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Milwaukee, WI, United States

Jackson J.L.,Zablocki Veterans Affairs Medical Center | Jackson J.L.,Medical College of Wisconsin | Kuriyama A.,Rakuwakai Otowa Hospital | Hayashino Y.,Kyoto University
JAMA - Journal of the American Medical Association | Year: 2012

Context: Botulinum toxin A is US Food and Drug Administration approved for prophylactic treatment for chronic migraines. Objective: To assess botulinum toxin A for the prophylactic treatment of headaches in adults. Data Sources: A search of MEDLINE, EMBASE, bibliographies of published systematic reviews, and the Cochrane trial registries between 1966 and March 15, 2012. Inclusion and exclusion criteria of each study were reviewed. Headaches were categorized as episodic (<15 headaches per month) or chronic (≥15 headaches per month) migraine and episodic or chronic daily or tension headaches. Study Selection: Randomized controlled trials comparing botulinum toxin A with placebo or other interventions for headaches among adults. Data Extraction: Data were abstracted and quality assessed independently by 2 reviewers. Outcomes were pooled using a random-effects model. Data Synthesis: Pooled analyses suggested that botulinum toxin Awas associated with fewer headaches per month among patients with chronic daily headaches (1115 patients, -2.06 headaches per month; 95% CI, -3.56 to -0.56; 3 studies) and among patients with chronic migraine headaches (n=1508, -2.30 headaches per month; 95% CI, -3.66 to -0.94; 5 studies). There was no significant association between use of botulinum toxin A and reduction in the number of episodic migraine (n=1838, 0.05 headaches per month; 95% CI, -0.26 to 0.36; 9 studies) or chronic tension-type headaches (n=675, -1.43 headaches per month; 95% CI, -3.13 to 0.27; 7 studies). In single trials, botulinum toxin A was not associated with fewer migraine headaches per month vs valproate (standardized mean difference [SMD], -0.20; 95% CI, -0.91 to 0.31), topiramate (SMD, 0.20; 95% CI, -0.36 to 0.76), or amitriptyline (SMD, 0.29; 95% CI, -0.17 to 0.76). Botulinum toxin A was associated with fewer chronic tension-type headaches per month vs methylprednisolone injections (SMD, -2.5; 95% CI, -3.5 to -1.5). Compared with placebo, botulinum toxin A was associated with a greater frequency of blepharoptosis, skin tightness, paresthesias, neck stiffness, muscle weakness, and neck pain. Conclusion: Botulinum toxin A compared with placebo was associated with a small to modest benefit for chronic daily headaches and chronic migraines but was not associated with fewer episodic migraine or chronic tension-type headaches per month. ©2012 American Medical Association. All rights reserved. Source

Lanska D.J.,Veterans Affairs Medical Center | Remler B.,Medical College of Wisconsin | Remler B.,Zablocki Veterans Affairs Medical Center
Neurology | Year: 2014

Zinc-induced myeloneuropathy was recently (re)discovered and its pathophysiology elaborated as resulting from secondary copper deficiency. However, myelopathy was a recognized problem among European zinc-smelter workers in the late 19th century, although these early reports have been overlooked in recent studies and reports. The purpose of this article is to translate and review German-language reports of myelopathy among zinc-smelter workers in Upper Silesia (now southern Poland) by Schlockow from the 1870s. Disease manifestations among zincsmelter workers developed after sustained zinc exposure over many years. The earliest symptoms were sensory and included paresthesias, dysesthesias, allodynia, and formication in the lower extremities, particularly the feet. Workers ultimately developed a clinical picture resembling subacute combined degeneration of the spinal cord with a spastic-ataxic gait with prominent proprioceptive impairment, sensory disequilibrium, and rombergism. Source

Pan B.,Medical College of Wisconsin | Guo Y.,Medical College of Wisconsin | Kwok W.-M.,Medical College of Wisconsin | Hogan Q.,Medical College of Wisconsin | And 2 more authors.
Journal of Pharmacology and Experimental Therapeutics | Year: 2014

Sigma-1 receptor (σ1R), an endoplasmic reticulum-chaperone protein, can modulate painful response after peripheral nerve injury. We have demonstrated that voltage-gated calcium current is inhibited in axotomized sensory neurons. We examined whether σ1R contributes to the sensory dysfunction of voltage-gated calcium channel (VGCC) after peripheral nerve injury through electrophysiological approach in dissociated rat dorsal root ganglion (DRG) neurons. Animals received either skin incision (Control) or spinal nerve ligation (SNL). Both σ1R agonists, (+)pentazocine (PTZ) and DTG [1,3-di-(2-tolyl)guanidine], dose dependently inhibited calcium current (/Ca) with Ba2+ as charge carrier in control sensory neurons. The inhibitory effect of σ1R agonists on/Ca was blocked by s1R antagonist, BD1063 (1-[2-(3,4-dichlorophenyl)ethyl]-4- methylpiperazine dihydrochloride) or BD1047 (N-[2-(3,4-dichlorophenyl)ethyl]-N- methyl-2-(dimethylamino)ethylamine dihydrobromide). PTZ and DTG showed similar effect on/Ca in axotomized fifth DRG neurons (SNL L5). Both PTZ and DTG shifted the voltage-dependent activation and steady-state inactivation of VGCC to the left and accelerated VGCC inactivation rate in both Control and axotomized L5 SNL DRG neurons. The σ1R antagonist, BD1063 (10 μM), increases/Ca in SNL L5 neurons but had no effect on Control and noninjured fourth lumbar neurons in SNL rats. Together, the findings suggest that activation of σR1 decreases/Ca in sensory neurons and may play a pivotal role in pain generation. Copyright © 2014 by The American Society for Pharmacology and Experimental Therapeutics. Source

Patel Z.M.,Emory University | Kennedy D.W.,University of Pennsylvania | Setzen M.,New York University | Poetker D.M.,Zablocki Veterans Affairs Medical Center | Delgaudio J.M.,Emory University
International Forum of Allergy and Rhinology | Year: 2013

Background: Patients present to physicians across multiple disciplines with the complaint of sinus headache. This lay term is widely accepted in the media, yet has been repeatedly questioned in the medical literature, and experts in the fields of otolaryngology, neurology, and allergy have agreed that it is an overused and often incorrect diagnosis in the majority of patients. There have been review articles and consensus panels established regarding this issue, but thus far no guidelines based purely on a review of the level of evidence provided by the literature. Methods: A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old, self-diagnosed or physician-diagnosed "sinus headache," clearly defined diagnostic criteria in diagnostic studies, and clearly defined primary clinical end-point in therapeutic studies. Results: We identified and evaluated the literature on diagnosing and treating patients with a primary complaint of sinus headache. The literature was reviewed for both quality of research design as well as benefit and harm of the proposed interventions. Conclusion: If a thorough neurologic and otolaryngologic evaluation is performed, the majority of patients presenting with sinus headache in the absence of significant acute inflammatory findings will be diagnosed with migraine. In this situation, the appropriate treatment for the majority of patients presenting with sinus headache is migraine directed therapy. In a highly select group of patients, directed nasal surgery addressing endonasal contact points may be an option. © 2013 ARS-AAOA, LLC. Source

Zinkevich N.S.,Medical College of Wisconsin | Gutterman D.D.,Medical College of Wisconsin | Gutterman D.D.,Zablocki Veterans Affairs Medical Center
American Journal of Physiology - Heart and Circulatory Physiology | Year: 2011

The involvement of reactive oxygen species (ROS) in regulating vascular function both in normal vessels and as part of an adaptive response during disease has been intensively studied. From the recognition that ROS serve as important signaling molecules has emerged multiple lines of evidence that there is a functional connectivity between intracellular sites of ROS production. This cross talk has been termed ROS-induced ROS release (RIRR) and is supported by a variety of observations showing that RIRR is a common mechanism for ROS amplification and regional ROS generation. The compartmentalization of ROS production within a cell is critical to its signaling function and is facilitated by microlocalization of specific scavengers. This review will provide descriptions and examples of important mechanisms of RIRR. © 2011 by the American Physiological Society. Source

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