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We have updated the migraine prevention guideline of the Canadian Headache Society from 2012, as there are new therapies available, and additionally, we have provided guidelines for the prevention of chronic migraine, which was not addressed in the previous iteration.
Methods:
We undertook a systematic review to identify new studies since the last guideline. For studies identified, we performed data extraction and subsequent meta-analyses where possible. We composed a summary of the evidence found and undertook a modified Delphi recommendation process. We provide recommendations for treatments identified and additionally expert guidance on the use of the treatments available in important clinical situations.
Results:
We identified 61 studies that were included in this evidence update and identified 16 therapies we focused on. The anti-calcitonin gene-related peptide (CGRP) agents were approved by Health Canada between 2018 and 2024 and provide additional options for episodic and chronic migraine prevention. We also summarize evidence for the use of propranolol, topiramate and onabotulinumtoxinA in addition to anti-CGRP agents as treatments for chronic migraine. We have downgraded topiramate to a weak recommendation for use and gabapentin to a weak recommendation against its use in episodic migraine. We have weakly recommended the use of memantine, levetiracetam, enalapril and melatonin in episodic migraine.
Conclusion:
Based on the evidence synthesis, we provide updated recommendations for the prevention of episodic and chronic migraine utilizing treatments available in Canada. We additionally provided expert guidance on their use in clinical situations.
Many astrophysical phenomena can only be studied in detail for objects in our galaxy, the Milly Way, but we know much more about the structure of thousands of nearby galaxies than we do about our own Galaxy. Accurate distance measurements in the Milky Way underpin our ability to understand a wide range of astrophysical phenomena and this requires observations from both the northern and southern hemisphere. Our ability to measure accurate parallaxes to southern masers has been hampered a range of factors, in particular the absence of a dedicated, homogeneous VLBI array in the south. We have recently made significant advances in astrometric calibration techniques which allow us to achieve trigonometric parallax accuracies of around 10 micro-arcseconds (μas) for 6.7 GHz methanol masers with a hetrogeneous array of 4 antennas. We outline the details of this new “multiview” technique and present the first trigonometric parallax measurements that utilise this approach.
Children and youth have tended to be under-reported in the historical scholarship. This collection of essays recasts the historical narrative by populating premodern Scottish communities from the thirteenth to the late eighteenth centuries with their lively experiences and voices. By examining medieval and early modern Scottish communities through the lens of age, the collection counters traditional assumptions that young people are peripheral to our understanding of the political, economic, and social contexts of the premodern era. The topics addressed fall into three main sections: theexperience of being a child/adolescent; representations of the young; and the construction of the next generation. The individual essays examine the experience of the young at all levels of society, including princes and princesses, aristocratic and gentry youth, urban young people, rural children, and those who came to Scotland as slaves; they draw on evidence from art, personal correspondence, material culture, song, legal and government records, work and marriage contracts, and literature.
Janay Nugent is an Associate Professor of History and a founding member of the Institute for Child and Youth Studies at the University of Lethbridge, Alberta, Canada; Elizabeth Ewan is University Research Chair and Professor of History and Scottish Studies at the Centre for Scottish Studies, University of Guelph, Ontario, Canada.
Contributors: Katie Barclay, Stuart Campbell, Mairi Cowan, Sarah Dunnigan, Elizabeth Ewan, Anne Frater, Dolly MacKinnon, Cynthia J. Neville, Janay Nugent, Heather Parker, Jamie Reid Baxter, Cathryn R. Spence, Laura E. Walkling, Nel Whiting.
Diagnostic considerations for juvenile onset Parkinsonism (onset at <21 years of age) include juvenile Huntington disease, Wilson disease, dentatorubral-pallidoluysian atrophy (DRPLA), storage diseases, and mitochondrial cytopathies. Neuronal Intranuclear Inclusion Disease (NIID) must also be considered.
Case Report:
We present a case of juvenile onset NIID with a predominantly Parkinsonian presentation, followed later by corticospinal, cerebellar, and lower motor neuron symptoms.
Conclusion:
Diagnosis of NIID can be made antemortem through rectal biopsy, however it was missed in this case. Rectal biopsy should be performed in all suspected cases, reviewed by an experienced neuropathologist and repeated if the suspicion for NIID is high. Pathologically, SUMO-1 immunohistochemistry appears to reliably label the neuronal inclusions and abnormal SUMOylation may play a part in the pathogenesis.
