Epileptic seizures and headache/migraine: A review of types of association and terminology

Abstract Purpose There are different possible temporal associations between epileptic seizures and headache attacks which have given rise to unclear or controversial terminologies. The classification of the International League Against Epilepsy does not refer to this type of disorder, while the International Classification of Headache Disorders (ICHD-2) defines three kinds of association: 1. migraine-triggered seizure ("migralepsy"), 2. hemicrania epileptica, and 3. post-ictal headache. Methods We performed an extensive review of the literature, not including "post-ictal" and "inter-ictal" headaches. Results On the basis of well-documented reports, the following clinical entities may be identified: (A) "epileptic headache (EH)" or "ictal epileptic headache (IEH)": in this condition headache (with or without migrainous features) is an epileptic manifestation per se , with onset, and cessation if isolated, coinciding with the scalp or deep EEG pattern of an epileptic seizure. EH maybe followed by other epileptic manifestations (motor/sensory/autonomic); this condition should be differentiated from "pure" or "isolated" EH, in which headache/migraine is the sole epileptic manifestation (requiring differential diagnosis from other headache forms). "Hemicrania epileptica" (if confirmed) is a very rare variant of EH, characterized by ipsilateral location of headache and ictal EEG paroxysms. (B) "Pre-ictal migraine" and "pre-ictal headache": when a headache attack is followed during, or shortly after, by a typical epileptic seizure. The migraine attack may be with or without aura, and its seizure-triggering role ("migraine-triggered seizure") is still a subject of debate. A differentiation from occipital epilepsy is mandatory. The term "migralepsy" has not been used uniformly, and may therefore led to misinterpretation. Conclusions On the basis of this review we suggest definitions and a terminology which may become the basis of a forthcoming classification of headaches associated with epileptic seizures

Botulinum toxin type a as a therapeutic agent against headache and related disorders

Botulinum neurotoxin A (BoNT/A) is a toxin produced by the naturally-occurring Clostridium botulinum that causes botulism. The potential of BoNT/A as a useful medical intervention was discovered by scientists developing a vaccine to protect against botulism. They found that, when injected into a muscle, BoNT/A causes a flaccid paralysis. Following this discovery, BoNT/A has been used for many years in the treatment of conditions of pathological muscle hyperactivity, like dystonias and spasticities. In parallel, the toxin has become a “glamour” drug due to its power to ward off facial wrinkles, particularly frontal, due to the activity of the mimic muscles. After the discovery that the drug also appeared to have a preventive effect on headache, scientists spent many efforts to study the potentially-therapeutic action of BoNT/A against pain. BoNT/A is effective at reducing pain in a number of disease states, including cervical dystonia, neuropathic pain, lower back pain, spasticity, myofascial pain and bladder pain. In 2010, regulatory approval for the treatment of chronic migraine with BoNT/A was given, notwithstanding the fact that the mechanism of action is still not completely elucidated. In the present review, we summarize experimental evidence that may help to clarify the mechanisms of action of BoNT/A in relation to the alleviation of headache pain, with particular emphasis on preclinical studies, both in animals and humans. Moreover, we summarize the latest clinical trials that show evidence on headache conditions that may obtain benefits from therapy with BoNT/A

Corrigendum: Child and adolescent behavior inventory (CABI): A new instrument for epidemiological studies and pre-clinical evaluation

Child and Adolescent Behavior Inventory (CABI): A New Instrument for Epidemiological Studies and Pre-Clinical Evaluation Clinical Practice & Epidemiology in Mental Health, 2013, 9: 51-61 Correction: Few corrections have been provided and replaced online in 15th, 20th, 21st and 22nd rows of the Appendix

Soft Mini Fuse Valve for Resilient Fluidically-Actuated Robots

Lately, soft fluidic actuation has gained widespread interest in all fields where compliance and adaptability are the main keywords. Despite their well-known advantages, soft fluidic actuators frequently present problems related to the elastomeric chambers' durability, affecting the overall system robustness and safety. Indeed, if a robot relies on the parallel pressurisation of multiple actuators, the burst of a single chamber leads to the failure of the entire fluidic circuit, with consequent potentially hazardous leaks. Here, we present the development of a Soft Mini-Fuse (SMIF) valve able to secure and maintain the system functionality even in case of burst failure of single components without affecting their overall bulkiness. By modelling the valve through both analytical and finite element tools, we defined the correlation between main geometrical features, material properties and a selected range of blocking pressures (0.1–1.0 bar). Finally, after validating the modelling tools, we characterised the device behaviour in a range of commonly employed actuation flows (0–15 l/min). The compact dimensions, the ease of integration and the demonstrated performances underline that the SMIF valve represents a novel valuable ally that guarantees stable actuation, limits human intervention and paves the way towards more resilient and autonomous soft fluidic robotic systems