scholarly journals Non-Invasive Neurostimulation Methods for Acute and Preventive Migraine Treatment—A Narrative Review

2021 ◽  
Vol 10 (15) ◽  
pp. 3302
Author(s):  
Stefan Evers
Keyword(s):  
Nerve Stimulation ◽  
Acute Attack ◽  
Narrative Review ◽  
Oral Drug ◽  
Minor Role ◽  
Migraine Treatment ◽  
Controlled Trials ◽  
Non Invasive ◽  
Number Of Patients ◽  
A Minor

Neurostimulation methods have now been studied for more than 20 years in migraine treatment. They can be divided into invasive and non-invasive methods. In this narrative review, the non-invasive methods are presented. The most commonly studied and used methods are vagal nerve stimulation, electric peripheral nerve stimulation, transcranial magnetic stimulation, and transcranial direct current stimulation. Other stimulation techniques, including mechanical stimulation, play only a minor role. Nearly all methods have been studied for acute attack treatment and for the prophylactic treatment of migraine. The evidence of efficacy is poor for most procedures, since no stimulation device is based on consistently positive, blinded, controlled trials with a sufficient number of patients. In addition, most studies on these devices enrolled patients who did not respond sufficiently to oral drug treatment, and so the role of neurostimulation in an average population of migraine patients is unknown. In the future, it is very important to conduct large, properly blinded and controlled trials performed by independent researchers. Otherwise, neurostimulation methods will only play a very minor role in the treatment of migraine.

Evaluating the reporting of adverse events in controlled clinical trials conducted in 2010–2015 on migraine drug treatments

Cephalalgia ◽  
2018 ◽  
Vol 38 (12) ◽  
pp. 1885-1895
Author(s):  
Peer Tfelt-Hansen ◽  
Janus Kaufmann Lindqvist ◽  
Thien Phu Do
Keyword(s):  
Adverse Events ◽  
Randomized Controlled Trials ◽  
International Headache Society ◽  
Controlled Trial ◽  
Migraine Treatment ◽  
Controlled Trials ◽  
Acute Administration ◽  
Drug Trials ◽  
Randomized Controlled ◽  
Number Of Patients

Background In 2008, the International Headache Society published guidelines on the “evaluation and registration of adverse events in clinical drug trials on migraine”. They listed seven recommendations for reporting adverse events in randomized controlled trials on migraine. The present study aimed to evaluate adherence to these recommendations, and based on the results, to recommend improvements. Methods We searched the PubMed/MEDLINE database to identify controlled trials on migraine drugs published from 2010 to 2015. For each trial, we noted whether five of the recommended parameters were presented. In addition, we noted whether adverse events were reported in abstracts. Results We identified 73 trials; 51 studied acutely administered drugs and 22 studied prophylactic drugs for migraine. The number of patients with any adverse events were reported in 74% of acute-administration and 86% of prophylactic drug trials. Only 30 (41%) of the 73 studies reported adverse events with data in the abstracts, and 27 (37%) abstracts did not mention adverse events. Conclusion Adverse events, both frequency and symptoms, should be reported to allow a fair judgement of benefit/tolerability ratio when randomized controlled trials in migraine treatment are published. Clinically significant adverse events should be included in the abstract of every randomized controlled trial in migraine treatment.

scholarly journals Neuromodulation techniques for acute and preventive migraine treatment: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Xavier Moisset ◽  
Bruno Pereira ◽  
Daniel Ciampi de Andrade ◽  
Denys Fontaine ◽  
Michel Lantéri-Minet ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Nerve Stimulation ◽  
Acute Treatment ◽  
Meta Analysis ◽  
Preventive Treatment ◽  
Migraine Treatment ◽  
Controlled Trials ◽  
Electrical Nerve Stimulation ◽  
Randomized Controlled

Abstract Background Several neuromodulation methods exists for migraine treatment. The aim of the present study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) focusing on migraine treatment using neurostimulation methods. Methods We searched Medline and Embase up to July 1, 2020 for RCTs reporting acute or preventive treatment of migraine with either non-invasive or invasive neurostimulation methods. Two researchers independently assessed the eligibility of the retrieved studies and extracted data. Outcomes for the quantitative synthesis were 2 h pain free for acute treatment and headache days per month for preventive treatment. We performed subgroup analyses by treatment (stimulation method and site of application). Estimates were pooled using random-effects meta-analysis. Results Thirty-eight articles were included in the qualitative analysis (7 acute, 31 preventive) and 34 in the quantitative evaluation (6 acute, 28 preventive). Remote electrical neuromodulation (REN) was effective for acute treatment. Data were insufficient to draw conclusions for any other techniques (single studies). Invasive occipital nerve stimulation (ONS) was effective for migraine prevention, with a large effect size but considerable heterogeneity, whereas supra-orbital transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation (PENS), and high-frequency repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) were effective, with small to medium effect sizes. Vagus-nerve stimulation, left prefrontal cortex rTMS, and cathodal transcranial direct current stimulation (tDCS) over the M1 had no significant effect and heterogeneity was high. Conclusion Several neuromodulation methods are of potential interest for migraine management, but the quality of the evidence is very poor. Future large and well-conducted studies are needed and could improve on the present results.

Rationale for electrical parameter determination in external trigeminal nerve stimulation (eTNS) for migraine: A narrative review

Cephalalgia ◽  
2018 ◽  
Vol 39 (6) ◽  
pp. 750-760 ◽  
Author(s):  
Clinton G Lauritsen ◽  
Stephen D Silberstein
Keyword(s):  
Drug Administration ◽  
Trigeminal Nerve ◽  
Nerve Stimulation ◽  
Food And Drug Administration ◽  
Narrative Review ◽  
Migraine Treatment ◽  
Electrical Parameters ◽  
Trigeminal Nerve Stimulation ◽  
Pain Pathways ◽  
Stimulation Of

Background Migraine is a primary headache disorder involving dysregulation of central and peripheral pain pathways. Medical treatment is often limited by drug side effects, comorbidities and poor compliance. This makes neuromodulation an ideal option for migraine treatment. Cefaly® is a transcutaneous electrical neurostimulator designed specifically for migraine treatment. It results in external trigeminal nerve stimulation of the supraorbital and supratrochlear nerves. External trigeminal nerve stimulation is effective for acute and preventive migraine treatment and may result in normalization of dysregulated pain pathways. Objective Our objective was to provide a narrative review of the neuroanatomical and pathophysiological basis of external trigeminal nerve stimulation for migraine treatment and to provide the rationale behind the choice of the electrical parameters used for external trigeminal nerve stimulation. Methods We reviewed external trigeminal nerve stimulation clinical trial publications, basic science neurostimulation literature, publications describing pathophysiological mechanisms in migraine, and documentation used in the application for the Food and Drug Administration approval of external trigeminal nerve stimulation. Results The electrical parameters used for external trigeminal nerve stimulation were chosen to maximize safety and efficacy. Critical parameters include generator characteristics, pulse shape, pulse duration, pulse frequency and session duration and frequency. We explain the rationale behind determination of each parameter. There is evidence of dysregulated central and peripheral pathways in migraine and evidence that external trigeminal nerve stimulation may normalize function of these pathways. Conclusion External trigeminal nerve stimulation is a safe and effective Food and Drug Administration-approved option for the acute and preventive treatment of migraine. The electrical parameters were optimized specifically for external stimulation of the trigeminal nerve to maximum safety, comfort and efficacy.

scholarly journals Neutron attenuation coefficients for non-invasive quantification of wood properties

Holzforschung ◽  
2009 ◽  
Vol 63 (4) ◽  
Author(s):  
David Mannes ◽  
Lidija Josic ◽  
Eberhard Lehmann ◽  
Peter Niemz
Keyword(s):  
Attenuation Coefficient ◽  
Wood Properties ◽  
Neutron Imaging ◽  
Minor Role ◽  
Attenuation Coefficients ◽  
Non Invasive ◽  
Scattering Correction ◽  
Strong Linear Correlation ◽  
A Minor ◽  
Paul Scherrer

Abstract Attenuation coefficients and mass attenuation coefficients of wood were determined theoretically and experimentally for thermal and cold neutrons. Experiments were carried out at the neutron imaging facilities at the Paul Scherrer Institute, Villigen (CH). For the calculation of theoretical attenuation coefficients, only the three main elemental components (carbon, oxygen and hydrogen) were taken into consideration. While hydrogen accounts only for 6% (by wt) of wood, over 90% of the attenuation can be attributed to this element. Nitrogen and other trace elements were estimated to have a negligible impact on the theoretical attenuation coefficient. For the experimental determination of the attenuation coefficients, samples from different European and tropical wood species were tested in order to examine the influence of density and extractives content. Experimental results show a very strong linear correlation between attenuation coefficient and wood density irrespective of the tested species and extractives content that play only a minor role. As neutrons are very susceptible to scattering, it is necessary to apply a scattering correction if a quantitative evaluation is intended.

Release of acetylcholine in the isolated heart

1981 ◽  
Vol 240 (4) ◽  
pp. H431-H440 ◽  
Author(s):  
K. Loffelholz
Keyword(s):  
Nerve Stimulation ◽  
Isolated Heart ◽  
Nerve Fibers ◽  
Neuronal Uptake ◽  
Minor Role ◽  
Release Of Acetylcholine ◽  
High Level ◽  
A Minor ◽  
And Diffusion ◽  
Neuroeffector Junction

This article summarizes methods for studying release of acetylcholine (ACh) in the heart and reviews the literature on release, synthesis, and inactivation of ACh. Cholinergic mechanisms involved in cardiac neuroeffector transmission are, in principle, the same as in ganglia and motor endplates, but their relative functional significance exhibits unique features. First, release of ACh evoked by nerve stimulation is maintained at a high level due to rapid formation of free extracellular choline from phospholipids. Choline derived from ACh hydrolysis plays a minor role in ACh synthesis. The constant efflux of choline allows continuous monitoring of changes in formation and removal of extracellular choline, e.g., by activation of neuronal uptake during nerve stimulation. Second, ACh released from terminal nerve fibers is rapidly washed into the circulation and thereby escapes hydrolysis by cholinesterase activity to a functionally significant extent. Hydrolysis and diffusion appear as equally important mechanisms of transmitter inactivation in the heart. The cardiac neuroeffector junction is not a morphological or functional entity restricted to adjacent pre- and postsynaptic elements.

scholarly journals NON-INVASIVE COMPUTERIZED SYSTEM FOR AUTOMATICALLY INITIATING VAGUS NERVE STIMULATION FOLLOWING PATIENT-SPECIFIC DETECTION OF SEIZURES OR EPILEPTIFORM DISCHARGES

2009 ◽  
Vol 19 (03) ◽  
pp. 157-172 ◽  
Author(s):  
ALI SHOEB ◽  
TRUDY PANG ◽  
JOHN GUTTAG ◽  
STEVEN SCHACHTER
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Patient Specific ◽  
Clinical Test ◽  
Testing Session ◽  
Non Invasive ◽  
Epileptiform Discharges ◽  
Number Of Patients ◽  
Computerized System

Objective: To demonstrate the feasibility of using a computerized system to detect the onset of a seizure and, in response, initiate Vagus nerve stimulation (VNS) in patients with medically refractory epilepsy. Methods: We designed and built a non-invasive, computerized system that automatically initiates VNS following the real-time detection of a pre-identified seizure or epileptiform discharge. The system detects these events through patient-specific analysis of the scalp electroencephalogram (EEG) and electrocardiogram (ECG) signals. Results: We evaluated the performance of the system on 5 patients (A-E). For patients A and B the computerized system initiated VNS in response to seizures; for patients C and D the system initiated VNS in response to epileptiform discharges; and for patient E neither seizures nor epileptiform discharges were observed during the evaluation period. During the 81 hour clinical test of the system on patient A, the computerized system detected 5/5 seizures and initiated VNS within 5 seconds of the appearance of ictal discharges in the EEG; VNS did not seem to alter the electrographic or behavioral characteristics of the seizures in this case. During the same testing session the computerized system initiated false stimulations at the rate of 1 false stimulus every 2.5 hours while the subject was at rest and not ambulating. During the 26 hour clinical test of the system on patient B, the computerized system detected 1/1 seizures and initiated VNS within 16 seconds of the appearance of ictal discharges; VNS did not alter the electrographic duration of the seizure but decreased anxiety and increased awareness during the post-seizure recovery phase. During the same testing session the computerized system did not declare any false detections. Significance: Initiating Vagus nerve stimulation soon after the onset of a seizure may abort or ameliorate seizure symptoms in some patients; unfortunately, a significant number of patients cannot initiate VNS by themselves following the start of a seizure. A system that automatically couples automated detection of seizure onset to initiation of VNS may be helpful for seizure treatment.

The Effect of Path Length and Display Size on Memory for Spatial Information

2012 ◽  
Vol 59 (3) ◽  
pp. 147-152 ◽  
Author(s):  
Katherine Guérard ◽  
Sébastien Tremblay
Keyword(s):  
Path Length ◽  
Potential Role ◽  
Spatial Information ◽  
Recall Performance ◽  
Minor Role ◽  
Length Effect ◽  
Serial Memory ◽  
Fixed Reference ◽  
A Minor

In serial memory for spatial information, some studies showed that recall performance suffers when the distance between successive locations increases relatively to the size of the display in which they are presented (the path length effect; e.g., Parmentier et al., 2005) but not when distance is increased by enlarging the size of the display (e.g., Smyth & Scholey, 1994). In the present study, we examined the effect of varying the absolute and relative distance between to-be-remembered items on memory for spatial information. We manipulated path length using small (15″) and large (64″) screens within the same design. In two experiments, we showed that distance was disruptive mainly when it is varied relatively to a fixed reference frame, though increasing the size of the display also had a small deleterious effect on recall. The insertion of a retention interval did not influence these effects, suggesting that rehearsal plays a minor role in mediating the effects of distance on serial spatial memory. We discuss the potential role of perceptual organization in light of the pattern of results.

Use of Different Tissue Thromboplastins in the Control of Anticoagulant-Therapy

1958 ◽  
Vol 02 (05/06) ◽  
pp. 462-480 ◽  
Author(s):  
Marc Verstraete ◽  
Patricia A. Clark ◽  
Irving S. Wright
Keyword(s):  
Prothrombin Time ◽  
Anticoagulant Therapy ◽  
Factor Vii ◽  
Rabbit Brain ◽  
Minor Role ◽  
Rabbit Lung ◽  
Coagulation Mechanism ◽  
Time Test ◽  
The One ◽  
A Minor

SummaryAn analysis of the results of prothrombin time tests with different types of thromboplastins sheds some light on the problem why the administration of coumarin is difficult to standardize in different centers. Our present ideas on the subject, based on experimental data may be summarized as follows.Several factors of the clotting mechanism are influenced by coumarin derivatives. The action of some of these factors is by-passed in the 1-stage prothrombin time test. The decrease of the prothrombin and factor VII levels may be evaluated in the 1-stage prothrombin time determination (Quick-test). The prolongation of the prothrombin times are, however, predominantly due to the decrease of factor VII activity, the prothrombin content remaining around 50 per cent of normal during an adequate anticoagulant therapy. It is unlikely that this degree of depression of prothrombin is of major significance in interfering with the coagulation mechanism in the protection against thromboembolism. It may, however, play a minor role, which has yet to be evaluated quantitatively. An exact evaluation of factor VII is, therefore, important for the guidance of anticoagulant therapy and the method of choice is the one which is most sensitive to changes in factor VII concentration. The 1-stage prothrombin time test with a rabbit lung thromboplastin seems the most suitable method because rabbit brain preparations exhibit a factor VII-like activity that is not present in rabbit lung preparations.

Produktivkraft als Versprechen

2016 ◽  
Vol 46 (185) ◽  
pp. 621-638 ◽  
Author(s):  
Christian Siefkes
Keyword(s):  
Private Consumption ◽  
Minor Role ◽  
Progressive Reduction ◽  
Internal Forces ◽  
A Minor

The ‘Fragment on Machines’ from Marx’s Grundrisse is often cited as an argument that the internal forces of capitalism will lead to its doom. But the argument that the progressive reduction of labor must doom capitalism lacks a proper foundation, as a comparison with the ‘Schemes of Reproduction’ given in Capital II shows. The latter, however, aren’t fully convincing either. In reality, more depends on the private consumption of capitalists than either model recognizes. Ultimately, most can be made of the ‘Fragment on Machines’ by reading it not as an exposure of capitalism’s internal contractions, but as a discussion of a possible communist future where labor (or work) will play but a minor role.

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