One-Year Consistent Safety, Utilization, and Efficacy Assessment of Remote Electrical Neuromodulation (REN) for Migraine Treatment

INTRODUCTION

Migraine is a chronic neurological disorder causing severe pain and disability in more than a billion people worldwide. Ideal treatment should provide long-term efficacy with minimal side effects. Previous studies indicate that remote electrical neuromodulation (REN) is an efficacious and safe treatment option for the acute treatment of migraine in clinical practice. This study examined long-term safety, utilization, and efficacy of REN during 12 consecutive usage months.

METHODS

Data from patients with migraine across the USA using REN to treat their migraine attacks were electronically collected from the Nerivio® device. All patients who used REN during 12 consecutive months were included, and data were compared across months. Safety was assessed by the number and type of adverse events. Utilization was measured by the number of monthly treatments. Efficacy was evaluated as consistent change in headache pain intensity, functional disability, and disappearance of associated symptoms from baseline to 2 h post treatment.

RESULTS

Data were analyzed from 409 people living with migraine who treated with REN for 12 consecutive months, performing a total of 39,531 treatments. The incidence of device-related adverse events (dAEs) was 1.96% (8/409), including two negligible (0.49%), five mild (1.22%), one moderate (0.24%), and no severe events. All patients continued treatment with REN despite dAEs. One-year average monthly utilization was 8.05 treatments (SD 1.15). Month-to-month utilization did not change during 12 months of consecutive use [F(4.895, 1997.204) = 2.014, p = 0.075, repeated-measures ANOVA]. One-year average efficacy showed 74.1% of users reported consistent 2-h pain relief, and 26.0% reported consistent pain freedom. Month-to-month pain relief and pain freedom did not change during 12 months of consecutive use [F(11, 1069) = 0.55, p = 0.873 and F(11, 1295) = 0.69, p = 0.750 respectively; generalized linear mixed model analysis].

CONCLUSION

REN is a safe and well-tolerated acute migraine treatment, with stable efficacy and utilization over 1 year, making it an advantageous non-drug option for the long-term management of this chronic disease.

TRIAL REGISTRATION NUMBER

NCT05760638.

Composition and herbicidal effect of Heracleum sosnowskyi essential oil

Plants of Heracleum sosnowskyi Manden. are rich in essential oil which might be of herbicidal potential. In this study, we examined 1) the content and chemical composition of H. sosnowskyi essential oil (EO) distilled from seeds and 2) the herbicidal effect of EO in a bioassay against germination of maize and five weed species. As a result, a 5.1% EO yield was obtained from the seeds of H. sosnowskyi. We identified sixty-two compounds of EO that constituted 96% of the total oil. Aliphatic esters were the main constituents of the EO, followed by aliphatic alcohols. The tested seeds showed different susceptibilities to the tested concentrations of EO (0.2 – 7.2 g L

Rare ocular manifestation in a case of West Nile virus meningoencephalitis

West Nile Virus (WNV) is an arthropod-borne flavivirus, which causes flu-like illness and is sporadically associated with encephalitis. Transmission to humans occurs following a bite from an infected mosquito, which acquires the virus after feeding on dead birds. WNV meningoencephalitis is a rare infection with a neuroinvasive disease occurring in less than 1% of the cases, with varied presentations including aseptic meningitis, meningoencephalitis, and acute flaccid paralysis. Chorioretinitis is the most common eye finding in this infection, while other ocular manifestations have been rarely reported in the literature. We present the first case report of WNV meningoencephalitis, with rare ocular manifestations of acute hemorrhagic conjunctivitis, bilateral subconjunctival hemorrhages, and nystagmus. The rare ocular findings of acute hemorrhagic conjunctivitis, bilateral subconjunctival hemorrhages, and nystagmus diagnosed in our case can guide clinicians toward early diagnosis of WNV meningoencephalitis, while serologic testing is still pending.

Refractory Status Epilepticus Treated With Vagal Nerve Stimulation

BACKGROUND AND IMPORTANCE

Status epilepticus (SE) refractory to medical treatment has a high mortality rate and few effective treatments.

CLINICAL PRESENTATION

We describe the implantation of a vagal nerve stimulator to help terminate a case of refractory SE. A 23-year-old man was in SE for 3 weeks without being able to be weaned from intravenous anesthetic agents. After implantation of a vagal nerve stimulator, SE soon terminated, and the patient could be weaned from sedative agents and made a full recovery.

CONCLUSION

Vagal nerve stimulator should be considered in cases of refractory SE.

Serum TRAIL levels in patients with epithelial ovarian cancer or primary peritoneal cancer treated with neoadjuvant chemotherapy. A pilot study

AIMS

The study attempted to evaluate the kinetics of changes in serum TRAIL levels as a potential predictive and prognostic factor in patients with epithelial ovarian cancer (EOC) or primary peritoneal carcinoma (PPC), eligible for an interval debulking surgery (IDS).

MATERIAL AND METHODS

17 patients with primary inoperable EOC or PPC in FIGO Stage IIIC or IV who underwent an exploratory operation were enrolled to the study. Serum TRAIL levels were determined by ELISA method (DIACLONE, Besancon Cedex, France) before and after two courses of neoadjuvant chemotherapy (NAC) based on paclitaxel and platinum analogue (cisplatin or carboplatin). The control group consisted of six healthy volunteers. The median difference in concentration of TRAIL (dTRAIL) between the initial marking and after two courses of NAC in each patient was 192 pg/ml and it was used for dichotomization of the test group.

RESULTS

Suboptimal interval debulking surgery (IDS) was performed in 23.5% (4/17) and optimal IDS in 76.5% (13/17) patients. TRAIL concentration before chemotherapy did not differ significantly between patients with EOC or PPC [1426.96 +/- 321.06 pg/ml (mean +/- SD) (U = 26, p = 0.08)] and the control group [1160.40 +/- 256.39 pg/ml (mean +/- SD. After two courses of NAC serum TRAIL concentration level was 1247.49 +/- 378.46 pg/ml (mean +/- SD). The difference was significant (Z = 2.44, p = 0.0147). Statistical analysis showed that dTRAIL did not significantly influence either extent of IDS (U = 35, p = 0.0962) or time to progression (log-rank test, p = 0.1185), overall survival (log-rank test, p = 0.1973) and response to treatment according to RECIST criteria (U = 35.5, p = 0.9616).

CONCLUSIONS

Serum TRAIL concentration levels changed significantly during NAC. However, it seems that the concentration of this protein has no critical value as a predictive or prognostic factor in patients with EOC or PPC.

Low temperatures in post-operative knee rehabilitation in rheumatoid arthritis patients

Low temperatures were applied (in addition to kinesitherapy), in the form of injected air cooled to -75 C and CO2, to 22 patients (34 knees) recovering from total knee alloplasty or synovectomy. Each procedure lasted 5-7 minutes. The control group consisted o 22 patients (34 knees) treated with kinesitherapy only.<br /> The range of active and passive flexion and extension in the operated knee joint was tested twice, once before the experiment began and once after the third week. During this period the subjective feeling of pain was also observed.<br /> The results were analyzed statistically using the t-Student test. Upon comparison of the results obtained by patients from both tested groups, it can be stated that the addition of low temperatures to the program of post-operative rehabilitation of the knee enables:<br /> - faster and more effective pain relief;<br /> - faster increase in the range of movement, especially flexion, in the operated knees.<br /> These results justify the conclusion that this method should be recommended in rehabilitation of the knee after surgery.