The following articles are currently In Press and will be published in the next issue of
Improved efficacy of pregabalin by restoring plasma vitamin D levels in migraine: a case report.
Antonio Siniscalchi, MD; Piergiorgio Lochner; Erika Cione, PhD; Adelia Michniewicz, Biotechnologist; Vincenzo Guidetti, MD; Luca Gallelli, MD
Migraine appears to be the most common neurological syndrome in primary care. Pain in migraine is mediated by the release of inflammatory mediators at the level of nerves and blood vessels. The antioxidant and neuroprotective effects of vitamin D in the central nervous system suggest that deficiency of this vitamin can be involved in migraine. Moreover, low serum levels of vitamin D correlates with a higher incidence of chronic pain, including migraine and in co-administered with anti-migraine treatment reduces the frequency of migraine attacks.
We report a 46-year old woman affected by migraine, anxiety and mild depressive mood (MSQ score: 24; BDI score: 34; VAS score: 8) that partially improved with pregabalin treatment (VAS: 5). Laboratory findings documented low serum levels of vitamin D (25-hydroxy-vitamin D: 12 ng/mL; normal range: 20-100 ng/mL; 1-25 di-hydroxy-vitamin D: 19 ng/mL, normal range: 25-66 ng/mL). The treatment with 10,000 UI vitamin D during pregabalin therapy induced an improvement of clinical symptoms (pain, anxiety and depression) and of the quality of life.
This case report suggest that in chronic migraine patient with anxiety and mild mood depression in treatment with pregabalin a supplementation of vitamin D improvement the clinical symptoms of migraine and a modulation of inhibitoy synaptic neurotransmission may explain this effect in our migraine patient.
Successful Resolution of Prominent Somatic Delusions following Bi-temporal Electroconvulsive Therapy in a patient with Treatment- Resistant Schizoaffective disorder
Joshua L. Cohen, PhD; My-Hanh Thi Vu, MD; Mirza Adam Beg, BS; Soumya Sivaraman, MD; and Badari Birur, MD
Somatic delusions occur in a variety of psychiatric disorders including schizophrenia, major depressive disorder, and bipolar disorder. Somatization is associated with lower quality of life and greater risk for suicide. Treatment of somatic delusions is extremely challenging. Here we report an interesting case of severe somatic delusions in a 48-year-old African-American female with a long history of treatment resistant schizoaffective disorder, with multiple somatic complaints surrounding constipation, pregnancy, jaw pain, body aches, vaginal itch, malodorous urine, and neck pain, despite normal clinical examinations and negative medical work up. Additionally, she endorsed persistent auditory and visual hallucinations. Her symptoms remained resistant to several trials of psychotropic medications, including clozapine. Chart review of past hospitalizations revealed significant improvement with Electroconvulsive Therapy (ECT), so the team decided to perform a course of six bi-temporal ECT treatments administered over two weeks. Stimulation was applied at a current of 800mA for 4.5s, with a pulse width of 1ms and frequency of 60 Hz. This case illustrates the successful use of ECT in treating prominent somatic delusions in a patient with treatment- resistant schizoaffective disorder.