Wilson Luiz Sanvito

Chronic Administration of Cannabidiol to Healthy Volunteers and Epileptic Patients

In phase 1 of the study, 3 mg/kg daily of cannabidiol (CBD) was given for 30 days to 8 health human volunteers. Another 8 volunteers received the same number of identical capsules containing glucose as placebo in a double-blind setting. Neurological and physical examinations, blood and urine analysis, ECG and EEG were performed at weekly intervals. In phase 2 of the study, 15 patients suffering from secondary generalized epilepsy with temporal focus were randomly divided into two groups. Each patient received, in a double-blind procedure, 200-300 mg daily of CBD or placebo. The drugs were administered for along as 4 1/2 months. Clinical and laboratory examinations, EEG and ECG were performed at 15- or 30-day intervals. Throughout the experiment the patients continued to take the antiepileptic drugs prescribed before the experiment, although these drugs no longer controlled the signs of the disease. All patients and volunteers tolerated CBD very well and no signs of toxicity or serious side effects were detected on examination. 4 of the 8 CBD subjects remained almost free of convulsive crises throughout the experiment and 3 other patients demonstrated partial improvement in their clinical condition. CBD was ineffective in 1 patient. The clinical condition of 7 placebo patients remained unchanged whereas the condition of 1 patient clearly improved. The potential use of CBD as an antiepileptic drug and its possible potentiating effect on other antiepileptic drugs are discussed.

The epidemiology of migraine in medical students.

The purpose of this study was to investigate the prevalence of migraine in medical students, as well as its clinical aspects and impact. All 595 medical students of Santa Casa School of Medicine of São Paulo, Brazil were asked if they had experienced any kind of headache in the past year. Those who responded positively were further investigated by an appropriate questionnaire. Diagnosis of migraine was based on the International Headache Society criteria of 1988. Forty percent of students suffered from some kind of headache; 40.2% of these headaches were migraine. The prevalence of migraine was 54.4% in women and 28.3% in men. Migraine headaches were unilateral in 24.2%, had a gradual onset in 69%, and were of a throbbing type in 88.3%. Migraine was considered incapacitating by 53.9% of students. Migraine with aura caused more disability than migraine without aura. Women experienced more intense migraine than men, and migraine with aura was especially more severe than migraine without aura. Photophobia, phonophobia, and nausea were more commonly encountered in migraine with aura. Despite the high prevalence, the high rate of disability, and the need for analgesic medication, only 7.1% of students with migraine had sought medical treatment.

Cluster-tic syndrome: report of five new cases

The so-called short lasting primary headaches include heterogenic entities that can be divided between those without pronounced autonomic activation and those where this activation is evident, which includes the cluster-tic syndrome. We report five new cases with age closer to the trigeminal neuralgias one, and concomitance of cluster headache and trigeminal neuralgia, which is less frequent in the literature. We also discuss briefly the pathophysiology of these clinical entities, suggesting that the trigeminus nerve is a common pathway of pain manifestation.

Cefaléia numular: relato de caso

Nummular headache or coin shaped cephalalgia was first described by Pareja and coworkers in 2002. It seems to be a primary headache that has a chronic course, with a circumscribed area of pain described by the patients as elliptic or coin shaped. Patients experience periods without pain followed by bouts of daily headache. In the original series of thirteen cases it was sometimes associated with other primary headaches, but not necessarily. It could also be related to cranial trauma. We present the first case of of nummular headache described in our country with clinical features similar to the original series. We intend to alert neurologists and pain specialists to the existence of this unusual headache and also discuss the possible differential diagnosis of this cephalalgia.

Tratamento agudo da crise de enxaqueca refratária na emergência: estudo comparativo entre dexametasona e haloperidol. Resultados preliminares

We studied the efficacy of dexametasone (4 mg) and haloperidol (5 mg) in the treatment of migraine in the emergency room. Twenty nine patients who had diagnosis of migraine according to the International Headache Society criteria and were evaluated for a painful episode at the emergency room of Santa Casa of Sao Paulo were included. All the patients scored their pain in 10 when evaluated, even after the use of intravenous analgesia (dipyrone). Fourteen patients were treated with haloperidol and the remaining 15 received dexametasone. The patients were asked about pain intensity at 30, 60, 90 and 120 minutes after the use of either the drugs. Both drugs were equally efficient in pain relief after two hours. Patients who were treated with haloperidol showed an important improvement (more than 50% of improve in the analogic pain scale) in the first 30 minutes. The dexametasone treated patients only reached this grade of analgesia after 120 minutes. Although we studied a small serie of patients, our data suggest that both drugs are efficient in the treatment of a refractory migraine attack. Haloperidol seemed to work quickly in pain relief. No important side effects were observed in neither groups.

Tumor maligno do sistema nervoso central associado a polipose do cólon com degeneração maligna

E relatado um caso caracterizado pela associacao de tumor do sistema nervoso central e polipose do colon. Foram encontrados apenas dois casos dessa natureza na literatura medica, relatados por Turcot e col. em dois irmaos, nos quais a afeccao teve inicio na puberdade, caracterizando-se pela presenca de tumor do sistema nervoso central associado a polipose do colon; nos dois casos o tumor do sistema nervoso era da linha gliomatosa e ocorreu transformacao carcinomatosa dos polipos. No caso aqui relatado, a molestia teve inicio aos 14 anos de idade e, do ponto de vista histologico, foi encontrado um espongioblastoma polar no tronco cerebral associado a polipos multiplos do colon, alguns com degeneracao carcinomatosa. Ate o momento, a paciente estudada representa caso isolado em sua familia.

Síndrome da cefaléia em salvas-nevralgia do trigêmeo: a propósito de dois casos

Two patients with cluster-tic syndrome are reported. The first, a 43-years-old man, complaining of trigeminal pain in the right side of the face, accompanied by homolateral autonomic signs, such as ocular injection, sweating and drooped eyelid. The cluster attack was triggered by chewing, shaving and washing the face. The periodicity of bouts was six months. The pain was relieved by carbamazepine (800 mg/day). The second patient, a 43-year-old man, with an excruciant, neuralgic pain in the left side of the face, accompanied by tearing, conjuntival injection, drooped eyelid, rhinorrhea, photophobia and phonophobia. The neurologic examination showed triggered points in the first and second division of the trigeminal nerve. The patient was treated with verapamil (160mg/day) and prednisone (60 mg/day), with relief of his symptoms. The periodicity of bouts was once a year. The literature was reviewed and 37 cases previosly reported are considered. We conclude that there are two different groups of patients. In the first group, the patients had cluster and trigeminal bouts in different time. In the second group, with only nine cases, the patients presented both cluster and trigeminal type of pain at the same time, as in the two cases reported here.

PAPEL DA CURVA DE AGREGAÇÃO PLAQUETÁRIA NO CONTROLE DA ANTIAGREGAÇÃO NA PREVENÇÃO SECUNDÁRIA DO ACIDENTE VASCULAR CEREBRAL ISQUÊMICO

INTRODUCTION: Stroke is the leading cause of death in Brazil. The risk of suffering a recurrent stroke is around 30% in 5 years. Antiplatelet therapy has been frequently used to prevent recurrent strokes without laboratory control. OBJECTIVE: To determine the value of the platelet aggregation test in the control of antiplatelet aggregation in the secondary stroke prevention. METHOD: Retrospective study from January 1990 to January 2001 with 189 patients with stroke that were followed up during this period with platelet aggregation curve. Patients with cardioembolic disease were excluded. Low aggregation rates of platelet aggregation activated by ADP and/or epinephrine lower or equal to 50% were considered. Patients were followed up for a period from one to six years to verify differences in stroke recurrence. RESULTS: Nine patients had had a recurrent stroke; 2,6% of the strokes occurred among the group with low aggregaton and 15,1% among the group with normal aggregation (0,03<OR<0,69, p<0,05). Most of the cases occurred in the second year after the first stroke. CONCLUSION: Platelet aggregation curve is a valid and a helpful laboratory test to therapeutic control of antiplatelet aggregation in secondary stroke prevention.

Sindrome de Klüver-Bucy determinada por encefalite a virus: relato de um caso

A case of peculiar form of Klüver-Bucy syndrome is reported. The diagnosis of viral meningoencephalitis was made by the clinical features and by cerebrospinal fluid and histological examination (brain biopsy). The computed tomography and electroencephalographic aspects are analysed. The viral meningoencephalitis was possibly herpetic in nature (herpes simplex virus). The patient here concerned, a woman aged twenty-one years old, during the clinical course of the disease showed insatiable appetite, psychic blindness, oral tendencies, aberrant sexual behavior and hypermetamorphopsia (Klüver-Bucy syndrome). The significance of these features is discussed.A case of peculiar form of Kluver-Bucy syndrome is reported. The diagnosis of viral meningoencephalitis was made by the clinical features and by cerebrospinal fluid and histological examination (brain byopsy). The computed tomography and electroencephalographic aspects are analysed. The viral meningoencephalitis was possibly herpetic in nature (herpes simplex virus). The patient here concerned, a woman aged twenty-one years old, during the clinical course of the disease showed insatiable appetite, psychic blindness, oral tendencies, aberrant sexual behavior and hypermetamorphopsia (Kluver-Bucy syndrome). The significance of these features is discussed.

Cefaléias em salvas: estudo das alterações autonômicas e outras manifestações associadas em 28 casos

The short lasting primary headaches are classified as those without autonomic activation and those with important activation, which includes the cluster headache. This study focuses on the pathophysiology of cluster headache mainly in its autonomic phenomenon (conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, partial ptosis and eyelid oedema) showing the involvement of superior salivatory nucleus with the pain stimulus propagation, which begins in the trigeminal nerve. The autonomic alterations were studied in 28 patients being lacrimation and conjunctival injection, the main features.