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Nonsurgical Treatment of Neuralgia and Cervicogenic Headache: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY - GLOBAL OPEN 2022; 10:e4412. [PMID: 35923980 PMCID: PMC9307300 DOI: 10.1097/gox.0000000000004412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
Abstract
Background: Extracranial compression of peripheral sensory nerves is one of many origins of chronic headaches. Identifying these patients can be difficult, and they are often diagnosed with neuralgia or cervicogenic headache. The recent literature provides the outcomes of surgical decompression in patients with these headaches. This study aimed to give an overview of the current literature on the nonsurgical treatment options and to evaluate the effectiveness of these treatments in patients with neuralgia and cervicogenic headache. Methods: Databases were searched to identify all published clinical studies investigating nonsurgical treatment outcomes in patients with neuralgia or cervicogenic headaches. Studies that reported numerical pain scores, nonnumerical pain scores, headache-free days, or the number of adverse events after nonsurgical treatment were included. Results: A total of 22 articles were included in qualitative analysis. The majority of studies included patients who received injection therapy. Treatment with oral analgesics achieved good results in only 2.5% of the patients. Better outcomes were reported in patients who received local anesthetics injection (79%) and corticosteroid injection (87%). Treatment with botulinum toxin injection yielded the highest percentage of good results (97%; 95% CI, 0.81–1.00). The duration of headache relief after injection therapy varied from 30 minutes to 5 months. Conclusions: The nonsurgical treatment of patients with neuralgia or cervicogenic headache is challenging. Injection therapy in patients with these types of headaches achieved good pain relief but only for a limited time. Surgical decompression may result in long-lasting pain relief and might be a more sustainable treatment option.
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Halpern LR, Gammal P, Adams DR. An Update on Diagnosis and Pharmacologic Therapy for Headache in the Oral and Maxillofacial Surgery Practice. Oral Maxillofac Surg Clin North Am 2021; 34:83-97. [PMID: 34802617 DOI: 10.1016/j.coms.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Headaches are synonymous with neurovascular pain (cephalalgias), which comprise a heterogeneous group of pain disorders that share a common anatomic region (head and neck). Headaches are often a "universal" disease presentation that is evaluated by the oral and maxillofacial surgeon. Pharmacologic therapy of headaches is most often based on the severity of symptoms and the degree of disability experienced by the patient. This article describes the epidemiology of neurovascular headaches, their pathophysiologic mechanisms/presentation, the workup of patients, and an up-to-date overview of pharmacologic approaches that can be applied in the oral and maxillofacial surgical practice to treat this patient population.
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Affiliation(s)
- Leslie R Halpern
- Oral and Maxillofacial Surgery, University of Utah, School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA.
| | - Paul Gammal
- Department of Dentistry/Oral Surgery, Woodhull Hospital and Mental Health Center, 760 Broadway, Brooklyn, NY 11206, USA
| | - David R Adams
- Oral and Maxillofacial Surgery, University of Utah, School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA
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Mnguni N, Olivier B, Mosselson J, Mudzi W. Prevalence of concurrent headache and temporomandibular disorders: a systematic review protocol. JBI Evid Synth 2020; 19:263-269. [PMID: 32740034 DOI: 10.11124/jbisrir-d-19-00255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to determine the concurrent prevalence of temporomandibular disorders and headaches in patients. INTRODUCTION Temporomandibular disorders affect the temporomandibular joint and associated orofacial structures. It is the second-most common musculoskeletal disorder experienced by adults. Headache is one of the most pervasive neurological disorders and can be an extremely disabling condition. Temporomandibular disorders and headache are known to often occur simultaneously and have a bi-directional relationship due to their close anatomical association. INCLUSION CRITERIA The systematic review will include all studies with adult participants (>18 years) experiencing headaches (migraine, migraine with/without aura, tension-type, cervicogenic, and chronic headache) with symptoms of temporomandibular disorders occurring concurrently. METHODS An initial search of PubMed will be followed by CINAHL, the Cochrane Central Register of Controlled Trials in the Cochrane Library, EBSCO MasterFILE Premier, PEDro, ProQuest Health and Medical Complete, Science Direct, and Scopus. Titles and abstracts of studies will be reviewed, and full text articles will be selected if the inclusion criteria are met. Studies that meet the eligibility criteria will then be assessed by two independent reviewers. Full-text articles will be selected if the inclusion criteria are met. A standardized critical appraisal checklist for studies reporting prevalence data will be used to assess methodological quality and a standardized data extraction tool will be used. The results from the included studies will be analyzed using JBI SUMARI software. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO (CRD42019139689).
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Affiliation(s)
- Nkazimulo Mnguni
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Benita Olivier
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,The Wits-JBI Centre for Evidenced-Based Practice: A JBI Affiliated Group, Johannesburg, South Africa
| | - Jackie Mosselson
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Witness Mudzi
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Mindfulness and Chronic Headache/Migraine: Mechanisms Explored Through the Fear-Avoidance Model of Chronic Pain. Clin J Pain 2019; 34:638-649. [PMID: 29271796 DOI: 10.1097/ajp.0000000000000580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To replicate a study by Schutze and colleagues on a headache sample, rather than a heterogenous chronic pain sample, investigating whether level of mindfulness predicts key components in the Fear-Avoidance Model of chronic pain (pain intensity, negative affect, pain catastrophizing, pain-related fear, pain hypervigilance, and functional disability); to investigate the relationships between level of mindfulness and headache/migraine pain intensity, frequency, and duration. MATERIALS AND METHODS Participants were 217 individuals who self-reported chronic headache/migraine (51 male, 166 female), aged between 18 and 65 years. Participants completed an online survey measuring demographics, mindfulness, the key components of the Fear-Avoidance Model, and headache pain intensity, duration, and frequency. RESULTS Mindfulness had significant negative correlations (P<0.05) with all variables except headache pain intensity and headache frequency. Mindfulness significantly predicted negative affect, pain catastrophizing, fear of pain, pain hypervigilance, and headache duration (P<0.05). Mindfulness remained a significant predictor of negative affect and pain hypervigilance after controlling for other key components and background characteristics (P<0.05). Mindfulness did not moderate the relationship between pain intensity and pain catastrophizing (P=0.204). DISCUSSION Findings suggest that mindfulness may be integrated into the Fear-Avoidance Model of chronic pain for individuals with chronic headache/migraine. Directions for future research are discussed.
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Faizi F, Tavallaee A, Rahimi A, Saghafinia M. Management of Chronic Daily Headache and Psychiatric Co-Morbidities by Lifestyle Modification: Participatory Action Research Combining New Communication Media. Anesth Pain Med 2017; 7:e42782. [PMID: 28920050 PMCID: PMC5594418 DOI: 10.5812/aapm.42782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/26/2016] [Accepted: 11/29/2016] [Indexed: 01/08/2023] Open
Abstract
Background Lifestyle modification has a significant role in chronic daily headache (CDH) management. Participatory action research (PAR) can play an important role in managing chronic medical conditions. However, it has been scarcely used in CDH management. Objectives This study aimed to empower patients with CDH to modify their lifestyle in order to reduce both their headache and related psychiatric co-morbidities in a multidisciplinary headache clinic at Baqiyatallah hospital, Tehran, IR Iran. Methods In the PAR plan, 37 patients (27 females) diagnosed with CDH were selected using purposeful sampling. Along with face-to-face group sessions, all available communication means such as phone calls, emails, short message system (SMS), and social media (Telegram) were used to facilitate the process. Questionnaires of health promotion lifestyle profile (HPLPІІ), visual analog scale (VAS), and depression-anxiety-stress scale (DASS21) were used to collect data. The data were analyzed using SPSS software. Results Mean age of the patients was 38.33 (± 9.7) years. Both “general pain” and “the worst imaginable pain” reduced (mean of reduction: 2.56 ± 2.7 and 2.3 ± 2.9, respectively, P < 0.001). > 50% of pain reduction occurred in “the worst imaginable pain" category (-1.45 ± 2.02, P < 0.001) and mean VAS score reduced to 5.20 (± 2.3) compared to the start of the study (7.50 ± 1.9, P < 0.001). Mean DASS-21 score also reduced significantly for depression (P < 0.016), anxiety (P < 0.026), and stress (P < 0.008). HPLPІІ score significantly improved (118.17 ± 14.8 vs. 160.83 ± 16.4, P < 0.001) and the highest increase was seen in the subscale of "stress management" (17.73 ± 2.8 vs. 25.53 ± 3.9, P < 0.001). Conclusions The empowering PAR plan combined with new communication tools helped the CDH patients better handle their lifestyle, reduce their headache, and lower their symptoms. Further studies with better use of currently available communication tools and social media are recommended for action research to be more applicable.
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Affiliation(s)
- Fakhrudin Faizi
- PhD Candidate in Pain Research and Management, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Tavallaee
- Associate Professor in Psychiatry, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Corresponding author: Abbas Tavallaee, MD, Associate Professor, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Tel: +98-2188053768, E-mail:
| | - Abolfazl Rahimi
- PhD, Assistant Professor, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Masoud Saghafinia
- Associate Professor of Anesthesiology, Pain fellowship Program, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Merlos M, Burgueño J, Portillo-Salido E, Plata-Salamán CR, Vela JM. Pharmacological Modulation of the Sigma 1 Receptor and the Treatment of Pain. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 964:85-107. [PMID: 28315267 DOI: 10.1007/978-3-319-50174-1_8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There is a critical need for new analgesics acting through new mechanisms of action, which could increase the efficacy with respect to existing therapies and reduce their unwanted effects. Current preclinical evidence supports the modulatory role of sigma-1 receptors (σ1R) in nociception, mainly based on the pain-attenuated phenotype of σ1R knockout mice and on the antinociceptive effect exerted by σ1R antagonists on pains of different etiologies. σ1R is highly expressed in different pain areas of the CNS and the periphery (particularly dorsal root ganglia), and interacts and modulates the functionality of different receptors and ion channels . The antagonism of σ1R leads to decreased amplification of pain signaling within the spinal cord (central sensitization), but recent data also support a role at the periphery. σ1R antagonists have consistently demonstrated efficacy in neuropathic pain , but also in other types of pain including inflammatory, orofacial, visceral, and post-operative pain. Apart from acting alone, when combined with opioids, σ1R antagonists enhance opioid analgesia but not opioid-induced unwanted effects. Interestingly, unlike opioids, σ1R antagonists do not modify normal sensory mechanical and thermal sensitivity thresholds but they exert antihypersensitive effects in sensitizing conditions, enabling the reversal of nociceptive thresholds back to normal values. Accordingly, σ1R antagonists are not strictly analgesics; they are antiallodynic and antihyperalgesic drugs acting when the system is sensitized following prolonged noxious stimulation or persistent abnormal afferent input (e.g., secondary to nerve injury). These are distinctive features allowing σ1R antagonists to exert a modulatory effect specifically in pathophysiological conditions such as chronic pain .
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Affiliation(s)
- Manuel Merlos
- Drug Discovery and Preclinical Development, ESTEVE. Parc Científic de Barcelona, Baldiri Reixac 4-8, 08028, Barcelona, Spain
| | - Javier Burgueño
- Drug Discovery and Preclinical Development, ESTEVE. Parc Científic de Barcelona, Baldiri Reixac 4-8, 08028, Barcelona, Spain
| | - Enrique Portillo-Salido
- Drug Discovery and Preclinical Development, ESTEVE. Parc Científic de Barcelona, Baldiri Reixac 4-8, 08028, Barcelona, Spain
| | - Carlos Ramón Plata-Salamán
- Drug Discovery and Preclinical Development, ESTEVE. Parc Científic de Barcelona, Baldiri Reixac 4-8, 08028, Barcelona, Spain
| | - José Miguel Vela
- Drug Discovery and Preclinical Development, ESTEVE. Parc Científic de Barcelona, Baldiri Reixac 4-8, 08028, Barcelona, Spain.
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Abstract
Pain is a universal experience with profound effects on the physiology, psychology, and sociology of the population. Orofacial pain (OFP) conditions are especially prevalent and can be severely debilitating to a patient's health-related quality of life. Evidence-based clinical trials suggest that pharmacologic therapy may significantly improve patient outcomes either alone or when used as part of a comprehensive treatment plan for OFP. The aim of this article is to provide therapeutic options from a pharmacologic perspective to treat a broad spectrum of OFP. Clinical-based systemic and topical applied pharmaceutical approaches are presented to treat the most common OFP syndromes.
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Affiliation(s)
- Leslie Halpern
- Residency, Oral and Maxillofacial Surgery, Meharry Medical College, 1005 TB Todd Jr. Boulevard, Nashville, TN 37208, USA.
| | - Porchia Willis
- Oral and Maxillofacial Surgery, Meharry Medical College, 1005 TB Todd Jr. Boulevard, Nashville, TN 37208, USA
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Altiokka O, Mutluay B, Koksal A, Ciftci-Kavaklioglu B, Ozturk M, Altunkaynak Y, Baybas S, Soysal A. Evaluation of interictal autonomic function during attack and remission periods in cluster headaches. Cephalalgia 2015; 36:37-43. [DOI: 10.1177/0333102415580112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 03/03/2015] [Indexed: 12/29/2022]
Abstract
Objective To investigate which part of the autonomic system is mainly involved and assess the sensitivity of face sympathetic skin response in cluster headache. Material and methods The study sample consisted of 19 drug-free cluster headache patients (16 males, three females) and 19 healthy volunteers. Demographic features and pain characteristics were thoroughly identified. Dysautonomic symptoms were evaluated during attack and remission periods of cluster headache patients. Orthostatic hypotension, R-R interval variation and sympathetic skin responses obtained from the face and four extremities were evaluated and the sensitivity of face sympathetic skin responses was assessed in contrast to extremity sympathetic skin responses. Results All sympathetic skin responses of face and extremities could be obtained during attack and remission periods. On the symptomatic side, mean latency of face sympathetic skin responses was longer compared to the asymptomatic side and controls (p = 0.02, p = 0.004). There were no differences in latency or amplitude of extremity sympathetic skin responses between symptomatic and asymptomatic sides and controls. No significant relationship was determined between sympathetic skin responses, R-R interval variation, orthostatic hypotension and cluster headache clinical features. Conclusion Sympathetic hypoactivity of the face seems to predominate the pathophysiology of cluster headache. Face sympathetic skin responses might be more sensitive compared to extremity sympathetic skin response in demonstrating dysautonomic symptoms in cluster headache patients.
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Affiliation(s)
- Ozlem Altiokka
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Belgin Mutluay
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Ayhan Koksal
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Beyza Ciftci-Kavaklioglu
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Musa Ozturk
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Yavuz Altunkaynak
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Sevim Baybas
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
| | - Aysun Soysal
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey
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Pyun K, Son JS, Kwon YB. Chronic activation of sigma-1 receptor evokes nociceptive activation of trigeminal nucleus caudalis in rats. Pharmacol Biochem Behav 2014; 124:278-83. [PMID: 24992726 DOI: 10.1016/j.pbb.2014.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/16/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
Abstract
Primary headache disorders, including migraine, are thought to be mediated by prolonged nociceptive activation of the trigeminal nucleus caudalis (TNC), but the precise mechanisms are poorly understood. Our past studies demonstrated that sigma-1 receptors (Sig-1R) facilitate spinal nociceptive transmission in several pain models. Based on these findings, this study asked if chronic activation of Sig-1R by intracisternal administration of the selective Sig-1R agonist, PRE084, produced TNC neuronal activation as a migraine trigger in rats. A single infusion of PRE084 (10, 50, 100, 500 nmol) significantly increased the number of Fos immunoreactive neurons (Fos-IR) in TNC, which BD1047 (a Sig-1R antagonist) reversed. Chronic infusion of PRE084 (100 nmol for 1, 3, 7 and 14 days) time-dependently elevated Fos-IR in TNC. The number of Fos-IR elevation from day 7 of infusion was comparable with a single capsaicin infusion as a headache model. Increase in face grooming/scratching behavior was evident from day 7, and peaked at day 14 of chronic PRE084 infusion, which was correlated with ΔFosB elevation and phosphorylation of extracellular signal-regulated kinase, and the NMDA receptor NR1 subunit in TNC. Following 14 days of PRE084 infusion, the number of Fos-IR increased until day 7 after final infusion. Moreover, by day 14, Fos-IR associated with PRE084 infusion was significantly reversed by NMDA receptor antagonist MK801, rather than BD1047. These findings indicated that chronic activation of Sig-1R could evoke prolonged neuronal activation in the trigeminovascular system.
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Affiliation(s)
- Kihyun Pyun
- Department of Computer Science and Engineering, Chonbuk National University, Jeonju 561-180, Republic of Korea
| | - Ji Seon Son
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju 561-180, Republic of Korea
| | - Young Bae Kwon
- Department of Pharmacology, Institute for Medical Science, Chonbuk National University Medical School, Jeonju, Republic of Korea.
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Thompson MD, Xhaard H, Sakurai T, Rainero I, Kukkonen JP. OX1 and OX2 orexin/hypocretin receptor pharmacogenetics. Front Neurosci 2014; 8:57. [PMID: 24834023 PMCID: PMC4018553 DOI: 10.3389/fnins.2014.00057] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 03/12/2014] [Indexed: 01/01/2023] Open
Abstract
Orexin/hypocretin peptide mutations are rare in humans. Even though human narcolepsy is associated with orexin deficiency, this is only extremely rarely due to mutations in the gene coding prepro-orexin, the precursor for both orexin peptides. In contrast, coding and non-coding variants of the OX1 and OX2 orexin receptors have been identified in many human populations; sometimes, these have been associated with disease phenotype, although most confer a relatively low risk. In most cases, these studies have been based on a candidate gene hypothesis that predicts the involvement of orexins in the relevant pathophysiological processes. In the current review, the known human OX1/HCRTR1 and OX2/HCRTR2 genetic variants/polymorphisms as well as studies concerning their involvement in disorders such as narcolepsy, excessive daytime sleepiness, cluster headache, polydipsia-hyponatremia in schizophrenia, and affective disorders are discussed. In most cases, the functional cellular or pharmacological correlates of orexin variants have not been investigated—with the exception of the possible impact of an amino acid 10 Pro/Ser variant of OX2 on orexin potency—leaving conclusions on the nature of the receptor variant effects speculative. Nevertheless, we present perspectives that could shape the basis for further studies. The pharmacology and other properties of the orexin receptor variants are discussed in the context of GPCR signaling. Since orexinergic therapeutics are emerging, the impact of receptor variants on the affinity or potency of ligands deserves consideration. This perspective (pharmacogenetics) is also discussed in the review.
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Affiliation(s)
- Miles D Thompson
- University of Toronto Epilepsy Research Program, Department of Pharmacology, University of Toronto Toronto, ON, Canada
| | - Henri Xhaard
- Faculty of Pharmacy, Centre for Drug Research, University of Helsinki Helsinki, Finland
| | - Takeshi Sakurai
- Department of Molecular Neuroscience and Integrative Physiology, Faculty of Medicine, Kanazawa University Kanazawa, Japan
| | | | - Jyrki P Kukkonen
- Biochemistry and Cell Biology, Department of Veterinary Biosciences, University of Helsinki Helsinki, Finland
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