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PubMed2006

The effect of inpatient rehabilitation programmes on quality of life in patients with cystic fibrosis: a multi-center study.

BACKGROUND: Disease-specific, multimodal inpatient rehabilitation programmes are designed to improve the physical, emotional, and social functioning of patients with cystic fibrosis (CF). This study investigates the effects of a 4-week inpatient rehabilitation program on health-related quality of life (QL). METHODS: 84 German patients with CF (16-62 years of age, FEV1 mean 52.9% of the predicted), participating in an inpatient rehabilitation programme, completed the Questions on Life Satisfaction-Modules (FLZM) at the beginning and one month after the end of intervention. The FLZM allows the multi-dimensional evaluation of subjectively perceived satisfaction with general and health-specific life domains. In addition, medical parameters (FEV1, Body Mass Index) and socio-demographic data were registered. RESULTS: Compared to the baseline scores, after rehabilitation, participants were significantly more satisfied with general, health-related, and CF-related aspects of their lives. Specifically, improvement was noted in the following items: breathing difficulties/cough, sleep, integration of therapy into daily routine, leisure activities, general health perception, physical condition and being free from anxiety. CONCLUSION: Comprehensive inpatient rehabilitation programmes are a promising strategy to improve the quality of life of adolescent and adult CF-patients.

Activities of Daily Living↗

PubMed2006

Multimodal treatment of osteosarcoma lung metastases.

OBJECTIVE: The diagnostic procedures, role of surgery and multimodal treatment for osteosarcoma pulmonary metastases are examined. METHODS: From January 2000 to June 2005, we observed 35 patients with osteogenic repetitions. Patients were studied by total-body computerised tomography (CT) and by thoracic single-photon emission computerised tomography (SPECT). Preoperative histological diagnosis was obtained by CT-guided transthoracic needle biopsy (23 cases) and fibre-optic bronchoscopy (12 cases). RESULTS: Four lower, 6 upper and 2 middle lobectomies were carried out using a thoracotomy approach. Video-assisted thoracoscopy was used in the other 23 patients who underwent 36 wedge resections. CT showed a sensitivity of 86 % and a specificity of 66 %; SPECT had a sensitivity of 80 % and a specificity of 100 %. Twenty-five patients are still living 25 +/- 11 months after the intervention. CONCLUSIONS: SPECT was demonstrated to offer a better result in the individualisation of secondary pulmonary nodules after primary osteosarcoma. The excision of all resectable lung metastases, integrated in a multidisciplinary strategy, offers good results in terms of survival.

Adult↗

PubMed2006

Transient receptor potential channels in cardiovascular function and disease.

Sustained elevation in the intracellular Ca2+ concentration via Ca2+ influx, which is activated by a variety of mechanisms, plays a central regulatory role for cardiovascular functions. Recent molecular biological research has disclosed an unexpectedly diverse array of Ca(2+-entry channel molecules involved in this Ca2+ influx. These include more than ten transient receptor potential (TRP) superfamily members such as TRPC1, TRPC3-6, TRPV1, TRPV2, TRPV4, TRPM4, TRPM7, and polycystin (TRPP2). Most of them appear to be multimodally activated or modulated and show relevant features to both acute hemodynamic control and long-term remodeling of the cardiovascular system, and many of them have been found to respond not only to receptor stimulation but also to various forms of stimuli. There is good evidence to implicate TRPC1 in neointimal hyperplasia after vascular injury via store-depletion-operated Ca2+ entry. TRPC6 likely contributes to receptor-operated and mechanosensitive Ca2+ mobilizations, being involved in vasoconstrictor and myogenic responses and pulmonary arterial proliferation and its associated disease (idiopathic pulmonary arterial hypertension). Considerable evidence has also been accumulated for unique involvement of TRPV1 in blood flow/pressure regulation via sensory vasoactive neuropeptide release. New lines of evidence suggest that TRPV2 may act as a Ca2+-overloading pathway associated with dystrophic cardiomyopathy, TRPV4 as a mediator of endothelium-dependent hyperpolarization, TRPM7 as a proproliferative vascular Mg2+ entry channel, and TRPP2 as a Ca2+-entry channel requisite for vascular integrity. This review attempts to provide an overview of the current knowledge on TRP proteins and discuss their possible roles in cardiovascular functions and diseases.

Animals↗

PubMedDate not supplied

Combined modality treatment of extremity soft tissue sarcomas.

BACKGROUND: Substantial progress has been made in the multimodality treatment of soft tissue sarcoma over the past decade. This review summarizes current state-of-the-art management for patients with extremity soft tissue sarcoma. METHODS: Literature-based review of combined modality treatment of extremity sarcoma. RESULTS: The revised staging system of the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) for this disease is described and a practical approach to diagnosis, evaluation, management, and follow-up of patients is presented. Brief summaries of the roles of surgical therapy, pre- and postoperative radiotherapy, pre- and postoperative chemotherapy, and concurrent chemoradiation in the management of extremity soft tissue sarcoma are provided, with summaries of the available data from randomized prospective trials. The data referenced and discussed herein provide the basis for stage-specific treatment recommendations for the management of patients with localized soft tissue sarcoma of the extremities. CONCLUSIONS: Soft tissue sarcoma remains a challenging disease to treat. The majority of patients require an integrated combined modality approach. Future research should be directed at developing more effective systemic therapies and minimizing the toxicities of local therapies.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2001

Neuroprotective role of neurophysiological monitoring during endovascular procedures in the spinal cord.

The endovascular treatment of spinal vascular malformations places the spinal cord at risk for ischemia. When these procedures are performed using general anesthesia, the neurophysiological monitoring methods currently available provide the only means by which to assess the functional integrity of sensory and motor pathways. Neurophysiological monitoring allows a warning for the neuroradiologist of impending irreversible neurological damage so that action may be taken for the prompt restoration of adequate spinal cord perfusion. Muscle motor evoked potentials (mMEPs) better reflect spinal cord perfusion in the anterior spinal artery territory than do somatosensory evoked potentials (SEPs), although their use during spinal endovascular procedures remains anecdotal in the literature. In the study reported here we assessed: (1) the feasibility of intraoperative neurophysiological monitoring, (2) the role of provocative tests with Amytal and Xylocaine, and (3) the specific but complementary role played by SEPs and mMEPs, during endovascular embolization of spinal vascular malformations and tumors. The results suggest that: (1) neurophysiological monitoring is feasible during most endovascular procedures in the spine and spinal cord under general anesthesia, (2) provocative tests enhance the safety of the procedure, (3) mMEPs are more feasible than SEPs and more sensitive than SEPs to provocative tests. We strongly suggest the use of multimodal neurophysiological monitoring and provocative tests during the endovascular treatment of spinal and spinal cord vascular lesions.

Algorithms↗

PubMedDate not supplied

Integrative properties of the Pe1 neuron, a unique mushroom body output neuron.

A mushroom body extrinsic neuron, the Pe1 neuron, connects the peduncle of the mushroom body (MB) with two areas of the protocerebrum in the honeybee brain, the lateral protocerebral lobe (LPL) and the ring neuropil around the alpha-lobe. Each side of the bee brain contains only one Pe1 neuron. Using a combination of intracellular recording and neuroanatomical techniques we analyzed its properties of integrative processing of the different sensory modalities. The Pe1 neuron responds to visual, mechanosensory, and olfactory stimuli. The responses are broadly tuned, consisting of a sustained increase of spike frequency to the onset and offset of light flashes, to horizontal and vertical movements of extended objects, to mechanical stimuli applied to the antennae or mouth parts, and to all olfactory stimuli tested (29 chemicals). These multisensory properties are reflected in its dendritic organization. Serial reconstructions of intracellularly stained Pe1 neurons using confocal microscopy reveal that the Pe1 neuron arborizes throughout all layers of MB peduncle with finger-like, vertically oriented dendrites. The peduncle of the MB is formed by the axons of Kenyon cells, whose dendritic inputs are organized in modality-specific subcompartments of the calyx region. The peduncular arborization indicates that the Pe1 neuron receives input from Kenyon cells of all calycal subcompartments. Because the Pe1 neuron changes its odor responses transiently as a consequence of olfactory learning, we hypothesize that the multimodal response properties might have a role in memory consolidation and help to establish contextual references in the long-term trace.

Adaptation, Physiological↗

PubMed1994

The role of free tissue transfer following oncologic resection in the lower extremity.

The current treatment of extremity sarcomas is multimodal, consisting of limb-sparing surgery, adjuvant radiotherapy, and/or chemotherapy. This approach has decreased the need for amputations and increased the demand for coverage of large composite defects. To date, the role of microsurgery in lower extremity reconstruction after oncologic resection has not been well defined. This study reviews a single center's experience with free tissue transfer for reconstruction of the lower extremity after oncologic resection. Fifty-nine free flaps were performed in 57 patients over a 5-year period. Forty-six patients (78%) underwent primary reconstruction and 35 patients (61%) received adjuvant therapy. Overall flap success rate was 96.6%. Most flaps were soft-tissue types including musculocutaneous (78%), skin only (11%), and muscle plus skin graft (4%). Osteocutaneous flaps were uncommon. There were major complications in 12% and minor complications in 7%. This study demonstrates that free tissue transfer for lower extremity reconstruction following oncologic resection has a high success rate that is similar to other free flap applications. It has become an integral part of lower extremity sarcoma management. Free flaps permit uninterrupted adjuvant therapy and enhance the efficacy of limb salvage surgery.

Adult↗

PubMed2005

Integration and segregation of inputs to higher-order neuropils of the crayfish brain.

Information about the input and output pathways of higher-order brain neuropils is essential for gaining an understanding of their functions. The present study examines the connectivity of two higher-order neuropils in the central olfactory pathway of the crayfish: the accessory lobe and its target neuropil, the hemiellipsoid body. It is known that the two subregions of the accessory lobe, the cortex and medulla, receive different inputs; the medulla receives visual and tactile inputs, whereas the cortex receives neither (Sandeman et al. [1995] J Comp Neurol 352:263-279). By using dye injections into the olfactory lobe, we demonstrate that the accessory lobe cortex and medulla also have differing connections with the olfactory lobe. These injections show that local interneurons joining the olfactory and accessory lobes branch primarily within the cortex with only limited branching within the medulla. Injections of different dyes into the two subregions of the hemiellipsoid body, HBI and HBII, show that the accessory lobe cortex and medulla also have separate output pathways. HBI is innervated by the output pathway from the cortex while HBII is innervated by the output pathway from the medulla. These injections also show that HBI and HBII are innervated by separate populations of local interneurons with differing connections to higher-order neuropils in the olfactory and visual pathways. These results suggest a segregation of olfactory and multimodal (including olfactory) inputs within both the accessory lobe and the hemiellipsoid body and provide evidence of important functional subdivisions within both neuropils.

Animals↗

PubMed2006

Polyopic heautoscopy: Case report and review of the literature.

Heautoscopy, i.e., the encounter with one's double, is a multimodal illusory reduplication of one's own body and self. In its polyopic form, more than one double is experienced. In the present article, we review fourteen published cases of polyopic heautoscopy and describe in detail the case of a 41-year-old man with polyopic heautoscopy resulting from a tumor in the insular region of the left temporal lobe. Our case is illustrative in several respects: (1) The patient's five doubles were all confined to the right hemispace. Laterality in this case is discussed with reference to previous cases of unilateral heautoscopy after focal brain damage, which generally do not show a hemispatial or hemispheric bias. (2) The patient's psychological affinity with his doubles, and also the extent of their echopraxia of his movements, decreased as a function of their perceived spatial distance from the patient's body, corroborating previous observations of associations between spatial and psychological phenomenologies during autoscopic phenomena. (3) While classical heautoscopy (the reduplication of a single body and self) is considered a breakdown in the integrative processes that enable us to identify our self with our body, the phenomenon of polyopic heautoscopy (a multiplication of body and self) points to the multiple mappings of the body, whose disintegration may give rise to the illusory experience of multiple selves.

Adult↗

PubMed1999

Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme.

BACKGROUND: Hospital stay after colonic surgery is usually between 5 and 10 days, limiting factors being pain, ileus, organ dysfunction and fatigue. Single-modality intervention to reduce these factors with laparoscopic surgery usually requires a hospital stay of 5 days. This paper reports the results of a multimodal rehabilitation regimen after open sigmoidectomy. METHODS: Sixteen unselected patients scheduled for elective sigmoid resection (median age 71 years) underwent operation under combined spinal-epidural anaesthesia. After operation, epidural analgesia was continued for 48 h, with immediate oral nutrition and mobilization, and with planned discharge 2 days after surgery. RESULTS: The median postoperative hospital stay was 2 (range 2-6) days (48 h), patients being mobilized for a median of 5 h on the second postoperative day (24-48 h) and for 10 h on the third day (48-72 h). Within 48 h of operation 14 patients had an oral intake of 2000 ml or more and 15 had resumed defaecation. Fatigue and pain scores were low during the first 8-9 days after operation, with a median of 13 h of mobilization per day after discharge. There were no medical or surgical complications during 30 days of follow-up, except for two patients who suffered postspinal headache. CONCLUSION: Postoperative recovery after open colonic surgery may be accelerated by effective pain relief integrated into an accelerated rehabilitation programme.

Adult↗

PubMed1999

Multimodal efferent and recurrent neurons in the medial lobes of cockroach mushroom bodies.

Previous electrophysiological studies of cockroach mushroom bodies demonstrated the sensitivity of efferent neurons to multimodal stimuli. The present account describes the morphology and physiology of several types of efferent neurons with dendrites in the medial lobes. In general, efferent neurons respond to a variety of modalities in a context-specific manner, responding to specific combinations or specific sequences of multimodal stimuli. Efferent neurons that show endogenous activity have dendritic specializations that extend to laminae of Kenyon cell axons equipped with many synaptic vesicles, termed "dark" laminae. Efferent neurons that are active only during stimulation have dendritic specializations that branch mainly among Kenyon cell axons having few vesicles and forming the "pale" laminae. A new category of "recurrent" efferent neuron has been identified that provides feedback or feedforward connections between different parts of the mushroom body. Some of these neurons are immunopositive to antibodies raised against the inhibitory transmitter gamma-aminobutyric acid. Feedback pathways to the calyces arise from satellite neuropils adjacent to the medial lobes, which receive axon collaterals of efferent neurons. Efferent neurons are uniquely identifiable. Each morphological type occurs at the same location in the mushroom bodies of different individuals. Medial lobe efferent neurons terminate in the lateral protocerebrum among the endings of antennal lobe projection neurons. It is suggested that information about the sensory context of olfactory (or other) stimuli is relayed by efferent neurons to the lateral protocerebrum where it is integrated with information about odors relayed by antennal lobe projection neurons.

Animals↗

PubMedDate not supplied

Visuo-tactile representation of near-the-body space.

Here we report findings from neuropsychological investigations showing the existence, in humans, of intersensory integrative systems representing space through the multisensory coding of visual and tactile events. In addition, these findings show that visuo-tactile integration may take place in a privileged manner within a limited sector of space closely surrounding the body surface, i.e., the near-peripersonal space. They also demonstrate that the representation of near-peripersonal space is not static, as objects in the out-of-reach space can be processed as nearer, depending upon the (illusory) visual information about hand position in space, and the use of tools as physical extensions of the reachable space. Finally, new evidence is provided suggesting the multisensory coding of peripersonal space can be achieved through bottom-up processing that, at least in some instances, is not necessarily modulated by more "cognitive" top-down processing, such as the expectation regarding the possibility of being touched. These findings are entirely consistent with the functional properties of multisensory neuronal structures coding near-peripersonal space in monkeys, as well as with behavioral, and neuroimaging evidence for the cross-modal coding of space in normal subjects. This high level of convergence ultimately favors the idea that multisensory space coding is achieved through similar multimodal structures in both humans and non-human primates.

Animals↗

PubMed2003

[Pain specialist in the assessment process].

Pain specialists are often involved in assessing social medical aspects of chronic pain patients. A standardized examination in the assessment process is not published. Data and statements on the assessment process between 1993 and 1997 were recorded from 15 experts by questionnaire. Statements to 568 reports were made. The majority of performance impairments were caused by back pain (35.9%) and headache (19.3%). All examiners integrated a psychological assessment. Although the assessment processes were very different, all examiners fulfilled the minimal criteria of the presented process for assessment of chronic pain patients. Verifying the symptoms as well as capturing some aspects of aggravation proved to be problematic. The present assessment practice is discussed with regard to the unequal procedure. On basis of the received data and the own experience in examination the process of structured assessment of chronic pain patients is presented under medical and psychological aspects. It contains a recommendation of a standardized process with minimal criteria and an optional supplement of the standardized process with problematical patients (e.g.demonstration, aggravation, simulation). Minimal demands on a qualified assessment of chronic pain patients should contain the study of the history, the German Pain-Questionnaire, the analysis of all the painful complaints with weighting their importance, the examination and the basic registration of sensational, emotional, cognitive, behavioral and social aspects of the chronic pain syndrome. An appended glossary of the most usable psychological tests with comments on their validation criteria aims to provide a more standard multimodal assessment of chronic pain patients complaints and functionability.

Humans↗

PubMed2000

Induction chemotherapy by superselective intra-arterial high-dose carboplatin infusion for head and neck cancer.

To evaluate the feasibility, maximum dose of drug tolerated, technical problems, systemic and local toxicity, response rate, overall and disease-free survival, we studied superselective intra-arterial infusion of high-dose carboplatin as part of a multimodality treatment for head and neck cancer. Forty patients with untreated stage II-IV head and neck squamous cell carcinomas received induction chemotherapy with high-dose carboplatin (three cycles at 2-week intervals using 300-350 mg/m2 per cycle), delivered via superselective transfemoral angiography followed by radiotherapy or surgery plus radiotherapy. No technical complications occurred during or after the infusion. Systemic toxicity was minimal, and local toxicity was moderate. At the end of chemotherapy the overall complete and partial response rate was 90% (36/40) at the primary site and 64% (16/25) at the neck nodes. The median follow-up was 24.4 months (range 3-52). To date 21 patients are alive without disease, 2 are alive with disease, 13 have died of disease, and 4 have developed a metachronous lung tumor. There was a good correlation between the response to chemotherapy and disease-free survival. No statistically significant benefit in survival was observed with respect to other series of head and neck tumors treated with different protocols. However, discriminating between responding and nonresponding patients, this procedure can have a prognostic significance in planning integrated treatments for these types of tumors.

Adult↗

PubMedDate not supplied

[The importance of brain stem evoked potentials in the diagnosis of neurosurgical patients].

The technique of Brainstem Electric Response Audiometry (BERA) is a non-invasive electrophysiologic method used in comatose patients for localization of areas of neuronal and synaptic dysfunction not evident in clinical evaluation. This test has a diagnostic and prognostic value in detection of abnormalities and evaluation of comatose head-injured patients at a reversible clinical stage. In contrast to most clinical signs, brainstem auditory evoked potentials are independent of levels of consciousness, analgesics, sedatives. This test is aetiologically non-specific and must be carefully integrated into the clinical situation. Generators of brainstem auditory evoked potentials are located in the auditory nerve (waves I and II) and brainstem (waves III-V). Patients in acute posttraumatic coma are assessed by means of Glasgow Coma Score (GCS), which is reliable in forecasting a favourable outcome. Patients with a score 8 points have an unfavourable outcome in 16%. Brainstem auditory evoked potentials are reliable predictors of unfavourable outcome. Subsequent brainstem auditory evoked potential testing provides relevant prognostic information, since improvement of graded brainstem auditory evoked potentials indicates a favourable outcome. Progressive deterioration of brainstem auditory evoked potentials indicates irreversible damage and is associated with unfavourable outcome, whereas singular abnormal evoked potentials may result from reversible neuronal dysfunction. The absence of waves III-V associated with the end EEG activity is the proof of brain death. Serial BERA monitoring has been used to evaluate progressive clinical syndromes, such as "uncal herniation" and evolving brain death. The use of serial BERA recordings appeared to improve the outcome predictions in comparison with single BERA tests. A combination of brainstem auditory evoked potentials, somatosensory and visual evoked potentials (multimodality evoked potentials-MEP) provides more information for management of a patient than a single evoked potential modality. The main goal to use BERA is early detection of secondary deterioration in comatose patients suffering from intracranial lesions. The results of brainstem auditory evoked potentials and clinical examination of patients obtained within the acute phase after head injury may indicate increased intracranial pressure (ICP) and incipient transtentorial herniation but do not always predict outcome (GOS). The outcome can be better evaluated later, 3-6 days after head injury. In summary, BERA is a non-invasive, safe and objective method of evaluating patients after severe head injury and adds valuable information for assessment of their outcome.

Brain Stem↗

PubMed2006

[Endometrial cancer -- suggestions for the update of the guidelines].

Surgical therapy is the mainstay of the treatment of endometrial cancer. Apart from total abdominal hysterectomy und bilateral salpingo-oophorectomy, complete pelvic and paraaortic lymphadenectomy has become an integral part of the primary surgical procedure, allowing for definite surgical/histopathological staging. In surgically staged patients, adjuvant measures including external radiotherapy can be applied with a clear indication and unnecessary toxicity can be avoided. In addition complete lymphadenectomy has probably a relevant therapeutic effect. As so far no randomized trials have been completed and lymphadenectomy in the often multi-morbid and obese endometrial cancer patients requires a certain amount of expertise, it is not accepted by all experts or is accepted only if a variety of parameters obtained pre- and intraoperatively are present. On the other hand, the National Comprehensive Cancer Network of the USA recommends a complete pelvic and paraaortic lymphadenectomy for all patients with endometrial cancer, except for those with Stage IA, Grade 1 disease where this procedure is optional. The efficacy of an adjuvant pelvic teletherapy in Stage I patients has been questioned by several randomized trials. In patients having a complete surgical staging, external radiotherapy is often not necessary and can be replaced by vaginal brachytherapy. In advanced stages of endometrial cancer chemotherapy has been shown to be superior to whole abdominal radiotherapy. New multimodal concepts including surgical staging, adjuvant chemo- and targeted radiotherapy have to be evaluated. In the palliative setting novel endocrine strategies are being assessed in addition to the well established progestagen therapy. The efficacy of the standard chemotherapy with adriamycin/cisplatin could be somewhat improved by adding paclitaxel, at the expense of a markedly increased toxicity. Women with the diagnosis of endometrial cancer should be treated in the context of certified clinical trials as it has become the standard for patients with breast or ovarian cancer.

Combined Modality Therapy↗

PubMed2005

Concurrent chemoradiotherapy for unresectable stage III non-small cell lung cancer.

Over the last two decades, several approaches to multimodality therapy have been investigated in patients with advanced unresectable non-small cell lung cancer. These include induction chemotherapy and concurrent chemoradiotherapy. Both approaches have been shown to be superior to radiation therapy alone. However, in several randomized trials, concomitant chemoradiotherapy was shown to be superior to the induction chemotherapy approach. It has been hypothesized that the addition of systemic dose sequential chemotherapy to concurrent chemoradiotherapy, either as induction or as consolidation chemotherapy, might further improve survival rates. Recently, the Cancer and Leukemia Group B reported on a randomized phase III trial directly evaluating the addition of two cycles of carboplatin and paclitaxel to concurrent chemoradiotherapy. In this study, induction chemotherapy failed to further improve survival rates of concurrent chemoradiotherapy. A previously conducted randomized phase II study also suggested no benefit from the addition of induction chemotherapy to concomitant chemoradiotherapy. Favorable phase II data have been published supporting the use of consolidation chemotherapy. However, to date, no large randomized study evaluating a possible benefit from consolidation chemotherapy has been completed. In addition to evaluating optimal sequencing strategies of combined modality therapy, current investigations are also focusing on the integration of novel agents, including chemotherapeutic and targeted therapies. Currently ongoing trials involving novel approaches are reviewed here.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1991

Clinical and pathophysiological observations in migraine and tension-type headache explained by integration of vascular, supraspinal and myofascial inputs.

A vascular-supraspinal-myogenic (VSM) model for pain in migraine based on our previous clinical and pathophysiological observations is proposed. According to the model, perceived pain (headache) intensity is determined by the sum of nociception from cephalic arteries and pericranial myofascial tissues converging upon the same neurons and integrated with supraspinal effects (usually facilitating). Vascular input predominates over myofascial input in migraine, whereas significance of supraspinal facilitation is difficult to estimate. The importance of these 3 effects may vary between patients and in the same individual with time. The model is in accordance with recent experimental studies showing convergence of somatovisceral afferents upon n. caudalis neurons. Also, long term potentiation due to nociceptive activation and sensitization of neurons to input from wider areas and non-nociceptive stimuli are relevant to our model. In tension-type headache, nociception is primarily myofascial, but vascular input cannot be disregarded. Supraspinal facilitation probably plays a large, sometimes dominant role (the MSV model). The model explains much of the complexity of the clinical picture of these disorders as well as their tendency to overlap and to change into one another. Also, a number of pathophysiological observations such as why muscles are tender during migraine, why trigger-point injection may cure migraine attacks and why chronic tension-type headache is often associated with episodes of pulsating pain, can be explained. The model gives a rational explanation of empirically developed, internationally accepted, multimodal treatment strategies for migraine and tension-type headache. It may thus serve a useful purpose in explaining the disorder to patients. Finally, the model points to several avenues of future research in animals and man.

Animals↗