There is evidence that some antidepressant drugs are beneficial in the prophylaxis of migraine. Previous reports have shown that migraine patients may respond to various antidepressant agents used for prophylactic therapy. The main purpose of this study was to compare the efficacy of antidepressants from 2 different groups (venlafaxine vs escitalopram) on people who had migraine headache without depression or anxiety. In this prospective study, we evaluated the headache diaries of 93 patients who were being treated with venlafaxine (n = 35) and escitalopram (n = 58). At the end of the 3-month period, patients were reassessed, and those with marked differences in attack frequency, duration, intensity (with visual analog scales), lost work-day equivalent index, and migraine disability assessment questionnaire were compared. There was a clear reduction in headache frequency (P < 0.0001), duration (P < 0.0001), and severity (P < 0.0001) in the venlafaxine group. In addition, there was a significant improvement in daily work performance during headaches (P < 0.0001). In the escitalopram group, monthly headache frequency (P < 0.026), duration (P < 0.002), and intensity (P < 0.027) all decreased significantly, although not to the same extent as with venlafaxine. After the third month of venlafaxine and escitalopram treatment, most of the patients (82.8% vs 96.5%) were seen to have moved to the minimal or infrequent migraine disability assessment group. According to our findings, venlafaxine and escitalopram are both effective in the prophylaxis of migraine headache without depression and anxiety. This effect was independent of mood disorder. Escitalopram should be the first choice because of its fewer side effects, but venlafaxine may be used if escitalopram is found to be insufficient.

The vinca alkaloids are neurotoxic, usually causing a peripheral neuropathy, but cranial neuropathies are rare as side effects. We describe a case of vincristine-induced multiple cranial and autonomic neuropathy, and sensory-motor axonal peripheral neuropathy (pan-neuropathy), which is an extremely rare fatal complication of this drug. The patient developed fulminant cranial, peripheral and significant autonomic neuropathy.

Background and purpose: Hyperthermia is a well-known factor for neurologic deterioration, morbidity, and mortality in the early phase of stroke. However, the timing, localization of lesion, origin of stroke, which may influence body temperature, have not been clearly established. Methods: The purpose of this study was to determine the relationship between body temperature and origin, lesion topography, and prognosis at 3 months after onset of stroke. Axillary temperature was taken every hour for 72 hours in 473 patients with supra- or infratentorial cerebral vascular lesion. The time at which hyperthermia (>38 degrees C) appeared was evaluated by logistic regression analyses regarding to stroke origin and lesion localization. The correlation between body temperature and stroke outcome was quantified by Barthel index and American Heart Association Stroke Outcome Classification by recording in each 12- hour interval from stroke onset during 72 hours and after 3 months. Results: The body temperature was higher in patients with large-artery atherosclerosis (odds ratio [OR], 3.98; 95% confidence interval [CI]= 2.16-8.97; P =.001) and hemorrhagic stroke (OR = 2.05, 95% CI = 1.07-8.68, P =.001) than those with small-artery disease. In patients with posterior circulation infarct, the body temperature was higher than those with anterior circulation infarct (OR = 3.71, 95% CI = 2.07-6.67, P =.001), whereas there was no difference between patients with infratentorial hemorrhage and those with supratentorial hemorrhage (OR = 1.04, 95% CI = 0.75-1.43, P =.80). High body temperature at 24 hours of stroke onset (OR = 2.17, 95% CI = 2.09-7.57, P =.001) and 48 hours (OR = 1.27, 95% CI = 1.06-4.84, P =.02) was correlated with poor outcome and mortality. Conclusion: An association between hyperthermia within 72 hours of ictus and stroke subtypes was observed among patients with ischemic and hemorrhagic stroke. Hyperthermic patients with total anterior circulation infarct, posterior circulation infarct, and supratentorial hemorrhage were associated with a marked increase of 3-months' mortality. Large-artery atherosclerosis, cardioembolism, and supra-infratentorial hemorrhage associated with hyperthermia may increase the severity of neurologic deficits.

Oropharyngeal dysphagia is not rare in older children before the adult age, especially the patients with cerebral palsy. Non-invasive simple tests are needed for the evaluation of children with neurogenic dysphagia including the patients with cerebral palsy. So we aimed to evaluate non-invasive ways to screen for dysphagia in children and the usefulness of this almost new electrophysiologic method for the detection of dysphagia in childs with cerebral palsy. Twenty-eight healthy children and 12 patients with cerebral palsy were investigated for the applicability of this method. The movement of the larynx was monitored using a simple piezoelectric wafer sensor and submental surface EMG activity was recorded by bipolar silver-chloride electrodes taped under the chin over the submental muscle complex. The onset and duration of pharyngeal swallowing was recorded from submental-suprahyoid muscles such as the mylohyoid-genitohyoid-anterior digastric complex. By this method, the maximal water volume capacity was measured in single swallows with progresively increasing water volumes, this was called 'dysphagia limit'. The healthy control childrens revealed to swallow the bolus at once maximally 11.2+/-0.4 and 2.5ml in average. Dysphagia limit varied from 7 to above 20ml water volume from age 5-16 years old. Patients with cerebral palsy had the dysphagia limit of 7.7+/-1.8 and 6.4ml in average. The dysphagia limit was significantly reduced in patients with cerebral palsy (p<0.05). Dysphagia limit seemed to be less sensitive in demonstrating the oropharyngeal swallowing disorders in childhood period (90% in the adult dysphagic patients). But the majority of patients with cerebral palsy (58%) showed abnormality. This electrophysiologic method is completely non-invasive, devoid from any hazard and applicable to children above 5 years. It may be candidate as a screening test before selection of dysphagic children.

A variety of medications can induce or enhance a tremor. Tremors most commonly affect the limbs, especially the arms. We report a patient who presented with a 5-6 Hz jaw tremor with a temporal association with the administration of citalopram. To our knowledge, this is the first report in literature, of a transient jaw tremor associated with citalopram. According to the current data, citalopram-induced jaw tremor can be explained by an indirect inhibitory effect on central dopaminergic activity.

We studied the various physiological aspects of oropharyngeal swallowing in Parkinson's disease (PD). Fifty-eight patients with PD were investigated by clinical and electrophysiological methods that measured the oropharyngeal phase of swallowing. All patients except 1 had mild to moderate degree of disability score. Dysphagia was demonstrated in 53% of all patients in whom the test of dysphagia limit was abnormal. All PD patients with or without dysphagia displayed the following abnormalities:(1) the triggering of the swallowing reflex was prolonged probably due to inadequate bolus control in the mouth and tongue and/or a specific delay in the execution of the swallowing reflex;(2) the duration of the pharyngeal reflex time was extremely prolonged due to slowness of the sequential muscle movements, especially those of the suprahyoid-submental muscles;(3) cricopharyngeal muscle of the upper oesophageal sphincter was found to be electrophysiologically normal; and (4) the electrophysiological phenomena in PD patients could not be strongly correlated with the degree of the disability and clinical score of the PD. It was concluded that various motor disorders of PD have considerable influence on oropharyngeal swallowing: hypokinesia, reduced rate of spontaneous swallowing, and the slowness of segmented but coordinated sequential movements rather than any abnormalities in the central pattern generator of the bulbar center. Some compensatory mechanisms in the course of PD may explain the benign nature of swallowing disorder until the terminal stage of the disease. Similarly, the swallowing problems of PD are not only related with the dopamine deficiency; some other nondopaminergic mechanisms may also be involved.

OBJECTIVE: To clarify the pathophysiology of dysphagia by electrophysiological methods. METHOD: Electrophysiological methods related to oropharyngeal swallowing were used to investigate 25 patients with cervical dystonia and 25 age matched normal volunteers. RESULTS: Dysphagia was suspected in 36% of patients with cervical dystonia on the basis of clinical assessment. The incidence of dysphagia increased to 72% on electrophysiological evaluation of pharyngeal swallowing. Submental muscle electromyographic (EMG) and laryngeal relocation times were significantly prolonged and the triggering time to swallowing reflex was significantly delayed. Some abnormalities seen in cricopharyngeal sphincter muscle EMG indicated that the striated sphincter muscle is hyperreflexive in some patients. CONCLUSION: Neurogenic dysphagia was more prominent and longer lasting than mechanical dysphagia, which was transient and varied from patient to patient. Although these electrophysiological methods were not suitable for detecting anatomical changes during swallowing, as in videofluoroscopic studies, observations supported the neurogenic cause of dysphagia in patients with any kind of cervical dystonia.

We report the first case of cerebral venous thrombosis (CVT) diagnosed in an adult with Down's syndrome (DS). A 25-year-old man with DS was admitted because of a generalized tonic-clonic seizure and prolonged postictal period. Cerebral magnetic resonance imaging (MRI) and MR venography revealed CVT. No particular cause of the thrombosis was identified. CVT may be an unusual cause of stroke in DS.

OBJECTIVES: To determine the clinical usefulness of an electrophysiologic method for evaluating dysphagia and to identify the effects of various head and neck positions on oropharyngeal swallowing. DESIGN: Experimental, with control group. SETTING: An electromyography laboratory. PARTICIPANTS: Patients with neurogenic dysphagia (n = 51) and healthy controls (n = 24). Patients were divided into 2 groups: those patients with unilateral lower cranial lesions (n = 9) and those without laterality in the function of the oropharyngeal muscles (n = 42). INTERVENTIONS: Subjects were instructed to swallow doses of water, gradually increasing in quantity from 1 to 25 mL under 5 conditions: neutral, chin up, chin tucked, head rotated right, and head rotated left. MAIN OUTCOME MEASURES: Change in dysphagia limit through specified head and neck postures. Oropharyngeal swallowing was evaluated by laryngeal movements that were detected by a piezoelectric sensor and electromyography of the submental muscle complex. Laryngeal sensor signals occurring within 8 seconds of a swallow were accepted as a sign of the dysphagia limit. RESULTS: In the control group, dysphagia limit did not change significantly with changes in head and neck postures, except for the chin-up posture (p <.05) in which piecemeal deglutition occurred when subjects swallowed volumes less than 20 mL. Dysphagia limit improved significantly (p <.05) in 67% of the patients with unilateral lower cranial lesions when the head was rotated toward the paretic side. In dysphagic patients with bilateral symptoms, a significant (p <.01) improvement in dysphagia limit occurred in 50% of patients in chin-tuck position, but in the chin-up position, 55% of the patients experienced a significant (p <.01) decrease in dysphagia limit. CONCLUSION: The electrophysiologic method of measuring dysphagia limit confirms neurogenic dysphagia and its severity in the neutral head position. Changes in head and neck positions do not significantly alter dysphagia limit in unimpaired subjects except for the chin-up position. Although the results obtained were not compared with other techniques (eg, videofluoroscopy), this simple electrophysiologic method for describing dysphagia limit may have a place in the evaluation of dysphagia and its variability in various head and neck positions.