Eugenia Rota

Increased intrathecal TGF-β1, but not IL-12, IFN-γ and IL-10 levels in Alzheimer’s disease patients

An inflammatory response has been hypothesised to be involved in the pathogenesis of primary dementias, above all Alzheimer’s disease (AD). This study was aimed at evaluating interleukin (IL)-12 and a panel of related cytokine levels in paired CSF and sera of demented patients. IL-12 (p70 heterodimer and total IL-12 p40 chain), interferon (IFN)-γ, IL-10 and transforming growth factor (TGF)-β1 levels were measured in 30 patients with probable Alzheimer’s disease (PrAD), 57 patients with other dementing disorders, including probable vascular dementia (PrVD), Parkinson’s disease (PD) and normal pressure hydrocephalus (NPH), and 25 cognitively normal control subjects. In the presence of unchanged concentrations of IL-12, IFN-γ and IL-10, the mean CSF level of TGF-β1 and the correspondent TGF-β1 index, but not the serum level, were significantly increased in PrAD compared to controls and PrVD, whereas no difference was found vs. NPH and PD. Our results support the pathophysiological role of TGF-β1 system in AD.

Electrophysiological findings of peripheral neuropathy in newly diagnosed type II diabetes mellitus.

Abstract  This study was aimed at assessing the electrophysiological signs of peripheral neuropathy in diabetes mellitus (DM) type II patients at diagnosis. Nerve conduction studies (NCS) of median, ulnar, peroneal, tibial and sural nerves were performed in 39 newly diagnosed DM subjects and compared to those of 40 healthy controls. Metabolic indices were also investigated. Electrophysiological alterations were found in 32 (82%) of the DM patients, and more than half of them (62.2%) showed multiple (two to five) abnormal parameters. Because most of the subjects (84.4%) had from two to five nerves involved, these alterations were widespread in the seven nerves evaluated. Forty‐two percent of the patients had NCS alterations suggestive of distal median mononeuropathy, implying that metabolic factors in DM make the median nerve more susceptible to focal entrapment. A reduced sensory nerve action potential (SNAP) amplitude was observed in the median nerve in 70% of the patients, in the ulnar in 69% and in the sural nerve only in 22%. In the presence of a decrease in the SNAP amplitude of the ulnar or median nerve, the SNAP amplitude of the sural nerve was normal in 82 or 80% of the subjects, respectively. This finding may be in keeping with a distal involvement of the sensory fibres, as explored by routine median or ulnar NCS. No correlation was found between metabolic indices and NCS parameters. In conclusion, a high percentage of newly diagnosed DM patients show signs of neuropathy, and upper limb nerve sensory NCS seem to be more sensitive in detecting it than lower limb NCS.

The Temperament and Character Inventory in women with migraine

The purpose of this work was to investigate: (1) the differences in temperament and character between 49 women with migraine and 49 controls using the Temperament and Character Inventory (TCI), and (2) the extent to which these differences were related to migraine or to the presence of comorbid depression. The migraine patients scored significantly higher than the controls in two temperament dimensions—Harm Avoidance (HA) and Persistence (P)—and significantly lower in one character dimension—Self-Directedness (SDir) (Student’s t). After multiple logistic regression, the TCI P and HA dimensions were significantly associated with the presence of migraine. The HA dimension was also related to the presence of depression. Our results show that in migraine the higher HA score could be partly associated to comorbid depression while the high P dimension seems to be solely related to the presence of migraine.

Effectiveness of an Educational and Physical Programme in Reducing Headache, Neck and Shoulder Pain: A Workplace Controlled Trial

This study was an 8-month controlled trial to evaluate the effectiveness of a workplace educational and physical programme in reducing headache and neck and shoulder pain. Central registry office employees (n = 192; study group) and 192 peripheral registry office and central tax office employees (controls) in the city of Turin, Italy were given diaries for the daily recording of pain episodes. After 2 months, the study group only began the educational and physical programme. The primary end-point was the change in frequency of headache and neck and shoulder pain expressed as the number of days per month with pain, and as the proportion of subjects with a ≥50% reduction of frequency (responder rate). The number of days of analgesic drug consumption was also recorded. Diaries completed for the whole 8 months were available for 169 subjects in the study group and 175 controls. The baseline frequency of headache (days per month) was 5.87 and 6.30 in the study group and in controls; frequency of neck and shoulder pain was 7.12 and 7.79, respectively. Mean treatment effects [days per month, 95% confidence interval (CI)] on comparing the last 2 months vs. baseline were: headache frequency −2.45 (−3.48, −1.43); frequency of neck pain −2.62 (−4.09, −1.16); responder rates (odds ratio, 95% CI) 5.51 (2.75, 11) for headache, 3.10 (1.65, 5.81) for neck and shoulder pain, and 3.08 (1.06, 8.90) for days with analgesic drug consumption. The study suggests that an educational and physical programme reduces headache and neck and shoulder pain in a working community.

Personality profiles and subjective perception of pain in head pain patients

ABSTRACT Little or no information is available regarding the effect of the personality characteristics of headache sufferers on the quality of pain perception. The aim of this study is to investigate, in head pain sufferers, the relationship between the personality profile, assessed by the MMPI, and the different dimensions of pain (sensory, affective and evaluative), as assessed by the MPQ. Three hundred and seventeen patients with Migraine and/or tension‐type headache (episodic or chronic) and myogenic facial pain were included. The Italian versions of the MMPI‐2 and MPQ were administered, and the pain level was measured by the VAS. Cluster analysis based on the clinical scales of MMPI identified four personality profiles closely corresponding to the MMPI profiles obtained by the previous researchers: “depressive” (Dep.), “emotionally overwhelmed” (Emot.), “conversive” (Conv.) and “Coper”. Differences in MPQ scales between personality profiles were investigated by means of a general linear model (GLM), adjusting for sex, age and pain level and type. Results of GLM analysis showed that the affective dimension was significantly higher in cluster Emot. than in Dep. (p = 0.027), Conv. (p = 0.002) and Coper (p = 0.003). Total PRI was significantly higher in Emot. than in Conv. (p = 0.010). The findings of the present study suggest that a specific personality profile (Emot.), characterized by a heavy emotional burden, may increase the affective dimension of pain with respect to a depressive profile (Dep.), a conversive profile (Conv.) or a normal profile (Coper), independent of sex, age and pain level and type.

A comparative analysis of personality profile and muscle tenderness between chronic migraine and chronic tension-type headache

This study was aimed at comparing the personality profile, the psychiatric comorbidity (depression and anxiety) and the tenderness of the pericranial and cervical muscles in women with chronic migraine (CM) and chronic tension-type headache (CTTH). Forty-one CM and 34 CTTH women were enrolled. A clinical evaluation (according to SCID-I) and a psychometric assessment (MMPI-2, STAI-1 and STAI-2) were performed. After palpation, a Pericranial muscle Tenderness Score (PTS) and a Cervical Muscle Tenderness Score (CTS) were calculated. No significant difference was detected in MMPI-2, STAI-1, STAI-2, PTS and CTS scores between the two groups. Anxiety and depression were present in 80% of CM and in 63% of CTTH women. We did not find any significant difference either in the personality profile or in the muscle tenderness between CM and CTTH patients. This similarity points to a role of these factors, in association with psychiatric comorbidity, in the chronicisation of headache.

Differential diagnosis of chronic dysimmune demyelinating polyneuropathies with and without anti-MAG antibodies.

The distinction between chronic demyelinating polyneuropathies associated with IgM paraproteinemia and anti–myelin‐associated glycoprotein (MAG) antibodies (MAG‐PN) and chronic inflammatory demyelinating polyneuropathies (CIDPs) relies on the anti‐MAG antibodies assay. The aim of the study was to identify clinical and electrophysiological features suggesting a diagnosis of MAG‐PN. Fourteen patients with MAG‐PN and 35 with CIDP were included, and a discriminant analysis was performed to identify the clinical and electrophysiological features suggestive of MAG‐PN. Pure sensory clinical phenotype, low median and ulnar terminal latency index, and absence of M responses in the lower limbs were significantly associated with the diagnosis of MAG‐PN, and indicate a moderate to large increase in probability of this diagnosis in patients with chronic dysimmune demyelinating polyneuropathies. Muscle Nerve, 2005

Migraine and Stroke: “Vascular” Comorbidity

Several comorbidities are associated to migraine. Recent meta-analyses have consistently demonstrated a relationship between migraine and stroke, which is well-defined for ischemic stroke and migraine with aura (MA), even stronger in females on oral contraceptives or smokers. However, there seems to be no clear-cut association between stroke in migraineurs and the common vascular risk factors, at least in the young adult population. Migraineurs also run an increased risk of hemorrhagic stroke, while the association between migraine and cardiovascular disease remains poorly defined. Another aspect is the relationship between migraine and the presence of silent brain lesions. It has been demonstrated that there is an increased frequency of ischemic lesions in the white matter of migraineurs, especially silent infarcts in the posterior circulation territory in patients with at least 10 attacks per month. Although there is a higher prevalence of patent foramen ovale (PFO) in migraineurs, the relationship between migraine and PFO remains controversial and PFO closure is not a recommended procedure to prevent migraine. As an increased frequency of cervical artery dissections has been observed in migrainous patients, it has been hypothesized that migraine may represent a predisposing factor for cervical artery dissection. There still remains the question as to whether migraine should be considered a true “vascular disease” or if the comorbidity between migraine and cerebrovascular disease may have underlying shared risk factors or pathophysiological mechanisms. Although further studies are required to clarify this issue, current evidence supports a clinical management where MA patients should be screened for other concomitant vascular risk factors and treated accordingly.

Long-Term Benefits of an Educational and Physical Program on Headache, and Neck and Shoulder Pain, in a Working Community

UNLABELLED We previously published the results of a controlled trial that showed the efficacy of a workplace educational and physical program in reducing headache, and neck and shoulder pain. Participants recorded daily pain episodes in diaries; after 2 months of baseline observation, the program was administered to the intervention arm only, and comparison with the control arm was performed at month 8. The objective of the present study was to confirm the long-term (14 months from the beginning of the study) benefit of the program in the intervention arm of the study (192 office employees). Outcome measures of the present analyses were: 1) the number of days/month with headache, and neck and shoulder pain; 2) the frequency of days with analgesic drug consumption; 3) the proportion of subjects with 4 or more days/month with headache or neck and shoulder pain at baseline who achieved a > or =50% reduction in pain (responder rate). Days/month with headache decreased from 5.50 at baseline (months 1-2) to 3.11 at months 13-14 (P < .001); from 6.79 to 3.88 (P < .001) for neck and shoulder pain; and from 1.72 to 0.86 (P < .001) for analgesic consumption. Responder rates were 58.8% (95%CI = 47.1-70.5) for headache, 60.9% (49.4-72.4) for neck and shoulder pain, and 68.2 % (48.7-87.6) for drug consumption. These results confirm that the program may be effective at long term. PERSPECTIVE This article presents the results at long term of an educational and physical program in reducing headache, and neck and shoulder pain, in a working community. Since the benefits remained stable for a considerable period of time, a randomized trial is ongoing to confirm these results on a larger, less-selected working population.

Entrapment neuropathies in diabetes mellitus

Neuropathy is a common complication of diabetes mellitus (DM) with a wide clinical spectrum that encompasses generalized to focal and multifocal forms. Entrapment neuropathies (EN), which are focal forms, are so frequent at any stage of the diabetic disease, that they may be considered a neurophysiological hallmark of peripheral nerve involvement in DM. Indeed, EN may be the earliest neurophysiological abnormalities in DM, particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy. This remarkable frequency of EN in diabetes is underlain by a peculiar pathophysiological background. Due to the metabolic alterations consequent to abnormal glucose metabolism, the peripheral nerves show both functional impairment and structural changes, even in the preclinical stage, making them more prone to entrapment in anatomically constrained channels. This review discusses the most common and relevant EN encountered in diabetic patient in their epidemiological, pathophysiological and diagnostic features.