Autonomic impairment in patients with migraine.

OBJECTIVE: Heart rate variability analysis of electrocardiogram is becoming an increasingly common method to non-invasively evaluate autonomic nervous function. The aim of the study was to investigate cardiac autonomic function in subjects with and without migraine by using 24-hour ambulatory electrocardiographic recordings. PATIENTS AND METHODS: We investigated 27 subjects with migraine (10 with migraine with aura and 17 without aura) during headache free periods and 10 age-matched healthy control subjects. The migraine was diagnosed using the International Classification of Headache Disorders 2nd Edition criteria. Beck Depression and Beck Anxiety Inventory forms were completed by all subjects. Time and frequency-domain of HRV was analyzed for two periods: diurnal and nocturnal. RESULTS: We found an increased frequency of anxiety and depressive symptoms in migraine patients, especially in migraine with aura group. The heart rate variability parameters SDNN, RMSSD, high frequency were decreased and low frequency was increased in migraine patients during night period compared with normal subjects, most affected were migraine with aura patients. During day period we found modification for SDNN, RMSSD and high frequency parameters only in migraine with aura group. CONCLUSIONS: Reduced parasympathetic activity with sympathetic predominance was found in migraine patients during the night period, most affected being migraine with aura patients.

Parkinson's disease and carotid intima-media thickness.

UNLABELLED: Reports about the impact of cerebrovascular disease (CVD) on clinical status in Parkinson's disease (PD) are rather controversial. There have been a few studies and inconsistent results regarding the coincidence of Parkinson's disease (PD) and atherosclerotic diseases, such as cerebrovascular disease. Carotid intima-media thickness (IMT) is a known marker for subclinical atherosclerosis. AIM: This study was done to investigate the carotid IMT between PD patients and controls. MATERIAL AND METHODS: A total of 54 PD patients and 50 controls were examined. The duration of Parkinson's disease, the severity of Parkinson's disease (the Hoehn-Yahr stage) and carotid IMT were examined. RESULTS: The mean Hoehn and Yahr stage was 2.78 (range 2-4). Duration of disease had a mean of 7.59 +/- 0.85 years. The left CCA mean IMT was 0.900 +/- 0.147 in Parkinson group and 0.828 +/- 0.118 in control group (p = 0.007). The right CCA mean IMT was 0.891 +/- 0.176 mm in the Parkinson group and 0.860 +/- 0.164 in control group (p = 0.360). No relationship between the Hoehn and Yahr stages or the duration of PD with the IMT were found by the Pearson's correlation test. CONCLUSIONS: The carotid IMT was higher in PD patients than in controls.

Autonomic dysfunction in type 2 diabetes mellitus with and without vascular dementia.

INTRODUCTION: Autonomic dysfunction has been implicated in sudden cardiac death and cognitive impairment in diabetes. OBJECTIVES: Objectives of the study were to examine the associations between vascular, metabolic risk factors, autonomic and cognitive function in patients with diabetes mellitus. METHOD: We investigate autonomic function in 45 participants with type 2 diabetes and in 23 age related normal subjects, using Ewing's tests and power spectral analysis of heart rate variability. Mini Mental State Examination and Hachinski's ischemic scale were used to identify vascular dementia. Only 11 patients were diagnosed with vascular dementia. RESULTS: The glycosylated haemoglobin, triglycerides, and systolic blood pressure had much larger values in vascular dementia patients compared to the controls. The averages of results obtained in heart rate deep-breathing, Valsalva ratio and lying-to-standing tests for vascular dementia patients are statistically lower than the averages for controls. Vascular dementia patients had a greater fall in blood pressure on standing (p<0.001) and reduced blood pressure responses to isometric exercise (p<0.001) in comparison with controls. Also they had an increase in the mean heart rate at rest (p<0.05), a decrease in time domain parameters of heart rate variability (p<0.001), and an increase in the low/high frequency component ratio (p<0.001) indicating a vagal-sympathetic dysfunction. CONCLUSIONS: Using standard cardiovascular reflex tests and analysis of heart rate variability we demonstrated an impairment of the autonomic nervous system in vascular dementia patients with marked parasympathetic dysfunction and sympathetic predominance.

[Secondary effects of chronic treatment with levodopa in Parkinson disease]. / Efecte secundare ale tratamentului cronic cu preparate de levodopa în boala Parkinson.

We have analysed the side effects of levodopa preparations in patients suffering from Parkinson's disease. The study has begun in 1993. All the patients were initially admitted in the Neurological Clinic of the Recovery Hospital in Iasi, and then followed in ambulatory condition. We have monitorized the apparition of adverse reactions of levodopa therapy, and tried to treat them by modifying doses and patterns of administration, by associating other drugs or by replacing levodopa with other drugs. We have initially included 116 patients, of whom 30 have developed secondary effects until June 2002. The most frequent secondary effects have been coreea, dystonia, mental adverse reactions, yo-yo-ing etc. Each one of the 30 patients has developed one or more types of secondary reaction.