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Objective: A prospective ultrasound study to analyze nerve size and its modifying factors in type 1 and type 2 diabetes mellitus. Methods: The cross-sectional areas (CSAs) of motor and sensory nerves in both upper and lower limbs were measured at 14 measurement points, using high resolution ultrasound in 26 patients with type 1 and 76 patients with type 2 diabetes, and in 50 control subjects. All diabetic patients underwent electrophysiological assessment to check for the presence of polyneuropathy. Results: Significant mild/moderate diffuse nerve enlargement was demonstrated in type 2 diabetes, more pronounced at compression sites versus non-compression sites, and on the upper limbs versus lower limbs (p value for pooled DM2 v. control group: <0.001). In type 1 diabetes, nerve enlargement was found only at one compression site (median nerve wrist; pâ¯=â¯0.002). No significant difference was found between patients with or without polyneuropathy. Conclusions: The primary predictors of nerve size in diabetes are anatomical location (i.e. compression sites versus non-compression sites, upper versus lower limbs) and type of diabetes. Changes occur before the electrophysiological signs of polyneuropathy are detected. Significance: Nerve ultrasound may contribute to early recognition of the neuropathic complications of diabetes.
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BACKGROUND: Despite its high prevalence, migraine remains underdiagnosed and undertreated. ID-Migraine is a short, self-administrated questionnaire, originally developed in English by Lipton et al. and later validated in several languages. Our goal was to validate the Hungarian version of the ID-Migraine Questionnaire. METHODS: Patients visiting two headache specialty services were enrolled. Diagnoses were made by headache specialists according to the ICHD-3beta diagnostic criteria. There were 309 clinically diagnosed migraineurs among the 380 patients. Among the 309 migraineurs, 190 patients had only migraine, and 119 patients had other headache beside migraine, namely: 111 patients had tension type headache, 3 patients had cluster headache, 4 patients had medication overuse headache and one patient had headache associated with sexual activity also. Among the 380 patients, 257 had only a single type headache whereas 123 patients had multiple types of headache. Test-retest reliability of the ID-Migraine Questionnaire was studied in 40 patients. RESULTS: The validity features of the Hungarian version of the ID-Migraine questionnaire were the following: sensitivity 0.95 (95% CI, 0.92-0.97), specificity 0.42 (95% CI, 0.31-0.55), positive predictive value 0.88 (95% CI, 0.84-0.91), negative predictive value 0.65 (95% CI, 0.5-0.78), missclassification error 0.15 (95% CI, 0.12-0.19). The kappa coefficient of the questionnaire was 0.77. CONCLUSION: The Hungarian version of the ID-Migraine Questionnaire had adequate sensitivity, positive predictive value and misclassification error, but a low specificity and somewhat low negative predictive value.
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Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/epidemiología , Encuestas y Cuestionarios/normas , Traducción , Adulto , Cefalalgia Histamínica/clasificación , Cefalalgia Histamínica/diagnóstico , Cefalalgia Histamínica/epidemiología , Femenino , Cefalea/clasificación , Cefalea/diagnóstico , Cefalea/epidemiología , Cefaleas Secundarias/clasificación , Cefaleas Secundarias/diagnóstico , Cefaleas Secundarias/epidemiología , Humanos , Hungría/epidemiología , Lenguaje , Masculino , Trastornos Migrañosos/clasificación , Reproducibilidad de los Resultados , Cefalea de Tipo Tensional/clasificación , Cefalea de Tipo Tensional/diagnóstico , Cefalea de Tipo Tensional/epidemiologíaAsunto(s)
Síndromes de Compresión Nerviosa/diagnóstico por imagen , Nervio Tibial/diagnóstico por imagen , Nervio Cubital/diagnóstico por imagen , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/fisiopatología , Nervio Tibial/fisiopatología , Nervio Cubital/fisiopatología , UltrasonografíaRESUMEN
BACKGROUND: Migraine affects more than 10% of the Hungarian population, causes significant disability and severely affects patients' generic and condition-specific quality of life. Despite these facts, a significant proportion of patients is not diagnosed and not treated adequately. Headache centres can provide care for only a fraction of all patients. The task of primary care providers would be greatly simplified by a reliable self-administered migraine screening questionnaire. OBJECTIVE: To develop a short and reliable questionnaire as a migraine screening tool. METHODS: Outpatients at the Headache Service, Department of Neurology, Semmelweis University completed a self-administered questionnaire which contained 9 yes/no questions about their headaches' characteristics. The number of 'yes' answers (the patients' total score) was evaluated in connection with the diagnosis based on the International Headache Society criteria. We calculated the sensitivity, specificity, positive and negative predictive value as well as the misclassification rate for each total score value and used these to establish the final cutoff value of the questionnaire. 306 patients (242 females, mean age 39.1 ± 13.3 years) were enrolled. The diagnosis was migraine in 244. RESULTS: Completing the questionnaire did not pose any difficulty for the patients. At a cutoff value of 5 points the questionnaire's sensitivity was 0.96 and specificity was 0.61. The positive predictive value was 0.91 and the negative pre- dictive value was 0.81. The misclassification rate was 0.11. DISCUSSION: Our results show that the questionnaire may help the diagnosis of migraine. In order to use it in medical practice, its further evaluation is necessary on a large representative sample of the Hungarian population.
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Tamizaje Masivo/métodos , Trastornos Migrañosos/diagnóstico , Encuestas y Cuestionarios/normas , Adulto , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Calidad de Vida , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: While examining patients with headache, abnormalities of unknown significance may quite frequently be encountered. In migraine small, subcortical, white matter abnormalities (WMAs) can be visualized by magnetic resonance images. The connection of these WMAs with the migraine is unclear, but some studies report the higher incidence of WMA in migraine. PATIENTS AND METHOD: The authors reviewed the MR scans of their new migraine patients younger than 55 years treated in period of 15 months, and compared the data with a control group. RESULTS: The prevalence of WMA was 10.3% among the migraineurs (78 patients without comorbidities such as hypertension, atherosclerotic heart disease, diabetes mellitus, autoimmune disorder or demyelinating disease) and it was 3.1% in the group of controls (32 persons younger then 55 years, and without migraine or other disease mentioned above). There were patients with WMA both below and above the age of 40; all of them were suffering from migraine without aura with 1 or more attack per month in variable times; none of them had smoked, the majority had not used oral contraceptive, and only a few of them used triptan or ergotamine. CONCLUSION: The data presented here shows that there is a relationship between migraine and WMA. The association of WMA and the risk of following stroke is not cleared. There are well known studies analysing the prevalence of silent infarction too, but we need a long prospective study to answer this question exactly.