1,720,997 research outputs found
Central and Peripheral Nervous Disorders
No full textThere is increasing attention on determinants of health including not only the genetic and biological differences between males and females defining what we usually call “sex” but also psychological, environmental, and sociocultural factors that define what is commonly called “gender” and which may affect disproportionally men’s and women’s health. “Dimorphic neurology” focuses on differences between men and women in the causes, manifestations, response to treatments, and outcomes of neurological diseases. In these pages the authors focus on the implications of sex, gender, and some of the most frequent neurologic diseases, such as stroke, dementia, epilepsy, migraine, and multiple sclerosis
Greater Occipital Nerve Infiltration During Pregnancy in Cluster Headache: A Case Report
No full textObjective To clarify whether the clinical response after the first 2 cycles with Onabotulinumtoxin A can accurately predict the long-term response. Background Onabotulinumtoxin-A (OBT-A) is an approved preventive treatment option for chronic migraine (CM). Nowadays, it remains to be clarified if the treatment has to be prolonged for at least an entire year (4 injections every 3 months - ie, quarterly, as proposed in the PREEMPT trials) or it can be halted after the second or third injection if not clinically effective. Design and Methods We conducted a multicenter observational cohort study based on real-life data on the usage of OBT-A in CM patients from 2 Italian headache centers, Roma Campus Bio-Medico and Milano Besta, adopting the whole 4-injections protocol. We performed a retrospective analysis of medical records of consecutive patients treated in the 2 centers. The main statistical analysis aimed to evaluate longitudinal measures related to headache (monthly headache frequency, monthly number of analgesic drugs, MIDAS). We hypothesized from our clinical practice with OBT-A that only 2 cycles of treatment were not enough to actually define the non-responder status to botulinum toxin A and that probably a longer time of treatment is needed to get the condition of long-term (delayed) responder. Results We considered 115 patients from the 2 centers: 53 in Roma and 62 in Milano. Regarding the main analysis, a clear improvement in each measure was obtained at the 6 months assessment and maintained up to 12 months. Comparing patients with <30% and >= 30% reduction in headache frequency between T0 and T2 or T4 (respectively, "Non-Responders" and "Responders"), we found that the agreement between the classification Responders/Non-Responders at T2 and T4 was not very high (79/104 = 76.0%, with a "moderate" Cohen's Kappa of 0.51), suggesting that the status at T4 is not fully predictable by the status at T2 (lambda = 0.47). Responders for headache frequency at T4 were 54.8%. Among Responders at T2, Responders at T4 were 47/62 = 75.8% (95% CI: 64.5%, 85.5%), while among Non-Responders at T2, Responders at T4 were 10/42 = 23.8% (95% CI: 11.9%, 38.1%). Similarly, even when considering the 50% reduction in painkillers consumption or in MIDAS total score between T0 and T2 as possible prognostic factors, the changes occurring at T4 are not strongly predictable by those at T2. Conclusions A >= 30% reduction in headache frequency at T2 cut-off is not adequate in predicting a late response to treatment: more than a quarter of excluded patients would miss a clinical improvement with an ongoing treatment, while in a similar percentage of Responders the treatment would lose efficacy. Results from our real-life study suggest that we possibly have to postpone the definition of Responder/Non-Responder to OBT-A at least after 1 year of treatment (4 cycles)
Back to the future: a case series on revisiting onabotulinumtoxinA for chronic migraine management after anti-CGRP therapies failure
No full textBackground: Chronic migraine (CM) management is still a challenge. Notwithstanding the success of anti-calcitonin gene-related peptide antibodies (anti-CGRP mAbs), not all patients respond to these treatments. Here, we revisit the efficacy of onabotulinumtoxinA (BTA) in patients who did not respond to anti-CGRP mAbs. Methods: This case series included 36 CM patients who demonstrated an insufficient response (<10% reduction in monthly headache days [MHD]) to anti-CGRP mAbs and who received a subsequent BTA treatment between December 2022 and February 2024. All patients had a minimum follow-up duration of six months with anti-CGRP mAb and BTA treatments. Results: The cohort comprised 12 patients (92% females, mean age of 49 years) affected by CM. Treatment with anti-CGRP mAbs produced in 7 (58.3%) patients an initial 20% reduction in MHD which, after a few months, was less than 10%; in 5 patients (41.6%) the response was >10% from the beginning of the treatment. A reduction in MHD of >50% was reported in 6 patients (50%) treated with BTA, and in 6 patients (50%) there was a less pronounced reduction (30-50%). Conclusions: This case series is the first report of patients who showed a meaningful response to BTA after an unsuccessful trial with anti-CGRP mAbs, suggesting a CGRP-independent action of BTA. However, due to the small sample size, further research is needed to support the proposal of a positive response to BTA in CM patients resistant to anti-CGRP mAbs and the consequent mechanistic implications
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
Recurrent Reversible Cognitive Impairment in a Cluster Headache Patient: A Case Report
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Prevalence, natural history and dynamic nature of chronic headache and medication overuse headache in Italy: The SPARTACUS study
Full text linkBackground: Chronic headaches and medication overuse headache are common and burdening conditions. No studies have evaluated the prevalence of chronic headache and medication overuse headache in an unselected Italian population. Methods: We performed a three-year cross-sectional and longitudinal population-based study to investigate prevalence, natural history, and prognostic factors of chronic headache. We delivered a self-administered questionnaire to 25,163 subjects. Chronic headache patients were interviewed by General Practitioners. After three years, medication overuse headache patients were invited to undergo a neurological evaluation at our Center. Results: 16,577 individuals completed the questionnaire; 6878 (41,5%) were episodic headache sufferers and 636 (3.8%) were chronic headache subjects. 239 (1.4%) patients were acute medication over-users. All medication overuse headache patients had migraine or headache with migrainous features. At the three-year follow-up of 98 patients, we observed conversion to episodic headaches in 53 (54.1%) patients. 27 (50.9%) patients remitted spontaneously. Conclusions: We present the first prevalence data on chronic headache and medication overuse headache in an unselected Italian population and a high rate of spontaneous remission. These data support the interpretation of medication overuse headache as a specific migraine-related disorder that may reflect chronic migraine’s dynamic nature, the need for more specific medication overuse headache diagnostic criteria, and highlight the priority of targeted public health policies
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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