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W. Wedekind - One of the best experts on this subject based on the ideXlab platform.
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Pathophysiology and psychopharmacology of dementia--a new study design. 2. Cyclandelate treatment--a placebo-controlled double-blind clinical trial.
Neuropsychobiology, 1997Co-Authors: R. Schellenberg, W. Wedekind, A. Todorova, F. Schober, Wilfried DimpfelAbstract:The aim of this randomized, double-blind, placebo-controlled 16-week study was to investigate the clinical efficacy of Cyclandelate (Natil®, 1,600 mg/day) in 139 adult outpatients with cognitive impairment (70 allocated to Cyclandelate; 69 to placebo). Quantitative-topological EEG, event-related potentials (P 300 ) and psychophysiological interview-based rating scales were used. The efficacy ofCyclandelate was demonstrated in the confirmatory statistical sense using a global Hailperin-Ruger test on 10 predefined primary variables at global significance level of 0.05 relating to psychopathology, psychometry, neuropsychophysiology and behavior. At psychopathological and behavioral level the reduction of the total scores of the rating scales (Alzheimer Disease Assessment Scale, Sandoz Clinical Assessment Geriatric Scale, and Nurnberger Selbsteinschatzungs-Liste) following a 16-week therapy revealed also an individual significant Cyclandelate-placebo distinction in the confirmatory statistical sense. A difference between verum and placebo was also observed by the increase of the number of correct answers during performance of the number symbol test (psychometrical level). The objective electrophysiological data (neuropsychophysiological level) support these findings. Of particular interest is that following Cyclandelate treatment the absolute theta power remained almost unchanged and an increase ofP 300 amplitude was observed. At the same time placebo led to a distinct theta power increase and a decrease of P 300 amplitude, which was interpreted as the reflection of an impairment of the initial clinical state. Summarizing, Cyclandelate proved to be efficacious compared to placebo in patients with mild to moderate cognitive impairment.
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Evidence of a pharmacokinetic-pharmacodynamic relationship between pharmaco-EEG in healthy subjects after administration of Cyclandelate
Arzneimittel-Forschung, 1994Co-Authors: Dimpfel W, W. Wedekind, Schober F, Kleinbloesem C, Coors CAbstract:In an open randomized cross-over study 800 mg Cyclandelate (Natil, CAS 456-59-7) was applicated to 24 young, male volunteers. Before and during 24 h after application of a single dose a 17-channel, quantitative topographical pharmaco-EEG was recorded. A significant increase of the spectral power density was observed in the alpha 2, beta 1 and beta 2 frequency bands starting 2 h after application until 4.5 h. The increase in beta 1 and beta 2 power was observed in the parietocentral area of the cortex. The difference between the circadian development of the EEG power and the development after medication was obvious after 3 until 4.5 h. For the beta frequencies only a weak statistical confirmation could be obtained, but for the alpha 2 frequency a significant difference between the circadian and the EEG power under Cyclandelate was found using the sign test. Altogether a quantitative effect on brain activity was detected after oral application of Cyclandelate, reaching its maximum before the blood concentration of the metabolites cyclandic glucuronide and mandelic acid reached their peak heights.
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Field potential analysis in the freely moving rat during the action of Cyclandelate or flunarizine.
Pharmacological Research, 1992Co-Authors: W. Dimpfel, W. Wedekind, M. SpülerAbstract:Summary Cyclandelate and flunarizine, two vasoactive Ca 2+ channel or Ca 2+ overload blockers have been compared with respect to their in vivo action on field potentials recorded from the depths of the brain in freely moving rats. Whereas Cyclandelate showed a dose dependent rapid onset of action in the range of 15 to 120 mg/kg i.p., flunarizine only induced weak effects very slowly, not reaching statistical relevance before the fourth hour after the injection (0.1 to 1.6 mg/kg). Even then no clear dose dependence could be recognized for flunarizine. With respect to the frequency content of the recorded signals a rather close similarity between both drugs could be seen. Comparison of the drug effects to our reference data base of more than 80 compounds revealed a close relationship to memantine, an antiparkinson drug, suspected to act on the NMDA (N-methyl-d-aspartate) receptor-ionophor complex controlling Ca 2+ fluxes. There is some indication that Cyclandelate might also act in a similar way at the molecular level.
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effects of Cyclandelate on the cns a double blind placebo controlled study of healthy subjects
Journal of Molecular Medicine, 1991Co-Authors: W. Dimpfel, P. Netter, M. Spüler, W. WedekindAbstract:The effect of Cyclandelate (Natil) on the CNS was tested in a double-blind, placebo-controlled pilot study on 48 healthy males using a single oral dosage of 1200 mg. The EEG was evaluated quantitatively by spectral analysis before and one hour as well as two and a half hours after drug or placebo administration under resting conditions and while performing a test of mental arithmetic. Under resting conditions the power in the alpha 2 frequency band of the signals from the frontal and central recordings was increased in the Cyclandelate group in comparison to the placebo group. This effect was still observed two and a half hours after drug intake. Under the condition of mental arithmetic no drug related effect was observed in the EEG. The Cyclandelate induced increase of spectral power in the alpha 2 frequency band under resting conditions demonstrates a general effect of Cyclandelate on the CNS. The results are discussed with respect to the known age related decrease of spectral power in the alpha frequency band. The established effect of Cyclandelate in young healthy subjects calls for a study with chronic treatment in elderly subjects or patients with cognitive deficits.
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Wirkungen von Cyclandelat auf das ZNS — Eine doppelblinde, placebo-kontrollierte Studie an gesunden Probanden
Klinische Wochenschrift, 1991Co-Authors: W. Dimpfel, P. Netter, M. Spüler, W. WedekindAbstract:The effect of Cyclandelate (Natil^®) on the CNS was tested in a double-blind, placebocontrolled pilot study on 48 healthy males using a single oral dosage of 1200 mg. The EEG was evaluated quantitatively by spectral analysis before and one hour as well as two and a half hours after drug or placebo administration under resting conditions and while performing a test of mental arithmetics. Under resting conditions the power in the alpha_2 frequency band of the signals from the frontal and central recordings was increased in the Cyclandelate group in comparison to the placebo group. This effect was still observed two and a half hours after drug intake. Under the condition of mental arithmetics no drug related effect was observed in the EEG. The Cyclandelate induced increase of spectral power in the alpha_2 frequency band under resting conditions demonstrates a general effect of Cyclandelate on the CNS. The results are discussed with respect to the known age related decrease of spectral power in the alpha frequency band. The established effect of Cyclandelate in young healthy subjects calls for a study with chronic treatment in elderly subjects or patients with cognitive deficits.
Hans-christoph Diener - One of the best experts on this subject based on the ideXlab platform.
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Antimigraine drugs
Journal of Neurology, 1999Co-Authors: Hans-christoph Diener, Holger Kaube, Volker LimmrothAbstract:Migraine is a paroxysmal disorder characterized by attacks of headache, nausea, vomiting, photophobia, phonophobia, and malaise. This review summarizes new treatment options for therapy of the acute attack. Mild or moderate migraine attacks are treated with antiemetics followed by analgesics such as aspirin, paracetamol, nonsteroidal anti-inflammatory drugs, or antiemetics combined with ergotamine or dihydroergotamine. Sumatriptan, a specific serotonin (5-HT)1B/D agonist is used when attacks do not respond to ergotamine, or when intolerable side effects occur. The new migraine drugs zolmitriptan, naratriptan, rizatriptan, and eletriptan differ slightly in their pharmacological profiles, which translates into minor differences in efficacy, headache recurrence, and side effects. New drugs in migraine prophylaxis include Cyclandelate, valproic acid and magnesium.
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Cyclandelate in the Prophylaxis of Migraine: A Randomized, Parallel, Double-Blind Study in Comparison with Placebo and Propranolol
Cephalalgia, 1996Co-Authors: Hans-christoph Diener, Föh M, Iaccarino C, Peter Wessely, Hansruedi Isler, Strenge H, M Fischer, Wedekind W, Z. TaneriAbstract:Cyclandelate inhibits calcium-induced contraction of vascular smooth muscle cells, platelet aggregation induced by thrombin, platelet-activating-factor and adenosine, and also suppresses a provoked 5HT release from platelets. This pharmacological profile suggests that Cyclandelate may have a potential prophylactic effect in migraine. To test this hypothesis, a double-blind multicentre study was performed in 214 patients to investigate the efficacy and tolerability of Cyclandelate compared to placebo and propranolol. After a 4-week baseline period, eligible patients (randomization 3:2:3) were treated for 12 weeks with daily doses of 1.200 mg Cyclandelate (n=81), placebo (n=55) or 120 mg propranolol (n=78). The number of migraine attacks (350% responders) and the migraine duration/month were compared based on the difference between baseline and the last 4 weeks of prophylactic treatment. The percentage of patients with a reduction in migraine attacks of 350% treated with cyclancelate (37.0%) or propranolol ...
W. Dimpfel - One of the best experts on this subject based on the ideXlab platform.
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Field potential analysis in the freely moving rat during the action of Cyclandelate or flunarizine.
Pharmacological Research, 1992Co-Authors: W. Dimpfel, W. Wedekind, M. SpülerAbstract:Summary Cyclandelate and flunarizine, two vasoactive Ca 2+ channel or Ca 2+ overload blockers have been compared with respect to their in vivo action on field potentials recorded from the depths of the brain in freely moving rats. Whereas Cyclandelate showed a dose dependent rapid onset of action in the range of 15 to 120 mg/kg i.p., flunarizine only induced weak effects very slowly, not reaching statistical relevance before the fourth hour after the injection (0.1 to 1.6 mg/kg). Even then no clear dose dependence could be recognized for flunarizine. With respect to the frequency content of the recorded signals a rather close similarity between both drugs could be seen. Comparison of the drug effects to our reference data base of more than 80 compounds revealed a close relationship to memantine, an antiparkinson drug, suspected to act on the NMDA (N-methyl-d-aspartate) receptor-ionophor complex controlling Ca 2+ fluxes. There is some indication that Cyclandelate might also act in a similar way at the molecular level.
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effects of Cyclandelate on the cns a double blind placebo controlled study of healthy subjects
Journal of Molecular Medicine, 1991Co-Authors: W. Dimpfel, P. Netter, M. Spüler, W. WedekindAbstract:The effect of Cyclandelate (Natil) on the CNS was tested in a double-blind, placebo-controlled pilot study on 48 healthy males using a single oral dosage of 1200 mg. The EEG was evaluated quantitatively by spectral analysis before and one hour as well as two and a half hours after drug or placebo administration under resting conditions and while performing a test of mental arithmetic. Under resting conditions the power in the alpha 2 frequency band of the signals from the frontal and central recordings was increased in the Cyclandelate group in comparison to the placebo group. This effect was still observed two and a half hours after drug intake. Under the condition of mental arithmetic no drug related effect was observed in the EEG. The Cyclandelate induced increase of spectral power in the alpha 2 frequency band under resting conditions demonstrates a general effect of Cyclandelate on the CNS. The results are discussed with respect to the known age related decrease of spectral power in the alpha frequency band. The established effect of Cyclandelate in young healthy subjects calls for a study with chronic treatment in elderly subjects or patients with cognitive deficits.
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Wirkungen von Cyclandelat auf das ZNS — Eine doppelblinde, placebo-kontrollierte Studie an gesunden Probanden
Klinische Wochenschrift, 1991Co-Authors: W. Dimpfel, P. Netter, M. Spüler, W. WedekindAbstract:The effect of Cyclandelate (Natil^®) on the CNS was tested in a double-blind, placebocontrolled pilot study on 48 healthy males using a single oral dosage of 1200 mg. The EEG was evaluated quantitatively by spectral analysis before and one hour as well as two and a half hours after drug or placebo administration under resting conditions and while performing a test of mental arithmetics. Under resting conditions the power in the alpha_2 frequency band of the signals from the frontal and central recordings was increased in the Cyclandelate group in comparison to the placebo group. This effect was still observed two and a half hours after drug intake. Under the condition of mental arithmetics no drug related effect was observed in the EEG. The Cyclandelate induced increase of spectral power in the alpha_2 frequency band under resting conditions demonstrates a general effect of Cyclandelate on the CNS. The results are discussed with respect to the known age related decrease of spectral power in the alpha frequency band. The established effect of Cyclandelate in young healthy subjects calls for a study with chronic treatment in elderly subjects or patients with cognitive deficits.
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Wirkungen von Cyclandelat auf das ZNS — Eine doppelblinde, placebo-kontrollierte Studie an gesunden Probanden
Klinische Wochenschrift, 1991Co-Authors: W. Dimpfel, P. Netter, M. Spüler, W. WedekindAbstract:The effect of Cyclandelate (Natil®) on the CNS was tested in a double-blind, placebocontrolled pilot study on 48 healthy males using a single oral dosage of 1200 mg. The EEG was evaluated quantitatively by spectral analysis before and one hour as well as two and a half hours after drug or placebo administration under resting conditions and while performing a test of mental arithmetics. Under resting conditions the power in the alpha2 frequency band of the signals from the frontal and central recordings was increased in the Cyclandelate group in comparison to the placebo group. This effect was still observed two and a half hours after drug intake.
M. Spüler - One of the best experts on this subject based on the ideXlab platform.
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Field potential analysis in the freely moving rat during the action of Cyclandelate or flunarizine.
Pharmacological Research, 1992Co-Authors: W. Dimpfel, W. Wedekind, M. SpülerAbstract:Summary Cyclandelate and flunarizine, two vasoactive Ca 2+ channel or Ca 2+ overload blockers have been compared with respect to their in vivo action on field potentials recorded from the depths of the brain in freely moving rats. Whereas Cyclandelate showed a dose dependent rapid onset of action in the range of 15 to 120 mg/kg i.p., flunarizine only induced weak effects very slowly, not reaching statistical relevance before the fourth hour after the injection (0.1 to 1.6 mg/kg). Even then no clear dose dependence could be recognized for flunarizine. With respect to the frequency content of the recorded signals a rather close similarity between both drugs could be seen. Comparison of the drug effects to our reference data base of more than 80 compounds revealed a close relationship to memantine, an antiparkinson drug, suspected to act on the NMDA (N-methyl-d-aspartate) receptor-ionophor complex controlling Ca 2+ fluxes. There is some indication that Cyclandelate might also act in a similar way at the molecular level.
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effects of Cyclandelate on the cns a double blind placebo controlled study of healthy subjects
Journal of Molecular Medicine, 1991Co-Authors: W. Dimpfel, P. Netter, M. Spüler, W. WedekindAbstract:The effect of Cyclandelate (Natil) on the CNS was tested in a double-blind, placebo-controlled pilot study on 48 healthy males using a single oral dosage of 1200 mg. The EEG was evaluated quantitatively by spectral analysis before and one hour as well as two and a half hours after drug or placebo administration under resting conditions and while performing a test of mental arithmetic. Under resting conditions the power in the alpha 2 frequency band of the signals from the frontal and central recordings was increased in the Cyclandelate group in comparison to the placebo group. This effect was still observed two and a half hours after drug intake. Under the condition of mental arithmetic no drug related effect was observed in the EEG. The Cyclandelate induced increase of spectral power in the alpha 2 frequency band under resting conditions demonstrates a general effect of Cyclandelate on the CNS. The results are discussed with respect to the known age related decrease of spectral power in the alpha frequency band. The established effect of Cyclandelate in young healthy subjects calls for a study with chronic treatment in elderly subjects or patients with cognitive deficits.
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Wirkungen von Cyclandelat auf das ZNS — Eine doppelblinde, placebo-kontrollierte Studie an gesunden Probanden
Klinische Wochenschrift, 1991Co-Authors: W. Dimpfel, P. Netter, M. Spüler, W. WedekindAbstract:The effect of Cyclandelate (Natil^®) on the CNS was tested in a double-blind, placebocontrolled pilot study on 48 healthy males using a single oral dosage of 1200 mg. The EEG was evaluated quantitatively by spectral analysis before and one hour as well as two and a half hours after drug or placebo administration under resting conditions and while performing a test of mental arithmetics. Under resting conditions the power in the alpha_2 frequency band of the signals from the frontal and central recordings was increased in the Cyclandelate group in comparison to the placebo group. This effect was still observed two and a half hours after drug intake. Under the condition of mental arithmetics no drug related effect was observed in the EEG. The Cyclandelate induced increase of spectral power in the alpha_2 frequency band under resting conditions demonstrates a general effect of Cyclandelate on the CNS. The results are discussed with respect to the known age related decrease of spectral power in the alpha frequency band. The established effect of Cyclandelate in young healthy subjects calls for a study with chronic treatment in elderly subjects or patients with cognitive deficits.
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Wirkungen von Cyclandelat auf das ZNS — Eine doppelblinde, placebo-kontrollierte Studie an gesunden Probanden
Klinische Wochenschrift, 1991Co-Authors: W. Dimpfel, P. Netter, M. Spüler, W. WedekindAbstract:The effect of Cyclandelate (Natil®) on the CNS was tested in a double-blind, placebocontrolled pilot study on 48 healthy males using a single oral dosage of 1200 mg. The EEG was evaluated quantitatively by spectral analysis before and one hour as well as two and a half hours after drug or placebo administration under resting conditions and while performing a test of mental arithmetics. Under resting conditions the power in the alpha2 frequency band of the signals from the frontal and central recordings was increased in the Cyclandelate group in comparison to the placebo group. This effect was still observed two and a half hours after drug intake.
M. J. Müller - One of the best experts on this subject based on the ideXlab platform.
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Langzeitwirksamkeit und Nebenwirkungen verschiedener Migräneprophylaktika—eine retrospektive Analyse
Der Schmerz, 1994Co-Authors: G. Haag, F. Mastrosimone, C. Iaccarino, M. J. MüllerAbstract:Introduction Drug therapy for the prevention of migraine attacks is becoming more and attacks is becoming more and more important. The aims of such prophylactic treatment are to reach a lower frequency, shorter duration and milder intensity of migraine attacks, and to reduce the intake of anti-migraine medication, to improve the quality of life and working ability. The question of efficacy and tolerance of established migraine prophylactics [1] has been thoroughly investigated in many studies. So far the question of sustained efficacy after a successful prophylactic treatment completion has not been a research priority, but it is nonetheless of great importance. Researchers at the neurologic scientific research institute of the university of Naples have followed up migraine out-patients after successful prophylactic treatment and observed that prophylactic agents differ not only in their immediate efficacy and safety, but also in long-term efficacy. Therefore, an open pilot study was performed with the prophylactic agents propranolol, flunarizine, pizotifen, DHE retard, methysergide and Cyclandelate in the recommended dossages (Tabe 1). Objective and methods The aim of this study was to determine whether the various prophylactic agents available differ in active and long-term efficacy (at the end of a period after a successful prophylaxis=follow-up) and in the distribution of long-term responders at the end of the follow-up. The side effects of all prophylactic agents during active prophylaxis were also compared. Initially, 387 outpatients who had successfully completed a period of prophylactic treatment were recruited, and 208 were included in the study. At the time of follow-up a further period of prophylactic treatment was recommended if the efficacy rate was lower than 40% of the baseline at the end of the active prophylaxis period. The patients kept migraine headache daries (MHD) during the active prophylaxis and the follow-up, recording the following migraine objectives: number of attacks, pain total index (PTI), frequency of awakening with headache, and use of analgesics. Results The results showed that Cyclandelate—actually a drug that is not yet officially accepted—had especially good results from the aspects of immediate efficacy, long-term efficacy and tolerance, compared with all other prophylactic agents. Significant differences were found in the duration of active prophylaxis. The mean monthly duration for patients treated with pizotifen (4.2), Cyclandelate (3.9), and DHE retard (3.8) was longer than for those treated with flunarizine (2.8), and for patients treated with pizotifen it was longer than for those receiving propranolol (3.4). The mean duration (in months) of the postprophylactic period was distinctly longer for patients treated with Cyclandelate (18.2) than for patients treated with DHE retard (12.9), flunarizine (13.1), propranolol (13.3) or pizotifen (13.8), but comparable with that after methysergide (17.2). Among the 208 patients, 85 were long-term responders (with no indication for repeated prophylaxis). No significant differences were found between the various groups, but the group of patients treated with Cyclandelate was the only one with more than 50% long-term responders (18 vs 14). In general, the side effects of pizotifen, flunarizine and DHE retard seemed to be most pronounced. For Cyclandelate, propranolol and methysergide fewer side effects were reported. Conclusion In spite of the uncontrolled pilot design, it can be said in summary that all prophylactic drugs were effective. Cyclandelate had a good safety profile, and in efficacy it was at least comparable to the other prophylactic drugs. Patients treated with Cyclandelate had a longer duration of active treatment and likewise a longer period of follow up. In addition, the proportion of patients with “no indication for repeated prophylaxis” at follow up was higher than for any of the other drugs. The results are interesting for medical practice and suggest replication in a randomized blind study. If the results yielded by the present study are confirmed, Cyclandelate should be classified as a drug of first choice for migraine prophylaxis. Der prophylaktischen Therapie der Migräne kommt große Bedeutung zu. Dabei steht neben der Frage nach der Effektivität unterschiedlicher Prophylaktika vor allem auch deren anhaltende Wirksamkeit nach einer erfolgreichen Prophylaxe sowie die Häufigkeit unerwünschter Nebenwirkungen im Vordergrund. Hierzu wurde am Institut für neurologisch wissenschaftliche Forschung der Universität Neapel eine retrospektive Analyse bei 208 mit unterschiedlichen Prophylaktika behandelten Patienten durchgeführt. Es zeigte sich, daß das bisher noch nicht zu den anerkannten Migräneprophylaktika zählende Cyclandelat bezüglich anhaltender Wirksamkeit nach erfolgreicher Prophylaxe und geringer Häufigkeit unerwünschter Nebenwirkungen besonders günstige Ergebnisse erzielte. Sollte sich dies Ergebnis in prospektiven Doppelblindstudien bestätigen, müßte Cyclandelat künftig als ein Migräneprophylaktikum der ersten Wahl empfohlen werden.
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Langzeitwirksamkeit und Nebenwirkungen verschiedener Migräneprophylaktika—eine retrospektive Analyse@@@Long-term efficacy and side effects of various migraine prophylactics: a retrospective analysis
Der Schmerz, 1994Co-Authors: G. Haag, F. Mastrosimone, C. Iaccarino, M. J. MüllerAbstract:INTRODUCTION Drug therapy for the prevention of migraine attacks is becoming more and attacks is becoming more and more important. The aims of such prophylactic treatment are to reach a lower frequency, shorter duration and milder intensity of migraine attacks, and to reduce the intake of anti-migraine medication, to improve the quality of life and working ability. The question of efficacy and tolerance of established migraine prophylactics [1] has been thoroughly investigated in many studies. So far the question of sustained efficacy after a successful prophylactic treatment completion has not been a research priority, but it is nonetheless of great importance. Researchers at the neurologic scientific research institute of the university of Naples have followed up migraine out-patients after successful prophylactic treatment and observed that prophylactic agents differ not only in their immediate efficacy and safety, but also in long-term efficacy. Therefore, an open pilot study was performed with the prophylactic agents propranolol, flunarizine, pizotifen, DHE retard, methysergide and Cyclandelate in the recommended dossages (Tabe 1). OBJECTIVE AND METHODS The aim of this study was to determine whether the various prophylactic agents available differ in active and long-term efficacy (at the end of a period after a successful prophylaxis=follow-up) and in the distribution of long-term responders at the end of the follow-up. The side effects of all prophylactic agents during active prophylaxis were also compared. Initially, 387 outpatients who had successfully completed a period of prophylactic treatment were recruited, and 208 were included in the study. At the time of follow-up a further period of prophylactic treatment was recommended if the efficacy rate was lower than 40% of the baseline at the end of the active prophylaxis period. The patients kept migraine headache daries (MHD) during the active prophylaxis and the follow-up, recording the following migraine objectives: number of attacks, pain total index (PTI), frequency of awakening with headache, and use of analgesics. RESULTS The results showed that Cyclandelate-actually a drug that is not yet officially accepted-had especially good results from the aspects of immediate efficacy, long-term efficacy and tolerance, compared with all other prophylactic agents. Significant differences were found in the duration of active prophylaxis. The mean monthly duration for patients treated with pizotifen (4.2), Cyclandelate (3.9), and DHE retard (3.8) was longer than for those treated with flunarizine (2.8), and for patients treated with pizotifen it was longer than for those receiving propranolol (3.4). The mean duration (in months) of the postprophylactic period was distinctly longer for patients treated with Cyclandelate (18.2) than for patients treated with DHE retard (12.9), flunarizine (13.1), propranolol (13.3) or pizotifen (13.8), but comparable with that after methysergide (17.2). Among the 208 patients, 85 were long-term responders (with no indication for repeated prophylaxis). No significant differences were found between the various groups, but the group of patients treated with Cyclandelate was the only one with more than 50% long-term responders (18 vs 14). In general, the side effects of pizotifen, flunarizine and DHE retard seemed to be most pronounced. For Cyclandelate, propranolol and methysergide fewer side effects were reported. CONCLUSION In spite of the uncontrolled pilot design, it can be said in summary that all prophylactic drugs were effective. Cyclandelate had a good safety profile, and in efficacy it was at least comparable to the other prophylactic drugs. Patients treated with Cyclandelate had a longer duration of active treatment and likewise a longer period of follow up. In addition, the proportion of patients with "no indication for repeated prophylaxis" at follow up was higher than for any of the other drugs. The results are interesting for medical practice and suggest replication in a randomized blind study. If the results yielded by the present study are confirmed, Cyclandelate should be classified as a drug of first choice for migraine prophylaxis.
