Papers by Dr. Elena Lebedeva
Неврология, нейропсихиатрия, психосоматика, 2018
Диагностика транзиторной ишемической атаки (ТИА) вызывает сложности, особенно это касается диффер... more Диагностика транзиторной ишемической атаки (ТИА) вызывает сложности, особенно это касается дифференциации ТИА с имитирующими ее состояниями. Четкие диагностические критерии могут повысить точность распознавания ТИА. Авторы настоящей статьи предлагают новые диагностические критерии ТИА. Цель исследования -разработка диагностических критериев для TИА и определение их чувствительности у группы пациентов с TИА, а также их специфичности у больных из России и Дании, страдающих мигренью с аурой. Пациенты и методы. Критерии для диагностики ТИА были созданы с использованием Международной классификации головной боли (МКГБ) и данных литературы о мигрени с аурой и клинических характеристиках и диагнозе ТИА. Чувствительность критериев тестировали в проспективном исследовании 120 пациентов, у которых ТИА развилась до того, как были разработаны эти критерии. Опрос пациентов проводили в остром периоде заболевания с помощью подробного полуструктурированного интервью. Пациенты, включенные в исследование, имели очаговую неврологическую симптоматику или признаки ретинальной ишемии с регрессом симптомов без острого повреждения мозговой ткани по данным магнитно-резонансной томографии с диффузионно-взвешенными изображениями (n=112) или компьютерной томографии (n=8) в течение 24 ч. Эти критерии были также тестированы на специфичность в группах пациентов из Дании (n=1390) и России (n=152), страдающих мигренью с аурой, у которых диагноз был установлен согласно МГКБ-3 бета. Результаты и обсуждение. Чувствительность предложенных критериев у пациентов с ТИА составила 99%. Специфичность у больных мигренью с аурой из Дании достигала 95% и из России -96%. Заключение. Новые диагностические критерии ТИА отличаются высокой чувствительностью и специфичностью. Они позволят улучшить диагностику ТИА. Рекомендуется продолжить тестирование этих критериев у пациентов с ТИА в будущих исследованиях.
Journal of Headache and Pain, Jun 10, 2020
Background: There are no previous controlled studies of sentinel headache in ischemic stroke. The... more Background: There are no previous controlled studies of sentinel headache in ischemic stroke. The purpose of the present study was to evaluate the presence of such headache, its characteristics and possible risk factors as compared to a simultaneous control group. Methods: Eligible patients (n = 550) had first-ever acute ischemic stroke with presence of new infarction on magnetic resonance imaging with diffusion-weighted imaging (n = 469) or on computed tomography (n = 81). As a control group we studied in parallel patients (n = 192) who were admitted to the emergency room without acute neurological deficits or serious neurological or somatic disorders. Consecutive patients with stroke and a simultaneous control group were extensively interviewed soon after admission using validated neurologist conducted semi-structured interview forms. Based on our previous study of sentinel headache in transient ischemic attacks we defined sentinel headache as a new type of headache or a previous kind of headache with altered characteristics (severe intensity, increased frequency, absence of effect of drugs) within seven days before stroke. Results: Among 550 patients with stroke 94 patients (17.1%) had headache during seven days before stroke and 12 (6.2%) controls (p < 0.001; OR 3.9; 95% CI 1.7-5.8). Totally 81 patients (14.7%) had sentinel headache within the last week before stroke and one control. Attacks of arrythmia during seven days before stroke were significantly associated with sentinel headache (p = 0.04, OR 2.3; 95% CI 1.1-4.8). Conclusions: A new type of headache and a previous kind of headache with altered characteristics during one week before stroke are significantly more prevalent than in controls. These headaches represent sentinel headaches. Sudden onset of such headaches should alarm about stroke.
Journal of Headache and Pain, Sep 18, 2014
Nevrologiâ, nejropsihiatriâ, psihosomatika, Mar 20, 2015
Целью настоящей работы был анализ качества диагностики и лечения первичной головной боли (ГБ) в р... more Целью настоящей работы был анализ качества диагностики и лечения первичной головной боли (ГБ) в разных социальных группах Уральского региона.
Journal of Headache and Pain, Aug 17, 2022
Background: It is poorly described how often headache attributed to stroke continues for more tha... more Background: It is poorly described how often headache attributed to stroke continues for more than 3 months, i.e. fulfils the criteria for persistent headache attributed to ischemic stroke. Our aims were: 1) to determine the incidence of persistent headache attributed to past first-ever ischemic stroke (International headache society categories 6.1.1.2); 2) to describe their characteristics and acute treatment; 3) to analyse the prevalence of medication overuse headache in patients with persistent headache after stroke; 4) to evaluate factors associated with the development of persistent headache after stroke. Methods: The study population consisted of 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke, among them 529 patients were followed up at least three months after stroke. Standardized semi-structured interview forms were used to evaluate these headaches during professional face-to-face interviews at stroke onset and telephone interviews at 3 months. Results: At three months, 61 patients (30 women and 31 men, the mean age 60.0) of 529 (11.5%) follow-up patients had a headache after stroke: 34 had a new type of headache, 21 had a headache with altered characteristics and 6 patients had a headache without any changes. Therefore 55 (10.4%) patients had a persistent headache attributed to ischemic stroke. Their clinical features included: less severity of accompanying symptoms, slowly decreasing frequency and development of medication overuse headache in one-third of the patients. The following factors were associated with these headaches: lack of sleep (29.1%, p = 0.009; OR 2.3; 95% CI 1.2-4.3), infarct in cerebellum (18.2%, p = 0.003; OR 3.0; 95% CI 1.4-6.6), stroke of undetermined etiology (50.9%, p = 0.003; OR 2.3; 95% CI 1.3-4.1), less than 8 points by NIHSS score (90.9%, p = 0.007; OR 3.4; 95% CI 1.4-8.6) and low prevalence of large-artery atherosclerosis (12.7%, p = 0.006; OR 0.3; 95% CI 0.2-0.80). Conclusion: Persistent headache attributed to ischemic stroke is not rare and frequently leads to medication overuse. The problem is often neglected because of other serious consequences of stroke but actually, it has a considerable impact on quality of life. It should be a focus of interest in the follow-up of stroke patients.
Nevrologiâ, nejropsihiatriâ, psihosomatika, Feb 22, 2022
Рекомендации российских экспертов по диагностике и лечению лекарственно-индуцированной головной б... more Рекомендации российских экспертов по диагностике и лечению лекарственно-индуцированной головной боли составлены на основании доказательной медицины, Международной классификации головных болей последнего пересмотра. Изложены основные сведения об эпидемиологии, факторах риска, патофизиологических механизмах, диагностике и наиболее эффективных лекарственных и немедикаментозных подходах к ведению пациентов с лекарственно-индуцированной головной болью. Ключевые слова: лекарственно-индуцированная головная боль; диагностика; классификация; хроническая мигрень; хроническая головная боль напряжения; лечение лекарственно-индуцированной головной боли; профилактика; нелекарственные методы.
Journal of Headache and Pain, Jan 20, 2022
Background: Defining the relationship between a headache and stroke is essential. The current dia... more Background: Defining the relationship between a headache and stroke is essential. The current diagnostic criteria of the ICHD-3 for acute headache attributed to ischemic stroke are based primarily on the opinion of experts rather than on published clinical evidence based on extensive case-control studies in patients with first-ever stroke. Diagnostic criteria for sentinel headache before ischemic stroke do not exist. The present study aimed to develop explicit diagnostic criteria for headache attributed to ischemic stroke and for sentinel headache. Methods: This prospective case-control study included 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke and 192 control patients (mean age 58.7, 36% males) admitted to the emergency room without any acute neurological deficits or severe disorders. Standardized semi-structured interview forms were used to evaluate past and present headaches during face-to-face interviews by a neurologist on admission to the emergency room in both groups of patients. All headaches were diagnosed according to the ICHD-3. We tabulated the onset of different headaches before a first-ever ischemic stroke and at the time of onset of stroke. We divided them into three groups: a new type of headache, the previous headache with altered characteristics and previous unaltered headaches. The same was done for headaches in control patients within one week before admission to the hospital and at the time of entry. These data were used to create and test diagnostic criteria for acute headache attributed to stroke and sentinel headache. Results: Our previous studies showed that headache at onset of ischemic stroke was present in 82 (14.9%) of 550 patients, and 81 (14.7%) patients had sentinel headache within the last week before a stroke. Only 60% of the headaches at stroke onset fulfilled the diagnostic criteria of ICHD-3. Therefore, we proposed alternative criteria with a sensitivity of 100% and specificity of 97%. Besides, we developed diagnostic criteria for sentinel headache for the first time with a specificity of 98% and a sensitivity of 100%. Conclusions: We suggest alternative diagnostic criteria for acute headache attributed to ischemic stroke and new diagnostic criteria for sentinel headache with high sensitivity and specificity.
European Journal of Neurology, 2021
The Lancet, 2021
Migraine is a neurovascular disorder that affects over 1 billion people worldwide. Its widespread... more Migraine is a neurovascular disorder that affects over 1 billion people worldwide. Its widespread prevalence, and associated disability, have a range of negative and substantial effects not only on those immediately affected but also on their families, colleagues, employers, and society. To reduce this global burden, concerted efforts are needed to implement and improve migraine care that is supported by informed health-care policies. In this Series paper, we summarise the data on migraine epidemiology, including estimates of its very considerable burden on the global economy. First, we present the challenges that continue to obstruct provision of adequate care worldwide. Second, we outline the advantages of integrated and coordinated systems of care, in which primary and specialist care complement and support each other; the use of comprehensive referral and linkage protocols should enable continuity of care between these systems levels. Finally, we describe challenges in low and middle-income countries, including countries with poor public health education, inadequate access to medication, and insufficient formal education and training of health-care professionals resulting in misdiagnosis, mismanagement, and wastage of resources.
The Journal of Headache and Pain, 2021
BackgroundThere have been several calls for estimations of costs and consequences of headache int... more BackgroundThere have been several calls for estimations of costs and consequences of headache interventions to inform European public-health policies. In a previous paper, in the absence of universally accepted methodology, we developed headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Here we apply this methodology and present the findings.MethodsData sources were published evidence and expert opinions, including those from an earlier economic evaluation framework using the WHO-CHOICE model. We used three headache-type-specific analytical models, for migraine, tension-type-headache (TTH) and medication-overuse-headache (MOH). We considered three European Region case studies, from Luxembourg, Russia and Spain to include a range of health-care systems, comparing current (suboptimal) care versus target care (structured services implemented, with provider-training and consumer-educ...
The Journal of Headache and Pain, 2020
Background In the emergency room, distinguishing between a migraine with aura and a transient isc... more Background In the emergency room, distinguishing between a migraine with aura and a transient ischemic attack (TIA) is often not straightforward and mistakes can be harmful to both the patient and to society. To account for this difficulty, the third edition of the International Classification of Headache disorders (ICHD-3) changed the diagnostic criteria of migraine with aura. Methods One hundred twenty-eight patients referred to the emergency room at the University Hospital of Lübeck, Germany with a suspected TIA were prospectively interviewed about their symptoms leading to admission shortly after initial presentation. The diagnosis that resulted from applying the ICHD-3 and ICHD-3 beta diagnostic criteria was compared to the diagnosis made independently by the treating physicians performing the usual diagnostic work-up. Results The new ICHD-3 diagnostic criteria for migraine with aura and migraine with typical aura display an excellent specificity (96 and 98% respectively), and ...
The Journal of Headache and Pain, 2013
Background As major causes of global public ill-health and disability, headache disorders are par... more Background As major causes of global public ill-health and disability, headache disorders are paradoxically ignored in health policy and in planning, resourcing and implementing health services. This is true worldwide. Russia, where the prevalence of headache disorders and levels of attributed disability are well in excess of the global and European averages, is no exception, while arcane diagnoses and treatment preferences are an aggravating factor. Urgent remedial action, with political support, is called for. Methods Yekaterinburg, in Sverdlovsk Oblast, is the chosen centre for a demonstrational interventional project in Russia, undertaken within the Global Campaign against Headache. The initiative proposes three actions: 1) raise awareness of need for improvement; 2) design and implement a three-tier model (from primary care to a single highly specialized centre with academic affiliation) for efficient and equitable delivery of headache-related health care; 3) develop a range of...
Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova, 2017
Представленные рекомендации по диагностике и лечению мигрени составлены на основании принципов до... more Представленные рекомендации по диагностике и лечению мигрени составлены на основании принципов доказательной медицины. Приведена Международная классификация мигрени последнего пересмотра. Методы диагностики и диагностические критерии ориентированы на различные формы мигрени. Рекомендации даны на основе сведений об эпидемиологии и патофизиологических механизмах мигрени. Охарактеризованы наиболее эффективные лекарственные и немедикаментозные подходы к ведению пациентов с мигренью.
Background: Defining the relationship between a headache and stroke is essential. The current dia... more Background: Defining the relationship between a headache and stroke is essential. The current diagnostic criteria of the ICHD-3 for acute headache attributed to ischemic stroke are based primarily on the opinion of experts rather than on published clinical evidence based on extensive case-control studies in patients with first-ever stroke. Diagnostic criteria for sentinel headache before ischemic stroke do not exist. The present study aimed to develop explicit diagnostic criteria for headache attributed to ischemic stroke and for sentinel headache.Methods: This prospective case-control study included 550 patients (mean age 63,1, 54% males) with first-ever ischemic stroke and 192 control patients (mean age 58.7, 36% males) admitted to the emergency room without any acute neurological deficits or severe disorders. Standardized semi-structured interview forms were used to evaluate past and present headaches during face-to-face interviews by a neurologist on admission to the emergency r...
Neurology, Neuropsychiatry, Psychosomatics, 2018
Диагностика транзиторной ишемической атаки (ТИА) вызывает сложности, особенно это касается диффер... more Диагностика транзиторной ишемической атаки (ТИА) вызывает сложности, особенно это касается дифференциации ТИА с имитирующими ее состояниями. Четкие диагностические критерии могут повысить точность распознавания ТИА. Авторы настоящей статьи предлагают новые диагностические критерии ТИА. Цель исследования-разработка диагностических критериев для TИА и определение их чувствительности у группы пациентов с TИА, а также их специфичности у больных из России и Дании, страдающих мигренью с аурой. Пациенты и методы. Критерии для диагностики ТИА были созданы с использованием Международной классификации головной боли (МКГБ) и данных литературы о мигрени с аурой и клинических характеристиках и диагнозе ТИА. Чувствительность критериев тестировали в проспективном исследовании 120 пациентов, у которых ТИА развилась до того, как были разработаны эти критерии. Опрос пациентов проводили в остром периоде заболевания с помощью подробного полуструктурированного интервью. Пациенты, включенные в исследование, имели очаговую неврологическую симптоматику или признаки ретинальной ишемии с регрессом симптомов без острого повреждения мозговой ткани по данным магнитно-резонансной томографии с диффузионно-взвешенными изображениями (n=112) или компьютерной томографии (n=8) в течение 24 ч. Эти критерии были также тестированы на специфичность в группах пациентов из Дании (n=1390) и России (n=152), страдающих мигренью с аурой, у которых диагноз был установлен согласно МГКБ-3 бета. Результаты и обсуждение. Чувствительность предложенных критериев у пациентов с ТИА составила 99%. Специфичность у больных мигренью с аурой из Дании достигала 95% и из России-96%. Заключение. Новые диагностические критерии ТИА отличаются высокой чувствительностью и специфичностью. Они позволят улучшить диагностику ТИА. Рекомендуется продолжить тестирование этих критериев у пациентов с ТИА в будущих исследованиях.
The Journal of Headache and Pain, 2018
Background: Headache is a common feature in acute cerebrovascular disease but no studies have eva... more Background: Headache is a common feature in acute cerebrovascular disease but no studies have evaluated the prevalence of specific headache types in patients with transient ischemic attacks (TIA). The purpose of the present study was to analyze all headaches within the last year and the last week before TIA and at the time of TIA. Methods: Eligible patients with TIA (n = 120, mean age 56.1, females 55%) had focal brain or retinal ischemia with resolution of symptoms within 24 h without presence of new infarction on MRI with DWI (n = 112) or CT (n = 8). All patients were evaluated within one day of admission by a single neurologist. As a control group we used patients (n = 192, mean age 58.7, females 64%) admitted with diagnoses "lumbago", "lumbar spine osteochondrosis" or "gastrointestinal ulcer". Results: One-year prevalence of migraine without aura was significantly higher in TIA patients than in controls: 20.8% and 7.8% respectively (p = 0.002, OR 3.1, 95% CI 1.6-6.2). 22 patients (18.3%) had sentinel or warning headache within the last week before TIA. At the time of TIA a new type of headache was observed in 16 patients (13.3%). No controls had a new type of headache. 12 of these 16 patients had migraine-like headache, 8 patients had tension-type-like headache and one patient thunderclap headache. Posterior circulation TIA was associated with headaches within last week before TIA and at the time of TIA much more frequently than anterior circulation TIA. Conclusions: The one year prevalence of migraine was significantly higher in TIA patients than in controls and so was the prevalence of headache within the last week before TIA and at the time of TIA. A previous headache that worsens and a new type of headache can be a warning of impending TIA.
Cephalalgia : an international journal of headache, 2017
Background The diagnosis of transient ischemic attacks is fraught with problems. The inter-observ... more Background The diagnosis of transient ischemic attacks is fraught with problems. The inter-observer agreement has repeatedly been shown to be low even in a neurological setting, and the specificity of the diagnosis is modest to low, reflected in a poor separation of transient ischemic attacks and mimics, particularly migraine with aura with its varied symptomatology. In other disease areas, explicit diagnostic criteria have improved sensitivity and specificity of diagnoses. We therefore present novel explicit diagnostic criteria for transient ischemic attacks tested for sensitivity and for specificity against migraine with aura. Methods The proposed criteria were developed using the format of the international headache classification. We drew upon the existing literature about clinical characteristics and diagnosis of migraine with aura and transient ischemic attacks. We tested the criteria for sensitivity in a prospectively-collected material of 120 patients with transient ischemic...
Acta Neurologica Scandinavica, 2014
Background-Unruptured saccular intracranial aneurysm (SIA) is associated with an increased preval... more Background-Unruptured saccular intracranial aneurysm (SIA) is associated with an increased prevalence of migraine, but it is unclear whether this is altered by clipping of the aneurysm. The aim of our study was to determine whether remission rate of migraine and other recurrent headaches was greater in patients with SIA after clipping than in controls. Methods-We prospectively studied 87 SIA patients with migraine or other recurrent headaches. They were interviewed about headaches in the preceding year before and 1 year after clipping using a validated semi-structured neurologist conducted interview. The remission rates of migraine and tension-type headache (TTH) in these patients were compared to 92 patients from a headache center. Diagnoses were made according to the ICHD-2. Results-During 1 year preceding rupture 51 patients with SIA had migraine. During the year after clipping, this was reduced by 74.5% (P < 0.0001). At first encounter, 47 control patients had migraine during the preceding year, and during 1 year of treatment, it was 41, a reduction 12.8% (P > 0.5). The decrease of migraine in SIA patients was significantly higher than in controls: 74.5% vs 12.8% (P < 0.001). A history of TTH was given by 33 patients with SIA during the year preceding rupture and by 44 during 1 year after clipping (P > 0.75). Forty-one control patients had TTH, 27 after 1 year of treatment, a reduction 34.1% (P < 0.05). No factors except clipping of the aneurysm could explain the remission of migraine. Conclusions-Migraine prevalence in patients with SIA decreases significantly after clipping. Further comparative studies of migraine after coiling vs clipping in SIA patients are needed.
The Journal of Headache and Pain, 2013
Background: Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it ... more Background: Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA. Methods: In a prospective case-control study 199 consecutive patients with SIA (103 females and 96 males, mean age: 43.2 years) received a semistructured face to face interview focusing on past headaches. All were admitted to hospital mostly because of rupture (177) or for unruptured aneurysm (22). In parallel we interviewed 194 blood donors (86 females, 108 males, mean age: 38.4 years). Diagnoses were made according to the International Headache Society criteria. Aneurysms were diagnosed by conventional cerebral angiography. Results: During the year before rupture, 124 (62.3%) had one or more types of headache. These headaches included: migraine without aura (MO): 78 (39.2%), migraine with aura (MA): 2 (1%), probable migraine (PM): 4 (2%), tension-type headache (TTH): 39 (19.6%), cluster headache (CH): 2 (1%), posttraumatic headaches (PH): 2 (1%). 1-year prevalence of headaches in controls was 32.5% (63 patients out of 194), they included: TTH: 45 (23.1%), MO: 17 (8.8%), PH: 1(0.5%). Only the prevalence of MO was significantly higher in patients with SIA (OR 6.7, 95% CI 3.8-11.9, p < 0.0001). Conclusions: Unruptured SIA cause a marked increase in the prevalence of migraine without aura but not in the prevalence of other types of headache.
Acta Neurologica Scandinavica, 2013
Objectives-Our purpose was to identify the incidence and significance of markers of systemic conn... more Objectives-Our purpose was to identify the incidence and significance of markers of systemic connective tissue abnormalities (CTA) in patients with saccular intracranial aneurysms (SIA). Materials and methods-This prospective case-control study included 199 consecutive patients with SIA (103 women and 96 men, mean age-43.2 years) and 194 control patientsblood donors (108men, 86women, mean age-38.4 years). Aneurysms were verified by conventional cerebral angiography. All patients were examined by the first author using a specially designed questionnaire and a standardized physical examination with special emphasis on systemic CTA. Results-Twelve markers of systemic CTA were significantly higher in patients with SIA than in controls: visible vessels on face and chest (59.8%), scoliosis (44.7%), varicose veins in legs (39.7%), flatfoot (34.6%), hyperextensibility of the skin (33.6%), spontaneous epistaxis (25.6%), easy bruising (20.6%), abdominal hernia (13.6%), periodontal disease (10.5%), chest deformations (7.5%), abdominal striae (3.5%), joint hypermobility (2.5%). A blinded validation study in a subset of 43 patients showed similar results. Among patients with SIA, 125 of 199 patients (62.8%) had at least three markers of systemic CTA compared with 23 (11.8%) of the controls (P < 0.0001, OR = 12.5, 95% CI 7.45-21.1). The mean number of markers of systemic CTA in patients with SIA was 3.07 and 1.17 in controls. Conclusion-Patients with SIA have multiple markers of systemic connective tissue abnormalities. Systemic weakness of connective tissue represents a risk factor for development of SIA. Identification of these markers may help in detection of high-risk patients.
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Papers by Dr. Elena Lebedeva