Medication overuse headache: withdrawal and prophylactic therapeutic regimen.

BACKGROUND: Medication overuse headache (MOH) is a secondary headache, whose diagnostic criteria were settled by the Second Edition of the International Classification of Headache Disorders and its subsequent revisions. Its diagnosis and treatment represent a growing problem worldwide and a challenge for headache specialists. OBJECTIVE: The aim of this study was to evaluate the efficacy of a therapeutic regimen for withdrawal of the overused drug and prophylaxis of headache in a population of patients suffering from MOH in 8 hospitals of Piemonte - Liguria - Valle d'Aosta. PATIENTS AND METHODS: Seventy patients, 58 females (82.9%) and 12 males (17.1%), mean age at observation 51.04 +/- 12.59 years, affected by MOH following International Headache Society diagnostic revised criteria were treated as inpatients (n = 40) or in Day Hospital (n = 30). Headache Index (HI) and Daily Drug Intake (DDI) were used for evaluating the severity of headache and medication overuse. The patients were treated by abrupt discontinuation of the overused drug and by a therapeutic protocol including i.v. hydration, dexhamethasone, metoclopramide, and benzodiazepines for 7-15 days. Prophylactic medication was started at the beginning of therapeutic protocol. Patients underwent follow-up controls 1, 3, and 6 months after discharge. The initial diagnosis was MOH in all patients included in the study. The overused medications were simple analgesics in 18 cases (25.7%), combination analgesics in 26 cases (37.1%), triptans alone in 9 cases (12.9%), or in combination with analgesics in 13 cases (18.6%), and ergot derivatives (in combination) in 4 cases (5.7%). We collected data from 59 patients at first follow-up (1 month), 56 after 3 months, and 42 after 6 months. RESULTS: Mean HI was 0.92 at admission, 0.19 at discharge, 0.35 after 30 days, 0.39 after 3 months, and 0.42 after 6 months. Mean DDI was 2.72 at admission, 0.22 at discharge, 0.31 after 1 month, 0.38 after 3 months, and 0.47 after 6 months. These results proved to be highly statistically significant. CONCLUSIONS: The protocol was generally effective, safe, and well-tolerated. The results tend to remain stable with time, and seem to be encouraging about long-term use of this therapeutic protocol on a larger number of patients suffering from MOH.

Risk factors for a first epileptic seizure after stroke: a case control study.

INTRODUCTION: The risk of seizures increases after stroke, but not all risk factors are known. We aimed to identify factors that increase the risk of a first seizure after a stroke. METHODS: Multicenter case-control study of 161 patients with a first seizure after stroke (105 provoked/acute and 56 unprovoked/remote symptomatic) matched to 279 hospital stroke controls by center, gender, age and timing of stroke. RESULTS: The risk of first seizure (odds ratio (OR), 95% confidence limits (CL)) was 3.6 (2.4-5.5) for cortical involvement, 2.5 (1.2-5.3) for multiple CT-scan lesions, 2.4 (1.5-3.9) for supratentorial lesions, 2.4 (1.6-3.7) for prior lesions on CT-scan, 2.1 (1.1-4.7) for family history of seizures, 2.0 (1.1-3.6) for use of epileptogenic drugs, 1.7 (1.0-2.9) for large lesions, 1.6 (1.0-2.8) for hemorrhagic lesions, and 1.4 (1.0-2.2) for cortical atrophy. After multivariate analysis, including all the factors significant in univariate analysis, the strongest independent predictor of a first seizure was cortical involvement (OR 3.3; 95% CL=2.1-5.0), followed by prior lesions (2.2; 1.4-3.4) and hemorrhagic stroke (1.8, 1.0-3.2). The multivariate analysis model for remote symptomatic seizures included cortical involvement, large size, and prior lesions; the model for acute seizures included cortical involvement, alcohol consumption >50 g/day, hemorrhagic stroke, and prior lesions on CT-scan. DISCUSSION: Cortical involvement, the presence of prior lesions on CT-scan, and hemorrhagic lesion are the most important risk factors for a first-ever seizure after stroke.

Effects of emotional face cueing on line bisection in neglect: a single case study.

One patient with left neglect (FM) and four right brain-damaged controls were tested on a line bisection task with pictures of neutral and emotional faces as unilateral cues. We thus manipulated the attentional salience of the cues (higher for emotional and lower for neutral faces) while keeping constant their physical dimensions. Our findings showed that left emotional faces were more effective than left neutral faces in reducing bisection errors only in FM. These data indicate that in the neglected hemispace cues bias attention rather than simply altering the perceptual point of balance of the line in the horizontal plane.