The present findings show that the combination of IA and Rtx induces rapid clinical remission and long-term control in difficult-to-treat pemphigus.

No abstract

Objective: The trigeminal autonomic reflex plays an important role in primary headache syndromes. Noninvasive vagal nerve stimulation (nVNS) may be an effective modulator of this reflex. Methods: Twenty-two healthy volunteers underwent kinetic oscillation stimulation (KOS) of the left nostril as a reliable trigger of the trigeminal autonomic reflex. Previous to KOS, left cervical nVNS, sham simulation, or no stimulation was applied. Lacrimation was quantified using the standardized Schirmer ll test. Results: Treatment with cervical nVNS significantly reduced lacrimation between no stimulation and nVNS on the ipsilateral side (minute 5: p = 0.026, ηp 2 = 0.85, 95% confidence interval [CI] = 1.39-18.04; no stimulation: minute 5, 14.4 AE 9.3 mm; nVNS: minute 5, 4.7 AE 8.6 mm, mean AE standard deviation) as well as between sham stimulation and nVNS (minute 5: p = 0.030, ηp 2 = 0.85, 95% CI = 1.04-17.24; sham: minute 5, 13.9 AE 6.4 mm). On the contralateral side, no significant increase between baseline and KOS was observed for nVNS (minute 5: p = 0.614, d = 0.12, 95% CI = −7.09 to 4.31; minute 5, 1.4 AE 11.5 mm) compared to both sham stimulation (minute 5: p = 0.023, d = 0.57, 95% CI = −11.46 to −0.96; minute 5, 6.2 AE 10.9 mm) and no stimulation (minute 5: p < 0.030, d = 0.62, 95% CI = −13.45 to −0.81; minute 5, 7.1 AE 11.4 mm). Interpretation: Cervical nVNS resulted in a robust bilateral reduction of provoked lacrimation. This effect could be mediated either by direct bilateral activation of structures such as the nucleus of the solitary tract or by a top-down modulation via the hypothalamus.

Background Recently it has been suggested that low frequency stimulation of the sphenopalatine ganglion (SPG) may provoke cluster-like attacks in cluster headache (CH) patients. The question arises whether a robust activation of cranial autonomic symptoms is sufficient to trigger CH attacks. Methods Kinetic oscillation stimulation (KOS) of the nasal mucosa generates ipsilateral marked autonomic symptoms, among which lacrimation is quantitatively measurable. KOS was applied to 29 CH-patients, including both episodic and chronic course. We measured lacrimation at rest and during stimulation, and assessed CH attacks within 24 hours after the experiment. Results Autonomic symptoms including lacrimation were robust and significantly generated, compared to rest. Six patients were lost to follow-up, but did not develop an attack during their stay in the clinic. Of the remaining 23 patients, none developed an attack in the next 4 hours after stimulation, despite marked cranial autonomic symptoms during stimulation. Discussion Peripheral stimulation close to the SPG generated a strong parasympathetic response. However, this stimulation was not sufficient to induce CH attacks, which suggests that a central component is crucial to attack generation.