Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy. The Italian Collaborative Group for the Study of Psychopathological Factors in Primary Headaches.

A multicenter study was carried out in 10 Italian Headache Centers to investigate the prevalence of psychosocial stress and psychiatric disorders listed by the IHS classification as the "most likely causative factors" of tension-type headache (TTH). Two hundred and seventeen TTH adult outpatients consecutively recruited underwent a structured psychiatric interview (CIDI-c). The assessment of psychosocial stress events was carried out using an ad hoc questionnaire. The psychiatric disorders that we included in the three psychiatric items of the fourth digit of the IHS classification were depressive disorders for the item depression, anxiety disorders for the item anxiety, and somatoform disorders for the item headache as a delusion or an idea. Diagnoses were made according to DSM-III-R criteria. At least one psychosocial stress event or a psychiatric disorder was detected in 84.8% of the patients. Prevalence of psychiatric comorbidity was 52.5% for anxiety, 36.4% for depression, and 21.7% for headache as a delusion or an idea. Psychosocial stress was found in 29.5% of the patients and did not differ between patients with and without psychiatric comorbidity. Generalized anxiety disorder (83.3%) and dysthymia (45.6%) were the most frequent disorders within their respective psychiatric group. The high prevalence of psychiatric disorders observed in this wide sample of patients emphasizes the need for a systematic investigation of psychiatric comorbidity aimed at a more comprehensive and appropriate clinical management of TTH patients.

Cognitive event-related potential in hepatic encephalopathy.

A study of auditory P300 was performed on 24 patients with cirrhosis of the liver: 13 patients with hepatic encephalopathy (HE grade 1-2) and 11 patients without clinical encephalopathy (HE grade 0). The patients were also assessed using spontaneous EEG and neuropsychological methods: Mini Mental State, Digit Span and Number Connection Test. The P3 latency was found to be significantly increased in all patients (100%) with HE grade 1-2 and in 6 patients (54.5%) with HE grade 0. The clinical value of using the P300 latency in the hepatic encephalopathy is subsequently discussed.

Cytokine secretion and eicosanoid production in the peripheral blood mononuclear cells of MS patients undergoing dietary supplementation with n-3 polyunsaturated fatty acids.

To demonstrate the influence of n-3 PUFA supplementation on cytokine and eicosanoid production in peripheral blood mononuclear cells (PBMCs) of MS patients (MSP), we investigated the impact of a 6-month dietary supplementation with these fatty acids on the levels of interleukin-1 beta (IL-1 beta), IL-2, interferon-gamma (IFN-gamma) and tumor necrosis factor-alpha (TNF-alpha) in the supernatants of stimulated PBMCs and serum soluble IL-2 receptors in a group of 20 relapsing-remitting (R-R) MSP and a group of 15 age-matched control individuals (CI). The production of PGE2 and LTB4 in the stimulated PBMCs was also assessed in patient and control groups supplemented with n-3 PUFAs. In both groups, n-3 PUFA supplementation led to a significant decrease in the levels of IL-1 beta and TNF-alpha, and this reduction was more pronounced in the 3rd and 6th month of supplementation. An analogous decrease was observed in the levels of IL-2 and IFN-gamma produced by stimulated PBMCs, and in the levels of serum soluble IL-2 receptors. n-3 PUFA supplementation also appeared to significantly affect prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) production in PBMCs, both in MSP and the control group. The reduced production of these proinflammatory eicosanoids, and the decrease of some cytokines with an immunohenancing effect as a consequence of n-3 PUFA supplementation, could modulate some immune functions which have been demonstrated to be altered in MSP.

Changes in auditory P3 event-related potentials in uremic patients undergoing haemodialysis.

A study on event-related P300 potential (ERPs) was performed in 20 patients suffering from chronic uraemia and undergoing haemodialysis in order to assessing the functioning of their cognitive processes. The patients were evaluated before and after a standard treatment of haemodialysis. The P300 potential was studied by means of the "oddball" paradigm and the acoustic modality. Moreover the patients' performance was assessed on the basis of the following psychological tests: the Mini Mental Test, the Number Connection Test and the Digit Span of the Wechsler Adult Intelligence Scale. A significant improvement in the P3 latency was demonstrated following the dialysis treatment. Even though a slight improvement in the N2-P3 deflexion amplitude was recorded after dialysis, it was not statistically significant. These data indicate a positive modification in the speed of the cortical function as a consequence of dialysis. These results suggest that the P3 latency obtained from auditory stimuli can help to assess the benefits obtained through extracorporeal dialysis, especially in the follow-up to the illness.

Neuropeptide Y plasma levels and serum dopamine-beta-hydroxylase activity in MS patients with and without abnormal cardiovascular reflexes.

An impairment in the autonomic function has been demonstrated in patients with multiple sclerosis (MS) using electrophysiological, pupillary and biochemical tests. Particularly evident were alterations in the cardiovascular reflexes, cutaneous sympathetic response and lymphomonocyte adrenergic binding. Electrophysiological and biochemical findings in MS patients have only occasionally been compared. Among the peripheral markers of the autonomic system, Neuropeptide Y (NPY) and dopamine-beta-hydroxylase (DBH) have been singled out as reliable indices of sympathetic function. The former is a peptide with a strong vasoconstrictive action, which is released from adrenergic endings together with noradrenaline following sympathetic activation. The latter is the enzyme which catalyses the conversion of dopamine to norepinephrine. It is located both in sympathetic endings and the chromaffin granules of adrenal medulla. To verify a failure in autonomic function in the course of MS, a battery of cardiovascular tests (assessing sympathetic and parasympathetic functions) was performed on 25 MS patients. The results were compared with a group of 20 age- and sex-matched control individuals. The plasma levels of NPY and the serum DBH activity were also determined in both groups. 52% of patients showed an impairment in sympathetic function in one or more tests (sustained handgrip, postural hypotension, cold face test). 48% of the patients had abnormal values in deep breathing test, indicating a failure of the parasympathetic function. 44% of patients showed also a paroxysmal tachycardia after cold face test, indicating an abnormal function of the vagal-cardiac and sympathetic-vascular smooth muscle pathways of the trigeminal nerve.(ABSTRACT TRUNCATED AT 250 WORDS)

Endothelin 1 in migraine and tension-type headache.

We determined the plasma levels of ET1, both interictally and ictally, in 50 migraine patients, 20 with aura (MPA) and 30 without aura (MPWA), comparing them with the levels of 40 age-matched tension-type headache patients (20 episodic and 20 chronic) (ETTHP and CTTHP) and the levels of a group of 20 healthy control subjects (CS). No statistically significant difference was evident between the mean ET1 plasma levels of MPA and those of MPWA, assessed in headache-free periods. The mean ET1 plasma levels of MPA and MPWA, assessed interictally, were significantly higher than those of CS. However, the values of plasma ET1 in ETTP and in CTTHP did not differ statistically from those of CS. MPA and MPWA ET1 plasma levels increased significantly within 2 h from the onset of attacks (p < 0.0001) and remained significantly higher between 4 and 6 h from the onset. The ET1 plasma levels of ETTHP and CTTHP assessed during attacks did not differ statistically from those of the same patients assessed in the headache-free periods. The increase in ET1 levels in MPA and MPWA patients when assessed ictally, suggests that this peptide is involved in the haemodynamic changes and vascular tone modifications observed during migraine attacks, particularly in the first phase of the ictal period.

Serum and salivary magnesium levels in migraine. Results in a group of juvenile patients.

In the last few years a fundamental role for magnesium in establishing the threshold for migraine attacks and involvement in the pathophysiologic mechanisms related to its onset has become evident. We measured serum and salivary magnesium levels in juvenile migraine patients (with and without aura) and in a group of healthy young individuals by atomic absorption spectrophotometry. Migraineurs were studied in migraine-free (interictal) periods and during attacks. In comparison with normal subjects, migraine patients had lower levels of serum and salivary magnesium interictally. Serum magnesium levels tended to be further reduced during attacks. With respect to the values of interictal periods we observed a reduction, not statistically significant, of salivary magnesium levels for both migraine groups. Serum, and to a lesser extent salivary magnesium level reduction, could be an expression, at the peripheral level, of reduced cerebral magnesium levels which would contribute, at least in part, to defining the threshold for migraine attacks.

Serum and salivary magnesium levels in migraine and tension-type headache. Results in a group of adult patients.

It has been suggested that magnesium plays a central role in different etiopathogenetic conditions involved in the onset of migraine. We measured, by atomic absorption spectrophotometry, serum and salivary magnesium levels in drug-free migraine patients with and without aura and in tension-type headache patients. Migraine sufferers with and without aura and tension-type headache had significantly lower levels of serum and salivary magnesium concentrations in the interical periods than a group of healthy young individuals. Serum magnesium levels tended to be further reduced during attacks in all patient groups studied. A statistically significant decrease in salivary magnesium levels was evident only for migraine patients with aura. Serum magnesium levels and to a lesser extent salivary magnesium levels might express indirectly the lowering of brain extracellular magnesium concentration which occurs in migraine patients both in the intererictal periods and ictally.

Study of the P300 and cerebral maps in subjects with multi-infarct dementia treated with cytidine.

A study of event-related P300 potential and cerebral EEG maps was performed in 20 patients affected by multi-infarct dementia (MID): 10 subjects were treated with placebo and 10 with cytidine. The trial was divided into three intervals. The patients, after a period of washout, were evaluated throughout the course of the trial by electrophysiological examination performed at baseline, after 90 min from the first IV injection, again after 30 days of IM therapy, and finally after 60 days of continued IM therapy. In the group treated with cytidine, the findings relevant to the study of the P300 showed a significant decrease in latency values compared to baseline (P less than 0.05 ANOVA) and an improvement. though not significant, in the amplitude values. Calculation of the mean relative power of EEG values showed a significant decrease in delta activity and an increase in alpha activity. In the subjects treated with placebo, no statistically significant variation was found in either P300 or EEG map recordings. On the basis of these investigations it has been demonstrated that the variations in the registrations can be correlated to the improved neuronal activity following treatment with cytidine.

Age correlation in the bulbo-cavernosus reflex.

A study was conducted in 120 normal male subjects (age range 15-20 years) by testing the bulbo-cavernosus reflex (BCR). The mean latency +/- SD of the reflex was 32.9 +/- 0.7 ms. BCR latency values reported in subjects grouped according to age (15-20, 21-30, 31-40, 41-50, 51-60, 61-70) did not vary significantly for individuals between the ages of 15 and 50; whereas, the latency values for the older age groups (5th and 6th groups), were statistically significant. In conclusion, the authors attribute the increased latency associated with age to changes which occur in the fibres of the nerve pathways and emphasize the importance of collecting normative data according to age groups.

Somatosensory-evoked potential study in headache patients.

Somatosensory-evoked potentials (SEPs) after median nerve stimulation were studied in 34 patients with common migraine, in 30 patients with muscle-contraction headache, and in 10 cluster headache patients. The SEPs were registered before and after histamine administration. Latency values in common migraineurs showed no variation when compared with those in controls. Although not statistically significant, the N1-P2 amplitude was increased in 14 (41.1%) of these patients after histamine stimulation. No changes were observed in muscle-contraction headache patients either with or without histamine administration. In all cluster headache patients, the N1-P2 amplitude decreased after histamine stimulation. These results are discussed in the light of current hypotheses concerning the pathophysiologic mechanisms of headache.

Neuropathy in children and adolescents with diabetes mellitus.

Nerve conduction velocities were studied in the median, posterior tibial, radial and sural nerves of 50 juvenile diabetics, average age 13 +/- 1.3 years and mean duration of diabetes 2.3 +/- 1.4 years. Motor conduction velocity (MCV) in the median nerve was reduced in 10% of the subjects, and in the posterior tibial in 32%. Sensory conduction velocity (SCV) in the radial nerve was reduced in 30% of the subjects, and in the sural in 44%. No relationship was found between the reduction in conduction velocity and the duration of diabetes; nevertheless, a correlation was observed between this reduction and the degree of glycaemic control represented by the glycosylated haemoglobin concentration. The authors emphasize the importance of good glycaemic control for the prevention of diabetic neuropathy.

Abnormalities of the erythrocyte membrane phospholipids in Friedreich's ataxia.

The phospholipid composition and the fatty acids of the phospholipids in the erythrocyte membranes were studied in 5 patients with Friedreich's ataxia. The sphingomyelin content was found to be insignificantly reduced, that of phophatidylethanolamine was, on the contrary, increased even if non-significantly. The linoleic acid content was significantly decreased both in the total fraction of the phospholipids and in the isolated phosphatidylcholine. The relationship between the phospholipid composition and the structure and function of the membrane are discussed.

Modifications of the erythrocyte membrane phospholipids in a family with cerebellar ataxia.

The phospholipid composition and the phospholipid fatty acids of the erythrocyte membrane were determined in a family affected with cerebellar ataxia. 3 adult subjects showed clear clinical signs of the disease, while 3 children were clinically healthy. The phosphatidylserine was diminished, and significant variations were seen in the composition of the fatty acids. The composition of the fatty acids of sphingomyelin was also altered. The same biochemical modifications were seen in patients as well as in their children without clinical signs of the disease.

[Uremic neuropathy and the type of dialysis]. / Neuropatia uremica e tipo di dialisi.

Motor conduction velocity of the median and posterior tibial nerves and sensory conduction velocity of the radial and sural nerves were examined in 45 uremic patients: 15 treated by hemodialysis (HD), 15 treated by combined peritoneal dialysis (CPD) and 15 treated as outpatients with peritoneal dialysis (CAPD). Motor and sensory conduction velocity were reduced in uremic patients treated by HD more than in those treated by CPD and CAPD; there were no significant differences between the last two groups.