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Podnar S.,Institute of Clinical Neurophysiology
Muscle and Nerve | Year: 2015

Introduction: Controversy persists as to whether the lung interposes on the needle electrode insertion path during diaphragm electromyography (EMG). Methods: Using high-resolution ultrasonography, we measured the distances between the medial recess of the intercostal spaces (ICSs) around the mid-clavicular line (MCL) and the lung margin. We performed measurements bilaterally during quiet breathing in the seated and supine positions. Results: We studied 10 young healthy men and found that, in the first ICS with the medial recess clearly (i.e., several cm) lateral to MCL (usually the eighth ICS), the distance between the recommended insertion site and the lung margin varied from 7.5 to 17cm. The distance was slightly larger on the right side and in the supine position. Conclusions: This study confirms that properly conducted "trans-intercostal" needle EMG of the diaphragm is generally safe in healthy subjects. © 2015 Wiley Periodicals, Inc.


D'Onofrio F.,Neurology Unit | Cologno D.,Institute of Clinical Neurophysiology | Petretta V.,Neurology Unit | Finocchi C.,University of Genoa | And 8 more authors.
Neurological Sciences | Year: 2011

Based on recent data about the association between restless legs syndrome (RLS) and migraine, we performed an observational study on the occurrence of RLS in patients affected by "pure" migraine with aura (pMA). We recruited 63 patients (33 females and 30 males) affected by MA without other types of primary headache among all patients referred in five Italian headache centers in a 1-year period. The prevalence of RLS in pMA patients (9.5%) is similar to that observed in Italian headache-free subjects (8.3%). No significant differences were found between pMA patients with and without RLS about clinical features of MA attacks and systemic and psychiatric diseases were investigated. Moreover, no association appeared between RLS and familial cases of MA. Differently from migraine without aura, our data do not confirm the existence of an association between RLS and MA, not even when a genetic factor is involved. © Springer-Verlag 2011.


Cologno D.,Institute of Clinical Neurophysiology | Mazzeo A.,Institute of Clinical Neurophysiology | Lecce B.,Institute of Clinical Neurophysiology | Mundi C.,Neurology Unit | And 3 more authors.
Neurological Sciences | Year: 2012

Migraine is a chronic, recurrent, disabling condition that affects millions of people worldwide. Proper acute care treatment for migraineurs is based on triptans, a class of specific medications approved over 20 years ago. Triptans are serotonin (5-HT1B/1D) receptor agonists that are generally effective, well tolerated and safe. Seven triptans are available worldwide, although not all are available in every country, with multiple routes of administration, giving to doctors and patients a wide choice. Despite the similarities of the available triptans, pharmacological heterogeneity offers slightly different efficacy profiles. Triptans are not pain medications, they are abortive migraine medications which cannot prevent migraines. In addition to migraine attacks, triptans are also helpful for cluster headaches. If they are useful in other primary headaches rather than migraine and cluster headache it is yet to be addressed. In the literature there are only limited controlled clinical data to support a migraine-selective activity for triptans. Reports are available about efficacy of triptans to stop attacks of other types of primary headache, such as tension type headache, hypnic headache and other rare forms of primary headaches. On the other hand, sumatriptan failed to treat the indomethacin-responsive primary headache disorders like chronic paroxysmal hemicrania and hemicrania continua, nor was it effective in the myofascial temporal muscle pain or in atypical facial pain. Why triptans are effective in so different types of primary headaches remain unclear. Up to date, it is not clear whether the antimigrainous activity of the triptans involves an action only in the periphery or in theCNSas well. Probably we should consider triptans as ''pain killers'' and not only as ''migraine killers''. We clearly need additional studies on triptans as putative analgesics in well-accepted animal and clinical models of acute and chronic somatic pain. © Springer-Verlag 2012.


D'Onofrio F.,Neurology Unit | Barbanti P.,Headache and Pain Unit | Petretta V.,Neurology Unit | Casucci G.,S. Francesco Nursing Home | And 4 more authors.
Neurological Sciences | Year: 2012

A large series of clinical and experimental observations on the interactions between migraine and the extrapyramidal system are available. Some previous studies reported high frequency of migraine in some basal ganglia (BG) disorders, such as essential tremor (ET), Tourette's syndrome (TS), Sydenham's chorea and more recently restless legs syndrome (RLS). For example, the frequency of migraine headache in a clinic sample of TS patients was found nearly fourfold more than that reported in the general population. To the best of our knowledge, no controlled studies have been conducted to determine a real association. ET and migraine headache have been considered comorbid diseases on the basis of uncontrolled studies for many years. In a recent Italian study, this comorbid association has been excluded, reporting no significant differences in the frequency of lifetime and current migraine between patients with ET and controls. Among mostly common movement disorders, RLS has been recently considered as possibly comorbid with migraine. Studies in selected patient groups strongly suggest that RLS is more common in migraine patients than in control populations, although no population-based study of the coincidence of migraine and RLS has yet been identified. The exact mechanisms and contributing factors for a positive association between migraine and RLS remain unclear.Anumber of possible explanations have been offered for the association of RLS and primary headache, but the three most attractive ones are a hypothetical dopaminergic dysfunction and dysfunctional brain iron metabolism, a possible genetic linkage and a sleep disturbance. More recently, the role ofBGin pain processing has been confirmed by functional imaging data in the caudate, putamen and pallidum in migraine patients. A critical appraisal of all these clinical and experimental data suggests that the extrapyramidal system is somehow related to migraine. Although the primary involvement of extrapyramidal system in the pathophysiology of migraine cannot as yet be proven, a more general role in the processing of nociceptive information and/or maybe part of the complex behavioral adaptive response that characterizes migraine may be suggested. © Springer-Verlag 2012.


Casucci G.,Casa di Cura S. Francesco | Villani V.,University of Rome La Sapienza | Villani V.,Regina Elena Cancer Institute | Cologno D.,Institute of Clinical Neurophysiology | D'Onofrio F.,Sg Moscati Hospital
Neurological Sciences | Year: 2012

Migraine is a chronic disorder with complex pathophysiology involving both neuronal and vascular mechanisms. Migraine is associated with an increased risk of vascular disorders, such as stroke and coronary heart disease. Obesity and diabetes are metabolic disorders with a complex association with migraine. Insulin resistance, which represents the main causal factor of diseases involved in metabolic syndrome, is more common in patients with migraine. A better understanding of the relationship between metabolic syndrome and migraine may be of great clinical interest for migraine management. © Springer-Verlag 2012.


Casucci G.,Casa di Cura S. Francesco | Villani V.,University of Rome La Sapienza | Villani V.,Regina Elena Cancer Institute | Cologno D.,Institute of Clinical Neurophysiology | D'Onofrio F.,Sg Moscati Hospital
Neurological Sciences | Year: 2012

Migraine is a chronic neurological disorder with episodic manifestations, progressive in some individuals. Preventive treatment is recommended for patients with frequent or disabling attacks. A sizeable proportion of migraineurs in need of preventive treatment does not significantly benefit from monotherapy. This short review evaluates the role of pharmacological polytherapy in migraine prevention. © Springer-Verlag 2012.


D'Andrea G.,Research and Innovation | Cevoli S.,NeuroLogica | Cologno D.,Institute of Clinical Neurophysiology
Neurological Sciences | Year: 2014

The use of herbal therapies is ancient and increasing worldwide. There is a growing body of evidence supporting the efficacy of various "complementary" and alternative medicine approaches in the management of headache disorders. Promising tools to treat migraine patients are herbal products. In particular constituents of Petasites hybridus, Tanacetum Parthenium and Ginkgo Biloba have shown antimigraine action in clinical studies. A miscellaneous of recreational drugs and other herbal remedies have been supposed to have a role in headache treatment but quality of clinical studies in this field is low and inconclusive. Further research is warranted in this area. © 2014 European Union.


Florindo D.,Neurology Unit | Daniela C.,Institute of Clinical Neurophysiology | Giulio C.,Neurology Unit | Vittorio P.,Neurology Unit | And 5 more authors.
Clinical Neurology and Neurosurgery | Year: 2011

Objective: To investigate the presence of Restless Legs Syndrome (RLS) in Cluster Headache (CH) patients compared to headache-free controls. Design and setting: Cross-sectional case-control study of CH patients presenting at tertiary headache centers over the period January-December 2008. Patients and participants: Fifty consecutive patients (6 women and 44 men) of mean age of 39.7 year (standard deviation 10.9) with episodic or chronic CH diagnosed according to ICHD-II criteria and 50 headache-free subjects matched by age and sex were recruited. Results: None of the CH patients had RLS. Six (12%) headache-free controls had RLS. Conclusions: Our data indicate no probable relationship between CH and RLS. However, since both conditions have a circadian rhythm and are associated with altered melatonin secretion, we conjecture that reduced nocturnal melatonin in CH likely allows sustained dopaminergic activity which could be protective against RLS in CH patients. © 2010 Elsevier B.V. All rights reserved.


PubMed | Institute of Clinical Neurophysiology
Type: | Journal: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology | Year: 2012

Migraine is a chronic, recurrent, disabling condition that affects millions of people worldwide. Proper acute care treatment for migraineurs is based on triptans, a class of specific medications approved over 20 years ago. Triptans are serotonin (5-HT1B/1D) receptor agonists that are generally effective, well tolerated and safe. Seven triptans are available worldwide, although not all are available in every country, with multiple routes of administration, giving to doctors and patients a wide choice. Despite the similarities of the available triptans, pharmacological heterogeneity offers slightly different efficacy profiles. Triptans are not pain medications, they are abortive migraine medications which cannot prevent migraines. In addition to migraine attacks, triptans are also helpful for cluster headaches. If they are useful in other primary headaches rather than migraine and cluster headache it is yet to be addressed. In the literature there are only limited controlled clinical data to support a migraine-selective activity for triptans. Reports are available about efficacy of triptans to stop attacks of other types of primary headache, such as tension type headache, hypnic headache and other rare forms of primary headaches. On the other hand, sumatriptan failed to treat the indomethacin-responsive primary headache disorders like chronic paroxysmal hemicrania and hemicrania continua, nor was it effective in the myofascial temporal muscle pain or in atypical facial pain. Why triptans are effective in so different types of primary headaches remain unclear. Up to date, it is not clear whether the antimigrainous activity of the triptans involves an action only in the periphery or in the CNS as well. Probably we should consider triptans as pain killers and not only as migraine killers. We clearly need additional studies on triptans as putative analgesics in well-accepted animal and clinical models of acute and chronic somatic pain.

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