RESUMO
The efficacy of a 6-day regimen of frovatriptan for menstrual migraine (MM; attacks starting on day -2 to +3 of menses) prevention in women with difficult-to-treat MM was assessed. Women with a documented inadequate response to triptans for acute MM treatment were included in this placebo-controlled, parallel-group trial. Women were randomized to double-blind treatment for three perimenstrual periods (PMPs) with either frovatriptan 2.5 mg (q.d. or b.i.d.) or placebo initiated 2 days before anticipated MM. The efficacy analysis included 410 women with 85% completing three double-blind PMPs. The mean number of headache-free PMPs was 0.92 with frovatriptan b.i.d., 0.69 with frovatriptan q.d. and 0.42 with placebo [P < 0.001 (b.i.d.) and P < 0.02 (q.d.) vs. placebo]. When migraine occurred, severity was reduced with frovatriptan q.d. (P < 0.001) and b.i.d. (P < 0.001) vs. placebo. Both frovatriptan regimens were well tolerated. In women with difficult-to-treat MM, a 6-day regimen of frovatriptan significantly reduced MM incidence and severity.
Assuntos
Carbazóis/uso terapêutico , Menstruação , Transtornos de Enxaqueca/prevenção & controle , Agonistas do Receptor de Serotonina/uso terapêutico , Triptaminas/uso terapêutico , Adolescente , Método Duplo-Cego , Feminino , História do Século XVI , Humanos , Pessoa de Meia-Idade , Transtornos de Enxaqueca/etiologia , Adulto JovemRESUMO
We performed a prospective study using preoperative magnetic resonance imaging to identify hippocampal formation atrophy in 15 consecutive patients with intractable partial epilepsy who had undergone a stereotactic resection of an extrahippocampal temporal lobe foreign-tissue lesion. A stereotactic lesionectomy was performed in all patients, i.e., only the imaging-defined lesion itself was resected. Hippocampal formation atrophy was identified in three of the 15 patients. Neuroimaging-detected hippocampal formation atrophy has been shown to be a reliable marker of moderate to severe mesial temporal sclerosis. All patients with hippocampal formation atrophy had an unfavorable operative outcome. Pathological examination of the hippocampus in one patient with neuroimaging-identified hippocampal formation atrophy who subsequently received an anterior temporal lobectomy revealed mesial temporal sclerosis. Nine of the 12 patients without hippocampal formation atrophy experienced a significant reduction in seizure tendency after lesionectomy. The surgically excised hippocampus in one patient without hippocampal formation atrophy who later underwent a temporal lobectomy showed no significant neuronal loss. Results of this study have modified the surgical approach taken at this institution in patients with temporal lobe lesional epilepsy. Patients with magnetic resonance imaging-defined dual pathology now undergo a temporal lobectomy which includes resection of the hippocampus and the foreign-tissue lesion.