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Biomedical subjects

A Kuritzky

Publications and source records attributed to A Kuritzky.

At least 19 recordsLinked to original sources
PubMed2003

Transformation into daily migraine with aura following transcutaneous atrial septal defect closure.

A link between migraine with aura and cardiac right-to-left shunting has been previously reported. Abortion or decreased frequency of migraine with aura attacks after atrial septal defect closure has been reported in the literature. We report the first case of transformation of migraine with aura into a daily pattern after atrial septal defect closure. A 48-year-old male who had been suffering from rather infrequent attacks of migraine with sensory and visual aura underwent transcutaneous closure of an atrial septal defect. His migraine attacks changed into a daily pattern the day following the procedure and remained so for 6 months. This change in pattern may be related to a changed intra-atrial pressure after the closure or some other unknown factor.

Heart Septal Defects, Atrial↗
PubMed2001

New-onset cluster headache in middle-age and elderly women.

Cluster headache is usually considered to affect young men. We hereby report on new-onset cluster headache in middle-aged and elderly women. We performed a retrospective chart review of female patients diagnosed with cluster headache (IHS criteria), and studied the charts of women in whom the headache started after the age of 50 years. Out of 168 patients (26 women, 15%) diagnosed with cluster headache, the headache started after the age of 50 years in seven women, of whom three reported past tension-type or migraine headaches. The mean age at the beginning of the headache was 61 +/- 8 years (range 52--72 years). In all cases, the pain was severe, strictly unilateral, and accompanied by at least one autonomic symptom. The average duration of the pain was 70 min (range 20 min--3 h), recurring daily for an average period of 7 weeks (range 1--16 weeks). Five patients had 1--2 pain attacks each day, while the other two experienced up to eight episodes of pain in 1 day. In two patients the periodicity of the pain was currently undetermined. In the remainder, the headache periods recurred every 1--4 years. Cluster headache is commonly considered to be a young-male disorder, but middle-aged and elderly women may also be affected. The characteristics of the pain and its manner of occurrence were similar in our cases to those reported in the young-male population.

Aged↗
PubMed2000

Daily migraine with aura: a new migraine variant.

The frequency of migraine attacks is not used as a diagnostic criterion, however, it is a very important factor in the evaluation of migraine severity and its treatment. Several studies report the frequency of migraine attacks using the International Headache Society criteria. No investigator, however, has reported daily migraine attacks. In the current report, we present five patients whose headaches transformed from episodic migraine to daily migraine with aura. To the best of our knowledge, this is the first description of this variant of migraine. The symptoms in all the patients described comply strictly with the International Headache Society criteria for the diagnosis of migraine with typical aura. An interesting additional observation concerns the beneficial effect of phenytoin, a drug that has not proved to be effective in migraine but showed some efficacy in our patients.

Aged↗
PubMed1999

[Apomorphine for treatment of "off-periods" in Parkinson's disease].

After 3-5 years of continuous use of 1-dopa preparations for Parkinson's disease, 25%-50% of patients develop side-effects such as the "on-off" phenomenon and involuntary movements that markedly impair function. One cause of these manifestations is evidently a disturbance in the absorption of 1-dopa. We attempted to avoid this problem by using subcutaneous injections. Apomorphine is a rapid-acting dopamine agonist which causes a return from "off" to "on" within minutes. We present the results of a trial of subcutaneous injections of apomorphine in 22 Parkinsonian patients (12 males, 10 females) with severe motor fluctuations. During 5 days prior to the apomorphine all received Motilium (domperidone, 60 mg/d) to prevent nausea and vomiting. All were hospitalized initially to determine optimal dosage and to teach them the technique of self-injection. 2 to 4 mg of apomorphine were injected 1 to 3 times daily for 2 to 12 months. In 17 patients (80%) "off" periods were reduced without significant side-effects. Apomorphine seems to be effective, tolerable treatment for shortening 1-dopa induced "off" periods.

Aged↗
PubMed1999

Headache in schizophrenic patients: a controlled study.

Various studies have indicated that chronic schizophrenic patients share a lower rate of headaches than the normal population. A questionnaire concerning the symptomatology of headache was administered to 108 schizophrenic patients in the chronic stage and to 100 normal subjects. The questions dealt with type, location, frequency, severity, and duration of headache, as well as with its accompanying phenomena. Both groups shared a high distribution of headache reports, and generally no significant differences were observed in the various parameters. It was found that schizophrenic patients tend to refrain from complaining about their headache, although they are capable of its precise description. No correlation was found between the type of headache and type of schizophrenia.

Adult↗
PubMed1998

Dihydroergotamine nasal spray in the treatment of acute migraine.

OBJECTIVE: To evaluate the efficacy and safety of dihydroergotamine (DHE) nasal spray in patients suffering from common or classical migraine. METHODS: In a double-blind parallel-group study, 52 outpatients with migraine were randomly allocated to DHE nasal spray or to placebo. Two puffs, one in each nostril, was taken as an initial dose (resulting in either 0.5 or 1 mg of DHE), followed by another puff (0.5 mg) after 30 and 60 minutes, if necessary, achieving a maximum dose of 2 mg for patients of the DHE 1-mg group or of 1.5 mg for patients of the 0.5-mg group. Four consecutive attacks were thus treated. The efficacy analysis was done for observed cases. The main outcome measure was reduction of the severity of the attacks. RESULTS: No differences were observed in the migraine characteristics or the number of treatments of the patients from the different groups. Dihydroergotamine 1 mg tended to provide better relief than 0.5 mg, although the effect was not statistically significant. Patients taking DHE used less rescue medications, with a dose-dependent effect. Side effects were reported by four patients receiving DHE but not placebo. The tolerability of the drug was assessed as good by 94% of the patients. CONCLUSION: These findings suggest that DHE nasal spray is well tolerated and has dose-dependent efficacy in migraine.

Acute Disease↗
PubMed1995

Myopathy, lactic acidosis, and sideroblastic anemia: a new syndrome.

We describe 2 sibs (brother and sister) with myopathy, sideroblastic anemia, lactic acidosis, mental retardation, microcephaly, high palate, high philtrum, distichiasis, and micrognathia. Very low levels of cytochromes a, b, and c were detected in the patients' muscle mitochondria. Deposition of iron within the mitochondria of bone marrow erythroblasts was observed on electron microscopy. Irregular and enlarged mitochondria with paracrystalline inclusions were also seen on electron microscopy of the patients' muscle specimen. Examination of DNA from the affected sibs showed no deletions in the mitochondrial DNA nor the mutations identified in the syndromes of mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS) or myoclonus, and epilepsy associated with rugged-red fibers (MERRF). Since the parents were first cousins and 2 of 6 sibs (male and female) were affected, we suggest that the syndrome expressed by our patients represents a previously unknown autosomal recessive disorder that includes mitochondrial myopathy, lactic acidosis, and sideroblastic anemia.

5-Aminolevulinate Synthetase↗
PubMed1994

Familial levodopa-responsive parkinsonian-pyramidal syndrome.

We present four patients--two pairs of siblings--followed for many years, with pyramidal and parkinsonian features, who responded consistently to levodopa therapy. The patients belong to two unrelated consanguineous families, suggesting that this condition is genetically determined and recessively inherited.

Adolescent↗
PubMed1993

Vestibulo-ocular reflex in migraine patients: the effect of sodium valproate.

We studied vestibulo-ocular reflex measurements in a group of 12 patients suffering from migraine without aura and evaluated the effect of sodium valproate given as prophylactic migraine therapy. The study was randomized, double blind and placebo controlled, with a crossover design. The horizontal vestibulo-ocular reflex was evaluated by the Sinusoidal Harmonic Acceleration test at 0.01, 0.02, 0.04, 0.08 and 0.16 Hz using a computerized rotatory chair system. No abnormalities were found for the vestibulo-ocular reflex gain, phase and asymmetry at each of the frequencies examined during the placebo treatment. These normal vestibulo-ocular reflex measurements contrasted with the repeated complaints of dizziness, vertigo and unsteadiness reported by 7 patients (58%). Sodium valproate affected neither vestibulo-ocular responses nor vestibular complaints but was effective in reducing migraine attacks in 8 of the 12 patients. These results demonstrate that the low frequency vestibulo-ocular reflex measurements are normal in patients suffering from migraine without aura.

Adult↗
PubMed1993

Reduced sensitivity of lymphocyte beta-adrenergic receptors in migraine.

Cyclic AMP (CAMP) accumulation induced by isoproterenol (IP) and forskolin in intact lymphocytes was determined in 12 patients with migraine and 12 healthy controls. Our data showed that IP CAMP accumulation (8.20 + 1.08 Pmol/million cells) was significantly (P = 0.033) lower than accumulation in the controls (14.39 + 2.44 Pmol/million cells). Forskolin-induced CAMP did not differ in the two groups. These findings support the association of migraine and a reduced lymphocyte beta-adrenergic receptor sensitivity. An alteration in lymphocyte beta-adrenergic receptor may reflect similar changes in central beta-adrenergic function and may be used as a probe to evaluate its activity.

Adult↗
PubMed1992

Indomethacin-resistant hemicrania continua.

"Hemicrania Continua", first described in 1984, is defined as a steady, non-paroxysmal, unilateral headache absolutely responsive to indomethacin. Four cases clinically compatible with "Hemicrania Continua" are described. All four cases were absolutely resistant to indomethacin treatment. It is concluded that "Hemicrania Continua" is a clinical entity which has an indomethacin-responsive subtype but is not strictly an indomethacin-responsive headache.

Adult↗
PubMed1992

Sodium valproate in the prophylactic treatment of migraine: a double-blind study versus placebo.

The efficacy of sodium valproate (Depalept) versus placebo in the treatment of migraine was evaluated in a double-blind randomized cross-over study in twenty-nine patients. The patients were divided into two groups each of which was alternately given 400 mg of sodium valproate B.I.d or placebo for eight weeks and then crossed over for an additional eight weeks. Our results show that in 86.2% of the patients sodium valproate was effective in preventing migraine or reducing the frequency, severity and duration of the attacks. In general, the drug was well tolerated and proved to be an effective treatment in migraine.

Adolescent↗
PubMed1992

Effect of sodium valproate on the secretion of prolactin, cortisol and growth hormone in migraine patients.

A single oral dose of 500 mg sodium valproate had no effect on prolactin, growth hormone and cortisol secretion in 10 migraine patients when compared with five healthy controls and four migraine patients receiving placebo. Basal values of prolactin (PRL), cortisol and growth hormone (GH) were within the normal range, though PRL basal levels were lower in three patients (21.5%) in the migraine group.

Adult↗
PubMed1992

Evidence for instability of the autonomic nervous system in patients with migraine headache.

Autonomic impairment in migraine is well documented. In order to evaluate the autonomic control in migraine, spectral analysis of heart rate fluctuations was performed on ten migraine patients, drug-free and during the inter-headache phase. They were compared to nine healthy controls and eight tension headache patients. A 24h Holter recording of ECG was performed for each subject. Every half hour, a short ECG subtrace was digitized and submitted to R wave detection, followed by computation of heart rate power spectrum. The spectral analysis of heart rate fluctuations disclosed significant differences between control subjects and patients with migraine. The migraine patients displayed markedly enhanced low frequency fluctuations (below 0.1 sec-1), during day hours (p less than 0.01) and especially at night (p less than 0.0006). In the respiratory frequency band (between 0.2 and 0.4 sec-1) no significant change was observed. Tension headache patients however, resembled the controls in that they did not display enhanced low frequency fluctuations. The enhancement at low frequencies fluctuations only, a frequency range known to be related to vasomotor control, suggests that the migraine patients are characterized by a clear sympathetic instability. This finding supports the hypothesis that migraine is of neural origin and is consistent with the observation of large variations in regional cerebral flow. Spectral analysis of heart rate fluctuations allows us to specify and quantitate this autonomic imbalance and may provide a useful tool for the evaluation of drug therapy in migraine.

Adult↗
PubMed1992

Propranolol in the prophylaxis of migraine--evaluation by spectral analysis of beat-to-beat heart rate fluctuations.

Migraine patients seem to suffer from a continuous autonomic imbalance. Sympathetic instability, expressed by enhanced low frequency fluctuations, which exists during the headache free intervals, was observed in our previous study by spectral analysis of heart rate (HR) fluctuations. Propranolol--a beta adrenoceptor antagonist, is widely used in migraine prophylaxis. In order to specify and quantitate propranolol efficacy in migraine, spectral analysis of heart rate fluctuations was performed on 10 migraine patients before and during the treatment with propranolol. They were compared to 10 healthy control patients and 6 migraine patients who were treated for several months with propranolol and then discontinued the medication. The analysis was carried out on a 24h Holter ECG recording, which was performed for each subject during a headache free interval. Short 256 sec subtraces, taken every 30 min from the 24h ECG signal, were submitted to A/D conversion, R wave detection and computation of heart rate power spectrum. Propranolol achieved a marked effect, when comparing the power spectra of HR fluctuations in treated versus untreated migraine patients. A strong reduction (to normal level) in the low frequency HR fluctuations in the range below 0.1 Hz., was apparent in patients treated with propranolol. Subjects who had received propranolol in the past and discontinued the drug, displayed a carry-over effect of reduced fluctuations even 2-3 months after its discontinuation. It seems that the propranolol efficacy in migraine is associated with the mechanism of stabilizing the fluctuations within the frequency band related to sympathetic activity, hereby moderating the vascular instability in migraine.

Adult↗