Electroacupuncture at Siguan points for migraine of liver yang hyperactivity: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical effect of electroacupuncture at Siguan points and flunarizine hydrochloride capsule on migraine of liver yang hyperactivity.@*METHODS@#A total of 110 patients with migraine of liver yang hyperactivity were randomly divided into an electroacupuncture group (55 cases, 2 cases dropped off) and a western medication group (55 cases, 2 cases dropped off). In the electroacupuncture group, electroacupuncture was applied at Siguan points (Hegu [LI 4] and Taichong [LR 3]), with disperse-dense wave of 2 Hz/100 Hz in frequency and current intensity of 0.1-1 mA, 30 min each time, once a day, 5 times per week for 4 weeks. Flunarizine hydrochloride capsule was given orally in the western medication group, 10 mg a day for 4 weeks. The visual analogue scale (VAS) score and the migraine attack days were observed before and after treatment, during follow-up of 1, 3 and 6 months, and the migraine symptom score was observed before and after treatment in the two groups.@*RESULTS@#After treatment, during follow-up of 1, 3 and 6 months, the VAS scores and the migraine attack days in the two groups were decreased compared with before treatment (Ｐ<0.05), and above indexes in the electroacupuncture group were lower than the western medication group (Ｐ<0.05). After treatment, the migraine symptom scores in the two groups were decreased (Ｐ<0.05), the change in the electroacupuncture group was greater than the western medication group (Ｐ<0.05).@*CONCLUSION@#Electroacupuncture at Siguan points could effectively reduce headache intensity and migraine attack days, relieve migraine symptoms in patients with migraine of liver yang hyperactivity, and the efficacy is superior to oral flunarizine hydrochloride capsules.

Systematic review and Meta-analysis on randomized controlled trial of efficacy and safety for acupuncture versus Flunarizine in treatment of migraine / 中国中药杂志

To systematically evaluate the efficacy and safety of acupuncture versus Flunarizine hydrochloride in the treatment of migraine. Four Chinese databases(CNKI, VIP, WanFang, CBM), three English databases(Cochrane Library, EMbase, Medline) and ClinicalTrail.gov were systematically and comprehensively retrieved. The retrieval time was from the establishment of each database to January 8, 2020. Randomized controlled trial(RCT) for acupuncture versus Flunarizine in the treatment of migraine were screened out according to inclusion criteria and exclusion criteria. The included studies were evaluated with the Cochrane bias risk assessment tool. The included studies was conducted by RevMan 5.3, and the outcome indicators were evaluated for evidence quality and strength of recommendation by the GRADE system. A total of 1 033 literatures were retrieved, and 23 studies were finally included. Except for 4 multiarm tests, the total sample size was 1 548, including 785 in acupuncture group and 763 in Flunarizine group. The overall quality of the included studies was not high. Meta-analysis results showed that the acupuncture group was superior to the Flunarizine group in reduction of headache frequency(SMD=-1.00, 95%CI[-1.45,-0.54], P<0.000 1). In reduction of headache intensity, acupuncture group was superior to Flunarizine group(SMD=-1.05, 95%CI[-1.41,-0.68], P<0.000 01). In reduction of headache duration, acupuncture group was superior to Flunarizine group(SMD=-1.42, 95%CI[-1.83,-1.02], P<0.000 1). The acupuncture group was superior to Flunarizine group(MD=-0.17, 95%CI[-0.21,-0.13], P<0.000 01) in reduction of the painkillers taking frequency. The acupuncture group was superior to Flunarizine group(SMD=-0.94, 95%CI[-1.35,-0.52], P<0.000 1) in allevia-tion of paroxysmal symptoms, such as nausea and vomiting. The GRADE system showed that the evidence level of the above indicators was extremely low, and the strength of recommendation was low. As for the occurrence of adverse reactions, the adverse reactions reported in the acupuncture group included in the study were all mild adverse reactions, like drowsiness, subcutaneous bleeding, local pain, subcutaneous hematoma and dizziness needle. The available evidence showed that acupuncture has a better efficacy than Flunarizine hydrochloride in the treatment of migraine in adult patients. However, due to the high bias risk in the included studies, the conclusions of this study shall be adopted with caution, and more high-quality studies shall be carried out for verification in the future.

Prophylactic treatment of vestibular migraine / Tratamento profilático da migrânea vestibular

Abstract Introduction: Vestibular migraine (VM) is now accepted as a common cause of episodic vertigo. Treatment of VM involves two situations: the vestibular symptom attacks and the period between attacks. For the latter, some prophylaxis methods can be used. The current recommendation is to use the same prophylactic drugs used for migraines, including β-blockers, antidepressants and anticonvulsants. The recent diagnostic definition of vestibular migraine makes the number of studies on its treatment scarce. Objective: To evaluate the efficacy of prophylactic treatment used in patients from a VM outpatient clinic. Methods: Review of medical records from patients with VM according to the criteria of the Bárány Society/International Headache Society of 2012 criteria. The drugs used in the treatment and treatment response obtained through the visual analog scale (VAS) for dizziness and headache were assessed. The pre and post-treatment VAS scores were compared (the improvement was evaluated together and individually, per drug used). Associations with clinical subgroups of patients were also assessed. Results: Of the 88 assessed records, 47 were eligible. We included patients that met the diagnostic criteria for VM and excluded those whose medical records were illegible and those of patients with other disorders causing dizziness and/or headache that did not meet the 2012 criteria for VM. 80.9% of the patients showed improvement with prophylaxis (p < 0.001). Amitriptyline, Flunarizine, Propranolol and Topiramate improved vestibular symptoms (p < 0.001) and headache (p < 0.015). The four drugs were effective in a statistically significant manner. There was a positive statistical association between the time of vestibular symptoms and clinical improvement. There was no additional benefit in hypertensive patients who used antihypertensive drugs as prophylaxis or depressed patients who used antidepressants in relation to other prophylactic drugs. Drug association did not show statistically significant results in relation to the use of a single drug. Conclusions: Prophylactic medications used to treat VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. The time of vestibular symptom seems to increase the benefit with prophylactic treatment.

Resumo Introdução: A migrânea vestibular (MV) é aceita atualmente como uma causa comum de vertigem episódica. O tratamento da MV envolve duas situações: as crises de sintomas vestibulares e o período intercrise. Para esse último, pode-se usar algum método de profilaxia. A recomendação atual é que se usem os mesmos medicamentos profiláticos usados para a enxaqueca, o que inclui os β-bloqueadores, antidepressivos e anticonvulsivantes. A recente definição diagnóstica da migrânea vestibular torna escasso o número de estudos sobre seu tratamento. Objetivo: Avaliar a eficácia do tratamento profilático usado em pacientes em um ambulatório de MV. Método: Revisão de prontuários de pacientes com MV pelos critérios da Bárány Society/International Headeache Society de 2012. Foram pesquisados os medicamentos usados e resposta ao tratamento obtida através da escala visual analógica (EVA) para tontura e cefaleia. Foram comparados os escores da EVA pré e pós-tratamento (a melhoria foi avaliada em conjunto e individualmente por droga usada). Também foram pesquisadas relações com subgrupos clínicos dos pacientes. Resultados: De 88 prontuários estudados, 47 foram elegíveis. Incluíram-se os pacientes que preenchiam os critérios diagnósticos para MV, foram excluídos os prontuários ilegíveis e aqueles de pacientes com outro distúrbio causador de tontura e/ou cefaleia que não preenchiam critérios de 2012 para MV. Apresentaram melhoria com a profilaxia 80,9% dos pacientes (p < 0,001). Amitriptilina, flunarizina, propranolol e topiramato apresentaram melhoria para sintomas vestibulares (p < 0,001) e para cefaleia (p < 0,015). Os quatro medicamentos foram eficazes de forma estatisticamente significante. Houve relação estatística positiva entre tempo de sintoma vestibular e melhoria clínica. Não houve benefício adicional para hipertensos que usaram anti-hipertensivos como profilaxia ou para os deprimidos que usaram antidepressivos em relação ao uso dos outros profiláticos. A associação de medicamentos não mostrou resultados estatisticamente significantes do uso de um medicamento isolado. Conclusões: Os medicamentos profiláticos usados para MV melhoram os sintomas dessa doença, porém não há diferença estatisticamente significante entre as respostas dos medicamentos profiláticos. O tempo de sintoma vestibular parece aumentar a melhoria obtida com o tratamento profilático.

Adherence to migraine treatment does not depend on the number of prescribed medications / A adesão ao tratamento da migrânea não depende do número de medicações prescritas

To compare the adherence between monotherapy and politherapy in prophylactic migraine treatment. Five hundred consecutive patients with migraine from a tertiary center were retrospectively studied as to the number of preventive medications prescribed during the first visit. Adherence, defined as returning for the next consultation after 4 to 6 weeks and following the prescribed regimens, were also evaluated and compared between patients. 71.8% were women, and 6% of the patients did not receive any preventive medication, 11.4% received one drug, 22.2% two drugs, 41.4% three drugs, and 19% four drugs for the prevention of migraine. The overall adherence was 79.6%. Respectively, 73.7, 71.8, 82.6 and 86.3% of those who received the prescription of one, two, three and four drugs returned, complying with the treatment. There is no difference in adherence to monotherapy or politherapy (one to four drugs) for the prophylaxis of migraine. .

Comparar a adesão entre monoterapia e politerapia no tratamento profilático da migrânea. Foram analisados retrospec-tivamente 500 pacientes com migrânea de um centro terciário, com vistas ao número de medicações preventivas prescritas na primeira consulta e adesão ao tratamento após 4 a 6 semanas. 71,8% da amostra era composta de mulheres. Em relação ao tratamento preventivo da migrânea, 6% não receberam medicação preventiva; 11,4% receberam uma droga; 22,2% duas drogas; 41,4% três drogas e 19% quatro drogas. A adesão média foi de 79,6%. Em relação à prescrição de uma, duas, três ou quatro drogas, essa adesão foi respectiva-mente de 73,7, 71,8, 82,6 e 86,3%. Não houve diferenças na adesão à prescrição de medicações em monoterapia ou politerapia (uma a quatro drogas) para o tratamento preventivo da migrânea. .

Migraña hemipléjica familiar / Familial hemiplegic migraine

Las cefaleas constituyen una causa frecuente de consulta en Pediatría, siendo la migraña el tipo más frecuente de las cefaleas primarias en la infancia. La asociación entre cefalea y hemiplejía aguda en la infancia pudiera corresponder a múltiples etiologías debiéndose considerar las de carácter hereditario. La migraña hemipléjica familiar se caracteriza por la presencia de crisis migrañosas con trastornos motores deficitarios transitorios, afasia o alteraciones sensitivas o sensoriales. Se describe el caso de una adolescente femenina de 12 años de edad, con antecedentes familiares de migraña, historia de cefalea migrañosa de un año de evolución, que cumple con los criterios establecidos por la Sociedad Internacional de Cefaleas de migraña hemipléjica familiar. El examen neurológico y los paraclínicos complementarios fueron normales. Se realizó tratamiento con flunarizina e ibuprofeno con evolución satisfactoria

Headaches are a frequent cause of consultation in Pediatrics, migraine being the most common type of primary headaches in children. The association between headache and acute hemiplegia in childhood may correspond to multiple etiologies, including those considered as inherited. Familial hemiplegic migraine is characterized by the presence of migraine crisis with transient motor deficit disorders, aphasia and sensitive or sensory disturbances. We describe the case of a 12 year-old girl with a family history of migraine, and migraine headache of a year of evolution, which meets the criteria established by the International Headache Society of Familial Hemiplegic Migraine. Neurological examination and the paraclinical studies were normal. She was treated with flunarizine and ibuprofen with satisfactory outcome

Quetiapine for the prevention of migraine refractory to the combination of atenolol + nortriptyline + flunarizine: an open pilot study / Quetiapina para a prevenção da migrânea refratária à combinação de atenolol + nortriptilina + flunarizina: estudo piloto aberto

BACKGROUND: Migraine is a prevalent neurological disorder. Although prevention is the mainstream treatment, some patients are refractory to standard therapies. AIM: To evaluate the use of quetiapine (QTP) in the preventive treatment of refractory migraine, defined as previous unresponsiveness to the combination atenolol + nortriptyline + flunarizine. METHOD: Thirty-four consecutive patients (30 women and 4 men) with migraine (ICHD-II) and headache attacks on less than 15 days per month not overusing symptomatic medications were studied. The main inclusion criterion was the lack of response (<50 percent reduction in attack frequency) after ten weeks to the combination of atenolol (60 mg/day) + nortriptyline (25 mg/day) + flunarizine (3 mg/day). The patients started on QTP as the sole treatment in a single daily dose of 25 mg, titrated to 75 mg. After ten weeks, headache frequency, consumption of rescue medications and adverse events were analyzed. RESULTS: Twenty nine patients completed the study. Among completers, 22 (75.9 percent; 64.7 percent of the intention-to-treat population) presented >50 percent headache reduction. The mean frequency of migraine days decreased from 10.2 to 6.2 and the average consumption of rescue medications decreased from 2.3 to 1.2 days/week. Adverse events were reported by 9 (31 percent) patients. CONCLUSION: Although limited by the open design, this study provides a pilot data to support the use of quetiapine in preventive treatment of refractory migraine.

INTRODUÇÃO: A migrânea é uma doença neurológica prevalente. Embora a prevenção seja o esteio principal do tratamento, alguns pacientes são refratários aos tratamentos tradicionais. OBJETIVO: Avaliar o uso da quetiapina (QTP) no tratamento preventivo da migrânea refratária definida como ausência de resposta ao uso prévio da combinação de atenolol com nortriptilina e flunarizina. MÉTODO: Trinta e quatro pacientes consecutivos (30 mulheres e 4 homens) com migrânea (CIC-II) e crises de cefaléia em menos de 15 dias/mês sem uso excessivo de sintomáticos foram estudados. O critério de inclusão principal foi a não obtenção na redução da frequência de cefaléia >50 por cento após 10 semanas de uso da combinação de atenolol (60 mg/dia) + nortriptilina (25 mg/dia) + flunarizina (3 mg/dia). Os pacientes iniciaram a QTP como tratamento único na dose de 25 mg à noite e aumentaram-na até 75 mg. Após 10 semanas de uso, a frequência da cefaléia, o consumo de sintomáticos e os efeitos colaterais foram avaliados. RESULTADOS: Vinte e nove pacientes completaram o estudo. Entre os que completaram, 22 (75.9 por cento; 64.7 por cento dos pacientes que foram incluídos) obtiveram redução da frequência >50 por cento. A frequência média de dias com migrânea por mês decresceu de 10,2 para 6,2. O consumo médio de sintomáticos caiu de 2,3 para 1,2 dias/semana. Efeitos colaterais foram relatados por 9 (31 por cento) pacientes. CONCLUSÃO: Apesar de limitado pela metodologia aberta, esse estudo oferece dados iniciais para a possível utilidade da QTP na prevenção da migrânea refratária.

Cefaléias: como eu trato? / Headache: how I treat

As cefaléias figuram entre as queixas mais comuns em unidades de atendimento primário. Ocupam o primeiro lugar entre os transtornos "benignos" incapacitantes, segundo dados da Organização Mundial de Saúde, com forte impacto socioeconômico. No artigo é descrito o manejo das diversas causas da cefaléia, com suas diferentes apresentações clínicas. A cefaléia tensional é a cusa primária mais comum, seguida pela cefaléia enxaquecosa.

Otimizando o componente farmacológico da terapia integrada da vertigem / Optimizing the pharmacological component of integrated balance therapy

A farmacoterapia é opção importante no tratamento das vestibulopatias periféricas. OBJETIVO: Identificar a medicação que otimiza a terapia integrada da vertigem (TIV) na doença de Ménière e em outras vestibulopatias periféricas. MATERIAL E MÉTODO: Estudo de casos em que pacientes com doença de Ménière ou outras vestibulopatias periféricas receberam TIV com betaistina, cinarizina, clonazepam, flunarizina, Ginkgo biloba ou sem medicação durante 120 dias. RESULTADOS: Na doença de Ménière, TIV com qualquer um dos medicamentos foi mais eficaz do que TIV sem medicação, após 60 dias; a betaistina foi mais efetiva que todas as outras drogas, após 60 e 120 dias. Nas outras vestibulopatias periféricas, diferenças significantes foram observadas entre TIV com betaistina, cinarizina, clonazepam ou flunarizina e TIV sem medicação após 60 dias e todas as drogas foram mais efetivas que TIV sem medicação após 120 dias; betaistina, cinarizina ou clonazepam foram igualmente efetivos e betaistina foi mais efetiva que flunarizina e Ginkgo biloba. Os tratamentos foram bem tolerados. CONCLUSÕES: TIV incluindo medicação é mais efetiva que sem medicação na doença de Ménière ou em outras vestibulopatias periféricas. Betaistina foi o medicamento mais efetivo na doença de Ménière e tão eficaz quanto cinarizina ou clonazepam em outras vestibulopatias periféricas.

Drug treatment is an important option for the treatment of peripheral vestibular diseases. AIM: To identify the drug component associated with optimal integrated balance therapy (IBT) for MénièreÆs disease or other peripheral vestibular disorders. MATERIALS AND METHODS: Analysis of a series of patients with MénièreÆs disease patients or patients with other peripheral vestibular disorders that received IBT involving either no medication or betahistine, cinnarizine, clonazepam, flunarizine or Ginkgo biloba during 120 days. RESULTS: In MénièreÆs disease, significant differences were observed for all drug therapies (60 days) versus no medication; betahistine was significantly more effective than all other drugs at 60 and 120 days. For non-MénièreÆs disorders, significant differences were observed among betahistine, cinnarizine, clonazepam and flunarizine and no medication after 60 days; all drug therapies were significantly more effective than no medication after 120 days; betahistine, cinnarizine or clonazepam were equally effective and betahistine was more effective than flunarizine and EGb 761. All treatment options were well tolerated. CONCLUSIONS: Drug therapies were more effective than no medication in the IBT for patients with MénièreÆs disease or other peripheral vestibular disorders. Betahistine was the most effective medication for patients with MénièreÆs disease and was as effective as cinnarizine and clonazepam for other peripheral vestibular disorders.

Hemiplegia alternante da criança: Relato de caso / Alternating hemiplegia of childhood: Case report

É apresentado um caso de hemiplegia alternante da criança com 13 anos que se iniciou mais tardiamente que o habitual. A evolução clínica sugere, contudo, tratar-se da hemiplegia alternante benigna da infância. O tratamento com flunarizina foi benéfico ao paciente.

Flunarizine for prophylactic treatment of childhood migraine.

OBJECTIVE: To determine the effectiveness of flunarizine for migraine prophylaxis in children. PATIENTS AND METHOD: Children aged between 7 and 15 years who had the indication for prophylactic treatment of migraine were recruited into a prospective study at the Department of Pediatrics, Ramathibodi Hospital, from January 1st to December 31st 1999. After verbal consent was obtained, flunarizine was administered either at 5-mg daily in those who had never received it or at 10-mg daily in those who previously took this drug within one year Serial evaluation for the severity of migraine including duration, intensity, and frequency of headache attacks was performed every 2 weeks for 6 months. RESULTS: Twenty-one children (10 boys, 11 girls) with a mean age of 11.3+/-2.48 years (range 7-15 years) were enrolled in the study. There were ten children who had migraine with aura. Initially, 5-mg daily and 10-mg daily of flunarizine were administered in 19 and 2 patients respectively. The dosage was increased to 10-mg daily after two weeks in 5 patients because of the unresponsiveness to the initial dose. Improvement was observed in 14 patients (66%) including 13 of 14 patients who received 5-mg daily and 1 of 7 patients who received 10 mg daily. Five patients (23%) had no recurrent attack. Nine patients (42%) had more than 50%-reduction of frequency of migraine and 3 of these had either shorter duration or less intensity of the attack. Clinical improvement was observed between 2 and 4 weeks after initiation of treatment. There was no adverse effect observed CONCLUSION: This is a preliminary result demonstrating that flunarizine is one of the effective drugs for migraine prophylaxis in children.

Interaction of flunarizine with sodium valproate or ethosuximide in gamahydroxybutyrate induced absence seizures in rats.

Sodium valproate(VPA), ethosuximide(ESM), 200 mg/kg ip and flunarizine (FLU) 5 or 10 mg/kg ip were first administered independently to rats in order to study their effects on behavioural and EEG aspects of spike and wave discharges (SWDs) induced by y- hydroxybutyrate (GHB,100 mg/kg ip). GHB treated rats show behavioural changes and concomitant repetitive EEG episodes of 7 to 9 Hz SWDs, mimicking human absence seizures (AS), and can be used as a pharmacological model. The number and duration of SWDs were calculated for 1 hr from the EEG and were parameters for drug evaluation. VPA and ESM at 200 mg/kg, significantly reduced SWD number and duration/hr, while FLU showed significant reduction only at 10 but not at 5 mg/kg. Combination of FLU, 10 mg/kg with either VPA or ESM showed significant reduction of SWD number and duration, suggesting an additive effect of the anti-absence agents with the calcium channel blocker, FLU, on experimental absence seizures in rats.

Migraña en niños: análisis de 295 casos / Migraine in children: an analysis of 295 cases

Introducción. La cefalea es causa común de interrupción del sueño o las actividades diarias; la migraña es un tipo específico de cefalea, que afecta al 2-5 por ciento de los niños. El objetivo del estudio es describir las características clínicas de un grupo de niños mexicanos con migraña y revisar algunas recomendaciones para su tratamiento. Material y métodos. Se estudiaron 295 pacientes menores de 15 años de edad, registrados en un período de 2 años y con un seguimiento mínimo de 3 meses. Todos ellos cumplieron los criterios de migraña de la Sociedad Internacional de Cefalea. Resultados. La edad promedio fue de 10 años 7 meses ñ 2 años y tenían 22 ñ 10 meses de evolución con cefalea (77 por ciento con 2 o más eventos por semana). El tipo de dolor más frecuente fue el pulsátil (74 por ciento) y el opresivo (22 por ciento); la mitad refirieron dolor hemicraneal, predominantemente frontal. Se clasificó como migraña con aura 56 por ciento, migraña sin aura 41 por ciento y el resto como migraña basilar. Los factores precipitantes más frecuentes fueron el desvelo y factores emocionales (56 y 51 por ciento respectivamente). El tratamiento sintomático más común fue acetaminofén (46 por ciento) y combinaciones con ergotamina (40 por ciento); mientras que el fármaco profiláctico más común fue la flunarizina (172 pacientes). Hubo reducción significativa del dolor en 81 por ciento de los casos. Conclusiones. La migraña es una entidad frecuente en niños y tiene buena respuesta al tratamiento farmacológico.

Cinarizina e flunarizina hoje / Cinarizine and flunarizine today

Cinarizina e flunarizina são antagonistas de cálcio usados para tratar e prevenir a ocorrência das vertigens. Estas drogas têm atividade antivertiginosa muito semelhante, mas a flunarizina apresenta um maior potencial para induzir depressão e reações extrapiramidais do que a cinarizina. Estes eventos adversos impedem o uso da flunarizina por mais do que poucas semanas de tratamento, especialmente em idosos. Por esta razão, quando for necessário usar um destes medicamentos em pacientes otoneurológicos, a cinarizina deveria ser a droga preferida para tratar a vertigem e sintomas associados, e a flunarizina deveria ser reservada especificamente para o tratamento a curto das crises de migrânia com manifestações vestibulares e dos equivalentes migranosos, como a vertigem paraxística benigna infantil e a vertigem recorrente benigna. Todos os pacientes tratados com estas drogas devem ser acompanhados para detectar precocemente qualquer evento adverso.

Additive anticonvulsant effect of flunarizine and sodium valproate on electroshock and chemoshock induced seizures in mice.

The efficacy of Flunarizine (FLU), a calcium channel blocker, in combination with conventional antiepileptic drugs, phenytoin (PHT), carbamazepine (CBZ), sodium valproate (VPA), and ethosuximide (ESM), at ED50 doses, were examined for protective effects against maximal electroshock seizures (MES) and pentylenetetrazol (PTZ) induced seizures in mice. In both models, only VPA and FLU showed significantly enhanced protection, which was additive ie. 100% protection. In the MES test, though FLU combined with PHT did show a slightly enhanced protection (66.6%), with CBZ there was no enhancement as compared to either drug alone. In the PTZ test, FLU with ESM showed 83% protection this however was not statistically significant. The findings of this study in mice suggest that FLU would be a suitable candidate for add-on therapy with VPA for clinical epilepsy.

Propranolol vs flunarizine vs flunarizine plus propranolol in migraine without aura prophylaxis

Fourty-five migraine without aura patients underwent a parallel double-blind trial aiming the comparison of the effects of propranolol 60 mg/day to flunarizine 10 mg/day and to propranolol 60 mg/day plus flunarizine 10 mg/day simultaneously. There were 3 groups, each one with 15 patients. After a 20-day-baseline period, each group received one kind of treatment during 120 days. Migraine index on propranolol was 23.4*, on flunarizine 18,7* and on both drugs 14.4*, mean frequency of attacks on propranolol was 1.26**, on flunarizine 1.2** and on both drugs, 1.13** (*p<0.05, **p<0.01 compared to baseline) and global evaluation was reduced with all forms of treatment. It was not found statistical differences between groups, nevertheless there was a trend in the group using two drugs reaching lower values in migraine index, frequency of attacks and global evaluation. In individuals using flunarizine (alone or associated with propranolol) the therapeutic effect was largely maintained up to 45 days after drug withdrawal.

Hemiplegia alternante da infância: relato de caso / Alternating hemiplegia of childhood: case report

A hemiplegia alternante da infância é uma condiçao muito rara, de causa desconhecida, caracterizada por déficit dimidiado alternante ou mesmo tetraplegia, cujas crises iniciam antes dos 18 meses de idade. Estas manifestaçoes sao episódicas e, freqüentemente, associadas a nistagmo, paralisias oculares transitórias, disfunçao do sistema nervoso autônomo, dispnéia, envolvimento cognitivo, distonia e coreoatetose. A investigaçao laboratorial desta síndrome nao tem evidenciado uma etiologia definida, embora existam possibilidades de uma relaçao com enxaqueca. No presente trabalho, o autor relata um caso e sua resposta ao tratamento com flunarizina.

Tratamento profilático da enxaqueca: estudo prospectivo aberto com a flunarizina em 100 pacientes / Prophylactic treatment of migraine: a prospective open study in 100 patients

A eficácia da flunarizina, na dose de 10 mg/dia, no tratamento profilático da enxaqueca foi avaliada em 100 pacientes 120 dias, em um estudo aberto. Noventa e três pacientes completaram o período da terapia referido e em 7 pacientes fomos obrigados a suspender a droga pela presença de importantes efeitos colaterais. Os principais efeitos adversos observados foram ganho de peso, sonolência diurna excessiva, cansaço e depressäo do humor. Oitenta e um enxaquecosos se beneficiaram do tratamento, pela aboliçäo das crises ou reduçäo significativa de sua incidência e/ou intensidade. Os resultados permitem concluir que a flumarizina é droga eficaz no tratamento profilático da enxaqueca