The new, two-dimensional WEIMuS showed good psychometric properties, is easy to use, and may therefore be a useful tool for the assessment of MS-associated fatigue. Multiple sclerosis patients suffer from different types of fatigue which could be attributed to cognitive and physical fatigue. Thus, MS-associated fatigue is different from common tiredness.

Purpose: Repetitive peripheral magnetic stimulation (rPMS) has been successfully applied recently in migraineurs to alleviate migraine symptoms. Symptom relief has been achieved by stimulating myofascial trigger points (mTrPs) of the trapezius muscles, which are considered part of the trigemino-cervical complex (TCC). However, effects on musculature have not been assessed in detail, and the specificity of effects to muscles considered part of the TCC yet has to be elucidated. Against this background, this study presents the setup of rPMS in migraine and evaluates effects on skeletal musculature. Materials and Methods: Thirty-seven adults (mean age: 25.0 ± 4.1 years, 36 females) suffering from migraine and presenting mTrPs according to physical examination underwent rPMS either to mTrPs in the trapezius muscles (considered part of the TCC; n = 19) or deltoid muscles (considered not part of the TCC; n = 18) during six sessions over the course of 2 weeks. Standardized questionnaires were filled in to assess any adverse events and experience with rPMS as well as satisfaction and benefits from stimulation. Algometry was performed to evaluate changes in pressure pain thresholds (PPTs). Results: All stimulation sessions were successfully performed without adverse events, with 84.2% of subjects of the trapezius group and 94.4% of subjects of the deltoid group describing rPMS as comfortable ( p = 0.736). Muscular pain or tension improved in 73.7% of subjects of the trapezius group and in 61.1% of subjects of the deltoid group ( p = 0.077). PPTs of the trapezius muscles clearly increased from the first to the last stimulation sessions—regardless of the stimulated muscle (rPMS to the trapezius or deltoid muscles). However, depending on the examined muscles the increase of PPTs differed significantly (subjects with stimulation of trapezius muscles: p = 0.021; subjects with stimulation of deltoid muscles: p = 0.080). Conclusion: rPMS is a comfortable method in migraineurs that can improve local muscular pain or tension. Furthermore, it is able to increase directly and indirectly the PPTs of the trapezius muscles (considered part of the TCC) when applied over mTrPs, supporting the role of the TCC in migraineurs.

Migraine is a burdensome disease with an especially high prevalence in women between the age of 15 and 49 years. Non-pharmacological, non-invasive therapeutic methods to control symptoms are increasingly in demand to complement a multimodal intervention approach in migraine. Thirty-seven subjects (age: 25.0 ± 4.1 years; 36 females) diagnosed with high-frequency episodic migraine who presented at least one active myofascial trigger point (mTrP) in the trapezius muscles and at least one latent mTrP in the deltoid muscles bilaterally prospectively underwent six sessions of repetitive peripheral magnetic stimulation (rPMS) over two weeks. Patients were randomly assigned to receive rPMS applied to the mTrPs of the trapezius (n = 19) or deltoid muscles (n = 18). Whereas the trapezius muscle is supposed to be part of the trigemino-cervical complex (TCC) and, thus, involved in the pathophysiology of migraine, the deltoid muscle was not expected to interfere with the TCC and was therefore chosen as a control stimulation site. The headache calendar of the German Migraine and Headache Society (DMKG) as well as the Migraine Disability Assessment (MIDAS) questionnaire were used to evaluate stimulation-related effects. Frequency of headache days decreased significantly in both the trapezius and the deltoid group after six sessions of rPMS (trapezius group: p = 0.005; deltoid group: p = 0.003). The MIDAS score decreased significantly from 29 to 13 points (p = 0.0004) in the trapezius and from 31 to 15 points (p = 0.002) in the deltoid group. Thus, rPMS applied to mTrPs of neck and shoulder muscles offers a promising approach to alleviate headache frequency and symptom burden. Future clinical trials are needed to examine more profoundly these effects, preferably using a sham-controlled setting. According to the Global Burden of Disease Study more than one billion people were suffering from migraine in 2016, making migraine one of the most prevalent neurological disorders worldwide 1. Especially women between the age of 15 and 49 years are concerned-in this group migraine is also the first cause of disability worldwide 1-4. Further, migraineurs show a considerably reduced health-related quality of life (QoL) and considerable loss in work productivity 5-7. The high impact of migraine on QoL is reflected by percentages as high as 85%

am Main, Medizinische Klinik H des Städtischen Krankenhauses Frankfurt am Main-Höchst, Medizinische Klinik des St.-Markus-Krankenhauses Frankfurt am Main, Medizinische Abteilungen des Bürgerhospitals und des Katharinen-Krankenhauses Frankfurt am Main, des Städtischen Krankenhauses in Hanau amMain, des Kreiskrankenhauses in Grofl-Umstadt und des Stadtkrankerihauses Neuwied

Ziel der Studie war die Verbesserung der Remissionsqualität durch Anwendung einer intensivierten Induktionstherapie, welche sich bei der kindlichen ALL bewährt hat (Westberliner Therapieprotokoll); in einer modifizierten Form für Adoleszente (15–35 J.) und in einer reduzierten Form für > 35–65jährige Patienten mit ALL oder AUL. Die 8-wöchige Induktionstherapie gliedert sich in zwei Therapiephasen. Phase I enthält Prednisolon, Vincristin, Daunorubicin und L-Asparaginase, Phase II Cyclophosphamid, Cytosin-Arabinosid und 6-Mercaptopurin. Die ZNS-Prophylaxe besteht aus intrathekalen Methotrexatgaben und einer Schädelbestrahlung mit 24 Gy. Nach 3 Monaten folgt eine Reinduktionstherapie ähnlich der Induktionstherapie, jedoch mit Dexamethason und Adriamycin statt Prednisolon und Daunorubicin und ohne L-Asparaginase. Eine Erhaltungstherapie mit 6-Mercaptopurin und Methotrexat wird über einen Zeitraum von 2 Jahren durchgeführt. Seit 1979, als sich die Studiengruppe formierte, bis zum 30.06.81 wurden 170 Patienten aus 25 Kliniken mit der Erstdiagnose ALL oder AUL nach dem Studienprotokoll behandelt. Bis zum 30.11.81 hatten 162 die Therapie beendet bzw. waren auswertbar. 77,8% erreichten eine komplette Remission, 80,7% der Altersgruppe 15–35 J. und 68,3% in der Gruppe > 35–65 J. Die mediane Überlebenszeit aller Patienten betrug 24 Monate, bei den 126 Patienten mit kompletter Remission ist der Median noch nicht erreicht (letzte Beobachtung 31 Mon.). Die mediane Remissionsdauer betrug 20 Monate. Folgende prognostische Faktoren haben sich für die Remissionsdauer ergeben: Anzahl der Zytostatika-Kurse bis zum Erreichen der kompletten Remission, die immunologischen Subtypen, das Alter und die initiale Leukozytenzahl. Die Ergebnisse dieser multizentrischen Therapiestudie sind bemerkenswert im Hinblick auf Remissionsrate und -dauer. Die große Patientenzahl erlaubt eine gute Definition von Prognosefaktoren. Für Patienten mit niedrigem Risiko besteht offensichtlich eine Heilungschance.