Cerebrospinal fluid glutamate levels in chronic migraine.

Both preclinical and clinical data link glutamate to the migraine pathophisiology. Altered plasma, platelets and cerebrospinal (CSF) glutamate levels have been reported in migraine patients. Chronic migraine is comorbid with several conditions. It has been recently shown chronic migraine comorbidity with fibromyalgia. The objective of this study was to study cerebrospinal fluid glutamate levels in chronic migraine patients with and without fibromyalgia. We studied 20 chronic migraine patients, with and without fibromyalgia, compared to age-sex matched controls. CSF glutamate levels were measured by HPLC. CSF glutamate demonstrated significantly higher levels in patients with fibromyalgia compared to those without fibromyalgia. Patients overall had higher CSF glutamate levels than controls. Mean pain score correlated with glutamate levels in chronic migraine patients. Tender points, the hallmark of fibromyalgia, can be considered as pressure allodynia, and is probably mediated by central sensitization, with increase in CSF glutamate levels. We postulate chronic migraine patients with fibromyalgia, in addition to have more disabling headaches, suffer from a more severe central sensitization process. This subtype of patients may respond to medications modulating glutamate receptors. Headache intensity correlate with glutamate levels in chronic migraine patients.

O papel das citocinas na disfunção ventricular avançada / The role of cytokines in advanced ventricualar dysfunction

A insuficiência cardíaca congestiva foi definida por muito tempo como uma síndrome envolvendo profundas alteraçöes hemodinâmicas e neuro-hormonais. Nos últimos anos, uma reação inflamatória exuberante tem sido observada na presença de disfunção ventricular sistólica severa, tanto em modelos experimentais como em ensaios clínicos. Essa resposta inflamatória envolve a ativaçäo e a liberaçäo de uma série de substâncias peptídicas denominadas citocinas. Essas substâncias parecem ter papel relevante tanto na gênese como na manutencçäo do processo de insuficiência ventricular, e podem ser utilizadas inclusive como marcadores prognósticos da doença. O presente artigo apresenta, de forma resumida, os principais estudos clínicos nessa área, destacando a correlaçäo entre determinadas citocinas e variáveis clínico-laboratoriais já descritas em portadores de insuficiência cardíaca congestiva avançada.