Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Cluster munitions are weapons that scatter smaller sub-munitions intended to kill or mutilate on impact. They have been used by the Israeli army in the south of Lebanon and are now scattered over wide rural areas affecting its inhabitants. Because of their easily "pickable" nature, sub-munitions can inflict injuries to the head and face regions. ⋯ During the study period, there were 417 casualties as a result of cluster munitions' blasts. Out of the total number of victims, 29 (7 %) were injured in the head and the face region. The convention on cluster munitions of 2008 should be adhered to, as these inhumane weapons indiscriminately and disproportionately harm innocent civilians, thereby violating the well-established international principles governing conflict and war today.
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An association between obesity and migraine has been observed in recent studies and it is supported by plausible biological mechanisms. The objective of this study is to evaluate the efficacy of frovatriptan and other triptans in the acute treatment of migraine, in patients enrolled in three randomized, double-blind, crossover, Italian studies and classified according to body mass index (BMI) levels, as normal weight or non-obese (NO, BMI 18.5-24.9 kg/m(2)) and overweight or obese subjects (O, BMI ≥ 25 kg/m(2)). 414 migraineurs with or without aura were randomized to frovatriptan 2.5 mg or rizatriptan 10 mg (study 1), frovatriptan 2.5 mg or zolmitriptan 2.5 mg (study 2), frovatriptan 2.5 mg or almotriptan 12.5 mg (study 3). After treating up to three episodes of migraine in 3 months with the first treatment, patients switched to the alternate treatment for the next 3 months. ⋯ Pain relapse occurred at 48 h in significantly (p < 0.05) fewer episodes treated with frovatriptan in both NO (26 vs. 36 %) and O (27 vs. 49 %). The rate of 48-h relapse was similar in NO and O with frovatriptan, while it was significantly (p < 0.05) higher in O with the comparators. Frovatriptan, in contrast to other triptans, retains a sustained antimigraine effect in NO and even more so in O subjects.
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Peripheral neurostimulation techniques have emerged as promising treatments for patients with medically intractable, highly disabling chronic daily headaches including chronic migraine (CM) and chronic cluster headache (CCH) besides other less common headache syndromes. Encouraging controlled and open label data in medically intractable CM and trigeminal autonomic cephalalgias (TACs) have suggested a meaningful therapeutic role for occipital nerve stimulation (ONS). In view of the frequent occurrence of pain in the first branch of trigeminal nerve, percutaneous supraorbital nerve stimulation alone or in combination with ONS has been used successfully in open label series of CM and CCH patients. ⋯ Preliminary data in patients with epilepsy and migraine have suggested a potential efficacy of vagus nerve stimulation in the treatment of primary headaches. Non-invasive devices targeting peripheral nerves have been developed and initial experience is emerging for the acute and preventive treatments of primary headache disorders. This review analyses the available evidence on the efficacy and safety of the different peripheral neurostimulation techniques.
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The aim was to evaluate whether patients with episodic migraine with (MA+) and without aura (MA-), during the interictal period of migraine would have an altered distensibility of the wall of cerebral arterial network and whether it would play a role in migraine headache. To evaluate the distensibility of the wall of cerebral arterial network, we measured the time-delay in milliseconds (ms) between the R-wave of an electrocardiogram and the arterial pulse wave of cerebral microcirculation (R-APWCMtd) on the frontal cortex detected by near-infrared spectroscopy (NIRS) in 10 patients with MA+ (age 39.5 ± 12.2 years), in 10 with MA- (age 40.3 ± 10.2 years), according to ICHD-3 criteria 2012, during the interictal period of migraine, and in 15 age-, sex- and height-matched healthy control subjects. ⋯ The increased distensibility leads to an increased flow pulsatility into intracranial dural meningeal vessels that may lead to a mechanical stimulation of the nociceptors that innervate the dural vasculature. This condition may play a role in promoting the sensitization of trigeminovascular afferents and sterile inflammation within the dura mater that are fundamental to the pathogenesis of migraine headache.
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Letter Case Reports
Parkinson's disease associated with myasthenia gravis and rheumatoid arthritis.