Failure of preventive treatments in migraine: An observational retrospective study in a tertiary headache center

Background: Although the criteria for acute migraine treatment and prevention have been well described, there are still unmet needs, general underuse and low benefits of preventive drugs. The aim of the present study was to retrospectively observe the short-term effect of preventive treatment in a cohort of migraine patients attending a tertiary headache center, using data from electronic medical records. Methods: This was an observational retrospective cohort study based on data collected in a tertiary headache center. Data were extracted from an electronic dataset collected from January 2009 to December 2019. The main selection criteria were as follows: age of 18-75 years; diagnosis of migraine without aura (MO), migraine with aura (MA) or chronic migraine (CM); a control visit 3 months after the first access; and prescription of preventive treatment with level of evidence 1 as reported by Italian guidelines. As the primary outcome, we considered the change in the frequency of headache at the follow-up visit. Then, as secondary outcome measures, we used disability scores, intensity of headache, and allodynia. As predictive factors, we considered age, migraine duration, sex, headache frequency, allodynia, anxiety and depression at baseline, and comorbidity with fibromyalgia. Results: Among the 6430 patients screened, 2800 met the selection criteria, 1800 returned to the follow-up visit, 550 withdrew because of adverse events, and 1100 were included the analysis. One hundred thirty-four patients had a frequency reduction of 50% or more. Flunarizine was used for less severe migraine, with a better effect compared to those of other drugs (odds ratio: 1.48; p: 0.022). Low headache frequency and absent or mild allodynia predicted a better outcome. Conclusions: The mild effect of preventive drugs on migraine features and even the number of patients who were lost to follow-up or dropped out because of adverse events confirm that in severe and chronic patients, the first line of prevention can only delay a more focused therapeutic approach

Il corpo e lo spazio della pena - Architettura, urbanistica e politiche penitenziarie (titolo del libro), Nuovo regolamento del 2000, concorso per nuove tipologie edilizie del 2001, carcere e città (capitolo di C. BURDESE nel quale descrive il progetto di R. LENCI)

Nel 2001 il Dipartimento dell’Amministrazione penitenziaria (DAP) bandì un concorso di idee per l’elaborazione di un prototipo di istituto penitenziario di media sicurezza a trattamento penitenziario qualificato, con l’obbiettivo di acquisire spunti per le future progettazioni. (…) Complessivamente, i progetti che ho visionato (…) sono risultati estemporanei e non all’altezza delle più evolute realizzazioni carcerarie internazionali contemporanee di allora. Tengo a precisare che escludo da questa valutazione non positiva il progetto dell’architetto Ruggero Lenci, che reputo sul piano della tecnica penitenziaria e delle problematiche del vivere in cattività conscio e maturo, circostanza questa che lo colloca, a pieno titolo, nel solco dell’innovazione architettonica penitenziaria nazionale. Cesare Burdese (in: Il corpo e lo spazio della pena, Ediesse, Roma 2011, pp.101, 106-109, ISBN: 978-88-230-1601-9

Effect of single dose Erenumab on cortical responses evoked by cutaneous a-delta fibers: A pilot study in migraine patients

Background: Erenumab is a monoclonal antibody against calcitonin gene-related peptide receptors, which showed efficacy in migraine attack prevention. The aims of the present pilot study were to i) evaluate the effect of single dose of Erenumab 70 mg on laser evoked potentials from trigeminal and brachial stimulation in a cohort of migraine patients; ii) correlate the neurophysiological changes with clinical outcome after 3 months’ treatment. Methods: Laser evoked potentials were recorded by 61 electroencephalogram channels before (T0), 1 h (T1) and 7 days after (T2) Erenumab 70 mg injection, stimulating the left and right forehead and the right hand. Laser evoked potential control 1 h after the injection served as placebo session. Results: Seventeen migraine patients were evaluated. The N1 and N2 component obtained from the right and left trigeminal stimulation diminished in amplitude at T2, compared to T0 and T1 conditions. N2 habituation reduction slightly recovered at T2. Laser evoked potential changes did not correlate with clinical improvement after 3 months of Erenumab treatment. Conclusions: A single dose of Erenumab has a mild inhibitory effect on cortical responses evoked from trigeminal cutaneous a-delta fibers. Though this phenomenon was not predictive of the clinical outcome, it confirms a wide representation of calcitonin gene-related peptide receptors on trigeminal afferents

Visually evoked phase synchronization changes of alpha rhythm in migraine: correlations with clinical features

Objective: This study aimed to compute phase synchronization of the alpha band from a multichannel electroencephalogram (EEG) recorded under repetitive flash stimulation from migraine patients without aura. This allowed examination of ongoing EEG activity during visual stimulation in the pain-free phase of migraine. Methods: Flash stimuli at frequencies of 3, 6, 9, 12, 15, 18, 21, 24, and 27 Hz were delivered to 15 migraine patients without aura and 15 controls, with the EEG recorded from 18 scalp electrodes, referred to the linked earlobes. The EEG signals were filtered in the alpha (7.513 Hz) band. For all stimulus frequencies that we evaluated, the phase synchronization index was based on the Hilbert transformation. Results: Phase synchronization separated the patients and controls for the 9, 24 and 27 Hz stimulus frequencies; hyper phase synchronization was observed in patients, whereas healthy subjects were characterized by a reduced phase synchronization. These differences were found in all regions of the scalp. Conclusions: During migraine, the brain synchronizes to the idling rhythm of the visual areas under certain photic stimulations; in normal subjects however, brain regions involved in the processing of sensory information demonstrate desynchronized activity. Hyper- synchronization of the alpha rhythm may suggest a state of cortical hypoexcitability during the interictal phase of migraine. Significance: The employment of non-linear EEG analysis may identify subtle functional changes in the migraine brai

Steady-state visual evoked potentials in the low frequency range in migraine: A study of habituation and variability phenomena

Contains fulltext : 218381.pdf (Publisher’s version ) (Closed access)Previous studies have revealed that migraine patients display an increased photic driving to flash stimuli in the medium frequency range. The aim of this study was to perform a topographic analysis of steady-state visual evoked potentials (SVEPs) in the low frequency range (3-9 Hz), evaluating the temporal behaviour of the F1 amplitude by investigating habituation and variability phenomena. The main component of SVEPs, the F1, demonstrated an increased amplitude in several channels at 3 Hz. Behaviour of F1 amplitude was rather variable over time, and the wavelet-transform standard deviation was increased in migraine patients at a low stimulus rate. The discriminative value of the F1 mean amplitude and variability index, tested by both an artificial neural network classifier and a support vector machine, were high according to both methods. The increased photic driving in migraine should be subtended by a more generic abnormality of visual reactivity instead of a selective impairment of a visual subsystem. Temporal behaviour of SVEPs is not influenced by a clear tendency to habituation, but the F1 amplitude seemed to change in a complex way, which is better described by variability phenomena. An increased variability in response to flicker stimuli in migraine patients could be interpreted as an overactive regulation mechanism, prone to instability and consequently to headache attacks, whether spontaneous or triggered.10 p