Peripheral blood monocytes in multiple sclerosis exacerbations

Monocytes [MO], macrophages, and microglia have a central role in the central nervous system inflammation of multiple sclerosis [MS]. During clinical activity in MS, MO activation markers increase and some interleukins and tumor necrosis factor-alpha levels are elevated. Our aim was to determine levels of absolute MO count and percentage in peripheral blood of MS patients during the attacks. We assessed the percentage of MO by examining the blood smears in 28 patients with definite MS, in 20 patients with acute cerebrovascular disease [CVD] and in 20 healthy control subjects. The mean value of absolute MO count in MS patients, CVD and control groups were as 606.67 +/- 170.52, 746.50 +/- 414.76 and 360.00 +/- 109.54 respectively. The mean values of MO percentage in MS patients, CVD and control group were 8.34 +/- 2.61%, 5.56 +/- 2.48% and 5.36 +/- 1.50% respectively. The mean percentage of MO was significantly elevated in MS patients compared with the both groups of CVD and control [P<0.001]. Our results suggest a possible role of an increase in MO activation in the acute exacerbations of Multiple Sclerosis

Chronic paroxysmal hemicrania responsive to lamotrigine

This report details a 45-year-old woman who has been suffering right-sided temporal and orbital headache attacks during last five years. The pain is characteristically associated with ipsilateral lacrimation, ptosis and rhinorrhoea. The frequency and duration of pain increased dramatically within last two years. Detailed neurological, physical and clinical examinations as well as routine blood tests revealed no abnormality. Magnetic resonance imaging of brain was normal. The patient was clinically diagnosed as chronic paroxysmal hemicrania and initially treated with indomethacin. Due to appearance of epigastric pains indomethacin treatment was replaced with lamotrigine which successfully resolved the symptoms