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To compare the efficacy of oral eletriptan, 40 mg and 80 mg, and oral sumatriptan, 50 mg and 100 mg, in the acute treatment of migraine.

Objective: To detect disconjugate ocular motor abnormalities and a possible extraocular muscle myotonic phenomenon in patients with myotonic dystrophy (MyD). Methods: The magnetic scleral search coil technique was used to record monocularly the small (25°) and large (50°) saccades, which were paced to two interstimulus intervals (ISIs), one short (1 s), the other long (5 s). The case study comprised 20 patients with MyD, 10 patients with multiple sclerosis (MS), and 10 controls. The amplitude, duration, peak velocity, and skewness of the velocity profile (ratio between the acceleration and the deceleration periods) of each saccade were measured. The disconjugate parameters (difference between the two eyes of the same measure), and the myotonic parameter (the maximal (as absolute value) short-long ISI difference between the same measures) were considered. Results: The disconjugate parameters were the same in all three groups. The mean values of myotonic parameters found in patients with MyD for duration (for both small and large target displacements) and skewness (for small target displacements only) differed from those found for both the MS and the control groups. Additionally, the occurrence of individual patients presenting with abnormal duration and skewness parameters was higher in the MyD than in the MS group. In patients with MyD, the saccade duration was longer for long than for short ISI; the effect derived from a prolongation of the acceleration period, which manifested as an increase in skewness. Conclusion: The results can be explained by a combination of the myotonic and the warm up phenomena. A delay in the relaxation (myotonia) of the extraocular muscle may be more evident after a long fixation period (long ISI) and it may improve by increasing saccade pacing (short ISI-warm up). This phenomenon is slight, and is unlikely to affect saccade performance significantly, but it may provide some insight into the nature of the disorder affecting extraocular and skeletal muscles in myotonic dystrophy.

Controversy continues to surround the monosynaptic and polysynaptic spinal reflexes during the different stages of sleep. In animal studies both of these reflexes were found to be depressed during desynchronized sleep. In humans, the H reflex was unchanged whereas the second component of the nociceptive flexion reflex was increased. However, abolition of the H reflex and F waves during REM sleep has also been reported. The aim of this investigation was to examine the effects of different sleep stages on the polysynaptic nociceptive flexion reflex. Six healthy volunteers were studied. The RIII reflex was studied according to Willer's method (1977) during the different stages of NREM and REM sleep. The RIII reflex threshold was found to increase during stage 2 of NREM sleep. It remained higher during stages 3 and 4. During REM sleep a further increase in the reflex threshold was observed. The reflex latency was prolonged during stage 4 of NREM sleep. There was evidence of further latency prolongation during REM sleep. It was also during REM sleep that the maximum increase in the amplitude and duration of the reflex were recorded.

L-Tryptophan (L-TP) has been used in migraine and other pain conditions. The mechanism underlying the analgesic effect is still partly undefined. In this study the effects of subchronic administration of L-5-hydroxytryptophan (L-5HTP) (with and without carbidopa) on plasma β-endorphin (b-EP) levels and subjective pain threshold and tolerance were investigated in seven healthy volunteers. To measure also an objective indicator of pain, the nociceptive flexion reflex threshold was studied. L-5HTP treatment with and without carbidopa administration increased b-EP levels significantly (p< 0.05). L-5HTP plus carbidopa induced an increase in b-EP significantly (p< 0.05) greater than that induced by L-5HTP alone. Neither the subjective pain threshold and tolerance nor the RIII threshold was modified by either treatment. Our data seem to point to the existence of a complex linkage between plasma opioid levels and pain perception.

In this study, the 24-hour pattern of blood pressure (BP), heart rate, and urinary catecholamine (CA) excretion and the response of BP and plasma CA to the tilt test have been investigated in 13 untreated patients affected by Parkinson's disease (PD) and in 11 age-matched healthy controls. Seven of the 13 PD subjects showed a fall of supine systolic BP greater than that in controls (ie, exceeding 20 of the preprandial value). A significant relationship was found in the PD group between the degree of postprandial hypotension and the 24-hour mean value of dopamine excretion. Eight PD subjects also showed orthostatic hypotension during the tilt test (performed in the morning hours) and in the postprandial phase. Basal norepinephrine plasma levels of PD patients, as well as their percentage increases on standing, were within the range of the controls. These data suggest the existence of a subtype of PD patient, characterized by a widespread impairment of cardiovascular responsiveness and bordering on syndromes of autonomic failure such as progressive autonomic failure or multiple system atrophy, or both.

Two groups of patients affected by Parkinson's disease (PD) were studied by electroretinography during dark adaptation (AERG) and visual evoked potentials (VEPs): nine patients had never been treated before and 31 were on therapy with L-Dopa plus Carbidopa. A significant reduction in amplitude of the 'b1' wave and 'a' wave and a significant delay of P1 wave with reduction of N1-P1 amplitude in VEPs were observed in both groups. A relationship between AERG and VEP alterations was found only in the group of patients treated with L-Dopa plus Carbidopa (p<0.02) and in the total group (p<0.05). Moreover, the degree of electrophysiological abnormalities was neither related to the severity of disease, nor to the duration of therapy and dosage. Retinal dysfunction in PD may be related to neurotransmitter abnormalities observed in this condition.

In a double-blind, parallel-group randomised trial of 3 months’ duration, the efficacy of cyclandelate 800mg twice daily in migraine prophylaxis was compared with that of flunarizine 5mg daily in 40 patients. In comparison with placebo and baseline values, both drugs significantly relieved symptoms of migraine as assessed by indices of pain total index, headache index, analgesic consumption and number of migraine days. Patients taking flunarizine experienced side effects such as drowsiness, weight gain and asthenia, while the most common complaint reported with cyclandelate was gastric upset. These results suggest that cyclandelate may be a useful alternative in migraine pro-phylaxis. Une étude randomisée en double-insu avec groupes parallèles, d’une durée de 3 mois, a permis de comparer l’efficacité du cyclandélate (800 mg deux fois par jour) à celle de la flunarizine (5 mg par jour) dans la prophylaxie de la migraine chez 40 patients. Par rapport au placebo et aux valeurs de base, les deux médicaments ont significativement réduit les symptômes migraineux évalués par l’index total de la douleur, l’index de céphalée, la consommation d’analgésiques et le nombre de jours de migraine. Les patients traités par la flunarizine ont présenté des effets secondaires à type de somnolence, de gain de poids et d’asthénie alors que les troubles gastriques ont été les principales manifestations indésirables observées sous cyclandélate. Ces résultats permettent de penser que le cyclandélate peut constituer une alternative utile dans le traitement prophylactique de la migraine. In un gruppo di ricerche randomizzate a doppio cieco délia durata di 3 mesi, su 40pazienti, l’efficacia di un trattamento con 800 mg di ciclandelato due volte al giorno nella profilassi dell’emicrania, venne paragonata a quella della flunarizina alla dose di 5 mg al giorno. Ambedue i farmaci, paragonati con il placebo ed i valori di base, hanno evidenziato in maniera significativa che i sintomi di emicrania erano valutabili dall’indice totale di sofferenza, dall’Vindice di cefalea, dal consumo di analgesico e dalla durata-giorni dell’emicrania. I pazienti trattati con flunarizina ebbero effetti collaterali quali sonnolenza, aumento di peso ed astenia, mentre il disturbo più comune lamentato dai pazienti trattati con il ciclandelato era insofferenza gastrica. Questi risultati suggeriscono che il ciclandelato può rappresentare un’ utile alternativa nella profilassi dell’emicrania. In een 3 maanden durende aselecte Studie met 40 patiënten werd de effectiviteit van cyclandelaat, toegediend in doses van 2 maal 800 mg per dag, vergeleken met die van flunarizine, 5 mg per dag, bij de profylaxe van migraine. In vergelijking met de placebo- en uit-gangswaarden was er bij beide geneesmiddelen een signiflcante vermindering van de migrai-nesymptomen waar te nemen. Dat blijkt uit de scores van de globale pijnindex, de hoofdpijn index, het analgeticagebruik en het aantal migrainedagen. Proefpersonen die flunarizine toegediend kregen, rapporteerden bijwerkingen zoals slaperigheid, gewichtstoename en asthenie. Bij het gebruik van cyclandelaat werden maagklachten als meest voorkomend gemeld. Deze resultaten duiden er op dat cyclandelaat een waardevol alternatief kan zijn bij de profylaxe van migraine.

Abstract: We evaluated insulin receptor activity on mononuclear leucocytes and erythrocytes in 9 patients with myotonic dystrophy and in 9 controls. The results demonstrated that in myotonic dystrophy:

We conducted a retrospective study of 150 patients with chronic daily headache (CDH) to determine how to categorize their headache according to the classification of the International Headache Society (IHS). All patients were first evaluated at Parma and Pavia Headache Centres (from January 1992 to March 1993) and had had headache for at least 15 days a month during the previous 6 months. Four patients were thereafter excluded due to poor reliability. The 146 patients who met our CDH criteria (92 with and 54 without clear-cut migraine attacks) could be classified into four groups: (i) chronic tension-type headache (CTTH)-27 patients; (ii) coexisting migraine plus CTTH-65 patients; (iii) unclassifiable daily headache-27 patients; and (iv) migraine and an unclassifiable interval headache-27 patients. Seventy-two percent of patients with CDH had migraine as the initial form of their headache. We therefore propose to revise the IHS classification for migraine, taking into account its evolution, and add two subcategories, migraine with interparoxysmal headache and chronic migraine.

L-Tryptophan (L-TP) has been used in migraine and other pain conditions. The mechanism underlying the analgesic effect is still partly undefined. In this study the effects of subchronic administration of L-5–hydroxy-tryptophan (L-5HTP) (with and without carbidopa) on plasma ß-endorphin (ß-EP) levels and subjective pain threshold and tolerance were investigated in seven healthy volunteers. To measure also an objective indicator for pain, the nociceptive flexion reflex threshold was studied. L-5HTP treatment with and without carbidopa administration increased ß-EP levels significantly (p < 0.05). L-5HTP plus carbidopa induced an increase in ß-EP significantly (p < 0.05) higher than that after L-5HTP alone. Neither subjective pain threshold and tolerance nor RIII threshold was modified by either treatment. Our data seem to point to the existence of a complex linkage between plasma opioid levels and pain perception.

According to International Headache Society classification criteria, the presence of pericranial muscle disorder in tension-type headache should be evaluated using one of the following methods: EMG, pressure algometry or manual palpation. The purpose of this study was to compare the results of these three methods in 15 patients with episodic tension-type headache, 29 with chronic tension-type headache and 22 presenting migraine without aura compared to those obtained in healthy individuals. Algometric and EMG recordings at the frontalis muscle during mental arithmetic were more impaired in episodic and chronic tension headache patients than in controls and migraine patients. Chronic tension headache patients were significantly impaired at the trapezius muscle in all three tests compared to controls. Our data indicate that when two or three tests were carried out the diagnostic capacity was significantly improved in comparison to only one test. Moreover, since a different pattern could be seen with pain and without pain, the existence of headache at the time of testing should be taken into consideration.

The case of a 24-year-old man with diabetes mellitus, diabetes insipidus, multisensory deficits and peripheral neuropathy is discussed.

Sixteen cerebrospinal fluid (CSF) specimens serially obtained during long-term follow-up of two patients with Devic's neuromyelitis optica (DNO) were compared with 65 CSF samples from patients with multiple sclerosis (MS). By statistical analysis, the CSF profile in DNO was found to differ from that observed in MS, mainly showing pleocytosis, blood-brain barrier damage, and absence of persistent immunoglobulin G synthesis within the central nervous system. Oligoclonal bands, detected with isoelectric focusing, were present in CSF of 92% of the patients with MS, and in three CSF specimens from one patient with DNO during the first 6 months after disease onset. The bands disappeared in two subsequent samples. This finding has never been described in MS. One patient with DNO had an apparent chronic-relapsing course probably due to steroid dependence. The clinical and CSF features of our cases favour the nosographic independence of DNO and MS.

In a case of acute intoxication produced by carbamazepine overdose ataxia and cyclic coma were the salient features. The mechanisms underlying these symptoms are discussed. Some peculiarities such as breathing irregularities and microhematuria are also described.