Habituation deficit of visual evoked potentials in migraine patients with hypermobile Ehlers-Danlos syndrome

Objectives: Migraine is one of the most frequent clinical manifestations of hypermobile Ehlers-Danlos syndrome (hEDS). The comorbidity between these two diseases has been only partially investigated. We aimed to observe whether neurophysiological alterations described in migraineurs in visual evoked potentials (VEPs) were present in hEDS patients with migraine. Methods: We enrolled 22 hEDS patients with migraine (hEDS) and 22 non-hEDS patients with migraine (MIG), with and without aura (according to ICHD-3), as well as 22 healthy controls (HC). Repetitive pattern reversal (PR)-VEPs were recorded in basal conditions in all participants. During uninterrupted stimulation, 250 cortical responses were recorded (4,000 Hz sample rate) and divided into epochs of 300 ms after the stimulus. Cerebral responses were divided into five blocks. The habituation was calculated as the slope interpolating the amplitudes in each block, for both the N75-P100 and P100-N145 components of PR-VEP. Results: We observed a significant habituation deficit of the P100-N145 component of PR-VEP in hEDS compared to HC (p = 0.002), unexpectedly more pronounced than in MIG. We observed only a slight habituation deficit of N75-P100 in hEDS, with a slope degree that was intermediate between MIG and HC. Discussion: hEDS patients with migraine presented an interictal habituation deficit of both VEPs components like MIG. Pathophysiological aspects underlying the pathology could account for the peculiar pattern of habituation in hEDS patients with migraine characterized by a pronounced habituation deficit in the P100-N145 component and a less clear-cut habituation deficit in the N75-P100 component with respect to MIG

Mental health outcomes among Italian health care workers during the COVID-19 pandemic

IMPORTANCE Health care workers (HCWs) exposed to COVID-19 have high rates of mental health issues. However, longitudinal data on the evolution of mental health outcomes in HCWs are lacking.OBJECTIVE To evaluate the mental health outcomes among Italian HCWs 14 months after the beginning of the COVID-19 pandemic.DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study collected data from March 1 to April 30, 2020 (T1) and from April 1 to May 31. 2021 (T2). from 2856 Italian HCWs aged 18 years or older who responded to an online questionnaire. Participants were also recruited via snowballing, a technique in which someone who receives the invitation to participate forwards it to his or her contacts. EXPOSURES Frontline vs second-line position, job type, hospitalization for COVID-19, and colleagues or family members affected by COVID-19.MAIN OUTCOMES AND MEASURES Outcomes are depression symptoms, anxiety symptoms, insomnia symptoms, and posttraumatic stress symptoms (PTSSs). Four different trajectories are described for each condition: resilient, remittent, incident, and persistent.RESULTS Of the 2856 HCWs, 997 (34.9%) responded to the follow-up assessment (mean [SD] age, 42.92 [10.66] years; 816 [82.0%] female). Depression symptoms (b = -2.88; 95% CI, -4.05 to -1.71), anxiety symptoms (b = -2.01; 95% CI, -3.13 to -0.88), and PTSSs (b = -0.77; 95% CI, -1.13 to -0.42) decreased over time; insomnia symptoms increased (b = 3.05; 95% CI, 1.63-4.47). Serving as a frontline HCW at Tl was associated with decreased symptoms of depression (b = -1.04; 95% CI, -2.01 to -0.07), and hospitalization for COVID-19 was associated with increased depression symptoms (b = 5.96; 95% CI, 2.01-9.91); younger age (b = -0.36; 95% CI, -0.70 to -0.03) and serving as a frontline HCW at T1 (b = -1.04; 95% CI, -1.98 to -0.11) were associated with decreased anxiety symptoms. Male sex was associated with increase in insomnia symptoms (b = 1.46; 95% CI, 0.39-2.53). Serving as a frontline HCW at T1 (b = -0.42; 95% CI, -0.71 to -0.13) and being a physician (b = -0.52; 95% CI, -0.81 to -0.24) were associated with a decrease in PTSSs, whereas younger age (b = 0.35; 95% CI, 0.09-0.61) and male sex (b = 0.12; 95% CI, 0.01-0.22) were associated with an increase in PTSSs. Depression trajectories were 629 resilient (65.5%), 181 remittent (18.8%), 58 incident (6.0%), and 92 persistent (9.6%). Anxiety trajectories were 701 resilient (73.3%), 149 remittent (15.6%), 45 incident (4.7%), and 61 persistent (6.4%). Insomnia trajectories were 858 resilient (88.9%), 77 remittent (8.0%), 20 incident (2.1%), and 10 persistent (1.0%). The PTSS trajectories were 363 resilient (38.5%), 267 remittent (28.3%). 86 incident (9.1%). and 226 persistent (24.0%).CONCLUSIONS AND RELEVANCE In this cohort study, relative to the beginning of the COVID-19 pandemic, mental health among HCWs has improved. Factors associated with change in mental health outcomes could help in the design of prevention strategies for HCWs