Serum adiponectin levels are increased in women chronic daily headache (CDH) sufferers. In addition, visceral obesity, as measured by waist-to-hip ratio, is a risk factor for CDH in women.

Background: To evaluate the clinical and economic impact of a specialty care management program among patients with multiple sclerosis.Methods: This retrospective cohort analysis included patients aged ≥18 years with ≥2 claims of multiple sclerosis diagnosis and ≥1 multiple sclerosis medications from 1 January 2004 to 30 April 2008. The outcome metrics included medication adherence and persistence, multiple sclerosis-related hospitalization, and multiple sclerosis-related cost. Multivariate analyses were performed to adjust for demographics and clinical characteristics.Results: Among the 3993 patients identified, 78.3% participated in the program and 21.7% did not. Over 12 months, medication adherence and persistence improved among participants but deteriorated among non-participants (medication possession ratio change: +0.08 vs −0.03, p < 0.001; persistence change: +29.2 days vs −9.2 days, p < 0.001). Multiple sclerosis-related hospitalization decreased from 9.6% to 7.1% for participants, whereas it increased from 10.1% to 12.0% for the non-participant group (p < 0.001). Multiple sclerosis-related medical spending (non-pharmacy) decreased among participants, but it increased among non-participants (mean: −US$264 vs + US$1536, p < 0.001). Total multiple sclerosis-related cost for both groups increased over time (+US$4471 vs +US$4087, p < 0.001).Conclusions: This program was associated with improved medication adherence and persistence, reduced multiple sclerosis-related hospitalization, and decreased multiple sclerosis-related medical costs. Unfortunately, the cost savings in the medical component did not offset the increased pharmacy expenditures during the 12-month follow-up period.

The prevalence of problem residents in neurology is similar to other disciplines, and various resources are available to remediate them.

The current research assessed how digital clock drawing test (dCDT) parameters compliment and convey additional information in conjunction with traditional clock drawing scoring methods in patients with multiple sclerosis (MS). MS and normal control (NC) clock drawing performance was initially scored using a 10-point scale where NC test performance classified MS patients into impaired versus non-impaired clock drawing groups. dCDT variables included intra-component latencies or the time elapsed between clock drawing components (i.e., time between last element drawn followed by the first clock hand); inter-digit latency (i.e., average time between drawing numbers; and quartile drawing time (i.e., total drawing time divided into four equal segments. Subsequent analyses assessed dCDT parameters and other neuropsychological tests related to deficits in processing speed and other neurocognitive functions. In the command condition impaired MS patients produced slower selected intracomponents and slower 3 rd and 4 th quartile latencies (p<0.032) compared to other groups. In the copy condition impaired MS patients also displayed slower selected intra-components and slower latencies in all four quartiles compared to NCs (p<0.003), but slower latencies only for the 3rd and 4th quartiles compared to non-impaired MS patients (p<0.016). Regression analyses associated slower combined intra-component latencies with reduced processing speed (Symbol Copy, WAIS-R-NI), category ('animal') fluency, and CVLT recognition discriminability, and the propensity to endorse selected CVLT list B recognition foils. The dCDT compliments traditional clock scoring methods, captures behavior previously unobtainable, and is related to processing speed and dysexecutive impairment known to be present in MS.

BackgroundThere are two major theories describing the pathophysiology of migraines. Vascular theory explains that migraines resulted from vasodilation of meningeal vessels irritating the trigeminal nerves and causing pain. More recently, a neural theory of migraine has been proposed, which suggests that cortical hyperexcitability leads to cortical spreading depression (CSD) causing migraine-like symptoms. Chronic migraine requires prophylactic therapy. When oral agents fail, there are several intravenous agents that can be used. Understanding underlying causes of migraine pain would help to improve efficacy of migraine medications by changing their mechanism of action. Yet to date no study has been made to investigate the link between vascular changes in response to medications for migraine versus pain improvements. Functional near-infrared spectroscopy (NIRS) has been used as an inexpensive, rapid, non-invasive and safe technique to monitor cerebrovascular dynamics.MethodIn this study, a multi-distance near-infrared spectroscopy device has been used to investigate the cortical vascular reactivity of migraine patients in response to drug infusions and its possible correlation with changes in pain experienced. We used the NIRS on 41 chronic migraine patients receiving three medications: magnesium sulfate, valproate sodium, and dihydroergotamine (DHE). Patients rated their pain on a 1–10 numerical scale before and after the infusion.ResultsNo significant differences were observed between the medication effects on vascular activity from near channels measuring skin vascularity. However, far channels—indicating cortical vascular activity—showed significant differences in both oxyhemoglobin and total hemoglobin between medications. DHE is a vasoconstrictor and decreased cortical blood volume in our experiment. Magnesium sulfate has a short-lived vasodilatory effect and increased cortical blood volume in our experiment. Valproate sodium had no significant effect on blood volume. Nonetheless, all three reduced patients’ pain based on self-report and no significant link was observed between changes in cortical vascular reactivity and improvement in migraine pain as predicted by the vascular theory of migraine.ConclusionNIRS showed the potential to be a useful tool in the clinical setting for monitoring the vascular reactivity of individual patients to various migraine and headache medications.