Showing papers by "Stefan Evers published in 2011"

Treatment of medication overuse headache--guideline of the EFNS headache panel.

Abstract: Background: Medication overuse headache is a common condition with a populationbased prevalence of more than 1–2%. Treatment is based on education, withdrawal treatment (detoxification), and prophylactic treatment. It also includes management of withdrawal headache. Aims: This guideline aims to give treatment recommendations for this headache. Materials and methods: Evaluation of the scientific literature. Results: Abrupt withdrawal or tapering down of overused medication is recommended, the type of withdrawal therapy is probably not relevant for the outcome of the patient. However, inpatient withdrawal therapy is recommended for patients overusing opioids, benzodiazepine, or barbiturates. It is further recommended to start individualized prophylactic drug treatment at the first day of withdrawal therapy or even before. The only drug with moderate evidence for the prophylactic treatment in patients with chronic migraine and medication overuse is topiramate up to 200 mg. Corticosteroids (at least 60 mg prednisone or prednisolone) and amitriptyline (up to 50 mg) are possibly effective in the treatment of withdrawal symptoms. Patients after withdrawal therapy should be followed up regularly to prevent relapse of medication overuse. Discussion and conclusion: Medication overuse headache can be treated according to evidence-based recommendations.

Pain catastrophizing and pain-related emotions: influence of age and type of pain.

Abstract: ObjectivesOne of the most important determinants of the individual pain experience is pain catastrophizing, reflecting an excessively negative cognitive and emotional orientation toward pain Its assessment by standard questionnaires, which ask participants to reflect on idiosyncratic past painful e

Self-medication of migraine and tension-type headache: summary of the evidence-based recommendations of the Deutsche Migräne und Kopfschmerzgesellschaft (DMKG), the Deutsche Gesellschaft für Neurologie (DGN), the Österreichische Kopfschmerzgesellschaft (ÖKSG) and the Schweizerische Kopfwehgesellschaft (SKG)

Abstract: The current evidence-based guideline on self-medication in migraine and tension-type headache of the German, Austrian and Swiss headache societies and the German Society of Neurology is addressed to physicians engaged in primary care as well as pharmacists and patients. The guideline is especially concerned with the description of the methodology used, the selection process of the literature used and which evidence the recommendations are based upon. The following recommendations about self-medication in migraine attacks can be made: The efficacy of the fixed-dose combination of acetaminophen, acetylsalicylic acid and caffeine and the monotherapies with ibuprofen or naratriptan or acetaminophen or phenazone are scientifically proven and recommended as first-line therapy. None of the substances used in self-medication in migraine prophylaxis can be seen as effective. Concerning the self-medication in tension-type headache, the following therapies can be recommended as first-line therapy: the fixed-dose combination of acetaminophen, acetylsalicylic acid and caffeine as well as the fixed combination of acetaminophen and caffeine as well as the monotherapies with ibuprofen or acetylsalicylic acid or diclofenac. The four scientific societies hope that this guideline will help to improve the treatment of headaches which largely is initiated by the patients themselves without any consultation with their physicians.

Association between lifestyle factors and headache.

Abstract: Modification of lifestyle habits is a key preventive strategy for many diseases. The role of lifestyle for the onset of headache in general and for specific headache types, such as migraine and tension-type headache (TTH), has been discussed for many years. Most results, however, were inconsistent and data on the association between lifestyle factors and probable headache forms are completely lacking. We evaluated the cross-sectional association between different lifestyle factors and headache subtypes using data from three different German cohorts. Information was assessed by standardized face-to-face interviews. Lifestyle factors included alcohol consumption, smoking status, physical activity and body mass index. According to the 2004 diagnostic criteria, we distinguished the following headache types: migraine, TTH and their probable forms. Regional variations of lifestyle factors were observed. In the age- and gender-adjusted logistic regression models, none of the lifestyle factors was statistically significant associated with migraine, TTH, and their probable headache forms. In addition, we found no association between headache subtypes and the health index representing the sum of individual lifestyle factors. The lifestyle factors such as alcohol consumption, smoking, physical activity and overweight seem to be unrelated to migraine and TTH prevalence. For a judgement on their role in the onset of new or first attacks of migraine or TTH (incident cases), prospective cohort studies are required.

Enhanced Rapid-Onset Cortical Plasticity in CADASIL as a Possible Mechanism of Preserved Cognition

Abstract: Ischemic small vessel disease (SVD) may lead to cognitive impairment, but cognitive deficits with a given burden of SVD vary significantly. The underlying mechanisms of impaired or preserved cognition are unknown. Here, we investigated the impact of ischemic SVD on rapid-onset cortical plasticity, as induced with a paired-associative stimulation protocol. To exclude concomitant effects of aging, we examined 12 middle-aged patients (48.3 ± 8.3 years) with cerebral autosomal dominant arteriopathy with subcortical infarctions and leucoencephalopathy (CADASIL) who suffered from severe ischemic SVD and a group of 12 age-matched controls (49.9 ± 8.3 years). Cognitive status, motor performance and learning, and motor cortex excitability in response to cathodal transcranial direct current stimulation (ctDCS) were assessed. White matter integrity was analyzed by conventional magnetic resonance imaging and diffusion tensor imaging. We found that cognitive and motor functions were largely preserved in CADASIL patients, while rapid-onset cortical plasticity was significantly higher in the CADASIL group compared with controls (repeated measures analysis of variance [group × time] interaction: P = 0.03). This finding was even more pronounced in patients with higher white matter lesion load. ctDCS revealed no evidence of cortical dysplasticity. We conclude that increased rapid-onset cortical plasticity may contribute to largely preserved cognitive and motor function despite extensive ischemic SVD.

Loss of sensory function in patients with idiopathic hand dystonia.

Abstract: Former studies suggest an additional involvement of the sensory nervous system, beside the involuntary contractions of antagonist muscles, in idiopathic hand dystonia. We studied contact heat-evoked potentials and quantitative sensory testing (QST) in 10 patients suffering from idiopathic hand dystonia and 10 age-matched healthy controls. Cortical potentials recorded from the vertex (Pz) after contact heat stimulation of the volar forearm and the dorsum of the hand at a temperature of 51°C showed significantly reduced A-δ-amplitudes. Numerical pain ratings on the affected side in comparison to the unaffected side and to healthy controls were significantly reduced. QST results showed an impairment of the thermal detection thresholds, the mechanical pain sensitivity and the mechanical pain threshold at the affected body side of the patients. Our results suggest a loss of distinct sensory functions of the affected hand in comparison with the contralateral hand and to matched healthy subjects in patients suffering from idiopathic hand dystonia. For the first time, an extended loss of sensory function could be shown in patients suffering from idiopathic hand dystonia. © 2010 Movement Disorder Society.

Frovatriptan for prophylactic treatment of cluster headache: lessons for future trial design.

Abstract: (Headache 2011;51:129-134) Objective.— The aim of this study was to determine whether frovatriptan would show efficacy in short term prophylactic treatment of episodic cluster headache (ECH) in comparison to placebo. Background.— The 5-hydroxytryptamine1B/d (5-HT1B/d)-agonists naratriptan, eletriptan, and frovatriptan have been shown to reduce the frequency of ECH. So far, no double-blind placebo-controlled trials have investigated the potential prophylactic effects of 5-HT1B/d-agonists in ECH. Methods.— The trial was conducted as a multi-center, placebo-controlled, randomized, double-blind, prospective phase III parallel-group trial with two independent treatment groups (5 mg frovatriptan vs placebo). It was planned to randomize about 96 patients (48 patients per group) into the trial to obtain 80 evaluable patients (40 patients per group). Results.— The study was prematurely discontinued after 13 months and enrollment of 11, instead of the planned 80 patients, by the sponsor due to infeasibility. Recruitment was slow and each of the patients included conducted major protocol violations. The differences in the primary and secondary endpoints were not significant. Conclusion.— This study shows that particular therapeutic aims are impossible to be addressed in a double-blind, randomized, parallel group, study design with specific inclusion and exclusion criteria according to the International Headache Society (IHS) guidelines for controlled trials of drugs in cluster headache. Further studies are required to evaluate the potential efficacy of triptans in the prophylactic treatment of ECH. The outcome of the trial suggests that the recommendations of the Guidelines for controlled Trials of Drugs in Cluster Headache from the IHS should be revised.

Treatment of miscellaneous idiopathic headache disorders (group 4 of the IHS classification) - Report of an EFNS task force

Abstract: Background and Purpose: Certain miscellaneous idiopathic headache disorders, which are regarded as entities, are grouped in chapter 4 of the International Classification of Headache Disorders. Recent epidemiological research suggests that these headache disorders are underdiagnosed. Objectives: To give expert recommendations for the different drug and non-drug treatment procedures of these different headache disorders based on a literature search and on consensus of an expert panel. Methods: All available medical reference systems were screened for all kinds of clinical studies on these headache disorders. The findings in these studies were evaluated according to the recommendations of the EFNS resulting in level A, B or C recommendations and good practice points. Recommendations: For all headache disorders, acute and prophylactic drug treatment is recommended based on case series and on expert consensus. Furthermore, recommendations for the differential diagnoses are given because these headache disorders can also present with a symptomatic form. The most effective drug for the majority of these headache disorders is indomethacin, mostly applied as long-term or short-term prophylaxis.

Headache and sleep: the missing links.

Abstract: Headache and sleep obviously show several clinical links, and even in antiquity good sleep was thought to be a cure for headache and bad sleep was said to be a trigger for headache. In the paper by Lateef and co-workers (1), a particular aspect of these links has been investigated: the comorbidity of poor sleep, in particular different types of insomnia, with headache (separately for headache in general, migraine without aura, migraine with aura). The authors show that headache in general, but not specifically migraine without or with aura, is associated with an approximately twofold increased risk for insomnia. This confirms previous studies which also linked sleep disturbances to headache in general (2). The authors further speculate about the underlying reason for this association in three ways. It might be that subjects with headache have a pathophysiology leading to both headache and insomnia; it might be that sleep disturbances are a trigger for headache in general; and it might be that headache induces insomnia. The strength of this study lies in the large representative population-based patient sample, which were interviewed in the United States with a focus on one specific sleep disturbance, namely insomnia. However, the interview questions for migraine and in particular for the migraine aura were not very specific, and it is doubtful whether the different headache diagnoses are completely reliable (e.g. some aura subtypes were not included). Furthermore, the study defined increased daytime sleepiness as one aspect of insomnia, wheres it is classified as hypersomnia in the International Classification of Sleep Disorders (ICSD) (3) and might not only be a result of insomnia in the night but a result of other sleep disorders. The obvious links between headache and sleep have increasingly become part of headache rather than of sleep research. From a systematic point of view, we can differentiate the following aspects:

Behandlung von Neuro-Aids auf der neurologischen Intensivstation

Abstract: Analysen des Verlaufs von Neuro-Aids auf der neurologischen Intensivstation sind selten Ziel war es, Pradiktoren fur „Versterben“ zu analysien Es wurden 56 Patienten, die im Mittel 39±0,7 Jahre alt waren, im Mittel 130±166 CD4+-Zellen/µl und eine Viruslast im Plasma von 146,520±198,059 Kopien/ml aufwiesen, wegen Neuro-Aids auf der neurolgischen Intensivstation behandelt Es waren 34% der Patienten Immigranten, von denen 74% aus Regionen der Sahara stammen Bei 57% wurde die Diagnose einer „Human-immunodeficiency-virus“- (HIV-)Infektion erst auf der Intensivstation gestellt Der Median fur den Zeitraum zwischen der Diagnose der HIV-Infektion und der Aufnahme auf die Intensivstation betrug fur Immigranten 8 Tage, fur die einheimischen HIV-Infizierten 10 Jahre Die haufigsten Neuromanifestationen der HIV-Infektion stellten die zerebrale Toxoplasmose, Kryptokokkose und die progressive multifokale Leukoenzephalopathie (PML) dar Wahrend des Aufenthalts verstarben 28 der Patienten (50%) Als negative Pradiktoren fur „Versterben auf der Intensivstation an Neuro-Aids“ stellten sich die Faktoren a) Beatmungspflichtigkeit, b) antiretroviral naiver Immigrant, c) primar zerebrales Lymphom und d) fehlende hochaktive antiretrovirale Therapie (HAART) bei der Aufnahme auf die Intensivstation heraus Die Versterbensrate bei Neuro-Aids ist deutlich hoher als bei internistischen Erkrankungen, die zur Behandlung auf einer Intensivstation fuhren Antiretroviral naive Immigranten weisen eine besonders hohe Versterbensrate im Vergleich zur einheimischen Bevolkerung auf Es sind noch erhebliche Anstrengungen notwendig, um weltweit HAART zur Verfugung zu stellen, sodass auch die Prognose von Neuro-Aids bei Behandlung auf der neurologischen Intensivstation verbessert wird