Mark 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
There have been numerous studies examining the effectiveness of long-distance psychotherapy as an alternative means of accessing and improving clinical outcomes for patients with depressive or anxiety disorders (Choi et al. Depress Anxiety 2014; epublished February 5, 2014; Lam et al. Br J Psychiatry 2013;203:358-365).
In recent years, the Internet has been used to deliver cognitive-behavioural therapy (CBT), psychodynamic psychotherapy and guided self-help programs (Johansson et al. BMC Psychiatry 2013;13:268, free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC3852703/pdf/1471-244X-13-268.pdf). Reins et al. BMC Psychiatry 2013;13:318, free full text at www.biomedcentral.com/content/pdf/1471-244X-13-318.pdf). Read More
The Global Burden of Disease Study (GBD 2010) is a large epidemiological study by the World Health Organization that has resulted in dozens of papers over the past decade.
As a result of improvements in some areas of population health (e.g. maternal and child health, sanitation, infection control) and the aging of the population, the health priorities are now shifting from mortality to morbidity – underscoring the significant impact of neurological and psychiatric disorders on burden of disease. Read More
REPORT 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