الفهرس | Only 14 pages are availabe for public view |
Abstract SUMMERY AND CONCLUSION Multiple sclerosis is an immune-mediated chronic disorder of the central nervous system in young adults, characterized by a spatial and temporal dissemination of the pathological process, with multiple areas of inflammation, demyelination, and glial sclerosis are observed in the white matter. Various symptoms and signs occur due to the affected areas in the brain and the spinal cord. Migraine is a complex, common, and disabling disorder of the brain, which is characterised by recurrent attacks of pulsationg moderate to severe headache associated with sensory symptoms pain and sensitivity to normal afferent information, such as light, sound, and head movement , in which both central and peripheral components of The trigeminal pain pathway probably plays a significant role, both in the symptoms and signs of the attack and in the mechanisms of action of antimigraine compounds. Migraine headache is a common feature in MS patients with variable prevalence among the studies 1.6–28.5% up to 60%. It can influence the diagnosis, radiological evaluation, treatment, and quality of life of these patients. Similarities in symptoms summery & conclusion 104 between patients with migraine and MS presenting with headache can lead to misdiagnosis. Likewise, MRI lesions which may be found in migraine patients without other neurological symptoms or signs may cause diagnostic confusion and patient anxiety. Studies addressing the pathophysiology of these comorbid conditions have not found a clear link, but brain stem lesions during the inflammatory processes, changes in the cytokines during the relapse , alternation in BBB permeability during migraine attacks and disease-modifying agents mode of action and side effect profiles have been proposed as possible association factors . Thorough evaluation of headache especially migraine headache in patients with MS is crucial to optimize patient management to help improve quality of life. Management of de novo or treatment-induced headache in the MS patient is fairly straightforward if the physician is aware of the problem. In our study 55 MS patients diagnosed according to revised Mc Donald criteria recruited from Neurology Departments, Ain Shams University Hospitals from which patients were subjected to thorough medical history taking, stressing on age at onset of MS, duration of illness, current therapy, yearly exacerbation rate and age of onset of migraine headache. Migraine diagnosis was done using a questionnaire based on criteria proposed by the International Classification of Headache Disorders 2nd Edition summery & conclusion 105 (ICHD2) , neurological disability evaluation was done by means EDSS and Migraine severity evaluation was done using MIDAS , MS severity was assessed MSS . In our 55 MS patient’s sample, 44 were female patients representing 80% & 11 were male patients representing 20% of the sample with Mean age 31.1 ± 7.9 years. Migraine headache was present in 19 patients (34.5%), which is a higher percentage than the general population. The mean age of onset of migraine headache among our studied group 22.27 ± 6.4 years, and the mean age of MS onset in this group 25± 7.04 which indicates that the majority of patients with coexisting Migraine and MS develop migraine years earlier. There was no statistical significant difference between the two patient groups regarding age of onset of MS, duration of illness and annual relapse rate EDSS or MSSS. However midbrain periaquidactal affection in MRI being more prevalent among MS patients with migraine. Also There was statistical significant correlation between occurence of severe migraine attack before MS relapse in patients who developed migraine headache for the first time conccurently with 1st MS presentation. summery & conclusion 106 Initiation of DMT and increase in the migraine severity which could be explained due to change in the cytokines balance. In conclusion Migraine is comorbid in patients with MS. The exact etiology and pathogenesis of these two seemingly disparate disorders is not completely understood. Research as to how and why they co- occur leads to improvement in the understanding of each. This research has contributed to the recognition of migraine symptoms and headache in MS, improving our diagnostic skills and care of these patients. In addition, it has strengthened our knowledge of the role of pain-modulating structures of the brainstem, and neuroimmunologic and inflammatory mechanisms which contribute to migraine. Such collaboration may one day culminate in the prevention and cure of two currently incurable and debilitating diseases |