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Schiller K, Rauchenzauner M, Avidgor T, Hannan S, Lorenzen C, Kaml M, Walser G, Unterberger I, Filippi V, Broessner G, Luef G. Primary headache types in adult epilepsy patients. Eur J Med Res 2023; 28:49. [PMID: 36707895 PMCID: PMC9881350 DOI: 10.1186/s40001-023-01023-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/29/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Headache is among the most common comorbidities in epilepsy. This study examined the distribution of different primary headache disorders in a large cohort of patients with diagnosed epilepsy. Headache types were analysed with regard to gender, type of epilepsy and antiepileptic drugs (AEDs). METHODS In this prospective single-centre study, 500 patients with epilepsy (250 female, mean age: 45.52 ± 17.26 years) were evaluated with regards to primary headache types using a validated German headache questionnaire categorizing for migraine (MIG), tension-type headache (TTH) or trigeminal autonomic cephalalgias (TAC), their combinations and unclassifiable headache. Data regarding type of epilepsy, seizure-associated headache, AED treatment and seizure freedom were collected. RESULTS Of 500 patients with epilepsy, 163 (32.6%) patients (108 female and 55 male) reported suffering from headaches at least 1 day per month. MIG (without aura, with aura) and TTH were the most frequent headache type (MIG 33.1%, TTH 33.1%). Female epilepsy patients reported headaches significantly more often than male patients (x2 = 8.20, p = 0.0042). In contrast, the type of epilepsy did not significantly affect headache distribution. Of 163 patients with headache, 66 (40.5%) patients reported seizure-associated headache and AEDs were used by 157 patients. Of importance, patients with AED monotherapy suffered from MIG less often when compared to patients on polytherapy (x2 = 4.79, p = 0.028). CONCLUSION MIG and TTH are the most common headache types in epilepsy patients and headache is more frequent among female epilepsy patients. Monotherapy in AEDs might have a beneficial effect on the frequency of headache compared to polytherapy.
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Affiliation(s)
- Katharina Schiller
- Department of Pediatrics and Neonatology, Hospital Ostallgaeu, Kaufbeuren, Germany ,grid.14709.3b0000 0004 1936 8649Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada ,grid.5361.10000 0000 8853 2677Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Rauchenzauner
- Department of Pediatrics and Neonatology, Hospital Ostallgaeu, Kaufbeuren, Germany ,grid.5361.10000 0000 8853 2677Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
| | - Tamir Avidgor
- grid.14709.3b0000 0004 1936 8649Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Sana Hannan
- grid.14709.3b0000 0004 1936 8649Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Carlo Lorenzen
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Manuela Kaml
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Gerald Walser
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Iris Unterberger
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Vera Filippi
- grid.5361.10000 0000 8853 2677Department of Neurology, Headache Outpatient Clinic, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Gregor Broessner
- grid.5361.10000 0000 8853 2677Department of Neurology, Headache Outpatient Clinic, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Gerhard Luef
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
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Rollo E, Romozzi M, Vollono C, Calabresi P, Geppetti P, Iannone LF. Antiseizure Medications for the Prophylaxis of Migraine during the Anti- CGRP Drugs Era. Curr Neuropharmacol 2023; 21:1767-1785. [PMID: 36582062 PMCID: PMC10514541 DOI: 10.2174/1570159x21666221228095256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022] Open
Abstract
Migraine and epilepsy are fundamentally distinct disorders that can frequently coexist in the same patient. These two conditions significantly differ in diagnosis and therapy but share some widely- used preventive treatments. Antiseizure medications (ASMs) are the mainstay of therapy for epilepsy, and about thirty different ASMs are available to date. ASMs are widely prescribed for other neurological and non-neurological conditions, including migraine. However, only topiramate and valproic acid/valproate currently have an indication for migraine prophylaxis supported by high-quality evidence. Although without specifically approved indications and with a low level of evidence or recommendation, several other ASMs are used for migraine prophylaxis. Understanding ASM antimigraine mechanisms, including their ability to affect the pro-migraine calcitonin gene-related peptide (CGRP) signaling pathway and other pathways, may be instrumental in identifying the specific targets of their antimigraine efficacy and may increase awareness of the neurobiological differences between epilepsy and migraine. Several new ASMs are under clinical testing or have been approved for epilepsy in recent years, providing novel potential drugs for migraine prevention to enrich the treatment armamentarium and drugs that inhibit the CGRP pathway.
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Affiliation(s)
- Eleonora Rollo
- Dipartimento Universitario di Neuroscienze, University Cattolica del Sacro Cuore, Rome, Italy
| | - Marina Romozzi
- Dipartimento Universitario di Neuroscienze, University Cattolica del Sacro Cuore, Rome, Italy
| | - Catello Vollono
- Dipartimento Universitario di Neuroscienze, University Cattolica del Sacro Cuore, Rome, Italy
- Neurofisiopatologia, Dipartimento di Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Paolo Calabresi
- Dipartimento Universitario di Neuroscienze, University Cattolica del Sacro Cuore, Rome, Italy
- Neurologia, Dipartimento di Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Pierangelo Geppetti
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
| | - Luigi F. Iannone
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
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Effat KG. Chronic craniomandibular pain after craniotomy: A long-term clinical study. Cranio 2022:1-8. [PMID: 36503374 DOI: 10.1080/08869634.2022.2154930] [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: 12/15/2022]
Abstract
OBJECTIVE Chronic craniomandibular/cervical pain and temporomandibular disorders have not been studied in patients who had a craniotomy several years previously. The aim of the current clinical work was to address these issues. METHODS A total group of 150 ambulant patients who had a previous craniotomy was subclassified according to whether or not the temporalis muscle was manipulated. RESULTS The average incidence of multiple subsite regional head and neck pain was 69.3% a number of years after a craniotomy. Evidence of internal derangement of the temporomandibular joint was significantly higher in the group that required manipulation of the temporalis muscle during the procedure. CONCLUSION The pattern of chronic craniomandibular/cervical pain experienced years after a craniotomy supports the brain neuromatrix theory of pain.
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Affiliation(s)
- Kamal G Effat
- Department of Otolaryngology, El- Sahel Teaching Hospital, Cairo, Egypt
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Yang CL, Jing JJ, Fu SY, Zhong YL, Su XZ, Shi ZM, Wu XZ, Yang F, Chen GZ. Ropivacaine-induced seizures evoked pain sensitization in rats: Participation of 5-HT/5-HT3R. Neurotoxicology 2022; 93:173-185. [DOI: 10.1016/j.neuro.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/17/2022] [Accepted: 10/04/2022] [Indexed: 11/15/2022]
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Chienwichai P, Nogrado K, Tipthara P, Tarning J, Limpanont Y, Chusongsang P, Chusongsang Y, Tanasarnprasert K, Adisakwattana P, Reamtong O. Untargeted serum metabolomic profiling for early detection of Schistosoma mekongi infection in mouse model. Front Cell Infect Microbiol 2022; 12:910177. [PMID: 36061860 PMCID: PMC9433908 DOI: 10.3389/fcimb.2022.910177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Mekong schistosomiasis is a parasitic disease caused by blood flukes in the Lao People’s Democratic Republic and in Cambodia. The standard method for diagnosis of schistosomiasis is detection of parasite eggs from patient samples. However, this method is not sufficient to detect asymptomatic patients, low egg numbers, or early infection. Therefore, diagnostic methods with higher sensitivity at the early stage of the disease are needed to fill this gap. The aim of this study was to identify potential biomarkers of early schistosomiasis using an untargeted metabolomics approach. Serum of uninfected and S. mekongi-infected mice was collected at 2, 4, and 8 weeks post-infection. Samples were extracted for metabolites and analyzed with a liquid chromatography-tandem mass spectrometer. Metabolites were annotated with the MS-DIAL platform and analyzed with Metaboanalyst bioinformatic tools. Multivariate analysis distinguished between metabolites from the different experimental conditions. Biomarker screening was performed using three methods: correlation coefficient analysis; feature important detection with a random forest algorithm; and receiver operating characteristic (ROC) curve analysis. Three compounds were identified as potential biomarkers at the early stage of the disease: heptadecanoyl ethanolamide; picrotin; and theophylline. The levels of these three compounds changed significantly during early-stage infection, and therefore these molecules may be promising schistosomiasis markers. These findings may help to improve early diagnosis of schistosomiasis, thus reducing the burden on patients and limiting spread of the disease in endemic areas.
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Affiliation(s)
- Peerut Chienwichai
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Kathyleen Nogrado
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phornpimon Tipthara
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Joel Tarning
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Yanin Limpanont
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phiraphol Chusongsang
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Yupa Chusongsang
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kanthi Tanasarnprasert
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Poom Adisakwattana
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Onrapak Reamtong
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- *Correspondence: Onrapak Reamtong,
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Shahisavandi M, Zeraatpisheh Z, Rostaminejad M, Asadi-Pooya AA. Treatment of postictal headache: a systematic review and future directions. Epilepsy Behav 2021; 119:107971. [PMID: 33940524 DOI: 10.1016/j.yebeh.2021.107971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postictal headache (PIH) is a common complaint among patients with epilepsy. The prevalence of PIH is 43%. In the current endeavor, we systematically reviewed the existing treatment options for PIH in order to depict the state of the field and also to propose a research agenda to advance this topic. METHODS MEDLINE, Scopus, and Embase from the inception to 4 February, 2021 were systematically searched for related published articles. In all electronic databases, the following search strategy was implemented and these key words (in all fields) were used: "post-ictal" AND "Headache" AND "Treatment". RESULTS The primary search yielded 626 studies; only five studies were related to the topic and were included in the current systematic review. None of these studies provided a good class of evidence. These studies suggested that flunarizine and sumatriptan may help patients with PIH. CONCLUSION While PIH is a common and disabling condition, its treatment is overlooked by the epilepsy society. Flunarizine and sumatriptan can be good candidates to be used in future clinical trials of the treatment of PIH. To obtain the desired evidence on the efficacy of either flunarizine or sumatriptan in treating PIH in patients with epilepsy, we need well-designed, randomized controlled trials.
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Affiliation(s)
- Mina Shahisavandi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zeraatpisheh
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
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