Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study.

OBJECTIVES: We aimed to assess the efficacy of greater occipital nerve (GON) blockade at chronic migraine (CM) treatment. MATERIALS AND METHODS: Patients with CM were randomly divided into two groups of 42. GON blockade was administered four times (once per week) with saline in group A or bupivacaine in group B. After 4 weeks of treatment, blinding was removed; in group A, GON blockade was achieved using bupivacaine, while group B continued to receive bupivacaine, and blockade was administered once per month, then followed for 2 months. Primary endpoint was the difference in number of headache days, duration of headache, and pain scores. RESULTS: Seventy-two of 84 patients completed the study. After 1 month of treatment, number of headache days had decreased from 16.9 ± 5.7 to 13.2 ± 6.7 in group A (P = 0.035) and from 18.1 ± 5.3 to 8.8 ± 4.8 in group B (P < 0.001), (P = 0.004, between groups); duration of headache (hour) had decreased from 24.2 ± 13.7 to 21.2 ± 13.4 in group A (P = 0.223) and from 25.9 ± 16.3 to 19.3 ± 11.5 in group B (P < 0.001), (P = 0.767, between groups). VAS score decreased from 8.1 ± 0.9 to 6.7 ± 1.6 in group A (P = 0.002) and from 8.4 ± 1.5 to 5.3 ± 2.1 in group B (P < 0.001), (P = 0.004, between groups). After blinding was removed (in 2nd and 3rd month), group A exhibited similar results like group B in 3rd month. CONCLUSIONS: Our results suggest that GON blockade with bupivacaine was superior to placebo and was found to be effective, safe, and cost-effective for the treatment of CM. According to our knowledge, this is the first randomized, multicentre, double-blind, and placebo-controlled study in the literature in this field of work.

Brief Pain Inventory score identifying and discriminating neuropathic and nociceptive pain.

OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the Brief Pain Inventory (BPI) as well as tests of its reliability, validity, and discriminative utility for estimating the status of chronic pain in neuropathic and nociceptive pain patients. METHOD AND PATIENTS: We enrolled 224 chronic pain (126 neuropathic pain and 98 nociceptive pain) patients. The original version of the BPI was translated into Turkish by standard procedures. An independent clinician determined the pain type. The factor analysis, reliability (internal consistency and test-retest reliability), and validity (agreement with the reference diagnosis and sensitivity, specificity, and positive and negative predictive values) were determined. Discriminant function analysis was then employed to determine whether BPI could differentiate between neuropathic and nociceptive pain. RESULTS: Cronbach's α-coefficient was 0.84 for the test and 0.83 for the retest. BPI scores for subjects did not significantly differ between applications r:0.96 (P < 0.01). Principal axis factoring with oblimin rotation revealed three interpretable factors: severity scale, activity interference, and sleep and mood interference. Compared to the clinical assessment, sensitivity, specificity, and positive and negative predictive values for criterion total BPI score were 79.37%, 46.9%, 65.8%, and 63.9%, respectively. CONCLUSION: The results suggest that Turkish version of BPI is a reliable and valid evaluation measure of neuropathic and nociceptive pain patients. This is the first study reporting the comparison and validation of psychometric properties of BPI in neuropathic and nociceptive pain group. Our data suggest that BPI may able to discriminate the origin of chronic pain.

Serum ferritin levels and early prognosis of stroke.

Iron and ferritin are known to have an important role in stroke as well as in other disorders. This prospective study was designed to determine whether administering ferritin levels might help to estimate the severity and prognosis of stroke. Fifty-one patients with a diagnosis of acute stroke were included in the study within 24 h from onset of symptoms. Serum ferritin and cortisol levels were assayed at admission. Clinical status was determined by the Canadian Stroke Scale at admission and on day 21. Serum ferritin level was found to be higher in patients with large lesion size (P < 0.01), deteriorated neurologic status during clinical follow-up (P = 0.03) and deceased patients (P < 0.01). Serum ferritin level was correlated with neurologic deficit (r = 0.50, P < 0.001). No correlation was found between serum cortisol and ferritin levels (r = 0.07, P = 0.7). Serum ferritin level (P = 0.007; OR = 1.02; 95% CI, 1.01-1.03) and large size of lesion (P = 0.021, OR = 11.92; 95% CI; 1.46-197.12) were independently associated with mortality. Increased serum ferritin levels correlate to severity of stroke and the size of the lesion.

Perception of bronchoconstriction in elderly asthmatics.

The impaired perception of bronchoconstriction in asthmatic patients may increase the risk of severe exacerbation. To characterize the perception of bronchoconstriction in elderly asthma patients, we compared the perception in older patients with that of younger patients. To determine the influence of perception of long-standing diseases, we further evaluated the perception in early-onset elderly asthma patients and in late-onset elderly asthma patients. The study group consisted of 80 stable asthmatic patients. The patients were grouped according to their age (group 1, < 60 years, n = 37, group 2, > or = 60 years, n = 43). Each group was separated into two subgroups according to the duration of symptoms (late-onset asthma 1A and 2A, < 5 years, early-onset asthma 1B and 2B, > or = 5 years). A histamine inhalation test was performed for each patient. Dyspnea was assessed by modified Borg scale. The Borg score in forced expiratory volume in 1 sec (FEV1) reduction by 20% was determined as perception score 20 (PS20). The mean perception scores of the elderly asthmatic patients were significantly lower than those of the younger asthmatic patients (group 1, PS20 = 2.35 +/- 0.17; group 2, PS20 = 1.37 +/- 0.12, p < 0.0001). The differences of mean perception score (PS20) between early- and late-onset subgroups were insignificant (IA, 2.63 +/- 0.30 and IB, 2.07 +/- 0.16, p = 0.101; 2A, 1.36 +/- 0.19 and 2B, 1.59 +/- 0.120, p = 0.91). The mean perception scores of male asthmatic patients were significantly lower than those of female patients (p = 0.03). There was a correlation between PS20 and % FEV1 in the younger group (r = 0.392, p = 0.02), but not in the elderly group (r = 139, p = 0.375). The correlation between PS20 and PD20 in both younger and elderly group was insignificant (p > 0.05). Elderly asthmatics perceive less intense respiratory distress for a decrease of 20% in FEV1 than do younger asthmatics. This underperception of bronchoconstriction may result in a delay in medical care during an acute asthmatic episode. Thus, we strongly recommend that elderly asthmatic patients should be followed up more frequently and closely.

Valproic acid in prophylaxis of refractory migraine.

OBJECTIVE: The efficacy and safety of valproic acid were assessed as a prophylactic agent in migraine patients who previously derived no significant benefit from conventional prophylactic medications for migraine. PATIENTS AND METHODS: One hundred and twenty patients aged 23-58 years with the diagnosis of migraine without aura. Response to therapy was determined by using a headache calendar detailing the frequency and severity of attacks. Reduction of 50% or greater in the frequency or severity of headache was considered as improvement. RESULTS: Improvement was observed in headache frequency within 67% of patients. Headache severity had been improved in 60% of patients. The mean average dosage of valproic acid was 1,250 mg daily. Most of the side effects are mild and tolerable. CONCLUSION: These results suggest that valproic acid is effective and safe in the treatment of refractory migraine headache.

Familial cerebellar ataxia and hypogonadism associated with sensorimotor axonal polyneuropathy.

In this article, we report two siblings who have familial cerebellar ataxia and hypogonadism associated with sensorimotor axonal polyneuropathy documented by light microscopy. This combination has not been reported previously in the literature. Cerebellar ataxia and hypogonadism is reviewed according to the clinical and laboratory features of the reported cases in the literature.

Superior cerebellar artery territory stroke.

OBJECTIVES: The purpose of this study was to clarify etiologic factors, prior symptoms and clinical features of isole superior cerebellar artery (SCA) territory infarcts. METHODS: All data were collected from consecutive 21 patients with isole SCA infarcts involved on computerized tomography. RESULTS: The risk factors including hypertension, cardiopathy and rhythm disturbances, hyperlipidemia, diabetes mellitus, abnormality in homeostasis, smoking, oral contraceptive have been identified. Headache, nausea-vomiting, vertigo, gait imbalance and diplopia were the most common complaints at onset. During the clinical course, the most common findings have been found as dysmetria and dysdiadochokinesia, dysarthria, ataxia and vertigo. Although 19 patients were improved in different degrees, 2 patients died because of cardiorespiratory arrest. Classical syndrome of SCA was only seen in 2 patients. CONCLUSION: According to our findings, SCA territory infarcts have multiple risk factors, and various clinical features as well as the syndrome of SCA are usually rare and incomplete.

Serotonin syndrome induced by transitioning from phenelzine to venlafaxine: four patient reports.

With the use of the newer antidepressants beyond the traditional tricyclics and monoamine oxidase inhibitors, newer options in headache prophylaxis are provided as well as the potential for undesirable and even potentially life-threatening interactions between medications. In this article, four patient reports of a specific interaction--the serotonin syndrome--are presented. These events resulted from transitioning headache patients from an older antidepressant (phenelzine) to a newer antidepressant (venlafaxine).