Emotional Evaluation of Pain in Migraine Patients

In the present study, we investigated how pain perception by migraine (MG) patients may differ from that of normal subjects. We simultaneously measured respiration and used an electroencephalogram to find inspiration-related (I-α) potentials during pain stimuli, which are usually observed in normal subjects during emotional arousal. There were no differences in pain threshold levels, maximum pain levels, scales of the level of pain, state, and trait anxiety, or respiratory rate during rest and stimulation between normal and MG subjects. When anticipating a pain stimulus, respiratory rate increased in both MG and normal subjects. However, I-α potentials were only found in normal subjects. We suggest that the absence of I-α potentials in MG patients may be due to the fact that pain-induced pervasive cortical excitability may not be sufficient to concentrate the brain rhythms to phase-lock. Hypersensitivity towards light, sound, and various sensations is often reported in MG. Thus, there may be a tendency in MG subjects to avoid concentrating on one external stimulus to protect against increased hypersensitivity. It may be that MG patients intuitively know that decentralizing their attention can avoid triggering an MG attack

Parallel Activation of the Amygdala and Visual Cortex Estimated by Dipole Tracing Analysis during Visual Stimulation of Fear and Sadness

In this study we used the electroencephalograph (EEG) dipole tracing method to analyze the visual and emotional evoked potentials (VEEPs) triggered by emotional stimuli induced by pictures of fear, sadness and happiness selected from the International Affective Picture System. We hypothesized that if we used the emotional pictures as triggers for averaging the EEG, we could determine VEEPs, and dipoles could be estimated in the visual cortex as well as in the areas related to the picture-induced emotions. We found the VEEP components elicited by fearful and sad stimuli were quite similar and there were no differences in the root mean square values of the positive waves, P1 and P2, in these two stimuli. However, the VEEP elicited by the happy stimulus had a significantly different amplitude compared to the fearful and sad stimuli. Different amplitude components of VEEPs between negative and positive emotions might be caused by differences in the processing of activations. The negative emotions of fear and sadness activated the amygdala in parallel with the visual cortex immediately after the stimuli; and at a later time period the anterior cingulate cortex was activated for conscious awareness of the negative emotions. A simple happy stimulus does not need parallel activation of the amygdala and anterior cingulate cortex, along with activation of the visual cortex. We suggest that parallel processing in the visual cortex and amygdala might serve to rapidly evaluate stimuli, in readiness for the conscious awareness of negative emotions

Amygdala Response During Anticipatory Anxiety in Patients with Tension-type Headache

Tension-type headache (TTH) is the most prevalent primary headache disorder, affecting 0.5%〜4.8% of the population worldwide. Psychological factors play an important role in the pathogenesis of TTH. For instance, depression and anxiety are thought to enhance central sensitization, and thus increase the frequency of headaches. In this study, we used the Minnesota Multiphasic Personality Inventory (MMPI) and measures of anxiety to analyze personality traits associated with TTH. Specifically, we were interested in the relationship between these variables, respiratory responses, and brain activity. Our results showed that individuals with TTH had significantly higher state anxiety scores compared with healthy controls. In addition, individuals with TTH showed a greater increase in RR during a stressful task involving anticipation of an electrical stimulation. During anticipatory anxiety, there was bilateral amygdala (AMG) activation in TTH patients, while only the right AMG was activated in healthy controls. Interestingly, patients in the TTH group with high levels of state anxiety and high scores on schizophrenia scales had the following MMPI personality traits: peculiar perception, poor familial relationship, difficulties concentrating, and lack of deep interest. We suggest that the psychological factors associated with the above-mentioned brain activation might induce peripheral muscle pressure, which then triggers headaches

Cross-talk between TLR3 and TNF-α or IFN-γ Signaling in Induction of CXCL8/IL-8 and CXCL10/IP-10 Expression in Airway Epithelial Cells

CXCL8/IL-8 is a chemoattractant for neutrophils and mast cells, and regulates inflammatory cell recruitment in allergy, infection, and other neutrophil-related diseases. Interferon (IFN) -γ-inducible protein 10 (CXCL10/IP-10) is a chemokine that attracts mononuclear cells, Th1 cells, and natural killer cells. We investigated the levels of CXCL8/IL-8 and CXCL10/IP-10 expression by airway epithelial cells after exposure to the inflammatory cytokines tumor necrosis factor (TNF) -α and IFN-γ, and to poly I:C, a synthetic analog of double-stranded RNA that is a ligand of Toll-like receptor 3 (TLR3). Poly I:C, TNF-α, IFN-γ, and combinations of poly I:C with TNF-α or IFN-γ were used to stimulate the airway epithelial cell line BEAS-2B. Following stimulation, we determined CXCL8/IL-8 and CXCL10/IP-10 mRNA levels by real-time PCR and protein levels by ELISA. Poly I:C treatment upregulated mRNA and protein expression for both CXCL8/IL-8 and CXCL10/IP-10. The addition of TNF-α, but not IFN-γ, to poly I:C further increased the expression of CXCL8/IL-8 mRNA and protein. The addition of either TNF-α or IFN-γ to the poly I:C treatment further increased CXCL10/IP-10 mRNA and protein expression. Cross-talk between TLR3 signaling and inflammatory cytokines regulates the expression of CXCL8/IL-8 and CXCL10/IP-10 in airway epithelial cells. From our results, TNF-α and IFN-γ produce different effects on TLR3 signaling

Anti-IgE therapy for allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is a severe type of asthma. Some cases are resistant to treatment, even with regular use of antiasthmatic drugs and antifungal agents. The diagnosis of ABPA was made in a 40-year-old patient with ABPA according to the Rosenberg-Patterson criteria. Symptoms were not controlled despite regular use of antiasthmatic drugs, daily systemic steroids, and antifungal agents. Omalizumab, administered in an attempt to stabilize these uncontrolled symptoms, was effective with no adverse events. Our experience suggests omalizumab is a potential candidate drug for controlling steroid-dependent ABPA

Unusual presentation of a skull base mass lesion in sarcoidosis mimicking malignant neoplasm: a case report

Abstract Background Sarcoidosis is a multi-organ disease of unknown etiology characterised by the presence of epithelioid granulomas, without caseous necrosis. Systemic sarcoidosis is rare among children, while neurosarcoidosis in children is even rarer whether it is systemic or not. Case presentation We described the case of a 12-year-old boy who presented with monocular vision loss accompanied by unusual MRI features of an extensive meningeal infiltrating mass lesion. The patient underwent surgical resection (biopsy) via a frontotemporal craniotomy to establish a definitive diagnosis based on the histopathology, since neurosarcoidosis remains a very difficult diagnosis to establish from neuroradiogenic imagings. Based on the histopathology of the resected mass lesion, neurosarcoidosis was diagnosed. On follow-up after 3 months of steroid therapy, the patient displayed a good response on the imaging studies. MRI revealed that the preexisting mass lesion had regressed extremely. We also conducted a small literature review on imaging studies, manifestations, appropriate treatments, etc., in particular neurosarcoidosis including children. Conclusion Although extremely rare, neurosarcoidosis, even in children, should be considered in the differential diagnosis of skull base mass lesions to avoid unnecessary aggressive surgery and delay in treatment, since surgery may have little role in the treatment of sarcoidosis