1,721,131 research outputs found
Seizure following the Use of the COX-2 Inhibitor Etoricoxib
Full text linkWe describe a case of epileptic seizures occurring after the use of a COX-2 inhibitor. A 61-year-old man was admitted to our department because of a generalized tonic-clonic seizure. EEG showed generalized slowdown of the activity. Neuroimaging and blood samples studies did not evidence alterations, but a careful pharmacological history revealed that the patient had taken the COX-2 inhibitor etoricoxib to treat lumbago few days before the onset of clinical symptoms. No seizures were reported after etoricoxib discontinuation and an EEG resulted to be normal two months after this. Conclusion. Knowing the pharmacological history of a patient is important for understanding the clinical presentation and selecting appropriate treatment. This is, to the best of our knowledge, the first reported case of generalized seizures associated with the use of COX-2 inhibitors
Brain stimulation in migraine
No full textMigraine is a very prevalent disease with great individual disability and socioeconomic burden. Despite intensive research effort in recent years, the etiopathogenesis of the disease remains to be elucidated. Recently, much importance has been given to mechanisms underlying the cortical excitability that has been suggested to be dysfunctional in migraine. In recent years, noninvasive brain stimulation techniques based on magnetic fields (transcranial magnetic stimulation, TMS) and on direct electrical currents (transcranial direct current stimulation, tDCS) have been shown to be safe and effective tools to explore the issue of cortical excitability, activation, and plasticity in migraine. Moreover, TMS, repetitive TMS (rTMS), and tDCS, thanks to their ability to interfere with and/or modulate cortical activity inducing plastic, persistent effects, have been also explored as potential therapeutic approaches, opening an interesting perspective for noninvasive neurostimulation for both symptomatic and preventive treatment of migraine and other types of headache. In this chapter we critically review evidence regarding the role of noninvasive brain stimulation in the pathophysiology and treatment of migraine, delineating the advantages and limits of these techniques together with potential development and future applicatio
The Unsolved Conundrum of Optimal Blood Pressure Target During Acute Haemorrhagic Stroke: A Comprehensive Analysis
No full textIntracerebral haemorrhage (ICH) is a devastating cerebrovascular disease, which accounts to 15% of all strokes. Among modifiable risk factors for ICH, hypertension is the most frequent. High blood pressure (BP) is detected in more than 75–80% of patients with ICH. Extremely elevated BP has been associated with early hematoma growth, a relatively frequent occur-rence and powerful predictor of poor outcome in patients with spontaneous ICH. On the other hand, excessively low BP might cause cerebral hypoperfusion and ultimately lead to poor outcome. This review will analyse the most important trials that have tried to establish how far should BP be lowered during acute ICH. These trials have demonstrated either a small non-significant benefit (INTERACT-2, INTEnsive blood pressure Reduction in Acute Cerebral haemorrhage Trial) or no benefit (ATACH-2, Antihypertensive treatment of acute cerebral haemorrhage II study) when intensive systolic BP reduc-tion was compared with modest or standard BP reduction. The more recent meta-analyses including studies investigating this issue yielded similar conclusions: aggressive BP control in the acute phase of ICH is not beneficial. For these reasons the 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension, do not recommend treatment to immediately lowerBPin patients with acute ICH and systolic BP < 220mmHg. Careful lowering of SBP to less than 180mmHg via i.v. Infusion may be considered only in patients with SBP ≥ 220mmHg
Is lack of habituation a biomarker of migraine? A critical perspective
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Two cases of cluster headache effectively treated with levetiracetam
Full text linkCluster headache (CH), which is characterized by recurrent attacks of short-lasting excruciating pain accompanied by
signs of autonomic dysfunction (ICHD-II) (Headache Classification Subcommittee of the IHS, 2004), is the most severe of the primary headache syndromes. CH is the most common of the trigeminal autonomic cephalalgias (TACs),
whose pathophysiology has not been completely elucidated (Leone and Bussone, 2009). The treatment of CH is still debated. Verapamil (a calcium antagonist) and lithium are the first-option drugs. Several drugs have been proposed as alternative treatments, but only some of these showed limited efficacy. Recently, a new-generation antiepileptic drug, topiramate (200 mg/day), was reported to ameliorate CH (Leone et al., 2003). Here we describe two cases of CH that became unresponsive to classical treatment and were effectively treated with levetiracetam (LEV)
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Recovery of aphasia: a case study with “dual” tdcs.
No full textObjectives. In the present study we used a “dual” tDCS (Vines et al., 2008; Giglia et al., 2011) training on inferior frontal gyrus’s (IFG) areas in order to improve the linguistic performance of EBE, an Italian female, left-handed, presenting a global aphasia following a stroke of right middle cerebral artery.
Materials. For the picture naming task, 20 object and 20 action images, selected from a set of picture standardized for frequency, were presented on a paper sheet one at time.
Method. Stimulation was used at 1mA for 15 minutes. Dual tDCS was given over both IFGs, cathode in the right (damaged areas) and anode in the left (preserved areas) daily for two weeks (weekend-free). The position of the electrodes was based on a previous pilot study on EBE, in which tDCS efficacy was greater when the cathode was positioned over the right Broca’s area and the anode over the left Broca’s area, compared to the opposite placement. One week after the end of the treatment, sham tDCS was delivered for another week. EBE performed the naming of the complete set of 40 pictures at the following times: before real tDCS (T0), immediately after the end of real tDCS (T1), before sham tDCS (T2) and after sham tDCS (T3). Since EBE was able to name no picture without a phonological cue (the first or the two first letters of the stimulus), the images in the picture naming task was first presented without cue, then with a first letter and, if no response was obtained, with the two first letters. The following scores were used: 0= incorrect response; 0.5= correct response with two letters of phonological cue; 1= correct response with one letter; 2= correct response without cue. Thus, a higher score means a better performance. These scores obtained at the four different times (conditions) of examination were compared by means of repeated measures one-way ANOVA.
Results. ANOVA showed a statistically significant main effect of conditions. As showed by Duncan's post hoc analysis EBE made significantly less errors after real tDCS (T1) with respect to baseline (T0) (p<0.05), while no significant changes in performance were observed after sham tDCS (T3 vs T0).
Discussion. Our study is the first in which dual stimulation is used in order to improve the linguistic performance of an aphasic patient. In our patient, considering left-handedness and aphasia following a right lesion, a right hemisphere dominance for language can be presumed. So, anodic stimulation of the left frontal areas could favor the recruitment of this area to compensate the function of the damaged language area; while cathodic stimulation of the right damaged area could have played its effect reducing transcallosal inhibitory drive to the homologue area.
Conclusion. Dual tDCS could be a promising tool for aphasic recovery. This study shows that an intense training (at least ten days) improves linguistic performance also for severe nonfluent chronic aphasia
CLINICAL EFFECTS OF DIFFERENT MONTAGES OF TRANSCRANIAL DIRECT CURRENT STIMULATION IN PATIENTS WITH PARKINSON’DISEASE
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