Convulsive Seizures as Presenting Symptom of Metronidazole-Induced Encephalopathy:A Case Report

Introduction: Encephalopathy and convulsive seizures are rare manifestations of metronidazole toxicity. The incidence is unknown, but the condition has most frequently been reported in patients in their fifth to sixth decades. Usually, this condition is regarded as reversible, but permanent deficits and even death have been reported. Case Report: A 66-year-old female patient undergoing metronidazole treatment for pleural empyema was admitted to our institution after her second episode of seizure. Over the course of 1 week after admittance, the patient developed several convulsive seizures along with progressive cerebellar dysfunction and cognitive impairment. MRI revealed bilateral, symmetrical hyperintense signal changes in the pons and dentate nuclei. EEG, ECG, lumbar puncture, and blood samples were normal. The patient improved already 2–3 days after discontinuation of metronidazole and was discharged fully recovered after 17 days. Follow-up clinical assessment and MRI were unremarkable. Conclusion: Metronidazole-induced encephalopathy is a rare condition, and due to a general lack of awareness the diagnosis is often delayed. This condition should be considered in metronidazole-treated patients presenting with unprovoked seizures, myoclonus, cerebellar signs, and encephalopathy. Characteristic MRI lesions may support the clinical suspicion

European Headache Federation (EHF) consensus on the definition of effective treatment of a migraine attack and of triptan failure

Attack; Migraine; TriptanAtaque; Migraña; TriptánAtac; Migranya; TriptanBackground Triptans are migraine-specific acute treatments. A well-accepted definition of triptan failure is needed in clinical practice and for research. The primary aim of the present Consensus was to provide a definition of triptan failure. To develop this definition, we deemed necessary to develop as first a consensus definition of effective treatment of an acute migraine attack and of triptan-responder. Main body The Consensus process included a preliminary literature review, a Delphi round and a subsequent open discussion. According to the Consensus Panel, effective treatment of a migraine attack is to be defined on patient well-being featured by a) improvement of headache, b) relief of non-pain symptoms and c) absence of adverse events. An attack is considered effectively treated if patient’s well-being, as defined above, is restored within 2 hours and for at least 24 hours. An individual with migraine is considered as triptan-responder when the given triptan leads to effective acute attack treatment in at least three out of four migraine attacks. On the other hand, an individual with migraine is considered triptan non-responder in the presence of failure of a single triptan (not matching the definition of triptan-responder). The Consensus Panel defined an individual with migraine as triptan-resistant in the presence of failure of at least 2 triptans; triptan refractory, in the presence of failure to at least 3 triptans, including subcutaneous formulation; triptan ineligibile in the presence of an acknowledged contraindication to triptan use, as specified in the summary of product characteristics. Conclusions The novel definitions can be useful in clinical practice for the assessment of acute attack treatments patients with migraine. They may be helpful in identifying people not responding to triptans and in need for novel acute migraine treatments. The definitions will also be of help in standardizing research on migraine acute care.This work is supported by a grant from the European Headache Federation to cover publication fees

Real-world effectiveness of fremanezumab for the preventive treatment of migraine: Interim analysis of the pan-European, prospective, observational, phase 4 PEARL study

Chronic; Episodic; Real-world evidenceCrònica; Episòdic; Evidència del món realCrónico; Episódico; Evidencia del mundo realBackground The ongoing Pan-European Real Life (PEARL) phase 4 study is evaluating fremanezumab effectiveness and safety for the prevention of episodic and chronic migraine. This interim analysis reports primary, secondary and exploratory endpoints from when 500 participants completed at least six months of treatment. Methods Adults with episodic migraine or chronic migraine maintaining daily headache diaries were enrolled upon initiation of fremanezumab. Primary endpoint: proportion of participants with ≥50% reduction in monthly migraine days during the six-month period after fremanezumab initiation. Secondary endpoints: mean change from baseline across months 1–12 in monthly migraine days, acute migraine medication use, and headache-related disability. Exploratory endpoint: mean change in headache severity from baseline across months 1–12. Safety was assessed through adverse events reported. Results Overall, 897 participants were enrolled and 574 included in the effectiveness analyses (episodic migraine, 25.8%; chronic migraine, 74.2%). Of participants with data available, 175/313 (55.9%) achieved ≥50% monthly migraine days reduction during the six-month period post-initiation. Across months 1–12, there were sustained reductions in mean monthly migraine days, acute medication use, disability scores, and headache severity. Few adverse events were reported. Conclusion PEARL interim results support the effectiveness and safety of fremanezumab for migraine prevention in a real-world population across several European countries. Trial registration: encepp.eu: EUPAS3511

Interest in and exposure to headache disorders among neurology residents in Denmark: A nationwide cross-sectional survey

Education; Migraine; TrainingEducación; Migraña; FormaciónEducació; Migranya; FormacióObjective Headache disorders constitute a leading cause of disability worldwide, but there is a consistent absence of awareness and educational activities for healthcare providers across regions. Thus, we found it timely to identify potential structural challenges and factors that may affect acquisition of knowledge of headache disorders and their management during their 4-year residency. Materials & Methods We conducted a nationwide cross-sectional survey of residents in neurology in Denmark including, but not limited to, questions on interest in neurological subspecialties and disorders, adequacy of training in headache disorders, exposure to headache disorders during training including time spent on headache disorders, exposure to specialist outpatient clinics, whether their hospital have a tertiary headache clinic, training in specific procedures (anesthetic blockade, e.g., greater occipital nerve blockade, and onabotulinumtoxinA for headache), and an estimate of proportion of cases with headache among patients managed in the last week. Results The survey was distributed to 127 residents in Denmark between March 2022 and April 2022. Of these, 59 (47%) completed all questions of the survey. Headache disorders were the fourth most popular subspecialties among respondents (n = 15 [25%]) following movement disorders (n = 27 [46%]), vascular neurology (n = 26 [44%]), and neuromuscular disorders (n = 25 [42%]). The mean number of hours spent in a course or a structured educational activity in headache disorders during residency was 12.1 h. Half of respondents (n = 27 [46%]) reported that they perceived their training in headache disorders to be inadequate. Conclusions Even in Denmark, a country with excellent headache services, half of residents in neurology report an inadequate training despite a higher-than-average number of hours of structured educational activities. These findings should incentivize stakeholders to make structural changes to improve education in headache disorders during the most fundamental years of training

Use of non-pharmacological therapies in individuals with migraine eligible for treatment with monoclonal antibodies targeting Calcitonin Gene-Related Peptide (CGRP)-signaling: a single-center cross-sectional observational study

Introduction: Accessibility of treatment with monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) signaling pathway is impeded by regulatory restrictions. Affected individuals may seek out other services including non-pharmacological therapies. Thus, we found it timely to ascertain the use of non-pharmacological therapies in individuals with treatment-resistant migraine eligible for and naïve to treatment with CGRP-signaling targeting monoclonal antibodies. Methods: We conducted a single-center cross-sectional observational study of patients eligible for and naïve to treatment with monoclonal antibodies targeting CGRP or its receptor. We recorded demographical information (gender, age, educational level, employment status, and income), disease burden (frequency of headache days and migraine days), previous use of preventive pharmacological medications for migraine, and use of non-pharmacological therapies over the past 3 months including frequency of interventions, costs, and patient-reported assessment of efficacy on a 6-point scale (0: no efficacy, 5: best possible efficacy). Results: We included 122 patients between 17 June 2019 and 6 January 2020; 101 (83%) were women and the mean age was 45.2 ± 13.3 years. One-third (n = 41 [34%]) had used non-pharmacological therapy within the past 3 months. Among these participants, the median frequency of different interventions was 1 (IQR: 1–2), the median number of monthly visits was 2.3 (IQR: 1.3–4), mean and median monthly costs were 1,086 ± 1471, and 600 (IQR: 0–1200) DKK (1 EUR = ~7.5 DKK), respectively, and median patient-reported assessment of the efficacy of interventions was 2 (IQR: 0–3). Conclusion: Even in a high-income country with freely accessible headache services and universal healthcare coverage, there was a non-negligible direct cost in parallel with low satisfaction for non-pharmacological therapies among patients at a tertiary headache center.info:eu-repo/semantics/publishedVersio

Post procedure headache in patients treated for neurovascular arteriovenous malformations and aneurysms using endovascular therapy

BACKGROUND: Though endovascular therapy (EVT) is increasingly applied in the treatment of intracranial vascular lesions, little is known about the effect of EVT on post-procedure headache. We aimed to investigate the prevalence of headache in patients who have undergone EVT for cerebral arteriovenous malformations (AVMs) and aneurysms. METHODS: A total of 324 patients underwent EVT treatment for aneurysms and AVMs at the Danish National Hospital from January 2012 to December 2014. We applied strict exclusion criteria in order to minimize the effect of other factors on headache occurrence, e.g., craniotomy. Eligible subjects were phone-interviewed using a purpose-developed semi-structured questionnaire. Headaches were classified according to ICHD-III beta criteria. RESULTS: The 59 patients underwent treatment of aneurysms (n = 43), cranial dural fistulas (n = 11), and AVMs (n = 5). There was a significant increase in overall headache (p = 0.017) and tension-type headache (TTH) (p = 0.012) within the first 3 months after EVT compared to 1 month before EVT. However, at interview time (median 2.5 years post-EVT), the increase in overall headache, migraine, and tension-type headache was not statistically significant. A minority of patients experienced headaches for the first time within 3 months of their EVT (migraine 4, TTH 10). At interview time, 50 % of these new headaches still persisted. CONCLUSION: Our results suggest a temporary increase in headache in the first 3 months after EVT, which normalizes over time. Clinicians may use this knowledge to better inform their patients of functional outcomes after their EVT procedure

THE REALITY OF THE ALGERIAN COURT TO SETTLE SPORTS DISPUTES UNDER SPORTS PROFESSIONALISM

تهدف هذه الدراسة إلى توضيح الدور الذي تقوم به المحكمة الجزائرية لتسوية النزاعات الرياضية كهيئة قانونية متخصصة في تسوية نزاعات الحركة الرياضية الوطنية، ومن بين هذه الأهداف نذكر :تسليط الضوء على المحكمة الجزائرية لتسوية النزاعات الرياضية كهيئة قانونية، مستقلة ومتخصصة والتعريف بها وبغرفها، وابراز الدور الذي تلعبه المحكمة الجزائرية لتسوية النزاعات الرياضية في تطبيق المنظومة الاحترافية .وتسليط الضوء على طبيعة القضايا المطروحة أمام المحكمة الجزائرية لتسوية النزاعات الرياضية وطرق معالجتها لهذه القضايا، وابراز القوة القانونية للأحكام و القرارات التي تصدرها المحكمة الجزائرية لتسوية النزاعات الرياضية كقطب متخصص. وتحديد مفهوم النزاع الرياضي وآليات تسويته على مستوى محكمة التحكيم الرياضي الجزائرية، الإطلاع على محتوى القوانين والقواعد الإجرائية التي تنظم سير محكمة التحكيم الرياضي الجزائرية. استخدم الباحثون المنهج الوصفي وتم جمع البيانات من خلال الاستبيان والمقابلة. وأبرزت النتائج المحكمة الجزائرية لتسوية النزاعات الرياضية تتمتع بالاستقلالية، وأن المحكمة الجزائرية لتسوية النزاعات الرياضية تلعب دوراً ايجابياً في تسوية نزاعات الناتجة عن تطبيق المنظومة الاحترافية في الجزائرThe aim of this study was to clarify the role of Algerian court as a professional community, some of these goals are to solve problems by using law, it has dependency, specialist, and identify the style of problems that solve, highlight the nature of the cases in front of the Algerian court to settle sports disputes, the legal force of judgments and decisions as a specialized pole, and defining the concepts of mathematical conflict and mechanism for setting it. To do those researchers used the description curriculum with questioner & interview Main results were that the court is independent, has a positive role at solving sports problems related to professionalism system in Algeri

Endovascular thrombectomy and post-procedural headache

BACKGROUND: We investigated the prevalence of post-procedural headache in patients who have undergone thrombectomy for ischemic stroke, and correlated history of migraine with risk of peri-procedural complications. A total of 314 patients underwent thrombectomy at the Danish National Hospital from January 2012 to December 2014. Eligible subjects were phone-interviewed using a purpose-developed semi-structured questionnaire according to the International Classification of Headache Disorders 3, beta version criteria. FINDINGS: Among 96 eligible subjects, there was a significant decrease in migraine (p = 0.022) within the first 3 months after EVT compared to 1 year before treatment, which was further evident at interview time (on average 1.6 years after EVT, p = 0.013). A minority of patients experienced headaches for the first time within 3 months of their EVT (migraine 2, TTH 9), which persisted at interview time for subjects with migraine. Out of 12 subjects with peri-procedural complications, 2 had a history of migraine with aura. CONCLUSION: Thrombectomy leads to a significant decrease in previously known migraine, and new onset of headache in a small subset of patients. A history of migraine does not appear to predispose to peri-procedural complications. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s10194-017-0719-0) contains supplementary material, which is available to authorized users

Enabling event-triggered data plane monitoring

We propose a push-based approach to network monitoring that allows the detection, within the dataplane, of traffic aggregates. Notifications from the switch to the controller are sent only if required, avoiding the transmission or processing of unnecessary data. Furthermore, the dataplane iteratively refines the responsible IP prefixes, allowing the controller to receive information with a flexible granularity. We implemented our solution, Elastic Trie, in P4 and for two different FPGA devices. We evaluated it with packet traces from an ISP backbone. Our approach can spot changes in the traffic patterns and detect (with 95% of accuracy) either hierarchical heavy hitters with less than 8KB or superspreaders with less than 300KB of memory, respectively. Additionally, it reduces controller-dataplane communication overheads by up to two orders of magnitude with respect to state-of-the-art solutions