Blink reflex habituation in migraine and chronic tension-type headache.

ΑBSTRACT: R1 and R2 blink reflex latencies were investigated blind in 55 patients with chronic tension-type headache, 55 patients with migraine, and 55 headache-free controls. Standard electrical stimulation of the supraorbital nerve was applied and the response was recorded from the ipsilateral orbicularis oculi muscles. There were no R1 or R2 latency differences between the three groups. During migraine attacks we observed a statistically significant reduction of R2 amplitude and area. The main finding of our study was the elicitation of the late R2" response at different interstimulus intervals in migraine patients compared to the tension-type headache and control groups. This could be considered an indication of habituation mechanism hyperexcitability, although further investigation is needed to confirm these findings and establish the neurophysiologic basis. This study suggests that blink reflex studies can be used routinely as a non-evasive and inexpensive method for the evaluation of headache patients.

Optimal treatment of HIV-associated neurocognitive disorders: myths and reality. A critical review.

BACKGROUND: The aim of this study was to review the clinical data on the effectiveness of the pharmacotherapy of HIV-associated neurocognitive disorders (HANDs). METHODS: A literature search of PubMed was performed (from January 1996 to October 2018) using the terms: 'HIV-associated neurocognitive disorders', 'HIV-associated dementia', 'mild neurocognitive disorder (MND)', 'asymptomatic neurocognitive impairment (ANI)', 'adjuvant therapies', 'antiretroviral treatment (cART)', 'neurotoxicity', 'cART intensification', 'fluid markers', 'cerebrospinal fluid', 'protease inhibitors', 'nonnucleoside reverse transcriptase inhibitor', 'nucleoside reverse transcriptase inhibitors', and 'integrase strand transfer inhibitors'. Additional references were identified from a review of literature citations. All English language clinical studies of adjunctive therapies and neuronal markers were selected in order to evaluate a closer relationship between the early involvement and the onset of cognitive decline. We identified 407 relevant studies, of which 248 were excluded based on abstract analysis. Finally, we analyzed 35 articles, organizing the results by cART, adjuvant and neuronal markers (total of 7716 participants). RESULTS: It is important to inform clinicians about the importance of accurate phenotyping of HIV patients, incorporating an array of markers relevant to HAND pathophysiology, in order to assess the individual's risk and potential response to future personalized antiretroviral treatment. CONCLUSION: So far, no clinical trials of HAND therapies are effective beyond optimal suppression of HIV replication in the central nervous system. Combination of validated neuronal markers should be used to distinguish between milder HAND subtypes and improve efficiency of clinical trials, after strict control of confounders.

Job stress and burnout in the care staff of Leros PIKPA Asylum 25 years after the first Deinstitutionalisation and Rehabilitation Greek Project.

Aims and method To identify correlates between burnout and job stress of care staff at Leros PIKPA Asylum. Forty-nine asylum employees were assessed by Maslach's Burnout Inventory, a sociodemographic questionnaire, the Perceived Stress Scale and the Job Content Questionnaire. Results Emotional exhaustion is related negatively to social support (P = 0.010, r = -0.362). Lack of job achievements is related positively to overall job responsibility (P = 0.040) and negatively to lack of job satisfaction (r = -0.430). Depersonalisation was negatively associated with support from superiors (P = 0.036). Employees with high levels of perceived stress reported higher levels of fatigue (P = 0.050). Positive associations of perceived stress with depression (P = 0.011) and sleep problems (P<0.001) were also detected. Positive correlation was found between monthly salary and lack of sense of personal achievement (P = 0.020). Clinical implications It is necessary to address these issues through staff education and stress management.

Perceived cognitive decline in multiple sclerosis impacts quality of life independently of depression.

Background/Aim. The aim of this study is to examine the effects of perceived cognitive dysfunction and of depression, on self-reported QoL, in a Greek population sample of MS patients. Methods. One hundred outpatients diagnosed with MS completed the Short-Form-36 Health Survey (SF-36), as well as the Perceived Deficits Questionnaire (PDQ) and the Depression subscale of the Mental Health Inventory (MHI), as part of a clinical evaluation which included the Expanded Disability Status Scale (EDSS) estimation. Multiple linear regression was conducted to determine the best linear combination of age, gender, education, EDSS, depression, attention/concentration, retrospective memory, prospective memory, and planning/organization, for predicting QoL scores. Results. In the multivariate regression analysis models, EDSS (P < 0.05), depression (P < 0.001), perceived planning/organization (P < 0.05), and perceived retrospective memory dysfunction (P < 0.05) independently predict quality of life scores. Age, sex, education level, and perceived attention/concentration dysfunction, as well as perceived prospective memory dysfunction, do not independently predict quality of life scores. Conclusions. Perceived planning/organization impairment and perceived retrospective memory impairment in MS patients predict QoL independently of the severity of disease and the severity of depression and therefore should be considered in the assessment of patient health status as well as in the design of treatment interventions and rehabilitation.

Effect of the emotional freedom technique on perceived stress, quality of life, and cortisol salivary levels in tension-type headache sufferers: a randomized controlled trial.

OBJECTIVE: To evaluate the short-term effects of the emotional freedom technique (EFT) on tension-type headache (TTH) sufferers. DESIGN: We used a parallel-group design, with participants randomly assigned to the emotional freedom intervention (n = 19) or a control arm (standard care n = 16). SETTING: The study was conducted at the outpatient Headache Clinic at the Korgialenio Benakio Hospital of Athens. PARTICIPANTS: Thirty-five patients meeting criteria for frequent TTH according to International Headache Society guidelines were enrolled. INTERVENTION: Participants were instructed to use the EFT method twice a day for two months. OUTCOME MEASURES: Study measures included the Perceived Stress Scale, the Multidimensional Health Locus of Control Scale, and the Short-Form questionnaire-36. Salivary cortisol levels and the frequency and intensity of headache episodes were also assessed. RESULTS: Within the treatment arm, perceived stress, scores for all Short-Form questionnaire-36 subscales, and the frequency and intensity of the headache episodes were all significantly reduced. No differences in cortisol levels were found in any group before and after the intervention. CONCLUSIONS: EFT was reported to benefit patients with TTH. This randomized controlled trial shows promising results for not only the frequency and severity of headaches but also other lifestyle parameters.

Ventricular bigeminy after subcutaneous administration of apomorphine in a patient with refractory Parkinson's disease: a case report.

Apomorphine is a well established treatment for the management of sudden, unexpected and refractory levodopa-induced "off" states in fluctuating Parkinson's disease either as bolus injections or as continuous infusions. Incidents of atrial fibrillation associated with the administration of the drug have been reported in the past but no incidents of ventricular arrhythmias. We report a case of ventricular bigeminy recorded in a female patient after the administration of apomorphine.

Influence of neurological level of injury in bones, muscles, and fat in paraplegia.

To investigate the influence of the neurological level of injury in bone mineral content (BMC) and mechanical properties, lean mass (LM), and fat mass (FM) among paraplegics with a similar duration of paralysis (DOP), we separated 30 paraplegics into group A (15 men, high-level paraplegia) and group B (15 men, low-level paraplegia) and compared them with group C (33 men, nondisabled). In all subjects, we measured stress-strain index (SSI) at 14% (SSI(2)) and 38% (SSI(3)) of the tibia length and the difference between them using peripheral quantitative computed tomography (XCT 3000 [Stratec Medizintechnik, Pforzheim, Germany]) and lower-limb BMC, LM, and FM (g) using whole-body dual-energy X-ray absorptiometry (Norland XR-36 [Norland Medical Systems, Inc; Fort Atkinson, Wisconsin]). Bone strength parameters, BMC, and LM were statistically decreased, but we found no difference in paraplegic FM compared with group C. We found a correlation between the DOP and the difference between SSI 3 and SSI 2 in group B (r = 0.53, p = 0.03 and r = 0.5, p = 0.04, respectively). We correlated DOP with FM in group A's lower limbs (r = 0.5, p = 0.05). Because of the nonsignificant DOP, the groups with paraplegia act differently in tibia mechanical properties and lower-limb body composition.

Transcranial Doppler in migraine attacks before and after treatment with oral zolmitriptan or sumatriptan.

BACKGROUND: Intracranial blood flow velocity (BFV) changes in migraine have been studied fairly extensively. Although a number of investigations have been performed in migraineurs with nitroglycerin-induced attacks, there has been no reported transcranial study involving such attack treated with zolmitriptan or sumatriptan. METHODS: With ultrasound, we studied the BFV and pulsatility index (PI) changes in the middle cerebral artery in 45 symptom free, otherwise healthy, unmedicated patients with migraine without aura, and in 15 age- and sex-matched controls before nitroglycerin, at the time of maximum head pain induced by nitroglycerin and every 30 minutes for 2 hours after zolmitriptan (15 subjects) or sumatriptan (15 subjects) administration. Headache was rated on a 4-point scale. RESULTS: During headache attacks, BFV decreased significantly (36.7+/-3.3, 38.4+/-3.4, and 37.4+/-4 cm/sec, respectively, in the zolmitriptan, sumatriptan, and nontreated migraine groups, but not in the controls who were migraine free (P <.01). These abnormalities disappeared 1 hour after zolmitriptan or sumatriptan administration (49.7+/-3.7 and 48.9+/-3.9 cm/sec, respectively). There were no significant changes in PI. CONCLUSION: Our data indicate that nitroglycerin-induced headache in individuals with migraine without aura is associated with BFV changes that are reversed by administration of an oral triptan.