RESUMEN
BACKGROUND AND PURPOSE: The digiti quinti sign (DQS) consists of a wider angle between the fourth and fifth fingers (ANG) indicative of subtle hemiparesis that has been found interictally in hemiplegic migraine (HM), suggesting a permanent subtle motor dysfunction. The aim of this study was to find a possible cortical origin for the DQS using blood oxygen level dependent (BOLD) functional (f) MRI. METHODS: Eight HM patients and 13 controls entered the cross-sectional study. We examined hand dominance, performed handgrip tests with dynamometry, documented the DQS graphically in two consecutive sessions, and used BOLD-fMRI during a motor task specifically designed to measure the evoked activation in the motor cortex (M1). The brain activation at the symptomatic side was compared with the contralateral hemisphere and with both correspondent hemispheres in controls. RESULTS: Subjects had a normal neurological examination, except for DQS in all HM patients. The activation amplitude (beta values) and the cluster extension (mm3 ) of the activation area in M1 was smaller at the affected side. Besides, the cluster extension correlated negatively with the disease time span. The ANG was wider bilaterally in patients and the fMRI signals were reduced in the patient's group. CONCLUSION: The DQS, a relevant clinical finding in HM, indicates a disrupted cortical activation.
Asunto(s)
Imagen por Resonancia Magnética , Migraña con Aura , Estudios Transversales , Fuerza de la Mano , Hemiplejía , Humanos , Imagen por Resonancia Magnética/métodosRESUMEN
OBJECTIVE: To evaluate the efficacy of lasmiditan (LTN) in treating migraine attacks of mild vs. moderate or severe pain intensity. METHODS: Pooled data from two single-attack, placebo-controlled studies (SAMURAI [NCT02439320] and SPARTAN [NCT02605174]), and a prospective, randomized, open-label study (GLADIATOR [NCT02565186]) were assessed. Efficacy measures included the proportion of attacks with 2-h pain freedom (PF), 2-h most bothersome symptom (MBS) freedom, and 24-h sustained pain freedom (SPF). Fisher's exact test was used to compare the proportion of PF, SPF, or MBS freedom outcomes among attacks treated at mild, moderate, or severe pain. RESULTS: In SAMURAI and SPARTAN, most treated attacks were of moderate (N = 2768) or severe (N = 1147) intensity, compared to mild (N = 65). Numerically greater 2-h PF and 24-h SPF response rates were observed in attacks treated at mild compared to moderate or severe pain. Analysis of GLADIATOR data included 273 (1.5%), 11,644 (65.1%), and 5948 (33.3%) attacks treated when pain was mild, moderate, and severe, respectively. In general, a significantly greater proportion of attacks treated at mild pain achieved 2-h PF and MBS freedom, as well as 24-h SPF. The incidence of treatment-emergent adverse events in LTN treatment groups were similar regardless of baseline head pain intensity. CONCLUSIONS: Data from two placebo-controlled, single-attack trials, and an open-label study including treatment of multiple attacks, suggested a tendency to relatively better efficacy outcomes when LTN treatment was initiated at mild vs. moderate to severe pain. Further research is needed to better understand the relationship of lasmiditan outcomes to the time of administration in the course of a migraine attack.
Asunto(s)
Trastornos Migrañosos , Agonistas de Receptores de Serotonina , Benzamidas , Método Doble Ciego , Cefalea , Humanos , Trastornos Migrañosos/tratamiento farmacológico , Piperidinas , Estudios Prospectivos , Piridinas , Resultado del TratamientoRESUMEN
In this manuscript we pay a tribute to Pierre Marie (1853-1940), highlighting his great contribution to medicine and neurology describing several diseases and syndromes. We mainly emphasize aspects of his personal life and personality traits. Considered one of the three greatest neurologists of the late nineteenth and early twentieth centuries, his brilliant career began at La Salpêtrière, followed by the development of a neurological school at Hospice Bicêtre. Pierre Marie had numerous disciples around the world, including Brazil, and published on various neurological and endocrinological themes. Back to La Salpêtrière, he concluded his professional life as a Neurology leader. However, after retirement, his demise was sad and lonely.
Asunto(s)
Neurólogos/historia , Neurología/historia , Francia , Historia del Siglo XIX , Historia del Siglo XX , Humanos , MasculinoRESUMEN
ABSTRACT In this manuscript we pay a tribute to Pierre Marie (1853-1940), highlighting his great contribution to medicine and neurology describing several diseases and syndromes. We mainly emphasize aspects of his personal life and personality traits. Considered one of the three greatest neurologists of the late nineteenth and early twentieth centuries, his brilliant career began at La Salpêtrière, followed by the development of a neurological school at Hospice Bicêtre. Pierre Marie had numerous disciples around the world, including Brazil, and published on various neurological and endocrinological themes. Back to La Salpêtrière, he concluded his professional life as a Neurology leader. However, after retirement, his demise was sad and lonely
RESUMO Neste manuscrito, prestamos homenagem a Pierre Marie (1853-1940), destacando sua grande contribuição para a medicina e a neurologia, descrevendo várias doenças e síndromes. Enfatizamos principalmente aspectos de sua vida pessoal e traços de personalidade. Considerado um dos três maiores neurologistas do final do século XIX e início do século XX, sua brilhante carreira começou em La Salpêtrière, seguida pelo desenvolvimento de uma escola de neurologia no Hospice Bicêtre. Pierre Marie teve numerosos discípulos em todo o mundo, incluindo o Brasil, e publicou sobre vários temas neurológicos e endocrinológicos. De volta a La Salpêtrière, ele concluiu sua vida profissional como líder da Neurologia. Porém, após aposentadoria, seu ocaso foi triste e solitário
Asunto(s)
Humanos , Masculino , Historia del Siglo XIX , Historia del Siglo XX , Neurólogos/historia , Neurología/historia , FranciaRESUMEN
OBJECTIVE: Facial nerve injury, affecting mainly the marginal mandibular branch, is the most frequent neurologic complication from parotidectomy. To test a modified Sunnybrook Facial Grading System as a new tool to assess the facial nerve function following parotidectomy, emphasizing the marginal mandibular branch. METHODS: We reviewed the medical records of 73 post-parotidectomy patients (40 female, 18-84 years old, mean age 53.2 years) with facial nerve sparing, referred to the Department of Physical Therapy. All patients had parotid neoplasms or advanced skin cancer, and were followed by the principal author between 2006 and 2014. RESULTS: The muscles innervated by the marginal mandibular branch were the most frequently affected (72.6%), particularly in patients undergoing neck dissection (p = 0.023). The voluntary movement scores obtained with the modified system were significantly lower compared with the original version (p < 0.001). The best and worst scores were observed in patients with benign parotid tumors and skin cancer, respectively. Patients requiring neck dissection (p = 0.031) and resection of other structures (p = 0.021) had the lowest scores, evidenced only with the modified version. Patients with malignant tumors had significantly worse ratings, regardless of the Sunnybrook system version. The post-physiotherapy analysis involved 50 patients. The worst facial rehabilitation outcomes were related to the marginal mandibular branch function. CONCLUSION: The modified Sunnybrook Facial Grading System improved the marginal mandibular branch assessment, preserving the evaluation of other facial nerve branches.
Asunto(s)
Traumatismos del Nervio Facial/diagnóstico , Nervio Facial/cirugía , Neoplasias de la Parótida/cirugía , Neoplasias Cutáneas/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Nervio Facial/fisiopatología , Traumatismos del Nervio Facial/etiología , Traumatismos del Nervio Facial/fisiopatología , Traumatismos del Nervio Facial/cirugía , Parálisis Facial/etiología , Parálisis Facial/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Glándula Parótida/cirugía , Neoplasias de la Parótida/fisiopatología , Evaluación del Resultado de la Atención al Paciente , Complicaciones Posoperatorias , Estudios Retrospectivos , Neoplasias Cutáneas/fisiopatología , Procedimientos Quirúrgicos Operativos/métodos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Duchenne de Boulogne is known mainly by the disease eponymously named "Duchenne muscular dystrophy", or pseudohypertrophic muscular dystrophy, although some experts consider that the original description of this disease does not belong to him. Less well known are the facts related to the tragic death of his beloved wife shortly after the birth of his only child, the unjustifiable distance he was forced to keep from this son for more than 30 years, and of being humiliated and professionally despised by his peers. These events made the life of this physician, physiologist, researcher and inventor extremely arduous. We emphasize some aspects of the history of this man, his work and his life, a true genius of few friends.
Asunto(s)
Electrofisiología/historia , Neurología/historia , Francia , Historia del Siglo XIX , Distrofia Muscular de Duchenne/historiaRESUMEN
ABSTRACT Facial nerve injury, affecting mainly the marginal mandibular branch, is the most frequent neurologic complication from parotidectomy. Objective To test a modified Sunnybrook Facial Grading System as a new tool to assess the facial nerve function following parotidectomy, emphasizing the marginal mandibular branch. Methods We reviewed the medical records of 73 post-parotidectomy patients (40 female, 18-84 years old, mean age 53.2 years) with facial nerve sparing, referred to the Department of Physical Therapy. All patients had parotid neoplasms or advanced skin cancer, and were followed by the principal author between 2006 and 2014. Results The muscles innervated by the marginal mandibular branch were the most frequently affected (72.6%), particularly in patients undergoing neck dissection (p = 0.023). The voluntary movement scores obtained with the modified system were significantly lower compared with the original version (p < 0.001). The best and worst scores were observed in patients with benign parotid tumors and skin cancer, respectively. Patients requiring neck dissection (p = 0.031) and resection of other structures (p = 0.021) had the lowest scores, evidenced only with the modified version. Patients with malignant tumors had significantly worse ratings, regardless of the Sunnybrook system version. The post-physiotherapy analysis involved 50 patients. The worst facial rehabilitation outcomes were related to the marginal mandibular branch function. Conclusion The modified Sunnybrook Facial Grading System improved the marginal mandibular branch assessment, preserving the evaluation of other facial nerve branches.
RESUMO A lesão do nervo facial é a principal complicação neurológica relacionada às parotidectomias e, em geral, o ramo marginal mandibular é o mais frequentemente acometido. Objetivo Testar um Sistema Sunnybrook de Graduação Facial modificado (mS-FGS) como uma nova ferramenta para avaliar a função do nervo facial após a parotidectomia, enfatizando o ramo marginal mandibular. Métodos Estudo retrospectivo, baseado em prontuários de 73 casos (40 do sexo feminino, 18-84 anos, idade média = 53,2), submetidos à parotidectomia, com preservação do nervo facial. Todos os pacientes apresentavam neoplasias parotídeas ou câncer de pele avançado, e foram tratados pela autora principal entre 2006 e 2014. Resultados Neste estudo, os músculos inervados pelo ramo marginal mandibular foram os mais acometidos (72,6% dos casos), principalmente nos pacientes que realizaram esvaziamento cervical (p = 0,023). Os Escores de Movimento Voluntário obtidos pelo sistema modificado foram inferiores aos obtidos pelo original (p < 0,001). As melhores pontuações foram observadas em pacientes com tumores benignos parotídeos e os piores resultados, naqueles com câncer de pele. Pacientes que necessitaram de esvaziamento cervical e ressecção de outras estruturas, além da parótida, apresentaram escores menores (p = 0,031 e p = 0,021), evidenciados apenas pelo sistema modificado. Os tumores malignos geraram escores significativamente menores, independentemente do instrumento empregado. A análise pós fisioterapia envolveu 50 casos. Os piores resultados, após a intervenção fisioterapêutica, também foram observados nos músculos inervados pelo ramo marginal mandibular. Conclusão A avaliação da disfunção facial pós-parotidectomia, através do Sistema Sunnybrook com a modificação proposta permitiu uma apreciação mais detalhada do ramo marginal mandibular, sem prejuízo à avaliação dos demais ramos.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Neoplasias Cutáneas/cirugía , Neoplasias de la Parótida/cirugía , Traumatismos del Nervio Facial/diagnóstico , Nervio Facial/cirugía , Glándula Parótida/cirugía , Complicaciones Posoperatorias , Neoplasias Cutáneas/fisiopatología , Procedimientos Quirúrgicos Operativos/métodos , Neoplasias de la Parótida/fisiopatología , Encuestas y Cuestionarios , Estudios Retrospectivos , Traumatismos del Nervio Facial/cirugía , Traumatismos del Nervio Facial/etiología , Traumatismos del Nervio Facial/fisiopatología , Nervio Facial/fisiopatología , Parálisis Facial/etiología , Parálisis Facial/fisiopatología , Evaluación del Resultado de la Atención al PacienteRESUMEN
ABSTRACT Duchenne de Boulogne is known mainly by the disease eponymously named "Duchenne muscular dystrophy", or pseudohypertrophic muscular dystrophy, although some experts consider that the original description of this disease does not belong to him. Less well known are the facts related to the tragic death of his beloved wife shortly after the birth of his only child, the unjustifiable distance he was forced to keep from this son for more than 30 years, and of being humiliated and professionally despised by his peers. These events made the life of this physician, physiologist, researcher and inventor extremely arduous. We emphasize some aspects of the history of this man, his work and his life, a true genius of few friends.
RESUMO Duchenne de Boulogne é conhecido por muitos principalmente devido à doença que leva seu nome - doença de Duchenne ou Distrofia Muscular Pseudo-hipertrófica - embora alguns historiadores considerem que a descrição original desta doença não lhe pertence. Menos conhecidos são os fatos relacionados à morte trágica de sua amada esposa logo após o nascimento de seu filho, o afastamento injusto que foi forçado a manter deste filho único por mais de 30 anos, e ser humilhado e profissionalmente desprezado por seus pares da comunidade neurológica, que em conjunto tornaram a vida desse médico, fisiologista, pesquisador e inventor, extremamente árdua. Enfatizamos alguns aspectos da história deste homem, seu trabalho e ocaso, protótipo de um verdadeiro gênio de poucos amigos.
Asunto(s)
Historia del Siglo XIX , Electrofisiología/historia , Neurología/historia , Distrofia Muscular de Duchenne/historia , FranciaRESUMEN
Charles Lasègue is reputed to have described the test/sign bearing his name, but he never wrote about it and misinterpreted its mechanism. The purpose of this note is to highlight the work of the Serbian, Laza Lazarevic, who was first to present the original report of this seminal sign in sciatica and provide its appropriate pathophysiological interpretation.
Asunto(s)
Técnicas de Diagnóstico Neurológico/historia , Ciática/historia , Francia , Historia del Siglo XIX , SerbiaRESUMEN
ABSTRACT Charles Lasègue is reputed to have described the test/sign bearing his name, but he never wrote about it and misinterpreted its mechanism. The purpose of this note is to highlight the work of the Serbian, Laza Lazarević, who was first to present the original report of this seminal sign in sciatica and provide its appropriate pathophysiological interpretation.
RESUMO Charles Lasègue guarda a reputação de ter descrito o sinal que leva seu nome, mas nunca escreveu sobre isso e interpretava erradamente sua etiopatogenia. O propósito desta nota é chamar atenção para o trabalho do sérvio Laza Lazarević, que apresentou a descrição original do sinal mais importante na ciatalgia e forneceu a interpretação apropriada da sua fisiopatologia.
Asunto(s)
Historia del Siglo XIX , Ciática/historia , Técnicas de Diagnóstico Neurológico/historia , Serbia , FranciaRESUMEN
Objective The main goal of this study was to correlate migraine improvement, after prophylactic therapy, with cortical thickness changes. Methods Cortical thickness maps were obtained with magnetic resonance imaging (MRI) from 19 patients with migraine before (first scan) and after (second scan) prophylactic treatment, and these were compared with controls using the FreeSurfer MRI tool. Cortical changes were correlated with the headache index (HI). Results Anincrease incortical thickness was found in the right cuneus and precuneus, somatosensory and superior parietal cortices in both patient scans, compared with the controls. No changes were observed in the left hemisphere. Following correction for multiple comparisons, no areas changed from the first to the second scan. Regression analysis showed a significant negative correlation between the HI improvement and cortical thickness changes in the left posterior cingulate, a region involved with nociception and, possibly, the development of chronic pain. Conclusion There were changes in cortical thickness in patients with migraine relative to controls in areas involved with vision and pain processing. Left posterior cingulate cortical changes correlated with headache frequency and intensity.
Asunto(s)
Giro del Cíngulo/patología , Trastornos Migrañosos/patología , Trastornos Migrañosos/prevención & control , Adulto , Estudios de Casos y Controles , Femenino , Giro del Cíngulo/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Trastornos Migrañosos/diagnóstico por imagen , Método de Montecarlo , Tamaño de los Órganos , Profilaxis Posexposición/métodos , Valores de Referencia , Reproducibilidad de los Resultados , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Resultado del Tratamiento , Adulto JovenRESUMEN
ABSTRACT Objective The main goal of this study was to correlate migraine improvement, after prophylactic therapy, with cortical thickness changes. Methods Cortical thickness maps were obtained with magnetic resonance imaging (MRI) from 19 patients with migraine before (first scan) and after (second scan) prophylactic treatment, and these were compared with controls using the FreeSurfer MRI tool. Cortical changes were correlated with the headache index (HI). Results Anincrease incortical thickness was found in the right cuneus and precuneus, somatosensory and superior parietal cortices in both patient scans, compared with the controls. No changes were observed in the left hemisphere. Following correction for multiple comparisons, no areas changed from the first to the second scan. Regression analysis showed a significant negative correlation between the HI improvement and cortical thickness changes in the left posterior cingulate, a region involved with nociception and, possibly, the development of chronic pain. Conclusion There were changes in cortical thickness in patients with migraine relative to controls in areas involved with vision and pain processing. Left posterior cingulate cortical changes correlated with headache frequency and intensity.
RESUMO Objetivos Correlacionar a melhora de pacientes enxaquecosos após tratamento preventivo com alterações na espessura do córtex cerebral. Métodos Espessura cortical foi determinada a partir de imagens de ressonância magnética (RM)em 19 pacientes com enxaqueca, antes (1ᵃ RM) e após (2ᵃ RM) o tratamento profilático, e comparada com controles, usando o programa FreeSurfer. Mudanças corticais foram correlacionadas com o índice de cefaleia (HI). Resultados O hemisfério direito apresentou aumento da espessura no córtex do cúneus e pré-cúneus, parietal superior e somatossensitivo na primeira RM e na segunda RM, em comparação aos controles. Após correção para comparações múltiplas, nenhuma região cortical se mostrou estatisticamente diferente entre a primeira e a segunda RM. A regressão mostrou correlação (negativa) significativa entre melhora do HI e mudanças na espessura cortical do cíngulo posterior esquerdo. Conclusão Existem alterações de espessura cortical em pacientes com enxaqueca em relação a controles em áreas envolvidas com processamento visual e com a dor. As alterações corticais no cíngulo posterior esquerdo variaram de acordo com a frequência e intensidade das crises.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Giro del Cíngulo/patología , Trastornos Migrañosos/patología , Trastornos Migrañosos/prevención & control , Tamaño de los Órganos , Valores de Referencia , Índice de Severidad de la Enfermedad , Imagen por Resonancia Magnética/métodos , Estudios de Casos y Controles , Método de Montecarlo , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento , Estadísticas no Paramétricas , Profilaxis Posexposición/métodos , Giro del Cíngulo/diagnóstico por imagen , Trastornos Migrañosos/diagnóstico por imagenRESUMEN
In this article, a group of experts in headache management of the Brazilian Headache Society developed through a consensus strategic measurements to treat a migraine attack in both the child and the adult. Particular emphasis was laid on the treatment of migraine in women, including at pregnancy, lactation and perimenstrual period.
Asunto(s)
Consenso , Trastornos Migrañosos/tratamiento farmacológico , Adulto , Brasil , Niño , Femenino , Humanos , Masculino , Trastornos Migrañosos/etiología , Embarazo , Complicaciones del Embarazo/tratamiento farmacológicoRESUMEN
Given that the medial olivocochlear efferent system reduces the amplitude of otoacoustic emissions (OAE), the aim of this study was to establish whether such a pathway is affected in women with migraine and phonophobia by means of OAE suppression testing. In this prospective case-control study, 55 women (29 with migraine and phonophobia and 26 healthy women) were subjected to transient-evoked otoacoustic emission (TEOAE) testing at frequencies from 1 to 4 kHz. The amplitudes of the TEOAE response before and after exposure to contralateral noise and the magnitude of TEOAE suppression were assessed. The average TEOAE amplitudes in conditions with and without exposure to contralateral noise were not significantly different between the groups. However, the magnitude of TEOAE suppression was lower in the group with migraine; that difference was only statistically significant for frequencies 1 and 1.5 kHz (p = 0.042 and p = 0.004, respectively). In this study, women with migraine and phonophobia exhibited deficits in OAE suppression, which points to a disorder affecting the medial olivocochlear efferent system.
Asunto(s)
Hiperacusia/fisiopatología , Trastornos Migrañosos/fisiopatología , Emisiones Otoacústicas Espontáneas/fisiología , Estimulación Acústica , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Lateralidad Funcional , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Psicoacústica , Adulto JovenRESUMEN
BACKGROUND: Jumping to conclusions due to impulsivity has been shown to be a sensitive marker for dopamine dysregulation and addictive behaviour patterns in treated patients with Parkinson's disease (PD). It is unknown whether drug naïve PD patients, who have never received dopaminergic therapy also have deficits in information sampling. METHODS: Twenty five de novo PD patients and twenty matched healthy controls were recruited and tested on the beads task, which is a validated information sampling task to assess reflection impulsivity and a temporal discounting questionnaire. RESULTS: Patients gathered significantly less information and made more irrational choices than matched controls. There was, however, no group difference on the temporal discounting questionnaire. CONCLUSIONS: Poor information sampling and irrational decision making may be an inherent component of the neuropsychological deficit in Parkinson's disease. These findings suggest that underlying impulsivity detected by a metric task is common in de novo PD.
Asunto(s)
Descuento por Demora/fisiología , Conducta Impulsiva/fisiología , Enfermedad de Parkinson/fisiopatología , Adulto , Anciano , Análisis de Varianza , Estudios de Casos y Controles , Conducta de Elección , Femenino , Humanos , Masculino , Escala del Estado Mental , Persona de Mediana Edad , Pruebas Neuropsicológicas , Desempeño Psicomotor , Encuestas y CuestionariosRESUMEN
Vertigo symptoms and subclinical vestibular dysfunctions may occur in migraine. The Minimal Caloric Test (MCT), an easy-to-perform, convenient and yet informative procedure was used to test the vestibular function in 30 vertigo-free migraine patients outside attacks and 30 paired controls. Although not statistically significant, a right-to-left nystagmus duration asymmetry greater than 25% was present in both groups. This difference was greater in the patients group, suggesting the presence of subclinical vestibular imbalance in migraine.
Asunto(s)
Pruebas Calóricas , Trastornos Migrañosos/complicaciones , Vértigo/etiología , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vértigo/diagnóstico , Adulto JovenRESUMEN
ABSTRACT In this article, a group of experts in headache management of the Brazilian Headache Society developed through a consensus strategic measurements to treat a migraine attack in both the child and the adult. Particular emphasis was laid on the treatment of migraine in women, including at pregnancy, lactation and perimenstrual period.
RESUMO Neste artigo um grupo de especialistas no tratamento de cefaleia da Sociedade Brasileira de Cefaleia através de um consenso elaborou medidas estratérgicas para tratar uma crise de migrânea tanto na criança como no adulto. Uma enfase particular foi dada no tratamento da migranea na mulher, incluindo gravidez, lactação e período perimenstrual.
Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Niño , Adulto , Consenso , Trastornos Migrañosos/tratamiento farmacológico , Complicaciones del Embarazo/tratamiento farmacológico , Brasil , Trastornos Migrañosos/etiologíaRESUMEN
ABSTRACT Vertigo symptoms and subclinical vestibular dysfunctions may occur in migraine. The Minimal Caloric Test (MCT), an easy-to-perform, convenient and yet informative procedure was used to test the vestibular function in 30 vertigo-free migraine patients outside attacks and 30 paired controls. Although not statistically significant, a right-to-left nystagmus duration asymmetry greater than 25% was present in both groups. This difference was greater in the patients group, suggesting the presence of subclinical vestibular imbalance in migraine.
RESUMO Vertigem e alterações vestibulares subclínicas têm sido identificadas na enxaqueca. O teste calórico mínimo é simples de realizar, informativo e conveniente. Ele foi realizado em 30 pacientes com enxaqueca sem queixa de vertigem e 30 controles pareados. Embora não estatisticamente significativo, ocorreu assimetria direita-esquerda superior a 25% na duração do nistagmo em ambos os grupos, maior nos pacientes, o que sugere a presença de desequilíbrio vestibular subclínico na enxaqueca.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Pruebas Calóricas , Vértigo/etiología , Trastornos Migrañosos/complicaciones , Estudios de Casos y Controles , Vértigo/diagnósticoRESUMEN
Migraine and vertigo are common disorders, with lifetime prevalences of 16% and 7% respectively, and co-morbidity around 3.2%. Vestibular syndromes and dizziness occur more frequently in migraine patients. We investigated bedside clinical signs indicative of vestibular dysfunction in migraineurs. Objective To test the hypothesis that vestibulo-ocular reflex, vestibulo-spinal reflex and fall risk (FR) responses as measured by 14 bedside tests are abnormal in migraineurs without vertigo, as compared with controls. Method Cross-sectional study including sixty individuals – thirty migraineurs, 25 women, 19-60 y-o; and 30 gender/age healthy paired controls. Results Migraineurs showed a tendency to perform worse in almost all tests, albeit only the Romberg tandem test was statistically different from controls. A combination of four abnormal tests better discriminated the two groups (93.3% specificity). Conclusion Migraine patients consistently showed abnormal vestibular bedside tests when compared with controls.
Enxaqueca e vertigem são desordens comuns, com prevalência de 16% e 7% respectivamente, e comorbidade em torno de 3,2%. Síndromes vestibulares e tonturas ocorrem mais frequentemente em enxaquecosos. Pesquisamos alterações vestibulares utilizando testes de beira-de-leito em enxaquecosos. Objetivo Verificar se as respostas dos reflexos vestíbulo-ocular, vestíbulo-medular e risco de quedas medidas por 14 testes de beira-de-leito são diferentes comparando-se enxaquecosos sem vertigem, e controles. Método Estudo transversal com sessenta pessoas, 30 enxaquecosos; 25 mulheres, 19-60 anos; e trinta controles saudáveis pareados por sexo e idade. Resultados Houve tendência de pior desempenho entre enxaquecosos em quase todos testes, porém apenas o teste de Romberg tandem foi estatisticamente diferente dos controles. Uma combinação de quatro testes anormais discrimina os grupos com especificidade de 93,3%. Conclusão O grupo de enxaquecosos mostrou consistentemente testes vestibulares de beira-de-leito anormais quando comparados a controles.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Trastornos Migrañosos/fisiopatología , Reflejo Anormal/fisiología , Pruebas de Función Vestibular , Enfermedades Vestibulares/diagnóstico , Accidentes por Caídas , Estudios Transversales , Mareo/diagnóstico , Prueba de Impulso Cefálico , Trastornos Migrañosos/complicaciones , Nistagmo Fisiológico , Sistemas de Atención de Punto , Factores de Riesgo , Reflejo Vestibuloocular/fisiología , Estadísticas no Paramétricas , Agudeza Visual , Enfermedades Vestibulares/complicacionesRESUMEN
UNLABELLED: Migraine and vertigo are common disorders, with lifetime prevalences of 16% and 7% respectively, and co-morbidity around 3.2%. Vestibular syndromes and dizziness occur more frequently in migraine patients. We investigated bedside clinical signs indicative of vestibular dysfunction in migraineurs. OBJECTIVE: To test the hypothesis that vestibulo-ocular reflex, vestibulo-spinal reflex and fall risk (FR) responses as measured by 14 bedside tests are abnormal in migraineurs without vertigo, as compared with controls. METHOD: Cross-sectional study including sixty individuals - thirty migraineurs, 25 women, 19-60 y-o; and 30 gender/age healthy paired controls. RESULTS: Migraineurs showed a tendency to perform worse in almost all tests, albeit only the Romberg tandem test was statistically different from controls. A combination of four abnormal tests better discriminated the two groups (93.3% specificity). CONCLUSION: Migraine patients consistently showed abnormal vestibular bedside tests when compared with controls.