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BACKGROUND AND PURPOSE: The identification of factors associated to health-related quality of life (HRQoL) measures in patients with migraine has major implications in terms of prognosis and treatment. This study aimed at investigating associations between HRQoL and comorbid mood and anxiety disorders. METHODS: Consecutive adult outpatients with a diagnosis of migraine with or without aura were assessed using the Mini International Neuropsychiatric Interview (M.I.N.I.) Plus version 5.0.0 and the Migraine-Specific Quality-of-Life Questionnaire (MSQ). RESULTS: Data of 112 patients (82 females), 69 without aura, mean age 41.2 +/- 13.3 years were analyzed. According to the M.I.N.I., 50% patients had a lifetime or current DSM-IV diagnosis of mood or anxiety disorder. There was no between-groups difference in MSQ total and subscale scores in relation to the presence/absence of psychiatric comorbidity, independently whether that was current or lifetime. In the group of subjects with psychiatric disorders, age at onset of migraine correlated with MSQ-total (rho = -0.407 P = 0.002), and subscale scores (Role Function-Restrictive, rho = -0.397, P = 0.002; Emotional Function, rho = -0.487, P < 0.001). CONCLUSIONS: Our findings suggest that current and/or lifetime psychiatric comorbidities are not associated with HRQoL measures in patients with migraine. However, patients with migraine and psychiatric comorbidities may represent a specific subgroup deserving particular attention for targeted interventions.

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We studied a group of 93 patients who had not previously suffered headache and who were consecutively admitted to the Emergency Department of the hospitals of Novara and Borgomanero, Italy because of a cranial trauma definable as minor according to the current International Headache Society (IHS) criteria. Two weeks after admission, all patients underwent a semi-structured interview which revealed that 24 (25.8%) had headache; 21 of these (22.5% of the original 93 patients) also had headache when they underwent a second interview eight weeks after the traumatic event. These 21 patients were diagnosed as having chronic post-traumatic headache associated with minor cranial trauma (5.2.2 of the IHS classification), and the prevalent clinical pattern of headache presentation was examined with the aim of attributing the fourth IHS classification code number. Eighteen of the 21 patients were found to have a tension-type pattern (5.2.2.2), and the remaining three had migraine (5.2.2.1); none had cluster headache (5.2.2.3). These data demonstrate a large prevalence of tension-type headache in patients with class 5.2.2 post-traumatic headache, and confirm the results of previously published studies that were not based on the diagnostic criteria of the current classification.

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In 20 patients with idiopathic generalized epilepsy who showed typical 3-Hz spike-and-wave (SW) EEG complexes, we studied the corticospinal motor output with a transcranial electromagnetic stimulator. First we measured the corticospinal discharge threshold for both hemispheres in the patient group and compared it with that of 10 age- and sex-matched volunteers. Threshold was significantly higher in the patient group, regardless of whether subjects were treated with antiepileptic drugs (AEDs). In 4 patients with very frequent SW paroxysms, we were able to study motor evoked potential (MEP) changes time-locked to epileptic EEG transients. The EEG signal was recorded bipolarly (C3-P3, C4-P4) by scalp needle-electrodes. For a given stimulus intensity, we collected and measured MEPs occurring during the spike or the wave portion of the SW complexes. Data were compared with those of MEPs obtained time-locked to normal EEG segments. MEP size was significantly decreased when the cortical stimulus was time-locked to the wave component, and was decreased or unchanged when the stimulus was time-locked to the spike. Magnetic stimulation never produced remarkable side effects.

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The purpose of the present study was the evaluation of the excitability threshold and the central motor conduction time (CCT) studied by means of electromagnetic cortical stimulation in ten subjects affected by menstrual migraine without aura, both in the ictal and the interictal period. The patients were chosen from among a group of 254 outpatients affected by migraine, diagnosed according to the International Headache Society criteria. The control group consisted of ten healthy female subjects. As far as CCTs were concerned no differences emerged between patients and controls. However in the patient group we found a significant increase in the excitability threshold values, both in the ictal and the interictal period, and in both hemispheres. If confirmed, the increased excitability threshold may be a useful neurophysiological correlate of migraine without aura.

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We studied the EMG potentials evoked in the bilateral first dorsal interosseus muscle by electromagnetic stimulation of the corticomotoneuronal descending system in 10 Parkinson's disease patients and in 10 age- and sex-matched normal controls. We selected patients who did not have tremor but had predominant rigidity with asymmetric body involvement. On the rigid side of the PD patients, the threshold to cortical stimulation was lower than on the contralateral side or than normal values. On average, patients had normal central conduction times, but their motor evoked potentials (MEPs) on the rigid side were larger than those of controls when the cortical stimulus was at rest or during slight tonic contraction of the target muscle. In the latter condition, a silent period shorter than that of controls followed MEPs, whereas the peripheral silent period following ulnar nerve stimulation at the wrist was prolonged. Alpha motor neuron excitability, tested by the F-wave method, was enhanced on the rigid side at rest. In rigidity, spinal motor nuclei may be more responsive than normal to descending inputs from motor cortex, or the entire corticomotoneuron system may prove hyperexcitable under given conditions.

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We report a case of multiple system atrophy-autonomic failure in which the most interesting features were the uncommon onset of a laryngeal stridor in the absence of orthostatic hypotension and the clinical-nosographic possibilities for the autonomic changes found. The differentiation between autonomic failure and pure autonomic failure and their relationship to multiple system atrophy are still under discussion. We agree with the authors who consider that the absence/presence of orthostatic hypotension may be taken as discriminant for this purpose.

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A single case study of a patient with 'visual form agnosia' is presented. A severe visual recognition deficit was accompanied by impairments in discriminating shape, reflectance, and orientation, although visual acuity and colour vision, along with tactile recognition and intelligence, were largely preserved. Neuropsychological and behavioural investigations have indicated that the patient is able to utilize visual pattern information surprisingly well for the control of hand movements during reaching, and can even read many whole words, despite being unable to make simple discriminative judgements of shape or orientation. She seems to have no awareness of shape primitives through Gestalt grouping by similarity, continuity or symmetry. It is proposed that many of these perceptual disorders might be the combined result of (1) a selective loss of the cortical elaboration of the magnocellular visual processing stream, and (2) a selective output disconnection from a central processor of visual boundaries and shape primitives in the occipital cortex.

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