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Shanghai, China

Liang J.-F.,National Yang Ming University | Liang J.-F.,Taipei Veterans General Hospital | Wang S.-J.,National Yang Ming University | Wang S.-J.,Taipei Veterans General Hospital | Wang S.-J.,Institute of Brain Science
Cephalalgia | Year: 2014

Background: Hypnic headache (HH), first reported in 1988, is a rare sleep-related headache disorder. In 2013 a new diagnostic criteria was proposed for HH in the International Classification of Headache Disorders, the third version beta (ICHD-3β). Purpose: This review aimed to update the clinical characteristics, therapeutic options and clinical outcomes in patients with HH and also validate the new diagnostic criteria. Methods: Based on a literature search in the major medical databases, we analyzed all case reports or case series on HH that have been published since the first description by Raskin. Except for symptomatic patients, all reported patients were included regardless of which diagnostic criteria were adopted. Four studies that reported the field-testing results of the ICHD-2 criteria were selected to validate the new ICHD-3β criteria. Results: In total, 250 adult and five childhood patients are described in this review. The majority of patients were elderly and their ages of onset were typically more than 50 years old (92%). Approximately 7.7% of patients had some trigeminal autonomic features, which are not permitted in the ICHD-3β criteria. Compared with the ICHD-2 criteria, the diagnostic rate under the new criteria increased from 65% to 85% in recently reported cases. Randomized control trials both for acute and prophylactic treatment are lacking. Based on observational studies, the most effective acute treatment is caffeine and prophylactic medications in use are lithium, caffeine and indomethacin. Without treatment, the disease course is usually protracted but spontaneous remission did occur in 12 patients (4.8%). In those treated with prophylactic agents, no recurrence was noted in 43% of patients, even following withdrawal of medication. Conclusions: The new ICHD-3β criteria are more sensitive and exhaustive for HH than the ICHD-2 criteria. Prophylactic treatment provides better outcomes; however, randomized controlled studies for treatment are needed to further verify the efficacy of the different drugs. © International Headache Society 2014. Source

Liu J.-Y.,Fudan University | Ding J.,Fudan University | Lin D.,Fudan University | He Y.-F.,Fudan University | And 8 more authors.
Journal of Magnetic Resonance Imaging | Year: 2013

Purpose: To evaluate regional brain iron deposition in minimal hepatic encephalopathy (MHE) patients using T2*-weighted gradient-echo imaging and to explore the relationship between T2* MR changes and cognitive performance. Materials and Methods: Forty hepatitis-B virus (HBV)-related cirrhotic patients and 22 age-, sex-, and education-matched healthy controls were included in this study. Of the patients, twenty eight patients were diagnosed with MHE. All subjects were administered Number Connection Test-A (NCT-A), Letter Digit Substitution Test (LDST), Rey-Osterrieth Complex Figure Test (RCFT), and the Mini-Mental State Examination (MMSE). T2*-weighted gradient-echo images were acquired using 3 Tesla MRI. Phase values (putative iron levels) in the frontal-basal ganglia-thalamocortical circuits were measured. Spearman correlation and multiple linear regression analysis were performed. Results: MHE patients exhibited significantly prolonged NCT-A time and decreased LDST, RCFT immediate and delayed recall scores. Significant decreases of phase values in the bilateral putamen were detected in MHE patients compared to without MHE patients and controls. Multiple linear regression analysis confirmed significant correlations between the phase values in the putamen and right frontal white matter and cognitive performances by MHE patients. Conclusion: Decreased phase values in the frontal cortical-basal ganglial circuits independently contribute to cognitive impairments in MHE patients. J. Magn. Reson. Imaging 2013;37:179-186. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc. Source

Lee Y.-J.,National Yang Ming University | Lee Y.-J.,Taipei Veterans General Hospital | Chen Y.-T.,Taipei City Hospital Heping Fuyou branch | Chen Y.-T.,Taipei Veterans General Hospital | And 10 more authors.
Cephalalgia | Year: 2014

Background: Cluster headache (CH) is well known to show a seasonal predilection; however, the impact of temperature and other meteorological factors on cluster periods (or bouts) has not been established. Methods: This nationwide survey included 758 patients with episodic CH retrieved from the Taiwan National Health Insurance Research Database from 2005 to 2009. Corresponding meteorological recordings were obtained from the Central Weather Bureau. A case-crossover study design was used to investigate the association between cluster periods and meteorological factors. Results: A total of 2452 episodes of cluster periods were recorded. The cluster periods were most frequent in the autumn and least frequent in the winter. Seasonal changes from winter to spring and from autumn to winter also increased the frequency of cluster periods. The risk of cluster periods increased when there was a higher mean temperature on event days (odds ratio (OR), 1.014, 95% confidence interval (CI), 1.005-1.023, =0.003) or within seven to 56 days. Either an increase or a decrease in temperature (0.05°C/day) following a warm period (mean temperature≥26°C) was associated with the onset of cluster periods. In contrast, a greater increase in temperature (0.15°C/day) following a cold period (mean temperature<21°C) was needed to evoke cluster periods. No such associations were found following moderate periods (21°C≤mean temperature<26°C). Discussion: Our study shows that temperature is associated with precipitating or priming cluster periods. The influence depends on the temperature of the preceding periods. © International Headache Society 2014. Source

Mao L.-Y.,Fudan University | Ding J.,Fudan University | Peng W.-F.,Fudan University | Ma Y.,Fudan University | And 4 more authors.
Epilepsia | Year: 2013

Interleukin 17A (IL-17A) is implicated in the pathogenesis of several neuroimmunologic diseases. We aimed to evaluate the relationship between IL-17A and seizure severity in patients with epilepsy. Seventy patients with probable symptomatic epilepsy and 68 healthy controls were included. Interictal serum IL-17A and related cytokine (IL-23, IL-6, IL-1β, interferon gamma (IFN-γ), and IL-10) levels were measured. The relationship between seizure severity and cytokine concentrations was assessed by Spearman correlation and multivariate linear regression test. IL-17A levels in the cerebrospinal fluid (CSF) were tested in 30 additional patients with epilepsy, either in the postictal or interictal period and 15 patients with idiopathic inflammatory demyelinating diseases (IIDDs). Interictal serum IL-17A levels were significantly elevated in patients with epilepsy compared to controls. IL-6, IFN-γ, and IL-1β levels were also markedly elevated. Spearman correlation analysis revealed positive correlation between IL-17A, IL-6 levels and Veterans Administration Seizures Frequency and Severity Rating Scale score(VA score); IFN-γ, IL-10 levels, and National Hospital Seizure Severity Scale (NHS3) score. In addition, IL-17A levels correlated significantly with seizure frequency. Multivariate linear regression test showed that only IL-17A levels were independently positively correlated with VA scores (B = 0.288, p = 0.027). Postictal IL-17A levels in the CSF were significantly elevated compared to interictal patients and patients with IIDDs. Our results suggest that interictal IL-17A levels correlated highly with seizure severity. © Wiley Periodicals, Inc. © 2013 International League Against Epilepsy. Source

Lee Y.-J.,Neurological Institute | Lee Y.-J.,National Yang Ming University | Hu Y.-W.,Cancer Center | Hu Y.-W.,National Yang Ming University | And 7 more authors.
Neuroepidemiology | Year: 2013

Background: Previous studies suggested a decreased risk of cancer among patients with Alzheimer's disease (AD). There is still a lack of data on the specific types of cancer, the risk factors, and the impact of cholinesterase inhibitors on developing cancer in AD. Methods: We performed a nationwide population-based study of 6,960 patients with AD between 1997 and 2006 using Taiwan's National Health Insurance database. Patterns of cancer incidence in AD patients were compared with those of the general population using standardized incidence ratios (SIRs). Results: Patients with AD had a reduced risk of developing overall cancer [SIR = 0.88, 95% confidence interval (CI) = 0.80-0.97]. Specifically, patients with AD were protected from lung cancers (SIR = 0.75, 95% CI = 0.57-0.98), especially men (SIR = 0.61, 95% CI = 0.40-0.88). In subgroup analyses, women, patients aged 60-79 years, and those diagnosed as having AD for more than 1 year were more likely to be protected from cancers. Conclusions: Our study demonstrates a decreased incidence of overall cancers in patients with AD, a finding lower than but consistent with Western countries. Patients with AD had a significantly decreased risk of lung cancer. Further investigation of genetic evidence linking AD to cancer is warranted. Copyright © 2012 S. Karger AG, Basel. Source

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