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Background The PRESTO study of non-invasive vagus nerve stimulation (nVNS; gammaCore®) featured key primary and secondary end points recommended by the International Headache Society to provide Class I evidence that for patients with an episodic migraine, nVNS significantly increases the probability of having mild pain or being pain-free 2 h post stimulation. Here, we examined additional data from PRESTO to provide further insights into the practical utility of nVNS by evaluating its ability to consistently deliver clinically meaningful improvements in pain intensity while reducing the need for rescue medication. Methods Patients recorded pain intensity for treated migraine attacks on a 4-point scale. Data were examined to compare nVNS and sham with regard to the percentage of patients who benefited by at least 1 point in pain intensity. We also assessed the percentage of attacks that required rescue medication and pain-free rates stratified by pain intensity at treatment initiation. Results A significantly higher percentage of patients who used acute nVNS treatment (n = 120) vs sham (n = 123) reported a ≥ 1-point decrease in pain intensity at 30 min (nVNS, 32.2%; sham, 18.5%; P = 0.020), 60 min (nVNS, 38.8%; sham, 24.0%; P = 0.017), and 120 min (nVNS, 46.8%; sham, 26.2%; P = 0.002) after the first attack. Similar significant results were seen when assessing the benefit in all attacks. The proportion of patients who did not require rescue medication was significantly higher with nVNS than with sham for the first attack (nVNS, 59.3%; sham, 41.9%; P = 0.013) and all attacks (nVNS, 52.3%; sham, 37.3%; P = 0.008). When initial pain intensity was mild, the percentage of patients with no pain after treatment was significantly higher with nVNS than with sham at 60 min (all attacks: nVNS, 37.0%; sham, 21.2%; P = 0.025) and 120 min (first attack: nVNS, 50.0%; sham, 25.0%; P = 0.018; all attacks: nVNS, 46.7%; sham, 30.1%; P = 0.037). Conclusions This post hoc analysis demonstrated that acute nVNS treatment quickly and consistently reduced pain intensity while decreasing rescue medication use. These clinical benefits provide guidance in the optimal use of nVNS in everyday practice, which can potentially reduce use of acute pharmacologic medications and their associated adverse events. Trial registration ClinicalTrials.gov identifier: NCT02686034.

Background Globally, a growing number of children and adolescents are left behind when parents migrate. We investigated the effect of parental migration on the health of left behind-children and adolescents in low-income and middle-income countries (LMICs). Methods For this systematic review and meta-analysis we searched MEDLINE, Embase, CINAHL, the Cochrane Library, Web of Science, PsychINFO, Global Index Medicus, Scopus, and Popline from inception to April 27, 2017, without language restrictions, for observational studies investigating the effects of parental migration on nutrition, mental health, unintentional injuries, infectious disease, substance use, unprotected sex, early pregnancy, and abuse in left-behind children (aged 0–19 years) in LMICs. We excluded studies in which less than 50% of participants were aged 0–19 years, the mean or median age of participants was more than 19 years, fewer than 50% of parents had migrated for more than 6 months, or the mean or median duration of migration was less than 6 months. We screened studies using systematic review software and extracted summary estimates from published reports independently. The main outcomes were risk and prevalence of health outcomes, including nutrition (stunting, wasting, underweight, overweight and obesity, low birthweight, and anaemia), mental health (depressive disorder, anxiety disorder, conduct disorders, self-harm, and suicide), unintentional injuries, substance use, abuse, and infectious disease. We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs) using random-effects models. This study is registered with PROSPERO, number CRD42017064871. Findings Our search identified 10 284 records, of which 111 studies were included for analysis, including a total of 264 967 children (n=106 167 left-behind children and adolescents; n=158 800 children and adolescents of non-migrant parents). 91 studies were done in China and focused on effects of internal labour migration. Compared with children of non-migrants, left-behind children had increased risk of depression and higher depression scores (RR 1·52 [95% CI 1·27–1·82]; SMD 0·16 [0·10–0·21]), anxiety (RR 1·85 [1·36–2·53]; SMD 0·18 [0·11–0·26]), suicidal ideation (RR 1·70 [1·28–2·26]), conduct disorder (SMD 0·16 [0·04–0·28]), substance use (RR 1·24 [1·00–1·52]), wasting (RR 1·13 [1·02–1·24]) and stunting (RR 1·12 [1·00–1·26]). No differences were identified between left-behind children and children of non-migrants for other nutrition outcomes, unintentional injury, abuse, or diarrhoea. No studies reported outcomes for other infectious diseases, self-harm, unprotected sex, or early pregnancy. Study quality varied across the included studies, with 43% of studies at high or unclear risk of bias across five or more domains. nterpretation Parental migration is detrimental to the health of left-behind children and adolescents, with no evidence of any benefit. Policy makers and health-care professionals need to take action to improve the health of these young people.

Fluctuating sex hormone levels during the menstrual cycle have been shown to affect functional cerebral asymmetries (FCAs) in cognitive domains, contributing to sex-related differences in functional cerebral organization. The line-bisection task is usually used to quantify disorders in spatial attention. Respect to spatial representation, it has been demonstrated that men outperform women in spatial analysis of complex auditory scenes. Although the line-bisection task is a rather indirect measure of callosal function, the importance of the corpus callosum in line-bisection, especially of posterior callosal areas, is demonstrated by several studies This study aims to observe whether there is an effect between gender, hormonal components and spatial attention. Thirty-three healthy volunteers (ten women in age of fertility and thirteen women in menopause and ten man) was investigated during a computer based line-bisection task (considering the position 1: central; 2 low distance right; 3 high distance right; 4 low distance left; 5 high distance left). EEG was recorded by 38 scalp electrodes according to the enlarged 10-20 system. A General Linear Model (GLM) was made considering the effect group and the effect of position in Lateralization for the component Amplitude (V) and Latencies (L). Level of significance was fixed at p

Fluctuating sex hormone levels during the menstrual cycle have been shown to affect functional cerebral asymmetries (FCAs) in cognitive domains, contributing to sex-related differences in functional cerebral organization. This study aims to observe changes induced by anodal tDCS in left parietal cortex on performance in a computer based visual line bisection task and event related potentials across menstrual cycle in fertile compared to menopause women. Twenty-three healthy volunteers (ten fertile women and thirteen menopausal women) were investigated. Subjects were submitted to a computer based line-bisection task (position 1: central; 2 low distance on right; 3 high distance on right; 4 low distance on left; 5 high distance on left): baseline (B), sham (S), tDCS (T), which were randomized in three consecutive months. EEG was recorded by 38 scalp electrodes according to the enlarged 10-20 system. Anodal tDCS was performed on the P3 derivation (cathode on left supra orbital site) (20 min 2 mA intensity). The group of fertile women was investigated during follicular, secretive and menstrual phases. Subjects were instructed to press the computer bar soon after the presentation of the subjective judged central position. The positive component in the time interval between 200-400 msec was evaluated by means of Brain Vision Analyzer 2.0, after a visual inspection and rejection of artifact. In basal condition the GLM test showed a significant increase of P300 amplitude (Phase p=0,002; Condition p=0,00; Phase *Conditions p=0,026) related to the 5 (high distance) target on the left hemisphere in the menstrual phase, compared to the secretive and follicular phases (fig.1). After the left parietal TDCS, the P3 amplitude was similar across the different phases and in relation to the different targets, in all the considered EEG derivations related to 5 line position across the different phases (Figure 2). Post hoc analysis (Bonferroni Test) for Left Latence and Amplitude indicated a significant effect in follicular condition (p =0,00), in secretive condition (p=0,00) and in menstrual condition (p=0,00). In menopause group, analyses for Condition showed in all lateralization channel significant values in A and in L (p

Previous studies indicated changes of motor cortex excitability in fibromyalgia (FM) patients and the positive results of transcranial stimulation techniques. The present study aimed to explore the metabolism of motor cortex in FM patients, in resting state and during slow and fast finger tapping, using functional Near-Infrared Spectroscopy (fNIRS), an optical method which detects in real time the metabolism changes in the cortical tissue. We studied 24 FM patients and 24 healthy subjects. We found a significant slowness of motor speed in FM patients compared to controls. During resting state and slow movement conditions, the metabolism of the motor areas was similar between groups. The oxyhemoglobin concentrations were significantly lower in patients than in control group during the fast movement task. This abnormality was independent from FM severity and duration. The activation of motor cortex areas is dysfunctional in FM patients, thus supporting the rationale for the therapeutic role of motor cortex modulation in this disabling disorder.