High prolactin levels as a worsening factor for migraine.

Many factors should be considered when an episodic migraine worsens and becomes chronic. Prolactin (PRL) was linked to the origin of pain in patients with microprolactinomas who developed different types of headaches. Our team carried out studies on 27 patients with a background of episodic headaches that became chronic. The patients were evaluated by means of a general examination, a neurological examination and a hormonal profile. Of the 27 patients, 7 of them had an increased level of prolactinaemia. All the patients were women, ranging from 17 to 57 years of age. Four of them had a pure form of migraine without aura, whereas 3 patients had both migraines without aura and tension-type headaches. They suffered from headache for a period ranging from 3 to 32 years and their headache became chronic 4-12 months prior to the visit. Their headache did not change in type, but only in severity and frequency. Two patients had no symptoms referable to high PRL levels; 4 patients had irregular menses or amenorrhoea. One of these patients also suffered galactorrhoea and two of these patients had a microprolactinoma at MRI; one patient was using estroprogestinic drugs, so her menstrual alteration could not be considered. The patients were followed-up for a period of 6-16 months. Six patients responded favourably after being treated with cabergoline, although some had already tried other drugs, which, however, had no effect on their headache. One patient improved after ceasing to take estroprogestinic, in spite of increased levels of PRL. Therefore, on this basis, PRL levels should always be considered when headache worsens. It is an adjunctive worsening factor, which can be easily eliminated.

Low-rate repetitive TMS allays central pain.

Only about 50% of central pain patients respond to motor cortex stimulation in the long run. There is a need for prognostic factors. Here we show that propofol test and TMS both predict short-term effect in nine patients with central pain. This may help reduce the number of failures.

Transcranial magnetic cortical stimulation relieves central pain.

Extradural cortical stimulation for neurogenic pain is a recent addition to the field of functional neurosurgery. About 50% of patients with central pain draw benefit in the long run. However, there is an urgent need for prognostic factors in order to cut the costs of the procedure. In this paper we report a statistically significant correlation between the subhypnotic propofol test, transcranial magnetic cortical stimulation (TMS) and the actual short-term outcome of extradural cortical stimulation in 9 patients. The propofol test and TMS appear to predict short-term effects of extradural cortical stimulation.

Chronic triventricular hydrocephalus: morphological and functional study before and after ventriculoperitoneal shunting.

We have neuroradiologically and neuropsycho-physiologically studied a case of chronic hydrocephalus due to congenital acqueductal stenosis, before and after ventriculoperitoneal shunting. The aims of the study were: 1) to point out the correlation between neuroimaging (Computerized Tomography/Magnetic Resonance Imaging) and mapping of Computerized Spectral Analysis EEG (CSA-EEG); 2) to monitor evoked bioelectrical activity by neurophysiological evaluation of acoustic and visual N1 and P3. Both bioelectrical activity and neuroimaging evaluation showed a considerable recovery of the neurobiological substratum after neurosurgical shunting, while neuropsychological investigation showed a slight improvement in all cognitive tasks.

Primary dementias: epidemiological and sociomedical aspects.

An epidemiological survey of primary dementia syndromes was conducted in the city of Bra (26287 residents) in the Piedmont region. All the patients for whom a diagnosis of senile dementia had already been recorded together with the cases coming to light as a result of a questionary circulated to general practitioners and neuropsychiatrists were subjected to a broad battery of neuropsychological tests. The prevalence rate proved to be 255 (+/- 61) per 100 000 of the population and 2028 (+/- 476) per 100 000 of the over 65s. Close attention was paid to dements living in nursing facilities. Factors favoring institutionalisation were: advanced age, severe motor impairment and female sex. No correlation between severity or dementia and institutionalisation was found.