Efficacy and feasibility of antidepressants for the prevention of migraine in adults: a meta-analysis.

BACKGROUND AND PURPOSE: Migraine has greatly impacted the quality of life for migraineurs and was ranked as the seventh highest specific cause of disability worldwide in 2012. Because of the role of serotonin in migraine mechanisms, antidepressants have been used in the prevention of migraine. However, the role of antidepressants for migraine prophylaxis in adults has not been completely established. Our aim was systematically to assess the efficacy and feasibility of antidepressants for the prevention of migraine in adults based on currently available literature. METHODS: A comprehensive search of databases was conducted including the Cochrane, PubMed, Web of Science and Embase databases from inception to July 2016. Randomized controlled trials that assigned adults with a clinical diagnosis of migraine to antidepressant or placebo treatment were included. The primary outcome was the reduction of migraine frequency or index. RESULTS: Overall, 16 randomized controlled trials including 1082 participants were identified. Antidepressants had a significant advantage over placebo in reducing the migraine frequency or index of adults with a standardized mean difference of -0.79 [95% confidence interval (CI) -1.13 to -0.45, P < 0.00001]. Patients receiving antidepressant therapy were more likely to experience an at least 50% reduction of headache burden than those receiving placebo (28.9% vs. 20.2%; risk ratio 1.40; 95% CI 0.97-2.02; P = 0.07). However, antidepressants were less well tolerated than placebo because of some adverse events (risk ratio 1.74, 95% CI 1.05-2.89, P = 0.03). CONCLUSIONS: Antidepressants are effective in the prophylaxis of migraine in adults, but the level of evidence for antidepressants except for amitriptyline seems to be quite shaky.

Fibulin-5: a novel biomarker for evaluating severity and predicting prognosis in patients with acute intracerebral haemorrhage.

BACKGROUND AND PURPOSE: The aim was to investigate relationships between serum fibulin-5 concentration and the severity or prognosis in patients with acute intracerebral haemorrhage (ICH). METHODS: Consecutive ICH patients and healthy controls were included and clinical data were collected. National Institute of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) were assessed at admission time within 3 days after bleeding. Cerebral haemorrhage volume was calculated and serum fibulin-5 concentration was measured at the same time. Multivariate linear regression analyses were performed to determine risk factors for serum fibulin-5 concentration and Spearman correlation coefficients were obtained to explore the relationships between fibulin-5 concentration and NIHSS or GCS scores. Patients were followed up for 3 months and the modified Rankin Scale was evaluated for all survivors. Receiver operating characteristic (ROC) curves were obtained to explore fibulin-5 concentration in predicting prognosis. RESULTS: Serum fibulin-5 concentration had increased in ICH patients compared with healthy controls (65.86 ± 26.39 µg/l vs. 40.66 ± 5.03 µg/l, P = 0.00) and was mainly influenced by haemorrhage volume (ß = 0.905, P = 0.000) and extension to ventricles (ß = 10.173, P = 0.097). Serum fibulin-5 concentration was positively correlated with NIHSS score (r = 0.511, P = 0.000) but inversely correlated with GCS score (r = -0.585, P = 0.000). Based on the ROC curves, the optimal cut-off point was 80.68 µg/l for death, and the sensitivity and specificity values of serum fibulin-5 were 77.8% and 93.2%, whilst the optimal cut-off point was 48.45 µg/l for poor prognosis and the sensitivity and specificity values were 86.4% and 54.1%, respectively. CONCLUSIONS: Serum fibulin-5 concentration can be regarded as a biomarker for evaluating disease severity and predicting prognosis in ICH patients.

Serum soluble nucleosome and the broad family of antinucleosome antibodies are associated with organ and tissue damage in systemic lupus erythematosus in a Chinese population.

Nucleosomes and the broad family of antinucleosome antibodies (ANAs; anti-double-stranded DNA, antihistone and antinucleosome antibodies) may contribute to the pathogenesis of systemic lupus erythematosus (SLE). We collected clinical information on 90 patients with SLE and 73 healthy volunteers and measured serum levels of the ANA family using a double-sandwich ELISA. The results showed that the levels of serum nucleosomes of patients with SLE was significantly lower and the levels of ANA were significantly higher than healthy controls. Negative correlations between serum nucleosomes and ANA, and positive correlations between individual ANAs were found. Patients with SLE with positive ANA had a significantly higher frequency of renal disorders than those with negative ANA. Determination of serum nucleosomes and ANAs contributes to SLE monitoring.