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Donald W Lewis

Publications and source records attributed to Donald W Lewis.

17 recordsLinked to original sources
PubMed2006

The pharmacological treatment options for pediatric migraine: an evidence-based appraisal.

The treatment of children and adolescents who suffer from migraine headaches must be individually tailored, flexible, and balanced with a blend of bio-behavioral measures, agents for acute treatment and, if needed, daily preventive medicines. While controlled data is limited, there is now enough evidence available to provide a rational framework to build treatment plans appropriate for the pediatric population. Essentially, the pharmacological management of pediatric migraine divides into agents for the acute attacks and agents used daily to prevent or reduce the frequency of attacks. For the acute treatment, the most rigorously studied agents are ibuprofen, acetaminophen, and the nasal spray forms of sumatriptan and zolmitriptan, all of which have shown both safety and efficacy in controlled trials. For preventive treatment the calcium channel blocker flunarezine has the best efficacy profile in controlled trials, but is not available in the U.S. A growing body of data, mostly uncontrolled, is emerging regarding the use of several anti-epileptic agents (e.g. topiramate, disodium valproate, levateracetam), as well as the antihistamine cyproheptadine and the anti-depressant amitriptyline.

Adolescent↗
PubMed2005

New practice parameters: what does the evidence say?

The American Academy of Neurology recently has published two practice parameters pertaining to children and adolescents with headache. The first focuses attention on the appropriate evaluation of the child with recurrent headache and reviews the data regarding laboratory investigation, electroencephalography (EEG), and neuroimaging. Routine laboratory investigation and EEG are not recommended. Neuroimaging is not recommended for children with recurring headaches and a normal neurologic examination unless there are historic features to suggest the recent onset of severe headache, change in the type of headache, or associated features that suggest neurologic dysfunction. If there are abnormalities on the neurologic examination (eg, focal findings, signs of increased intracranial pressure, significant alteration of consciousness) or the coexistence of seizures, then neuroimaging is recommended. The second parameter evaluates relevant data regarding the acute and preventive therapies for pediatric migraine.

Adolescent↗
PubMed2005

The "other" primary headaches in children and adolescents.

Headache represents one of the most common reasons why children and adolescents are referred to pediatric neurology practices where the most common headache syndromes diagnosed are migraine and its variants, and chronic daily headache. The bulk of recent literature regarding headache in children has focused on these two clinical entities even though large epidemiologic studies have demonstrated that tension-type headache may be two to three times more common in children. Why has so little attention been given to these other disorders? The purpose of this review is to examine the "other" primary headache disorders in children and adolescents.

Adolescent↗
PubMed2005

Intensity of quartz-tungsten-halogen light-curing units used in private practice in Toronto.

BACKGROUND: The authors conducted a study to determine light intensity and heat/glare measurements of quartztungsten-halogen (QTH) light polymerization units used in dental offices. METHODS: Research assistants visited 100 dental offices and assessed 214 QTH light units. They recorded each unit's model, age, service history, light intensity and heat/glare emissions. RESULTS: Mean light intensity was 526 milliwatts per square centimeter (120-1,000 mW/cm2), with 26 units having intensity less than 300 mW/cm2. The mean light unit age was 5.6 years. Light units older than three years had significantly lower output intensities than those that were one, two or three years old. The authors found a wide range of heat/glare measurements (3-300 mW/cm2), with 4.6 percent of the units having values greater than 50 mW/cm2, including three with values of more than 200 mW/cm2. The mean light intensity of units serviced in the preceding year was 539 mW/cm2; it was 418 mW/cm2 for units serviced from one to six years previously. CONCLUSIONS: Light intensity and heat/glare values varied among the 214 units; some units had values well outside the recommended levels. Each unit's age and service history significantly affected its intensity. An awareness campaign is needed to promote testing, repair or replacement of light polymerization units. Periodic testing of light polymerization units should be considered by regulatory bodies to ensure optimum quality of composite restorations. CLINICAL IMPLICATIONS: Light polymerization units in some private dental offices in Toronto had intensities that may result in composites restorations with inferior properties. Dentists need to regularly monitor the intensity of the light polymerization units and maintain the units to ensure quality composite restorations.

Analysis of Variance↗
PubMed2005

The treatment of pediatric migraine.

The management of pediatric migraine requires a balance of biobehavioral measures coupled with agents for acute treatment and, if needed, daily preventive medicines. A recent American Academy of Neurology practice parameter has critically reviewed the limited data regarding the efficacy and safety of medicines for the acute and preventive therapy of pediatric migraine. The first step is to establish the headache frequency and degree to which the migraines impact upon lifestyle and performance. The next step is to institute nonpharmacologic measures such as regulation of sleep (improved sleep hygiene), moderation of caffeine, regular exercise, and identification of provocative influences (eg, stress, foods, social pressures). A wide variety of therapeutic options exist for patients whose migraine headaches occur with sufficient frequency and severity to produce functional impairment. The most rigorously studied agents for the acute treatment of migraine are ibuprofen, acetaminophen, and sumatriptan nasal spray, all of which have shown safety and efficacy in controlled trials. Daily preventive drug therapies are warranted in about 20% to 30% of young migraine sufferers. The particular drug selected for the individual patient requires an appreciation of comorbidities such as affective or anxiety disorders, co-existent medical conditions such as asthma or diabetes, and acceptability of potential toxicities such as weight gain, sedation, or tremor.

Adrenergic beta-Antagonists↗
PubMed2005

The migraine variants.

The migraine variants are unique to pediatrics and are a fascinating and challenging group of disorders characterized by the onset of focal neurological signs and symptoms such as hemiparesis, altered consciousness nystagmus, or ophthalmoparesis followed by headache. Because all of the diagnoses discussed represent diagnoses of exclusion, only after a careful medical history, a physical examination, and appropriate neurodiagnostic studies can they be entertained comfortably. Often, these ominous neurological signs initially lead the clinician in the direction of epileptic, cerebrovascular, traumatic, or metabolic disorders, and only after thorough neurodiagnostic testing does the diagnosis become apparent. Some of these entities occur in infants and young children in which the medical history is limited.

Child↗
PubMed2005

Efficacy of halogen photopolymerization units in private dental offices in Toronto.

PURPOSE: Light units used for polymerization of resin composites are subject to deterioration with age, and frequent maintenance is required to maintain optimal efficacy. This study examined the efficacy of quartz-tungsten-halogen light units in private dental offices in Toronto for polymerization of resin composites. MATERIALS AND METHODS: One hundred dental offices met all selection criteria and agreed to participate in the study. The light intensity was determined for a total of 214 light units. Disk-shaped specimens, 2.5 mm thick, were made from 2 resin composites (Charisma, Heraeus Kulzer; Point 4, Kerr Corp) and were subjected to photopolymerization: Charisma for 20 seconds (99 units) and Point 4 for 20 and 40 seconds (all 214 units). Knoop hardness values for the upper and lower surfaces of each specimen were determined, and relative hardness values (hardness of lower surface/hardness of upper surface x 100) were calculated. Data were analyzed using descriptive statistics, t-tests, 1-way analysis of variance, and simple and multiple linear regression (a = 0.05). RESULTS: The light intensity of the individual units varied widely, from 120 to 1,000 mW/cm2. Surface hardness and relative hardness were significantly (p < 0.05) and positively associated with light intensity, and wide ranges in surface hardness and relative hardness values were observed. Mean relative hardness ranged from 34.8% to 57.7%. CONCLUSIONS: Light polymerization units in private dental offices displayed a wide range in light intensity, and many had below-recommended levels. Of the resin composite specimens polymerized for 40 seconds with each of the 214 light units, only 10% reached the desired relative hardness of at least 80%. A positive linear relationship was found between light intensity and relative hardness. Increased exposure time resulted in a significant increase in relative hardness. Also, relative hardness was found to be dependent on the brand of composite material used. Dentists should regularly monitor the condition of light units and replace deteriorating parts.

Analysis of Variance↗
PubMed2004

Topiramate for migraine prevention: a randomized controlled trial.

CONTEXT: Small open-label and controlled trials suggest that the antiepileptic drug topiramate is effective for migraine prevention. OBJECTIVE: To assess the efficacy and safety of topiramate for migraine prevention in a large controlled trial. DESIGN, SETTING, AND PATIENTS: A 26-week, randomized, double-blind, placebo-controlled study was conducted during outpatient treatment at 52 North American clinical centers. Patients were aged 12 to 65 years and had a 6-month history of migraine (International Headache Society criteria) and 3 to 12 migraines a month but no more than 15 headache days a month during a 28-day prospective baseline phase. INTERVENTIONS: After a washout period, patients meeting entry criteria were randomized to topiramate (50, 100, or 200 mg/d) or placebo. Topiramate was titrated by 25 mg/wk for 8 weeks to the assigned or maximum tolerated dose, whichever was less. Patients continued receiving that dose for 18 weeks. MAIN OUTCOME MEASURES: The primary efficacy measure was change from baseline in mean monthly migraine frequency. Secondary efficacy measures included responder rate (proportion of patients with > or =50% reduction in monthly migraine frequency), reductions in mean number of monthly migraine days, severity, duration, and days a month requiring rescue medication, and adverse events. The month of onset of preventive treatment action was assessed. RESULTS: Of 483 patients randomized, 468 provided at least 1 postbaseline efficacy assessment and comprised the intent-to-treat population. Mean monthly migraine frequency decreased significantly for patients receiving topiramate at 100 mg/d (-2.1, P =.008) and topiramate at 200 mg/d (-2.4, P<.001) vs placebo (-1.1). Statistically significant reductions (P<.05) occurred within the first month with topiramate at 100 and 200 mg/d. The responder rate was significantly greater with topiramate at 50 mg/d (39%, P =.01), 100 mg/d (49%, P<.001), and 200 mg/d (47%, P<.001) vs placebo (23%). Reductions in migraine days were significant for the 100-mg/d (P =.003) and 200-mg/d (P<.001) topiramate groups. Rescue medication use was reduced in the 100-mg/d (P =.01) and 200-mg/d (P =.005) topiramate groups. Adverse events resulting in discontinuation in the topiramate groups included paresthesia, fatigue, and nausea. CONCLUSION: Topiramate showed significant efficacy in migraine prevention within the first month of treatment, an effect maintained for the duration of the double-blind phase.

Adolescent↗
PubMed2004

Toward the definition of childhood migraine.

PURPOSE OF REVIEW: The intent of this review is to provide an update on the current understanding of the diagnostic criteria, classification, pathophysiology, evaluation, and management of pediatric migraine. RECENT FINDINGS: The International Headache Society has recently revised its diagnostic criteria and classification system in the 2004 International Criteria for Headache Disorders. These new criteria have incorporated many developmentally sensitive changes that will allow broader application in children and adolescents. Appreciation of the new classification system requires understanding of current views of the pathophysiology of migraine. Migraine is now viewed as an inherited disorder with a primary neuronal initiation of a cascade of neurochemical processes culminating in a spreading wave of cortical neuronal depolarization and regional oligemia. The evaluation of a child with headache begins with a thorough medical history and complete physical and neurologic examination. One of the key questions for the bedside clinician is when to perform further diagnostic studies. Extensive review concludes that the role of further ancillary diagnostic studies, specifically EEG and neuroimaging, is limited. The management of pediatric migraine requires a balance of biobehavioral measures coupled with agents for acute treatment and, if needed, daily preventive medicines. The pharmacologic management of pediatric migraine has been subjected to thorough review, and controlled data unfortunately are limited. The most rigorously studied agents for the acute treatment of migraine are ibuprofen, acetaminophen, and sumatriptan nasal spray, all of which have shown safety and efficacy in controlled trials. For preventive or prophylactic treatment in the population of children and adolescents with frequent, disabling migraine, flunarizine (not available in the United States) is the most efficacious agent, but encouraging data are emerging regarding the use of several antiepileptic agents such as topiramate, disodium valproate, levetiracetam, the antihistamine cyproheptadine, and the antidepressant amitriptyline. SUMMARY: Recent literature has reshaped the definition, evaluation, and management of pediatric migraine.

Adolescent↗
PubMed2004

Prophylactic treatment of pediatric migraine.

BACKGROUND: Migraine occurs in 3% to 5% of young children and up to 18% of adolescents. Management requires a tailored regimen of pharmacological and behavioral measures that consider the headache burden and disability. Patients with frequent or disabling attacks (or both) may warrant preventive agents. OBJECTIVE: To investigate the patterns of prophylactic treatment of pediatric migraine within one pediatric neurology practice. METHODS: All charts of patients diagnosed with headache (International Classification of Diseases [ICD] code 784.0) and migraine (codes 346.0, 346.1, and 346.2) during January 2001 July 2001 were retrospectively reviewed to identify diagnosis, demographics, medical decision making, rationale for treatment selections, and outcome assessments. Migraine was diagnosed according to the 1997 proposed pediatric migraine revisions to the International Headache Society. RESULTS: Charts of 250 children and adolescents, aged 3.2 to 18 years (mean, 12), were reviewed. One hundred twenty-six (50%) were prescribed prophylaxis, along with intermittent analgesic agents. Mean age of those provided with daily prophylaxis was 12.4 years (range, 3.9 to 18), and the mean age of those managed with intermittent therapies was 11.5 years. Preventive agents included amitriptyline (n = 73), cyproheptadine (n = 30), propranolol (n = 8), valproic acid (n = 3), naproxen (n = 3), nimodipine (n = 3), imipramine (n = 3), and topiramate (n = 3). Amitriptyline was the most commonly prescribed agent (58%). Ten patients initially treated with other agents were changed to amitriptyline. Fifteen patients required dosing adjustments, 2 stopped treatment, and 7 changed to other agents for lack of efficacy. Mean headache frequency before treatment was 10.9 per month (range, 4 to 15). After treatment, the mean headache frequency decreased to 4.1 per month (range, 0 to 12), a decrease of 62.4% (n = 54). The overall positive response rate was 89%. Cyproheptadine was the second most commonly prescribed agent (mean age, 8.8 years). Thirty patients were initially treated, 5 later changed to cyproheptadine, 6 required dosage changes, 5 changed to other agents for lack of efficacy, and 1 stopped treatment. Mean headache frequency before treatment was 8.4 per month (range, 4 to 15) and following treatment decreased to 3.75 per month (range, 0 to 12), a decrease of 55.3%. The overall positive response rate was 83%. CONCLUSIONS: Fifty percent of patients with migraine were prescribed daily prophylactic medicines, reflecting a referral bias. The most commonly prescribed agents were amitriptyline (preferred for the older patients) and cyproheptadine (preferred for the younger patients). The overall positive response rates were 89% for amitriptyline and 83% for cyproheptadine during a 6-month follow-up. Headache frequencies were reduced with amitriptyline by 62% and with cyproheptadine by 55%. Long-term follow-up of this population is ongoing, and prospective studies are needed.

Adolescent↗
PubMed2003

Familial neck-tongue syndrome.

Neck-tongue syndrome is an uncommon clinical entity characterized by brief attacks of intense unilateral stabbing pain in the upper neck or occipital region upon sudden rotation of the head, accompanied by ipsilateral numbness of the tongue. Eight patients, 5 teenagers and 3 adults, with neck-tongue syndrome are presented. Each of the 5 adolescents had normal examinations and normal neuroimaging. The 3 adults were parents of the affected children and had experienced transient symptoms during their adolescence suggesting an autosomal dominant inheritance pattern.

Adolescent↗
PubMed2002

Headaches in children and adolescents.

Headaches are common during childhood and become more common and increase in frequency during adolescence. The rational, cost-effective evaluation of children with headache begins with a careful history. The first step is to identify the temporal pattern of the headache--acute, acute-recurrent, chronic-progressive, chronic-nonprogressive, or mixed. The next step is a physical and neurologic examination focusing on the optic disc, eye movements, motor asymmetry, coordination, and reflexes. Neuroimaging is not routinely warranted in the evaluation of childhood headache and should be reserved for use in children with chronic-progressive patterns or abnormalities on neurologic examination. Once the headache diagnosis is established, management must be based on the frequency and severity of headache and the impact on the patient's lifestyle. Treatment of childhood migraine includes the intermittent use of oral analgesics and antiemetics and, occasionally, daily prophylactic agents. Often, the most important therapeutic intervention is confident reassurance about the absence of serious underlying neurologic disease.

Adolescent↗
PubMed2002

Children's ibuprofen suspension for the acute treatment of pediatric migraine.

OBJECTIVE: To compare the efficacy of a single over-the-counter dose (7.5 mg/kg, p.o.) of children's ibuprofen suspension vs. placebo for the acute treatment of pediatric migraine. BACKGROUND: Migraine occurs in 4% of young children. There is a paucity of controlled clinical research in the treatment of childhood migraine and there are currently no approved drugs in the USA for treatment of migraine in children < or = 12 years of age. The purpose of this study is to assess the efficacy and tolerability of a single OTC dose of ibuprofen suspension for the acute treatment of childhood migraine. METHODS: Prospective, double-blind, placebo-controlled, parallel group, randomized study of children 6-12 yrs with migraine (I.H.S.-R 1997) treating 1 attack with a 7.5 mg/kg liq. ibuprofen vs matching placebo. Efficacy measures: (1). Headache severity based upon a 4 pt scale (severe, mod., mild, no headache) at 30, 60, 90, 120, 180 and 240 minutes post dose, and (2). nausea, vomiting, and photo/phonophobia at 120 min. The 1 degrees endpoint was cumulative % of responders (severe or mod. headache reduced to mild or none) by 120 minutes. Secondary endpoints were headache recurrence within 4-24 hours and need for rescue medicines within 4 hours. RESULTS: 138 enrolled; 84 treated/completed diary. 45 active agent, 39 placebo. The 2 groups were comparable (active: placebo) - Ages: 9: 9.1, gender boy/girl - 1.25: 1.6, and diagnosis: migraine w/o aura - 86%: 79%. Concomitant use of prophylactic Rx: 24%: 10% (Table 3). Nausea was eliminated in 60% of the ibuprofen treated patients and 39% of the placebo group (p<0.001). Vomiting, photophobia and phonophobia had marginal, but not statistically significant, decreases at 2 hours. A striking gender difference was noted (Table 4): No AE's were reported. CONCLUSION: Children's ibuprofen suspension at an OTC dose of 7.5 mg/kg is an effective and well-tolerated agent for pain relief in the acute treatment of childhood migraine, particularly in boys. There is a striking difference in gender response rates and placebo responder rates between girls and boys. The boys responded at a statistically significant rate, and girls failed to do so because of a very high placebo responder rate. Multi-center trials are recommended.

Acute Disease↗
PubMed2002

Treatment of paediatric headache.

Headaches are very common during childhood and become increasingly frequent during adolescence. The diagnosis of primary headache disorders (e.g., migraine and tension-type headache) rests principally on clinical criteria as set forth by the International Headache Society. Treatment options include acute or episodic measures, prophylactic agents and non-pharmacological or behavioural interventions. From review of available evidence, the most efficacious acute treatments of paediatric migraine include the non-steroidal anti-inflammatory agent ibuprofen at 7.5 - 10 mg/kg/dose or nasal sumatriptan at doses of 5 or 20 mg. For those patients with headaches that occur with sufficient frequency and severity to warrant daily prophylaxis, controlled data are limited. Agents which are likely to be beneficial include amitriptyline, flunarizine (not available in the US) and cyproheptadine. Clinical experience with the anti-epileptic agents topiramate and valproate suggests an expanding role for the prevention of paediatric migraine in the future.

Adolescent↗
PubMed2002

Migraine headaches in the adolescent.

Migraine headaches are common in adolescents. Characterized by recurring attacks of intense, pounding, and nauseating frontal or temporal head pain, migraine headaches are a significant contributor to school absences and lost productivity during the adolescent years and beyond. A systematic management program can be instituted to minimize these deleterious effects. The first step is to establish the diagnosis and reassure the patient that there is no serious underlying cause such as a brain tumor. The next step involves identification of lifestyle contributors followed by appropriate modification of sleep, activity, stress, diet, and other provocative influences, often with behavioral therapies. There is a vast, new pharmacologic armamentarium for the acute and preventative management of migraine. The choices depend on the headache burden: the individual patient's pattern, frequency, intensity, disability, and pain tolerance. This chapter reviews the phenomena of adolescent migraine with emphasis on office management.

Adolescent↗