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1.
J Laryngol Otol ; 134(7): 586-591, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32713357

RESUMO

OBJECTIVE: Given the lack of evidence on patients with medically refractory vestibular migraine, this study aimed to identify factors associated with pharmacotherapy failure and progression to botulinum toxin injection in vestibular migraine. METHODS: A retrospective cohort study was conducted on definite vestibular migraine patients from September 2015 to July 2019 who completed the Dizziness Handicap Inventory at least six weeks apart.. RESULTS: The study comprised 47 patients (mean age = 50.2 ± 15.8 years), with a mean follow-up time of 6.0 ± 6.0 months. The mean pre-treatment Dizziness Handicap Inventory score was 57.5 ± 23.5, with a mean reduction of 17.3 ± 25.2 (p < 0.001) at last follow up. Oscillopsia (r = 0.458, p = 0.007), failure of first medication (r = 0.518, p = 0.001) and pre-treatment Dizziness Handicap Inventory question 15 (an emotional domain question) score (r = 0.364, p = 0.019) were the only variables significantly correlated with progression to botulinum toxin injection. CONCLUSION: Motion hypersensitivity, failure of first medication, and fear of social stigmatisation suggest a decreased treatment response. These symptoms may require more aggressive treatment at an earlier stage.


Assuntos
Toxinas Botulínicas/uso terapêutico , Tontura/tratamento farmacológico , Transtornos de Enxaqueca/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Toxinas Botulínicas/administração & dosagem , Tontura/etiologia , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Nortriptilina/uso terapêutico , Propranolol/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Topiramato/uso terapêutico , Falha de Tratamento , Verapamil/uso terapêutico , Adulto Jovem
2.
Acta otorrinolaringol. esp ; 71(3): 140-146, mayo-jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-192628

RESUMO

ANTECEDENTES Y OBJETIVO: La migraña vestibular (MV) es una de las causas de síndrome vestibular episódico. Existen muchos fármacos disponibles para su profilaxis y actualmente su elección se realiza mayoritariamente según las comorbilidades del paciente. El objetivo de este artículo es medir la concordancia de un grupo de otorrinolaringólogos en la elección de profilaxis y evaluar el papel que ejerce sobre esta un algoritmo asistido para la elección de profilaxis. MATERIAL Y MÉTODO: Las historias clínicas de 10 pacientes con MV fueron ofrecidas a 10 otorrinolaringólogos, a los que se les pidió que seleccionasen para cada paciente el fármaco que considerasen más adecuado entre 5 opciones posibles. Se calcularon los índices κ de Fleiss entre los 10 otorrinolaringólogos solos y se recalcularon incluyendo al algoritmo como undécimoevaluador, y la κ de Cohen entre cada otorrinolaringólogo y el algoritmo. Se ofreció a los otorrinolaringólogos la opción de cambiar su respuesta tras conocer la respuesta del algoritmo, y ambos índices fueron calculados nuevamente. RESULTADOS: El índice κ de Fleiss fue de 0,302. Dicho índice se elevó a 0,343 tras introducir al algoritmo como evaluador. Tras ofrecer las soluciones propuestas por el algoritmo, se mejoró la κ de Cohen en 9 de los 10 evaluadores y la κ de Fleiss subió a 0,711. CONCLUSIONES: La concordancia entre otorrinolaringólogos para elegir profilaxis para la MV se define como «justa». Las respuestas del algoritmo para la elección de profilaxis se situaron próximas a la opinión media de los otorrinolaringólogos, elevando la concordancia entre ellos a «sustancial»


BACKGROUND AND OBJECTIVE: Vestibular migraine (VM) is a cause of episodic vestibular syndrome. There are many drugs available for its prophylaxis and currently the choice is mainly made according to the patient's comorbidities. The aim of this article was to measure the agreement of a group of otorhinolaryngologists in the choice of a prophylactic treatment and to evaluate the role of an assisted algorithm in the choice of this prophylaxis. MATERIAL AND METHOD: The medical records of 10 patients with VM were offered to 10 otolaryngologists who were asked to select for each patient the drug they considered most appropriate among five possible options. The Fleiss' κ index was calculated among the 10 otolaryngologists alone, recalculating it including the algorithm as the eleventh evaluator, and Cohen's κ index was calculated between each otolaryngologist and the answers of the algorithm. The otolaryngologists were offered the option to change their responses after knowing the responses of the algorithm and then both indexes were calculated again. RESULTS: The Fleiss' κ index was .302. This index was raised to .343 after introducing the algorithm as an evaluator. After offering the responses proposed by the algorithm, Cohen's κ was improved in 9 of the 10 evaluators, and Fleiss' κ rose to .711. CONCLUSIONS: The agreement between otorhinolaryngologists in choosing prophylaxis for MV can be defined as "fair". The responses of the algorithm for the choice of prophylaxis were close to the average opinion of the otolaryngologists, raising the agreement between them to "substantial"


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Antibioticoprofilaxia , Algoritmos , Doenças Vestibulares/etiologia , Transtornos de Enxaqueca/tratamento farmacológico , Acetazolamida/uso terapêutico , Propranolol/uso terapêutico , Flunarizina/uso terapêutico , Topiramato/uso terapêutico , Doenças Vestibulares/prevenção & controle , Amitriptilina/uso terapêutico
3.
Obesity (Silver Spring) ; 28(6): 1023-1030, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32441476

RESUMO

OBJECTIVE: Weight regain (WR) after Roux-en-Y gastric bypass surgery (RYGB) starts to occur 2 years after surgery, ultimately affecting at least 25% of patients. A limited number of studies have evaluated the impact of antiobesity medications (AOMs) on this phenomenon. METHODS: This study reviewed the electronic medical records of 1,196 patients who underwent RYGB between 2004 and 2015. WR was evaluated by comparing each patient's weight during subsequent postoperative office visits to nadir weight (lowest weight after RYGB, n = 760), taking into consideration the interval during which WR occurred. Patients who were prescribed AOMs and came to follow-up visits were classified as adherent users, whereas those who missed their follow-up visits were considered nonadherent. This study used a linear mixed model, Cox regression, and generalized equation estimator to determine the impact of AOMs on WR trajectory, hazard ratio for time to event, and odds ratio for repeated event occurrence, respectively. RESULTS: Despite the lack of a unified protocol for using AOMs, the three statistical models converged to show that phentermine and topiramate, used individually or in combination, can significantly reduce WR after RYGB. CONCLUSIONS: Phentermine and topiramate are effective in mitigating WR after RYGB. Further studies are needed to help ascertain optimal use of AOMs after bariatric surgery.


Assuntos
Fármacos Antiobesidade/uso terapêutico , Derivação Gástrica/métodos , Fentermina/uso terapêutico , Topiramato/uso terapêutico , Ganho de Peso/efeitos dos fármacos , Adulto , Fármacos Antiobesidade/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fentermina/farmacologia , Período Pós-Operatório , Estudos Retrospectivos , Topiramato/farmacologia
5.
BMC Neurol ; 20(1): 145, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32312236

RESUMO

BACKGROUND: Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late onset, X-linked genetic, neurodegenerative disorder caused by a "premutation (PM)" in the fragile X mental retardation 1 (FMR1) gene. Here we report a case of FXTAS from mainland of China who presented with rare orthostatic tremor. A review of tremor of FXTAS in the literature is also included. CASE PRESENTATION: A 67-year-old right-handed farmer started with tremor of both legs 8 years ago which was present while standing but absent when sitting or lying and progressed with unsteady gait one and a half years ago. The brain MRI showed high intensity signal in the bilateral middle cerebellar peduncles (MCP) in T2-weighted and fluid-attenuated inversion recovery (FLAIR) images and gene test for premutation for FMR1 was positive with 101 CGG repeats. The patient met the the diagnosis of definite FXTAS. Clonazepam and topiramate were administered to control tremor. We reviewed the literature and identified 64 cases with detailed clinical and genetic information. Orthostatic tremor associated with FXTAS is very rare. We found 85.2% patients reported tremor,42.6% with intention tremor,36.1% with kinetic tremor,32.8% with rest tremor and 29.5% with posture tremor. 37.7% of patients who have tremor showed at least two types of tremor. There were 6 patients with isolated rest tremor. There was 2 patient with voice tremor and 6 with head tremor. We also found that 74.6% FXTAS patients had family history of FMR1 gene associated diseases including Fragile X syndrome (FXS), FXTAS or fragile X-associated primary ovarian insufficiency (FXPOI). CONCLUSIONS: Adding our data to the available literature suggests that orthostatic tremor could be a rare initial manifestation of FXTAS and the review will increasing our understanding the phenotype of tremor in FXTAS. Family history of FMR1 gene associated diseases might be an important clue to the diagnosis.


Assuntos
Ataxia , Síndrome do Cromossomo X Frágil , Tremor , Idoso , Anticonvulsivantes/uso terapêutico , Ataxia/diagnóstico , Ataxia/tratamento farmacológico , Ataxia/genética , Ataxia/fisiopatologia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Clonazepam/uso terapêutico , Síndrome do Cromossomo X Frágil/diagnóstico , Síndrome do Cromossomo X Frágil/tratamento farmacológico , Síndrome do Cromossomo X Frágil/genética , Síndrome do Cromossomo X Frágil/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Topiramato/uso terapêutico , Tremor/diagnóstico , Tremor/tratamento farmacológico , Tremor/genética , Tremor/fisiopatologia
6.
Medicine (Baltimore) ; 99(17): e18704, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332593

RESUMO

BACKGROUND: Hypoxic ischemic encephalopathy (HIE) is brain injury caused by different reasons and the most common diagnosed is neonatal HIE. Most of the existing treatments have their own shortcomings or there are still some unexplained mechanisms in it. Topiramate (TPM) is a new drug for the treatment for seizures in neonates with HIE, but is currently used off-label. Our protocol aims to access the efficiency and safety of TPM for HIE. METHODS AND ANALYSIS: Eight databases will be searched by 2 independent researchers for the article on the topic of using TPM as treatment for HIE, including PubMed, the Cochrane Central Register of Controlled Trials (Cochrane Library), Embase, and Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wang Fang Database and Chinese Science and Technology Periodical database (VIP). The included papers are those published from the established date of the databases to 2019. The therapeutic effects based on the grade of neonatal behavioral neurological assessment will be regarded as the primary outcomes. RevMan V5.3 will be used to compute the data synthesis and carry out meta-analysis. The risk of bias will be appraised by the Cochrane risk of bias tool. Rare ratio for dichotomous outcomes and mean different for continuous data will be expressed with 95% confidence intervals (CI) for analysis. A random effects model or a fixed effects model will be employed, when heterogeneity is found or not. Subgroup analysis and sensitivity analysis will be applied if the heterogeneity is obvious. RESULTS: This study will provide the recent evidence of TPM for HIE from reducing seizure acticity. CONCLUSION: The conclusion of this study will provide proof to evaluate if TPM is effective and safe in the treatment of HIE.PROSPERO registration number: PROSPERO CRD42018117981.


Assuntos
Anticonvulsivantes/uso terapêutico , Hipóxia-Isquemia Encefálica/tratamento farmacológico , Topiramato/uso terapêutico , Anticonvulsivantes/efeitos adversos , Humanos , Hipóxia-Isquemia Encefálica/complicações , Hipóxia-Isquemia Encefálica/mortalidade , Recém-Nascido , Estresse Oxidativo/efeitos dos fármacos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Convulsões/tratamento farmacológico , Convulsões/etiologia , Índice de Gravidade de Doença , Topiramato/efeitos adversos
8.
J Clin Neurosci ; 72: 31-38, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31959558

RESUMO

ATP1A3 related disease is a clinically heterogeneous condition currently classified as alternating hemiplegia of childhood, rapid-onset dystonia-parkinsonism and cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss. Recently, it has become apparent that a remarkably large subgroup is suffering from often difficult-to-treat epilepsy. The aim of the present study was to assess the prevalence and efficacy of commonly used anti-epileptic-drugs (AEDs) in patients with ATP1A3 related seizures. Therefore, we performed a retrospective study of patients in combination with a systematic literature-based review. Inclusion criteria were: verified ATP1A3 mutation, seizures and information about AED treatment. The literature review yielded records for 188 epileptic ATP1A3 patients. For 14/188 cases, information about anti-epileptic treatment was available. Combined with seven unpublished records of ATP1A3 patients, a sample size of 21 patients was reached. Most used AED were levetiracetam (n = 9), phenobarbital (n = 8), valproic acid (n = 7), and topiramate (n = 5). Seizure reduction was reported for 57% of patients (n = 12). No individual AEDs used (either alone or combined) had a success rate over 50%. There was no significant difference in the response rate between various AEDs. Ketogenic diet was effective in 2/4 patients. 43% of patients (n = 9) did not show any seizure relief. Even though Epilepsy is a significant clinical issue in ATP1A3 patients, only a minority of publications provide any information about patients' anti-epileptic treatment. The findings of treatment effectiveness in only 57% (or lower) of patients, and the non-existence of a clear first-line AED in ATP1A3 related epilepsy stresses the need for further research.


Assuntos
Epilepsia/genética , Hemiplegia/genética , ATPase Trocadora de Sódio-Potássio , Adulto , Anticonvulsivantes/uso terapêutico , Ataxia Cerebelar/genética , Criança , Distúrbios Distônicos , Epilepsia/dietoterapia , Epilepsia/tratamento farmacológico , Feminino , Perda Auditiva Neurossensorial , Hemiplegia/dietoterapia , Hemiplegia/tratamento farmacológico , Humanos , Levetiracetam , Masculino , Mutação , Atrofia Óptica/genética , Reflexo Anormal , Estudos Retrospectivos , Convulsões/genética , Topiramato , Ácido Valproico/uso terapêutico
9.
J Neuroimmunol ; 340: 577144, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31954282

RESUMO

We report the case of a 25-year-old woman who developed temporal lobe epilepsy associated with systemic lupus erythematosus (SLE). Serum and cerebrospinal fluid samples showed high titers of anti-ribosomal P (anti-P) antibodies with negative anti-NMDAR antibodies. She was receiving prednisone and azathioprine, with normalization of SLE serum markers, but without changes in titers of anti-P antibodies. No seizure control was achieved using valproic acid, levetiracetam and lamotrigine. However, she had a selective response to topiramate, an AMPAR blocker, maintained during 6 years of follow-up. We discuss the pathophysiology of this autoimmune epilepsy associated with high titer anti-P antibodies.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Vasculite Associada ao Lúpus do Sistema Nervoso Central/complicações , Proteínas Ribossômicas/imunologia , Topiramato/uso terapêutico , Adulto , Autoanticorpos/imunologia , Autoantígenos/imunologia , Epilepsia Resistente a Medicamentos/etiologia , Epilepsia do Lobo Temporal/tratamento farmacológico , Epilepsia do Lobo Temporal/etiologia , Feminino , Humanos , Vasculite Associada ao Lúpus do Sistema Nervoso Central/imunologia
10.
Ann Otol Rhinol Laryngol ; 129(5): 421-427, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31786960

RESUMO

OBJECTIVES: To evaluate the efficacy of a multi-modal migraine prophylaxis therapy for patients with hyperacusis. METHODS: In a prospective cohort, patients with hyperacusis were treated with a multi-modal step-wise migraine prophylactic regimen (nortriptyline, verapamil, topiramate, or a combination thereof) as well as lifestyle and dietary modifications. Pre- and post-treatment average loudness discomfort level (LDL), hyperacusis discomfort level measured by a visual analogue scale (VAS), and scores on the modified Khalfa questionnaire for severity of hyperacusis were compared. RESULTS: Twenty-two of the 25 patients (88%) reported subjective resolution of their symptoms following treatment. Post-treatment audiograms showed significant improvement in average LDL from 81.3 ± 3.2 dB to 86.4 ± 2.6 dB (P < .001), indicating increased sound tolerability. The VAS discomfort level also showed significant improvement from a pre-treatment average of 7.7 ± 1.1 to 3.7 ± 1.6 post-treatment (P < .001). There was also significant improvement in the average total score on modified Khalfa questionnaire (32.2 ± 3.6 vs 22.0 ± 5.7, P < .001). CONCLUSIONS: The majority of patients with hyperacusis demonstrated symptomatic improvement from migraine prophylaxis therapy, as indicated by self-reported and audiometric measures. Our findings indicate that, for some patients, hyperacusis may share a pathophysiologic basis with migraine disorder and may be successfully managed with multimodal migraine prophylaxis therapy.


Assuntos
Audição/fisiologia , Hiperacusia/complicações , Transtornos de Enxaqueca/prevenção & controle , Nortriptilina/uso terapêutico , Qualidade de Vida , Topiramato/uso terapêutico , Verapamil/uso terapêutico , Inibidores da Captação Adrenérgica/uso terapêutico , Adulto , Idoso , Anticonvulsivantes/uso terapêutico , Quimioterapia Combinada , Feminino , Seguimentos , Testes Auditivos , Humanos , Hiperacusia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/fisiopatologia , Estudos Prospectivos , Resultado do Tratamento , Vasodilatadores/uso terapêutico , Escala Visual Analógica , Adulto Jovem
11.
Indian J Pediatr ; 87(1): 1-2, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31811502
12.
Rinsho Shinkeigaku ; 60(1): 46-50, 2020 Jan 30.
Artigo em Japonês | MEDLINE | ID: mdl-31852872

RESUMO

A 22-year-old female was admitted to our hospital due to acute onset of severe headache, confusion, and deterioration of consciousness. Results of initial examinations did not suggest cerebrovascular diseases, encephalitis, or nonconvulsive status epilepticus. Over the next several weeks, her level of consciousness fluctuated in parallel with the severity of headache. The electroencephalogram, recorded during a symptomatic episode, showed lack of posterior dominant rhythm, and the single-photon emission CT (SPECT) also revealed a decrease in cerebral blood flow predominantly in the occipital lobes. Administration of sodium valproate and topiramate, recommended as treatment for migraine, dramatically ameliorated her headache and consciousness. Although this was an adult-onset case, her symptoms and clinical course were similar with the diagnosis of ICHD-3-unlisted confusional migraine rather than other listed subtypes of migraine with aura. Further accumulation of similar adult-onset cases is necessary to clarify the nature of this illness.


Assuntos
Epilepsia , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/tratamento farmacológico , Adulto , Feminino , Humanos , Transtornos de Enxaqueca/classificação , Topiramato/administração & dosagem , Ácido Valproico/administração & dosagem , Adulto Jovem
13.
Arch. Soc. Esp. Oftalmol ; 94(12): 614-618, dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-190015

RESUMO

Mujer de 36 años diagnosticada de hipertensión intracraneal idiopática tratada con acetazolamida y topiramato, que presenta desprendimientos neurosensoriales retinianos. La paciente fue seguida durante 2 años estableciéndose una relación entre los desprendimientos neurosensoriales y el topiramato, con recurrencias tras la introducción del topiramato y mejoría tras la retirada del mismo. Estos hechos señalan al topiramato como posible responsable del cuadro. El topiramato podría ser responsable de la aparición de desprendimientos neurosensoriales de la retina y mácula. Aunque los casos de efusión cilio coroidea producidos por este fármaco son bien conocidos, sus efectos secundarios sobre la retina son menos frecuentes. Ya que se trata de un fármaco de amplio uso, tanto neurólogos como oftalmólogos deberían ser conscientes de sus posibles efectos secundarios


A 36 year-old woman with idiopathic intracranial hypertension was treated with topiramate and acetazolamide. The patient was followed-up for 2 years, with a relationship between neurosensory detachments and topiramate being established, with recurrences after the introduction of topiramato and improvement after its withdrawal. These findings point topiramate as a possible cause of the clinical picture. Topiramate may cause retinal and macular neurosensory detachments. Although the ciliochoroidal effusion cases caused by this drug are well-known, its retinal side effects are less common. As it is a widely used drug, neurologists and ophthalmologists should be aware of its possible ocular side effects


Assuntos
Humanos , Feminino , Adulto , Anti-Hipertensivos/efeitos adversos , Macula Lutea , Descolamento Retiniano/induzido quimicamente , Topiramato/efeitos adversos , Acetazolamida/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Fundo de Olho , Hipertensão Intracraniana/tratamento farmacológico , Recidiva , Tomografia de Coerência Óptica
14.
Epilepsia ; 60(12): 2448-2458, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31713232

RESUMO

OBJECTIVE: Novel treatments are needed to control treatment-resistant status epilepticus (SE). We present a summary of clinical cases where oral topiramate (TPM) was used in refractory SE (RSE) and superrefractory SE (SRSE). METHODS: A review of medical records was carried out to detect TPM administration in SE patients treated in Frankfurt and Marburg between 2011 and 2016. The primary outcome question concerned SE resolution after TPM initiation. RESULTS: In total, TPM was used in 106 of 854 patients having a mean age of 67.4 ± 18.1 years, 61 of whom were female (57.5%). The median latency from SE onset to TPM initiation was 8.5 days. Patients with SE had previously failed a median of five other antiepileptic drugs. The median initial TPM dose was 100 mg/d, which was uptitrated to a median maintenance dose of 400 mg/d. Treatment with TPM was continued for a median time of 12 days. TPM was the last drug provided to 42 of 106 (39.6%) patients, with a resultant response attributed to TPM observed in 29 of 106 (27.4%) patients. A response was attributed to TPM in 21 (31.8%) of 66 RSE cases and eight (20%) of 40 SRSE cases. Treatment-emergent adverse events were attributed to TPM usage in two patients, one each with pancreatitis and hyperchloremic acidosis, and in 38 patients (35.8%), hyperammonemia was seen. Thirty-four of these patients received a combination of TPM and valproate and/or phenobarbital. The intrahospital mortality rate was 22.6% (n = 24). SIGNIFICANCE: The rate of SE cessation attributed to TPM treatment (27.4%) represents a relevant response given the late treatment position of TPM and the treatment latency of more than 8 days. Based on these results and in line with the findings of other case series, TPM can be considered an alternative option for treating RSE and SRSE.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Topiramato/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
15.
Arch Soc Esp Oftalmol ; 94(12): 614-618, 2019 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31610900

RESUMO

A 36 year-old woman with idiopathic intracranial hypertension was treated with topiramate and acetazolamide. The patient was followed-up for 2 years, with a relationship between neurosensory detachments and topiramate being established, with recurrences after the introduction of topiramato and improvement after its withdrawal. These findings point topiramate as a possible cause of the clinical picture. Topiramate may cause retinal and macular neurosensory detachments. Although the ciliochoroidal effusion cases caused by this drug are well-known, its retinal side effects are less common. As it is a widely used drug, neurologists and ophthalmologists should be aware of its possible ocular side effects.


Assuntos
Anti-Hipertensivos/efeitos adversos , Macula Lutea , Descolamento Retiniano/induzido quimicamente , Topiramato/efeitos adversos , Acetazolamida/uso terapêutico , Adulto , Anti-Hipertensivos/uso terapêutico , Feminino , Fundo de Olho , Humanos , Hipertensão Intracraniana/tratamento farmacológico , Recidiva , Tomografia de Coerência Óptica
16.
Folia Neuropathol ; 57(3): 267-276, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31588713

RESUMO

The present study aimed at exploring a potentially neuroprotective effect of topiramate (TPM), one of the most commonly used newer-generation, broad-spectrum, antiepileptic drugs against ultrastructural damage of hippocampal synaptic endings in the experimental model of febrile seizures (FS). The study used male young Wistar rats aged 22-30 days, divided into three experimental groups and the control group. Brain maturity in such animals corresponds to that of 1- or 2-year-old children. Hyperthermic stress was evoked by placing animals in a 45°C water bath for four consecutive days. TPM at a dose of 80 mg/kg b.m. was administered with an intragastric tube before and immediately after FS. Specimens (1 mm3) collected from the hippocampal CA1 and CA3 sectors, fixed via transcardial perfusion with a solution of paraformaldehyde and glutaraldehyde, were routinely processed for transmission-electron microscopic analysis. Advanced ultrastructural changes induced by hyperthermic stress were manifested by distinct swelling of hippocampal pre- and post-synaptic axodendritic and axospinal endings, including their vacuolization and disintegration. The axoplasm of the presynaptic boutons contained a markedly decreased number of synaptic vesicles and their abnormal accumulation in the active synaptic region. The synaptic junctions showed a dilated synaptic cleft and a decreased synaptic active zone. TPM used directly after FS was ineffective in the prevention of hyperthermia-induced injury of synaptic endings in hippocampal CA1 and CA3 sectors. However, "prophylactic" administration of TPM, prior to FS induction, demonstrated a neuroprotective effect against synaptic damage in approximately 25% of the synaptic endings in the hippocampal sectors, more frequently located in perivascular zones. It was manifested by smaller oedema of both presynaptic and postsynaptic parts, containing well-preserved mitochondria, increased number and regular distribution of synaptic vesicles within the axoplasm, and increased synaptic active zone. Our current and previous findings suggest that TPM administered "prophylactically", before FS, could exert a favourable effect on some synapses, indirectly, via the vascular factor, i.e. protecting blood-brain barrier components and through better blood supply of the hippocampal CA1 and CA3 sectors, which may have practical implications.


Assuntos
Anticonvulsivantes/farmacologia , Região CA1 Hipocampal/efeitos dos fármacos , Região CA3 Hipocampal/efeitos dos fármacos , Terminações Pré-Sinápticas/efeitos dos fármacos , Convulsões Febris/patologia , Topiramato/farmacologia , Animais , Região CA1 Hipocampal/ultraestrutura , Região CA3 Hipocampal/ultraestrutura , Modelos Animais de Doenças , Masculino , Microscopia Eletrônica de Transmissão , Fármacos Neuroprotetores/farmacologia , Terminações Pré-Sinápticas/ultraestrutura , Ratos , Ratos Wistar
18.
J Headache Pain ; 20(1): 92, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470791

RESUMO

BACKGROUND: Chronic migraine is a disabling condition that is currently underdiagnosed and undertreated. In this narrative review, we discuss the future of chronic migraine management in relation to recent progress in evidence-based pharmacological treatment. FINDINGS: Patients with chronic migraine require prophylactic therapy to reduce the frequency of migraine attacks, but the only currently available evidence-based prophylactic treatment options for chronic migraine are topiramate and onabotulinumtoxinA. Improved prophylactic therapy is needed to reduce the high burden of chronic migraine in Italy. Monoclonal antibodies that target the calcitonin gene-related peptide (CGRP) pathway of migraine pathogenesis have been specifically developed for the prophylactic treatment of chronic migraine. These anti-CGRP/R monoclonal antibodies have demonstrated good efficacy and excellent tolerability in phase II and III clinical trials, and offer new hope to patients who are currently not taking any prophylactic therapy or not benefitting from their current treatment. CONCLUSIONS: Treatment of chronic migraine is a dynamic and rapidly advancing area of research. New developments in this field have the potential to improve the diagnosis and provide more individualised treatments for this condition. Establishing a culture of prevention is essential for reducing the personal, social and economic burden of chronic migraine.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Toxinas Botulínicas Tipo A/uso terapêutico , Doença Crônica , Pessoas com Deficiência , Humanos , Transtornos de Enxaqueca/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Topiramato/uso terapêutico
19.
J Headache Pain ; 20(1): 88, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416424

RESUMO

BACKGROUND: Migraine diagnosis is based on clinical aspects and is dependent on the experience of the attending physician. This study aimed to describe the patients journey profile until they start their experience in a tertiary headache center. METHODS: In a cross-sectional study, medical charts from migraine patients were reviewed to describe which treatments, procedures and follow-up strategies are performed until the first appointment with a headache specialist. Patients from both sexes, ≥18 years old, which came to their first visit from March to July 2017 were included. Sociodemographic information, headache characteristics, diagnostic methods previously used, clinical history, family history and the treatments previously used were assessed in the first appointment with a specialist. Patient Health Questionnaire-9 and General Anxiety Disorder-7 were also applied. Descriptive analyses were performed to describe the sample profile and statistical tests were used to evaluate factors associated with the type of migraine (chronic or episodic). RESULTS: The sample consisted of 465 patients. On average, the pain started 17.1 (SD = 11.4) years before the first appointment with a headache specialist. Most of patients were classified as having chronic migraine (51.7%), with an average frequency of 15.5 (SD = 9.9) days per month. Regarding patients' journey until a specialist, most patients were submitted to laboratory tests (74.0%), cranial tomography (66.8%) and magnetic resonance imaging (66.8%) as diagnostic methods, and preventive drugs (70.2%) and acupuncture (61.0%) as treatments. After stratification by migraine type as episodic or chronic, patients with chronic migraine were submitted to more magnetic resonance imaging test, acupuncture, psychotherapy, used preventive drugs, and reported to have used topiramate without beneficial effects. CONCLUSIONS: Brazilian patients with migraine experiment a long journey until getting to a headache specialist and are submitted to a great number of unnecessary exams, especially those with chronic migraine.


Assuntos
Transtornos de Enxaqueca/terapia , Terapia por Acupuntura , Adolescente , Adulto , Estudos Transversais , Feminino , Cefaleia , Humanos , Masculino , Pessoa de Meia-Idade , Topiramato/uso terapêutico
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