Categories
Neurochecklists updates

8 practical neurology numbers to welcome the new year!

As 2020 kicks in…

And you make your resolutions….

Here are some practical numbers

To kickstart the new year.

Numbers. Andy Maguire on Flickr. https://www.flickr.com/photos/andymag/10947544804

 

 

“16”

The 16 MRI signs of IIH 

“21” 

The 21 predictors of conversion from CIS to MS

 

“25”

The 25 unusual types of headaches

 

“28”

The 28 unusual presentations of myasthenia gravis

 

“32”

The 32 migraine co-morbidities

 

“35”

The 35 unusual presentations of MS

 

“50”

The 50 adverse effects of pembrolizumab

 

“66”

The 66 causes of trigeminal neuralgia

The Numbers. Annie Pilon on Flickr. https://www.flickr.com/photos/anniehp/4326154694

___________________

For more helpful neurology numbers in 2020

Keep up with www.neurochecklists.com

Numbers in a City. See-ming Lee on Flickr. https://www.flickr.com/photos/seeminglee/7994149144
Categories
Neurochecklists updates

30 recently revised and updated practical neurology checklists

Neurochecklists is proud of being comprehensive and practical.

But more than that, we take pride in keeping each checklist updated.

To do this, we keep a keen eye on all relevant developments in the literature.

And below are just a few of the checklists that we have recently revised.

They all reflect findings from the latest neurology publications.

***

Anti Ma2 syndrome

Cerebral aneurysms rupture risk factors

Cerebral vein thrombosis

CGRP monoclonal antibodies

CJD

Dural AV fistula management

Giant cell arteritis treatment

Gluten sensitivity neurology

IIH clinical features

King-Denborough syndrome

Levetiracetam

Migraine acute treatment

MND c9orf72

Multiple sclerosis clinical features

Narcolepsy

Normal pressure hydrocephalus

Ocular myasthenia gravis

Oculopharyngeal muscular dystrophy

Ocrelizumab

Parkinson’s disease risk factors

Post stroke recrudescence

PSP variants

Psychogenic seizures

Rapid onset dystonia-parkinsonism

Retinal migraine

Seizure manifestations

Stiff person syndrome

Subacute combined degeneration

Suprascapular neuropathy

Thrombolysis

***

Categories
Headaches

Does migraine reduce the risk of diabetes?

Associations between migraine and type 2 diabetes in women: findings from the E3N Cohort Study

Fagherazzi G, El Fatouhi D, Fournier A, et al.

JAMA Neurol 2019; 76:257-263.

Abstract

BACKGROUND:

Little is known about the associations between migraine and type 2 diabetes and the temporality of the association between these 2 diseases. To evaluate the association between migraine and type 2 diabetes incidence as well as the evolution of the prevalence of active migraine before and after type 2 diabetes diagnosis.

METHODS:

We used data from the E3N cohort study, a French prospective population-based study initiated in 1990 on a cohort of women born between 1925 and 1950. The E3N study participants are insured by a health insurance plan that mostly covers teachers. From the eligible women in the E3N study, we included those who completed the 2002 follow-up questionnaire with information available on migraine. We then excluded prevalent cases of type 2 diabetes, leaving a final sample of women who were followed up between 2004 and 2014. All potential occurrences of type 2 diabetes were identified through a drug reimbursement database. Statistical analyses were performed in March 2018.

RESULTS:

From the 98 995 women in the study, 76 403 women completed the 2002 follow-up survey. Of these, 2156 were excluded because they had type 2 diabetes, leaving 74 247 women. Participants had a mean (SD) age of 61 (6) years at baseline, and all were free of type 2 diabetes. During 10 years of follow-up, 2372 incident type 2 diabetes cases occurred. A lower risk of type 2 diabetes was observed for women with active migraine compared with women with no migraine history (univariate hazard ratio, 0.80 [95% CI, 0.67-0.96], multivariable-adjusted hazard ratio, 0.70 [95% CI, 0.58-0.85]). We also observed a linear decrease in active migraine prevalence from 22% (95% CI, 16%-27%) to 11% (95% CI, 10%-12%) during the 24 years prior to diabetes diagnosis, after adjustment for potential type 2 diabetes risk factors. A plateau of migraine prevalence around 11% was then observed for 22 years after diagnosis.

CONCLUSIONS:

We observed a lower risk of developing type 2 diabetes for women with active migraine and a decrease in active migraine prevalence prior to diabetes diagnosis. Further targeted research should focus on understanding the mechanisms involved in explaining these findings.

This paper is cited in the neurochecklist:

Migraine: risk factors

Abstract link

By Reversing Your Diabetes Today – http://reversingyourdiabetestoday.com/https://pixabay.com/en/diabetes-blood-finger-glucose-777001/, CC0, Link
Categories
Headaches

What is the stroke risk of contraceptives in people with migraine?

 Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC). 

Sacco S, Merki-Feld GS, Ægidius KL, et al

J Headache Pain 2017; 18:108.

Abstract

Background:

Several data indicate that migraine, especially migraine with aura, is associated with an increased risk of ischemic stroke and other vascular events. Of concern is whether the risk of ischemic stroke in migraineurs is magnified by the use of hormonal contraceptives. As migraine prevalence is high in women of reproductive age, it is common to face the issue of migraine and hormonal contraceptive use in clinical practice.

Methodology:

In this document, we systematically reviewed data about the association between migraine, ischemic stroke and hormonal contraceptive use. Thereafter a consensus procedure among international experts was done to develop statements to support clinical decision making, in terms of cardiovascular safety, for prescription of hormonal contraceptives to women with migraine.

Results:

Overall, quality of current evidence regarding the risk of ischemic stroke in migraineurs associated with the use of hormonal contraceptives is low. Available data suggest that combined hormonal contraceptive may further increase the risk of ischemic stroke in those who have migraine, specifically migraine with aura.

Conclusions:

Thus, our current statements privilege safety and provide several suggestions to try to avoid possible risks. As the quality of available data is poor further research is needed on this topic to increase safe use of hormonal contraceptives in women with migraine.

See also:

Champaloux SW, Tepper NK, Monsour M, et al. Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke. Am J Obstet Gynecol 2017; 216:489.e1-489.e7.

Both references are cited in the neurochecklist:

Migraine and stroke: contraceptive risk

By BetteDavisEyes at English Wikipedia – Transferred from en.wikipedia to Commons.; transfer was stated to be made by Tanvir., Public Domain, Link

Abstract link 1

Abstract link 2

Categories
Headaches

Is migraine a risk for suicide?

Association of suicide risk with headache frequency among migraine patients with and without aura.

Lin YK, Liang CS, Lee JT, et al.

Front Neurol 2019; 10:228.

Abstract

Background:

Migraines with aura have been associated with suicide in adolescents and young adults, but the association between suicide and migraine frequency has not been determined. This study investigated suicidal ideation and suicide attempts among patients with varying frequencies of migraines, with and without auras.

Methods:

This cross-sectional study analyzed 528 patients aged between 20 and 60 years from a headache outpatient clinic in Taiwan. All patients completed a set of questionnaires, including a demographic questionnaire, the Migraine Disability Assessment questionnaire, the Hospital Anxiety and Depression Scale, the Beck Depression Inventory, and the Pittsburgh Sleep Quality Index. Suicide risk was evaluated by self-reported lifetime suicidal  ideation and attempts. Patients were divided into low-frequency (1-4 days/month), moderate-frequency (5-8 days/month), high-frequency (9-14 days/month), and chronic (≥15 days/month) migraine groups. The association between migraine frequency and suicidality was investigated using multivariable linear regression and logistic regression.

Results:

The rates of suicidal ideation and suicide attempts were the highest for chronic migraine with aura (ideation: 47.2%; attempts: 13.9%) and lowest in migraine-free controls (2.8%). Migraine frequency was an independent risk factor for suicidal ideation and attempts in patients with aura (both P trend < 0.001), but not in patients without aurasMigraine aura and depression were associated with higher risks of suicidal ideation and suicide attempts in patients with migraine.

Conclusion:

High migraine frequency has a correlation with high suicide risk in patients who experience an aura, but not in other patients with migraine.

This paper is cited in the neurochecklist

Migraine co-morbidities

Abstract link

The only consolation was this beautiful flower at Suicide Point. Shankar S on Flickr. https://www.flickr.com/photos/shankaronline/28484079831
Categories
General

What are the 10 most eminently curable neurological disorders?

Neurologists are often at the receiving end of the jokes of other medical specialists. They facetiously remark that neurologists know a lot, but do very little to cure their patients. Admittedly we do our fair share of dispensing weak platitudes, and we do break bad news with embarrassing regularity. There is no doubt that, for many diseases, all we have in stock are symptomatic or palliative. This is sadly the case with many familiar disorders such as Alzheimer’s disease (AD), Huntington’s disease, Charcot Marie Tooth disease (CMT), Freidreich’s ataxia (FA), essential tremor (ET), and myotonic dystrophy.

Three treatment capsules close-up. Marco Verch Professional Photographer and Speaker on Flickr. https://www.flickr.com/photos/30478819@N08/46513130444/in/photostream/

It is even true that at the extreme end of neurological practice, there are conditions that literally turn a deaf ear to all our entreaties, brush off everything we hurl at them, taunt us with reckless abandon, and run relentlessly mortal courses. Such is the dismal state of affairs with diseases such as rabies encephalitis, Creutzfeldt Jakob disease (CJD), and motor neurone disease (MND).

 

Hypodermic needle-IMG7418. Steven Depolo on Flickr. https://www.flickr.com/photos/stevendepolo/3020361085

But neurologists don’t just tap their patients knees, and then raise their hands up in despair. We do more than just lend our patients a listening ear, or a leaning shoulder to cry on. We do have at our disposal a vast armamentarium that can control many neurological diseases, even if we need to use these chronically. Such is the state of play with diseases such as migraine, epilepsy, multiple sclerosis (MS), narcolepsy, myasthenia gravis (MG), restless legs syndrome (RLS)Wilson’s disease, and Parkinson’s disease (PD).

Mapping the brain. NIH History Office on Flickr. https://www.flickr.com/photos/historyatnih/14359347545

But beyond just treatment, what patients really want is total cure. And neurologists can lay claim to this as well. Some diseases of the nervous system  can indeed be permanently remedied, their victims requiring no long-term medications to maintain the cure. To prove this, here are our 10 most eminently curable neurological disorders, linked to their treatment checklists.

***

Bacterial meningitis

Viral encephalitis

Autoimmune encephalitis

Wernicke’s encephalopathy

Ischaemic stroke

Idiopathic intracranial hypertension (IIH)

Cervical compressive myelopathy

Guillain Barre syndrome (GBS)

Meningioma

Normal pressure hydrocephalus (NPH)

***

It is important to note that curable neurological disorders are also potentially serious, and do carry the risk for serious complications, and even death, if not treated early and adequately. You may check out our previous blog posts to see the dark side of these disorders:

on ‘Have we missed anyone out? Please drop us a hint!

By JustfixingawrongnumberOwn work, CC0, Link
Categories
Headaches

Does migraine reduce the risk of developing diabetes?

Associations between migraine and type 2 diabetes in women: findings from the E3N cohort study

Fagherazzi G, El Fatouhi D, Fournier A, et al.

JAMA Neurol 2018 (Epub ahead of print)

Abstract

IMPORTANCE:

Little is known about the associations between migraine and type 2 diabetes and the temporality of the association between these 2 diseases.

OBJECTIVE:

To evaluate the association between migraine and type 2 diabetes incidence as well as the evolution of the prevalence of active migraine before and after type 2 diabetes diagnosis.

DESIGN, SETTING, AND PARTICIPANTS:

We used data from the E3N cohort study, a French prospective population-based study initiated in 1990 on a cohort of women born between 1925 and 1950. The E3N study participants are insured by a health insurance plan that mostly covers teachers. From the eligible women in the E3N study, we included those who completed the 2002 follow-up questionnaire with information available on migraine. We then excluded prevalent cases of type 2 diabetes, leaving a final sample of women who were followed up between 2004 and 2014. All potential occurrences of type 2 diabetes were identified through a drug reimbursement database. Statistical analyses were performed in March 2018.

RESULTS:

From the 98 995 women in the study, 76 403 women completed the 2002 follow-up survey. Of these, 2156 were excluded because they had type 2 diabetes, leaving 74 247 women. Participants had a mean (SD) age of 61 (6) years at baseline, and all were free of type 2 diabetes. During 10 years of follow-up, 2372 incident type 2 diabetes cases occurred. A lower risk of type 2 diabetes was observed for women with active migraine compared with women with no migraine history (univariate hazard ratio, 0.80 [95% CI, 0.67-0.96], multivariable-adjusted hazard ratio, 0.70 [95% CI, 0.58-0.85]). We also observed a linear decrease in active migraine prevalence from 22% (95% CI, 16%-27%) to 11% (95% CI, 10%-12%) during the 24 years prior to diabetes diagnosis, after adjustment for potential type 2 diabetes risk factors. A plateau of migraine prevalence around 11% was then observed for 22 years after diagnosis.

CONCLUSIONS:

We observed a lower risk of developing type 2 diabetes for women with active migraine, and a decrease in active migraine prevalence prior to diabetes diagnosis. Further targeted research should focus on understanding the mechanisms involved in explaining these findings.

Also see:

Antonazzo IC, Riise T, Cortese M, et al. Diabetes is associated with decreased migraine risk: a nationwide cohort study. Cephalalgia 2018; 38:1759-1764.

Both papers are cited in the Neurochecklist:

Migraine co-morbidities

Abstract link 1

Abstract link 2

Headache. Diego Fornero on Flikr. https://www.flickr.com/photos/destino2003/6689434475
Categories
Headaches

Does diabetes reduce the risk of migraine?

Diabetes is associated with decreased migraine risk: a nationwide cohort study

Antonazzo IC, Riise T, Cortese M, et al.

Cephalalgia 2017 (Epub ahead of print).

Abstract

Background:

Results from studies on diabetes and migraine risk are conflicting, which may be due to methodological limitations. Prospective studies with long follow-up could increase our understanding of the relationship between the two diseases.

Method:

We performed a cohort study including the whole Norwegian population alive on 01.01.2004, using prescriptions registered in the Norwegian prescription database to identify individuals developing type 1 diabetes, type 2 diabetes and migraine during follow-up (10 years). We used Cox proportional hazards regression to estimate rate ratios with corresponding 95% confidence intervals for the effect of diabetes on migraine risk, adjusting for age, sex, and educational level.

Result:

We identified 7,883 type 1 diabetes patients and 93,600 type 2 patients during the study period. Type 1 diabetes was significantly associated with a subsequent decreased migraine risk during follow-up in the age- and sex-adjusted analyses (0.74; 0.61-0.89). Type 2 diabetes was also associated with a significantly lower migraine risk (0.89; 0.83-0.95). Further adjustment for educational level yielded similar results for both diabetes.

Conclusion:

Both type 1 and type 2 diabetes were significantly associated with a decreased risk of migraine. This suggests that diabetes or diabetes treatment may have a protective effect on the development of migraine.

Also see

Berge LI, Riise T, Fasmer OB, et al. Does diabetes have a protective effect on migraine? Epidemiology 2013; 24:129-134.

Both references are cited in the neurochecklist:

Migraine risk factors

Abstract link

By Reversing Your Diabetes Today – http://reversingyourdiabetestoday.com/https://pixabay.com/en/diabetes-blood-finger-glucose-777001/, CC0, Link
Categories
Headaches

Is magnesium an effective migraine preventative?

Magnesium in migraine prophylaxis-is there an evidence-based rationale? A systematic review

von Luckner A, Riederer F.

Headache 2018; 58:199-209.

Abstract

OBJECTIVE:

The primary objective was to systematically evaluate the existing evidence base on magnesium in migraine prophylaxis.

METHODS:

The search for clinical trials published from 1990 to 2016 was separately conducted by AvL and FR using standard search terms as well as MeSh terms on PubMed and EMBASE. Randomized, double-blind, placebo-controlled trials investigating prophylactic magnesium administration in migraineurs aged 18-65 were considered eligible. In a mutual effort, the studies found were sorted and analyzed under consideration of the guidelines for controlled trials for drugs in migraine by the International Headache Society and using predefined eligibility criteria. The resulting clinical trials were jointly analyzed by FR and AvL applying the evidence classification scheme by the American Academy of Neurology and the Cochrane bias tool to assess the evidence-base. In accordance with the guidelines for controlled trials, the number of migraine days and number of migraine attacks were chosen as primary efficacy parameters. The present review was not registered.

RESULTS:

Out of 204 search results, five clinical trials fulfilling the selection procedure were found. One out of two Class I evidence trials showed a significant reduction of the number of migraine attacks compared with placebo, while two out of three Class III trials evinced a statistically significant reduction of the primary efficacy parameters compared with placebo.

CONCLUSION:

This systematic review provides Grade C (possibly effective) evidence for prevention of migraine with magnesium. Prophylactic treatment of migraine by means of high levels of magnesium dicitrate (600 mg) seems to be a safe and cost efficient strategy in clinical use.

This reference is cited in the neurochecklist:

Migraine: drug prophylaxis

Abstract link

By CSIRO, CC BY 3.0, Link