Search PubMed⌕ Search

Biomedical subjects

P Wessely

Publications and source records attributed to P Wessely.

At least 37 records · Page 2Linked to original sources
PubMed1994

Efficacy and tolerability of amitriptylinoxide in the treatment of chronic tension-type headache: a multi-centre controlled study.

Amitriptyline is the medication of first choice in the treatment of chronic tension-type headache. In 197 patients with chronic tension-type headache (87M and 110F with a mean age of 38 +/- 13 (18-68)) efficacy and tolerability of 60-90 mg amitriptylinoxide (AO) were compared with 50-75 mg amitriptyline (AM) and placebo (PL) in a double-blind, parallel-group trial consisting of a four weeks' baseline phase and 12 weeks of treatment. The primary study endpoint was a reduction of at least 50% of the product of headache duration and frequency and a reduction of at least 50% in headache intensity. Statistics used were Fisher's exact test and analysis of variance. No significant difference emerged between AO, AM and PL with respect to the primary study endpoint. Treatment response occurred in 30.3% of the AO, 22.4% of the AM and 21.9% of the PL group. A reduction in headache duration and frequency of at least 50% was found in 39.4% on AO, in 25.4% on AM and in 26.6% on PL (PAO-PL = .1384, PAM-PL = 1.000, PAO-AM = .0973). A reduction in headache intensity of at least 50% was found in 31.8% on AO, in 26.9% on AM and in 26.6% on PL (PAO-PL = .5657, PAM-PL = 1.000, PAO-AM = .5715). Trend analysis with respect to a significant reduction of headache intensity (p < 0.05) and the product of headache duration and frequency revealed a superior effect of AO.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Use and abuse of analgesics in tension-type headache.

Eighty patients suffering from tension-type headache for an average of 21 years were asked to report on all drugs they had ever taken (type, dosage, duration of intake, efficacy) or were taking currently. The patients had consumed on average 6.3 different drugs. The cumulative doses of derivatives of para-aminophenol, pyrazolone, and salicylic acid in some cases reached a maximum of several kilograms. Most drugs were classified by the patients as "moderately effective". The rating "very effective" was assigned primarily to barbiturates; however, barbiturates are no longer used as components of compound analgesic drugs in Austria. At the time of investigation, patients consumed 2.5 (mean) different drugs, primarily as compound preparations. Seventeen patients (21%) showed signs of possible analgesics- or ergotamine-induced headache and were therefore advised to undergo withdrawal therapy. Our results show that patients with tension-type headache are at considerable risk of becoming drug-dependent and of acquiring analgesics-induced headache.

Adult↗
PubMed1994

[Polypragmasy in chronic tension headache?].

The various forms of treatment (drugs as well as non-drug therapy) of patients suffering from tension type headache are presented. Analgesics and non-steroidal antirheumatics are used in the management of episodic tension type headache, as well as acute exacerbation of chronic tension type headache. In view of the presumably multifactorial pathogenesis, a multidimensional therapeutic approach is required in patients with chronic tension type headache. Antidepressive drugs (thymoleptics) are usually prescribed as basic therapy. Additional implementation of non-drug therapeutic measures tailored to individual symptomatology is advisable, such as EMG biofeedback, other relaxation techniques, massage, physiotherapy and--in selected cases--psychotherapy or acupuncture.

Analgesics↗
PubMed1993

[SUNCT syndrome--case report and review of the literature].

The SUNCT syndrome is a recently described headache disorder characterised by shortlasting, unilateral headache attacks with conjunctival injection and tearing. Our report presents a further case and compares the findings in our patient with those in the cases described earlier. In addition, we review the literature and discuss possible aetiological and pathogenetic factors as well as the differential diagnosis of SUNCT syndrome, trigeminal neuralgia and cluster headache syndromes.

Adult↗
PubMed1993

[Calcium channel blockers in therapy of neurologic diseases].

The clinical use of calcium antagonists (Ca-antagonists) in neurological diseases focuses on 2 main therapeutic fields: (a) For the therapy of migraine flunarizine is the first choice therapy and nimodipine is a second line treatment. With verapamil cluster headache can be treated successfully, flunarizine shows less impressive clinical efficacy. The therapy with flunarizine may be restricted due to the incidence of extrapyramidal disturbances and depressions as known side effects. (b) The therapy of clinical conditions after subarachnoidal bleeding with nimodipine is well established. In the therapy of acute cerebral ischemia the therapeutic efficacy of nimodipine administered orally is not therapeutically proved until now; the intravenous administration of nimodipine offers the risk of acute hypotensive reactions. At present the usefulness of the administration of ca-antagonists in the so-called cerebrovascular insufficiency or dementia and various others cerebral disorders with vertigo could not be demonstrated.

Brain Ischemia↗
PubMed1993

[Tension headache--new evaluation of symptomatology based on International Headache Society diagnostic criteria].

This study presents the history and clinical findings in 80 patients suffering from tension-type headache diagnosed according to the criteria (group 2) proposed in 1988 by the Headache Classification Committee of the International Headache Society (IHS). The aim of this investigation was to evaluate the extent to which the symptomatology in our cases still corresponds with the clinical picture of tension headache described in the older literature. A positive family history of headache was obtained in 59% of the patients; mothers of headache patients were affected five times more often than fathers; a history of migraine was reported as frequently as tension-type headache in the families of the investigated patients. The first manifestation of headaches arose almost exclusively in the first four decades of life, whereby two peaks (15-20 and 35-40 years) were observed in patients with the episodic form. Headache in younger patients showed no distinct diurnal pattern; headache in older patients, however, predominantly occurred immediately after awakening from sleep or in the morning. Changes of weather and psychosocial stress were the most frequent precipitating factors; additionally, the premenstrual period, occupational stress, and sleep deprivation were precipitating factors in female patients. Bilateral pain was most often located in the occipital/nuchal, in the frontal, and the periorbital regions. Headache was usually described as pressing/tightening in quality. Difficulties in concentration and the need of rest were the most important associated symptoms. Photophobia, phonophobia and autonomic symptoms were less frequent and are probably partially drug-related and may also be due to the fact that the selected group of patients suffered from severe forms of headache. 33 of our 80 patients belonged to the subgroup "with disorders of pericranial muscles" (IHS criteria: groups 2.1.1., 2.2.1). A remarkable low percentage of patients, especially of the male sufferers, reported regular smoking and/or drinking habits. Oral contraceptives influenced neither frequency nor intensity of headache attacks. Signs of depressive disorders were present in 28% of the female patients. The differences in symptomatology of tension-type headache between patients with episodic and chronic forms, between female and male patients, and also between younger and elderly patients are documented and have to be taken into account in the diagnostik evaluation of this condition.

Adult↗
PubMed1993

[Effectiveness and tolerance of amitriptyline oxide in chronic tension headache--a multicenter double-blind study versus amitriptyline versus placebo].

Tricyclic antidepressants, especially amitriptyline, are the medication of first choice in the treatment of chronic tension headache. Few previous studies meet modern standards of study design and statistical analysis. Tolerability and efficacy of 60-90 mg amitriptyline oxide (AO) as a single dose in the evening were compared with 50-75 mg amitriptyline (AM) and placebo (PL) in a double-blind, parallel-group trial consisting of a 4-week baseline phase and 12 weeks of treatment. The 3-armed study was conducted in 7 centers. The inclusion criterion was tension-type headache on at least 15 days monthly with a duration of at least 6 months. Exclusion criteria were a migraine history, previous participation in another clinical trial within the last 3 months, drug abuse, medication with other antidepressants or tranquilizers, current use of other acknowledged prophylactic headache medication, lack of compliance, major psychiatric disorder according to DSM-III and medical contra-indications against tricyclic antidepressants. The primary study endpoint was a reduction at least 50% of the product of headache duration and frequency and a reduction at least 50% in headache intensity. Statistics used were Fisher's Exact Test and an analysis of variance. A total of 211 patients were included in this trial. One hundred ninety-seven cases, 87 males and 110 females, with a mean age of 38 +/- 13 (18-68) years, could be analysed completely (66 AO, 67 AM, 64 PL). With regard to the strictly defined primary study endpoint, no significant difference emerged between AO, AM and PL: treatment responders were 30.3% with AO, 22.4% with AM and 21.9% with PL (PAO-PL = 0.3210, PAM-PL = 1.000, PAO-AM = 0.3299 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Tension headache and the cervical spine--plain X-ray findings.

The aim of the present study was to investigate if there is any causal connection between plain X-ray findings of the cervical spine and tension headache. We evaluated the X-rays of the cervical spine of 243 patients, in 91 of which the diagnosis was "tension headache", in 102 "headache not fulfilling the criteria of tension headache" and in 50 "spondylogenic complaints without headache". We compared these three groups with regard to frequency and severity of radiologically assessable changes of the cervical spine and found that patients with tension headache had normal findings significantly more often and significantly less often functional or organic changes or both than patients of the other two groups. The radiologically assessable changes of the cervical spine are unlikely to have an essential role in the cause or mechanism of tension headache.

Adult↗
PubMed1992

Speech arrest as first symptom of a tumour in the supplementary motor area.

There are only few reports in the literature on isolated episodes of speech arrest as first symptom of a tumour in the supplementary motor area. These episodes of speech arrest are due to seizure activity and must be distinguished from speech arrest due to transient ischaemic attacks. The diagnosis may be difficult because the tumour may erroneously be suspected in the lower portion of the sensorimotor strip and may, hence, be missed on CT if apical sections of the regions are not performed. Clinical and experimental aspects of this problem are discussed on the basis of a case report and a review of the literature.

Aged↗
PubMed1991

Long-term results of migraine prophylaxis with flunarizine and beta-blockers.

We followed-up 64 migraine patients after discontinuation of successful interval prophylaxis with flunarizine, propranolol or metoprolol, to investigate how long the therapeutic success would last, if further prophylaxis would be successful again, and what factors would influence the prognosis. We found that 16 out of 64 patients experienced a lasting reduction of migraine frequency, whereas 48 patients did improve initially, but later experienced a relapse. Further prophylaxis was effective in 29, poorly effective in 11, and ineffective in 8 of these patients; in 7 of the 8 non-responders prophylaxis was not changed. Negative prognostic factors were frequent attacks, a history of analgesic abuse and/or analgesic withdrawal therapy and ineffective previous prophylaxis. In conclusion, the therapeutic success decreases dramatically in the majority of patients several months after discontinuation of prophylaxis; further prophylaxis is more effective if the substance class is changed; increased analgesic intake is the most important prognostic factor. As a strategy for migraine prophylaxis we propose sequential changing of interval prophylaxis or--in patients with negative prognostic factors--long-term prophylaxis.

Adult↗
PubMed1991

Thalamic ischemia in transient global amnesia: a SPECT study.

We performed 99mTc-HMPAO SPECT in a patient during transient global amnesia and twice thereafter. SPECT during the attack showed a significant diminution of regional blood flow in the left thalamus and a less marked diminution in the right thalamus. Quantitative evaluation of global 99mTc-HMPAO uptake indicated a diffuse depression of cerebral blood flow. At follow-up to 40 days after the attack, global uptake and thalamic flow indices normalized, but there was a persistent reduction of left frontal flow values.

Amnesia↗
PubMed1991

Subarachnoid hemorrhage of unknown etiology: early prognostic factors for long-term functional capacity.

Forty-one patients suffering subarachnoid hemorrhage (SAH) of unknown etiology were re-investigated at an average of 91 months after the bleed to determine functional capacity. Nineteen patients were performing at their previous level of work, five were employed part-time, and four could not work due to the SAH. Five patients showed a moderate disability in activities of daily living but were not dependent on help, one patient was severely disabled, and two had died. There was one rebleed. Early prognosis of an unfavorable outcome was possible on the basis of three clinical variables on admission: a history of hypertension, a Hunt and Hess grade of greater than II, and the presence of focal neurological deficits. In addition, the presence of an organic mental syndrome at discharge was identified as a predictive factor for reduced functional capacity later on. Other clinical variables in the acute stage, including sex, age, history of headache, interval between SAH and admission, impaired consciousness, and cognitive deficits, were not related to a limited functional level. Residual neurological deficits and the Glasgow Outcome Scale score on discharge were also not predictive of restrictions in global functions evaluated by means of the Karnofsky Performance Scale status at follow-up review.

Activities of Daily Living↗
PubMed1990

[24-hour blood pressure determination in Shy-Drager syndrome. A case report].

The case history is presented of a 57 year-old male patient suffering from the Shy-Drager syndrome. This syndrome was first described by G. M. Shy and G. A. Drager in 1960. The clinical manifestations are extrapyramidal, with Parkinsonian features, combined with severe orthostatic hypotension and failure of the autonomic nervous system. Apart from the standard clinical investigations in this condition, namely the orthostasis test and polygraphic recording of the EEG, ECG, breathing and blood pressure on the tilting table, additional non-invasive long-term determination of the blood pressure was carried out. This method allows simultaneous measurement of blood pressure and heart rate without appreciably interfering with the patient's daily activities.

Autonomic Nervous System↗
PubMed1990

[The significance of EMG artefacts in isoelectric EEG].

Five potential organ donors showed muscle artefacts during isoelectrical EEG recording. The electromyographic examination revealed MUAP activity occurring as doublets, triplets and quadruplets. All patients had normal blood chemistry except reduced CO2 and increased O2 partial pressures. We assume that the recorded "tetaniform" muscle activity is due to hyperexcitability of the nerve membrane caused by artificial hyperventilation.

Adult↗
PubMed1989

Longterm prognosis of analgesic withdrawal in patients with drug-induced headaches.

We studied long-term prognosis and prognostic variables for therapeutic outcome of analgesic withdrawal in 54 patients with drug-induced headaches. The duration of headache history was 21.9 +/- 12.8 years. Each patient took an average of 38.8 +/- 22.8 tablets or suppositories a week and an average of 2.5 distinct drugs. Most patients used drugs containing several components. Caffeine was contained in at least one drug in all cases, ergotamine in 80.0% and pyrazolone in 77.1%. All patients were admitted to the hospital for two weeks. The analgesics were discontinued abruptly and the withdrawal symptoms were alleviated by neuroleptics and neurotropics. During the second week of hospital stay we started a basic therapy with calcium antagonists or beta blockers in patients suffering from migraine initially and with tricyclic antidepressants, physical therapy or biofeedback in patients suffering from tension type headaches initially. At the end of the study (mean follow-up period = 16.8 +/- 13.6 months) 38 patients (70.1%) were evaluated. 76.3% of these patients had significantly reduced their analgesic intake, 60.5% had experienced a significant relief of headache both in intensity and frequency, and 23.7% were therapeutic failures. Analysis of the time course of relapse revealed the first six months after hospital discharge as the critical period determining long-term success. The variables tested for prognostic relevance (age, sex, duration of headache history, number of tablets or suppositories taken a week, organic mental syndrome, and type of initial headaches) were not statistically significant.

Adult↗
PubMed1988

[Stress management in migraine].

The aim of this study was to investigate the physiological and psychological mechanisms underlying migraine, 21 patients with migraine, 21 healthy controls and a group of 21 asthmatics participated in the investigation. All patients and controls were female. Using flicker frequency analysis we determined unspecific cortical activation, whereas autonomic activation was measured by means of the skin conductance level and the skin conductance response. Furthermore, stress management was objectivated by a self-rating scale (SVF). Our findings suggest the hypothesis of inadequate regulation of autonomic especially sympathetic reactions, which along with inadequate stress overcoming mechanisms appear to be of importance in the triggering of migraine attacks.

Adaptation, Psychological↗
PubMed1988

[The distal portion of the ulnar nerve--recording technic and normal values].

Normal values for the distal portion of the ulnar nerve are proposed. In 52 normals without clinical symptoms of peripheral nerve lesion the following neurographic parameters were recorded on the right side and in 45 cases on the left side, too: distal latency wrist-hypothenar, compound action potential from hypothenar, distal latency wrist-M, adductor pollicis, compound action potential from the M. adductor pollicis, antidrome nerve conduction velocity wrist-digit V, difference of latencies M. adductor pollicis-hypothenar, difference of compound action potential hypothenar-M. adductor pollicis and side differences of these parameters. A linear regression analysis was performed to investigate the dependence of these parameters from age. Our normal values allow an exact localisation of peripheral lesions of the ulnar nerve (Loge de Guyon, Ramus volaris superficialis, Ramus profundus).

Action Potentials↗