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Biomedical subjects

W D Gerber

Publications and source records attributed to W D Gerber.

At least 37 records · Page 2Linked to original sources
PubMed1999

Reliability of infrared plethysmography in BVP biofeedback therapy and the relevance for clinical application.

Biofeedback methods are well established as behavioral techniques for the therapy of various psychophysiological diseases. The forms of feedback generally employed are muscle activity (electromyogram), skin temperature, brain activity (electroencephalogram), and vasomotoricity. The latter technique, which employs plethysmographic feedback, has been studied most extensively in the therapy of migraine (vasoconstriction training, blood volume pulse training). Although the clinical efficacy has been demonstrated in several studies, little is known about the psychometric properties of this technique. This study examined the intrasession and intersession reliability of the pulse volume amplitude (PVA). The results showed that the PVA measurements within a single biofeedback session were highly reliable. Repositioning of the probe within the session resulted in a lower correlation coefficient, but one that was still sizable and significant. The PVA values from different sessions were not reliable (or comparable).

Adult↗
PubMed1999

Slow cortical potentials in migraine: a comparison of adults and children.

Amplitudes of contingent negative variation (CNV) in 40 migraine patients were studied during the pain-free period and compared with healthy controls (n = 24). The early component (initial CNV) is especially more negative in migraine patients. Within the migraine group, 14 children with migraine without aura (mean age 13.6 years) were compared with 11 healthy children (mean age 12.4 years). Migraine children differ from healthy children in the same manner that adult migraine patients differ from healthy adults. The CNV of five healthy children did not differ from the CNV of their siblings suffering from migraine. We suggest that there is a family-related cortical hypersensitivity which does not necessarily lead to the development of migraine.

Adolescent↗
PubMed1998

[Sleeping behavior and migraine. An evaluation by daily self-reports].

PROBLEM: Regarding the coherence of sleeping behavior and the occurrence of migraine attacks, we conducted a study based on migraine and sleeping diaries. METHODS: Besides the daily recording of times of falling asleep and waking up, duration of sleep, sleep disruption and quality of sleep, clinical migraine parameters like occurrence of migraine attacks, headache intensity and duration and the daily mood rating were registered over periods of at least 6 weeks. In the analyses, we defined two classes of events: (1) nights not followed by a migraine attack; (2) nights followed by migraine. We examined a retrospective sample (23 patients with altogether 580 attacks) and a prospective sample (16 patients with altogether 96 attacks). RESULTS: In both samples, we found that the duration of sleep was significantly reduced in nights followed by migraine (6.8 vs. 8.1 h and 6.4 vs. 7.2 h respectively) due to earlier awakening, with unchanged time of falling asleep. Up to two thirds of the observed migraine attacks were reported to be present directly after awakening. Quality of sleep was markedly reduced in nights followed by a migraine attack (i.e. sleep disruptions, feeling exhausted/no feeling of restedness when wakening up). We found only weak and insignificant correlations between the foregoing daily mood rating and the quantitative parameters of sleeping behavior on nights followed by migraine; somewhat more pronounced correlations were observable between the mood rating and the qualitative sleep parameters. CONCLUSIONS: Overall, we conclude that the observed changes in sleeping behavior are largely part of the migraine attack, with the possibility that REM sleep functions as a migraine trigger. In clinical application, we strongly recommend the use of daily self-observations of patients' sleep-related behaviors in the migraine diary, identifying migraine-prone sleeping habits and evaluating their potency for triggering migraine attacks.

English Abstract↗
PubMed1998

Prediction of migraine attacks using a slow cortical potential, the contingent negative variation.

Amplitudes of contingent negative variation (CNV) as a slow cortical potential in migraine patients were recorded before and after migraine attacks. The level of CNV amplitudes, especially of the early component, showed a trend in rise of negativity 1 day before the attack, whereas amplitudes were normal for 2-3 days following an attack. In most cases the attack occurred when the CNV amplitude showed maximum negativity. We conclude that migraine-susceptible days are indicated by a high CNV amplitude the day before the attack.

Adult↗
PubMed1998

Contingent negative variation in patients with chronic daily headache.

The aim of this study was the investigation of amplitude and habituation of contingent negative variation (CNV) in migraine and chronic daily headache (CDH) patients in order to describe possible neurophysiological features responsible for the clinical transformation and worsening of the headache. Fifteen females suffering from migraine without aura and 15 females diagnosed with CDH evolved from migraine without aura with interparoxysmal chronic tension-type headache (transformed migraine), underwent CNV recording. Fifteen healthy females matched for age served as controls. CNV was obtained from C3 and C4 using the standard reaction time paradigm and 3 sec ISI. The amplitudes and habituation of total CNV, early and late components, and of post-imperative negative variation (PINV) were calculated. The migraine patients were characterized by significantly more pronounced negativity of the early component and total CNV, compared to CDH sufferers and controls. CDH patients demonstrated significantly reduced negativity of the late component and pronounced PINV compared to the other groups. The early component of CNV did not habituate in migraine or CDH patients. However, the impaired habituation in CDH was related to significantly lower amplitudes. These results support the diagnostic and scientific value of habituation in migraine research and therapy. Late components of CNV and PINV can be considered as predictive variables for transformation of migraine. The results are discussed in terms of the relationship between late CNV, PINV, environment control abilities and susceptibility for development of depression.

Adaptation, Psychological↗
PubMed1998

Biobehavioral correlates in migraine: the role of hypersensitivity and information-processing dysfunction.

In this paper we address the role of specific abnormal behavioral patterns (such as perfectionism or hypersensitivity) which have been described as psychological characteristics in migraine patients. We propose that behavioral abnormalities may be the result of a determined cortical hypersensitivity and an associated social learning process. New neuro(psycho)physiological data support the concept that migraine is a brainstem-related information-processing dysfunction that is characterized by cortical hypersensitivity and reduced habituation to stimuli. The cortical activity reflects a (time) periodicity and may be due to endogenous or exogenous factors. Based on the current understanding of behavioral and neurophysiological aspects of migraine, we postulate a two-process model of migraine aetiology: (i) a genetically determined hyperactivity of the central monoaminergic (catecholaminergic) system, which could be possibly modulated by learning processes and (ii) a homeostatic (counter) regulation and mobilization of reduced (mitochondrial) energy reserve.

Behavior↗
PubMed1995

Contingent negative variation during migraine attack and interval: evidence for normalization of slow cortical potentials during the attack.

The contingent negative variation (CNV) amplitudes of 16 subjects with migraine without aura were studied during pain-free intervals and during attacks and the results were compared with those of 22 healthy subjects. In 32 trials the CNV amplitudes were calculated for (a) "total interval", (b) "early CNV component", (c) "late CNV component", and (d) habituation. There was a significantly higher total CNV amplitude in migraine subjects during pain-free intervals compared to that of the healthy subjects and migraine patients during an attack. Healthy subjects as well as subjects studied during the attack showed a significant habituation whereas migraine subjects studied during pain-free intervals did not. This suggests that the higher CNV amplitude in migraine patients studied between pain-free attacks may be due in part to impaired habituation.

Adult↗
PubMed1993

[Compliance problems and behavioral medicine implications in the drug therapy of pain].

Many patients, even cancer patients do not take their medication at all or at the prescribed dose showing thus a form of noncompliance. Reasons for this are manyfold and differ from patient to patient. They may undergo dynamic changes in the course of disease. Experience shows, that compliance is mainly improved when patients have the impression to be responsible for their comportment. This is an important goal in therapy of patients with chronic pain. Of particular importance is therefore the doctor-patient relation, i.e. non-compliance thus always indicates a disturbed doctor-patient relation.

Chronic Disease↗
PubMed1993

Contingent negative variation--findings and perspectives in migraine.

Contingent negative variation (CNV) is a negative cerebral potential which is related to attention and arousal. CNV occurs during an experimental situation in which stimuli and responses are serially organized. Between attacks migraine patients have on average higher negative amplitudes compared to healthy controls or patients with tension-type headache. Successful treatment with beta-blocking agents decreases CNV amplitudes. In spite of encouraging findings in neurological disorders, CNV is not widely used. In this review some possible reasons for this are pointed out.

Brain↗
PubMed1993

Is increased amplitude of contingent negative variation in migraine due to cortical hyperactivity or to reduced habituation?

The aim of this study was to compare the habituation kinetics of contingent negative variation (CNV) between 12 migraineurs without aura and matched healthy controls. CNV was studied with a 3 sec interval between the warning stimulus (WS) and the imperative stimulus (IS). The data from (a) the total interval (WS-IS), (b) early component, and (c) late component were analyzed. During successive trials the habituation kinetics were determined using regression analysis. On CNV averaged over 32 trials, migraine patients had a significantly higher negativity in the total interval compared to controls. When sequential blocks of four trials were analyzed, the most significant finding in migraineurs was lack of habituation of the early CNV component. The present study indicates that a delayed habituation, rather than a general increased cortical activity, is responsible for the CNV abnormalities in migraine without aura. We suggest that migraineurs between attacks not only have a cortical hyperexcitability, but also a lack of cortical inhibition causing delayed habituation.

Acoustic Stimulation↗
PubMed1991

Responders and non-responders to metoprolol, propranolol and nifedipine treatment in migraine prophylaxis: a dose-range study based on time-series analysis.

The aim of the present study was to ascertain, on the basis of single case statistics and time-series analysis, responder and non-responder rates for metoprolol, propranolol and nifedipine in migraine prophylaxis. In addition, an attempt was made to identify the dose relationship for the various drugs on headache parameters. In a double-blind dose-finding study, 58 patients were treated in five consecutive dosage steps each lasting 1-3 months. All patients kept a headache diary before, during and after treatment. Serum drug levels were also determined. The data were assessed by time-series analysis, as well as by multiple regression and analysis of variance. A significant improvement was noted in 54.4% of patients with migraine during treatment with metoprolol. The study did not confirm the high success rates in migraine prophylaxis of nifedipine and propranolol quoted in the literature. Administration of nifedipine led to an increase in migraine attacks in 71% of the patients. Nifedipine was of no value in the prophylaxis of migraine. Only 32% of patients showed a reduction in frequency of migraine attacks during administration of propranolol. The analysis of variance failed to show any significant difference between the responder rates for metoprolol and propranolol. Higher doses of propranolol and metoprolol were more effective. Multiple regression analysis explained a considerable part of variance for propranolol (but not for metoprolol) as a result of reduced intake of ergotamine preparations and analgesics. It can therefore be concluded that part of the prophylactic effect of propranolol is attributable to a reduction in the use of migraine medication.

Adolescent↗
PubMed1989

Central effects of drugs used in migraine prophylaxis evaluated by visual evoked potentials.

The present study used recordings of visual potentials evoked by pattern reversal (VEPs) to investigate the central effects of three drugs used in migraine prophylaxis: the calcium channel blocker nifedipine, the beta-1-selective blocker metoprolol, and the nonselective beta adrenoreceptor blocker propranolol. The study involved 58 patients with common or classical migraine who were treated in a double-blind randomized study over a period of 7 months, while the effectiveness of prophylactic treatment was recorded in headache diaries that were subjected to time series analysis. VEPs were recorded at the beginning of a 2-month baseline period without treatment, after 4 months of treatment, and at the end of a 3-month washout period. At baseline, migraine patients had significantly higher VEP amplitudes and longer latencies than did a group of 87 healthy control subjects. Patients were separated by statistical analysis into responders and nonresponders to each prophylactic treatment. Nifedipine had no effects on the frequency, intensity, and duration of migraine attacks, nor on amplitude and latency of the VEPs. In contrast, the use of beta blockers resulted in a significant decrease in VEP amplitude, both in responders and nonresponders, whereas VEP latency remained unchanged. VEP amplitudes returned to the initial values at follow-up in the nonresponders, but stayed at lower levels in responders. Beta blockers thus appear to have a significant effect on the increased excitability of the visual system in patients with migraine, although their action is not directly related to their reduction of migraine frequency.

Adult↗