Diffusion tensor imaging in pediatric patients with dystonia.

BACKGROUND: Childhood-onset dystonia is often progressive and severely impairs a child´s life. The pathophysiology is very heterogeneous and treatment responses vary in patients with dystonia. Factors influencing treatment effects remain to be elucidated. We hypothesize that differences in brain connectivity and fiber coherence contribute to the heterogeneity in treatment response among pediatric patients with inherited and acquired dystonia. METHODS: Twenty patients with childhood-onset dystonia were retrospectively recruited including twelve patients with inherited or idiopathic, and eight patients with acquired dystonia (mean age 10 years; 8 female/12 male). Fiber density between the internal part of the globus pallidus and selective target regions, as well as the diffusion measures of fractional anisotropy (FA) and mean diffusivity (MD) were analyzed and compared between different etiologies. RESULTS: Patients with acquired dystonia presented higher fiber density to the premotor cortex and putamen and lower FA values in the thalamus compared to patients with inherited/idiopathic dystonia. MD in the premotor cortex was higher in patients with acquired dystonia, while it was lower in the thalamus. CONCLUSION: Diffusion MRI reveals microstructural and network alterations in patients with dystonia of different etiologies.

Headache in men: forgotten in practice and ignored in research.

In general practice, the sex-specific consultation rate for headache is only slightly lower for men than it is for women. Headache is 2 to 3 times more common in women than it is in men, and women outnumber men in general practice by 2-fold. However, in headache practice they seem to outnumber men by 4- to 5-fold, suggesting a specific barrier to seeking specialty care. Although there is extensive literature specifically concerning headache in women, a PubMed search did not reveal any publications specifically addressing the problem in men, with the exception of cluster headache, a well-known headache condition that is more frequent in men. As a first attempt at filling this void, we analyzed the headache features, associated symptoms, and precipitating, aggravating, and relieving factors in 100 randomly selected men from a headache practice. Our results indicate that headache is a significant medical problem in men, and they seem to be underrepresented when it comes to seeking expert headache care.