SYNOPSIS,
Chronic paroxysmal hemicrania (CPH) is a cluster headache variant, characterized by daily, frequent, unilateral, excruciatingly severe but rather short lasting headache attacks, which will not surface during chronic indomethacin medication. Three of five patients with an established diagnosis of CPH were able to precipitate attacks by head flexion (or rotation), whereas this ability was not detected in any of 40 patients with regular cluster headache. Attacks with associated unilateral tearing, conjunctival injection, slight miosis, ptosis and headache may start 4–15 second after beginning of head flexion. Precipitated and spontaneous attacks seem identical both clinically and as far as the immediate increment in corneal indentation pulse (CIP) amplitudes and intraocular pressure are concerned.
There are various alternative explanations for the underlying mechanism, the most plausible of which concerns sympathetic nerve involvement.
Although acute brachial neuritis is a well-known syndrome, factors that contribute to its pathogenesis are not yet understood. Only once before has this syndrome been reported in connection with Ehlers-Danlos syndrome. We describe here a 24-year-old man who suddenly developed acute multiple brachial neuritis of the right shoulder and on neurologic examination showed an associated finding of Ehlers-Danlos syndrome. The latter syndrome was also confirmed in other members of his family. This combination may have been overlooked previously. Mechanical and traumatic factors may play an important role in both pathogenesis and therapy.
A randomized, double-blind cross-over trial was carried out in 10 patients with narcolepsy to evaluate the effect of 600 mg femoxetine versus placebo. In comparison to placebo, femoxetine treatment resulted in a significant decrease in both the number and severity score of cataplectic attacks per day. There were also significantly fewer attacks of sleep paralysis, whilst the effects on nightmare and hypnogenic hallucinations were minor. The frequency of sleep attacks decreased slightly during femoxetine treatment, but the overall estimated sleep time during the day and excessive daytime sleepiness remained un-affected. An ambulatory sleep recording for 48 h one week after the start of the femoxetine and placebo period showed that femoxetine treatment resulted in a significant decrease in the total time spent in REM sleep. The side-effects of femoxetine were restricted to transient nausea in 2 patients. It is concluded that femoxetine or other selective serotonin reuptake inhibitors may be a useful alternative for narcoleptic patients who experience troublesome side-effects with tricyclic antidepressants.
The effects of acute intravenous injection of acebutolol 25 mg on the EEG were investigated in 5 normal subjects. On-line EEG analysis was carried out by a special purpose mini-computer using normalised slope descriptors (hjorth parameters). No significant changes were found apart from those due to drowsiness in 2 subjects, although minute to minute ECG frequency was significantly lowered (p = 0.031). The EEG, which is considered to be a sensitive tool, failed to show any conclusive evidence of any central action of the drug. The effects of beta-adrenergic blockers on the CNS are not yet fully understood.
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