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Nicola Allegri,1 Federica Rossi,2 Federica Del Signore,2 Paolo Bertazzoni,3 Roberto Bellazzi,4 Giorgio Sandrini,5 Tomaso Vecchi,1 Davide Liccione,1 Alessia Pascale,6 Stefano Govoni6 1Department of Brain and Behavioral Sciences, University of Pavia, 2Pavia and Vigevano Neuropsychological Center for Alzheimer’s Disease, 3”Bertazzoni” Pharmacy General Partnership, Vigevano, 4Nephrology and Dialysis Ward, Civil Hospital of Vigevano, 5C. Mondino National Institute of Neurology Foundation, IRCCS, 6Department of Drug Sciences, Section of pharmacology, University of Pavia, Pavia, Italy Purpose: Correct drug prescription in the elderly is a difficult task that requires careful survey of the current pharmacological therapies. In this article, we reviewed the drug prescriptions provided to 860 persons aged 65 years or over, residing in a small city of Lombardy, Italy.Methods: Subjects were recruited from a local nursing home, the Pavia and Vigevano Neuropsychological Center for Alzheimer’s Disease, general practitioners’ offices, and the local University of the Third Age. For each patient, the amount of potentially inappropriate prescriptions (PIPs), sedative and anticholinergic load (SL and AL, respectively), and drug–drug interactions were evaluated.Results: Widespread polypharmacy, giving rise to 10.06% of PIPs in the whole collection of prescriptions, was observed. In particular, PIPs mainly concern drugs acting at the central nervous system level, mostly benzodiazepines and antipsychotics. Moreover, approximately one-fourth of the subjects had an elevated SL and approximately one-tenth a high AL. Drug–drug interactions were frequent (266 requiring medical attention), up to five for each single patient. Of concern was the underuse of antidementia drugs: only 20 patients received a cholinesterase inhibitor or memantine, although 183 patients were potentially suitable for this treatment.Conclusion: These results demonstrate the need to develop novel strategies aimed at improving the quality of drug prescription. Keywords: drug prescription, elderly, Beers criteria, drug–drug interactions, sedative load

Stefano Tamburin,1 Stefano Paolucci,2 Francesca Magrinelli,1 Massimo Musicco,2,3 Giorgio Sandrini4,5 On behalf of the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) 1Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, 2Santa Lucia Foundation, IRCCS, Rome, 3Institute of Biomedical Technologies (IBT) National Research Council of Italy (CNR), Segrate, Milan, 4C. Mondino National Institute of Neurology Foundation, IRCCS, 5Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy Abstract: Pain is very common in the neurorehabilitation setting, where it may not only represent a target for treatment but can also negatively influence rehabilitation procedures directly or through the side effects of painkillers. To date, there are neither guidelines nor consensus on how to assess and treat pain in neurorehabilitation. Because of the very scanty pieces of evidence on this topic, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) was promoted under the auspices of different scientific societies. This article illustrates the rationale, methodology, and topics of the ICCPN. The recommendations of the ICCPN will offer some information on how to deal with pain in neurorehabilitation and may represent the starting point for further studies.Keywords: assessment, consensus conference, neurology, pain, rehabilitation, treatment

Stefano Tamburin,1 Stefano Paolucci,2 Nicola Smania,1,3 Giorgio Sandrini4,51Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, 2Santa Lucia Foundation, IRCCS, Rome, 3Neuromotor and Cognitive Rehabilitation Research Centre, University of Verona, Verona, 4C. Mondino National Institute of Neurology Foundation, IRCCS, 5Department of Brain and Behavioural Sciences, University of Pavia, Pavia, ItalyOn behalf of the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN)Pain is one of the most common reasons for seeking medical attention. When chronic, it diminishes self-perceived health status, interferes with everyday activities, lowers productivity, and affects personal relationships.

BackgroundSystemic nitroglycerin (NTG) activates brain nuclei involved in nociceptive transmission as well as in neuroendocrine and autonomic functions in rats. These changes are considered relevant for migraine because NTG consistently provokes spontaneous-like migraine attacks in migraineurs. Several studies have suggested a relationship between the endocannabinoid levels and pain mediation in migraine. URB937, a peripheral inhibitor of fatty acid amide hydrolase (FAAH)-the enzyme that degrades anandamide, produces analgesia in animal models of pain, but there is no information on its effects in migraine.AimWe evaluated whether URB937 alters nociceptive responses in the animal model of migraine based on NTG administration in male rats, using the tail flick test and the plantar and orofacial formalin tests, under baseline conditions and after NTG administration. Furthermore, we investigated whether URB937 affects NTG-induced c-Fos expression in the brain.ResultsDuring the tail flick test, URB937 showed an antinociceptive effect in baseline conditions and it blocked NTG-induced hyperalgesia. URB937 also proved effective in counteracting NTG-induced hyperalgesia during both the plantar and orofacial formalin tests. Mapping of brain nuclei activated by NTG indicates that URB937 significantly reduces c-Fos expression in the nucleus trigeminalis caudalis and the locus coeruleus.ConclusionsThe data suggest that URB937 is capable of changing, probably via indirect mechanisms, the functional status of central structures that are important for pain transmission in an animal model of migraine.

Byline: Hans-Christoph Diener (1), P. Tfelt-Hansen (2), C. Dahlof (3), M. J. A. Lainez (4), G. Sandrini (5), Sh.-J. Wang (6), W. Neto (7), U. Vijapurkar (7), A. Doyle (7), D. Jacobs (7) Keywords: placebo--controlled; migraine; topiramate; prophylaxis; propranolol Abstract: Abstract. Topiramate (TPM) has shown efficacy in migraine prophylaxis in two large placebo--controlled, dose--ranging trials. We conducted a randomised, doubleblind, multicentre trial to evaluate the efficacy and safety of two doses of topiramate vs placebo for migraine prophylaxis, with propranolol (PROP) as an active control. Subjects with episodic migraine with and without aura were randomised to TPM 100 mg/d, TPM 200 mg/d, PROP 160 mg/d (active control), or placebo. The primary efficacy measure was the change in mean monthly migraine frequency from the baseline phase relative to the double--blind treatment phase. Five hundred and seventy--five subjects were enrolled from 61 centres in 13 countries. TPM 100 mg/d was superior to placebo as measured by reduction in monthly migraine frequency, overall 50% responder rate, reduction in monthly migraine days, and reduction in the rate of daily rescue medication use. The TPM 100 mg/d and PROP groups were similar with respect to reductions in migraine frequency, responder rate, migraine days, and daily rescue medication usage. TPM 100 mg/d was better tolerated than TPM 200 mg/d, and was generally comparable to PROP. No unusual or unexpected safety risks emerged. These findings demonstrate that TPM 100 mg/d is effective in migraine prophylaxis. TPM 100 mg/d and PROP 160 mg/d exhibited similar efficacy profiles. Author Affiliation: (1) Department of Neurology, University Essen, Hufelandstr 55, 45122, Essen, Germany (2) Department of Neurology, University of Copenhagen Glostrup Hospital, Glostrup, Denmark (3) Gothenburg Migraine Clinic, Gothenburg, Sweden (4) Department of Neurology, Hospital Clinico Universitario University of Valencia, Valencia, Spain (5) Headache Centre IRCC C. Mondino Foundation, University of Pavia, Pavia, Italy (6) Neurological Institute Taipei, Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan (7) Johnson &amp Johnson, Pharmaceutical Research and Development, LLC Raritan, NJ USA Article History: Registration Date: 01/01/2004 Received Date: 02/01/2004 Accepted Date: 08/03/2004

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 [...]