Kathleen B Digre

University of Utah, Salt Lake City, Utah, United States

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Publications (102)392.76 Total impact

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    ABSTRACT: Purpose: Benign essential blepharospasm (BEB) generally is considered a disorder of adults; however, it rarely can present in childhood or adolescence. The main purpose of this study was to determine the prevalence of BEB in children and adolescents. Our research question was whether blepharospasm is seen in children or adolescents as well as in the adult population. Methods: We conducted a retrospective chart review at the University of Utah and Johns Hopkins University. We reviewed our databases for diagnoses of blepharospasm and tic disorder over the past 10 years in patients of all ages. Charts then were reviewed to confirm the diagnosis, and a questionnaire was sent to subjects whose blepharospasm had apparently begun before age 20 years. Results: We identified 26 patients diagnosed with eyelid spasms that had begun while under the age of 20. We confirmed BEB in four of these cases. Of these individuals, all had developed symptoms in adolescence or before and all were still symptomatic but had noted improvement in the severity and frequency of their symptoms. Conclusions: Although rare, BEB can develop in the first decade of life, producing symptoms and signs that are similar to adults, with persistence into adulthood.
    Child s Nervous System 10/2015; DOI:10.1007/s00381-015-2938-5 · 1.11 Impact Factor

  • Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 06/2015; 35(3). DOI:10.1097/WNO.0000000000000265 · 1.95 Impact Factor
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    ABSTRACT: The study purpose was to examine vision-specific and overall health-related quality of life (QOL) at baseline in Idiopathic Intracranial Hypertension Treatment Trial patients who were newly diagnosed and had mild visual loss. We also sought to determine the associations between vision-specific QOL scores and visual symptoms, visual function, pain, headache-related disability, and obesity. We assessed QOL using the 36-Item Short Form Health Survey, National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), and 10-Item NEI-VFQ-25 Neuro-Ophthalmic Supplement. We compared these results with those of previously reported idiopathic intracranial hypertension (IIH) QOL studies. We assessed relationships between QOL and other clinical characteristics. Among 165 participants with IIH (161 women and 4 men with a mean age ± SD of 29.2 ± 7.5 years), vision-specific QOL scores were reduced compared with published values for disease-free controls. Scores of participants were comparable to published results for patients with multiple sclerosis and a history of optic neuritis. A multiple linear regression model for the NEI-VFQ-25 composite score found that perimetric mean deviation in the best eye, visual acuity in the worst eye, visual symptoms, and pain symptoms (headache, neck pain), but not obesity, were independently associated with QOL. IIH affects QOL at time of diagnosis even in patients with mild visual impairment. Vision-specific QOL in patients with newly diagnosed IIH may be as decreased as that for patients with other neuro-ophthalmic disorders. IIH treatment should target visual loss and other symptoms of increased intracranial pressure associated with reduced QOL. Reduced QOL does not simply reflect obesity, an underlying IIH risk factor. © 2015 American Academy of Neurology.
    Neurology 05/2015; 84(24). DOI:10.1212/WNL.0000000000001687 · 8.29 Impact Factor
  • Kathleen B Digre ·

    Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 05/2015; 35(2). DOI:10.1097/WNO.0000000000000257 · 1.95 Impact Factor
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    ABSTRACT: Background We used in vivo corneal confocal microscopy to investigate structural differences in the sub-basal corneal nerve plexus in chronic migraine patients and a normal population. We used a validated questionnaire and tests of lacrimal function to determine the prevalence of dry eye in the same group of chronic migraine patients. Activation of the trigeminal system is involved in migraine. Corneal nociceptive sensation is mediated by trigeminal axons that synapse in the gasserian ganglion and the brainstem, and serve nociceptive, protective, and trophic functions. Noninvasive imaging of the corneal sub-basal nerve plexus is possible with in vivo corneal confocal microscopy.Methods For this case–control study, we recruited chronic migraine patients and compared them with a sex- and age-similar group of control subjects. Patients with peripheral neuropathy, a disease known to be associated with a peripheral neuropathy, or prior corneal or intraocular surgery were excluded. Participants underwent in vivo corneal confocal microscopy using a Heidelberg Retinal Tomography III confocal microscope with a Rostock Cornea Module. Nerve fiber length, nerve branch density, nerve fiber density, and tortuosity coefficient were measured using established methodologies. Migraine participants underwent testing of basal tear production with proparacaine, corneal sensitivity assessment with a cotton-tip applicator, measurement of tear break-up time, and completion of a validated dry eye questionnaire.ResultsA total of 19 chronic migraine patients and 30 control participants completed the study. There were no significant differences in age or sex. Nerve fiber density was significantly lower in migraine patients compared with controls (48.4 ± 23.5 vs 71.0 ± 15.0 fibers/mm2, P < .001). Nerve fiber length was decreased in the chronic migraine group compared with the control group, but this difference was not statistically significant (21.5 ± 11.8 vs 26.8 ± 5.9 mm/mm2, P < .084). Nerve branch density was similar in the two groups (114.0 ± 92.4 vs 118.1 ± 55.9 branches/mm2, P < .864). Tortuosity coefficient and log tortuosity coefficient also were similar in the chronic migraine and control groups. All migraine subjects had symptoms consistent with a diagnosis of dry eye syndrome.Conclusions We found that in the sample used in this study, the presence of structural changes in nociceptive corneal axons lends further support to the hypothesis that the trigeminal system plays a critical role in the pathogenesis of migraine. In vivo corneal confocal microscopy holds promise as a biomarker for future migraine research as well as for studies examining alterations of corneal innervation. Dry eye symptoms appear to be extremely prevalent in this population. The interrelationships between migraine, corneal nerve architecture, and dry eye will be the subject of future investigations.
    Headache The Journal of Head and Face Pain 04/2015; 55(4). DOI:10.1111/head.12547 · 2.71 Impact Factor
  • Kenneth J Mack · Kathleen Digre ·
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    ABSTRACT: The American Migraine Prevalence and Prevention (AMPP) Study, a prospective population-based study of nearly 24,000 adults with headache, has identified individuals with both episodic and chronic migraine, and followed them for multiple years. To date, the AMPP dataset has resulted in nearly 40 publications, several published in Neurology (R). Previous data from this study have shown that each year, 2.5% of episodic migraine cases transform into chronic migraine. It has identified multiple risk factors for the development of chronic migraine, including medication overuse of opiates and barbituates,(1) headache frequency,(2) depression,(3) lower household income,(4) and persistent frequent nausea.(5</SUP)
    Neurology 01/2015; 84(7). DOI:10.1212/WNL.0000000000001273 · 8.29 Impact Factor
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    ABSTRACT: Utah women from some cultural minority groups have higher overweight/obesity rates than the overall population. We utilized a gender-based mixed methods approach to learn about the underlying social, cultural and gender issues that contribute to the increased obesity risk among these women and to inform intervention development. A literature review and analysis of Utah's Behavioral Risk Factor Surveillance System data informed the development of a focus group guide. Focus groups were conducted with five groups of women: African immigrants from Burundi and Rwanda, African Americans, American Indians/Alaskan Natives, Hispanics/Latinas, and Pacific Islanders. Six common themes emerged: (1) health is multidimensional and interventions must address health in this manner; (2) limited resources and time influence health behaviors; (3) norms about healthy weight vary, with certain communities showing more preference to heavier women; (4) women and men have important but different influences on healthy lifestyle practices within households; (5) women have an influential role on the health of families; and (6) opportunities exist within each group to improve health. Seeking insights from these five groups of women helped to identify common and distinct cultural and gender themes related to obesity, which can be used to help elucidate core obesity determinants. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Evaluation and program planning 12/2014; 51. DOI:10.1016/j.evalprogplan.2014.12.003 · 0.89 Impact Factor
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    ABSTRACT: Objective: To characterize a cohort of patients with the signs and symptoms of posterior reversible encephalopathy syndrome (PRES), but with clinical and radiologic involvement of the spinal cord. Methods: We report 2 cases of PRES with spinal cord involvement and identified an additional 6 cases in the Medline database using various search terms related to "spinal PRES," "spinal reversible posterior leukoencephalopathy syndrome," and "spinal hypertensive encephalopathy." We analyzed the clinical and imaging characteristics of the 8 cases. Results: Average age was 31 years, with 5 male and 3 female patients. All patients had severe acute hypertension and a confluent, expansile central spinal cord T2 hyperintensity spanning at least 4 spinal segments, originating at the cervicomedullary junction. Of 8 patients, 7 had hypertensive retinopathy, a favorable clinical course with only antihypertensive treatment, and resolution of the spinal cord lesions on follow-up imaging. A total of 4 of 8 patients had symptoms referable to the spinal cord lesions and only 1 of 8 had a seizure. Conclusion: In light of the already wide definition of PRES, we propose a new syndrome named PRES with spinal cord involvement (PRES-SCI). Clinicians should suspect PRES-SCI when patients with PRES have neurologic signs referable to the spinal cord, extreme elevation in blood pressure, MRI lesions that extend to the cervicomedullary junction, or grade IV hypertensive retinopathy. These clinical scenarios should prompt a cervical spine MRI to help guide patient management decisions and prognostication. When clinicians evaluate longitudinally extensive spinal T2 hyperintensities, they should consider PRES-SCI, which, if diagnosed, would spare patients the morbidity of a standard myelitis workup and empiric treatment.
    Neurology 10/2014; 83(22). DOI:10.1212/WNL.0000000000001026 · 8.29 Impact Factor
  • Kathleen B Digre ·

    Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 09/2014; 34(4). DOI:10.1097/WNO.0000000000000179 · 1.95 Impact Factor
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    Michael Wall · James J Corbett · Deborah I Friedman · Grant T. Liu · Kathleen B. Digre ·

    Neurology 07/2014; 83(2):198-200. DOI:10.1212/01.wnl.0000452039.32455.3e · 8.29 Impact Factor
  • Kathleen B Digre ·

    Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 06/2014; 34(3). DOI:10.1097/WNO.0000000000000142 · 1.95 Impact Factor
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    Neurology 05/2014; 82(19):1752-3. DOI:10.1212/01.wnl.0000449937.36671.08 · 8.29 Impact Factor
  • Deborah I. Friedman · Grant T. Liu · Kathleen B. Digre ·

    Neurology 03/2014; 82(11):1012-1012. · 8.29 Impact Factor
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    ABSTRACT: The pseudotumor cerebri syndrome (PTCS) may be primary (idiopathic intracranial hypertension) or arise from an identifiable secondary cause. Characterization of typical neuroimaging abnormalities, clarification of normal opening pressure in children, and features distinguishing the syndrome of intracranial hypertension without papilledema from intracranial hypertension with papilledema have furthered our understanding of this disorder. We propose updated diagnostic criteria for PTCS to incorporate advances and insights into the disorder realized over the past 10 years.
    Neurology 03/2014; 82(11):1011-2. DOI:10.1212/WNL.0000000000000200 · 8.29 Impact Factor
  • Deborah I Friedman · Grant T Liu · Kathleen B Digre ·

    Neurology 03/2014; 82(11):1012. DOI:10.1212/WNL.0000000000000510 · 8.29 Impact Factor
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    Richard Dasheiff · Deborah I Friedman · Grant T Liu · Kathleen B Digre ·

    Neurology 03/2014; 82(11):1012. DOI:10.1212/01.wnl.0000445497.78083.b9 · 8.29 Impact Factor
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    ABSTRACT: Patients with 'visual snow' report continuous tiny dots in the entire visual field similar to the noise of an analogue television. As they frequently have migraine as a comorbidity with ophthalmological, neurological and radiological studies being normal, they are offered various diagnoses, including persistent migraine aura, post-hallucinogen flashback, or psychogenic disorder. Our aim was to study patients with 'visual snow' to characterize the phenotype. A three-step approach was followed: (i) a chart review of patients referred to us identified 22 patients with 'visual snow'. Fifteen had additional visual symptoms, and 20 patients had comorbid migraine, five with aura; (ii) to identify systematically additional visual symptoms, an internet survey (n = 275) of self-assessed 'visual snow' subjects done by Eye On Vision Foundation was analysed. In two random samples from 235 complete data sets, the same eight additional visual symptoms were present in >33% of patients: palinopsia (trailing and afterimages), entoptic phenomena (floaters, blue field entoptic phenomenon, spontaneous photopsia, self-light of the eye), photophobia, and nyctalopia (impaired night vision); and (iii) a prospective semi-structured telephone interview in a further 142 patients identified 78 (41 female) with confirmed 'visual snow' and normal ophthalmological exams. Of these, 72 had at least three of the additional visual symptoms from step (ii). One-quarter of patients had 'visual snow' as long as they could remember, whereas for the others the mean age of onset was 21 ± 9 years. Thirty-two patients had constant visual symptoms, whereas the remainder experienced either progressive or stepwise worsening. Headache was the most frequent symptom associated with the beginning or a worsening of the visual disturbance (36%), whereas migraine aura (seven patients) and consumption of illicit drugs (five, no hallucinogens) were rare. Migraine (59%), migraine with aura (27%), anxiety and depression were common comorbidities over time. Eight patients had first degree relatives with visual snow. Clinical investigations were not contributory. Only a few treatment trials have been successful in individual patients. Our data suggest that 'visual snow' is a unique visual disturbance clinically distinct from migraine aura that can be disabling for patients. Migraine is a common concomitant although standard migraine treatments are often unhelpful. 'Visual snow' should be considered a distinct disorder and systematic studies of its clinical features, biology and treatment responses need to be commenced to begin to understand what has been an almost completely ignored problem.
    Brain 03/2014; 137(5). DOI:10.1093/brain/awu050 · 9.20 Impact Factor
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    ABSTRACT: : We describe a patient with vision loss from an optic neuropathy caused by Propionibacterium acnes pachymeningitis. The patient's optic neuropathy was stabilized with appropriate antibiotic therapy.
    Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 03/2014; 34(3). DOI:10.1097/WNO.0000000000000101 · 1.95 Impact Factor
  • Kathleen B Digre · Krista Kinard ·
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    ABSTRACT: Purpose of review: This review discusses evaluation and treatment of neuro-ophthalmic disorders in the pregnant patient. Recent findings: Any neuro-ophthalmic abnormality seen in nonpregnant women can be seen in pregnant women. Pregnancy-specific complications (preeclampsia and eclampsia) cause visual symptoms and can affect the entire visual axis. Summary: Appropriate evaluation and examination is important to preserve the health and vision of the mother and prevent complications in the fetus. Evaluation should proceed in the same way for a pregnant patient as it would for a nonpregnant patient, with few exceptions. Treatment decisions may be influenced by stage of pregnancy.
    02/2014; 20(1 Neurology of Pregnancy):162-76. DOI:10.1212/01.CON.0000443843.25686.62
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    ABSTRACT: To evaluate the reproducibility of in vivo confocal microscopy for quantitative corneal nerve analysis in different corneal locations. Corneal confocal microscopy was performed on 10 healthy participants, and the corneal nerve fiber length, corneal nerve fiber density, corneal nerve branch density, and tortuosity coefficient were measured at 5 predetermined locations for only the right eye. Bland-Altman plots, intraclass correlation coefficient (ICC), and coefficient of variation of all 4 corneal nerve measurements were compared between 2 visits and between readers to assess reproducibility. Two technicians performed a masked analysis of images from both visits. Ten participants with a mean age of 31.3 ± 2.8 years were imaged at 2 different time points separated by a mean of 4.3 ± 4.3 weeks. The interobserver agreements were better than the intervisit agreements for all the 4 corneal nerve measurements as evaluated using Bland-Altman plots. The intervisit ICC ranged from 0.13 to 0.45, and the interobserver ICC ranged from 0.55 to 0.94. The differences between observers and the differences between sessions were not statistically different among all the 5 locations (P > 0.1) for each corneal nerve measurement. Single confocal images have poor reliability for any of the 4 corneal nerve measurements, and there is no single location on the cornea that has improved reproducibility. Averaging 5 images, from different locations, improves the reproducibility and is essential for obtaining clinically meaningful data.
    Cornea 08/2013; 32(10). DOI:10.1097/ICO.0b013e31829dd7f8 · 2.04 Impact Factor

Publication Stats

1k Citations
392.76 Total Impact Points


  • 1989-2015
    • University of Utah
      • • Department of Neurology
      • • John Moran Eye Center
      • • Department of Ophthalmology and Visual Sciences
      Salt Lake City, Utah, United States
  • 2004-2014
    • Salt Lake City Community College
      Salt Lake City, Utah, United States
  • 1999
    • Jules Stein Eye Institute
      Maryland, United States
  • 1987-1988
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States