tests and neuroimaging procedures in non-acute headache (2nd edition).

BACKGROUND AND PURPOSE: A large number of instrumental investigations are used in patients with non-acute headache in both research and clinical fields. Although the literature has shown that most of these tools contributed greatly to increasing understanding of the pathogenesis of primary headache, they are of little or no value in the clinical setting. METHODS: This paper provides an update of the 2004 EFNS guidelines and recommendations for the use of neurophysiological tools and neuroimaging procedures in non-acute headache (first edition). Even though the period since the publication of the first edition has seen an increase in the number of published papers dealing with this topic, the updated guidelines contain only minimal changes in the levels of evidence and grades of recommendation. RESULTS: (i) Interictal EEG is not routinely indicated in the diagnostic evaluation of patients with headache. Interictal EEG is, however, indicated if the clinical history suggests a possible diagnosis of epilepsy (differential diagnosis). Ictal EEG could be useful in certain patients suffering from hemiplegic or basilar migraine. (ii) Recording evoked potentials is not recommended for the diagnosis of headache disorders. (iii) There is no evidence warranting recommendation of reflex responses or autonomic tests for the routine clinical examination of patients with headache. (iv) Manual palpation of pericranial muscles, with standardized palpation pressure, can be recommended for subdividing patient groups but not for diagnosis. Pain threshold measurements and EMG are not recommended as clinical diagnostic tests. (v) In adult and pediatric patients with migraine, with no recent change in attack pattern, no history of seizures, and no other focal neurological symptoms or signs, the routine use of neuroimaging is not warranted. In patients with trigeminal autonomic cephalalgia, neuroimaging should be carefully considered and may necessitate additional scanning of intracranial/cervical vasculature and/or the sellar/orbital/(para)nasal region. In patients with atypical headache patterns, a history of seizures and/or focal neurological symptoms or signs, MRI may be indicated. (vi) If attacks can be fully accounted for by the standard headache classification (IHS), a PET or SPECT scan will normally be of no further diagnostic value. Nuclear medical examinations of the cerebral circulation and metabolism can be carried out in subgroups of patients with headache for the diagnosis and evaluation of complications, when patients experience unusually severe attacks or when the quality or severity of attacks has changed. (vii) Transcranial Doppler examination is not helpful in headache diagnosis. CONCLUSION: Although many of the examinations described in the present guidelines are of little or no value in the clinical setting, most of the tools, including thermal pain thresholds and transcranial magnetic stimulation, have considerable potential for differential diagnostic evaluation as well as for the further exploration of headache pathophysiology and the effects of pharmacological treatment.

Migraines with and without aura and their response to preventive therapy with topiramate.

Data from the Prolonged Migraine Prevention (PROMPT) with Topiramate trial were evaluated post hoc to determine whether topiramate could prevent migraine auras, and whether its efficacy in preventing migraine headaches was similar in patients with (MA; n = 269) and without (MoA; n = 542) aura. Migraines and auras were recorded during prospective baseline, 6-month open-label (OL) topiramate and 6-month double-blind (DB), placebo-controlled phases. In the last 28 OL days, migraines without aura and migraine auras decreased by 43.1% and 54.1%, respectively, in MA patients. MoA patients experienced a 44.3% reduction in migraines. In the DB phase, increases in migraines with placebo vs. topiramate were similar to the full study, but were generally not statistically significant, probably due to lack of power in the subgroup analysis. Similarly, there were no statistically significant changes in number of auras between groups. Thus, topiramate appears to reduce migraine auras in parallel with headache reductions, which are similar in patients with and without aura.

Evaluation and proposal for optimization of neurophysiological tests in migraine: part 2--neuroimaging and the nitroglycerin test.

Neuroimaging methods have been widely used in headache and migraine research. They have provided invaluable information on brain perfusion, metabolism and structure during and outside of migraine attacks, contributing to an improved understanding of the pathophysiology of the disorder. Human models of migraine attacks are indispensable tools in pathophysiological and therapeutic research. This review of neuroimaging methods and the attack-provoking nitroglycerin test is part an initiative by a task force within the EUROHEAD project (EU Strep LSHM-CT-2004-5044837-Workpackage 9) with the objective of critically evaluating neurophysiological tests used in migraine. The first part, presented in a companion paper, is devoted to electrophysiological methods, this second part to neuroimaging methods such as functional magnetic resonance imaging, positron emission tomography and voxel-based morphometry, as well as the nitroglycerin test. For each of these methods, we summarize the results, analyse the methodological limitations and propose recommendations for improved methodology and standardization of research protocols.

Ganglio intramamario metastásico como primera manifestación del cáncer de mama / Metastatic intramammary lymph node as the first manifestation of breast cancer

No disponible

Resonancia magnética funcional de la corteza visual: estudio de las relaciones entre la intensidad del estímulo y la respuesta BOLD / Functional magnetic resonante imaging of the visual cortex relation between stimulus intensity and bold response

Introducción. La investigación sobre la visión ocupa un lugar central en neurociencia. Nuevas técnicas de neuroimagen, como la resonancia magnética funcional (RMf), permiten aumentar el conocimiento sobre el funcionamiento del sistema visual rápidamente y de forma no invasiva. El presente estudio examina el efecto de pequeños cambios en la intensidad de un estímulo sobre la respuesta de la corteza visual. Objetivos. Analizar la reacción de la corteza visual ante diferentes intensidades de una fuente luminosa, y examinar las posibles diferencias en la respuesta BOLD entre controles y sujetos con fotofobia. Sujetos y métodos. Se realizo una RMf (3 T) a 20 controles y a 20 sujetos con fotofobia, durante la estimulación visual con diferentes intensidades de luz. Se cuantificó la respuesta BOLD, tanto el área como a la intensidad del cambio de señal, en el córtex occipital. Resultados. Se encontró una relación directa entre la intensidad de los estímulos y la respuesta de la corteza occipital, con cambios significativos en el área de activación y con tendencia similar (aunque no significativa) en la intensidad de la respuesta BOLD. Además, la respuesta cortical es más pronunciada en sujetos con fotofobia, sobre todo en intensidades bajas e intermedias. Conclusiones. La RMf se muestra como una técnica válida y robusta para el registro de respuestas consistentes y reproducibles entre distintos sujetos y grupos, tanto para el estudio del funcionamiento normal de la corteza occipital como en casos de respuesta anómala, lo que abre la posibilidad de utilizarla en estudios clínicos

Introduction. Visual system is a high interest topic in neuroscience research. The new neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), allow us to quickly improve our knowledge on the visual system using non-invasive methods. This work examines the effect of small changes in the intensity of a visual stimulus over the BOLD response in the visual cortex. Aims. To perform a detailed analysis of the visual cortex reaction to different intensities of a light source and to verify the ties between the intensity of the visual stimulus and the cortical response. Subjects and methods. Using fMRI (3 T), we registered BOLD response (area and intensity of the signal change) in 20 photophobic patients and 20 controls while viewing different stimulus intensities from a light source. Results. We found a direct relation between stimulus intensity and occipital response. We show that cortical reactivity is higher in patients with photophobia than normal controls, specially for the lower and medium intensities. Conclusions. fMRI is a valid and robust technique to register consistent and reproducible responses in different groups of subjects. It is useful for the study of normal cortex functioning as well as for clinical use