cover image European Journal of Neurology

European Journal of Neurology

1998 - Volume 5
Issue 6 | November 1998
Previous Issue

REVIEW

Abstract

This review of the literature reveals that migraine is a common, chronic condition featuring episodic attacks which vary in severity and sympatomatology. Throbbing, unilateral headache, which is aggravated by activity, is the most prominent feature, although a high proportion of sufferers also experience phonophobia, photophobia, and nausea, which may lead to vomiting. Preceding aura is a less common feature of the attack. The frequency and duration of migraine attacks varies widely between individuals, though the median frequency is around 1 attack per month and median duration is roughly 24 h. Migraine attacks can have a profound effect on the day‐to‐day lives and well‐being of the sufferer. In the long term, migraine may cause profound emotional changes and result in coping strategies that interfere with working, social and family life and many normal daily activities. These effects are apparent in quality of life studies on migraine patients. Thus, the impact of migraine on many quality of life parameters is similar to that of other chronic conditions such as osteoarthritis, diabetes and depression. Reduction in the personal burden of migraine can be facilitated by encouraging migraine sufferers to consult their doctor, through accurate diagnosis of migraine headaches and assessment of the disability suffered by the migraineurs, and through improved and well‐executed treatment strategies.

Read full article
Free access for EAN members – please log in.
Authors:
Carl G.H. Dahlöf and Glen D. Solomon
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560525.x

RESEARCH PAPERS

Abstract

Zolmitriptan is a selective 5‐HT receptor agonist for acute oral imgraine theraphy. This randomized, placebo|controlled, parallel‐grup study investigated the efficacy and tolerability of oral zolmitriptan (5, 10, 15 and 20 mg) in the tretment of single acute migraine attacks. Of 1181 patients randomized, 840 were evaluable for the primary efficacy analysis. Headache response rates (a reduction in headache intensity from severe or moderate at baseline to mild or no pain at 2 hours post‐treatment) were similaracross the zolmitriptan dose groups (66%, 71%, 69% and 77% for 5 mg, 10 mg, 15 mg and 20 mg, respectively) and were significantly higher than that for placebo (19%; all groups < 0.001). A headache response was reponse was reposted at 1 hour by 40‐50% of zolmitriptan recipients (16% placebo). At 2 hours post dose,39‐47% of zolmitriptan‐treated patients were pain‐free, compared with 1% of placebo recipients. Headache recurrence occurred in 21‐29% (upper 95% CI 37.1) of zolmitriptan‐treated patients and in 65% (95% CI 38.3, 85.8) of placebo recipients. Zolmitriptan was well tolerated at each dose. The most commonly reported adverse events were asthenia, dizziness, paraesthesia and feelings of heaviness. Mostadverse events were of mildor moderate intensity and were efficacy and tolerability profile, the dose response data suggest that lower doses would also offer significant efficacy.

Read full article
Free access for EAN members – please log in.
Authors:
Carl Dahlöf, Hans‐Christoph Diener, Peter J. Goadsby, Hélène Massiou, Jes Olesen, Jean Schoenen, Marcia Wilkinson, Ruth M. Sweet and Ken B. Klein
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560535.x

RESEARCH PAPERS

Abstract

In 10 patients with Charcot‐Marie‐Tooth disease type 1 (CMT1), hereditary motor and sensory neuropathy (HMSN) type, 1, deymyelinating form, and 10 patients with CMT2, HMSN type 2, axonal form, monoclonal antibodies directed against dystrophin, spectrin, desmin, vimentin and a myoblast and satellite‐cell related antigen, Leu‐19, were applied to muscle biopsies from the anterior tibial muscle. Data from the biopsies were compared with those from 20 age‐and sexmatched healthy controls, Both CMT1 and CMT2 patients had normal stainings for dyustrophin and spectrin, indicating a normal muscle fibre cytoskeletal structure. In the CMT2 group, seven patients had increased staining for desmin in the majority of the atrophic fibres. In the CMT1 group, six of the patients had a normal desmin stating in normal sized and in atrophic muscle fibres, while the remaining four patients had an increased staining for a desmin in a few atrophic muscle fibres. Seven CMT2 patients and one CMT1 patient had increased staining of vimentin in some atrophic muscle atrophi muscle fibres. These immunohistochemical data support earlier findings of muscle fibre histopathological differences in CMT1 and CMT2 patients, possible reflecting different pathophysiological mechanisms in the two disorders.

Read full article
Free access for EAN members – please log in.
Authors:
UllaBritt Ericson, Tor Ansved and Kristian Borg
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560545.x

RESEARCH PAPERS

Abstract

This study is aimed at assessing the prevalence and feature sof psychotic symptoms in a sample of 180 patients with Alzheimer's disease (AD). Sixty‐four patients (35.5% of the sample) showed one or more psychotic symptoms. The presence of these symptoms correlated with the severity of the patients' cognitive impairment, as well as the patients' age at first assessement. Sex, duration of illness, education and familiar history for dementia were not significantly correlated with the psychotic symptoms. Hallucination was the most common symptom (24.4% of the whole sample), followed by delusion (18.3%) and misperceptin (11.1%). Visual hallucinations were more frequent than auditory, and, among delusions, persecutory and theft thems were largely prevailing. Misperceptions included television related phenomena and phantom boarder illusions. A follow‐up study of 37 patients demonstreated the association between the presence of psychotic symptoms and a steeper slop of cognitive deterioration.

Read full article
Free access for EAN members – please log in.
Authors:
Sergio Della Sala, Andrea Francescani, Silvia Muggia and Hans Spinnler
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560553.x

RESEARCH PAPERS

Abstract

Hippocampal cholinergic neurostimulating peptide (HCNP), originally purified from the hippocampus of young rats, enhances the cholinergic development of rat medial septal nuclei This report concerns the determination of the HCNP content of the cerebrospinal fluid (CSF) of 173 clinically, and of 22 clinico‐pathologically defined patients. A radiommunossay was used throughout. The HCNP level was relatively uniform among the clinically defind patients for almost all non‐Alzheimer's patients, the level fell within the range delimited by ± 2 SD of the mean of all patients taken together, and none of them had a level above this range. By contrast, the early‐onset Alzheimer's diseas patients could be divided on the basis of their HCNP level into two groups, one with high levels (markedly above the mean ± 2 SD range), and the other with levels similar to those of the other patients. The analysis of the CSF samples obtained postmortem revealed that Group I Alzheimer‐type dementia (ATD) patients with clinico‐pathologically established diagnoses had a strikingly higher level of HCNP than patients with either Group II ATD or cerebral vascular diseas. These results suggest that HCNP is involved in certain pathophysiological alterations associated with dementia, and that its determination may be useful in patient evaluation.

Read full article
Free access for EAN members – please log in.
Authors:
Yasukuni Tsugu, Kosei Ojika, Noriyuki Matsukawa, Tamaki Iwase, Yasushi Otsuka, Eiichi Katada and Shigehisa Mitake
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560561.x

RESEARCH PAPERS

Abstract

Ideomotor apraxia is one the earliest disturbances in Alzheimer's disease(AD); no test of this disturbance has yet been validated for elderly people. We propose a test of meaningless gesture imitation and its relevance;in elderly people is studied. The Ideomotor Aprazia Test (IAT) consists of showing 10 gestures. Each item is graded from 0 to 3. IAT was carried;out on 55 patients with AD (mean age:86.8 ± 6.8(71–100); mean MMS score: 14.6 ± 6.3) and 26 elderly patients without cognitive impairment (mean age:84.1 ± 7.5(70–100); mean MMS score:27.5 ± 1.9). The inter‐rater relilability, a threshold, the apparent sensitivity and specificity and the relationship bestween the MMS score and the ideomotor apraxia score were determined. The mean apraxia score was 14.9 ± 7.3 in the AD group and 28 ± 1.6 in the normal group (P < 0.0001). Inter‐rater agreement is excellent (P = 0.995). The threshold is 27. The apparent sensitivity and specificity are very good (95% and 98%, respectively). The correlataion between the MMS score and ideomotor apraxia score. IAT is the first test that evaluates meaningless gesture imitating capacity in an elderly population. It is easy and quick‐to‐perform test, useful routienly for diagnois of AD and is correlatead with the severity of cognitive impairment.

Read full article
Free access for EAN members – please log in.
Authors:
N. Dobigny‐Roman, B. Dieudonne‐moinet, D. Tortrat, M. Verny and B. Forotte
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560571.x

RESEARCH PAPERS

Abstract

The symptom of fatigue is a frequent complaint in multiple sclerosis (MS) patients. Signs of fatigability have been documented in these patients as well. However, correlation with signs of objective fatigue had not been clariffied in MS. The aim of this study was to assertain the existence of muscular fatigue in multiple seclerosis patients. and to find out if there is a correlation between the subjective symptom of fatigue and muscular fatigue.

Read full article
Free access for EAN members – please log in.
Authors:
Jorge Iriarte and Purificación de Castro
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560579.x

RESEARCH PAPERS

Abstract

Clinical and autopsy findings are described in 14 patients who had suffered from spinal cord compression due to metastatic disease. All patients were clinically examined at the time of diagnosis of spinal cord compression, and followed until death. Autopsy studies of the cord revealed microscopic tumors similar to the primary tumor in seven cases. There were white matter lesions varying from slight to severe loss of myelin in seven cases. A correlation between the myelin damage and the patients ambulation just before death was found.

Read full article
Free access for EAN members – please log in.
Authors:
Susanne Helweg‐Larsen and Henning Laursen
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560587.x

RESEARCH PAPERS

Abstract

Eight patients with parkinsonism who developed severe orthostatic sypotension, were treated with oral ergotamine/caffeine. Significant long‐term improvement in standing systolic blood pressure and symptoms of syncope and light‐headedness were observed in four of these patients. One patient in whom the drug was effective discontinued it because of nausea. Another lost benefit after 2 weeks of sucessful therapy. Significant supine systolic hypertension occureed in only one patient, which was easily managed by nifedipine given at night. Symptoms or signs of ergotism were not observed. Oral ergotamine/caffeine should be considered as a cost‐effective teratment for refactory orthostatic hypotension in carefully selected patients with parkinsonism.

Read full article
Free access for EAN members – please log in.
Authors:
Richard B. Dewey, Surendra D. Rao, Stephanie L. Holmburg and Ronald G. Victor
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560593.x

RESEARCH PAPERS

Abstract

In order to examine the effect of age and nitric oxide synthase inhibitor ‐nitro‐L‐arginine methl ester (‐NAME) we studied the changes on major neurotransmitter receptor systems in 6 (adult and 24‐month‐old (aged) Fischer male rats using receptor autoradiography. ‐name was administrated intraperitoneally in aged rats once a day for 4 weeks. [H]QNB (quinuclidinyl benzilate) HC (hemicholinium‐3) [H] muscimol H] SCH 23390 ([‐methyl‐H] ‐methyl‐H][+]‐8‐chloro‐2 3 4 5‐tetrahydro‐3‐methyl‐5‐phenyl‐7‐il‐benzazepine) H] mazindol were used as markers of muscarinic acetylcholine receptors high‐high‐affinity choline uptake sites GABA (γ‐aminobutyric acid (SP2)) receptors dopamine D receptors dopamine D receptors and dopamine uptake sites respectively. The age‐related change in H muscimol binding in the brain was more pronounced than that in [H] QNB H]HC H]SCH 23390 H] nemonapride and H] nemonapride and H] mazindol binding.Chronic treatment (4 weeks) with ‐NAME caused no significant changes in [sp1)H] muscimol H SCH 23390 and [H] nemonapride binding in most areas of aged rat brain as compared with vehicle‐treated aged animals. However chronic treatment with ‐NAME caused a significant reduction in H] HC and H] mazindol binding in any brain regions of aged rats in comparison with the vehicle‐treated aged animals. These results demonstrate that the GABAergic system is more susceptible to aging processes than cholinergic and dopaminergic systems in teh brain. Furthermore our findings suggest that nitric oxide may play some role in the regulation of choline uptake and dopamine uptake systems during aging processes.

Read full article
Free access for EAN members – please log in.
Authors:
Tsutomu Araki, Yoshiteru Oshima, Hiroyki Kato, Katsuro Shuto and Yasuto Itoyama
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560601.x

CASE REPORT

Abstract

Nephropathic cystinosis is a hereditary disorder characterized by a specific defect in the transport of cystine across the lysosomal membrane leading to an accumulation of protein‐free cystine in tissues including conjuctiva liver bone marrow and kidney. Renal transplantation is necessary because of renal failure. With improved life‐expectancy neurological complications have been reported including cases of distal myopathy diagnosed ante‐and post mortem. We report on two further rare cases of two siblings suffering from cystinosis who developed a predominantly distal myopathy proven electrophysiologically and on biopsy during life. The reported clinical picture of a distal atrophy resembling a neurogenic disease confirms a picture apparently typical in cystinosis. Possible effects of cysteamine therapy on the course of the myopathy are discussed.

Read full article
Free access for EAN members – please log in.
Authors:
O. Kastrup, S. Koeppen, K. Schwechheimer, M. Keidel and H. C. Diener
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560609.x

CASE REPORT

Abstract

Primary writing tremor is a task‐specific tremor that is considered to be unilateral. We report a 59‐year‐old man with a 5‐year history of a typical primary writing tremor in the right hand who developed similar symptoms in teh left hand.

Read full article
Free access for EAN members – please log in.
Authors:
Félix J. Jiménez‐Jiménez, Francisco Cabrera‐Valdivia, Miguel Ortí‐Pareja, Teresa Gasalla, Antonio Tallón‐Barranco and Martín Zurdo
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560613.x

CASE REPORT

Abstract

Visual hallucinations are commonly associated with seizures drug effects psychiatric disorders or visual loss as ‘release’ phenomena. We report the case of a previously healthy 65‐year‐old woman who was admitted to hospital with intermittent headache episodes accompanied by complex visual hallucinations. During these episodes the patient's blood pressure was 220/120 mm Hg. In between symptomatic episodes she had no complaints and felt healthy. The neurological and ophthalmological examinations were normal but cerebral magnetic resonance imaging (MRI) showed multiple white matter abnormalities in the parieto‐occipital regions. Rapid reversal of the symptoms and imaging abnormalities occurred concurrently with lowering of blood pressure. The history and the findings were similar to those recently described in the clinicoradiological ‘posterior leukoencephalopathy’ syndrome. Different pathogenic mechanisms are discussed.

Read full article
Free access for EAN members – please log in.
Authors:
Chantal M.E. Tallaksen, Emilia Kerty and Søren Bakke
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560615.x

SPECIAL ARTICLE

Abstract

In this paper we report about the Danish Year of the brain 1997 because it may serve as a model for other countries. It was possible in Denmark to organize a very large scale effort which has been well received by the general public and which has significantly improved the image of the neurological disciplines. The resources spent on nationwide initiatives in the Danish Year of the Brain are more than 2 million ECU in country with 5 million inhabitants. In addition however considerably amounts were spent in each country of Denmark. Since all professionals have worked for free innumerable hours of work have not been budgeted. In fact the Danish Year of the Brain has been the largest privately organized health campaign ever held in Denmark and it has been so successful that the Danish Heart Association. Which is old well organized and extremely strong financially has been worried about the shift of attention from the heart to the brain.

Read full article
Free access for EAN members – please log in.
Authors:
Jes Olesen, Gunilla Öberg and Per Vestergaard
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560619.x

LETTER TO THE EDITOR

Response of thalamic pain syndrome to lamotrigine

Read full article
Free access for EAN members – please log in.
Authors:
Pietro B. Carrieri, Vincenzo Provitera, Luigi Lavorgna and Roberto Bruno
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560625.x

LETTER TO THE EDITOR

The decline of neurology versus radiology? Current status of neuroradiology in Turkey

Read full article
Free access for EAN members – please log in.
Authors:
Okan Bolukbasi and Ali Akyol
Article first published online:
13 Feb 2003 | DOI: 10.1046/j.1468-1331.1998.560627.x