Introduction In 2020 Coronavirus Disease 2019 (COVID-19) was declared as a global pandemic. Self-reported stress, anxiety, and insomnia, which are believed to be common triggers for epilepsy, are more likely to occur. We aimed to establish the influence of COVID-19 pandemic itself so as changes in the daily life routine related to pandemic on epilepsy course in pediatric patients. The unique form of clinical care which is telemedicine was also taken into consideration. We wanted to evaluate patients' satisfaction with telemedicine and if changing stationary visits into telemedicine influenced epilepsy course in our patients. Methods Patients, who attended developmental neurology outpatient clinic in the period March-December 2020 were collected. As patients were minors, legal guardians were asked to fill out the questionnaire. Patients were divided according to the outcome into three groups: those with a worsened, stable or improved course of epilepsy during the pandemic. Appropriate statistical tests for two-group and multi-group comparisons have been implemented. Post-hoc p values were also calculated. Results 402 questionnaires were collected. Most of the patients had a stable course of epilepsy during the pandemic; in 13% of participants an improvement has been observed, worsening of the disease was seen in 16% of patients. Age, sex, type of epilepsy, number of seizure incidents before pandemic, and duration of the disease had no statistically significant connection with changes in the course of the disease. Behavioral changes and altered sleep patterns were found to be more common in the worsened group. 58% of patients were satisfied with telemedicine. Poorer satisfaction was connected with less frequent visits, cancellation of scheduled appointments, and lack of help in case of need of emergency situation. Conclusion Epilepsy course in pediatric patients seems to be stable during COVID-19 pandemic. Sleep disturbances and changes in a child's behavior may be related to increase in seizures frequency. Telemedicine is effective tool for supervising children with epilepsy. Patients should be informed about possible ways of getting help in urgent cases.

Stroke is a life-threatening condition in which accurate diagnoses and timely treatment are critical for successful neurological recovery. The current acute treatment strategies, particularly non-invasive interventions, are limited, thus urging the need for novel therapeutical targets. Arginine vasopressin (AVP) receptor antagonists are emerging as potential targets to treat edema formation and subsequent elevation in intracranial pressure, both significant causes of mortality in acute stroke. Here, we summarize the current knowledge on the mechanisms leading to AVP hyperexcretion in acute stroke and the subsequent secondary neuropathological responses. Furthermore, we discuss the work supporting the predictive value of measuring copeptin, a surrogate marker of AVP in stroke patients, followed by a review of the experimental evidence suggesting AVP receptor antagonists in stroke therapy. As we highlight throughout the narrative, critical gaps in the literature exist and indicate the need for further research to understand better AVP mechanisms in stroke. Likewise, there are advantages and limitations in using copeptin as a prognostic tool, and the translation of findings from experimental animal models to clinical settings has its challenges. Still, monitoring AVP levels and using AVP receptor antagonists as an add-on therapeutic intervention are potential promises in clinical applications to alleviate stroke neurological consequences.

Objective: To investigate whether web searching for headache disorders presents some circannual rhythm.Background: Studies support the influence of seasonal rhythms in primary headache disorders such as cluster headache (CH) and episodic migraine. We investigated whether internet users' searching for headaches reflect these circannual rhythms. Methods:This was an internet-based study using the Google Trends (Google) platform. The 10-year interest across four related topics (headache, migraine, tensiontype headache [TTH], and CH) in 31 European countries was scanned.Results: Significant differences between months were found for the topics "headache" and "migraine." Interest in the former was superior in February (median for all countries, 61 [25th-75th percentile, 45-80]), ), and November (61 [45-76]). The lowest search volumes for headache appeared in July (52 [37-66]) (p < 0.001). Migraine was searched most commonly in ) and rarely in June (46.5 [31-64]) (p < 0.001). Differences were observed for the topic of headache in Northern Europe (p = 0.001) and for headache and migraine in Central Europe (p < 0.001 and p = 0.016 respectively) but not in the southern region. TTH and CH were apparently less searched and no evident trends regarding them were present (median, 22 [0-44] for for CH; direct popularity comparison: headache 56 [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63], migraine 16 [12][13][14][15][16][17][18][19][20][21][22][23][24], TTH 2 [1-2], and CH 2 [1][2]; between-month differences, p = 0.168 and p = 0.081 respectively).Conclusions: Public attention on headache-related topics on the internet is distributed according to a significant trend of increased searching around spring and autumn. It suggests that a large number of patients may experience some level of seasonal variation in their headaches. Assessment of whether those temporal changes are present in clinical practice is necessary.

Objectives The pathogenesis of fibromyalgia syndrome (FMS) is unclear. Transcranial ultrasonography revealed anechoic alteration of midbrain raphe in depression and anxiety disorders, suggesting affection of the central serotonergic system. Here, we assessed midbrain raphe echogenicity in FMS. Methods Sixty-six patients underwent transcranial sonography, of whom 53 were patients with FMS (27 women, 26 men), 13 patients with major depression and physical pain (all women), and 14 healthy controls (11 women, 3 men). Raphe echogenicity was graded visually as normal or hypoechogenic, and quantified by digitized image analysis, each by investigators blinded to the clinical diagnosis. Results Quantitative midbrain raphe echogenicity was lower in patients with FMS compared to healthy controls (p<0.05), but not different from that of patients with depression and accompanying physical pain. Pain and FMS symptom burden did not correlate with midbrain raphe echogenicity as well as the presence and severity of depressive symptoms. Conclusion We found reduced echogenicity of the midbrain raphe area in patients with FMS and in patients with depression and physical pain, independent of the presence or severity of pain, FMS, and depressive symptoms. Further exploration of this sonographic finding is necessary before this objective technique may enter diagnostic algorithms in FMS and depression.