David Tabby

Oligomerization state-dependent elevations of adiponectin in chronic daily headache

Objective: To evaluate serum adiponectin levels in female episodic migraineurs (EMs) and chronic daily headache (CDH) sufferers. Background: Obesity is a risk factor for headache “chronification.” Adiponectin (ADP) is an adipocytokine secreted primarily by adipose tissue. ADP and its oligomers (high-molecular-weight [HMW], middle-molecular-weight [MMW], and low-molecular-weight [LMW] ADP) have been shown to modulate several inflammatory pathways that have also been shown to be associated with migraine pathophysiology. Methods: Age- and body mass index (BMI)-matched women participants were enrolled. Anthropometric measures (including waist-to-hip ratio [WHR] and BMI) were measured in all participants. Serum total ADP (T-ADP) levels and its oligomers were measured in EMs during headache-free periods and CDH sufferers at baseline level of pain, as compared with healthy control subjects using ELISA. Results: Although total body obesity as estimated by BMI showed no significant association between participants, visceral obesity as estimated by WHR was significantly associated with CDH as compared with EMs and controls. WHR was also inversely related to both T-ADP (p = 0.008) and HMW-ADP (p = 0.002). After adjusting for WHR, serum T-ADP levels were higher in CDH sufferers (10.1 ± 4.0) than in both EMs (8.6 ± 3.5) and controls (7.5 ± 2.4) (p = 0.024). In addition, HMW-ADP was higher in CDH (6.1 ± 2.8) as compared with EMs (4.2 ± 1.7) and controls (3.9 ± 1.5) (p = 0.003). MMW-ADP was also higher in CDH (2.0 ± 1.2) as compared with EMs (1.5 ± 0.7) and controls (1.1 ± 0.4) (p = 0.009). Conclusion: Serum adiponectin levels are increased in women chronic daily headache (CDH) sufferers. In addition, visceral obesity, as measured by waist-to-hip ratio, is a risk factor for CDH in women.

Current status of neurology grand rounds.

Objective:We sought to compare the current status of Neurologic Grand Rounds (NGRs) in training programs with the status observed in Medical Grand Rounds. Methods:A survey was sent to 124 departments of neurology in the United States that are accredited by the American Council of Graduate Medical Education via an online Web tool. We collected data regarding the attendance, objectives, format, educational structure, and perceived changes and trends over time. Results:Seventy-five (60%) surveys were returned: 10% were completed by the department chairperson, 4% by the chief resident, and 54% by another faculty member. NGRs were offered by 99% of the programs surveyed, and 95% of the programs conduct NGRs accredited for Continuing Medical Education. Almost all of the respondents agreed that the education of faculty, house staff, and full-time faculty was very important. Ninety-three percent of the programs hold clinical case presentations, and 60% have patients in attendance for the presentation. Programs reported that the quality, importance, and educational value of NGRs had either not changed or had increased over time (94%, 91%, and 89%, respectively). Conclusion:NGRs continue to be an important component of neurology residency training programs. The results of our survey were comparable to those obtained by others studying Medical Grand Rounds. Objectives, components, attendance, format, changes, and trends were also similar.

Cerebral reactivity in migraine patients measured with functional near-infrared spectroscopy.

BackgroundThere are two major theories describing the pathophysiology of migraines. Vascular theory explains that migraines resulted from vasodilation of meningeal vessels irritating the trigeminal nerves and causing pain. More recently, a neural theory of migraine has been proposed, which suggests that cortical hyperexcitability leads to cortical spreading depression (CSD) causing migraine-like symptoms. Chronic migraine requires prophylactic therapy. When oral agents fail, there are several intravenous agents that can be used. Understanding underlying causes of migraine pain would help to improve efficacy of migraine medications by changing their mechanism of action. Yet to date no study has been made to investigate the link between vascular changes in response to medications for migraine versus pain improvements. Functional near-infrared spectroscopy (NIRS) has been used as an inexpensive, rapid, non-invasive and safe technique to monitor cerebrovascular dynamics.MethodIn this study, a multi-distance near-infrared spectroscopy device has been used to investigate the cortical vascular reactivity of migraine patients in response to drug infusions and its possible correlation with changes in pain experienced. We used the NIRS on 41 chronic migraine patients receiving three medications: magnesium sulfate, valproate sodium, and dihydroergotamine (DHE). Patients rated their pain on a 1–10 numerical scale before and after the infusion.ResultsNo significant differences were observed between the medication effects on vascular activity from near channels measuring skin vascularity. However, far channels—indicating cortical vascular activity—showed significant differences in both oxyhemoglobin and total hemoglobin between medications. DHE is a vasoconstrictor and decreased cortical blood volume in our experiment. Magnesium sulfate has a short-lived vasodilatory effect and increased cortical blood volume in our experiment. Valproate sodium had no significant effect on blood volume. Nonetheless, all three reduced patients’ pain based on self-report and no significant link was observed between changes in cortical vascular reactivity and improvement in migraine pain as predicted by the vascular theory of migraine.ConclusionNIRS showed the potential to be a useful tool in the clinical setting for monitoring the vascular reactivity of individual patients to various migraine and headache medications.

Neurology Resident Conferences: Should Students Attend Morning Report and Grand Rounds?

Medical students are required to attend neurology resident conferences although the conferences may present information above their level. No studies so far have assessed the level of perceived knowledge gained by medical students in neurology grand rounds or morning report. We sought to better understand what students perceived to be of educational value in resident conferences by sending a Survey Monkey questionnaire to all fourth-year neurology clerks at Drexel University College of Medicine. Students generally agreed that they learned to take a more specific history, perform a better examination, evaluate a patient’s social environment, and understand the limitations of technology in clinical practice. Morning Report and Grand Rounds were perceived by neurology clerks to be a valuable part of their medical education.