Showing papers by "Stefan Evers published in 1999"

Dynamic Changes of Cognitive Habituation and Serotonin Metabolism During the Migraine Interval

Abstract: Migraine patients show a specific cognitive processing with a loss of habituation in the interval and a normal habituation in the attack as measured by event-related potentials (ERPs). It is unknow...

The cerebral haemodynamics of music perception. A transcranial Doppler sonography study.

Abstract: The perception of music has been investigated by several neurophysiological and neuroimaging methods. Results from these studies suggest a right hemisphere dominance for non-musicians and a possible left hemisphere dominance for musicians. However, inconsistent results have been obtained, and not all variables have been controlled by the different methods. We performed a study with functional transcranial Doppler sonography (fTCD) of the middle cerebral artery to evaluate changes in cerebral blood flow velocity (CBFV) during different periods of music perception. Twenty-four healthy right-handed subjects were enrolled and examined during rest and during listening to periods of music with predominant language, rhythm and harmony content. The gender, musical experience and mode of listening of the subjects were chosen as independent factors; the type of music was included as the variable in repeated measurements. We observed a significant increase of CBFV in the right hemisphere in non-musicians during harmony perception but not during rhythm perception; this effect was more pronounced in females. Language perception was lateralized to the left hemisphere in all subject groups. Musicians showed increased CBFV values in the left hemisphere which were independent of the type of stimulus, and background listeners showed increased CBFV values during harmony perception in the right hemisphere which were independent of their musical experience. The time taken to reach the peak of CBFV was significantly longer in non-musicians when compared with musicians during rhythm and harmony perception. Pulse rates were significantly decreased in non-musicians during harmony perception, probably due to a specific relaxation effect in this subgroup. The resistance index did not show any significant differences, suggesting only regional changes of small resistance vessels but not of large arteries. Our fTCD study confirms previous findings of right hemisphere lateralization for harmony perception in non-musicians. In addition, we showed that this effect is more pronounced in female subjects and in background listeners and that the lateralization is delayed in non-musicians compared with musicians for the perception of rhythm and harmony stimuli. Our data suggest that musicians and non-musicians have different strategies to lateralize musical stimuli, with a delayed but marked right hemisphere lateralization during harmony perception in non-musicians and an attentive mode of listening contributing to a left hemisphere lateralization in musicians.

Drug-Induced Headache: Long-Term Results of Stationary Versus Ambulatory Withdrawal Therapy:

Abstract: Drug-induced headache is a well-known complication of the treatment of primary headache disorders, and its successful management is only possible by withdrawal therapy. However, it is unknown wheth...

Metabolic characterization of AIDS dementia complex by spectroscopic imaging.

Abstract: Prospective proton chemical shift imaging (CSI) of the brain was performed in 30 HIV-1-seropositive patients and 11 healthy controls. Significant (P < 0.05) reductions in the N-acetyl-L-aspartate (NAA)/total creatine (Cr), and NAA/total choline (Cho) ratios and significant increases in Cho/Cr occurred in patients with 1) AIDS-defining diagnoses; 2) <200 CD4 lymphocyte counts/μl; 3) neurological evidence for an AIDS dementia complex (ADC); 4) magnetic resonance imaging (MRI) signs of cerebral atrophy. The basal ganglia and the insula were affected to approximately the same extent and without indications of spatial variations within these areas. Reduced NAA seems to indicate progressive neuronal injury or loss due to productive HIV infection in the brain and its clinical picture ADC. Spectroscopic abnormalities were, however, also observed in neurologically normal HIV patients or those with normal MRI results. Proton CSI may therefore serve as an early quantitative marker of central nervous system involvement in AIDS. J. Magn. Reson. Imaging 1999;9:10–18 © 1999 Wiley-Liss, Inc.

Cerebral vasculopathy in HIV infection revealed by transcranial Doppler: A pilot study.

Abstract: Background and Purpose—There is growing evidence for affection of cerebral vessels during human immunodeficiency virus (HIV) infection. We prospectively evaluated cerebrovascular reserve capacity (CRC) in HIV-seropositive patients by transcranial Doppler sonography (TCD) after systemic administration of acetazolamide. We hypothesized that a disturbed vasoreactivity would reflect the cerebral arteries’ involvement in HIV infection. Methods—We assessed the mean blood flow velocity (BFV) of the middle cerebral artery and its increase after intravenous administration of 1 g acetazolamide (CRC) in 31 HIV-infected individuals without symptoms of cerebrovascular disease (mean±SD age, 39±11 years). Stenotic or occlusive lesions of the large brain-supplying arteries were excluded by color-coded duplex and transcranial imaging. BFV and CRC were also measured in an age-matched group of 10 healthy control subjects. Patients were classified according to clinical, laboratory, and neurophysiological parameters. We also ...

Sumatriptan and ergotamine overuse and drug-induced headache: a clinicoepidemiologic study.

Abstract: Drug-induced headache, particularly ergotamine-induced headache, is a common problem in migraine treatment. Some case reports suggest that even the new serotonergic antimigraine drugs such as sumatriptan can lead to overuse and subsequent drug-induced headache. We performed a controlled study to identify the rate of sumatriptan overuse and sumatriptan-induced headache and compared it to the rate of ergotamine overuse and ergotamine-induced headache. Two thousand sixty-five consecutive heachache patients, all experienced in intake of sumatriptan (n = 631) or ergotamine (n = 620), were enrolled over a three-year study period. The rates of overuse and drug-induced headache and the clinical features of the subgroups were compared. Risk factors for sumatriptan overuse were identified. The rates of ergotamine and sumatriptan overuse were 14.2% and 3.5%, respectively (p < 0.001). Drug-induced headache could be found more frequently in cases of ergotamine overuse than in cases of sumatriptan overuse (68% versus 32%; p < 0.01). Development of sumatriptan overuse was most common in patients with previous drug-induced headache (68%), combined headache as the primary headache type (45%), and subcutaneous application of sumatriptan (45%). We conclude that sumatriptan intake can lead to overuse and subsequent drug-induced headache. The risk for overuse and drug-induced headache is significantly lower than in patients with ergotamine intake. This might be caused in part by the relatively short period of sumatriptan availability on the market. The new generation of serotonin-1B/D-receptor agonists in the treatment of headache should have a potential for overuse similar to that of traditional headache drugs.

A retrospective long-term analysis of the epidemiology and features of drug-induced headache.

Abstract: Drug-induced headache is well known to resul from the abuse of compounds taken for the treatment of primary headache. The features of drug-induced headache depend on various features including the availability of drugs, the regional health system, and psychogenic factors of the patients. We performed a retrospective study on a series of 257 consecutive German patients presenting with drug-induced headache during the period 1983–1996. Our aim study was to evaluate the demographic features, the frequency of various drugs used, in particular of ergotamine derivates, and changes in these features during the study period. The frequency of drug-induced headache among all headache patients was 8%, with a female preponderance of 81%. Drug-induced headache occurred in all age groups, predominantly in migraine patients (35%). The mean number of substances used was 2.7, mainly, acetaminophen (47.9%), ergotamine tartrate (45%), and combined analgesics (56%). We did not find a significant difference between the associations with ergotamine tartrate and dihydroergotamine, although the latter was taken less frequently. Comparing the early and late years of our study period, there were no changes in the frequency of drug-induced headache (8% versus 7%), although changes in the frequency of some drugs changed (barbiturates, ergotamine tartrate, and codeine intake decreased whereas nonsteroidal anti-inflationary drugs, combined analgesics, and sumatriptan intake increased). Our data suggest that changes in drug availability and the introduction of classification criteria and treatment recommendations did not have a major impact on the frequency of drug-induced headache.

Drug treatment of migraine in children: a comparative review.

Abstract: Migraine according to the criteria of the International Headache Society, occurs in about 3 to 7% of all children. Despite this high incidence, and unlike the situation with adult migraine, only a very few controlled trials have investigated the acute and prophylactic treatment of migraine in children. In the acute migraine attack, ibuprofen 10 mg/kg and paracetamol (acetaminophen) 15 mg/kg have been shown to be effective, with only a few adverse effects. In severe migraine attacks, dihydroergotamine mesylate (dihydroergotamine) administered orally (20 to 40 microg/kg) or intravenously (maximum 1 mg/day) may be helpful, but there have been no large placebo-controlled trials of this treatment. Oral sumatriptan has not been effective in several double-blind and placebo-controlled trials; administered subcutaneously, this drug might be helpful but the only data for this application come from open trials. For migraine prophylaxis, only flunarizine 5 mg/day has been shown to be effective in more than 1 double-blind, placebo-controlled trial. Some evidence also exists that propranolol >60 mg/day and pizotifen 0.5 to 1.5 mg/day are effective; however, the results from different trials are contradictory. For all other drugs studied in migraine prophylaxis, the results remain vague (e.g. amitriptyline, nimodipine, trazodone) or suggest inefficacy (e.g. timolol, clonidine, tryptophan). In migraine-related disorders, pizotifen 0.5 to 0.75 mg/day for abdominal migraine and flunarizine 10 to 25 mg/day for alternating hemiplegia have been shown to be effective. Most of the drugs used in the treatment of migraine in children are well tolerated and without relevant adverse effects. In migraine prophylaxis, the most common adverse effects are drowsiness and bodyweight gain.

Cognitive processing is involved in cluster headache but not in chronic paroxysmal hemicrania.

Abstract: Background: Cognitive processing in migraine is characterized by a loss of habituation during the interval and increased latencies in an attack. No studies are available on event-related potentials (ERPs) in cluster headache or chronic paroxysmal hemicrania. Objective: To determine the involvement of cognitive processing in cluster headache and chronic paroxysmal hemicrania as measured by ERPs. Methods: Visually evoked ERPs were measured in 50 patients with episodic cluster headache, 11 patients with chronic cluster headache, and 12 patients with chronic paroxysmal hemicrania. Measurements were performed in the cluster period outside an attack with and without prophylactic medication and not in the cluster period. Results: Latencies of the endogenous ERP components were significantly increased during the cluster period as compared with outside the cluster period and with healthy subjects. In chronic cluster headache, latencies of both endogenous and exogenous components were increased. Medication with prophylactic drugs normalized the ERP latencies in episodic cluster headache; in chronic cluster headache, ERP latencies were decreased without complete normalization. No changes of ERP latencies and amplitudes could be observed in chronic paroxysmal hemicrania. A loss of cognitive habituation as it is known in migraine could not be observed in either cluster headache or chronic paroxysmal hemicrania. Conclusions: Our data suggest that central structures generating ERPs are involved in the pathophysiology of cluster headache during the cluster period but not outside the cluster period. This is in concordance with recent neuroimaging findings on the central role of the hypothalamus and the right frontal cortex in cluster headache and supports the hypothesis of a central origin of cluster headache. Furthermore, the data suggest that cluster headache and chronic paroxysmal hemicrania are distinct entities.

Psychosoziale Beeinträchtigung durch chronische Kopfschmerzen Evaluation des Inventars zur Beeinträchtigung durch Kopfschmerzen (IBK)

Abstract: Chronische primare Kopfschmerzen beeintrachtigen die Lebensqualitat der Betroffenen wesentlich. Bislang ist diese Beeintrachtigung durch allgemein schmerzbezogene Instrumente erfast worden, wahrend kopfschmerzspezifische Instrumente zur Erfassung der akuten Beeintrachtigung der Lebensqualitat fur den deutschsprachigen Raum bislang nicht vorliegen. Im amerikanischen Raum ist ein Headache Disability Inventory (HDI) evaluiert worden, der in der hier vorgelegten Studie als Grundlage zur Entwicklung eines eigenstandigen deutschsprachigen „Inventar zur Beeintrachtigung durch Kopfschmerzen” (IBK) dient. Anhand von 94 konsekutiven Patienten mit primaren Kopfschmerzen (59 weiblich, 35 mannlich; mittleres Alter 40±12 Jahre) ist der FBK hinsichtlich der Testgutekriterien untersucht worden. Dabei zeigte sich ein hoher Wert fur Cronbachs Alpha (a=0,90). Die Test-Retest-Reliabiliat nach 3 Monaten war ebenfalls hoch (r=0,87). Eine Untergliederung des FBK in Subskalen fur die emotionale und funktionale Beeintrachtigung ergab ahnlich hohe Werte fur die interne Konsistenz und die Test-Retest-Reliabilitat dieser Subskalen. Die Scorewerte der einzelnen Kopfschmerzdiagnosen unterschieden sich nicht signifikant voneinander, jedoch zeigte der Clusterkopfschmerz im Vergleich zur Migrane in post-hoc-Analysen eine signifikant grosere Beeintrachtigung in der Gesamtskala und in den Subskalen. Der Scorewert des IBK korrelierte signifikant mit den Kopfschmerztagen pro Monat (r=0,41; p<0,0003), jedoch nicht mit der Erkrankungsdauer und anderen demographischen Grosen. Mit dem IBK liegt erstmals ein deutschsprachiges kopfschmerzspezifisches Instrument zur Erfassung der Lebensqualitat vor, es eignet sich sowohl im klinischen Alltag zur Erhebung eines Eingangsstatus und zur Kontrolle des Therapieerfolgs als auch fur wissenschaftliche Fragestellungen.

Coincidence of familial hemiplegic migraine and hemicrania continua? A case report.

Abstract: A case is presented of a 39-year-old woman with a history of simultaneous Familial hemiplegic migraine (FHM) and hemicrania continua (HC). The family history of the patient revealed different types of migraine and cyclic syndromes in childhood in four generations. The possible links between FHM and HC are discussed. The pedigree gives further evidence that cyclic syndromes in childhood belong to the spectrum of migraine.

The impact of ergotamine-induced headache and ergotamine withdrawal on information processing.

Abstract: Ergotamine abuse and subsequent ergotamine-induced headache is a common problem in the pharmacological treatment of migraine and other headache types; often, withdrawal therapy is necessary. This study investigated whether ergotamine abuse affects information processing and whether withdrawal therapy can lead to an improvement of information processing. We designed a standardized neurophysiological retrospective (ergotamine abuse) and prospective (ergotamine withdrawal) study in a supraregional headache outpatient clinic. Seventy-one patients abusing ergotamine derivatives with subsequent daily headache were enrolled and compared to 36 migraine patients without ergotamine intake and 36 healthy subjects. Information processing was evaluated by latencies and amplitudes of visually evoked event-related potentials (ERP) before and after ergotamine withdrawal therapy. P3 latency of the ERP was significantly increased in ergotamine abuse (442 ± 45 ms) versus migraine (415 ± 40 ms) and healthy subjects (410 ± 33 ms), there was no difference between ergotamine tartrate and dihydroergotamine abuse. The migraine specific loss of habituation in information processing as measured by P3 latency could not be observed in migraine patients with ergotamine abuse. After successful withdrawal therapy in 36 patients, the abnormally prolonged P3 latency was significantly shortened (452 ± 47 ms versus 433 ± 30 ms; P < 0.004). Our findings imply that information processing is impaired by ergotamine abuse and can be improved but not normalized after withdrawal therapy. Furthermore, our data provide strong evidence that ergotamine, besides its peripheral effects, has a central mode of action.

Kryptokokkenmeningoenzephalitis von HIV-infizierten Immigranten¶Diagnostische und therapeutische Aspekte unter Berücksichtigung der “evidence-based medicine”– Ein Überblick

Abstract: Die Kryptokokkenmeningoenzephalitis ist eine der haufigsten Meningoenzephalitiden von AIDS-Patienten. Ihre Haufigkeit betrug vor der Einfuhrung der Triazol-Antibiotika wie Difluconazol 5–10% aller AIDS-Patienten, sank jedoch in den letzten Jahren. Klinisch imponieren meist unspezifische Zeichen einer meningealen Reizung, wahrend fokale neurologische Symptome selten sind. Prognostisch entscheidend fur die mit einer hohen Mortalitat verbundenen Erkrankung sind eine rechtzeitige, hochdosierte Antimykotikatherapie, die derzeit ublicherweise mit Amphotericin B, Flucytosin und Fluconazol durchgefuhrt wird. Der Nachweis von Kryptokokken-Antigen im Liquor, die Darstellung von Kryptokokken im Tuschepraparat und die ublicherweise positive Liquor-Kryptokokkenkultur bestatigen die klinische Verdachtsdiagnose. Aktuelle Entwicklungen zielen auf Optimierung der antimykotischen Therapie. In den letzten Jahren wurde die lebenslange Tertiarpravention mit Difluconazol oral etabliert. Mittelfristig wird die Prognose der Patienten von der zugrundeliegenden Immunsuppression bestimmt, so das nach erfolgreicher Therapie eine moderne antivirale Kombinationstherapie zusatzlich zur Tertiarpravention dringend indiziert ist. Die vorliegende Ubersicht thematisiert Entscheidungssituationen in der Behandlung von Patienten mit Kryptokokkenmeningoenzephalitis anhand von Prinzipien der “evidence-based medicine”.