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Mult Scler Relat Disord ; 41: 102004, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32078935


BACKGROUND: The availability of new disease-modifying treatments (DMTs) in the last years has changed the therapeutic strategies used in Multiple Sclerosis (MS). We aimed to describe trend in DMTs utilization and persistence to treatment in a large sample of patients attending 10 MS centres from four provinces of Veneto, Italy. METHODS: Demographic, clinical and DMTs information of patients regularly followed from January 2011 to August 2018 were recorded and analysed. Persistence at 12, 24 months and at last follow-up was assessed by Kaplan Meier survival analysis. Multivariable Cox- proportional hazard model was used to identify predictors of persistence. RESULTS: Of 3025 MS patients 65.7% were in treatment al last follow-up. Dimethylfumarate (DMF) was the most prescribed single drug among first-line and fingolimod among second-line DMTs. In the cohort of 1391 cases starting any DMT since 2011 12.9% stopped within 6 months, 24% within 12 and 40.3% within 24 months. Disease duration > 5 years at therapy start was predictive of greater risk of discontinuation, while age and sex were not. DMF use was predictive of higher persistence at 12 and 24 months, but not at last follow-up when azathioprine and glatiramer acetate showed the highest persistence compared to other DMTs. Side effects represented the main reason of discontinuation. CONCLUSION: The use of the new oral DMTs greatly increased since their approval but persistence in the long-term is not better than with old drugs. The treatment choice is still a challenge both for patients and their doctors.

Toxins (Basel) ; 11(9)2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31470654


Chronic Migraine (CM) is a disabling neurologic condition with a severe impact on functioning and quality of life. Successful therapeutic management of patients with CM is complex, and differences in therapeutic response could be attributable to genetically determined factors, sensitivity to pharmacological treatment, psychosocial and relational factors affecting the patient's compliance and approach on the therapeutic treatment. The aim of this prospective observational study was to explore self-efficacy, coping strategies, psychological distress and headache-related disability in a cohort of 40 patients with CM (mean age: 46.73; standard deviation 13.75) treated with OnabotulinumtoxinA and the relationship between these clinical and psychological aspects and acute medication consumption during OnabotulinumtoxinA prophylactic treatment. Patients presented an overall significant reduction in the Headache Index (HI) (p < 0.001), HI with severe intensity (p = 0.009), and total analgesic consumption (p = 0.003) after the prophylactic treatment. These results are in line with the literature. Despite this, higher nonsteroidal anti-inflammatory drugs consumption was associated with higher psychological distress, higher HI with severe and moderate intensity, and worse quality of life. Conversely, triptans consumption was correlated with HI of mild intensity, and problem-focused coping strategies. To conclude, the psychological profile, and in particular, the psychological distress and specific coping strategies might influence the self-management of acute medication.

Eur J Phys Rehabil Med ; 54(1): 1-12, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28750504


BACKGROUND: Chronic migraine is a disabling disorder associated with myofascial and trigger point disorders in the neck. Pharmacological management is the first line of treatment; however, rehabilitation procedures aimed at lessening symptoms of myofascial and trigger point disorders may add value in the management of headache symptoms. AIM: The aim of this study was to evaluate the feasibility of myofascial and trigger point treatment in chronic migraine patients receiving prophylactic treatment with onabotulinumtoxinA. To evaluate the treatment effects on headache frequency and intensity, analgesic consumption, cervical range of motion, trigger point pressure pain threshold, quality of life, and disability. DESIGN: Pilot, single-blind randomized controlled trial with two parallel groups. SETTING: Neurorehabilitation Unit. POPULATION: Twenty-two outpatients with chronic migraine. METHODS: Patients were randomly assigned to receive either cervicothoracic manipulative treatment (N.=12) or transcutaneous electrical nerve stimulation (TENS) in the upper trapezius (N.=10). Treatment consisted of 4 sessions (30 min/session, 1 session/week for 4 weeks). A rater blinded to treatment allocation evaluated outcomes before treatment, during treatment, and 1 month after the end of treatment. Consistent with the pilot nature of the study, feasibility was considered the primary outcome and efficacy the secondary outcome. RESULTS: All patients completed the study. No adverse events were reported. No significant between-group differences in pain intensity were observed during the study period. At post-treatment evaluation, the total consumption of analgesics (P=0.02) and non-steroidal anti-inflammatory (P=0.02) drugs was significantly lower in the manipulative treatment group than in the TENS group. These effects paralleled significant improvements in trigger point sensitivity and cervical active range of motion. CONCLUSIONS: Manipulative techniques aimed at reducing peripheral nociceptive triggers might add value in the management of chronic migraine symptoms and lower acute medication use. CLINICAL REHABILITATION IMPACT: An interdisciplinary approach comprising pharmacological and non-pharmacological strategies can reduce analgesic consumption and myofascial dysfunction symptoms in chronic migraine patients.

Inibidores da Liberação da Acetilcolina/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Transtornos de Enxaqueca/terapia , Manipulações Musculoesqueléticas , Síndromes da Dor Miofascial/terapia , Pontos-Gatilho , Adolescente , Adulto , Idoso , Analgésicos/uso terapêutico , Doença Crônica , Estudos de Viabilidade , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Medição da Dor , Projetos Piloto , Amplitude de Movimento Articular , Método Simples-Cego , Estimulação Elétrica Nervosa Transcutânea , Resultado do Tratamento , Adulto Jovem
Front Hum Neurosci ; 8: 318, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24904361


BACKGROUND: Extensive research on both healthy subjects and patients with central nervous damage has elucidated a crucial role of postural adjustment reactions and central sensory integration processes in generating and "shaping" locomotor function, respectively. Whether robotic-assisted gait devices might improve these functions in Multiple sclerosis (MS) patients is not fully investigated in literature. PURPOSE: The aim of this study was to compare the effectiveness of end-effector robot-assisted gait training (RAGT) and sensory integration balance training (SIBT) in improving walking and balance performance in patients with MS. METHODS: Twenty-two patients with MS (EDSS: 1.5-6.5) were randomly assigned to two groups. The RAGT group (n = 12) underwent end-effector system training. The SIBT group (n = 10) underwent specific balance exercises. Each patient received twelve 50-min treatment sessions (2 days/week). A blinded rater evaluated patients before and after treatment as well as 1 month post treatment. Primary outcomes were walking speed and Berg Balance Scale. Secondary outcomes were the Activities-specific Balance Confidence Scale, Sensory Organization Balance Test, Stabilometric Assessment, Fatigue Severity Scale, cadence, step length, single and double support time, Multiple Sclerosis Quality of Life-54. RESULTS: Between groups comparisons showed no significant differences on primary and secondary outcome measures over time. Within group comparisons showed significant improvements in both groups on the Berg Balance Scale (P = 0.001). Changes approaching significance were found on gait speed (P = 0.07) only in the RAGT group. Significant changes in balance task-related domains during standing and walking conditions were found in the SIBT group. CONCLUSION: Balance disorders in patients with MS may be ameliorated by RAGT and by SIBT.

Pain Physician ; 15(3): 245-53, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22622909


BACKGROUND: Chronic migraine (CM) and medication overuse headache (MOH) are disabling conditions that may be only partially managed with conservative treatments. Occipital nerve stimulation (ONS) is an innovative treatment for headache disorders. OBJECTIVES: To investigate the safety and efficacy of ONS for CM and MOH patients and to evaluate changes in disability, quality of life, and drug intake in implanted patients. STUDY DESIGN: Prospective, randomized cross-over study. METHODS: Eligible patients who responded to a stimulation trial underwent device implantation and were randomized to "Stimulation On" and "Stimulation Off" arms. Patients crossed over after one month, or when their headaches worsened. Stimulation was then switched On for all patients. Disability as measured by the Migraine Disability Assessment (MIDAS), quality of life (SF-36), and drug intake (patient's diary) were assessed over a one-year follow-up. RESULTS: Thirty-four patients (76% women, 34% men, mean age: 46 ± 11 years) were enrolled; 30 were randomized and 29 completed the study. Headache intensity and frequency were significantly lower in the On arm than in the Off arm (p < 0.05) and decreased from the baseline to each follow-up visit in all patients with Stimulation On (median MIDAS A and B scores: baseline = 70 and 8; one-year follow-up = 14 and 5, p < 0.001). Quality of life significantly improved (p < 0.05) during the study. Triptans and nonsteroidal anti-inflammatory drug use fell dramatically from the baseline (20 and 25.5 doses/month) to each follow-up visit (3 and 2 doses/month at one year, p < 0.001). A total of 5 adverse events occurred: 2 infections and 3 lead migrations. LIMITATIONS: Single-centre study, relatively small number of patients, absence of a control group. CONCLUSIONS: According to the results obtained, ONS appears to be a safe and effective treatment for  carefully selected CM and MOH patients.

Terapia por Estimulação Elétrica/métodos , Transtornos de Enxaqueca/terapia , Adulto , Idoso , Estudos Cross-Over , Terapia por Estimulação Elétrica/efeitos adversos , Eletrodos Implantados , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/fisiopatologia , Nervos Periféricos/fisiopatologia , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento