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G N O'Neill,
K Dawson,
K Schmierer,
D H Miller,
L Kappos, R Gold,
E Havrdova,
M Yang,
E Meluzinova,
D G MacManus,
M Eraksoy,
V Limmroth,
M Dufek,
T A Yousry,
C H Polman
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D G MacManus,
D H Miller,
L Kappos,
R Gold,
E Havrdova, V Limmroth,
C H Polman,
K Schmierer,
T A Yousry,
M Eraksoy,
E Meluzinova,
M Dufek,
M Yang,
G N O'Neill,
K Dawson
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[show abstract]
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ABSTRACT: Kopfschmerzen gehören zu den am häufigsten beklagten Beschwerden und Symptomen in der ärztlichen Praxis. Die Migräne ist mit
einer Prävalenz von 8% bei Männern und 12–15% bei Frauen die zweithäufigste Kopfschmerzform. In den letzten 100 Jahren hat
sich ein dramatischer Wissenszuwachs in den Bereichen Epidemiologie, Pathophysiologie, Akuttherapie und präventive Behandlung
der Migräne ergeben. Zum Durchbruch in der Akutbehandlung von Migräneattacken führte die Entdeckung der Triptane. Für die
medikamentöse Migräneprophylaxe stehen β-Rezeptoren-Blocker, Kalziumantagonisten und Neuromodulatoren zur Verfügung. Eine
wichtige Rolle spielt die nichtmedikamentöse Migräneprophylaxe. Neue Versorgungsstrukturen, wie die Integrierte Versorgung
Kopfschmerz, gewährleisten eine bessere Versorgung von Patienten mit Migräne, insbesondere chronischer Migräne.
Headaches are one of the most common disorders and symptoms in daily medical practice. The prevalence of migraine is 8% in
men and 12–15% in women. Dramatic progress in the areas of epidemiology, pathophysiology, and acute and preventive therapy
of migraine has been made over the past 100 years, with triptans being the breakthrough for treating acute migraine attacks.
Beta blockers, calcium antagonists, and neuromodulators are available for preventive migraine therapy. Nonpharmacologic treatment
also plays an important role in migraine prevention. New medical care structures such as integrated headache care provide
better support for patients with migraine, particularly those with chronic migraine.
Der Schmerz 04/2012; 22:51-60. · 0.88 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Kopfschmerzen gehören zu den am häufigsten beklagten Beschwerden und Symptomen in der ärztlichen Praxis. In den letzten 100
Jahren hat sich ein dramatischer Wissenszuwachs in den Bereichen Epidemiologie, Pathophysiologie, Akuttherapie und präventiver
Therapie ergeben. Der Durchbruch in der Akutbehandlung von Migräneattacken kam mit der Einführung der Triptane. Für die medikamentöse
Migräneprophylaxe stehen β-Rezeptoren-Blocker, Kalziumantagonisten und Neuromodulatoren zur Verfügung. Unbefriedigend ist
immer noch die Behandlung des chronischen Spannungskopfschmerzes. Der Clusterkopfschmerz wird in der Gruppe der trigeminoautonomen
Kopfschmerzen subsumiert. Eine zunehmend wichtige Rolle spielt der medikamenteninduzierte Dauerkopfschmerz. Neue Versorgungsstrukturen
wie die integrierte Versorgung Kopfschmerz sorgen für eine bessere Betreuung von Patienten mit chronischen Kopfschmerzen.
Headaches are one of the most common disorders and symptoms in daily medical practice. There has been dramatic progress of
knowledge in the fields of epidemiology, pathophysiology, acute treatment, and preventive therapy over the past 100 years.
Triptans have been the breakthrough in the treatment of acute migraine attacks. Beta blockers, calcium antagonists, and neuromodulators
are available for preventive migraine therapy. Treatment for chronic tension headache is still unsatisfying. Cluster headache
is part of the group of trigemino-autonomic headaches. Headache from medication overuse plays an increasingly important role.
New medical care structures such as integrated headache care provide better support for patients with chronic headache disorders.
Der Nervenarzt 04/2012; 78:7-14. · 0.68 Impact Factor
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ABSTRACT: Efficacy and safety data have not previously been compiled for intramuscular interferon beta-1a (IM IFNβ-1a) in patients with multiple sclerosis (MS) ≥ 50 years of age. We investigated the efficacy and safety of IM IFNβ-1a in patients segregated by 50 and 40 years of age in separate meta-analyses.
The MS Clinical Research Group Study, the Controlled High-Risk Subjects AVONEX(®) (IM IFNβ-1a) MS Prevention Study, the IFNβ-1a European Dose-Comparison Study, and a multicenter, open-label antigenicity and safety study of human serum albumin-free IM IFNβ-1a were analyzed.
Overall, 906 patients (68 aged ≥ 50 years and 838 aged <50 years, or 323 aged ≥ 40 years and 583 aged <40 years) received IM IFNβ-1a for ≥ 24 months. At baseline, patients ≥ 50 years had significantly higher Expanded Disability Status Scale scores than patients <50 years (3.4 vs. 2.8; P < 0.001), but fewer relapses in the three preceding years (2.6 vs. 3.4; P < 0.001); patients ≥ 40 years and <40 years exhibited similar differences. After 2 years of treatment, there were no significant differences in annualized relapse rate, sustained disability progression, time to sustained disability progression, or number of MRI-identified gadolinium-enhanced lesions between age groups in either analysis. The cumulative probability of relapse was significantly lower in patients ≥ 40 years versus patients <40 years (0.601 vs. 0.702; P < 0.001). Adverse event incidence did not differ significantly between age groups in either analysis.
IM IFNβ-1a is effective and well tolerated in patients with MS ≥ 40 and ≥ 50 years as well as younger patients.
European Journal of Neurology 07/2011; 19(1):142-8. · 3.69 Impact Factor
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D G MacManus,
D H Miller,
L Kappos,
R Gold,
E Havrdova, V Limmroth,
C H Polman,
K Schmierer,
T A Yousry,
M Eraksoy,
E Meluzinova,
M Dufek,
M Yang,
G N O'Neill,
K Dawson
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ABSTRACT: BG-12, an immunomodulatory agent, reduces frequency of new gadolinium-enhancing (Gd+) lesions in relapsing multiple sclerosis (MS). This study reports the effect of 240 mg BG-12 orally three times daily (tid) for 24 weeks on the evolution of new Gd+ lesions to T1-hypointense lesions. Brain magnetic resonance imaging (MRI) scans from patients in placebo and 240 mg BG-12 tid arms of a phase 2b study were examined retrospectively. Included patients had at least one new Gd+ lesion from weeks 4 to 12. Week 24 scans were analyzed for number and proportion of new Gd+ lesions that evolved to T1-hypointense lesions. Eighteen patients receiving BG-12 and 38 patients receiving placebo were included in the analysis. The analysis tracked 147 new Gd+ lesions in patients from the BG-12 group and 221 Gd+ lesions in patients from the placebo group. The percentage of Gd+ lesions that evolved to T1-hypointense lesions was 34% lower with BG-12 treatment versus placebo (29%, BG-12; 44%, placebo; odds ratio 0.51; 95% confidence interval 0.43, 0.61; p < 0.0001). In addition to reducing frequency of new Gd+ lesions, BG-12 significantly reduced probability of their evolution to T1-hypointense lesions in patients with MS compared with placebo.
Journal of Neurology 10/2010; 258(3):449-56. · 3.47 Impact Factor
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ABSTRACT: Natalizumab has been recommended for the treatment of relapsing-remitting multiple sclerosis (RRMS) in patients with insufficient response to interferon-beta/glatiramer acetate (DMT) or aggressive MS. The pivotal trials were not conducted to investigate natalizumab monotherapy in this patient population.
Retrospective, multicenter study in Germany and Switzerland. Five major MS centers reported all RRMS patients who initiated natalizumab >or=12 months prior to study conduction.
Ninety-seven RRMS patients were included [69% female, mean age 36.5 years, mean Expanded Disability Status Scale (EDSS) 3.4; 93.8% were pre-treated with DMT], mean treatment duration with natalizumab was 19.3 +/- 6.1 months. We found a reduction of the annualized relapse rate from 2.3 to 0.2, 80.4% were relapse free with natalizumab. EDSS improved in 12.4% and 89.7% were progression free (change of >or= 1 EDSS point). Eighty-six per cent of patients with highly active disease (>or= 2 relapses in the year and >or= 1 Gadolinium (Gd)+ lesion at study entry, n = 20) remained relapse free. The mean number of Gd enhancing lesions was reduced to 0.1 (0.8 at baseline). Discontinuation rate was 8.2% (4.1% for antibody-positivity).
Natalizumab is effective after insufficient response to other DMT and also in patients with high disease activity.
European Journal of Neurology 07/2009; 17(1):31-7. · 3.69 Impact Factor
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ABSTRACT: Natalizumab has been recommended for the treatment of patients with relapsing remitting multiple sclerosis with insufficient response to interferon-beta (IFN-beta) or glatiramer acetate (GA).
Prospective, observational study.
We found a reduction of the annualized relapse rate from 2.1 under IFN-beta or GA to 0.2 one year after switching to natalizumab. There were 94% fewer gadolinium enhancing lesions with natalizumab.
Natalizumab reduced short term clinical and MRI activity in second line therapy and efficacy is comparable to first line therapy as demonstrated in the pivotal trials.
European Journal of Neurology 02/2009; 16(3):424-6. · 3.69 Impact Factor
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ABSTRACT: Prevalence rates of headache in multiple sclerosis (MS) patients varied widely in recent studies. This study aimed to investigate the 1 year prevalence of headache in MS compared with the general population.
Population-based case-control study in Germany.
We included 491 patients with definite MS (68% female, mean age 45.3 years, 63.7% relapsing remitting MS, mean Expanded Disability Status Scale (EDSS) 3.2, 106 treated with interferon-beta, 53 with glatiramer acetate, 271 untreated) and 447 age and gender matched controls. Headache was diagnosed with a validated questionnaire according to the International Headache Society Criteria. Headache prevalence was 56.2% (tension type headache 37.2%, migraine 24.6%). Headache prevalence rates did not differ from controls. Headache was not associated with disability or treatment. Trigeminal neuralgia was found in 6.3% of MS cases.
Results suggest that headache in MS patients reflects comorbidity in most conditions.
European Journal of Neurology 01/2009; 16(2):262-7. · 3.69 Impact Factor
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ABSTRACT: Headaches are one of the most common disorders and symptoms in daily medical practice. The prevalence of migraine is 8% in men and 12-15% in women. Dramatic progress in the areas of epidemiology, pathophysiology, and acute and preventive therapy of migraine has been made over the past 100 years, with triptans being the breakthrough for treating acute migraine attacks. Beta blockers, calcium antagonists, and neuromodulators are available for preventive migraine therapy. Nonpharmacologic treatment also plays an important role in migraine prevention. New medical care structures such as integrated headache care provide better support for patients with migraine, particularly those with chronic migraine.
Der Schmerz 03/2008; 22 Suppl 1:51-8; quiz 59-60. · 0.88 Impact Factor
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ABSTRACT: This proof-of-concept study evaluated the efficacy of prednisone for the treatment of withdrawal symptoms in patients with medication overuse headache (MOH) in a randomized, placebo-controlled, double-blind design. Twenty patients were randomized and underwent in-patient withdrawal therapy. The total number of hours with severe or moderate headache within the first 72 and 120 h was significantly lower in the prednisone group. The results show that prednisone might be effective in the treatment of medication withdrawal headache.
Cephalalgia 03/2008; 28(2):152-6. · 3.43 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Headaches are one of the most common disorders and symptoms in daily medical practice. There has been dramatic progress of knowledge in the fields of epidemiology, pathophysiology, acute treatment, and preventive therapy over the past 100 years. Triptans have been the breakthrough in the treatment of acute migraine attacks. Beta blockers, calcium antagonists, and neuromodulators are available for preventive migraine therapy. Treatment for chronic tension headache is still unsatisfying. Cluster headache is part of the group of trigemino-autonomic headaches. Headache from medication overuse plays an increasingly important role. New medical care structures such as integrated headache care provide better support for patients with chronic headache disorders.
Der Nervenarzt 10/2007; 78 Suppl 1:7-13; quiz 14. · 0.68 Impact Factor
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European Journal of Neurology 07/2007; 14(6):e12-3. · 3.69 Impact Factor
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ABSTRACT: Epidemiological data on trigeminal unilateral autonomic symptoms in patients with migraine are scarce. The authors wanted to provide a population-based evaluation of the prevalence of unilateral autonomic features in migraine patients and an assessment of the expression of unilaterality of autonomic symptoms and head pain in patients with UAs compared to other migraine patients. A population based sample of 6000 inhabitants of the city of Essen in Germany was screened using a previously validated standard questionnaire. Three thousand three hundred and sixty subjects (56% of a total 6000) responded. 841 subjects had migraine, out of which 226 reported accompanying unilatral auetonomic symptoms (26.9%, CI 95% [23.9-30%]). Unilateral autonomic symptoms in patients with migraine are common and have been widely underestimated in the past. One out of four migraine patients regularly experiences one or more unilateral autonomic symptoms during their attack. Migraine patients with accompanying autonomic symptoms seem to experience their pain more unilateral and more severe than non-UA patients.
Cephalalgia 06/2007; 27(6):504-9. · 3.43 Impact Factor
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ABSTRACT: Trigeminal and somatic nociceptive systems were studied in controls (n=15), episodic migraine (n=16), analgesics (n=14) and triptan-induced medication overuse headache (MOH) (n=15) before and after withdrawal. Patients with MOH and comorbid depressive symptoms and depression without headache were studied to investigate the influence of depression. Trigeminal nociception was studied by simultaneous registration of pain-related cortical potentials (PREP) and nociceptive blink reflex (nBR) following nociceptive-specific electrical stimulation of the forehead. Somatic nociception was evaluated using PREP of upper limbs. We found facilitation of both trigeminal and somatic PREP but not of nBR in MOH, which normalized after withdrawal. No differences were found comparing analgesics vs. triptan MOH. No differences were observed between controls and patients with episodic migraine and depression without headache. A transient facilitation was found of trigeminal and somatic nociceptive systems in MOH, which was more pronounced on a supraspinal level.
Cephalalgia 10/2006; 26(9):1106-14. · 3.43 Impact Factor
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ABSTRACT: The aim of this research was to study the prevalence of chronic headache (CH) and associated socio-cultural factors in Turkish immigrants and native Germans. Five hundred and twenty-three Turkish and German company employees were screened using a standard questionnaire. Those who suffered from headaches were also examined by a neurologist. Complete data were available for 471 (90%) subjects. Thirty-four participants (7.2%) had CH. Two independent factors for association with CH could be identified: overuse of acute headache medication (OR = 72.5; 95% CI 25.9-202.9), and being a first-generation Turkish immigrant compared with native Germans (OR = 4.4; 95% CI 1.4-13.7). In contrast, the factor associated with chronic headache was not increased in second-generation Turkish immigrants. Medication overuse was significantly more frequent in first-generation Turkish immigrants (21.6%) compared with second-generation Turkish immigrants (3.3%) and native Germans (3.6%; chi(2) = 38.0, P < 0.001). First-generation Turkish immigrants did not contact headache specialists at all, compared with 2.8% of second-generation Turkish immigrants and 8.8% of native Germans (chi(2) = 118.4, P < 0.001). Likewise no first-generation Turkish immigrant suffering from CH received headache preventive treatment, compared with 6.6% of native Germans (chi(2) = 19.1, P = 0.014). The data from this cross-sectional study reveal a high prevalence of chronic headache as well as a very low utilization of adequate medical care in first-generation Turkish immigrants in Germany.
Cephalalgia 10/2006; 26(10):1177-81. · 3.43 Impact Factor
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Cephalalgia 07/2006; 26(6):763-6. · 3.43 Impact Factor
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ABSTRACT: The prevalence of migraine in Germany is up to 14% in the female and up to 8% in the male population and peaks between the age of 35 and 45. Few studies have investigated the productivity loss and resulting costs attributable to migraine in Germany or addressed the question whether these costs can be reduced by optimal treatment. In recent years, 5-HT(1B/D) agonists (so-called triptans), a generation of drugs highly specific for migraine treatment, have been introduced. Seven 5-HT(1B/D) agonists have been approved in Germany with more than 20 dosage forms. We present a model that enables employers to estimate the annual cost of migraine and the annual cost that could be saved by treatment of migraine with rizatriptan compared with the use of non-specific antimigraine medication. A representative German company with 10,000 employees is used for the reference case analysis. This company is predicted to have 580 female and 284 male employees with migraine. These employees are estimated to lose 6992 workdays or 31.8 person years of productive effort annually due to migraine, valued approximately 1,431,719 euros. The value of work loss that could be avoided by treating migraine with rizatriptan is estimated at 619,094 euros annually. These data indicate that costs arising from lost productivity can be reduced by treating migraine headaches with a triptan.
International Journal of Clinical Practice 04/2006; 60(3):295-9. · 2.41 Impact Factor
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ABSTRACT: This study examined the efficacy of lamotrigine in the prevention of migraine aura. Fifty nine patients suffering from migraine with aura received lamotrigine in a controlled three year prospective open study. Treatment response was defined as a reduction of aura frequency each month by at least 50%. Primary endpoint was reached by three quarters of the patients. Lamotrigine significantly reduced both frequency of migraine aura (mean, 1.5 (SD, 0.6) each month before v 0.4 (0.7) after treatment; p < 0.001) and aura duration (mean, 27 (SD, 11) minutes before v 8 (14) after treatment; p < 0.001). Furthermore, more than three quarters of those patients with a reduction of aura symptoms experienced a significant reduction of frequency of migraine attacks (mean, 2.1 (SD, 1.0) each month before v 1.2 (1.1) after treatment; p < 0.001). Lamotrigine was highly effective in reducing migraine aura and migraine attacks. The strong correlation between reduction of aura symptoms and migraine attacks stresses the potential role of aura-like events and possibly cortical spreading depression as a trigger for trigeminal vascular activation, and subsequently the development of migraine headaches.
Journal of Neurology Neurosurgery & Psychiatry 12/2005; 76(12):1730-2. · 4.76 Impact Factor
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ABSTRACT: With more than 8 million sufferers in Germany alone, migraine is one of the most frequent medical disorders. Recent discoveries in the pathophysiology and genetics of headaches, as well as specific developments in pharmacology, have paved the way for a significant improvement in both acute migraine treatment and migraine prevention. Within the group of 5-HT(1B/D)-agonists (triptans), seven substances with 23 dosages and formulations have been approved in Germany that allow the customized treatment of migraine attacks. In addition, several new drugs such as valproic acid or topiramate are now available as drugs of first choice for migraine prevention, as well as the well established beta blockers, thus enabling the physician to tailor the preventative treatment according to the individual needs of the patient.
Der Internist 11/2005; 46(10):1087-95. · 0.30 Impact Factor
