BACKGROUND:Some of the excitatory neurotransmitters including glutamate have been suggested to be involved in headache pathophysiology. To our knowledge, there is a lack of publication about flunarizine efficacy in chronic tension-type headache (CTTH) treatments and the roles of glutamate in CTTH pathophysiology.AIM:This study aimed to investigate the flunarizine effect on serum levels of glutamate and its correlation with headache intensity based on the Numeric Rating Scale for pain (NRS) scores in CTTH patients.METHOD:In a prospective randomised, double-blind study with pre and post-test design, seventy-three CTTH patients were randomly allocated with flunarizine 5 mg, flunarizine 10 mg and amitriptyline 12.5 mg groups. The serum levels of glutamate and NRS scores were measured before and after 15-day treatment.RESULTS:Flunarizine 5 mg was more effective than flunarizine 10 mg and amitriptyline 12.5 mg in reducing serum glutamate levels, whereas amitriptyline 12.5 mg was the most effective in reducing headache intensity. There was found nonsignificant, but very weak negative correlation between headache intensity and serum glutamate levels after flunarizine 5 mg administration (r = -0.062; P = 0.385), nonsignificant very weak negative correlation after flunarizine 10 mg administration (r = -0.007; P = 0.488) and there was found a significant moderate positive correlation (r = 0.508; P = 0.007) between headache intensity and serum glutamate levels after amitriptyline 12.5 mg administration.CONCLUSION:Since there was no significant correlation found between serum glutamate and headache intensity after treatment with flunarizine, it is suggested that decreasing of headache intensity after flunarizine treatment occurred not through glutamate pathways in CTTH patients.

COMPARATIVE ANALGESIC EFFECTS OF AMITRIPTYLINE, GABAPENTIN, AND PREGABALIN IN DIABETIC NEUROPATHY AND TRIGEMINAL NEURALGIAABSTRACTIntroduction: The management of neuropathic pain is a challenge for clinicians because of its nonspecific and difficult clinical to treat characteristics. The e use of antidepressant drugs such as amitriptyline and anticonvulsants such as gabapentin and pregabalin has shown various efficacy overcoming neuropathic pain.Aim: To compare the analgesic  efficacy of amitriptyline, gabapentin, and pregabalin  in patients with diabetic neuropathy and trigeminal neuralgia.Methods: This is an experimental pre and post test study on patients with diabetic neuropathy and trigeminal neuralgia in neurology clinic Haji Adam Malik Hospital, Medan, from April 2015 to march 2017. in each disease, subjects were divided into three groups, each was treated either with oral amitriptyline 12.5mg, gabapentin 100mg, or pregabalin 75mg twice daily. The Numeric Rating Scale to assess pain intensity were examined before and after two weeks after treatment.Results: The number of diabetic neuropathy subjects was 75, while trigeminal neuralgia subjects was 30, each were divided into three groups treated either with amitriptyline, gabapentin, or pregabalin. There were no differences on pain intensity changes in diabetic neuropathy groups but significant differences were shown in trigeminal neuralgia groups.Discussion: Amitriptyline, gabapentin, and pregabalin effective to lower pain intensity in trigeminal neuralgia significantly compare to diabetic neuropathy.Keywords: Amitriptyline, diabetic neuropathy, gabaptentin, pregabalin, trigeminal neuralgiaABSTRAKPendahuluan: Pengelolaan nyeri neuropatik merupakan tantangan bagi klinisi karena karakteristik klinisnya yang nonspesifik dan tatalaksananya yang sulit. Penggunaan antidepresan seperti amitriptilin dan antikonvulsan seperti gabapentin dan pregabalin mempunyai efikasi yang berbeda-beda dalam mengatasi nyeri neuropatik.Tujuan: Mengetahui perbedaan efek analgesik dari amitriptilin, gabapentin, dan pregabalin pada penderita neuropati diabetik dan neuralgia trigeminal.Metode: Studi eksperimental pre dan post test terhadap pasien neuropati diabetik atau neuralgia trigeminal yang berobat ke Poliklinik Neurologi RSUP Haji Adam Malik, Medan, sejak bulan April 2015 hingga Maret 2017. Semua subjek dibagi menjadi tiga kelompok untuk setiap penyakit, yang masing-masing mendapatkan amitriptilin 12,5mg, gabapentin 100mg, dan pregabalin 75mg, dengan frekuensi pemberian obat dua kali sehari setiap kelompok. Pengukuran intensitas nyeri dengan menggunakan Numeric rating Scale dilakukan sebelum dan setelah dua minggu pengobatan.Hasil: Didapatkan subjek dengan neuropati diabetik sebanyak 75 orang dan neuralgia trigeminal 30 orang yang masing-masing dibagi menjadi 3 kelompok dengan terapi amitriptilin, gabapentin, dan pregabalin. Tidak terdapat perbedaan rerata perubahan intensitas nyeri yang bermakna pada kelompok neuropati diabetik, namun bermakna pada subjek neuralgia trigeminal.Diskusi: Amitriptilin, gabapentin, dan pregabalin memiliki efikasi dalam menurunkan intensitas nyeri pada neuralgia trigeminal secara bermakna dibandingkan pada neuropati diabetik.Kata kunci: Amitriptilin, gabapentin, neuralgia trigeminal, neuropati diabetik,pregabalin

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease that causes severe demyelination, especially in the optic nerve and spinal cord with typical clinical manifestations of acute optic neuritis and transverse myelitis. The symptoms can occur simultaneously or separated by a variable period. NMOSD is associated with serum aquaporin antibodies 4 immunoglobulin G (AQP4-IgG). CASE PRESENTATION: We report a case of a 22-year-old male with complaints of weakness of all four limbs, impaired vision, urinary incontinence, and dyspnea. The Expanded Disability Status Scale (EDSS) was nine. Spinal magnetic resonance imaging (MRI) showed longitudinal extensive transversal myelitis. The brain MRI showed a normal impression, whereas the brain magnetic resonance spectroscopy (MRS) examination showed a description of the mild demyelination process. The serum antibody AQP4 (AQP4-IgG) results were seronegative, the cerebrospinal fluid examination was normal, and the oligoclonal band was negative. The ophthalmoscopic examination found bilateral papillary atrophy but optical coherence tomography (OCT) was still normal. Somatosensory evoked potential and visual evoked potential examinations were abnormal. The patient was diagnosed with NMOSD and was given combination immunosuppressant therapy, corticosteroids, and therapeutic plasma exchange. The patient experienced significant improvement with EDSS decreased to six. CONCLUSION: In the case of relapsing NMOSD patient, combination therapy of immunosuppressants, corticosteroids, and TPE was used. There were significant improvements from EDSS nine to six.

Background: Previous research has shown that flunarizine may be used for the prophylactic treatment of migraine and that plasma glutamate level monitoring in patients with migraine can serve as a biomarker of response to treatment. Our aim was to assess the efficacy of flunarizine and the correlation of glutamate levels in Chronic Tension-type Headache (CTTH) with response to medication. Methods: We studied 19 patients with diagnosis of CTTH according to International Classification of Headache Disorder, 2nd edition criteria. The level of plasma glutamate was measured before and after 8-weeks prophylactic treatments. Subjects were randomized into three interventional groups (flunarizine 5 mg, flunarizine 10 mg and placebo). Glutamate levels were measured by means of Glutamate ELISA Kit KA1909 Abnova.        Results: Flunarizine 5 mg group had lower mean plasma glutamate levels significantly compared to placebo (p < 0.00; 95% CI: 0.40-1.07). Flunarizine 10 mg group had lower mean of plasma glutamate levels significantly compared to placebo (p< 0.00; 95% CI: 0.53-1.27). However, there were no significant differences of mean plasma glutamate levels between flunarizine 5 mg group and flunarizine 10 mg group (p < 0.37; 95% CI: -(0.54) - 0.21). There were no significant differences in headache frequency reduction among the three interventional groups. Conclusions: The usage of flunarizine as prophylactic treatment can reduce plasma glutamate levels significantly in CTTH patients. Either flunarizine or placebo showed no significant difference in reducing headache frequency in CTTH patients.

Background: Alberta Stroke Program Early CT Score (ASPECTS) is a valid method for assessing early ischemic changes in the middle cerebral artery from a CT scan of patient with acute ischemic stroke. One of the factors that influence ASPECTS is stroke onset time, where a very subtle level of hypodensity in early onset can provide poor reliability on ASPECTS assessments. Aim of the study was to determine the relationship between the onset of acute ischemic stroke and ASPECTS. Methods: This study used a cross-sectional design with Chi-Square method in patients with acute ischemic stroke and anterior circulation stroke treated in The Stroke Corner and Integrated Ward of Haji Adam Malik General Hospital during the months of February -May 2019. All patients were evaluated for ASPECTS and stroke onset at admission. Stroke onset was divided into 3 parts: Under 24 hours, 24 -<48 hours and 48-72 hours. ASPECTS value was assessed by 2 observers. Authors categorized the ASPECT value into 2 groups: Low (≤7) and High (˃7). Results: Among 36 patients with Acute Ischemic Stroke, mean age was 55.7±13.9 years old, which male and female shares equal number by 18 persons (50%). Mean ASPECTS score was 7.2±2.0. This research found 5 patients (13.9%) with less than 24 hours onset and low ASPECTS score, 3 patients (8.3%) with 24 -<48 hours onset and low ASPECTS score, 7 patients (19.4%) with 24 -<48 hours onset and high ASPECTS score, 8 patients (22.2%) with 48-72 hours onset and low ASPECTS score, and 2 patients (5.6%) with 48-72 hours of onset and high ASPECTS score. Valuation of ASPECTS from both observers was considered as excellent (statistic K value = 0.9). Conclusions: ASPECTS has a significant relationship with stroke onset (p=0.029) and the initial ischemic change will be seen more clearly with increasing stroke onset time.Cite this article as: Nasution I, Surbakti KP, Lubis ND, Ekayana E. Correlation between acute ischemic stroke onset with Alberta stroke program early CT score. Int J Res Med Sci 2020;8:1299-302.