Patient Case Report: Memantine for the Treatment of Occipital Neuralgia.

Occipital neuralgia (ON) is described as a shooting, stabbing pain in the posterior part of the scalp that involves the occipital nerve. The epidemiology and pathophysiology are uncertain, but ON is considered distinct from other headache types. At the time of this writing, memantine for the treatment of ON has not been described in the literature. The following details a case report of successful treatment of ON with memantine. A 64-year-old, 91-kg, White man presented with severe headache associated with ON. Previous trials of oral medications, acupuncture, or physical therapy did not provide relief. The patient reported 15 ON headache days per month, use of 18 sumatriptan tablets per month, and daily use of as-needed ibuprofen. Because of inadequate relief of ON from other treatments, memantine was started. After titration to memantine 10 mg by mouth twice daily, the patient reported he was "100% headache free" from his ON pain. The patient tolerated memantine well without adverse effects. This case report displays safe, effective, and novel treatment of ON with memantine 10 mg by mouth daily, twice daily. The known safety, tolerability, and pharmacodynamics of memantine may warrant its off-label use in future studies exploring efficacy in ON.

Population and size-specific distribution of Atlantic salmon Salmo salar in the Baltic Sea over five decades.

Population-specific assessment and management of anadromous fish at sea requires detailed information about the distribution at sea over ontogeny for each population. However, despite a long history of mixed-stock sea fisheries on Atlantic salmon, Salmo salar, migration studies showing that some salmon populations feed in different regions of the Baltic Sea and variation in dynamics occurs among populations feeding in the Baltic Sea, such information is often lacking. Also, current assessment of Baltic salmon assumes equal distribution at sea and therefore equal responses to changes in off-shore sea fisheries. Here, we test for differences in distribution at sea among and within ten Atlantic salmon Salmo salar populations originating from ten river-specific hatcheries along the Swedish Baltic Sea coast, using individual data from >125,000 tagged salmon, recaptured over five decades. We show strong population and size-specific differences in distribution at sea, varying between year classes and between individuals within year classes. This suggests that Atlantic salmon in the Baltic Sea experience great variation in environmental conditions and exploitation rates over ontogeny depending on origin and that current assessment assumptions about equal exploitation rates in the offshore fisheries and a shared environment at sea are not valid. Thus, our results provide additional arguments and necessary information for implementing population-specific management of salmon, also when targeting life stages at sea.

Experimental evidence of gradual size-dependent shifts in body size and growth of fish in response to warming.

A challenge facing ecologists trying to predict responses to climate change is the few recent analogous conditions to use for comparison. For example, negative relationships between ectotherm body size and temperature are common both across natural thermal gradients and in small-scale experiments. However, it is unknown if short-term body size responses are representative of long-term responses. Moreover, to understand population responses to warming, we must recognize that individual responses to temperature may vary over ontogeny. To enable predictions of how climate warming may affect natural populations, we therefore ask how body size and growth may shift in response to increased temperature over life history, and whether short- and long-term growth responses differ. We addressed these questions using a unique setup with multidecadal artificial heating of an enclosed coastal bay in the Baltic Sea and an adjacent reference area (both with unexploited populations), using before-after control-impact paired time-series analyses. We assembled individual growth trajectories of ~13,000 unique individuals of Eurasian perch and found that body growth increased substantially after warming, but the extent depended on body size: Only among small-bodied perch did growth increase with temperature. Moreover, the strength of this response gradually increased over the 24 year warming period. Our study offers a unique example of how warming can affect fish populations over multiple generations, resulting in gradual changes in body growth, varying as organisms develop. Although increased juvenile growth rates are in line with predictions of the temperature-size rule, the fact that a larger body size at age was maintained over life history contrasts to that same rule. Because the artificially heated area is a contemporary system mimicking a warmer sea, our findings can aid predictions of fish responses to further warming, taking into account that growth responses may vary both over an individual's life history and over time.