1,720,969 research outputs found
Carotid artery intima and media thickness is a marker of large artery stroke in patients with severe carotid stenosis
No full textEfficacy of topiramate and valproate in chronic migraine
No full textOBJECTIVES:
The aim of this study was to compare the efficacy of sodium valproate and topiramate in treating chronic migraine.
METHODS:
Forty-nine patients with chronic migraine were randomly assigned to 1 of 2 groups of treatment: 750 mg/day valproate or 75 mg/day topiramate. Efficacy variables were number of days with headache over a 30-day period and changes in Migraine Disability Assessment (MIDAS) scores at 3 months.
RESULTS:
At baseline the 2 groups had similar numbers of days with headache and mean MIDAS scores. At the end of the treatment period, a significant reduction in 30-day headache frequency with respect to baseline (P < 0.00001) and a significant reduction in MIDAS scores (P < 0.00001) were recorded in both groups. There were no significant differences in beneficial effects between the 2 drugs.
DISCUSSION:
Valproate and topiramate seem to be able to manage successfully chronic migraine without substantial differences in efficacy and tolerability. This affords clear practical advantages-in the event of failure of or intolerance for one treatment, the patient may be switched to the other
Cerebral hemodynamics in patients with multiple sclerosis
No full textBackground and Purpose: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. Although the currently predominant view is that of an autoimmune inflammatory condition, changes in brain vasculature can occur and contribute to pathophysiology. The aim of this study was to evaluate cerebral hemodynamics in patients with MS and explore its relationship with disease status. Methods: Patients with MS and age- and sex- matched healthy controls were recruited. All participants underwent assessment of cerebral hemodynamics through transcranial Doppler ultrasonography. Cerebral vasomotor reactivity (CVR) to hypercapnia was measured by the breath-holding index (BHI). Results: A total of 80 patients with MS and 80 healthy controls were recruited. BHI values obtained in healthy controls, relapsing-remitting (RR)-MS and secondary progressive (SP)-MS patients were 1.15±0.11, 0.87±0.18 and 0.51±0.20, respectively (p<0.001). Group-wise, patients showed decreased CVR in comparison to controls and BHI values were significantly lower in SP-MS than in RR-MS patients. At linear regression analysis, the disease form was significantly associated with cerebral hemodynamics being the SP phenotype an independent predictor of lower BHI values [β=-0.36, 95% confidence interval (CI): -0.44 to -0.27, p<0.001; adjusted β=-0.37, 95% CI: -0.50 to -0.23, p<0.001). Conclusions: Cerebrovascular hemodynamic insufficiency in MS may be secondary to the downstream effects of neuro-inflammatory cascades
Sialic acid and sialidase activity in acute stroke
Full text linkStroke is a heterogeneous syndrome caused by multiple disease mechanisms,
resulting in a disruption of cerebral blood flow with subsequent tissue damage.
It is well known that erythrocytes have a large amount of sialic acid and could
represent a model to investigate changes occurring in a pathology like stroke.
The aim of this study was to investigate a possible relationship among
erythrocyte membrane, plasma and sialic acid content. The possible impact of the
sialic acid content and the activity of sialidase on stroke severity was also
evaluated. The study population consisted of 54 patients with a first stroke and
of 53 age-and sex matched healthy volunteers. The total bound sialic acid was
substantially decreased in patients. There was a significant correlation between
the sialidase activity values and the severity of the neurological deficit
defined by the National Institute of Health Stroke Scale. This study shows that
low sialic acid erythrocyte concentrations with contemporary high sialic acid
plasma levels and elevated sialidase activity can be considered as markers of
ischemic stroke. Further investigations are needed to clarify the possible role
of these biochemical changes in producing and sustaining cerebral ischemic
damage
Long-term outcome in multiple sclerosis patients treated with fingolimod
No full textBackground and Purpose: Ongoing disease activity during treatment has been associated to worse disability outcomes in patients with Multiple Sclerosis (MS). The aim of this study was to assess the 5-year response to fingolimod (FTY) treatment in patients with relapsing-remitting (RRMS) in a real-life setting. Methods: We included RRMS patients who received FTY for at least 6 months and had a follow-up ≥ 60 months. Treatment response was assessed through the No Evidence of Disease Activity (NEDA)-3 status. Results: Eighty-eight patients were included, of which 51 (58.0%) were NTZ-naïve and 37 (42.0%) NTZ-switchers. The mean age was 38.9 (9.5) years and 58 (65.9%) were females. The proportion of patients on FTY treatment who maintained the NEDA-3 status at 5 years was 55.9% among NTZ-naïve patients and 35.0% among NTZ-switchers (p=0.138). Predictors of NEDA-3 status were lower Expanded Disability Status Scale score at baseline (adjOR=0.28, 95% CI 0.10-0.77; p=0.013) in NTZ-naïve patients and fewer relapses in the 12 months before starting FTY in NTZ-switchers (adjOR=0.05, 95% CI 0.003-0.79; p=0.034). Conclusions: This study supports the potential of FTY as a disease-modifying treatment for the long-term management of RRMS patients. Patients with milder disability and fewer clinical relapses before treatment may achieve a better disease control
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