One simple question detects motion sickness susceptibility in migraine patients.

OBJECTIVE: To find out if motion sickness susceptibility (MSS) of vestibular migraine (VM) patients and migraine only (MO) patients can be reliably detected with a single simple question: "Can you read while travelling in a car without getting motion sick?". METHOD: Ninety-two definite VM and 58 MO patients and 74 healthy control (HC) subjects were asked about their MSS and about being able to read while riding in a car without becoming motion sick. A Motion Sickness Susceptibility Questionnaire (MSSQ-Short) including childhood (MSA), adulthood (MSB) and total (MST) parts was also administered to all participants. ROC curves of MSSQ-Short were prepared for "not being able to read in a car" as the gold standard. RESULTS: Mean MSA scores were significantly higher in both VM and MO patients than in HCs (p < 0.001), but their scores were not significantly different (p = 0.171). Mean MSB and MST scores were significantly higher in VM than in MO patients (p < 0.001) and both VM and MO patients had significantly higher scores than HCs (p < 0.001). MSA scores were significantly higher than MSB scores in MO patients (p < 0.001). All sections of the questionnaire were associated with high area-under-curve values for MSS detected by the question about being able to read in a car without becoming motion sick. CONCLUSION: We propose that all migraine patients could have the same level of MSS in childhood but MO patients are able to compensate over years, but VM patients are not. A quick way to determine MSS is to ask about the ability to read without becoming motion sickness while riding a car.

Video head impulse and suppression head impulse test in vestibular migraine.

BACKGROUND: Vestibular Migraine (VM) is a frequent cause of recurrent spontaneous vertigo. While some report a normal Video Head Impulse Test (vHIT) in VM, others observed abnormal results on this test. Whether or not methodological discrepancies could be the cause of these differences is not known. There are 2 vHIT methods: subjects fixating an earth-fixed target (HIMP paradigm) or a head-fixed target, the suppression head impulse test (SHIMP paradigm). OBJECTIVES: The present study aimed to compare VM patients against healthy controls on both HIMP and SHIMP in order to unravel any differences between them. METHODS: Forty-eight VM patients and 27 healthy controls tested with both the HIMP and SHIMP paradigm. Results: Our 48 VM patients showed mean VOR normal range gains in both the HIMP and SHIMP paradigms, although there were some VOR impairments in individual semicircular SCCs. VM patients with motion sickness had lower horizontal VOR gain than those without motion sickness, with the HIMP, but not the SHIMP paradigm. CONCLUSION: VM patients have normal VOR gain with either vHIT paradigm. SIGNIFICANCE: The clinical significance of this observation is that a definitely abnormal vHIT with either method is unlikely to be due to vestibular migraine and an alternative diagnosis should be sought.

Examination of eye movements during visual scanning of real-world images in Alzheimer's disease and amnestic mild cognitive impairment.

Available evidence shows that Alzheimer's disease (AD) patients display inefficiencies in visual scanning of their surroundings, directing their attention towards non-relevant aspects of scenes. Not much is known about eye movements during visual scanning in individuals with amnestic mild cognitive impairment (aMCI). Notably, a consensus has yet to be reached on this issue. Furthermore, prior research has indicated the existence of visual attention deficits in individuals diagnosed with AD and aMCI. The objective of this study was to examine the visual scanning patterns of individuals diagnosed with AD, aMCI, and healthy controls (HC) when viewing various scenes. Thirty patients with AD, 32 aMCI, and 32 HC were included in the study. A set of 30 real-life scene images were presented to the participants in the visual scanning task. Participants' eye events were monitored using the EyeLink 1000 Plus in this task. The results indicate a significant reduction in total fixation duration, number of scanned areas, fixation counts, and saccade counts in AD as compared to those with aMCI and HC. The research did not reveal any significant statistical differences in eye parameters between the aMCI and HC groups. This study found abnormalities in visual scanning in AD compared to aMCI and HC. Visual scanning patterns of aMCI patients were not different from HC. Previous studies have specifically shown visual attention difficulties in AD and MCI. Our findings may be related to visual attention difficulties in AD. In addition, this study is the first to examine visual scanning behaviour with real-world images in AD and aMCI.

Comparison of clinical features in patients with vestibular migraine and migraine.

Vestibular migraine (VM) is accepted as the most common cause of spontaneous episodic vertigo. In most patients, vestibular symptoms follow migraine headaches that begin earlier in life. The aim of this multicenter retrospective study was to find out the differences between migraine patients without any vestibular symptoms (MwoV) and VM patients and to delineate the specific clinical features associated with VM. MwoV and VM patients were compared regarding demographic features, migraine headache years, headache attack frequency, intensity, symptoms associated with headache and vertigo attacks, presence of menopause, history of motion sickness and family history of migraine. Four-hundred and forty patients with MwoV and 408 patients with VM were included in the study. Migraine with aura was more frequent in patients with MwoV (p = 0.035). Migraine headache years was longer (p < 0.001) and headache intensity was higher in patients with VM (p = 0.020). Aural fullness/tinnitus was more common in patients with VM (p < 0.001) when all other associated symptoms were more frequent in patients with MwoV (p < 0.001) as well as attack triggers (p < 0.05). Presence of menopause and motion sickness history was reported more frequently by VM patients (p < 0.001). Logistic regression analysis indicated that longstanding history of migraine with severe headache attacks, aural fullness/tinnitus accompanying attacks, presence of menopause, previous motion sickness history were the differentiating clinical features of patients with VM.

Uncorrected errors and correct saccades in the antisaccade task distinguish between early-stage Alzheimer's disease dementia, amnestic mild cognitive impairment, and normal aging.

Alzheimer's disease (AD) dementia is a degenerative illness that is characterized by a gradual decline in cognitive abilities. Amnestic mild cognitive impairment (aMCI) is seen as a precursor to AD. The changes in antisaccade performance that can be seen in MCI may provide important clues in the early detection of AD. Therefore, the antisaccade deficits in AD and aMCI remain a research question. This study aimed to examine antisaccade responses and the relationship between antisaccade and cognitive function in AD, aMCI, and healthy controls (HC). This study included 30 patients with early-stage AD, 34 with aMCI, and 32 HC. Patients with AD showed higher rates of uncorrected error, anticipatory saccades and corrected errors, as well as decreased correct saccade rates, and shortened saccade latency compared to aMCI and HC in this study. Patients with aMCI exhibited increased rates of express saccades relative to HC. The antisaccade task and cognitive domains were found to be significantly related. Our study showed that the rate of correct saccades has the capacity to distinguish AD from HC with 87% sensitivity and 86% specificity (AUC = 0.93, p < 0.001). In addition, the rate of uncorrected errors was found to be capable of distinguishing AD from HC with 84% sensitivity and 83% specificity (AUC = 0.91, p < 0.001). This study presented promising findings that these parameters can be used clinically to differentiate AD and aMCI from healthy older individuals.

Factors determining the response to treatment in patients with vestibular migraine.

PURPOSE: To find out clinical features associated with poor response to treatment in vestibular migraine (VM). METHODS: VM patients treated with drugs recommended in migraine prophylaxis were included in this multicenter study. Migraine features including type, age of onset of headache and vertigo attacks, attack frequency, intensity, associated symptoms, triggering factors, presence of interictal dizziness/imbalance, anxiety, depression, history of motion sickness, and family history of migraine were noted. Amitriptyline, flunarizine, propranolol, topiramate and venlafaxine were chosen depending on patients' individual requirements. Maximum dose of each drug was tried for 2 months to decide its efficacy. In the case of inefficacy, it was changed with another preventive drug of different class. If there was still no improvement, two drugs of different classes were combined. ≥ 50% reduction in attack frequency and severity in patients using one drug and a combination of two drugs was compared, with patients showing <50% reduction despite combination therapy, regarding their clinical features. RESULTS: The results of 430 VM patients, 65 men and 365 women with a mean age of 42.2 ± 12.2 years (range: 17-74 years), were analyzed. CONCLUSION: Cutaneous allodynia frequently associated with female sex, comorbid anxiety and depression and interictal dizziness/imbalance enhanced with comorbid anxiety were risk factors for reduced treatment response. Aural fullness might be the clue of impending concomitant Meniere's disease not responding to migraine preventives.

Vestibular migraine, demographic and clinical features of 415 patients: A multicenter study.

OBJECTIVE: To evaluate demographic and clinical features of vestibular migraine (VM) patients METHODS: Four hundred fifteen patients with VM were evaluated by using a structured questionnaire in addition to clinical examination. RESULTS: The mean age of headache and vertigo onset was 25 years and 39 years, respectively. In 12.3%, benign paroxysmal positional vertigo (BPPV) was detected during the interictal period. Ten percent had hearing loss on audiometry, in 8.7% it was one-sided low-frequency sensory-neural hearing loss below 2000 Hz and the history was typical for Meniere's disease (MD) in addition to VM. Tinnitus was present in 94.4%, aural fullness in 83.4%, nausea in 72.2% and vomiting in 30.5% of patients with VM/MD. The prevalence of these symptoms was higher in patients with VM/MD than in pure VM. Median attack severity determined by visual analog scale measured in centimeters from 0 to 10 was 8 for headache and 7 for vertigo for the whole group. Severe headache was significantly correlated with age of ≤ 43 years (OR: 6.831, 95% CI: [4.10-11.63]; p < 0.001) and severe vertigo was significantly correlated with age ≥ 41 years (OR: 7.073, 95% CI: [4.55-10.98]; p < 0.001). Motion sickness was revealed from past medical history in 51.8%. Family history of migraine was present in 72.5% and the age of onset of both migraine headaches (p = 0.008) and vertigo attacks (p = 0.004) was lower in these patients. CONCLUSION: Younger patients suffered more severe headache attacks whereas vertigo attack severity was higher in the elderly. BPPV and MD were commonly associated with VM and VM/MD was accompanied by aural and autonomic features more frequently than pure VM. Previous history of motion sickness was detected in more than half of the whole group. Family history of migraine was associated with younger onset of migraine headaches and vertigo attacks.

The influence of stimulus eccentricity on prosaccade outcomes in patients with Alzheimer's Disease dementia at an early stage and amnestic mild cognitive impairment.

INTRODUCTION: Prosaccade task is a widely used objective method to evaluate reflexive saccade and visual attention. The study aimed to investigate prosaccade stimulus eccentricity, compare prosaccade parameters in patients with Alzheimer's disease dementia (AD), amnestic mild cognitive impairment (aMCI), and neurotypical adults (NA), and examine the relationship between prosaccade and neuropsychological tests. METHODS: Thirty patients with AD, 34 with aMCI, and 32 NA were included in the study. Eye movements were recorded with the EyeLink 1000 Plus in the prosaccade task, and this study evaluated cognitive function with comprehensive neuropsychological tests assessing attention, memory, executive function, visuospatial function, and language domains. RESULTS: The correct saccade rates of patients with AD were significantly lower than NA in the 5° and 10° stimulus eccentricities. Patients with AD had significantly longer latencies in the 10° stimulus eccentricity than those with aMCI and NA. Patients with aMCI did not differ in prosaccade performance compared to NA. Prosaccade parameters were significantly correlated with all cognitive domains. As the amplitude of the stimuli increased, the rate of correct saccades decreased, while the express saccade rate, latency, amplitude, and peak velocity increased. CONCLUSION: Our findings that correct saccade rates and latency may be distinguishing parameters of early AD are promising. This study also found that stimulus eccentricity affects prosaccade measures in AD, MCI, and NA.

Characteristic differences between vestibular migraine and migraine only patients.

BACKGROUND: Vestibular migraine (VM) is one of the most common causes of vertigo in clinical practice but it is not always easy to make the correct diagnosis. Our aims were to find out how VM patients differ from migraine only (MO) patients, to evaluate co-morbid depression in these two groups and to determine if their disease has an effect on their quality of life. METHODS: We studied 50 definite VM and 35 MO patients. Each patient was asked about: age of onset, duration of headaches, presence of aura, headache characteristics, triggering factors, associated features, motion sickness history and family history of migraine. VM patients were also asked about their vertigo attacks and accompanying symptoms. Each patient also completed the following questionnaires: (1) Migraine Disability Assessment Scale (MIDAS); (2) headache severity with VAS (Visual Analog Scale); (3) Allodynia Symptom Checklist (ASC-12); (4) Beck Depression Inventory (BDI); (5) World Health Organization Quality of Life Questionnaire Short Form-12 (WHOQL-SF12); (6) Activities Specific Balance Confidence Scale (ABC). VM patients also completed the Dizziness Handicap Inventory (DHI). RESULTS: We found that VM patients were more likely than MO patients to be female, post-menopausal, depressed, motion sick, complaining of imbalance and of food-triggered headaches. In contrast, MO patients were more likely than VM patients to have severe headaches and that these can be triggered by certain odors and by noise. CONCLUSION: Our findings showed differences between VM and MO patients and attention to these differences could help clinicians diagnose, characterize and manage their VM patients.

Plasma levels of inflammatory mediators in vestibular migraine.

Objectives: Vestibular migraine (VM) is an under-recognized entity with substantial burden for the individual and society. The underlying mechanism of VM and its distinction from other migraine mechanisms still remain unclear. Inflammatory pathways have been suggested to contribute to vestibular migraine. Our aim was to further investigate the possible role of inflammation in the pathophysiology of VM.Methods: We recruited 30 patients with VM diagnosed according to ICHD-3 criteria and 50 gender- and age-matched controls. Blood samples were obtained from 11 VM patients during an attack and from 13 VM patients under prophylactic treatment. Plasma levels of calcitonin gene related peptide (CGRP), neurokinin A (NKA), substance P (SP), NLRP1, NLRP3, caspase-1, IL-1ß, IL-6, TNF-α and NFκB were measured by ELISA.Results: IL-6 levels were significantly reduced in VM patients, whereas levels of other inflammation parameters were comparable to those of healthy controls. Levels of inflammatory mediators were not correlated with clinical parameters. Likewise, there were no significant differences among VM patients with and without headache attack and prophylactic treatment.Conclusion: Our results argue against involvement of systemic inflammation in the pathophysiology of VM.

Convergence spasm due to aquaporin-positive neuromyelitis optica spectrum disorder.

A female 27 presented with nausea and diplopia for 1 week. On examination she had normal vertical gaze but would develop convergence with miosis whenever she made horizontal saccades. Pupils were 6 mm and unreactive to light. MRI showed extensive hyperintensity in the dorsal midbrain and thalamus. Spinal MRI and CSF were both normal. Serum aquaporin-4-antibody was positive. She was treated with steroids and plasmapheresis and after 3 months convergence spasm resolved but pupils remained unreactive. Neuromyelitis optica often presents with brainstem signs, rarely a dorsal midbrain syndrome. Convergence spasm is occasionally of organic neurologic origin.

Intrathecal IgM index correlates with a severe disease course in multiple sclerosis: Clinical and MRI results.

OBJECTIVES: Intrathecally synthesized IgM can be seen not only in the cerebrospinal fluid (CSF) in infectious and inflammatory diseases of the central nervous system, but also in that of patients with multiple sclerosis (MS). Intrathecal IgM synthesis in MS seems to be correlated with an unfavorable disease course. In one cross-sectional study, intrathecal synthesis of IgM (IgM index) was found to be correlated with cranial magnetic resonance imaging (MRI) parameters. The purpose of this study was to determine the possible relationship between the IgM index and MRI and clinical parameters. PATIENTS AND METHODS: Eighty-one patients with MS (58 female) undergoing lumbar puncture were included in the study. Fifty-one patients had a relapsing-remitting (RR) disease course, while 30 cases were secondary progressive MS (SPMS). IgM was detected in paired CSF and serum specimens using ELISA. The IgM index was calculated using the formula CSF IgM/serum IgM: CSF albumin/serum albumin. IgM indexes higher than 0.1 were considered "increased". All patients underwent brain and whole spinal cord MRI. RESULTS: The IgM index was normal in 43 of the 81 patients (53.1%) and increased in 38 (46.9%). A significant correlation was determined between the IgM index and Expanded Disability Status Scale (EDSS) (r=0.638, p=0.001). Most of the subjects with increased IgM indexes were SPMS patients, 28 having a SPMS course and 10 a RRMS course. Only two patients with SPMS courses had normal IgM indexes. EDSS scores were significantly higher in patients with increased IgM indexes (EDSS 4.3 vs EDSS 2.8, p=0.000). All patients with EDSS >3 had increased IgM indexes. All patients with IgM index values higher than 0.2 IgM had SPMS courses and EDSS >6. Time to onset of the secondary progressive phase of the disease was correlated with IgM index values (p=0.004). IgM index values were also correlated with T1 hypointense lesions (r=0.0431, p=0.008) and Gd enhancing lesions (r=0.0396, p=0.006). Patients with increased IgM indexes also had more spinal lesions (p=0.000). No relation was determined between an increased IgM index and an increased IgG index. No relation was determined with IgG oligoclonal band positivity. No correlation was also observed between IgM index and IgG index values. CONCLUSION: According to our findings, intrathecal IgM synthesis is associated with a worse long-term prognosis. It also correlates with a higher relapse rate, greater disability, and worse MRI outcomes. Early observation of increased IgM index values will be a helpful tool for clinicians in selecting patients for early immunomodulatory or immunosuppressant treatments.

High performance computing for deformable image registration: towards a new paradigm in adaptive radiotherapy.

The advent of readily available temporal imaging or time series volumetric (4D) imaging has become an indispensable component of treatment planning and adaptive radiotherapy (ART) at many radiotherapy centers. Deformable image registration (DIR) is also used in other areas of medical imaging, including motion corrected image reconstruction. Due to long computation time, clinical applications of DIR in radiation therapy and elsewhere have been limited and consequently relegated to offline analysis. With the recent advances in hardware and software, graphics processing unit (GPU) based computing is an emerging technology for general purpose computation, including DIR, and is suitable for highly parallelized computing. However, traditional general purpose computation on the GPU is limited because the constraints of the available programming platforms. As well, compared to CPU programming, the GPU currently has reduced dedicated processor memory, which can limit the useful working data set for parallelized processing. We present an implementation of the demons algorithm using the NVIDIA 8800 GTX GPU and the new CUDA programming language. The GPU performance will be compared with single threading and multithreading CPU implementations on an Intel dual core 2.4 GHz CPU using the C programming language. CUDA provides a C-like language programming interface, and allows for direct access to the highly parallel compute units in the GPU. Comparisons for volumetric clinical lung images acquired using 4DCT were carried out. Computation time for 100 iterations in the range of 1.8-13.5 s was observed for the GPU with image size ranging from 2.0 x 10(6) to 14.2 x 10(6) pixels. The GPU registration was 55-61 times faster than the CPU for the single threading implementation, and 34-39 times faster for the multithreading implementation. For CPU based computing, the computational time generally has a linear dependence on image size for medical imaging data. Computational efficiency is characterized in terms of time per megapixels per iteration (TPMI) with units of seconds per megapixels per iteration (or spmi). For the demons algorithm, our CPU implementation yielded largely invariant values of TPMI. The mean TPMIs were 0.527 spmi and 0.335 spmi for the single threading and multithreading cases, respectively, with <2% variation over the considered image data range. For GPU computing, we achieved TPMI =0.00916 spmi with 3.7% variation, indicating optimized memory handling under CUDA. The paradigm of GPU based real-time DIR opens up a host of clinical applications for medical imaging.

Sulfatide and its synthetic analogues recognition by Moraxella catarrhalis.

Moraxella catarrhalis is one of the major pathogens of respiratory and middle ear infections. Attachment of this bacterium to the surface of human pharyngeal epithelial cells is the first step in the pathogenesis of infections. This study revealed that sulfatide might act as a binding molecule for the attachment of M. catarrhalis to human pharyngeal epithelial cells. Furthermore, six different synthetic sulfatides were found to inhibit the attachment of M. catarrhalis significantly at an optimum concentration of 10 microg/ml. Synthetic sulfatides may have the potential to be used as a therapy to prevent M. catarrhalis infections.