1,721,798 research outputs found
Profilo di Enrico Greppi
No full textEnrico Greppi creò nel 1954, presso la Clinica medica di Firenze il primo Centro Cefalee in Italia. La scuola di Greppi affrontava lo studio dei meccanismi patogenetici delle cefalee focalizzando la ricerca sulla serotonina e questi studi portarono all'introduzione di primi farmaci per la profilassi dell'emicrania metisergide e pizotifene. Sempre Greppi e Marinetti nel 1934 segnalarono l'azione ipotensiva liquorale della caffeina
Headache: one of the most common and troublesome adverse reactions to drugs.
No full textIt is difficult to attribute the diagnosis of adverse drug reaction to a condition which is also a common symptom. The decision might be arduous in the case of headache, because this disorder is very frequent in the general population. The drugs that more frequently induce headache belong to a variety of therapeutic classes with different mechanisms of action and different toxicity. In the majority of cases the headache has not a typical feature, it is dosedependent, and is associated to other symptoms of neurotoxicity. Some drugs cause, instead, a specific headache: this is the case of NO donors, which are also used in experimental studies in order to induce headache.This review describes the classes of drugs which induce headache, analyzes the frequency of headache induction among the drugs of the same class, and discusses the possible mechanisms underlying headache induction. It is to be hoped that a better awareness of this issue would help the physician to consider it in the differential diagnosis of a recent-onset or changed headache and to avoid prescription of drugs known to cause headache to patients already suffering from this disorder
Storia della Sindrome di Neri Barrè
No full textNell'adunanza scientifica della Società Medico Chirurgica di Bologna del 16 gennaio 1919 il Prof. Vincenzo Neri bolognese (1880-1960) tiene una comunicazione sui "fenomeni cerebrali nei feriti di simpatico cervicale". Egli descrive una costellazione di sintomi che seguono a tempi variabili alle ferite in 9 soldati. Inizia così a Bologna la storia della "sindrome del simpatico cervicale posteriore", descritta inizialmente da neri e confermata nel 1925 da Barrè
Drugs and progression from episodic to chronic migraine
No full textTo prevent progression from episodic to chronic migraine with analgesic overuse it is recommended that migraine patients with severe and frequent attacks receive: 1. an effective acute treatment, 2. early initiation of prophylaxis [1]. Unfortunately, available drugs for acute and prophylactic treatments of migraine have limited efficacy, just in more severe patients. Twenty percent of migraine women experience migraine attacks in at least two thirds of their menstrual cycles. These attacks are more impairing, longer lasting, and have more associated symptoms, greater severity, susceptibility to relapse, and resistance to treatment than nonmenstrual episodes. Severe and prolonged attacks are associated with the risk of becoming chronic. It follows that many of the women with chronic migraine and medication overuse who address headache centers suffered from menstrual episodic migraine at the onset. The strong impact of menstrual migraine on chronification is demonstrated by the fact that its improvement by hormonal therapy is related with either the conversion of chronic migraine to an episodic pattern or a significant reduction of medication overuse [2]. Yet, for this so common and serious disorder there is no specific highly effective pharmacological therapy. With prophylactic treatments only 50% - 65% of patients can expect a reduction of 50% of attacks. Prophylactic drugs do not significantly change the severity and length of the attacks. In addition, the choice among the drugs recommended is empirical. After a physician has prescribed, by trial and error, the third or fourth prophylactic drug without benefits, it may be too late: migraine may have become chronic and complicated by medication overuse. Actually, patients with chronic headache have a higher prevalence of the use of migraine prophylactic medications compared to those with episodic headache. Therefore, even if the advances achieved in the treatment of migraine in the last 20 years are to be appreciated, they are not yet sufficient. If they were decisive, the prevalence of chronic headache and analgesic overuse would probably decrease over time. It remains instead stable. Overall, these data indicate that more effective acute and prophylactic treatments are needed and markers of response must be identified, to allow choosing soon the optimal drug for the individual patient. It has been suggested that chronic migraine with medication overuse is a marker of refractory. Maybe, in many patients medication overuse is a signal of the limitations of currently available drugs to treat more severe migraine.
1. Evers S, Marziniak M (2010) Clinical features, pathophysiology, and treatment of medication-overuse headache. Lancet Neurol 9:391-401.
2. Calhoun A, Ford S (2008) Elimination of menstrual-related migraine beneficially impacts chronification and medication overuse. Headache 48:1186-1193
Issues and solutions in the management of chronic headaches
No full textIn the management of chronic headaches many problems are encountered and the solutions are only partial. The problem the solution of which would lead to the greatest benefits is the prevention of these conditions. To implement prevention it is recommended that patients with severe and frequent headaches receive, in addition to the diagnosis: 1. an effective treatment of the attack; 2. early initiation of prophylactic therapy that is appropriate for dosing and length and duration, the identification and treatment of comorbidities and modifiable risk factors for progression. However, it is not easy to put in place these recommendations. For the acute treatment medications non-specific analgesic- anti-inflammatory drugs and triptans are available. One must remember that NSAIDs have a ceiling of action and explain to the patient that increasing the dose over the recommended does not increase the analgesic action but only the side effects. It is still necessary to restrict their use in patients with heart disease and hypertension because of their cardiovascular toxicity and today we know that this effect concerns all COX inhibitors. These medications are a good choice for perimenstrual attacks as the system of PGs seems specifically involved in the pathogenesis of menstrual migraine. It has been also suggested that COX inhibitors are protective against the development of medication-overuse headache in patients with low (<10d/mo) frequency of headache. Many migraine patients respond poorly to oral NSAIDs but the parenteral route, that avoids the problems of absorption in case of nausea or vomiting, is not always viable outside the hospital. Also the absorption of oral triptans is reduced during the migraine attack and so the result is not predictable. Several patients woke up in the last hours of the night with severe migraine attacks, with nausea and vomiting, probably already in allodynic phase where oral triptans are ineffective. All triptans give better results when used early, before allodynia develops. Only the injectable sumatriptan is effective in these conditions.
The early initiation of prophylactic therapy is regarded as the decisive intervention to prevent chronification. Prophylactic drug have limited efficacy. Approximately 50% of patients can expect a reduction of 50% of attacks. Moreover, prophylactic treatments do not significantly change the severity and length of the attacks, which is just what the patient needs. In addition, the choice among the drugs recommended is empirical, in that there are no factors predictive of response
Concentrazioni plasmatiche di naltrexone e 6-beta-naltrexolo in soggetti in trattamento a lungo termine
No full textIl naltrexone e’ un farmaco completamente assorbito per via orale (Licko, 1980) (Perez-Reyes et al 1980) , varia pero’ la velocita’ di assorbimento in quanto il Tmax e’ compreso tra i 30 minuti e le 2 ore. E’ sottoposto ad un esteso first pass effect (Kogan et al., 1977) e buona parte del farmaco assorbito e’ convertito in diversi metaboliti (Meyer et al., 1984).
La percentuale della dose somministrata per via orale che raggiunge immodificata il circolo sistemico varia a seconda degli studi dal 5-6 (Meyer et al., 1984) al 20, 40 (Chiang C N et al, 1984) o 60% (Wall et al., 1981). Il Naltrexone e’ eliminato dal corpo primariamente per metabolismo epatico (liver metabolization) (Verebey et al., 1976) (Cone et al., 1974) (Dayton and Inturrisi, 1976); solo l’1% di una dose orale si ritrova invariata nelle urine. La tappa principale e’ la riduzione del keto gruppo a gruppo alcolico con la formazione del 6-b-naltrexolo (Cone 1973). Il 6-b-naltrexolo e’ un antagonista considerably weaker than naltrexone (da 1/15 Cone E J et al. 1974) - 1/26 - 1/53 della potenza del naltrexone negli animali (Blumberg and Ikeda, 1976) ma non ci sono dati nell’uomo (The potency ratio in humans is unknown). Da tutti gli studi effettuati i livelli ematici di questo metabolita variano notevolemente da un soggetto all’altro ma sono sempre risultati molto piu’ elevati di quelli del naltrexone e pertanto potrebbe contribuire alla durata del blocco dei narcotici. Sia il naltrexone che il 6-b-naltrexolo vengono poi estesamente glicuronoconiugati (glucuronic acid). Altri metaboliti di minore importanza sono il 2-hydroxy- 3-O-methyl naltrexone e il 2-hydroxy-3-O-methyl-6b-naltrexol e forse i loro glicuronoconiugati. Vi è un'importante variazione interindividuale delle concentrazioni plasmatiche di naltrezone e di 6 -beta-naltrexolo. Proprio per queste differenze non è stato possibile individuare un range terapeutico ottimale
Accanimento terapeutico o riduzione del danno
No full textNella maggioranza dei casi i tossicodipendenti che si rivolgono ai servizi manifestano un sincero desiderio di sospendere l'uso di droga ma pochi realizzano tale intenzione e molti continuano ad usarla ed abusarla malgrado il loro desiderio o gli sforzi terapeutici degli operatori. L'epidemia del virus HIV ha drammatic amente peggiorato la qualità di vita dei tossicodipendenti. Di fronte al rischio di contrarre l'infezione da HIV è necessario un intervento terapeutico sanitario e psicosociale che abbia come fine una "riduzione del danno"
Applicazione della metodologia LCA al settore dei materiali polimerici
No full textl carattere versatile della plastica ne ha fatto il materiale di elezione per la maggior parte delle industrie, dal packaging all’industria alimentare, passando per il settore delle costruzioni, dell’edilizia, dell'auto motive, dell’elettricità, dell’elettronica e anche dell’agricoltura. Nonostante la crescente domanda mondiale, l’industria delle materie plastiche si trova ad affrontare sfide significative imposte dall’aumento dei costi energetici e dall’accesso limitato alle materie prime. Per rimanere produttivi e competitivi, i produttori di plastica e le aziende che la lavorano devono individuare modalità creative di risparmio energetico, conservazione delle risorse, miglioramento dei livelli di riciclaggio e sviluppo di nuove generazioni di materiali.
Il problema dell’impatto ambientale della plastica può essere ridotto, con metodi di recupero tramite raccolta differenziata e di riutilizzo degli stessi materiali a fine vita (riciclo). Per soluzioni più definitive, si punta oggi a sostituire le plastiche tradizionali con plastiche biodegradabili
Cefalea: tassonomia e problematiche diagnostiche
No full text. La classificazione dell’International Headache Society del 1988 per la prima volta inserisce la cefalea drug-induced come una entità diagnostica distinta, tra le cefalee secondarie, nel sottotipo 8.2 Headache induced by chronic substance use or exposure. Nella second edition of the International Headache classification (2004) questa denominazione viene sostituita con medication-overuse headache, si stabilisce che la diagnosi “definite” di medication-overuse headache richiede il miglioramento del disturbo sospendendo l’overuse di farmaci, e vengono indicate le specifiche caratteristiche delle diverse subforms che la compongono. Le revisioni successive che, eliminano prima queste caratteristiche delle cefalee, e poi la diagnosi di probabile medication-overuse headache rendono più facilmente utilizzabile la diagnosi di medication-overuse headache ai fini clinici e di studio. Allo stesso tempo però, eliminando la necessità della prova del ruolo causale dei farmaci, cioè che la cefalea migliori sospendendo l’overuse, si modifica anche la base classificatoria della medication-overuse headache come cefalea secondaria. Di conseguenza nei trials clinici potranno venir inclusi, come uno stesso gruppo omogeneo, pazienti con cefalee primarie e drug overuse e pazienti con medication-overuse headache.
Noi proponiamo di continuare ad utilizzare la diagnosi di probabile medication-overuse headache a scopo di studio. Inoltre, per analizzare meglio il ruolo dei diversi farmaci sullo sviluppo di questa cefalea e sugli esiti dei trattamenti, proponiamo di ristrutturare la classificazione delle subforms di medication-overuse headache according to the presence or absence of a dependence producing property of overused drugs
Rational Use of Lasmiditan for Acute Migraine Treatment in Adults: A Narrative Review
No full textPurpose: This narrative review provides an update on the research that led to the development of ditans and lasmiditan for the acute treatment of migraine in adults and discusses the potential advantages and disadvantages of lasmiditan in clinical use.
Methods: The electronic databases PubMed, Scopus, and ClinicalTrials.gov were searched from database inception through January 9, 2021, to identify relevant studies. Search results were assessed for their overall relevance to this review.
Findings: Because part of the effect of the triptans is mediated by the serotonin 1F receptors, which are not present in the smooth muscle, a pure agonist of these receptors, lasmiditan, was developed. Lasmiditan is hypothesized to act on antinociceptive pathways and inhibit the calcitonin gene-related peptide release. Lasmiditan was approved by the US Food and Drug Administration in 2019 based on the results of 2 pivotal trials that found a significant difference from placebo in the percentage of patients who achieved freedom from pain and most bothersome symptom at 2 h. The main concern of lasmiditan derives from its
central nervous systemerelated adverse effects, mainly dizziness and paraesthesia, probably attributable to its high blood brain barrier penetration. These central nervous system adverse effects impair driving performance for hours and might be suboptimal for individuals with migraine who want to quickly stop the migraine attack to resume their activities as soon as possible.
Implications: Despite the advantage of being beneficial in the acute treatment of migraine without vasocostrictive action, lasmiditan also presents limitations, in particular the central nervous system adverse effects. Moreover, head-to-head trials against triptans and gepants are indispensable to determine the better option for patients
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