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Irimia P, Santos-Lasaosa S, Pozo-Rosich P, Leira R, Pascual J, Láinez JM. Eptinezumab for the preventive treatment of episodic and chronic migraine: a narrative review. Front Neurol 2024; 15:1355877. [PMID: 38523607 PMCID: PMC10959239 DOI: 10.3389/fneur.2024.1355877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Eptinezumab, a monoclonal antibody that targets calcitonin gene-related peptide (CGRP), was recently approved in Europe for the prophylactic treatment of migraine in adults who have at least four migraine days a month. Eptinezumab is administered by intravenous infusion every 12 weeks. During recent months, a considerable amount of evidence from eptinezumab trials has been published. The aim of this review is to describe the existing evidence on the tolerability, safety and efficacy of eptinezumab in patients with migraine. Data from randomized (PROMISE-1, PROMISE-2, RELIEF and DELIVER) and open-label (PREVAIL) phase 3 clinical trials have demonstrated the favorable effect of eptinezumab in migraine symptoms from first day of treatment. These studies showed that eptinezumab results in an overall reduction in mean monthly migraine days (MMDs), increases in the ≥50% and ≥ 75% migraine responder rates (MRRs) and improvements in patient-reported outcome measures in both patients with episodic migraine (EM) and with chronic migraine (CM), including patients who failed previous preventive treatments. The RELIEF trial also showed that eptinezumab, within 2 h of administration, reduced headache pain, migraine-associated symptoms and acute medication use when administered during a migraine attack. Eptinezumab benefits manifested as early as day 1 after dosing and with the subsequent doses lasted up to at least 2 years. Treatment-emergent adverse events reported by ≥2% of patients included upper respiratory tract infection and fatigue. Current evidence demonstrates that eptinezumab has a potent, fast-acting, sustained migraine preventive effect in patients with EM and CM. Eptinezumab has also shown to be well tolerated, supporting its use in the treatment of patients with migraine and inclusion in the current migraine therapeutic options.
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Affiliation(s)
| | - Sonia Santos-Lasaosa
- Aragon Institute for Health Research (IIS Aragon), Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, VHIR, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Rogelio Leira
- Department of Neurology, Headache Unit, Hospital Clínico Universitario, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Julio Pascual
- Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - José Miguel Láinez
- Department of Neurology, Hospital Clínico Universitario, Universidad Católica de Valencia, Valencia, Spain
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Vázquez-Reza M, Custodia A, López-Dequidt I, Aramburu-Núñez M, Romaus-Sanjurjo D, Ouro A, Botelho J, Machado V, Iglesias-Rey R, Pías-Peleteiro JM, Leira R, Blanco J, Castillo J, Sobrino T, Leira Y. Periodontal inflammation is associated with increased circulating levels of endothelial progenitor cells: a retrospective cohort study in a high vascular risk population. Ther Adv Chronic Dis 2023; 14:20406223231178276. [PMID: 37360414 PMCID: PMC10285583 DOI: 10.1177/20406223231178276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/09/2023] [Indexed: 06/28/2023] Open
Abstract
Background One of the main biological mechanisms behind the link between periodontitis and atherosclerotic vascular diseases is vascular endothelial dysfunction. Particularly, circulating endothelial progenitor cells (EPCs) have been considered a biomarker of altered vascular endothelial function. Objectives The aim of this study was to investigate relationship between periodontal inflammation and increased number of circulating EPCs. Design This is retrospective cohort study. Methods In this study, 85 elderly patients with a previous history of hypertension were followed up to 12 months. A baseline full-mouth periodontal assessment was carried out, and the amount of periodontal tissue inflamed per subject was calculated as a proxy of periodontal inflammation [periodontal inflamed surface area (PISA)]. The number of circulating EPCs (CD34+/CD133+/KDR+) was determined by flow cytometry from peripheral blood samples collected at baseline and 12 months. Results Mean concentrations of CD34+/CD133+/KDR+ progenitor cells were higher in periodontitis patients than in those without periodontitis at baseline [55.4, 95% confidence interval (CI) = 20.8 to 90.0 versus 27.2, 95% CI = 13.6 to 40.8, p = 0.008] and 12 months (114.6, 95% CI = 53.5 to 175.7 versus 19.1, 95% CI = 10.8 to 27.4, p = 0.003). A significant increase over the follow-up was noticed in the group of subjects with periodontitis (p = 0.049) but not in the nonperiodontitis group (p = 0.819). PISA was independently associated with CD34+/CD133+/KDR+ EPCs at baseline (B coefficient = 0.031, 95% CI = 0.005 to 0.058; p = 0.021). The relationship between PISA and CD34+/CD133+/KDR+ EPCs at 12 months was confounded by increased baseline body mass index (B coefficient = 0.064, 95% CI = -0.005 to 0.132; p = 0.066). Conclusion Periodontal inflammation is associated with high number of CD34+/CD133+/KDR+ EPCs, thus supporting a potential link between periodontitis and endothelial dysfunction.
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Affiliation(s)
- María Vázquez-Reza
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antía Custodia
- NeuroAging Laboratory (NEURAL) Group, Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital, Santiago de Compostela, Spain
| | - Iria López-Dequidt
- Neurology Department, University Clinical Hospital, Santiago de Compostela, Spain
| | - Marta Aramburu-Núñez
- NeuroAging Laboratory (NEURAL) Group, Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital, Santiago de Compostela, Spain
| | - Daniel Romaus-Sanjurjo
- NeuroAging Laboratory (NEURAL) Group, Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital, Santiago de Compostela, Spain
| | - Alberto Ouro
- NeuroAging Laboratory (NEURAL) Group, Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital, Santiago de Compostela, Spain
| | - João Botelho
- Periodontology Department and Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz – Cooperativa de Ensino Superior, Caparica, Portugal
| | - Vanessa Machado
- Periodontology Department and Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz – Cooperativa de Ensino Superior, Caparica, Portugal
| | - Ramón Iglesias-Rey
- Neuroimaging and Biotechnology Laboratory (NOBEL) Group, Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital, Santiago de Compostela, Spain
| | - Juan Manuel Pías-Peleteiro
- NeuroAging Laboratory (NEURAL) Group, Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital, Santiago de Compostela, Spain
| | - Rogelio Leira
- Neurology Department, University Clinical Hospital, Santiago de Compostela, Spain
| | - Juan Blanco
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Castillo
- Neuroimaging and Biotechnology Laboratory (NOBEL) Group, Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital, Santiago de Compostela, Spain
| | - Tomás Sobrino
- NeuroAging Laboratory (NEURAL) Group, Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain
| | - Yago Leira
- NeuroAging Laboratory (NEURAL) Group, Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital, Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Dopico J, Botelho J, Ouro A, Domínguez C, Machado V, Aramburu-Nuñez M, Custodia A, Blanco T, Vázquez-Reza M, Romaus-Sanjurjo D, Blanco J, Leira R, Sobrino T, Leira Y. Association between periodontitis and peripheral markers of innate immunity activation and inflammation. J Periodontol 2023; 94:11-19. [PMID: 35665930 DOI: 10.1002/jper.22-0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/13/2022] [Accepted: 06/01/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Immune response leading to increased systemic inflammation is one of the mechanisms linking periodontitis to chronic inflammatory diseases. The aim of this study was to compare the expression of toll-like receptors 2 and 4 in monocytes and neutrophils (TLR2M, TLR2N, TLR4M, and TLR4N) and its endogenous ligands (cellular fibronectin [cFN] and heat shock protein 60 [HSP60]) in patients with and without periodontitis. Additionally, the relationship between cFN and HSP60 expression with innate immunity activation and systemic inflammatory response (interleukin 6 [IL-6]) was also evaluated. METHODS A case-controlled study was designed in which 30 patients with periodontitis (cases) and 30 age- and sex-matched participants without periodontitis (controls) were included. Fasting blood samples were collected to determine: (1) expression of TLR2N, TLR2M, TLR4N, and TLR4M by flow cytometry; and (2) serum concentrations of cFN, HSP60, and IL-6 by ELISA technique. RESULTS Expression of TLR2M (411.5 [314.2, 460.0] vs. 236.5 [204.0, 333.0] AFU), TLR2N (387.0 [332.0, 545.5] vs 230.0 [166.2, 277.7] AFU), TLR4M (2478.5 [1762.2, 2828.0] vs 1705.0 [1274.5, 1951.2] AFU), and TLR4N (2791.0 [2306.7, 3226.2] vs. 1866.0 [1547.5, 2687.2] AFU) as well as serum levels of cFN (301.1 [222.2, 410.9] vs. 156.4 [115.3, 194.0] ng/ml) and IL-6 (10.4 [6.5, 11.5] vs. 3.5 [2.6, 4.9] pg/ml) were significantly higher in periodontitis patients than those without periodontitis. A positive association was found between periodontitis and cFN (odds ratio [OR] = 1.028, p < 0.001), TLR2N (OR = 1.026, p < 0.001), TLR4M (OR = 1.001, p = 0.002), and IL-6 (OR = 1.774, p < 0.001). CONCLUSIONS Periodontitis patients exhibited high expression of TLRs, cFN, and IL-6.
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Affiliation(s)
- José Dopico
- Faculty of Odontology and Medicine, Periodontology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - João Botelho
- Periodontology Department and Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz and Cooperative de Ensino Superior, Caparica, Portugal
| | - Alberto Ouro
- NeuroAging Group, Clinical Neurosciences Research Laboratories (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Clara Domínguez
- Neurology Department, University Clinical Hospital, Santiago de Compostela, Spain
| | - Vanessa Machado
- Periodontology Department and Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz and Cooperative de Ensino Superior, Caparica, Portugal
| | - Marta Aramburu-Nuñez
- NeuroAging Group, Clinical Neurosciences Research Laboratories (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Antía Custodia
- NeuroAging Group, Clinical Neurosciences Research Laboratories (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Teresa Blanco
- Allergy Department, University Hospital Puerta del Hierro, Madrid, Spain
| | - María Vázquez-Reza
- Faculty of Odontology and Medicine, Periodontology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Daniel Romaus-Sanjurjo
- NeuroAging Group, Clinical Neurosciences Research Laboratories (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Juan Blanco
- Faculty of Odontology and Medicine, Periodontology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rogelio Leira
- Neurology Department, University Clinical Hospital, Santiago de Compostela, Spain
| | - Tomás Sobrino
- NeuroAging Group, Clinical Neurosciences Research Laboratories (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Yago Leira
- Faculty of Odontology and Medicine, Periodontology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain.,NeuroAging Group, Clinical Neurosciences Research Laboratories (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Santos-Lasaosa S, Belvís R, Cuadrado ML, Díaz-Insa S, Gago-Veiga A, Guerrero-Peral AL, Huerta M, Irimia P, Láinez JM, Latorre G, Leira R, Pascual J, Porta-Etessam J, Sánchez Del Río M, Viguera J, Pozo-Rosich P. Calcitonin gene-related peptide in migraine: from pathophysiology to treatment. Neurologia (Engl Ed) 2022; 37:390-402. [PMID: 35672126 DOI: 10.1016/j.nrleng.2019.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/07/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION It has been observed in recent years that levels of such molecules as calcitonin gene-related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase-activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients' migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity. DEVELOPMENT The Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics. CONCLUSIONS The clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.
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Affiliation(s)
- S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain.
| | - R Belvís
- Unidad de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M L Cuadrado
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - S Díaz-Insa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Fe, Valencia, Spain
| | - A Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - A L Guerrero-Peral
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Investigación de Salamanca (IBSAL), Spain
| | - M Huerta
- Sección de Neurología, Hospital de Viladecans, Barcelona, Spain
| | - P Irimia
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, Spain
| | - J M Láinez
- Servicio de Neurología, Hospital Clínico Universitario de Valencia, Universidad Católica de Valencia, Valencia, Spain
| | - G Latorre
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - R Leira
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - J Pascual
- Hospital Universitario Marqués de Valdecilla e IDIVAL, Santander, Spain
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - M Sánchez Del Río
- Departamento de Neurología, Clínica Universidad de Navarra, Madrid, Spain
| | - J Viguera
- Consulta de Cefalea, Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - P Pozo-Rosich
- Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grupo de Investigación en Cefalea, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
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5
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Santos-Lasaosa S, Belvís R, Cuadrado ML, Díaz-Insa S, Gago-Veiga A, Guerrero-Peral AL, Huerta M, Irimia P, Láinez JM, Latorre G, Leira R, Pascual J, Porta-Etessam J, Sánchez Del Río M, Viguera J, Pozo-Rosich P. Calcitonin gene-related peptide in migraine: from pathophysiology to treatment. Neurologia 2022; 37:390-402. [PMID: 31326215 DOI: 10.1016/j.nrl.2019.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/07/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION It has been observed in recent years that levels of such molecules as calcitonin gene-related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase-activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients' migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity. DEVELOPMENT The Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics. CONCLUSIONS The clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.
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Affiliation(s)
- S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto Aragonés de Ciencias de la Salud, Zaragoza, España.
| | - R Belvís
- Unidad de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M L Cuadrado
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - S Díaz-Insa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Fe, Valencia, España
| | - A Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, España
| | - A L Guerrero-Peral
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España; Instituto de Investigación de Salamanca (IBSAL), España
| | - M Huerta
- Sección de Neurología, Hospital de Viladecans, Barcelona, España
| | - P Irimia
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, España
| | - J M Láinez
- Servicio de Neurología, Hospital Clínico Universitario de Valencia. Universidad Católica de Valencia, Valencia, España
| | - G Latorre
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario de Fuenlabrada. Universidad Rey Juan Carlos, Madrid, España
| | - R Leira
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - J Pascual
- Hospital Universitario Marqués de Valdecilla e IDIVAL, Santander, España
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - M Sánchez Del Río
- Departamento de Neurología, Clínica Universidad de Navarra, Madrid, España
| | - J Viguera
- Consulta de Cefalea, Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - P Pozo-Rosich
- Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Investigación en Cefalea; VHIR; Universitat Autònoma de Barcelona, Barcelona, España
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Gallardo VJ, Alpuente A, Cerda-Company X, Torres-Ferrus M, Sanchez Del Rio M, Lainez JM, Leira R, Trochet J, Pozo-Rosich P. The impact of a digital platform on migraine patient-centered outcome research. Evaluation of midolordecabeza.org, a headache website in Spanish. Headache 2021; 61:1403-1410. [PMID: 34601726 DOI: 10.1111/head.14225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/30/2021] [Accepted: 07/19/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This internet survey aimed to analyze the activity of midolordecabeza.org, a specialized website for headache stakeholders. BACKGROUND eHealth tools, such as websites, can be educational for stakeholders of a specific disease, such as patients. This is particularly helpful in chronic disorders such as migraine. eHealth also enhances patient-centered outcome research. The website midolordecabeza.org has the stated aim of organizing key information on headache making it accessible and useful for all stakeholders, and, eventually promoting patient participation. METHODS We analyzed Google Analytics (GA) data to study the web's activity, traffic source, geographical distribution of access, registered-user behavior, electronic device performance, and temporary references with greater web activity. RESULTS From January 2015 until December 2020, the website registered 1,121,585 visitors, 1,775,953 sessions, and a total of 3,833,144 views with an average time per session of nearly 2 min. Higher data traffic has been registered in Spanish-speaking countries such as Spain (33.3%; 591,256/1,775,953), where Spain's regions with higher views were statistically significantly correlated with the nationwide migraine prevalence (ρ = 0.505; p = 0.039). In regard to social behavior, returning users were statistically significantly associated with being a woman (84.0%; 5696/6781), and they predominantly acceded from organic searches (50.6%; 3434/6781). When answering available open surveys, 72.5% (1827/2520) described their migraine as a disabling disease with high impact on their daily tasks and 64.4% (14,016/21,764) were unaware of what their headache diagnosis is. CONCLUSIONS Spanish-speaking patients with migraine around the world increasingly visited the headache-specialized website midolordecabeza.org using different electronic devices, showing great interest in their disease. This website allowed them to get updated information on their disease, share clinical data with physicians, and finally express their concerns.
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Affiliation(s)
- Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Headache Unit, Neurology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Xim Cerda-Company
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Headache Unit, Neurology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - José Miguel Lainez
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valencia, Spain
| | - Rogelio Leira
- Headache Unit, Neurology Department, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Patricia Pozo-Rosich
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Headache Unit, Neurology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Belvís R, Irimia P, Pozo-Rosich P, González-Oria C, Cano A, Viguera J, Sánchez B, Molina F, Beltrán I, Oterino A, Cuadrado E, Gómez-Camello A, Alberte-Woodward M, Jurado C, Oms T, Ezpeleta D, de Terán JD, Morollón N, Latorre G, Torres-Ferrús M, Alpuente A, Lamas R, Toledano C, Leira R, Santos S, Del Río MS. MAB-MIG: registry of the spanish neurological society of erenumab for migraine prevention. J Headache Pain 2021; 22:74. [PMID: 34273947 PMCID: PMC8285868 DOI: 10.1186/s10194-021-01267-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Erenumab was approved in Europe for migraine prevention in patients with ≥ 4 monthly migraine days (MMDs). In Spain, Novartis started a personalized managed access program, which allowed free access to erenumab before official reimbursement. The Spanish Neurological Society started a prospective registry to evaluate real-world effectiveness and tolerability, and all Spanish headache experts were invited to participate. We present their first results. METHODS Patients fulfilled the ICHD-3 criteria for migraine and had ≥ 4 MMDs. Sociodemographic and clinical data were registered as well as MMDs, monthly headache days, MHDs, prior and concomitant preventive treatment, medication overuse headache (MOH), migraine evolution, adverse events, and patient-reported outcomes (PROs): headache impact test (HIT-6), migraine disability assessment questionnaire (MIDAS), and patient global improvement change (PGIC). A > 50% reduction of MMDs after 12 weeks was considered as a response. RESULTS We included 210 patients (female 86.7%, mean age 46.4 years old) from 22 Spanish hospitals from February 2019 to June 2020. Most patients (89.5%) suffered from chronic migraine with a mean evolution of 8.6 years. MOH was present in 70% of patients, and 17.1% had migraine with aura. Patients had failed a mean of 7.8 preventive treatments at baseline (botulinum toxin type A-BoNT/A-had been used by 95.2% of patients). Most patients (67.6%) started with erenumab 70 mg. Sixty-one percent of patients were also simultaneously taking oral preventive drugs and 27.6% were getting simultaneous BoNT/A. Responder rate was 37.1% and the mean reduction of MMDs and MHDs was -6.28 and -8.6, respectively. Changes in PROs were: MIDAS: -35 points, HIT-6: -11.6 points, PIGC: 4.7 points. Predictors of good response were prior HIT-6 score < 80 points (p = 0.01), ≤ 5 prior preventive treatment failures (p = 0.026), absence of MOH (p = 0.039), and simultaneous BoNT/A treatment (p < 0.001). Twenty percent of patients had an adverse event, but only two of them were severe (0.9%), which led to treatment discontinuation. Mild constipation was the most frequent adverse event (8.1%). CONCLUSIONS In real-life, in a personalized managed access program, erenumab shows a good effectiveness profile and an excellent tolerability in migraine prevention in our cohort of refractory patients.
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Affiliation(s)
- Robert Belvís
- Headache and Neuralgia Unit, Department of Neurology, Hospital de La Santa Creu I Sant Pau, C/ Mas Casanova 90, CP08025, Barcelona, Spain.
| | - Pablo Irimia
- Clínica Universitaria de Navarra, Pamplona, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall D´Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall D´Hebron Pain Research Group, Vall D´Hebron Research Institute, Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | - Javier Viguera
- Hospital Universitario Virgen de La Macarena, Sevilla, Spain
| | | | | | - Isabel Beltrán
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Agustín Oterino
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | | | - Noemí Morollón
- Headache and Neuralgia Unit, Department of Neurology, Hospital de La Santa Creu I Sant Pau, C/ Mas Casanova 90, CP08025, Barcelona, Spain.,Hospital Universitario Dexeus, Barcelona, Spain
| | | | - Marta Torres-Ferrús
- Headache Unit, Neurology Department, Hospital Universitari Vall D´Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall D´Hebron Pain Research Group, Vall D´Hebron Research Institute, Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- Headache Unit, Neurology Department, Hospital Universitari Vall D´Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall D´Hebron Pain Research Group, Vall D´Hebron Research Institute, Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Raquel Lamas
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Rogelio Leira
- Hospital Universitario de Santiago de Compostela, de Compostela, Spain
| | - Sonia Santos
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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8
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Láinez-Andrés JM, Ashina M, Belvís R, Díaz-Insa S, Ezpeleta D, García-Azorín D, González-Oria C, Guerrero AL, Guillém A, Holle-Lee D, Huerta-Villanueva M, Irimia P, Leira R, Pascual J, Porta-Etessam J, Pozo-Rosich P, Rodríguez-Vico JS, Sánchez Del Río M, Santos-Lasaosa S, Silberstein S. 1st Post-European Headache Federation Meeting: a review of the latest developments presented at the 2020 European Headache Federation Congress. Rev Neurol 2021; 72:S1-S19. [PMID: 34180043 DOI: 10.33588/rn.72s02.2021155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION After the European Headache Federation (EHF) Congress, renowned Spanish neurologists specialised in migraine presented the most significant latest developments in research in this field at the Post-EHF Meeting. DEVELOPMENT The main data presented concerning the treatment of chronic and episodic migraine were addressed, with attention paid more specifically to those related to preventive treatments and real-life experience in the management of the disease. An important review was carried out of the new therapeutic targets and the possibilities they offer in terms of understanding the pathophysiology of migraine and its treatment. An update was also presented of the latest developments in the treatment of migraine with fremanezumab, a monoclonal antibody recently authorised by the European Medicines Agency. Participants were also given an update on the latest developments in basic research on the pathology, as well as an overview of the symptoms of migraine and COVID-19. Finally, the repercussions of migraine in terms of its burden on the care and economic resources of the health system were addressed, along with its impact on society. CONCLUSIONS The meeting summarised the content presented at the 14th EHF Congress, which took place in late June/early July 2020.
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Affiliation(s)
| | - M Ashina
- Rigshospitalet Glostrup, Glostrup, Dinamarca
| | - R Belvís
- Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, España
| | - S Díaz-Insa
- Hospital Universitario La Fe, Valencia, España
| | - D Ezpeleta
- Hospital Universitario Quirón Salud Madrid, Pozuelo de Alarcón, España
| | - D García-Azorín
- Hospital Universitario Clínico de Valladolid, Valladolid, España
| | | | - A L Guerrero
- Hospital Universitario Clínico de Valladolid, Valladolid, España
| | - A Guillém
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | | | - P Irimia
- Clínica Universitaria de Navarra, 31008 Pamplona, España
| | - R Leira
- Hospital Clínico Universitario de Santiago de Compostela, A Coruña, España
| | - J Pascual
- Hospital Universitario Marqués de Valdecilla, Santander, España
| | | | - P Pozo-Rosich
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
| | | | | | - S Santos-Lasaosa
- Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, España
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9
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Leira Y, Domínguez C, Ameijeira P, López-Arias E, Ávila-Gómez P, Pérez-Mato M, Sobrino T, Campos F, Blanco J, Leira R. Mild systemic inflammation enhances response to OnabotulinumtoxinA in chronic migraineurs. Sci Rep 2021; 11:1092. [PMID: 33441852 PMCID: PMC7806961 DOI: 10.1038/s41598-020-80283-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/14/2020] [Indexed: 01/03/2023] Open
Abstract
The anti-inflammatory effect of OnabotulinumtoxinA (OnabotA) has been a matter of discussion for many years. In chronic migraine, however, increased pro-inflammatory state is associated with good response to OnabotA. We aimed to investigate whether a mild systemic inflammatory state elicited by a common oral infection (periodontitis) could enhance treatment response to OnabotA. In this study, we included 61 chronic migraineurs otherwise healthy treated with OnabotA of which 7 were poor responders and 54 good responders. Before receiving OnabotA therapy, all participants underwent a full-mouth periodontal examination and blood samples were collected to determine serum levels of calcitonin gene-related peptide (CGRP), interleukin 6 (IL-6), IL-10 and high sensitivity C-reactive protein (hs-CRP). Periodontitis was present in 70.4% of responders and 28.6% of non-responders (P = 0.042). Responders showed greater levels of inflammation than non-responders (IL-6: 15.3 ± 8.7 vs. 9.2 ± 4.7 ng/mL, P = 0.016; CGRP: 18.8 ± 7.6 vs. 13.0 ± 3.1 pg/mL, P = 0.002; and hs-CRP: 3.9 ± 6.6 vs. 0.9 ± 0.8 mg/L, P = 0.003). A linear positive correlation was found between the amount of periodontal tissue inflamed in the oral cavity and markers of inflammation (IL-6: r = 0.270, P = 0.035; CGRP: r = 0.325, P = 0.011; and hs-CRP: r = 0.370, P = 0.003). This report shows that in presence of elevated systemic inflammatory markers related to periodontitis, OnabotA seems to reduce migraine attacks. The changes of scheduled inflammatory parameters after treatment and subsequent assessment during an adequate period still need to be done.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute and NIHR UCLH Biomedical Research Centre, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK. .,Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain. .,Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain. .,Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Clara Domínguez
- Department of Neurology, Headache Unit, University Clinical Hospital, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Pablo Ameijeira
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Esteban López-Arias
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Paulo Ávila-Gómez
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - María Pérez-Mato
- Neuroscience and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, La Paz University Hospital, Neuroscience Area of IdiPAZ Health Research Institute, Universidad Autónoma de Madrid, Madrid, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Juan Blanco
- Periodontology Unit, UCL Eastman Dental Institute and NIHR UCLH Biomedical Research Centre, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK.,Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rogelio Leira
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Department of Neurology, Headache Unit, University Clinical Hospital, University of Santiago de Compostela, Santiago de Compostela, Spain
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10
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Irimia P, Martínez-Valbuena I, Mínguez-Olaondo A, Domínguez-Vivero C, Sánchez-Arias JA, Martínez-Vila E, Luquin MR, Leira R. Interictal amylin levels in chronic migraine patients: A case-control study. Cephalalgia 2020; 41:604-612. [PMID: 33269952 DOI: 10.1177/0333102420977106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Recently, amylin and its receptors were found in different structures involved in migraine pathophysiology. Here, we evaluate interictal concentrations of amylin and calcitonin gene-related peptide in peripheral blood as biomarkers for chronic migraine. METHODS We prospectively recruited patients with episodic migraine, chronic migraine and healthy controls. Interictal amylin and calcitonin gene-related peptide levels were assessed in blood samples using enzyme linked immunosorbent assay. RESULTS We assessed plasma samples from 58 patients with episodic migraine (mean age 37.71 ± 10.47, 87.9% female), 191 with chronic migraine (mean age 46.03 ± 11.93, 95% female), and on 68 healthy controls (mean age 43.58 ± 11.08 years, 86% female). Body mass index was 25.94 ± 4.53 kg/m2 for migraine patients and 25.13 ± 4.92 kg/m2 for healthy controls (p = 0.0683). Interictal plasma amylin levels were higher in chronic migraine patients (47.1 pg/mL) than in the episodic migraine patients (28.84 pg/mL, p < 0.0001) and healthy controls (24.74 pg/mL, p < 0.0001). Plasma calcitonin gene-related peptide levels were increased (20.01 pg/mL) in chronic migraine patients when compared to healthy controls (11.37 pg/mL, p = 0.0016), but not to episodic migraine patients (18.89 pg/mL, p = 0.4369). Applying a cut-off concentration of 39.68 pg/mL plasma amylin, the sensitivity to differentiate chronic migraine from healthy controls was 57.6% and the specificity was 88.2%. Variables such as age, analgesic overuse, depression, allodynia, use of preventive medication or a history of aura did not influence the plasma concentrations of amylin or calcitonin gene-related peptide. CONCLUSION Interictal plasma amylin levels are higher in patients with chronic migraine and may serve as a diagnostic biomarker for chronic migraine.
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Affiliation(s)
- Pablo Irimia
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain.,Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - Iván Martínez-Valbuena
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain.,Navarra's Health Research Institute (IDISNA), Pamplona, Spain.,Regenerative Therapy Laboratory, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Ane Mínguez-Olaondo
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain.,Department of Neurology, Hospital Universitario Donostia, San Sebastián, Spain
| | - Clara Domínguez-Vivero
- Department of Neurology, Hospital Clínico Universitario, Universidade de Santiago de Compostela, Spain.,Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Spain
| | - Juan-Antonio Sánchez-Arias
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain.,Navarra's Health Research Institute (IDISNA), Pamplona, Spain.,Regenerative Therapy Laboratory, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Eduardo Martínez-Vila
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain.,Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - María-Rosario Luquin
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain.,Navarra's Health Research Institute (IDISNA), Pamplona, Spain.,Regenerative Therapy Laboratory, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Rogelio Leira
- Department of Neurology, Hospital Clínico Universitario, Universidade de Santiago de Compostela, Spain.,Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Spain
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11
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Santos-Lasaosa S, Cuadrado M, Gago-Veiga A, Guerrero-Peral A, Irimia P, Láinez J, Leira R, Pascual J, Porta-Etessam J, Sánchez del Río M, Viguera Romero J, Pozo-Rosich P. Evidencia y experiencia del uso de onabotulinumtoxinA en neuralgia del trigémino y cefaleas primarias distintas de la migraña crónica. Neurologia 2020; 35:568-578. [DOI: 10.1016/j.nrl.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/20/2022] Open
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12
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Rodríguez‐Castro E, Lagorio AN, Bejarano‐García A, Aguiar P, Cortés J, Leira R. Prolonged Migraine Stuttering Aura: Structural, Functional, and Video Neuroimaging Study of an Atypical Migraine Aura. A Case Report. Headache 2020; 60:776-780. [DOI: 10.1111/head.13780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/13/2020] [Accepted: 02/03/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Emilio Rodríguez‐Castro
- Department of Neurology Complejo Hospitalario Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - Ariela N. Lagorio
- Department of Neurology Complejo Hospitalario Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - Alejandro Bejarano‐García
- Department of Nuclear Medicine Complejo Hospitalario Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - Pablo Aguiar
- Department of Nuclear Medicine Complejo Hospitalario Universitario de Santiago de Compostela Santiago de Compostela Spain
- Molecular Imaging Group IDIS Facultad de Medicina Universidad de Santiago de Compostela Santiago de Compostela Spain
| | - Julia Cortés
- Department of Nuclear Medicine Complejo Hospitalario Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - Rogelio Leira
- Department of Neurology Complejo Hospitalario Universitario de Santiago de Compostela Santiago de Compostela Spain
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13
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Leira R, Domínguez C. Author response: Iron deposition in periaqueductal gray matter as a potential biomarker for chronic migraine. Neurology 2020; 94:235-236. [DOI: 10.1212/wnl.0000000000008893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Gago-Veiga A, Santos-Lasaosa S, Cuadrado M, Guerrero Á, Irimia P, Láinez J, Leira R, Pascual J, Sanchez del Río M, Viguera J, Pozo-Rosich P. Evidence and experience with onabotulinumtoxinA in chronic migraine: Recommendations for daily clinical practice. Neurología (English Edition) 2019. [DOI: 10.1016/j.nrleng.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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15
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Leira Y, Ameijeira P, Domínguez C, López‐Arias E, Ávila‐Gómez P, Pérez‐Mato M, Sobrino T, Campos F, D'Aiuto F, Leira R, Blanco J. Periodontal inflammation is related to increased serum calcitonin gene‐related peptide levels in patients with chronic migraine. J Periodontol 2019; 90:1088-1095. [DOI: 10.1002/jper.19-0051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/10/2019] [Accepted: 05/07/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Yago Leira
- Periodontology UnitUCL Eastman Dental Institute and HospitalUniversity College London London UK
- Periodontology UnitFaculty of Medicine and OdontologyUniversity of Santiago de Compostela Santiago de Compostela Spain
- Medical‐Surgical Dentistry (OMEQUI) Research GroupHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Pablo Ameijeira
- Periodontology UnitFaculty of Medicine and OdontologyUniversity of Santiago de Compostela Santiago de Compostela Spain
| | - Clara Domínguez
- Department of NeurologyHeadache UnitUniversity Clinical HospitalUniversity of Santiago de Compostela Santiago de Compostela Spain
| | - Esteban López‐Arias
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Paulo Ávila‐Gómez
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - María Pérez‐Mato
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Francisco Campos
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Francesco D'Aiuto
- Periodontology UnitUCL Eastman Dental Institute and HospitalUniversity College London London UK
| | - Rogelio Leira
- Department of NeurologyHeadache UnitUniversity Clinical HospitalUniversity of Santiago de Compostela Santiago de Compostela Spain
- Clinical Neurosciences Research LaboratoryDepartment of NeurologyClinical University HospitalHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Juan Blanco
- Periodontology UnitFaculty of Medicine and OdontologyUniversity of Santiago de Compostela Santiago de Compostela Spain
- Medical‐Surgical Dentistry (OMEQUI) Research GroupHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
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16
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Leira Y, Ameijeira P, Domínguez C, López-Arias E, Ávila-Gómez P, Pérez-Mato M, Sobrino T, Campos F, D'Aiuto F, Leira R, Blanco J. Severe periodontitis is linked with increased peripheral levels of sTWEAK and PTX3 in chronic migraineurs. Clin Oral Investig 2019; 24:597-606. [PMID: 31111284 DOI: 10.1007/s00784-019-02950-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/03/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Periodontitis (PD) and chronic migraine (CM) have been recently linked, and inflammatory processes and vascular endothelial changes are hypothesized as potential mediators of this relationship. The aim of this cross-sectional analysis was to investigate the potential association of PD with vascular systemic inflammation and complement activation in patients with CM. MATERIALS AND METHODS Ninety-four chronic migraineurs underwent a full-mouth periodontal evaluation and a measure of PD activity and severity, namely the periodontal inflamed surface area (PISA) was calculated for each patient. We divided CM patients according to their periodontal status: mild PD (N = 14), moderate PD (N = 22), severe PD (N = 19), and non-PD (N = 39). Serum levels of C-reactive protein (CRP), pentraxin 3 (PTX3), soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK), and complements C3 and C4 were measured outside of migraine attacks. RESULTS We found that severe periodontal patients had significantly higher circulating levels of PTX3 and sTWEAK compared with those without PD (2475.3 ± 1646.8 pg/mL vs. 516.6 ± 1193.8 pg/mL, P < 0.0001 and 672.4 ± 118.2 pg/mL vs. 485.7 ± 112.2 pg/mL, P < 0.0001; respectively). For the remaining biomarkers, no significant differences were found between groups. Severe PD was independently associated with higher levels of PTX3 (β = 1997.6, P < 0.0001) and sTWEAK (β = 187.1, P < 0.0001) but not with CRP, C3, and C4. PISA positively correlated to PTX3 (r = 0.475, P < 0.0001) and sTWEAK (r = 0.386, P < 0.0001). CONCLUSIONS Based on these preliminary results, severe PD was linked with vascular systemic inflammation in patients with CM. However, further longitudinal studies should be performed to confirm these findings. CLINICAL RELEVANCE sTWEAK and PTX3 measured in serum could be used as biomarkers in the PD-CM link.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK. .,Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain. .,Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Pablo Ameijeira
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Clara Domínguez
- Department of Neurology, Headache Unit, University Clinical Hospital, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Esteban López-Arias
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Paulo Ávila-Gómez
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - María Pérez-Mato
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK
| | - Rogelio Leira
- Department of Neurology, Headache Unit, University Clinical Hospital, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Blanco
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain.,Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Domínguez C, López A, Ramos-Cabrer P, Vieites-Prado A, Pérez-Mato M, Villalba C, Sobrino T, Rodriguez-Osorio X, Campos F, Castillo J, Leira R. Iron deposition in periaqueductal gray matter as a potential biomarker for chronic migraine. Neurology 2019; 92:e1076-e1085. [DOI: 10.1212/wnl.0000000000007047] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/31/2018] [Indexed: 12/16/2022] Open
Abstract
ObjectiveTo study iron deposition in red nucleus (RN), globus pallidus (GP), and periaqueductal gray matter (PAG) as a potential biomarker of chronic migraine (CM) and its association with levels of biomarkers related to migraine pathophysiology.MethodsThis case-control study included 112 patients with migraine (55 CM, 57 episodic migraine [EM]) and 25 headache-free controls. We analyzed iron deposition using 3T MRI and the NIH software platform ImageJ; we analyzed serum levels of markers of inflammation, endothelial dysfunction, and blood-brain barrier (BBB) disruption by ELISA in peripheral blood during interictal periods.ResultsPatients with CM showed larger iron grounds volume in RN compared to patients with EM (70.2 ± 6.8 vs 25.5 ± 7.3 μL, p < 0.001) and controls (70.2 ± 6.8 vs 15.1 ± 10.8 μL, p < 0.001), as well as larger iron deposits in PAG compared to patients with EM (360.3 ± 6.5 vs 249.7 ± 6.9 μL, p < 0.001) and controls (360.3 ± 6.5 vs 168.6 ± 10.3 μL, p < 0.001). In PAG, differences were also significant between patients with EM and controls. No significant differences were obtained for GP. Receiver operating characteristic curves showed that the optimal threshold for iron volume was 15 μL in RN (80% sensitivity, 71% specificity) and 240 μL in PAG (93% sensitivity, 97% specificity). Iron grounds volume in PAG was correlated with higher plasma levels of soluble tumor necrosis factor–like WEAK (r = 0.395, p = 0.005) and cellular fibronectin (r = 0.294, p = 0.040).ConclusionsPatients with CM showed increased iron deposition in RN and PAG compared to patients with EM and controls. Iron grounds volume in PAG identified correctly patients with CM and was associated with elevated biomarkers of endothelial dysfunction and BBB disruption.
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Domínguez C, Pozo-Rosich P, Leira Y, Leira R. Unilateral pain and shorter duration of chronic migraine are significant predictors of response to onabotulinumtoxin A. Eur J Neurol 2018; 25:e48. [PMID: 29575364 DOI: 10.1111/ene.13570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- C Domínguez
- Service of Neurology, Headache Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - P Pozo-Rosich
- Hospital Universitario Vall d'Hebron, Headache Research Group, Vall d'Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Y Leira
- OMEQUI Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - R Leira
- Service of Neurology, Headache Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
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Leira Y, Ameijeira P, Domínguez C, Leira R, Blanco J. High serum procalcitonin levels in patients with periodontitis and chronic migraine. J Periodontol 2018. [DOI: 10.1002/jper.17-0603] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Yago Leira
- Periodontology UnitFaculty of Medicine and OdontologyUniversity of Santiago de Compostela Santiago de Compostela Spain
- Odontología Médico‐Quirúrgica (OMEQUI) Research GroupHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Pablo Ameijeira
- Periodontology UnitFaculty of Medicine and OdontologyUniversity of Santiago de Compostela Santiago de Compostela Spain
| | - Clara Domínguez
- Service of NeurologyHeadache UnitHospital Clínico UniversitarioUniversity of Santiago de Compostela Santiago de Compostela Spain
| | - Rogelio Leira
- Service of NeurologyHeadache UnitHospital Clínico UniversitarioUniversity of Santiago de Compostela Santiago de Compostela Spain
| | - Juan Blanco
- Periodontology UnitFaculty of Medicine and OdontologyUniversity of Santiago de Compostela Santiago de Compostela Spain
- Odontología Médico‐Quirúrgica (OMEQUI) Research GroupHealth Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
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Ameijeira P, Leira Y, Domínguez C, Leira R, Blanco J. Association between periodontitis and chronic migraine: a case-control study. Odontology 2018; 107:90-95. [PMID: 29651667 DOI: 10.1007/s10266-018-0360-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/03/2018] [Indexed: 12/22/2022]
Abstract
The aim of this investigation was to examine whether chronic periodontitis (CP) is a risk indicator of chronic migraine (CM). We performed a case-control study consisted of 102 cases (patients diagnosed with CM) and 91 controls (non-CM individuals) matched by age and gender. Full-mouth periodontal charts, demographic, medical, clinical, as well as neurological data were obtained. In addition, high sensitive C-reactive protein serum levels were determined from blood samples of both cases (taken during migraine interictal period) and controls. The prevalence of CP was significantly higher in patients with CM compared to those without CM (58.8 vs. 30.8%, p < 0.0001). Logistic regression analysis showed that CP was significantly associated with the presence of CM, independently of well-known chronifying factors of migraine (OR 2.4; 95% CI 1.2-4.7; p = 0.012). Based on our results, CP could be considered as a risk indicator of CM. However, more evidence is necessary to investigate if this relationship is causal or not.
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Affiliation(s)
- Pablo Ameijeira
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Rúa Entrerríos S/N, 15782, Santiago de Compostela, Spain
| | - Yago Leira
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Rúa Entrerríos S/N, 15782, Santiago de Compostela, Spain. .,Odontología Médico-Quirúrgica (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Clara Domínguez
- Headache Unit, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Rogelio Leira
- Headache Unit, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Juan Blanco
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Rúa Entrerríos S/N, 15782, Santiago de Compostela, Spain.,Odontología Médico-Quirúrgica (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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21
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Domínguez C, Pozo-Rosich P, Torres-Ferrús M, Hernández-Beltrán N, Jurado-Cobo C, González-Oria C, Santos S, Monzón MJ, Latorre G, Álvaro LC, Gago A, Gallego M, Medrano V, Huerta M, García-Alhama J, Belvís R, Leira Y, Leira R. OnabotulinumtoxinA in chronic migraine: predictors of response. A prospective multicentre descriptive study. Eur J Neurol 2017; 25:411-416. [PMID: 29171146 DOI: 10.1111/ene.13523] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/20/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE OnabotulinumtoxinA is a treatment specifically approved for the prophylaxis of chronic migraine in adults. The aim of this study was to assess the effectiveness of OnabotulinumtoxinA in chronic migraine after 1 year of treatment in a real-life setting and to identify clinical predictors of outcome. METHODS We designed a prospective multicentre study performed in 13 hospitals in Spain. Patients underwent a complete medical history and examination. They were treated with OnabotulinumtoxinA every 12 weeks for 1 year. Data about outcome, adverse events, abortive medication use, emergency room use and disability were collected at 3 and 12 months. RESULTS A total of 725 subjects completed the study. At 12 months, 79.3% showed >50% reduction in number of headaches per month and 94.9% reported no adverse events. Unilaterality of pain, fewer days of disability per month and milder headache at baseline were correlated with good outcome. Duration of disease <12 months increased the chances of response to treatment with OnabotulinumtoxinA (odds ratio, 1.470; 95% confidence interval, 1.123-2.174; P = 0.045). CONCLUSIONS This study confirmed the effectiveness of treatment with OnabotulinumtoxinA after 1 year of treatment. The chances of a good outcome may be increased by starting treatment in the first 12 months after chronic migraine diagnosis.
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Affiliation(s)
- C Domínguez
- Service of Neurology, Headache Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela
| | - P Pozo-Rosich
- Hospital Universitario Vall d'Hebron, Headache Research Group, Vall d'Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - M Torres-Ferrús
- Hospital Universitario Vall d'Hebron, Headache Research Group, Vall d'Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - N Hernández-Beltrán
- Hospital Universitario Vall d'Hebron, Headache Research Group, Vall d'Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain.,Neuroclinica and Promedan, Medellin, Colombia
| | | | | | - S Santos
- Hospital Clínico Universitario Lozano Blesa, Zaragoza
| | | | - G Latorre
- Hospital Universitario de Fuenlabrada, Madrid
| | | | - A Gago
- Hospital Universitario Basurto, Bilbao
| | - M Gallego
- Hospital Universitario La Princesa, Madrid
| | - V Medrano
- Hospital General Universitario de Elda, Alicante
| | | | | | - R Belvís
- Hospital Universitario Dexeus, Barcelona
| | - Y Leira
- OMEQUI Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - R Leira
- Service of Neurology, Headache Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela
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Leira Y, Ameijeira P, Domínguez C, Leira R, Blanco J. The role of leptin as a biomarker in the relationship between periodontitis and chronic migraine. J Clin Periodontol 2017; 44:1208-1214. [PMID: 28922461 DOI: 10.1111/jcpe.12819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 01/03/2023]
Abstract
AIM To evaluate the prevalence of periodontitis (CP) and its contribution to serum leptin levels in chronic migraine (CM). MATERIAL AND METHODS In this case-control study, we included 150 subjects divided into healthy controls (n = 58) and CM patients (n = 92). Demographic, neurological, clinical data as well as full-mouth periodontal records were obtained. Serum leptin levels were measured by ELISA technique. RESULTS Both the prevalence of CP and mean serum leptin levels were significantly higher in patients with CM in comparison with controls (57.6% versus 36.2%, p = .01 and 16.4 versus 7.2 ng/ml, p < .0001, respectively). Patients from the CM group who had CP showed significantly higher leptin concentrations than CM patients without CP (19.8 versus 11.8 ng/ml, p < .0001). Multivariable linear regression analysis showed that CP was an independent contributor to raised leptin levels in CM patients (R2 = 0.270, p = 0.013). CONCLUSIONS CP is prevalent in CM patients and when present it contributes to elevated serum leptin levels, independently of other confounding factors. Therefore, it seems that CP via leptin could be involved in the process of migraine chronification.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain.,Odontología Médico-Quirúrgica (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Pablo Ameijeira
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Clara Domínguez
- Service of Neurology, Headache Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rogelio Leira
- Service of Neurology, Headache Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Blanco
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain.,Odontología Médico-Quirúrgica (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Domínguez C, Vieites-Prado A, Pérez-Mato M, Sobrino T, Rodríguez-Osorio X, López A, Campos F, Martínez F, Castillo J, Leira R. CGRP and PTX3 as Predictors of Efficacy of Onabotulinumtoxin Type A in Chronic Migraine: An Observational Study. Headache 2017; 58:78-87. [PMID: 29131327 DOI: 10.1111/head.13211] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/02/2017] [Accepted: 06/26/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study is to find a relation between several biomarkers in peripheral blood and outcome after treatment with onabotulinumtoxin A (OnabotA). BACKGROUND OnabotA is an effective treatment in chronic migraine (CM). Different studies have tried to find predictors of response to treatment, either with clinical characteristics, neuroimaging features, or molecular biomarkers; however, it is still not possible to predict the individual outcome. METHODS We measured serum levels of biomarkers of inflammation (IL-6, IL-10, TNF-α, and hs-CRP), endothelial dysfunction (PTX3 and sTWEAK), blood-brain barrier disruption (cFN), brain damage (S100b, NSE), and trigemino-vascular activation (CGRP) by ELISA in a group of CM patients treated with OnabotA and healthy controls. After 24 weeks, patients were classified in two groups according to their outcome considering variations in headache frequency: nonresponders (nonimprovement or improvement <50%) and responders (improvement >50%). We compared baseline levels of biomarkers between these groups. RESULTS Sixty-two patients diagnosed with CM (IHS 2013 criteria) who fulfilled criteria for treatment with OnabotA and 24 healthy controls were included. Fifteen patients did not respond to treatment (24.2%) and 47 were responders (75.8%). Pentraxin 3 (PTX3) serum levels (1455.4 ± 487.5 pg/mL versus 720.3 ± 334.1 pg/mL, P < .0001) and calcitonin gene-related peptide (CGRP) serum levels (133.1 ± 86.6 ng/mL versus 58.2 ± 91.7 ng/mL, P = .004) were significantly higher in responders than nonresponders. Serum basal levels of PTX3 >1000 pg/mL (AUC 0.908; 95% CI: 0.827-0.990) and CGRP >50 ng/mL (AUC 0.800; 95% CI: 0.652-0.947) were associated with good response to OnabotA treatment. CONCLUSIONS These results show that molecular markers of trigeminovascular activation (CGRP) and endothelial dysfunction (PTX3) are associated with response to OnabotA and may act as new biomarkers for the selection of treatment in chronic migraineurs.
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Affiliation(s)
- Clara Domínguez
- Department of Neurology, Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Alba Vieites-Prado
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - María Pérez-Mato
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Xiana Rodríguez-Osorio
- Department of Neurology, Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana López
- Department of Neurology, Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Martínez
- Department of Neurology, Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Rogelio Leira
- Department of Neurology, Hospital Clínico Universitario, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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Dominguez C, Vieites-Prado A, Perez-Mato M, Sobrino T, Rodriguez-Osorio X, Lopez A, Campos F, Martinez F, Castillo J, Leira R. Role of adipocytokines in the pathophysiology of migraine: A cross-sectional study. Cephalalgia 2017; 38:1005-1006. [PMID: 29034787 DOI: 10.1177/0333102417731351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Clara Dominguez
- 1 Department of Neurology, Hospital Clinico Universitario, 16697 University of Santiago de Compostela , Santiago de Compostela, Spain
| | - Alba Vieites-Prado
- 2 Clinical Neurosciences Research Laboratory, University of Santiago de Compostela, Santiago de Compostela, Spain.,3 Health Research Institute of Santiago de Compostela (IDIS), Hospital Clinico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Perez-Mato
- 2 Clinical Neurosciences Research Laboratory, University of Santiago de Compostela, Santiago de Compostela, Spain.,3 Health Research Institute of Santiago de Compostela (IDIS), Hospital Clinico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Tomas Sobrino
- 2 Clinical Neurosciences Research Laboratory, University of Santiago de Compostela, Santiago de Compostela, Spain.,3 Health Research Institute of Santiago de Compostela (IDIS), Hospital Clinico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Xiana Rodriguez-Osorio
- 1 Department of Neurology, Hospital Clinico Universitario, 16697 University of Santiago de Compostela , Santiago de Compostela, Spain
| | - Ana Lopez
- 1 Department of Neurology, Hospital Clinico Universitario, 16697 University of Santiago de Compostela , Santiago de Compostela, Spain
| | - Francisco Campos
- 2 Clinical Neurosciences Research Laboratory, University of Santiago de Compostela, Santiago de Compostela, Spain.,3 Health Research Institute of Santiago de Compostela (IDIS), Hospital Clinico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Martinez
- 1 Department of Neurology, Hospital Clinico Universitario, 16697 University of Santiago de Compostela , Santiago de Compostela, Spain
| | - Jose Castillo
- 2 Clinical Neurosciences Research Laboratory, University of Santiago de Compostela, Santiago de Compostela, Spain.,3 Health Research Institute of Santiago de Compostela (IDIS), Hospital Clinico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rogelio Leira
- 1 Department of Neurology, Hospital Clinico Universitario, 16697 University of Santiago de Compostela , Santiago de Compostela, Spain
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Domínguez C, Vieites-Prado A, Pérez-Mato M, Sobrino T, Rodríguez-Osorio X, López A, Campos F, Martínez F, Castillo J, Leira R. Role of adipocytokines in the pathophysiology of migraine: A cross-sectional study. Cephalalgia 2017; 38:904-911. [PMID: 28677995 DOI: 10.1177/0333102417720213] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Obesity is a risk factor for migraine and headache chronification. Adipocytokines may be involved in this correlation. Objective To relate serum adipocytokine levels to clinical and biochemical parameters associated with migraine. Methods We measured levels of leptin, adiponectin and other inflammatory (interleukin 6, interleukin 10, tumor necrosis factor α, high sensitivity C-reactive protein) and endothelial (pentraxin 3, soluble TNF-like weak inducer of apoptosis) molecules potentially related to migraine pathophysiology in a group of migraine patients (IHS 2013) and healthy controls. Results One hundred and eleven patients (mean age 39.7 years, 93% female) and 24 healthy controls (mean age 35.9 years, 90% female) were included. Fifty-six patients were diagnosed with episodic migraine (mean age 35.1 years, 98.2% female) and 55 patients with chronic migraine (mean age 44.4 years, 89.5% female). Leptin serum levels (15.2 ng/mL, SD = 10.5 vs . 3.1 ng/mL, SD = 0.9; p < 0.001) and adiponectin serum levels (72.3 µg/mL, SD = 38.5 vs . 37.7 µg/mL, SD = 16.9; p < 0.001) were significantly increased in migraine patients. Leptin serum levels (15.5 ng/mL, SD = 9.7 vs . 10.8 ng/mL, SD = 6.0; p < 0.001) and adiponectin serum levels (65.8 µg/mL, SD = 42.9 vs . 33.2 µg/mL, SD = 31.0; p < 0.001) were significantly higher in chronic compared to episodic migraine patients. We found a positive correlation between leptin levels and inflammatory biomarkers: IL6 (r = 0.498; p < 0.001), TNF-α (r = 0.389; p < 0.001), and hs-CRP (r = 0.422; p < 0.001). Conclusions Leptin and adiponectin are increased in migraineurs. There is a correlation between adipocytokine levels and other inflammation-related molecules. This suggests a potential role of adipocytokines in migraine pathophysiology and chronification.
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Affiliation(s)
- Clara Domínguez
- 1 Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alba Vieites-Prado
- 2 Clinical Neurosciences Research Laboratory, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Pérez-Mato
- 2 Clinical Neurosciences Research Laboratory, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Tomás Sobrino
- 2 Clinical Neurosciences Research Laboratory, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Xiana Rodríguez-Osorio
- 1 Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana López
- 1 Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Campos
- 2 Clinical Neurosciences Research Laboratory, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Martínez
- 1 Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Castillo
- 1 Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain.,2 Clinical Neurosciences Research Laboratory, University of Santiago de Compostela, Santiago de Compostela, Spain.,3 Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rogelio Leira
- 1 Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
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Ameijeira P, Leira Y, Blanco J, Leira R. Periodontal disease as a potential factor of migraine chronification. Med Hypotheses 2017; 102:94-98. [PMID: 28478842 DOI: 10.1016/j.mehy.2017.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/26/2017] [Accepted: 03/11/2017] [Indexed: 01/03/2023]
Abstract
Migraine is a hereditary constitutional base disorder, which is characterized by recurrent episodes of headache pulsatile characteristics associated with photophobia/phonophobia, nausea and/or vomiting. The main complication in migraine is the chronicity of the process, now recognized as a chronic migraine. Although pathogenic mechanisms that may influence the pathophysiology of migraine and its possible chronicity are not fully understood, previous studies have shown in patients with migraine molecular alterations of systemic inflammation, neurogenic inflammation, endothelial dysfunction, innate immunity, dysfunction of matrix proteases and blood-brain barrier. Periodontal disease is an inflammatory lesion caused by bacteria. After the bacterial infection begins, an immune response that will be responsible for individual susceptibility appears. More advanced forms of periodontitis have demonstrated molecular alterations of inflammation, endothelial dysfunction, dysfunction of matrix proteases and innate immunity, similar to those observed in migraine. Furthermore, the main molecular mediators of neurogenic inflammation related to activation of the trigeminovascular system, which are characteristic of migraine, are overexpressed in gingival crevicular fluid and mucosa in patients with periodontal disease. Hypertension, hypercholesterolemia, insulin resistance, stroke or coronary artery disease are comorbidities that periodontal disease and migraine could share. Therefore, several mechanisms and hypotheses could explain the possible association between both diseases. However, epidemiological and molecular studies will be necessary to provide a better understanding of this potential association, which could be implicated in the chronification of migraine.
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Affiliation(s)
- Pablo Ameijeira
- Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Yago Leira
- Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Juan Blanco
- Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rogelio Leira
- Department of Neurology, Headache Unit, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
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Ramos ML, García-Cabo C, Leira R, Domínguez C, Pozo-Rosich P, Vila C, Laínez MJ, Pascual J. Comorbidity between idiopathic overactive bladder and chronic migraine. Cephalalgia 2017; 38:581-584. [PMID: 28114808 DOI: 10.1177/0333102417690127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective We tested whether overactive bladder (OAB) and chronic migraine (CM) could be comorbid. Patients and methods CM women, aged 40-69 years, answered a validated OAB questionnaire. Prevalence data were compared with those reported in our country in the general population (GP) using the same questionnaire. Results We interviewed 231 CM women. Eighty-four met OAB criteria. OAB prevalence in CM patients was significantly higher than that found in the GP (36.4% vs. 21.8% in the GP; p = 0.0001). There were 34 CM women aged 40-49 years (34.3% vs. 15.2%; p = 0.001), 35 aged 50-59 years (38.9% vs. 21.7%; p = 0.004) and 15 aged 60-69 years (35.7% vs. 24.5%; p = 0.15) meeting OAB criteria. Seventy-seven (33% vs. 9.9%; p = 0.002) needed more than eight micturitions/24 h, 61 (26.4% vs. 8.1%, p = 0.002) experienced nocturia and 43 (18.6% vs. 8.1%; p = 0.001) urinary incontinence. Conclusion In this exploratory study, at least in women, OAB and CM are comorbid, which suggests shared mechanisms.
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Affiliation(s)
- Marta L Ramos
- 1 Service of Neurology, University La Sabana, Bogotá, Colombia
| | - Carmen García-Cabo
- 2 Neuroscience Area, Service of Neurology and Faculty of Medicine, University Hospital Central de Asturias, Oviedo, Spain
| | - Rogelio Leira
- 3 Service of Neurology, University Hospital Santiago de Compostela, Spain
| | - Clara Domínguez
- 3 Service of Neurology, University Hospital Santiago de Compostela, Spain
| | | | - Carme Vila
- 4 Service of Neurology, University Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Julio Pascual
- 2 Neuroscience Area, Service of Neurology and Faculty of Medicine, University Hospital Central de Asturias, Oviedo, Spain.,6 Service of Neurology, University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain
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Pascual J, Leira R, Láinez JM. Combined Therapy for Migraine Prevention? Clinical Experience with A β-Blocker Plus Sodium Valproate in 52 Resistant Migraine Patients. Cephalalgia 2016; 23:961-2. [PMID: 14984228 DOI: 10.1046/j.1468-2982.2003.00615.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim was to explore whether combining a β-blocker and sodium valproate could lead to an advantage in efficacy in patients with migraine previously resistant to the two medications in monotherapy. Fifty-two patients (43 women) with a history of episodic migraine with or without aura, and previously unresponsive to β-blockers and sodium valproate in monotherapy, were treated with a combination of propranolol or nadolol and sodium valproate in an open-label fashion. Eight patients (15%) discontinued due to adverse events. Fifteen (29%) did not respond. The remaining 29 cases (56%) showed response (>50% reduction in migraine days). The response was excellent in nine (17%). From this open trial, combination therapy with a β-blocker and sodium valproate appears to be a good migraine preventative in some previously resistant migraine cases. Controlled trials are now necessary to determine the true advantage in efficacy of this combination in difficult to treat migraineurs.
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Affiliation(s)
- J Pascual
- Service of Neurology, Department of Medicine (UC), University Hospital 'Marqués de Valdecilla', Santander, Spain.
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Leira Y, López-Dequidt I, Arias S, Rodríguez-Yáñez M, Leira R, Sobrino T, Campos F, Blanco M, Blanco J, Castillo J. Chronic periodontitis is associated with lacunar infarct: a case-control study. Eur J Neurol 2016; 23:1572-9. [PMID: 27418418 DOI: 10.1111/ene.13080] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 06/09/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Chronic periodontitis (ChP) and lacunar infarct (LI) are two common diseases amongst the elderly. Although several studies have shown an association between ischaemic stroke and ChP, little is known about the relationship between ChP and LI. The study aims to investigate whether ChP is associated with the presence of lacunar stroke. METHODS An age- and gender-matched case-control study of 62 cases (subjects diagnosed with LI) and 60 controls is reported. Clinical periodontal measures (probing pocket depth, recession, clinical attachment level, full mouth plaque score and full mouth gingival bleeding on probing score) were assessed, and associated risk factors for periodontitis and lacunar stroke were ascertained by means of a structured questionnaire. RESULTS Chronic periodontitis showed a strong association with LI after adjusting for common vascular risk factors (odds ratio 4.20; 95% confidence interval 1.81-10.20; P = 0.001). Likewise, severe ChP and LI also tended to be significantly associated, independent of other vascular covariates (odds ratio 3.53; 95% confidence interval 1.07-12.77; P = 0.04). CONCLUSIONS Chronic periodontitis was independently associated with the presence of LI after adjusting for well-known vascular risk factors for lacunar stroke. Further observational studies are necessary to investigate the pathophysiological mechanisms that can explain this relationship.
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Affiliation(s)
- Y Leira
- Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain. .,Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - I López-Dequidt
- Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - S Arias
- Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - M Rodríguez-Yáñez
- Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - R Leira
- Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - T Sobrino
- Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - F Campos
- Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - M Blanco
- Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - J Blanco
- Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - J Castillo
- Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
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Leira R. [Creation and enhancement of headache units: the view of neurologists and heads of neurology departments]. Rev Neurol 2015; 61 Suppl 1:S9-S12. [PMID: 26337645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Headache is the most common reason for visiting in neurology. Almost a third of all patients surveyed in this specialty visit for this reason. The gradual increase in the complexity of the care afforded to patients with headaches requires neurologists to become more specialised and leads to the creation of specialised units where this more complex care can be implemented. The heads of the neurology department are responsible for structuring and coordinating the different care units. This article shows the findings of a survey carried out on a group of heads of neurology departments in order to determine the current state of headache units, that is, their opinion regarding the creation, functioning and development of headache units in Spanish hospitals, and the parameters of their efficacy and effectiveness.
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Affiliation(s)
- R Leira
- Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Espana
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del Río MS, Leira R, Pozo-Rosich P, Laínez JM, Alvarez R, Pascual J. EHMTI-0103. Errors in recognition and management are still frequent in cluster headache. J Headache Pain 2014. [PMCID: PMC4180431 DOI: 10.1186/1129-2377-15-s1-c50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sánchez Del Rio M, Leira R, Pozo-Rosich P, Laínez JM, Alvarez R, Pascual J. Errors in recognition and management are still frequent in patients with cluster headache. Eur Neurol 2014; 72:209-12. [PMID: 25227490 DOI: 10.1159/000362517] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/28/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To analyze the trajectory to diagnosis and information provided in a series of cluster headache (CH) patients from five headache clinics. METHODS CH patients were asked to fill in an ad hoc questionnaire. RESULTS Seventy-five patients (mean age 41.5 years, 67 males) completed the questionnaire. Patients had visited during an average of 4.9 years a mean of 4.6 physicians who had obtained 2.5 neuroimaging procedures per patient before getting a diagnosis of CH. Sixty-three (84%) had received no diagnosis (21 cases; 28%), while 43 (57%) had been given an average of 2.1 alternative diagnoses. Migraine, trigeminal neuralgia and sinusitis were the most frequent mistakes. After diagnosis, 55% had subjectively received poor/very poor information on CH. Ninety-five percent had poor or incorrect information about the nature of the disease, or acute (70%) and preventive (61%) treatments. Etiology (90%), management options (36%) and potential adverse events of medications (29%) were their main information demands. CONCLUSIONS Although CH is an invalidating and clinically clear-cut disorder suffered by around 1/1,000 people, it is still frequently unrecognized and/or mistaken for other disorders, which calls for a better knowledge and education in the diagnosis of the main primary headaches.
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Rodríguez-Osorio X, Leira R. Response to Oterino et al.: Analysis of endothelial precursor cells in chronic migraine: a case-control study. Cephalalgia 2014; 34:1025-6. [PMID: 24921404 DOI: 10.1177/0333102414526054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Rogelio Leira
- Hospital Clínico Universitario, Santiago de Compostela, Spain
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Leira R. [OnabotulinumtoxinA in chronic migraine: from the theory of clinical trials to clinical practice]. Rev Neurol 2014; 58 Suppl 2:S3-S11. [PMID: 24687883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The introduction of OnabotulinumtoxinA (OnabotA) in the treatment of chronic migraine has brought with it a significant change in the management of these patients. Its novel mechanism of action, the fact that it is administered as an injection and the need to repeat treatment and control regimens all suggest the need to modify the therapeutic strategy applied in this clinical situation. This article briefly reviews the main clinical evidence on the effectiveness of OnabotA in chronic migraine based on the clinical trials conducted to date. At the same time it also performs a critical analysis of the application of OnabotA in daily clinical practice. It includes the findings of a survey carried out on Spanish neurologists about their experience in the application of OnabotA in patients with chronic migraine in order to determine the real situation in our milieu. The main conclusions include the need to use suitable doses of OnabotA, together with appropriate injection points, the non-exclusion of patients with very frequent crises, concomitant preventive treatment or medication abuse, waiting up to 15 days in order to be able to observe the clinical effectiveness and not considering OnabotA as ineffective until after having performed 2-3 infiltration regimens.
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Affiliation(s)
- Rogelio Leira
- Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Espana
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Campos F, Sobrino T, Pérez-Mato M, Rodríguez-Osorio X, Leira R, Blanco M, Mirelman D, Castillo J. Glutamate oxaloacetate transaminase: a new key in the dysregulation of glutamate in migraine patients. Cephalalgia 2013; 33:1148-54. [PMID: 23674828 DOI: 10.1177/0333102413487444] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Based on the capacity of the blood-resident enzyme glutamate oxaloacetate transaminase (GOT) to metabolize blood glutamate, our aim was to study the association of GOT activity with serum glutamate levels and clinical parameters in patients with migraine. METHODS This case-control study included 45 episodic migraine patients (IHS 2004 criteria) and 16 control subjects. We analyzed glutamate and GOT activity in peripheral blood samples obtained during interictal periods and migraine attacks ( N = 15). Frequency, severity, and duration of attacks and time of evolution were also recorded. RESULTS Migraine patients showed lower GOT activity than controls (15.2 ± 2.9 vs. 18.7 ± 3.8 U/l) and higher levels of glutamate (153.7 ± 68.6 vs. 121.5 ± 59.2 μM) (all P < 0.05). A negative correlation was found between GOT activity and glutamate levels ( R = -0.493; P < 0.0001) in interictal periods; however, this negative correlation was lost during attacks ( R = -0.026; P = 0.925). During attacks, we found a positive correlation between the time elapsed from attack onset and glutamate levels ( R = 0.738; P < 0.0001), but not for GOT activity ( R = -0.075; P = 0.809). CONCLUSIONS Migraine patients showed reduced GOT activity and increased levels of blood glutamate levels as compared to control subjects. Furthermore, a negative correlation was found between GOT activity and glutamate levels in interictal periods.
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Affiliation(s)
- Francisco Campos
- Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Institute for Sanitary Research of Santiago de Compostela (IDIS), University of Santiago de Compostela, Spain
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Lainez-Andres JM, Caminero A, Diaz-Insa S, Gracia-Naya M, Huerta-Villanueva M, Irimia P, Jimenez-Hernandez MD, Leira R, Sanchez del Rio-Gonzalez M. [Triptans in clinical practice: effectiveness, tolerance and patient's satisfaction with medication (TRIPRACLI study)]. Rev Neurol 2013; 56:143-151. [PMID: 23359075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION AND AIMS This study was aimed determining the effectiveness, tolerance and satisfaction of patients with migraine as regards different triptans, according to the characteristics of their attacks. At the same time it sought to establish a predictive model that can be used to recommend one or another, depending on those characteristics. PATIENTS AND METHODS Retrospective observation-based study conducted in headache units in a number of different centres. Patients included in the study were those with migraine who used the same triptan to treat their attacks. Data concerning preference, effectiveness, speed and tolerance were analysed. RESULTS The analysis included 160 patients (88 females), with a mean age of 42.92 years. The most commonly used triptans were eletriptan, almotriptan and rizatriptan. Both patients and doctors reported a high degree of satisfaction (88% and 65%) with the triptan that was used. In the surveys on preference, patients preferred their current triptan to the previous one (83%) or to non-specific drugs. The overall score on a visual analogue scale was above 7 for all the triptans, without any differences from one to another. On analysing the use of a particular triptan depending on the characteristics of the attacks, no statistically significant differences were found. CONCLUSIONS In this selected group of patients, triptans are a treatment that patients claim to be very satisfied with. Although there are no overall differences in the scores among different triptans, the fact that certain triptans are used more by patients after previous experiences with others suggests that they are more effective. We did not find any parameter that predicts the use of a particular triptan.
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Affiliation(s)
- J M Lainez-Andres
- Servicios de Neurología, Hospital Clínico Universitario, Universidad Católica de Valencia, Espana.
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Arias-Rivas S, Rodríguez-Yañez M, Cortés J, Pardo-Parrado M, Aguiar P, Leira R, Castillo J, Blanco M. Familial hemiplegic migraine with prolonged global aura: follow-up findings of subtraction ictal SPECT co-registered to MRI (SISCOM). Cephalalgia 2012; 32:1013-4. [PMID: 22933508 DOI: 10.1177/0333102412457093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
All authors contributed equally to this work. Susana Arias-Rivas wrote the main paper. Manuel Rodriguez-Yáñez investigated the supplementary data. Julia Cortés and Pablo Aguiar performed the nuclear image studies and analysed and described the neuroimaging results. María Pardo, Rogelio Leira and Jose Castillo jointly conceived the study, followed the patient and prepared the manuscript. Miguel Blanco discussed the results. All authors discussed the results and implications and commented on the manuscript at all stages.
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Affiliation(s)
- Susana Arias-Rivas
- Neurology Department, ANEVAS, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
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Rodríguez-Osorio X, Sobrino T, Brea D, Martínez F, Castillo J, Leira R. Endothelial progenitor cells: a new key for endothelial dysfunction in migraine. Neurology 2012; 79:474-9. [PMID: 22815557 DOI: 10.1212/wnl.0b013e31826170ce] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aimed to study endothelial function with biochemical and ultrasonographic markers and its relation with endothelial progenitor cells (EPCs) in patients with migraine. METHODS We performed a case-control study including 47 patients with episodic migraine (International Headache Society 2004 criteria) and 23 control subjects. We analyzed flow-mediated dilation (FMD) in the dominant brachial artery, calcitonin gene-related peptide (CGRP), and vascular endothelial growth factor (VEGF) levels by ELISA, nitric oxide stable metabolites (NOx) by high-performance liquid chromatography, and EPCs in peripheral blood samples, obtained during interictal periods (n = 47) and migraine attacks (n = 19). Frequency, severity, duration of attacks, and time of evolution of migraine were also recorded. RESULTS Patients with migraine showed lower numbers of EPCs than control subjects (9.4 ± 5.0 vs 17.9 ± 6.0 colony forming unit-endothelial cells [CFU-ECs]; p < 0.0001) and higher levels of CGRP (164.2 ± 139.1 vs 37.1 ± 38.5 pg/mL), VEGF (473.4 ± 398.7 vs 72.6 ± 56.6 pg/mL), and NOx (1225.2 ± 466.1 vs 671.9 ± 358.6 μM) (all p < 0.05). During attacks, higher levels for CGRP (298.2 ± 100.3 pg/mL) and NOx (1,656.8 ± 259.5 μM) and lower numbers of EPC (7.2 ± 3.2 CFU-ECs) were observed (all p < 0.05). No changes were found for FMD in interictal periods or during headache. In relation to clinical parameters, EPCs decreased with the time of evolution of migraine (r = -0.592; p < 0.0001). CONCLUSIONS Patients with migraine show reduced numbers of EPCs and increased levels of CGRP, NOx, and VEGF than control subjects. Furthermore, EPC counts decrease as migraine progresses in time. These findings suggest altered endothelial function in patients with migraine.
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Affiliation(s)
- Xiana Rodríguez-Osorio
- Department of Neurology, Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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Sobrino T, Rodríguez-González R, Blanco M, Brea D, Pérez-Mato M, Rodríguez-Yáñez M, Leira R, Castillo J. CDP-choline treatment increases circulating endothelial progenitor cells in acute ischemic stroke. Neurol Res 2012; 33:572-7. [PMID: 21708065 DOI: 10.1179/016164110x12807570510176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The increase in circulating endothelial progenitor cells (EPCs) is associated with a better outcome in patients with acute ischemic stroke. CDP-choline (citicoline) increases brain plasticity after experimental stroke. Therefore, we study if citicoline treatment could increase the EPC concentration after ischemic stroke. METHODS Forty-eight patients with a first-ever non-lacunar ischemic stroke were consecutively included in the study within 12 hours of symptoms onset. Patients received treatment (n = 26) or non-treatment (n = 22) with oral citicoline (2000 mg/day) from acute phase of ischemic stroke and for 6 weeks. EPC colonies were quantified as early outgrowth colony forming unit-endothelial cell (CFU-EC) at admission (before citicoline treatment) and day 7. We defined the EPC increment during the first week as the difference in the numbers of CFU-EC between day 7 and admission. RESULTS CFU-ECs were similar at baseline between patients treated and non-treated with citicoline (7.7±6.1 versus 9.1±7.3 CFU-EC, P = 0.819). However, patients treated with citicoline and recombinant tissue-plasminogen activator (rt-PA) showed a higher EPC increment compared to patients treated only with citicoline or non-treated (35.4±15.9 versus 8.4 ± 8.1 versus 0.9 ± 10.2 CFU-EC, P < 0.0001). In a logistic model, citicoline treatment [odds ratio (OR), 17.6; confidence interval (CI) 95%, 2.3-137.5, P = 0.006] and co-treatment with citicoline and rt-PA (OR, 108.5; CI 95%, 2.9-1094.2, P = 0.001) were independently associated with an EPC increment⩾4 CFU-EC. CONCLUSION The administration of citicoline and the co-administration of citicoline and rt-PA increase EPC concentration in acute ischemic stroke.
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Affiliation(s)
- Tomás Sobrino
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, IDIS, University of Santiago de Compostela, Spain
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Rodríguez-Yáñez M, Arias-Rivas S, Fernández-Ferro J, Leira R, Castillo J, Blanco M. [Clopidogrel and stroke]. Rev Neurol 2011; 53:561-573. [PMID: 22012820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Despite the significant reduction in mortality, ischemic stroke is the leading cause of morbidity and mortality in adults in industrialized countries. Antiplatelet therapy has reduced the risk of stroke and other vascular events. Although most commonly used treatment is aspirin, other antiplatelet drugs with different mechanisms of action have been developed. Clopidogrel blocks platelet aggregation by inhibiting the adenosine diphosphate receptor and the subsequent activation of the complex IIb/IIIa. In addition to its antiplatelet action, it also has pleiotropic effects, reducing the inflammatory mechanisms that occur during ischemia. Clopidogrel has demonstrated a benefit over aspirin in preventing vascular events, especially in patients at high cardiovascular risk. In this paper we review the main studies that have been conducted with clopidogrel in preventing ischemic stroke, either as monotherapy or in combination with other antiplatelet agents.
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Affiliation(s)
- Manuel Rodríguez-Yáñez
- Servicio de Neurología, Hospital Clinico de Santiago de Compostela, 15706 Santiago de Compostela, Espana
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Rodríguez-Yáñez M, Sobrino T, Arias S, Vázquez-Herrero F, Brea D, Blanco M, Leira R, Castellanos M, Serena J, Vivancos J, Dávalos A, Castillo J. Early biomarkers of clinical-diffusion mismatch in acute ischemic stroke. Stroke 2011; 42:2813-8. [PMID: 21836082 DOI: 10.1161/strokeaha.111.614503] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Clinical-diffusion mismatch (CDM; National Institutes of Health Stroke Scale score≥8 and diffusion-weighted imaging lesion volume<25 mL) has been suggested as a surrogate of ischemic brain at risk of infarction and might be used to recognize salvageable ischemic tissue. Our aim was to identify early biomarkers associated with the presence of CDM. METHODS We prospectively evaluated CDM in 226 patients (71.6±11.1 years, 58% men) with hemispheric ischemic stroke within 12 hours from symptom onset (median, 3.6 hours). Diffusion-weighted MRI lesion volume was measured by manual segmentation method. Serum levels of glutamate, aspartate, interleukin-10, tumor necrosis factor-α, interleukin-6, S100β, neuron-specific enolase, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, active matrix metalloproteinase-9, and cellular fibronectin were determined by immunoassay or high-performance liquid chromatography techniques in blood samples obtained at admission. RESULTS CDM was found in 61 patients (26.9%). Patients with CDM had higher serum levels of interleukin-10, tumor necrosis factor-α, and glutamate and lower serum levels of neuron-specific enolase, interleukin-6, and active matrix metalloproteinase-9 (all P<0.0001). Binary logistic regression showed that tumor necrosis factor-α≥21 pg/mL (OR, 21), glutamate≥230 μmol/L (OR, 27), neuron-specific enolase≥23 ng/mL (OR, 0.05), interleukin-6≥10 pg/mL (OR, 0.06), and active matrix metalloproteinase-9≥21 ng/mL (OR, 0.28) were independent molecular predictors of CDM after adjustment for covariates. The association of interleukin-10≥23 pg/mL and glutamate≥230 μmol/L levels predicted CDM with a sensitivity of 96% and a specificity of 98%. CONCLUSIONS High levels of interleukin-10, tumor necrosis factor-α, and glutamate as well as low levels of neuron-specific enolase, interleukin-6, and active matrix metalloproteinase-9 are associated with CDM.
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Affiliation(s)
- Manuel Rodríguez-Yáñez
- Neurovascular ARea, Department of Neurology, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, University of Santiago de Comostela, Santiago de Compostela, Spain
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Santos-García D, Blanco M, Serena J, Rodríguez-Yáñez M, Leira R, Castillo J. Impaired brachial flow-mediated dilation is a predictor of a new-onset vascular event after stroke. Cerebrovasc Dis 2011; 32:155-62. [PMID: 21778713 DOI: 10.1159/000328651] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 04/07/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Brachial arterial flow-mediated dilation (FMD) is associated with an increased risk of vascular events. Our aim was to investigate the relationship between FMD measured in the acute phase of ischemic stroke and a new major adverse vascular event in a consecutive cohort of patients followed up for 48 months after an acute first-ever stroke. METHODS We measured FMD in 120 consecutive patients with acute ischemic stroke using high-resolution ultrasonography. FMD was calculated as the relationship between the basal diameter of the brachial artery before and after transient vascular occlusion. Intima-media thickness, extracranial carotid atherosclerosis, stroke severity National Institute of Health Stroke Scale, and modified Rankin Scale at 3 months were also evaluated. A vascular event was defined as any of the following: vascular disease (VD) death, nonfatal myocardial infarction (MI), nonfatal recurrent stroke (RS), claudication or peripheral arterial thrombosis (PVD), angioplasty or cardiac bypass graft surgery. RESULTS There were 34 new major adverse vascular events in 32 of 120 patients (26.7%): 21 (61.8%) RS, 5 (14.7%) VD death, 5 (14.7%) MI, and 3 (8.8%) PVD. The presence of carotid artery plaque (81.3 vs. 46%; p < 0.0001), atrial fibrillation (37.5 vs. 14.8%; p = 0.007) and FMD (5.30 ± 7.48 vs. 10.54 ± 7.02; p = 0.001) were associated with new-onset vascular events. FMD ≤4.5% was an independent predictor of new-onset vascular events (hazards ratio 3.48; 95% confidence interval 1.26-9.63; p = 0.01). CONCLUSIONS FMD is an independent predictor for a new-onset vascular event after first-ever ischemic stroke.
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Affiliation(s)
- Diego Santos-García
- Stroke Unit, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, c/Travesa da Choupana s/n, Santiago de Compostela, Spain
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Rodríguez-González R, Sobrino T, Rodríguez-Yáñez M, Millán M, Brea D, Miranda E, Moldes O, Pérez J, Lomas DA, Leira R, Dávalos A, Castillo J. Association between neuroserpin and molecular markers of brain damage in patients with acute ischemic stroke. J Transl Med 2011; 9:58. [PMID: 21569344 PMCID: PMC3113955 DOI: 10.1186/1479-5876-9-58] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 05/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuroserpin has shown neuroprotective effects in animal models of cerebral ischemia and has been associated with functional outcome after ischemic stroke. Our aim was to study whether neuroserpin serum levels could be associated to biomarkers of excitotoxicity, inflammation and blood brain barrier disruption. METHODS We prospectively included 129 patients with ischemic stroke (58.1% male; mean age, 72.4 ± 9.6 years) not treated with tPA within 12 hours (h) of symptoms onset (mean time, 4.7 ± 2.1 h). Poor functional outcome at 3 months was considered as a modified Rankin scale score >2. Serum levels of neuroserpin, Interleukin 6 (IL-6), Intercellular adhesion molecule-1 (ICAM-1), active Matrix metalloproteinase 9 (MMP-9), and cellular fibronectin (cFn) (determined by ELISA) and glutamate (determined by HPLC) were measured on admission, 24 and 72 h. The main variable was considered the decrease of neuroserpin levels within the first 24 h. ROC analysis was used to select the best predictive value for neuroserpin to predict poor functional outcome due to a lack of linearity. RESULTS The decrease of neuroserpin levels within the first 24 h was negatively correlated with serum levels at 24 hours of glutamate (r = -0.642), IL-6 (r = -0.678), ICAM-1 (r = -0.345), MMP-9 (r = -0.554) and cFn (r = -0.703) (all P < 0.0001). In the multivariate analysis, serum levels of glutamate (OR, 1.04; CI95%, 1.01-1.06, p = 0.001); IL-6 (OR, 1.4; CI95%, 1.1-1.7, p = 0.001); and cFn (OR, 1.3; CI95%, 1.1-1.6, p = 0.002) were independently associated with a decrease of neuroserpin levels <70 ng/mL at 24 h after adjusting for confounding factors. CONCLUSIONS These findings suggest that neuroprotective properties of neuroserpin may be related to the inhibition of excitotoxicity, inflammation, as well as blood brain barrier disruption that occur after acute ischemic stroke.
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Affiliation(s)
- Raquel Rodríguez-González
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Rodríguez-Yáñez
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mónica Millán
- Department of Neurosciences, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - David Brea
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Elena Miranda
- University of Cambridge, Cambridge Institute for Medical Research, Cambridge, UK
| | - Octavio Moldes
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Pérez
- Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga, Facultad de Ciencias, Campus de Teatinos, Málaga, Spain
| | - David A Lomas
- University of Cambridge, Cambridge Institute for Medical Research, Cambridge, UK
| | - Rogelio Leira
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antoni Dávalos
- Department of Neurosciences, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - José Castillo
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
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Rodríguez I, Lema I, Blanco M, Rodríguez-Yáñez M, Leira R, Castillo J. Vascular Retinal, Neuroimaging and Ultrasonographic Markers of Lacunar Infarcts. Int J Stroke 2010; 5:360-6. [DOI: 10.1111/j.1747-4949.2010.00462.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Lacunar infarcts may be caused by macro-or microvascular disease due to several mechanisms. Aim This study aims to demonstrate that retinal vascular disturbances in patients with lacunar infarcts associated with neuroimaging and ultrasound markers can help to identify small-vessel disease. Methods Prospective ambulatory study of patients with ischaemic stroke and a control group. A retinographic study was performed by 20° bilateral optic disc stereophotography and 50° bilateral optic fundus retinography. Microangiopathy was evaluated as the presence of nonparenchymal vascular affectation and retinopathy as at least one retinal disturbance. Ultrasonographic study evaluated carotid disorder parameters and the mean pulsatility index. The MRI protocol included T1-weighted, T2-weighted, DP-weighted and FLAIR. Results We included 156 nonlacunar infarcts, 39 lacunar infarcts and 50 controls. Microangiopathy was more frequent in hypertensive (62.6% vs. 35.7%, P<0.0001) and vascular retinopathy in diabetic patients (11.7% vs. 3.8%, P=0.039). Microangiopathy (97.4% vs. 41.1%, P<0.0001) and leukoaraiosis (94.4% vs. 50.3%, P<0.0001) were more frequent and the mean pulsatility index was higher (1.9±0.2 vs. 1.4±0.5, P<0.0001) in patients with lacunar infarcts. Lacunar infarcts were independently associated with microangiopathy (odds ratio 12.81, 95% CI 1.52–107.86), the mean pulsatility index (odds ratio 8.13, 95% CI 1.17–56.20) and leukoaraiosis (odds ratio 3.45, 95% CI 1.09–10.93). The presence of leukoaraiosis plus microangiopathy was associated with lacunar infarcts with odds ratio 21.31 (95% CI 8.74–51.93). Conclusions The association of retinal microangiopathy (but not vascular retinopathy) and leukoaraiosis is linked to small-vessel disease and may be a useful marker of lacunar infarcts not secondary to a macrovascular lesion.
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Affiliation(s)
- Iria Rodríguez
- Department of Neurology – Stroke Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Isabel Lema
- Instituto Galego de Oftalmoloxía, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Miguel Blanco
- Department of Neurology – Stroke Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Manuel Rodríguez-Yáñez
- Department of Neurology – Stroke Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Rogelio Leira
- Department of Neurology – Stroke Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
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Sobrino T, Millán M, Castellanos M, Blanco M, Brea D, Dorado L, Rodríguez-González R, Rodríguez-Yáñez M, Serena J, Leira R, Dávalos A, Castillo J. Association of growth factors with arterial recanalization and clinical outcome in patients with ischemic stroke treated with tPA. J Thromb Haemost 2010; 8:1567-74. [PMID: 20456746 DOI: 10.1111/j.1538-7836.2010.03897.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY BACKGROUND Growth factors (GF) such as vascular endothelial growth factor (VEGF), angiopoietin-1 (Ang-1) and granulocyte-colony stimulating factor (G-CSF) have been associated with greater efficacy of tissue plasminogen activator (tPA) in experimental studies. OBJECTIVES To study the association of these GF with arterial recanalization and clinical outcome in patients with acute ischemic stroke treated with tPA. METHODS We prospectively studied 79 patients with ischemic stroke attributable to MCA occlusion treated with i.v. tPA within the first 3 h from onset of symptoms. Continuous transcranial color-coded sonography (TCCS) was performed during the first 2 h after tPA bolus to assess early MCA recanalization. Hemorrhagic transformation (HT) was classified according to ECASS II definitions. Good functional outcome was defined as a Rankin scale score of 0-2 at 90 days. GF levels were determined by ELISA. RESULTS Mean serum levels of VEGF, G-CSF and Ang-1 at baseline were significantly higher in patients with early MCA recanalization (n = 30) (all P < 0.0001). In the multivariate analysis, serum levels of VEGF (OR, 1.03), G-CSF (OR, 1.02) and Ang-1 (OR, 1.07) were independently associated with early MCA recanalization (all P < 0.0001). On the other hand, patients with parenchymal hematoma (PH) (n = 20) showed higher levels of Ang-1 (P < 0.0001). Ang-1 (OR, 1.12; P < 0.0001) was independently associated with PH, whereas patients with good outcome (n = 38) had higher levels of G-CSF (P < 0.0001). G-CSF was independently associated with good outcome (OR, 1.12; P = 0.036). CONCLUSIONS These findings suggest that GF may enhance arterial recanalization in patients with ischemic stroke treated with t-PA, although they might increase the HT.
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Affiliation(s)
- T Sobrino
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
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Pascual J, Sánchez del Río M, Jiménez MD, Láinez-Andrés JM, Mateos V, Leira R, Pozo-Rosich P, Guzmán-Quilo C. [Chronic migraine as seen by neurologists and patients: results of the CIEN-mig project (III)]. Rev Neurol 2010; 50:705-710. [PMID: 20533248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Data on the reality of chronic migraine in our clinics are scarce. AIM. To know the frequency of consultation and attitude of the neurologist regarding chronic migraine, and the opinion of patients with this condition. SUBJECTS AND METHODS A total of 145 neurologists consulted electronically two questionnaires. The first tested the impact of chronic migraine and their approach in the daily practice. The second was filled in by the consecutive patients. RESULTS A total of 4.1% of patients consulted due to chronic migraine, mostly women in their forties. The average time for diagnosis was 28.7 months. All neurologists recommended preventive treatment from the beginning. More than a quarter kept this treatment for more than a year and used drug combinations. Only half thought that overuse was the reason for chronic migraine and the majority allowed non-steroidal anti-inflammatories and triptans at restricted doses. Only half of the patients knew they had chronic migraine. In their opinion, heredity and the absence of an early and serious treatment could contribute for chronic migraine development. CONCLUSIONS Almost one patient per day consults due to chronic migraine, which gives an idea of its impact. A better feed-back with primary care level is necessary, if we consider that the delay in the diagnosis is longer than two years. The majority of neurologists follows the current recommendations of the Headache Group of the Spanish Society of Neurology.
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Affiliation(s)
- Julio Pascual
- Servicios de Neurología, Hospital Universitario Central de Asturias, Oviedo, Asturias.
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Pascual J, Sánchez del Río M, Jiménez MD, Láinez-Andrés JM, Mateos V, Leira R, Pozo-Rosich P, Guzmán-Quilo C. [Satisfaction of the migraine patient attending neurology clinics: results of CIEN-mig project (II)]. Rev Neurol 2010; 50:641-645. [PMID: 20514635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Migraine is the most common neurological consultation in our country. AIM. To analyse the satisfaction level of the patient with migraine attending our clinics. PATIENTS AND METHODS A total of 160 neurologists asked 10 consecutive migraine patients to fill in a satisfaction questionnaire. RESULTS The questionnaire was answered by 1330 patients. The most important factors they considered for their neurologists were professional experience and kindness. Patients thought neurologist should improve in time to explain treatment and accessibility. Almost 90% of patients considered that treatments for migraine had improved, but almost half of them were not satisfied with the management in primary care setting. Patients were more satisfied with symptomatic treatment (69.1%) than with preventatives (50.4%). More than half had a neuroimaging study due to their headaches. Only half thought that such an study would improve their satisfaction. CONCLUSIONS The level of satisfaction of the migraine patient attending our clinics has improved in the last years. In patients' opinion the aspects which should be improved are the time to explain migraine and its treatment, accessibility and preventive treatment.
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Affiliation(s)
- Julio Pascual
- Servicios de Neurología, Hospital Universitario Central de Asturias, 33006 Oviedo, España.
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Pascual J, Sánchez del Río M, Jiménez MD, Láinez-Andrés JM, Mateos V, Leira R, Pozo-Rosich P, Guzmán-Quilo C. [Approach of neurologists in Spain to migraine: results of the CIEN-mig project (I)]. Rev Neurol 2010; 50:577-583. [PMID: 20473832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Headache is the most frequent neurological reason for consultation in our country. AIM To obtain descriptive data on the approach and satisfaction of the neurologist regarding the diagnosis, burden and management of headaches, and migraine in particular, together with the relationship with primary care physicians (PCP). SUBJECTS AND METHODS A total of 160 neurologists participated and answered electronically five questionnaires during one year. The results for patients were obtained in a standard clinic day and for the first 10 patients. RESULTS The mean number of patients/day was 20.7. Thirty-six percent consulted due to headache, most under 50 and women. Half had migraine; in 70% daily activities were moderate-severely affected. Almost half had missed at least one work day due to migraine in the previous month. Neurologist considered that headache background of PCP should improve, mainly regarding preventive treatment. Complementary studies were asked in a rather low proportion of patients; CT (35%) being the most frequent. The majority indicated triptans, and in the mild phase of pain, and neuromodulators or beta-blockers for the preventive treatment. CONCLUSIONS Migraine is the first reason for consultation in the Neurology Services of our country and impacts negatively in the quality of life of our patients, usually women below 50. Its management should be improved with a better feedback with PCP and the use of the most efficacious treatments.
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Affiliation(s)
- Julio Pascual
- Servicios de Neurología, Hospital Universitario Central de Asturias, Oviedo, España.
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Pascual-Gómez J, Gracia-Naya M, Leira R, Mateos V, Alvaro-González LC, Hernando I, Oterino A, Iglesias--Díez F, Caminero A, García-Moncó JC, Forcea N, Guerrero-Peral AL, Bueno V, Santos-García D, Pérez C, Blanco M, Pego-Reigosa R, Rodríguez R, Mederer-Hengstl S, Pato-Pato A, Sánchez-Herrero J, Maciñeiras-Montero JL, Ortega F, Arias M, Díaz-González M. [Zonisamide in the preventive treatment of refractory migraine]. Rev Neurol 2010; 50:129-132. [PMID: 20146184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Chronic migraine refractory to preventive treatment is a common clinical situation in general neurology clinics. The aim is to analyse our experience with zonisamide in the preventive treatment of patients with frequent refractory migraine. PATIENTS AND METHODS Those patients with no response or intolerance to topiramate and at least one more preventative received zonisamide. This drug was increased 25 mg per week up to 200 mg/day. The efficacy of zonisamide was evaluated in terms of 'response' (reduction in attack frequency below 50%) at the third month of treatment. RESULTS Our series comprises a total of 172 patients, with ages ranging from 22 to 69 years. 85% were women. The final dosage of zonisamide was 50-200 mg/day, with the 100 mg/day being the most frequently administered dose. Zonisamide was efficacious (response) in 76 (44%) patients; response being excellent in 22 (13%). MIDAS score was reduced by 43.2%. Zonisamide was not tolerated by 27% of the patients, mainly due to subjective mental slowness or digestive symptoms. CONCLUSIONS These results, obtained in a big sample of patients refractory or intolerant to topiramate and other preventatives, indicate that, at least in conditions of daily clinical practice, zonisamide, at relatively low dosages, is an option to be considered for the preventive treatment of patients with frequent migraine.
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Affiliation(s)
- Julio Pascual-Gómez
- Servicios de Neurología, Hospital Universitario Marques de Valdecilla, Santander, Espana.
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Corominas R, Sobrido MJ, Ribasés M, Cuenca-León E, Blanco-Arias P, Narberhaus B, Roig M, Leira R, López-González J, Macaya A, Cormand B. Association study of the serotoninergic system in migraine in the Spanish population. Am J Med Genet B Neuropsychiatr Genet 2010; 153B:177-84. [PMID: 19455600 DOI: 10.1002/ajmg.b.30972] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In order to evaluate the contribution of 19 serotonin-related genes to the susceptibility to migraine in a Spanish population we performed a case-control association study of 122 single nucleotide polymorphisms (SNPs), selected according to genetic coverage parameters, in 528 migraine patients -308 with migraine without aura (MO) and 220 with migraine with aura (MA)- and 528 sex-matched migraine-free controls. The single-marker analysis identified nominal associations with the migraine phenotype or with the MO or MA subtypes. The multiple-marker analysis revealed risk haplotypes in three genes that remained significantly associated with migraine after correction by permutations. Two-marker risk haplotypes were identified in the HTR2B (rs16827801T-rs10194776G) and MAOA (rs3027400G-rs2072743C) genes conferring susceptibility to MO, and a four-marker haplotype in DDC was specific of MA (rs2329340A-rs11974297C-rs2044859T-rs11761683G). The present study supports the involvement of HTR2B and MAOA genes in the genetic predisposition to MO, while DDC might confer susceptibility to MA. These results suggest a differential involvement of serotonin-related genes in the genetic background of MO and MA.
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Affiliation(s)
- R Corominas
- Grup de Recerca en Neurologia Infantil i Psiquiatria Genètica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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