References1. Picard N, Strick PL. Motor areas of the medial wall: a review of their location and functional activation. Cereb Cortex 1996;6:342-353. 2. Rizzolatti G, Luppino G, Matelli M. The organization of the cortical motor system: new concepts. Electroencephalogr Clin Neurophysiol 1998; 106:283-296. 3. Laplane D, Talairach J, Meininger V, Bancaud J, Orgogozo JM. Clinical consequences of corticectomies involving the supplementary motor area in man. J Neurol Sci 1977;34:301-314. 4. Morecraft RJ, Louie JL, Herrick JL, Stilwell-Morecraft KS. Cortical innervation of the facial nucleus in the non-human primate: a new interpretation of the effects of stroke and related subtotal brain trauma on the muscles of facial expression.There is increasing evidence that melatonin secretion and pineal function are related to headache disorders. Altered melatonin levels have been found in cluster headache, migraine with and without aura, 1 menstrual migraine, 2 and chronic migraine. 3 A great variety of melatonin mechanisms may be linked to headache pathophysiology. 3 Melatonin may have antiinflammatory effect, it scavenges toxic free radicals, reduces the up-regulation of proinflammatory cytokines, and inhibits nitric oxide synthase activity and dopamine release. It also interferes with membrane stabilization, ␥-aminobutyric acid and opioid analgesia potentiation, protection from glutamate neurotoxicity, neurovascular regulation, and serotonin modulation. Melatonin and indomethacin share similar chemical structure. 4 Melatonin is then a possible candidate for migraine prevention. We tested the hypothesis of the potential effectiveness of melatonin for migraine prophylaxis.Methods.We performed an open-label trial of melatonin, 3 mg, for migraine prevention. Forty patients with episodic migraine with or without aura according to the International Headache Society (IHS) diagnostic criteria were screened for the baseline period. Three patients did not have headaches during the baseline period; three patients were lost to follow-up evaluation. Thirty-four patients (29 women, 5 men) started prophylactic treatment with melatonin, 3 mg, 30 minutes before bedtime. Thirtytwo patients completed the study. All patients signed an informed consent form. The local and federal ethics committees approved the study.Study participants experienced between two and eight migraine attacks per month. Chronic daily headache patients were excluded. Patients on preventive therapy 3 months before recruitment for the trial were excluded. Patients were examined, and an adequate headache history was ascertained. Patients with insomnia or considerable sleep hygiene problems were excluded. The total study length was 4 months, with a 1-month baseline period and 3-month therapy phase. A study diary was provided to each study participant.The primary endpoint was the percentage of patients with Ͼ50% reduction in headache frequency comparing baseline vs month 3 after treatment. Headache intensity, duration, and analgesic consumption were also ascertained. Analgesic...

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Narcolepsy is characterized by excessive daytime sleep and cataplexy. Sleep paralysis and hypnagogic hallucinations can be added to this clinical picture 1,2 . Narcolepsy involves an unknown physiopathology but with a known association with the HLA DQB1*06023 allele 3 . This would fortify the hypothe- ABSTRACT -Narcolepsy is characterized by excessive daytime sleep and cataplexy. Little is known about the possible difference in pathophysiology between patients with or without cataplexy. Obje�tive: To quantify T CD4, T CD8 and B lymphocytes in subgroups of patients with narcolepsy and the presence or absence of the HLA-DQB1*0602 allele between groups. Method: Our study was prospective and controlled (transversal) with 22 narcoleptic patients and 23 health control subjects. Patients underwent an all-night polysomnographic recording (PSG) and a multiple sleep latency Test (MSLT). The histocompatibility antigen allele (HLA-DQB1*0602), T CD4, CD8 and B lymphocytes were quantified in control subjects and in narcoleptics. Results: The HLA-DQB1*0602 allele was identified in 10 (62.5%) of our 16 cataplexic subjects and in 2 (33.3%) of the 6 patients without cataplexy (p=0.24). In control subjects, HLA-DQB1*0602 allele was identified in 5 (20%). A significant decrease in T CD4 and B lymphocytes was found in narcoleptic patients with recurrent cataplexy when compared with our patients without cataplexy. Con�lusion: Autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis were associated with a decrease in sub-group of T CD4 and B lymphocytes. A drop in B lymphocytes count in reumathoid arthritis might, it is posited, be correlated to the presence of HLA-DRB1 allele along with an overall worsened outcome of the affliction. The theory of an increase in consumption of B lymphocytes over the maturation phase has likewise been put forward. Our study reinforces the view that narcolepsy should be considered from an immunological perspective.Key wORDS: narcolepsy, lymphocytes, immunology, HLA-DQB1*0602 allele. estudo dos linfócitos t Cd4, Cd8 e B em pacientes com narcolepsiaReSUMO -A narcolepsia é caracterizada por sonolência excessiva diurna e cataplexia. Pouco se sabe sobre as diferenças fisiopatológicas entre pacientes com e sem cataplexia. Objetivo: Quantificar os linfócitos T CD4, T CD8 e B e a presença do alelo HLA-DQB1*0602 nos subgrupos de pacientes com narcolepsia. Mé� todo: O estudo foi prospectivo e controlado (transversal) com 22 pacientes portadores de narcolepsia e 23 sujeitos controle. Os pacientes realizaram polissonografia (PSG) de noite inteira e teste de múltiplas latên-cias do sono (TMLS). O alelo do antígeno de histocompatibilidade (HLA-DQB1*0602) e os linfócitos T CD4, T CD8 e B foram quantificados nos pacientes e sujeitos controle. Resultados: O alelo HLA-DQB1*0602 foi encontrado em 10 (62,5%) dos 16 pacientes com cataplexia e em 2 (33,3%) dos 6 pacientes sem cataplexia (p=0,24). Nos sujeitos controle, o alelo HLA-DQB1*0602 foi encontrado em 5 sujeitos (20%). Um aumento significativo...

-Background: Studies have shown a high prevalence of migraine among narcoleptic patients. HLA-DQB1*0602 and HLA DRB1 alleles are closely associated with narcolepsy. An increase in the HLA-DRB1 allele frequency in patients with visual aura has raised greater awareness of the genetic background in migraine. Purpose: Since the regions DR and DQ of the HLA are in tightly linkage desiquilibrium we hypothesize that HLA-DQB1*0602 might be associated to the pathophysiology of migraine. Method: We analyzed the presence of HLA DQB1*0602 allele in 50 healthy subjects with no history of migraine, 53 patients with migraine without aura and 52 patients with migraine with aura. Results: There was no difference in the frequency of HLA DQB1*0602 allele when control subjects and all patients were compared. We failed to note any difference in frequencies when comparing migraine patients with and without aura. Conclusion: Further studies with different patient populations, with other hypothalamic markers (melatonin, hypocretin) in migraine patients may shed light on to its pathophysiology.KEY WORDS: migraine, narcolepsy, HLA DQB1*0602 allele, genetics. Prevalência do alelo HLA DQB1*0602 em pacientes com enxaquecaRESUMO -Contexto: Estudos têm demonstrado o aumento da prevalência de enxaqueca em pacientes com narcolepsia, um distúrbio de sono associado a um gene do sistema HLA, o alelo HLA-DQB1*0602. As regiões DQ e DR do HLA estão em alto desequilíbrio de ligação e já foi descrito um aumento da freqüência do alelo HLA DRB1 em pacientes com enxaqueca com aura visual, o que fortalece uma hipótese de herança genética para a enxaqueca. Objetivo: Nossa hipótese é que o alelo HLA-DQB1*0602 pode estar relacionado com a fisiopatologia da enxaqueca destes pacientes. Método: Nós analisamos a presença do alelo HLA-DQB1*0602 em 50 voluntários sadios sem história de enxaqueca, 53 pacientes com enxaqueca sem aura e 52 pacientes com aura. Resultados: Não houve diferença entre os controles sadios e os pacientes com en-