The purpose of this study was to determine the safety and efficacy of botulinum toxin type A (BOTOX; Allergan, Irvine, USA) in migraine prophylaxis. We performed a double-blind, randomized, 90-day placebo-controlled study that enrolled 30 adult migraineurs. Patients received 50 units botulinum toxin type A (n=15) or placebo (n=15). Outcome measures were monthly frequency and duration of migraine attacks and the number of severe attacks. Botulinum toxin type A produced significantly greater reductions in the frequency of migraine attacks of any severity at Day 90 (-3.14 vs. -0.53; p <0.05) and in the frequency of severe migraine attacks at Days 60 (-1.4 vs. -0.54; p <0.05) and 90 (-1.8 vs. -0.20; p <0.02). One patient in the botulinum toxin type A group experienced mild, transient frontalis muscle weakness lasting approximately 30 days. Botulinum toxin type A injections were well tolerated and provided effective migraine prophylaxis in these patients.

Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.

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Familial amyloidotic polyneuropathy type I is an autosomal dominant inherited disorder characterized by progressive peripheral and autonomic neuropathy, associated with neural and systemic amyloid deposits. The abnormality usually lies in the transthyretin (TTR) gene. We report a 25 years old man with 18 months history of dysesthesias and pain in the toes, abnormal micturition and sexual dysfunction. Neurophysiologically studies disclosed a sensory-motor axonal polyneuropathy. Autonomic tests showed sympathetic and parasympathetic involvement. An electron micrograph of sural nerve revealed amyloid fibrils in the endoneurium. His mother died after a clinical history suggestive, in retrospect, of familial amyloidotic polyneuropathy type I. The clinical and genetic analysis of this cause of polyneuropathy are discussed (Rev Méd Chile 2003; 131: 1179-82). (Recibido el 30 de abril, 2003. Aceptado en versión corregida el 25 de agosto, 2003.

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