Migraine recurrence is not associated with depressive or anxiety symptoms. Results of a randomized controlled trial.

In order to investigate the plausible association of migraine recurrence with anxiety and depressive symptoms, a multicentre, randomized, double-blind, placebo-controlled, crossover clinical trial was conducted using sumatriptan as a vehicle drug. Migraineurs were randomly assigned to receive either 50 mg sumatriptan or placebo for three consecutive migraine attacks, and then cross over to the other treatment for three more migraine attacks. The primary measurements were the observed rate of migraine recurrence in relation to (i) patient's mood condition, measured by the Hamilton rating scales for depression and anxiety and (ii) patient's general health and functioning measured by the Symptom Checklist (SCL)-90-R. Migraine recurrence was defined as any migrainous headache that occurred within 24 h post treatment, only when pain free at 2 h was achieved. The analysis of efficacy was performed on 376 migraine attacks treated with sumatriptan and 373 attacks treated with placebo. Recurrence ratio was 14.1% and 5.1%, respectively (P = 0.045). The number needed to treat for pain free at 2 h post dose was 5.4. Recurrence was not affected by Hamilton scores for depression or anxiety, SCL-90-R scores or treatment. Apparently, depressive or anxiety symptoms do not influence headache recurrence in acute pharmaceutical migraine treatment, but further investigation is required.

The effects of slow waves in the screening EEGs of pilot cadets on P300 ERP and memory scanning performance.

BACKGROUND: Electroencephalography (EEG) screening of pilot candidates has long been established but remains controversial. The EEG records of 0-15% of the test population demonstrate the presence of brief periods of slow waves (theta, 4-7.9 Hz and delta, 0-3.9 Hz). The significance of these EEG findings for pilot selection has not been defined. HYPOTHESIS: We investigated whether the existence of slow waves in the EEG records of cadet pilots was related to differences in their cognitive performance. If so, the EEG could serve as a tool for cognitive assessment in candidate pilot screening. The relationship between spontaneous EEG slowing and cognitive performance has not been investigated although there is evidence of EEG slowing during the performance of short-term memory tasks. METHODS: Some 116 screening EEG records were re-evaluated for the presence of slow wave activity. Cadets with positive records and a control group performed: a) a modified version of Sternberg's visual memory scanning task on a PC computer; and b) the auditory "OddBall" behavioral task for eliciting the P300 evoked response using the Nicolet Spirit Evoked Potential System. RESULTS: Analysis of the behavioral and electrophysiological data was divided in EEG groups: a) Normal; b) Bilateral slowing only during hyperventilation; c) Bilateral slowing; d) Slowing with right dominance; and e) Slowing with left dominance, showed no significant difference among the groups for all parameters measured. CONCLUSIONS: Brief periods of bilateral or focal EEG slow activity in the records of pilot cadets could not predict differences in cognitive function as this was assessed in these experiments. Specific neuropsychological screening procedures might be more valuable for this purpose than the standard EEG screening.

Measurement of autonomic dysregulation in multiple sclerosis.

OBJECTIVE: Patients with definite multiple sclerosis (MS) were tested for autonomic nervous system (ANS) dysfunction using clinical symptomatology criteria and non-invasive laboratory testing. Exactly 45.45% of patients exhibited subjective symptoms of autonomic dysfunction and 42.42% of patients had abnormal laboratory tests results. METHODS: The sympathetic ANS tests were abnormal in 30.3% of MS patients and the parasympathetic ANS tests were abnormal in 18.18% of MS patients. The most sensitive test for the presence of autonomic dysfunction was the sympathetic skin response. CONCLUSION: Autonomic dysfunction was often subclinical and we conclude that it is preferable to combine several tests for a more thorough and accurate evaluation of the ANS impairment in MS.