The Effect of Onabotulinum Toxin-A on Frequency of Headache, Severity of Headache and Health Related Life-Quality at Patients With Resistant Chronic Migraine

WOS: 000365428100008Introduction: Resistant chronic migraine (RCM) causes a considerable decline in the quality of life and work efficiency of the patients and ultimately might even decrease their socioeconomic level because of severe and permanent headaches. In addition, migraine attacks force patients to rush to the emergency rooms, which leads to overcrowding and exhaustion of medical resources. In this study, the effect of onabotulinum toxin A (OBoNT-A) treatment was assessed in terms of efficiency and the quality of life retrospectively at patients with RCM. Method: 15 patients with RCM who were given 155 IU OBoNT-A treatment twice in 12 weeks have been studied retrospectively in terms of change of headache frequency, severity, and the health related quality of life scores (physical function, physical restriction, pain, general health, vitality, social function, emotion and mental health categories) for 24 weeks. Response to treatment is identified as >= 30% decrease in headache frequency while the change in the quality of life was determined with short form-36 before and after treatment. Findings: Average headache frequency was 26.3 day/month before treatment. After 24 weeks, 93% of the patients were responsive to the treatment. After OBoNT-A treatment average headache frequency decreased to 16,6 day/month in 12 weeks and to 17,8 day/month in 24 weeks (p<0.001). Average health related quality of life scores before treatment were under 50%, while all the health related quality of life scores improved after treatment(p<0.001). At the end of 24 weeks, headache severity significantly decreased (p<0.001). Conclusion: OBoNT-A is an effective treatment in patients with RCM and it must be considered a first line treatment for RCM patients considering the cost-effectiveness researches

A Case of Listeria Rhombencephalitis Mimicking Vertebrobasilar Stroke

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MRI perfusion findings in acute cerebral infarction and perfusion parameters used in the evaluation penumbra

WOS: 000393168200002Objective: In this trial, our objective is to emphasize the importance of the magnetic resonance perfusion in the early diagnosis and therapy of cerebral ischemia and to discuss the reliable perfusion maps for identifying peunumbra. Material and Methods: Participants of this trial have been selected among patients who applied to the Ege University Radiology Department with cerebrovascular event and had an acute infarct which was diagnosed by MR. Among 20 of these patients, dynamic suceptibilite contrast (DSC) imaging with 1.5 T MR Magnetom Vision, Siemens, Erlangen, Germany) was performed with standart head bandage. At contrast perfusion imaging a bolus of 0.1 mmol/kg Gadolinium was injected by a speed of 3ml/sec. Multishot echoplanar imaging (EPI) imaging was performed for determining the changes at T2* relaxation time. The DSC perfusion parametres and function maps were obtained and eveluated at the postprocessing stage. The precence of penumbra was diagnosed by comparing the perfusion maps with difusion images. Results: Seventy nine percent of the patients had a lesser degree of cerebral blood volume (CBV) and cerebral blood flow (CBF) at the infarcted area then contrary hemisphere but at 11% of the patients there was no difference with contrary hemisphere. Five percent of the patients had remarkable blood flow increase. This was thought to be cause of the important role of the brain's autoregulation function. There was an expected delay at 90% of the patients in contrast passing time and peak time. By comparing the diffusion with perfusion maps, the penumbra was diagnosed at 4 patients by mean transit time (MTT) and time to pic (TTP) maps, at 3 patients by CBF map and at 1 patient by CBV map. Conclusion: The early diagnosis and evaluation of acute ischemic stroke, improves the patients' quality of life. The perfusion MR has a pathfinder role in the diagnosis and therapy of acute infarct. Penumbra is a dynamic tissue and the treatment after the early identifying of the penumbra, defines the patients prognosis. The most reliable perfusion map for determining the penumbra is controversial and much more trials are need to be done about this subject. According to recent trials and our investigation, the penumbra area seems to be larger which is determined by using the TTP and MTT maps. This condition is due to the exaggerated appearance of the ischemic penumbra secondary to the benign oligemia with severe arterial occlusive changes. In the literature the most reliable maps are relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) maps for demonstrating the last infarct area and our findings are also in the same way

Evaluation of posterior reversible encephalopathy syndrome from different aspects: What is the role of serum LDH and albumin level in pathogenesis?

WOS: 000379745500009Background: Posterior reversible encephalopathy syndrome (PRES), is characterized by headache, lethargy, visual complaints and epileptic seizures. Brain imaging findings include abnormalities of the white matter and the grey matter. The diagnosis currently relies on clinical manifestations and typical neuroimaging findings. Different pathophysiological factors can play role in the disease process. The purpose of this study is to review causes, clinical aspects, imaging-laboratory findings and prognosis in patients diagnosed with PRES. Method: Patients who showed clinical and magnetic resonance imaging (MRI) findings consistent with PRES between January 2011 and December 2014 were included in the study. Patient data were collected retrospectively from hospital records. Results: Total number of patients was 22 (18 female, 4 male). Median age was 28 years (range 18-84). Comorbid conditions included eclampsia (n=10, 45%), pre-eclampsia (n=1, 4.5%), HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome (n=1), primary kidney disease (n=3, 13%). Acute elevation of blood pressure was found in 9 patients (40%). Five patients (22%) were using steroids or immunosupressive drugs. Typical PRES imaging pattern with bilateral parieto-occipital involvement was present in 15/22 patients (68%) and occipital involvement was present in 3/22 patients (14%). Atypical neuroimaging features included frontal involvement in 10 patients (45%), basal ganglia gray matter lesion in 1 patient (4%) and the cerebellum was involved in 3 patients (14%). Serum LDH level was high in 13 patients (59%). Hypoalbuminemia was detected in 12 patients (54%). Conclusion: Although hypertension is thoughtto be the main pathologic factor in the disease process, endothelial dysfunction seems to be equally important

Cost Analysis of Nosocomial Infections in a Tertiary Care Referral Hospital's Neurology Intensive Care Unit: A Case-Control Study

WOS: 000365428100009Aim: The purpose of this study is to overview nosocomial infections (NI), to determine risk factors and to evaluate the clinical and financial impact of NI on direct hospital cost among neurology intensive care unit (NICU) patients in a tertiary-care referral hospital. Material and Methods: A retrospective case control study was performed. The sample size was calculated to be at least 51 per group. A list of the last 55 patients who acquired an infection in NICU was obtained from infection control committee. These patients were matched with uninfected patients according to age, sex, diagnosis. The data were collected from patient files, accounting records. Results: A total of 79 NI occurred in 55 cases. The most common NI were pneumonia (48%), catheter related urinary tract infection (39%). Acinetobacter baumannii (25%) is most commonly responsible for NI. NI were detected less in patients who were conscious, non-intubated, without blood transfusion, tracheostomy, urinary catheter or mechanical ventilation. The mortality ratio was 53.1% in cases and 30.8% in controls. The excess costs of NI were $7121.15 and extra length of stay was 26.9 days. Although reimbursement took longer than six months, the Social Security Institution paid back the total billing amount. Conclusion: Given the impact on monetary and health costs of NI, measures to prevent NI in the hospital are strongly recommended for patient safety and for hospital reputation. NICUs in tertiary care referral facilities do not cause financial burden; on the contrary, they provide an opportunity to balance the budget

Efficacy and Safety of 400 and 800mg Etodolac vs. 1,000mg Paracetamol in Acute Treatment of Migraine: A Randomized, Double-blind, Crossover, Multicenter, Phase III Clinical Trial

WOS: 000315962200003PubMed ID: 22730906Aim: We aimed to determine the efficacy and safety of etodolac, in acute migraine attacks in comparison with paracetamol (acetaminophen). Methods: We designed a randomized, double-blind, crossover phase III clinical trial for patients diagnosed with migraine for at least 1year, according to ICHD-II criteria. Two hundred and twenty-nine adult patients having 2 to 8 attacks monthly from 17 centers were included. The patients were instructed to use 3 attack treatment packages consisting of 1,000mg paracetamol, 400mg etodolac, and 800mg etodolac on 3 migraine attacks of moderatesevere intensity each in a 3-month treatment period, interchangeably. Results: Any pain medication was used in 1,570 migraine attacks while study treatments were used in 1,047 attacks. The results for 1,000mg paracetamol, 400 mg etodolac, and 800 mg etodolac were as follows: response of headache at 2hours 44.9%, 48.3% and 46.1%; pain-free at 2hours 19.2%, 19.3% and 24.1%; sustained pain-free from 2 to 24hours 34.3%, 38.3% and 41.1%; relapse rates in 2 to 24hours 7.3%, 14.3% and 9.7%. There were no statistically significant differences between the groups regarding the headache response, pain-free, sustained pain-free, and relapse rates. Nausea, vomiting, phonophobia, or photophobia decreased similarly in all groups within 24hours of treatment administration. Drug-related adverse events were noted in 8 patients with 1,000mg paracetamol, in 9 patients with 400mg etodolac and in 9 patients for 800mg etodolac during the study. Comment: Our study showed that etodolac is a safe and effective alternative in acute migraine treatment and showed comparable efficacy to paracetamol 1,000mg. Etodolac may be considered as an alternative option for acute treatment of migraine.Nobel IlacThis study was supported by Nobel Ilac, San. Tic AS and the study audits and follow-up were carried out by Omega Research Group