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Abstract Introduction Occipital nerve stimulation (ONS) is used to treat therapy-resistant chronic migraine. Clinical use has resulted in a wide intraindividual and interindividual variation of clinical efficacy. The aim of this study was to analyze a potential relationship between sociodemographic variables, headache parameters, perceived sensory quality, perceived sensory location, as well as clinical efficacy. Methods Thirty-two subjects (21.9% male, mean age 45.77 years) suffering from chronic migraine refractory to other treatment and therefore treated with ONS were included in this study. We used a computer-based imaging method for mapping the ONS-induced perceived sensory location, the perceived spatial sensory field size, as well as the perceived sensory quality in a long-term course over 21 months in weekly time intervals. Additionally, the effect of ONS on the migraine headache was documented weekly by the participants using a verbal rating scale. Over the observation period, a total of 808 individual weekly data sets were recorded and a potential relationship between ONS-induced perceptions and headache parameters could be analyzed. Results We found that 48.9% of stimulation intervals were reported as effective by patients. Women displayed a significantly higher responder rate than men. The reported effectiveness did not differ depending on age, the average number of migraine days per month, the MIDAS score, or the duration of the migraine disorder prior to ONS treatment. Implantation with trial period led to significantly lower responder rates than without the trial period. The most frequently perceived sensory quality of “tingling” was found significantly more frequently in non-responders than in responders. Responders displayed significantly lower pleasantness scores for their reported perceptions than non-responders. Sensations that were spatially perceived above the line connecting the external acoustic meati with the external occipital protuberance (MOP line) led to patients reporting a positive clinical effect significantly more frequently than sensations spatially perceived below the MOP line. Spatially small fields of sensory perception were correlated with a higher responder rate than those covering broader areas. Conclusions The ONS-induced sensory location, the size of the spatial sensory field, as well as the sensory quality are significantly correlated with the reported clinical effectiveness. The results suggest that besides surgical technique, the individual and continuous programming of the stimulation parameters is clinically relevant in increasing the therapeutic effectiveness.

In the present case we report about an encephalomeningocele in an adult female. Since the cause of this medical entity is a congenital fusion defect of the neural tube of the cranial base, most of the encephaloceles occurs in children leading to facial disfigurement. In the rare cases described in adults, rhinorrhea is usually present. Here we present a case of temporobasal encephalomeningocele in a 72-year-old female patient suffering from headaches in the last 4-5 years. No rhinorrhea or other significant neurological symptoms were noticed. No congenital cause was apparent. After diagnostic steps including brain magnetic resonance imaging (MRI), cranial computed tomography (CT) and MR cisternography, an encephalomeningocele was diagnosed. Through a pterional approach this was completely removed. The only symptom the patient complaint about, headache, was eliminated after surgery.

Vascular endothelial growth factor (VEGF) is one of the most important angiogenesis factors. In many tumors, VEGF plays a pivotal role for their vascularization and is necessary to supply the malignant tissue with oxygen and nutrients. However, VEGF receptors (VEGFR) have recently been detected also on some tumor cells, and autocrine mitogenic effects of VEGF have been suspected. Since glioma cells are known to produce large amounts of VEGF, we investigated VEGFR-expression and effects of VEGF on glioma cells. The three glioma cell lines and eight glioma cells cultivated from WHO grade IV gliomas investigated strongly expressed VEGF121 and VEGF165, but weakly either VEGFR-1 or -2, sometimes for both, as evidenced by reverse transcription-polymerase chain reaction (RT–PCR) and immunocytochemistry. Quantitative RT–PCR revealed a 1000- to 50-fold lower expression of VEGFR than in cultivated human umbilical vein endothelial cells. In two glioma cell lines analyzed, VEGF induced a weak tyrosine phosphorylation of the VEGFR, but downstream signal transduction effects on the mitogen-activated protein kinases p42/p44 or transcription factors like AP-1 or NFκB were within the background of the methods. In accordance, VEGF or the VEGFR agonists VEGF-D or placenta growth factor (PlGF) did not produce significant effects on glioma cell proliferation or VEGF production. We conclude that despite a low expression of VEGFR in some glioma cells functional effects are low and autocrine growth stimulatory effects within a glioma are minor. [ABSTRACT FROM AUTHOR]

Gliomas are characterized by a deregulation of growth factor production and growth factor receptors expression, e.g. overproduction of the cytokine transforming growth factor-β (TGF-β) and overexpression/constitutive activation of receptors for the epidermal growth factor (EGF). Potential interactions of such growth factors and their signaling cascades could enhance the malignancy of these tumors. Therefore, we investigated the effects of TGF-β and EGF alone and in combination on the proliferation of glioma cells cultivated from eight solid human WHO grade IV gliomas and one glioma cell line, analyzed the expression and intactness of the TGF-β-signaling molecules Samd-4 and -2, and the phosphorylation of the EGF-signaling kinases ERK 1/2. The effects were divergent and complex: Whereas EGF mostly stimulated glioma cell proliferation, TGF-β either enhanced, inhibited or had no significant effect on proliferation. In combination, co-stimulation and inhibition of the EGF-induced mitogenic activity could be observed. Smad-4/-2 were expressed in all glioma cells, one point mutation at base 1595 in Smad-4 did not affect its protein sequence. In part of the glioma cells, reduced phosphorylation of ERK 1/2 and expression of cyclin-dependent kinase inhibitor 1 or p21 was observed in co-stimulation experiments. These experiments show that TGF-β can inhibit EGF-mediated effects only in some gliomas, whereas it enhances it in others. The interaction of both factors is very complex and varies between different gliomas. [ABSTRACT FROM AUTHOR]

Is sexual orientation associated with structural differences in the brain? To address this question, 80 homosexual and heterosexual men and women (16 homosexual men and 15 homosexual women) underwent structural MRI. We used voxel-based morphometry to test for differences in grey matter concentration associated with gender and sexual orientation. Compared with heterosexual women, homosexual women displayed less grey matter bilaterally in the temporo-basal cortex, ventral cerebellum, and left ventral premotor cortex. The relative decrease in grey matter was most prominent in the left perirhinal cortex. The left perirhinal area also showed less grey matter in heterosexual men than in heterosexual women. Thus, in homosexual women, the perirhinal cortex grey matter displayed a more male-like structural pattern. This is in accordance with previous research that revealed signs of sex-atypical prenatal androgenization in homosexual women, but not in homosexual men. The relevance of the perirhinal area for high order multimodal (olfactory and visual) object, social, and sexual processing is discussed.