Few studies have examined whether patients with epilepsy are satisfied with how they are managed. A University of Calgary study has investigated this issue in a systematic review of the literature (Wiebe et al. Epilepsia 2014; epublished February 6, 2014). Read More
Neurology
MS patient website tops 70,000 visits
June 3, 2014MSology.com, the sister site of NeuroSens, has recorded 70,000 visits by people wanting more information about multiple sclerosis. The site was launched in August 2012 by Lind Publishing as a weekly news service to provide patients and their families with accurate, up-to-date information about MS research. Lind currently publishes four weekly or biweekly news services for patients and healthcare professionals. Read More
The time course of MS – AudioSlide presentation
May 28, 2014Mark S. Freedman HBSc MSc MD CSPQ FAAN FRCPC
Professor of Medicine (Neurology)
University of Ottawa
Director, Multiple Sclerosis Research Unit
The Ottawa Hospital-General Campus
Ottawa, Ontario, Canada
Dr. Mark Freedman, University of Ottawa, provides an overview of the pathophysiological events that occur during the time course of MS – from radiologically isolated syndrome to secondary-progressive MS. Read More
Migraine: will the circle (of Willis) be unbroken?
May 2, 2014REPORT FROM THE AMERICAN ACADEMY OF NEUROLOGY (AAN) ANNUAL MEETING, PHILADELPHIA PA, APRIL 26-MAY 3, 2014 – It has been suggested that circle of Willis variants may contribute to the pathogenesis of migraine as a result of decreased or more variable regional cerebral blood flow (Cucchiara et al. Med Hypotheses 2008;70:860-87).
This has been investigated in the Anatomy and Cerebral Hemodynamic Evaluation of Migraine (ACHE-M) controlled study of migraine patients with and without aura (Cucchiara et al. PLoS One 2013;8:e71007).
An incomplete circle of Willis on MR angiography was significantly more common in migraine with aura compared to controls (32% vs. 13%); while migraine without aura had intermediate results (21%). An incomplete circle of Willis was more common in males compared to females (79% vs. 59%). However, an analysis of 156 subjects found no significant differences in global or regional cerebral blood flow on perfusion MRI, although there was greater asymmetry in hemispheric cerebral blood flow in migraine patients. The authors speculated that circle of Willis variants may allow for relative ischemia during situations of increased metabolic demand.
As a follow-up to that study, Cucchiara and colleagues have now examined the relationship between circle of Willis variants, cerebral blood flow and white matter hyperintensities (WMH) (AAN 2014; abstract P6.199). A high WMH load was more common in migraine than controls (23% vs. 17%), although differences were not significant. Increased WMH were not generally associated with lower cerebral blood flow, but migraine patients with aura and a high WMH load did appear to have lower cerebral blood flow.
Two prior studies using MR angiography have also reported an association between an incomplete circle of Willis and migraine (Bugnicourt et al. Headache 2009;49:879-886; Cavestro et al. Can J Neurol Sci 2011;38:494-499). Further investigations are needed to determine if circle of Willis variants contribute to the increased risk of ischemic stroke in migraine patients.
Guest Reviewer: Dr. Daniel Selchen, Head of Neurology, St. Michael’s Hospital, Toronto, Canada
Smaller studies in MS: vitamin D, fatigue and dietary salt
May 2, 2014REPORT FROM THE AMERICAN ACADEMY OF NEUROLOGY (AAN) ANNUAL MEETING, PHILADELPHIA PA, APRIL 26-MAY 3, 2014 – For over 50 years, solar radiation and vitamin D have been implicated in the pathogenesis of MS (Acheson et al. Acta Psychiatr Scand Suppl 1960;35:132-147), in large part due to the latitude effect. However, the relevance of serum 25(OH)D levels and the virtues of vitamin D supplementation remain controversial. Read More