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Pediatric Neurology Jul 2024The pediatric migraine phenotype may exhibit differences to adults, leading to diagnostic challenges. We aimed to perform a cross-sectional systematic study to...
BACKGROUND
The pediatric migraine phenotype may exhibit differences to adults, leading to diagnostic challenges. We aimed to perform a cross-sectional systematic study to characterize the extended phenotype of pediatric migraine.
METHODS
New migraine patients presenting to the Children's Headache Clinic were included (n = 105). Data were collected via a detailed symptom questionnaire at the first clinical encounter and were analyzed using descriptive statistics, Cohen kappa (k), Spearman correlation (ρ), and Poisson and binomial logistic regression models within SPSS.
RESULTS
Patients were 65% female and aged five to 17 years (median 14, interquartile range [IQR] 11 to 15), with a mean disease duration of 4.7 years (S.D. 2.8). Monthly headache frequency was 1 to 30 days (median 30, IQR 12 to 30). Attack duration varied between 2 and 168 hours (median 12, IQR 5 to 72). The majority (81%) experienced bilateral headache. Premonitory symptoms (PS) were reported by 93% (range 0 to 7; mood change and tiredness most commonly), cranial autonomic symptoms (CAS) by 58% (range 0 to 6; pallor and lacrimation most commonly), and premonitory CAS by 23%. Vertigo (53%) and allodynia (16%) were present. The laterality of headache and CAS showed agreement (k = 0.5, P < 0.001). For every year of disease duration, 1.07 times more PS were reported (95% confidence interval [CI] 1.03 to 1.12, P < 0.001). The number of CAS (odds ratio 2.13, 95% CI 1.2 to 3.8, P = 0.01) significantly predicted allodynia.
CONCLUSIONS
Children display a more enriched PS phenotype with disease chronicity. CAS and allodynia may be markers of central sensitization with shared neurobiological mechanisms in the absence of peripheral nociceptor activation.
Topics: Humans; Migraine Disorders; Cross-Sectional Studies; Female; Child; Male; Adolescent; Phenotype; Child, Preschool
PubMed: 38718550
DOI: 10.1016/j.pediatrneurol.2024.03.026 -
Journal of Central Nervous System... 2024After standard care, 55%-75% of patients after stroke show a persistent paresis of the upper limb (UL). Assistive devices are developed to increase the patients' level...
The assistive potential of functional electrical stimulation to support object manipulation in functional upper extremity movements after stroke: A randomized cross-over study.
BACKGROUND
After standard care, 55%-75% of patients after stroke show a persistent paresis of the upper limb (UL). Assistive devices are developed to increase the patients' level of independence in daily life.
OBJECTIVES
To investigate the potential of Functional Electrical Stimulation (FES) to assist object manipulation in activities of daily life.
DESIGN
Seventeen patients after stroke were tested and analyzed in a randomized cross-over design.
METHODS
Functional grasping was assessed by means of the Action Research Arm Test (ARAT) and the modified Box and Block Test (mBBT), in one session with and another without FES assistance. The order of sessions was randomized. Patients' motivation was assessed after each session. Task performance and motivation were compared between conditions using the Wilcoxon test and subgroup analyses were performed for impairment severity by distribution-based mixed-factor analyses.
RESULTS
When analyzing the total ARAT, FES did not effectively assist the overall performance ( = .142), but did assist the performance of objects of the Grasp category ( = .020). Impairment severity showed an interaction with the orthotic effect ( = .012), as severely impaired patients profited from FES assistance and mild-moderately impaired did not. When focusing on the more functional items of the ARAT (i.e., excluding scores from thumb-middle and thumb-ring finger combinations), there was a significant orthotic effect of FES on task performance ( = .023). Further, there was an orthotic effect for the number of transported blocks in the mBBT ( = .033), exclusively prominent in the group of severely impaired patients. Functional Electrical Stimulation did not increase the patients' motivation ( = .959), which was high after both conditions.
CONCLUSION
Functional Electrical Stimulation has the potential to support object manipulation, but is dependent on impairment severity and object type. To observe a consistent orthotic effect, features of the stimulator should be further developed to generate appropriate grasps and forces across subjects and objects.
TRIAL REGISTRATION
The trial was registered with the German Clinical Trials Register (DRKS00025889).
PubMed: 38715966
DOI: 10.1177/11795735241247812 -
Journal of Clinical Neurology (Seoul,... May 2024
PubMed: 38713078
DOI: 10.3988/jcn.2023.0445 -
Health Open Research 2023Vestibular migraine (VM) is a relatively new diagnostic entity with incomplete knowledge regarding pathophysiological mechanisms and therapeutic guidelines. By reporting...
BACKGROUND
Vestibular migraine (VM) is a relatively new diagnostic entity with incomplete knowledge regarding pathophysiological mechanisms and therapeutic guidelines. By reporting the effect of manual cervical therapy (MCT) on people with VM, we suggest a possible role for upper cervical afferents in VM treatment and/or pathogenesis. The objective was to describe the change in clinical presentation and self-reported symptoms of VM corresponding to MCT and followed up to six months.
METHODS
A nonrandomised *ABA design was utilised to consecutively and prospectively evaluate selected patients with diagnosed VM. Symptom characteristics (frequency and intensity) were recorded along with standardised patient-reported outcomes (PROs) to document the response to MCT.
RESULTS
Three patients were recruited who met the diagnostic criteria for VM. All three patients demonstrated improvement in both migraine attack and interictal symptom frequency. These improvements mirrored changes in PROs and were sustained over a six-month follow-up period.
CONCLUSIONS
The improvement that coincided with the intervention including MCT was rapid, observable and sustained. This suggests that the upper cervical spine could be a therapeutic target in VM and may have implications for future research into the pathogenesis of VM.
PubMed: 38708034
DOI: 10.12688/healthopenres.13319.3 -
Diabetes, Metabolic Syndrome and... 2024Female nurse, 44-years-old with a weight of 127 pounds. She attended our emergency clinic for an urgent care due to post COVID-19 vertigo and anxiety. Her problem began...
CASE SUMMARY
Female nurse, 44-years-old with a weight of 127 pounds. She attended our emergency clinic for an urgent care due to post COVID-19 vertigo and anxiety. Her problem began with severe, short-lived attacks of objective-circular type vertigo, accompanied by nausea and vomiting. The symptoms occurred when she assumed a lying position, turn right and sat or stood upright.
INTERVENTIONS
The patient received medical prescription for hypothyroidism, vertigo and anxiety symptoms. Oral route feeding was started and was well tolerated.
OUTCOMES
The patient showed good evolution with the treatment. Currently, she is at home with daily intake of levothyroxine and losartan without complications.
CONCLUSION
The clinical case suggests that in patients with hypothyroidism, COVID-19 infection may trigger and exacerbate vertigo and anxiety.
PubMed: 38706809
DOI: 10.2147/DMSO.S459711 -
Otolaryngologia Polska = the Polish... Dec 2023<b><br>Introduction:</b> Vertigo is a subjective sensation of swaying, tilting, spinning, instability, or being off-balance [1]. The concept of vertigo... (Review)
Review
<b><br>Introduction:</b> Vertigo is a subjective sensation of swaying, tilting, spinning, instability, or being off-balance [1]. The concept of vertigo is not a precise term due to the possibility of its being related to numerous variable, frequently co-occurring sensations as experienced by the patient. For this reason, diagnosing the origin of vertigo quite frequently poses a serious dilemma for physicians. Dizziness can be of peripheral or central origin. Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo and is currently considered to account for about 14-42% of all cases of vertigo, depending on the authors [2-4]. However, this figure may be underestimated due to frequent misdiagnoses.</br> <b><br>Aim:</b> The aim of this paper is to review the currently available international literature on the use of the TRV chair so as to assess its usefulness and effectiveness in the diagnostics and possibly subsequent treatment of BPPV and its components.</br> <b><br>Materials and methods:</b> Included in this literature review are peer-reviewed papers authored by various research teams as available in PubMed, Google Scholar, and Scopus databases.</br> <b><br>Results:</b> The TRV chair is helpful in precise diagnosis and subsequent treatment of BPPV subtypes (canalithiasis and cupulolithiasis) as well as in the evaluation of the number of affected canals, as shown in the papers analyzed in this review.</br> <b><br>Conclusions:</b> The use of TRV in the context of diagnosis and therapy of benign paroxysmal positional vertigo presents with potential for the improvement of diagnostic results, management protocols, and patients' quality of lives.</br>.
Topics: Humans; Benign Paroxysmal Positional Vertigo; Vertigo; Male; Female; Postural Balance; Dizziness
PubMed: 38706261
DOI: 10.5604/01.3001.0054.0942 -
Nature Communications May 2024The neural basis of fear of heights remains largely unknown. In this study, we investigated the fear response to heights in male mice and observed characteristic...
The neural basis of fear of heights remains largely unknown. In this study, we investigated the fear response to heights in male mice and observed characteristic aversive behaviors resembling human height vertigo. We identified visual input as a critical factor in mouse reactions to heights, while peripheral vestibular input was found to be nonessential for fear of heights. Unexpectedly, we found that fear of heights in naïve mice does not rely on image-forming visual processing by the primary visual cortex. Instead, a subset of neurons in the ventral lateral geniculate nucleus (vLGN), which connects to the lateral/ventrolateral periaqueductal gray (l/vlPAG), drives the expression of fear associated with heights. Additionally, we observed that a subcortical visual pathway linking the superior colliculus to the lateral posterior thalamic nucleus inhibits the defensive response to height threats. These findings highlight a rapid fear response to height threats through a subcortical visual and defensive pathway from the vLGN to the l/vlPAG.
Topics: Animals; Male; Fear; Mice; Geniculate Bodies; Superior Colliculi; Mice, Inbred C57BL; Visual Pathways; Periaqueductal Gray; Neurons; Primary Visual Cortex; Visual Perception; Behavior, Animal
PubMed: 38702319
DOI: 10.1038/s41467-024-48147-x -
BMC Neurology May 2024During episodes of benign paroxysmal positional vertigo (BPPV), individuals with migraine, compared with individuals without migraine, may experience more severe...
BACKGROUND
During episodes of benign paroxysmal positional vertigo (BPPV), individuals with migraine, compared with individuals without migraine, may experience more severe vestibular symptoms because of their hyperexcitable brain structures, more adverse effects on quality of life, and worse recovery processes from BPPV.
METHODS
All patients with BPPV were assigned to the migraine group (MG, n = 64) and without migraine group (BPPV w/o MG, n = 64) and completed the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), VDI Health-Related Quality of Life Scale (VDI-HRQoLS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) at the time of BPPV diagnosis (baseline) and on the one-month follow-up. Headache Impact Test-6 and Migraine Disability Assessment Scale were used for an assessment of headache. Motion sickness was evaluated based on the statement of each patient as present or absent.
RESULTS
Compared with the BPPV w/o MG, the MG had higher VSS scores at baseline [19.5 (10.7) vs. 11.3 (8.5); p < 0.001] and on one-month follow-up [10.9 (9.3) vs. 2.2 (2.7), p < 0.001]; experienced more severe dizziness and imbalance symptoms based on the VDI-SS at baseline (61.9% vs. 77.3%; p < 0.001) and after one month (78.9% vs. 93.7%, p < 0.001); and more significantly impaired quality of life according to the VDI-HRQoLS at baseline (77.4% vs. 91.8%, p < 0.001) and after one month (86.3% vs. 97.6%, p < 0.001). On the one-month follow-up, the subgroups of patients with moderate and severe scores of the BAI were higher in the MG (39.2%, n = 24) than in the BPPV w/o MG (21.8%, n = 14) and the number of patients who had normal scores of the BDI was lower in the MG than in the BPPV w/o MG (67.1% vs. 87.5%, p = 0.038).
CONCLUSION
Clinicians are advised to inquire about migraine when evaluating patients with BPPV because it may lead to more intricate and severe clinical presentation. Further studies will be elaborated the genuine nature of the causal relationship between migraine and BPPV.
Topics: Humans; Male; Benign Paroxysmal Positional Vertigo; Female; Migraine Disorders; Middle Aged; Adult; Quality of Life; Recovery of Function; Follow-Up Studies; Dizziness; Aged
PubMed: 38698310
DOI: 10.1186/s12883-024-03606-2 -
Archives de Pediatrie : Organe Officiel... May 2024The consequence of complete or partial uncompensated vestibular dysfunction in children is usually balance disorders, with the risk of falls and increased fatigue,...
Guidelines of the French Society of Otorhinolaryngology and Head and Neck Surgery (SFORL) for vestibular rehabilitation in children with vestibular dysfunction. A systematic review.
INTRODUCTION
The consequence of complete or partial uncompensated vestibular dysfunction in children is usually balance disorders, with the risk of falls and increased fatigue, particularly during tasks requiring postural control. The aim of these recommendations is to establish guidelines for vestibular rehabilitation (VR) in children with vestibular impairment.
MATERIAL AND METHODS
The guidelines were developed based on a systematic review of the international literature, validated by a multidisciplinary group of French-speaking otorhinolaryngologists, scientists, and physiotherapists. They are classified as grade A, B, C, or expert opinion according to a decreasing level of scientific evidence.
RESULTS
A PubMed search of studies published between January 1990 and December 2021 was carried out using the keywords "vestibular," "rehabilitation," and "children". After filtering and reviewing the articles, a total of 10 publications were included to establish the recommendations.
CONCLUSION
It is recommended that a vestibular assessment be carried out before VR, including a study of vestibulo-ocular reflex, otolithic function, and postural control. In cases of vestibular dysfunction, physiotherapy treatment is recommended from an early age to train different aspects of postural control, including anticipatory and reactive postural adjustments. VR adapted to the pediatric population is recommended for children whose vestibular dysfunction leads to functional disorders or symptoms of vertigo for those who have suffered head trauma. It is recommended that children with bilateral vestibular impairment be treated using gaze stabilization exercises for adaptation and substitution. Optokinetic stimulation and virtual reality are not recommended for children and young adolescents.
Topics: Humans; Vestibular Diseases; Child; Societies, Medical; France
PubMed: 38697883
DOI: 10.1016/j.arcped.2024.02.006