DOCSLIB.ORG

The Effect of Pulsed Radiofrequency (PRF) for the Treatment of Supraorbital Neuropathic Pain -A Report of Three Cases

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Effect of Pulsed Radiofrequency (PRF) for the Treatment of Supraorbital Neuropathic Pain -A Report of Three Cases Anesth Pain Med 2012; 7: 117～120 ￭Case Report￭ The effect of pulsed radiofrequency (PRF) for the treatment of supraorbital neuropathic pain -A report of three cases- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea Hyun-Min Bae, Young Hoon Kim, Sang-Wook Kim, and Dong Eon Moon Historically, peripheral neuropathic pain has occasionally been is often difficult to treat [1]. Both a systematic review of difficult to treat. Both a systematic review of the evidence as well evidence and a clinical experience show that medical treatment as clinical experience have demonstrated that treatment options provides effective pain relief in only about 50% of patient including polypharmacy provide effective pain relief in only half of the patients with neuropathic pain. After peripheral nerve injury, with neuropathic pain [2]. Recently new interventional method, the incidence of degenerative alterations in the spinal cord and pulsed radiofrequency (PRF) has been introduced for the central pathologic sensitization are possible. Due to this obser- treatment of peripheral neuropathic pain. PRF is a neuromo- vation, It may be difficult to treat this group of patients with peripheral neuropathic pain by therapeutic intervention of the peripheral nerve. dulatory technique that is felt to be safer than conventional Pulsed radiofrequency (PRF) has several benefits for treatment of continuous radiofrequency (CRF). Although the exact mecha- this condition including, accuracy and safety, and the elimination nism of action for PRF is unknown, current literature supports of thermal lesions due to the reduction in the target tissue involvement of electromagnetic fields resulting in neuromodu- temperature (below 42 degrees). We treated three cases of supra- orbital neuropathic pain using PRF, and discovered that two of the lation. Numerous case reports and case series of PRF of patients had significant pain relief at the six month time point. numerous peripheral nerves and ganglions for treatment of (Anesth Pain Med 2012; 7: 117∼120) chronic neuropathic pain can be found in the literature. The majority of the uncontrolled and observational studies are not Key Words: Central sensitization, Peripheral neuropathy, Pulsed radiofrequency, Supraorbital neuropathic pain yet to prove therapeutic effect of PRF in neuropathic pain. We performed PRF in three cases of supraorbital neuralgia, two cases had a good pain relief for six months, but one case had Supraorbital neuropathic pain involves severe sharp pain little. along the route of the supraorbital nerve, and may have symptoms such as allodynia, hyperalgesia, hypoesthesia and CASE REPORTS dysesthesia. Current therapies include medical treatment, supraorbital nerve block, neuromodulation with implanted pulse Case 1 generators. Unlike pain resulting from nociceptive processes, neuropathic pain is associated with primary lesion or disease A 74-year-old male presented with complaint of left fore- of the nervous system itself. Chronic peripheral neuropathic head and temporal pain for 8 months after occurrence of pain sometimes reflects sensitization and altered processing of herpes zoster. He noted a sharp, burning pain, paresthesia, and pain signals by the peripheral and central nervous systems and mild hypoesthesia. Just before his visit, the patient underwent a left supraorbital nerve block and received pregabalin 75 mg Received: January 4, 2012. twice a day, tramadol (75 mg)/acetaminophen (650 mg) combi- Revised: January 27, 2012. nation three times a day in other hospital. He rated his pain Accepted: February 14, 2012. Corresponding author: Dong Eon Moon, M.D., Department of as 70/100 using VAS (consisting of a 100 mm line with 0 on Anesthesiology and Pain Medicine, College of Medicine, The Catholic one end, representing no pain, and 100 on the other, represen- University of Korea, 505, Banpo-dong, Seocho-gu, Seoul 137-040, Korea. ting the worst pain ever experienced) score in first visit. He Tel: 82-2-2258-2236, Fax: 82-2-537-1951, E-mail: [email protected] 117 118 Anesth Pain Med Vol. 7, No. 2, 2012 Fig. 1. Fluoroscopic image shows AP view (A) and lateral view (B) of 22-gauge RF needle, 5 cm with 4 mm active tip inserted supraorbital notch. told us his pain relief for 1 week to undergo a left supraor- After 1 week of her first visit, change of her pain is a little. bital nerve block in other hospital. After 1 week, PRF was She underwent PRF in a left supraorbital nerve in the same performed in a left supraorbital nerve. A radiofrequency method as a case 1, her pain reduced to 30/100 using VAS thermocouple machine (model neuro N50, stockett GmbH, score. Following 2 weeks, her VAS score was 30/100 and we Germany) was used for the procedure. The patient's left reduced her medication to pregabalin 75 mg, tramadol (18.75 forehead was prepped with betadine and draped in a sterile mg)/acetaminophen (162.5 mg) combination twice a day. Her manner. We advanced the 22 gauge, 50 mm radiofrequency VAS score (30/100) was maintained for 6 months. needle with 4 mm active blunt tip via supraorbital notch Case 3 without any anesthetic infiltration under C-arm fluoroscopic guidance (Fig. 1). And stimulating at 50 Hz and 0.5 mA until A 77-year-old female reported of left forehead pain more paresthesia of the patient's left supraorbital nerve concordant than 3 years after occurrence of herpes zoster. She described a with his area of pain was obtained. Paresthesia was detected at sharp pain with dysesthesia, severe hypoesthesia, and dynamic 0.4 volt. After 1% lidocaine 1 ml was injected, PRF was per- allodynia. She rated her pain as 90/100 using VAS score. She formed for 120 second at 42 degrees Celsius. One additional received pregabalin 150 mg, tramadol (37.5 mg)/acetaminophen PRF was given after half turn of the needle. After he (325 mg) combination three times a day. After a left supraor- underwent PRF, his VAS score decreased 10/100. Following 2 bital nerve block was offered, she informed of some pain weeks, he rated his pain as 20/100 using VAS score, and relief for a few hours. After one week, she underwent PRF in reported decreased severity and frequency of pain. We a left supraorbital nerve in the same method as a case 1, there decreased his medication to pregabalin 75 mg twice a day, was little effect in 80/100 using VAS score. Following 2 tramadol (37.5 mg)/acetaminophen (325 mg) combination three weeks, she still complained severe pain. Thereafter her VAS times a day. At 6 months follow up, his VAS score (20/100) score was maintained 70/100 to 90/100. is maintained. Case 2 DISCUSSION We evaluated a 27-year-old female who had a left forehead Neuropathic pain is conceptualized as the result of an area pain for 12 months. 13 months ago, she was placed on aberrant learning process, associated with maladaptive plasticity the implant in left forehead for aesthetic purpose. It was of the nervous system [3]. In the absence of nerve damage, removed 10 months ago because of left forehead area pain. responses to noxious stimuli are reversible. In contrast, the Nevertheless her VAS score of 70/100 was lasted. She com- development of neuropathic pain requires persistent injury or plained sharp pain and hyperalgesia. She underwent a supraor- abnormal function of the peripheral or central nervous system. bital nerve block, her VAS score decreased to 3/10 for 3 Neuropathic pain syndromes may be divided into two groups, days. Medication included pregabalin 75 mg, tramadol (18.75 central and peripheral, based on the location of the nervous mg)/acetaminophen (162.5 mg) combination three times a day. system lesion. In fact, alterations of central nervous system Hyun-Min Bae, et al：Pulsed radiofrequency for supraorbital neuropathic pain 119 physiology may play an important role in many of the panied severe symptoms with dysesthesia, sensory loss, dyna- neuropathic pain conditions connected with peripheral patho- mic allodynia for more than 3 years. We thought that the logy, being difficult to differentiate certainly between peripheral patient had great central component of pain generation to be and central pain [4]. When conservative treatment including considered his severe symptoms. If central sensitization is medical therapy was not effective in neuropathic pain, PRF induced in the patient, PRF in peripheral nerve alone may also may be used in the additional treatment. have little effect. We assumed that one case had no effect of CRF and PRF are 2 types of RF that are used clinically. In PRF because of central sensitization. We guessed that the general, the advantage of RF includes the ability to stimulate patients of successful cases had generally a little or little neural elements before lesioning, thereby offering precise central component of pain generation. Because the patients targeting with avoidance of ablating the wrong nerves and have generally mild to moderate symptoms as follows: static providing long-lasting analgesia [5]. PRF is a newer alternative allodynia, sharp pain, paresthesia, burning pain, and relatively to CRF with the proposed advantage of avoiding the compli- short duration [8-10]. cation of deafferentation pain and unintended nerve damage Central sensitization has been altered the particular functional that infrequently can be seen after neural ablation. It uses states of circuits in the CNS and no longer directly reflects radiofrequency current in short (20 ms), high-voltage bursts the specific qualities of peripheral noxious stimuli [12]. At the and the silent phase (480 ms) to allow time for heat elimina- time of peripheral injury, an abnormal injury discharge may be tion. Generally, keeping the target tissue below 42 degrees sufficient to produce long term changes in the excitability of Celsius, so PRF does not cause thermal lesions [6].
Load more

Recommended publications
  • Cervical Schwannoma: Report of Four Cases
    25-Cervical_3-PRIMARY.qxd 7/10/12 5:22 PM Page 345 CASE REPORT Cervical Schwannoma: Report of Four Cases Rohaizam Jaafar, MD (UKM), Tang Ing Ping, MS ORL-HNS (UM), Doris Evelyn Jong Yah Hui, MS ORL-HNS (UKM), Tan Tee Yong, MS ORL-HNS (UM), Mohammad Zulkarnaen Ahmad Narihan, MPATH (UKM) School of Health Sciences, Health Campus, Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. SUMMARY Physical examination revealed a 3 x 3 cm mass located at Extracranial schwannomas in the head and neck region are right lateral upper third of the cervical region. The mass was rare neoplasms. The tumours often present as asymptomatic, firm, mobile and non-tender. She had a right facial nerve slowly enlarging lateral neck masses and determination of palsy (House-Brackman Grade IV) due to a previous operation the nerve origin is not often made until the time of surgery. for a right acoustic neuroma in 2000 and a right supraorbital Preoperative diagnosis maybe aided by imaging studies such wound for a plexiform schwannoma in 2007. as magnetic resonance imaging or computed tomography, while open biopsy is no longer recommended. The accepted A computed tomography of the neck and thorax was treatment for these tumors is surgical resection with performed and showed a well defined, minimally enhancing preservation of the neural pathway. We report four cases of lesion at the left parapharyngeal space measuring 2.4 x 4.3 x cervical schwannomas that we encountered at our center 10 cm. The left carotid sheath vessel is displaced medially. during four years of period.
    [Show full text]
  • Case Report Head and Neck Schwannomas: a Surgical Challenge—A Series of 5 Cases
    Hindawi Case Reports in Otolaryngology Volume 2018, Article ID 4074905, 10 pages https://doi.org/10.1155/2018/4074905 Case Report Head and Neck Schwannomas: A Surgical Challenge—A Series of 5 Cases Ishtyaque Ansari,1 Ashfaque Ansari,2 Arjun Antony Graison ,2 Anuradha J. Patil,3 and Hitendra Joshi2 1Department of Neurosurgery, MGM Medical College & Hospital, Aurangabad, India 2Department of ENT, MGM Medical College & Hospital, Aurangabad, India 3Department of Plastic Surgery, MGM Medical College & Hospital, Aurangabad, India Correspondence should be addressed to Arjun Antony Graison; [email protected] Received 25 September 2017; Accepted 29 January 2018; Published 4 March 2018 Academic Editor: Abrão Rapoport Copyright © 2018 Ishtyaque Ansari et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Schwannomas, also known as neurilemmomas, are benign peripheral nerve sheath tumors. +ey originate from any nerve covered with schwann cell sheath. Schwannomas constitute 25–45% of tumors of the head and neck. About 4% of head and neck schwannomas present as a sinonasal schwannoma. Brachial plexus schwannoma constitute only about 5% of schwannomas. Cervical vagal schwannomas constitute about 2–5% of neurogenic tumors. Methods. We present a case series of 5 patients of schwannomas, one arising from the maxillary branch of trigeminal nerve in the maxillary sinus, second arising from the brachial plexus, third arising from the cervical vagus, and two arising from cervical spinal nerves. Result. Complete extracapsular excision of the tumors was achieved by microneurosurgical technique with preservation of nerve of origin in all except one.
    [Show full text]
  • Tumors of the Brachial Plexus (XI-1)
    E. LOCAL SYNDROMES OF THE UPPER LIMBS AND RELATIVELY GENERALIZED SYNDROMES OF THE UPPER AND LOWER LIMBS GROUP XI: PAIN IN THE SHOULDER, ARM, AND HAND Tumors of the Brachial Plexus (XI-1) Definition Progressive aching, burning pain with paresthesias and sensory and motor impairment in the distribution of a branch or branches of the brachial plexus due to tumor. Site Shoulder and upper limb. System Nervous system. Tumors Benign tumors: schwannoma, neurofibroma. Malignant tumors: malignant schwannoma and fibrosarcoma, metastatic neoplasm or direct invasion from other lesion, neuroblastoma, ganglioneuroma (secondary neoplasia of peripheral nerves occurs frequently in lymphoma, leukemia, multiple myeloma). Breast, lung and thyroid neoplasia frequently involve the brachial plexus. Main Features Incidence: the specific tumors of peripheral nerve are extremely rare. Sex Ratio: there is no sex predilection. Age of Onset: young adulthood. They are more common with von Recklinghausen’s disease. Pain Quality: the pain tends to be constant, gradual in onset, aching, and burning, and associated with paresthesias in the distribution of the pain, progressive wasting of muscles depending upon what groups are involved, and sensory loss. Intensity: severe. Associated Symptoms The pain is generally not affected by activity. There is associated sensory loss and muscle wasting depending upon the area of the brachial plexus involved. Pain relief is often not adequate, even with significant narcotics. Signs and Laboratory Findings The laboratory findings are those of the underlying disease. Signs are loss of reflexes, sensation, and muscle strength in the distribution of the involved portion of the plexus. There may be a local mass. The diagnosis is usually made promptly by X-ray or by CT scan.
    [Show full text]
  • Sciatic Neuropathy from a Giant Hibernoma of the Thigh: a Case Report
    A Case Report & Literature Review Sciatic Neuropathy From a Giant Hibernoma of the Thigh: A Case Report Salim Ersozlu, MD, Orcun Sahin, MD, Ahmet Fevzi Ozgur, MD, and Tolga Akkaya, MD ibernomas—rare, uniformly benign soft-tissue the gastrocnemius/soleus, posterior tibialis, and toe flexors tumors of brown fat—were originally described (tibial nerve-innervated muscles); and sensory abnormali- in 1906 by Merkel.1 These tumors are usually ties throughout the entire sciatic nerve distribution. The found in the scapular2 and posterior cervical common peroneal, posterior tibial, superficial peroneal, Hregions or (more rarely) in the folds of the buttocks or on and sural nerves were electrodiagnostically evaluated, and the thigh.3-5 reduced amplitude in the peroneal and the tibialis poste- Sciatic neuropathy is an infrequently diagnosed focal rior nerves was detected. Sensory nerve conduction of the mononeuropathy. Few case reports of lipomas compressing superficial peroneal and sural nerves in the left leg was the sciatic nerve or its peripheral branches have appeared in less than that in the right leg. These findings confirmed the literature.6-8 The present case report is to our knowledge active motor and sensory sciatic mononeuropathy of the the first on sciatic nerve palsy caused by a hibernoma. left leg. Plain x-rays of the left leg showed a large soft-tissue CASE REPORT mass without calcification. Magnetic resonance imaging A woman in her early 30s was referred to our clinic with a (MRI) of the left leg revealed a well-circumscribed large painless left-side posterior thigh mass that had been slowly soft-tissue mass that was 27 cm at its maximum dimen- enlarging over 5 years.
    [Show full text]
  • Scalp Dysesthesia. Case Report Disestesia Do Escalpo
    BrJP. São Paulo, 2020 jan-mar;3(1):86-7 CASE REPORT Scalp dysesthesia. Case report Disestesia do escalpo. Relato de caso Letícia Arrais Rocha1, João Batista Santos Garcia1, Thiago Alves Rodrigues1 DOI 10.5935/2595-0118.20200016 ABSTRACT RESUMO BACKGROUND AND OBJECTIVES: Scalp dysesthesia is JUSTIFICATIVA E OBJETIVOS: A disestesia do escalpo ca- characterized by the presence of several localized or diffuse symp- racteriza-se pela presença de diversos sintomas localizados ou toms, such as burning, pain, pruritus or stinging sensations, wi- difusos, como queimação, dor, prurido ou sensações de picada, thout objective findings in the physical examination of the pa- sem achados objetivos no exame físico do paciente que possam tient that can explain and link the existing symptomatology to explicar e ligar os sintomas existentes à alguma outra etiologia. some other etiology. The aim of this study was to describe a case O objetivo deste estudo foi descrever um caso de disestesia de of scalp dysesthesia, from its clinical and laboratory investigation escalpo, desde a sua investigação clínica e laboratorial, até a con- and the conduct adopted. duta adotada. CASE REPORT: A 38-year-old male patient, first assigned to RELATO DO CASO: Paciente do sexo masculino, 38 anos. Pri- the Dermatology Service, with complaints of pruritus in the meiramente foi ao serviço de Dermatologia com queixa de pru- scalp for 5 years. In the consultation at the Pain Service, the pa- rido em couro cabeludo há cinco anos. Na consulta do Serviço tient complained of daily, intermittent and burning dysesthetic de Dor, o paciente queixava-se de sensações disestésicas como: sensations, such as tingling and pruritus in the bipariethoccipital formigamento e prurido em região biparieto-occipital que piora region, worsening with heat and associated with severe pain in com o calor, associada à dor de forte intensidade, diária, intermi- the cervical region.
    [Show full text]
  • Pain and Dysesthesia in Patients with Spinal Cord Injury: a Postal Survey
    Spinal Cord (2001) 39, 256 ± 262 ã 2001 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/01 $15.00 www.nature.com/sc Original Article Pain and dysesthesia in patients with spinal cord injury: A postal survey NB Finnerup*,1, IL Johannesen2, SH Sindrup3, FW Bach1 and TS Jensen1 1Department of Neurology and Danish Pain Research Centre, University Hospital of Aarhus, Denmark; 2Department of Rheumatology, Viborg Hospital, Denmark; 3Department of Neurology, Odense University Hospital, Denmark Study design: A postal survey. Objectives: To assess the prevalence and characteristics of pain and dysesthesia in a community based sample of patients with spinal cord injury (SCI) with special focus on neuropathic pain. Setting: Community. Western half of Denmark. Methods: We mailed a questionnaire to all outpatients (n=436) of the Viborg rehabilitation centre for spinal cord injury. The questionnaire contained questions regarding cause and level of spinal injury and amount of sensory and motor function below this level. The words pain and unpleasant sensations were used to describe pain (P) and dysesthesia (D) respectively. Questions included location and intensity of chronic pain or dysesthesia, degree of interference with daily activity and sleep, presence of paroxysms and evoked pain or dysesthesia, temporal aspects, alleviating and aggravating factors, McGill Pain Questionnaire (MPQ) and treatment. Results: Seventy-six per cent of the patients returned the questionnaire, (230 males and 100 females). The ages ranged from 19 to 80 years (median 42.6 years) and time since spinal injury ranged from 0.5 to 39 years (median 9.3 years). The majority (475%) of patients had traumatic spinal cord injury.
    [Show full text]
  • Chemotherapy-Induced Neuropathy and Diabetes: a Scoping Review
    Review Chemotherapy-Induced Neuropathy and Diabetes: A Scoping Review Mar Sempere-Bigorra 1,2 , Iván Julián-Rochina 1,2 and Omar Cauli 1,2,* 1 Department of Nursing, University of Valencia, 46010 Valencia, Spain; [email protected] (M.S.-B.); [email protected] (I.J.-R.) 2 Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain * Correspondence: [email protected] Abstract: Although cancer and diabetes are common diseases, the relationship between diabetes, neuropathy and the risk of developing peripheral sensory neuropathy while or after receiving chemotherapy is uncertain. In this review, we highlight the effects of chemotherapy on the onset or progression of neuropathy in diabetic patients. We searched the literature in Medline and Scopus, covering all entries until 31 January 2021. The inclusion and exclusion criteria were: (1) original article (2) full text published in English or Spanish; (3) neuropathy was specifically assessed (4) the authors separately analyzed the outcomes in diabetic patients. A total of 259 papers were retrieved. Finally, eight articles fulfilled the criteria, and four more articles were retrieved from the references of the selected articles. The analysis of the studies covered the information about neuropathy recorded in 768 cancer patients with diabetes and 5247 control cases (non-diabetic patients). The drugs investigated are chemotherapy drugs with high potential to induce neuropathy, such as platinum derivatives and taxanes, which are currently the mainstay of treatment of various cancers. The predisposing effect of co-morbid diabetes on chemotherapy-induced peripheral neuropathy depends on the type of symptoms and drug used, but manifest at any drug regimen dosage, although greater neuropathic signs are also observed at higher dosages in diabetic patients.
    [Show full text]
  • Numb Chin Sydrome : a Subtle Clinical Condition with Varied Etiology
    OLGU SUNUMU / CASE REPORT Gülhane Tıp Derg 2015;57: 324 - 327 © Gülhane Askeri Tıp Akademisi 2015 doi: 10.5455/gulhane.44276 Numb chin sydrome : A subtle clinical condition with varied etiology Devika SHETTY (*), Prashanth SHENAI (**), Laxmikanth CHATRA (**), KM VEENA (**), Prasanna Kumar RAO (**), Rachana V PRABHU (**), Tashika KUSHRAJ (**) SUMMARY Introduction One of the rare neurologic symptoms characterized by hypoesthesia or Numb Chin Syndrome (NCS) is a sensory neuropathy cha- paresthesia of the chin and the lower lip, limited to the region served by the mental nerve is known as Numb chin syndrome. Vast etiologic factors have been racterized by altered sensation and numbness in the distribu- implicated in the genesis of numb chin syndrome. Dental, systemic and malignant tion of the mental nerve, a terminal branch of the mandibular etiologies have been well documented. We present a case of a 59 year old female patient who reported with all the classical features of numb chin syndrome. On division of trigeminal nerve. Any dysfunction along the course magnetic resonance imaging, the vascular compression of the trigeminal nerve of trigeminal nerve and its branches, intracranially and ext- root was evident which has been infrequently documented to be associated with racranially either by direct injury or compression of the nerve the condition. We have also briefly reviewed the etiology and pathogenesis of 1 numb chin syndrome and also stressed on the importance of magnetic resonance can predispose to NCS. Various etiologic factors have been imaging as an investigative modality in diagnosing the condition. considered of which dental procedures and dental pathologies Key Words: Numb Chin Syndrome, Mental nerve neuropathy, trigeminal nerve root, are the most common benign causes.
    [Show full text]
  • COVID-19 Vaccine (Vero Cell), Inactivated (Sinopharm) Manufacturer: Beijing Institute of Biological Products Co., Ltd
    COVID-19 Vaccine Explainer 24 MAY 20211 COVID-19 Vaccine (Vero Cell), Inactivated (Sinopharm) Manufacturer: Beijing Institute of Biological Products Co., Ltd The SARS-CoV-2 Vaccine (VeroCell) is an inactivated vaccine against coronavirus disease 2019 (COVID-19) which stimulates the body’s immune system without risk of causing disease. Once inactivated viruses get presented to the body’s immune system, they stimulate the production of antibodies and make the body ready to respond to an infection with live SARS-CoV-2. This vaccine is adjuvanted (with aluminum hydroxide), to boost the response of the immune system. A large multi-country phase 3 trial has shown that two doses administered at an interval of 21 days had the efficacy of 79% against symptomatic SARS-CoV-2 infection 14 days or more after the second dose. The trial was not designed and powered to demonstrate efficacy against severe disease. Vaccine efficacy against hospitalization was 79%. The median duration of follow up available at the time of review was 112 days. Two efficacy trials are underway. The data reviewed at this time support the conclusion that the known and potential benefits of Sinopharm vaccine outweigh the known and potential risks. Date of WHO Emergency Use Listing (EUL) recommendation: 7 May 2021 Date of prequalification (PQ): currently no information National regulatory authorities (NRAs) can use reliance approaches for in-country authorization of vaccines based on WHO PQ/EUL or emergency use authorizations by stringent regulatory authorities (SRAs). Product characteristics Presentation Fully liquid, inactivated, adjuvanted, preservative-free suspension in vials and AD pre-filled syringes Number of doses Single-dose (one dose 0.5 mL) Vaccine syringe type Two available presentations: and needle size 1.
    [Show full text]
  • Neuromyotonia with Polyneuropathy, Prominent Psychoorganic Syndrome
    Ehler and Meleková Journal of Medical Case Reports (2015) 9:101 DOI 10.1186/s13256-015-0581-0 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Neuromyotonia with polyneuropathy, prominent psychoorganic syndrome, insomnia, and suicidal behavior without antibodies: a case report Edvard Ehler* and Alena Meleková Abstract Introduction: Peripheral nerve hyperexcitability disorders are characterized by constant muscle fiber activity. Acquired neuromyotonia manifests clinically in cramps, fasciculations, and stiffness. In Morvan’s syndrome the signs of peripheral nerve hyperexcitability are accompanied by autonomic symptoms, sensory abnormalities, and brain disorders. Case presentation: A 70-year-old Caucasian man developed, in the course of 3 months, polyneuropathy with unpleasant dysesthesia of lower extremities and gradually increasing fasciculations, muscle stiffness and fatigue. Subsequently, he developed a prominent insomnia with increasing psychological changes and then he attempted a suicide. Electromyography confirmed a sensory-motor polyneuropathy of a demyelinating type. The findings included fasciculations as well as myokymia, doublets and multiplets, high frequency discharges, and afterdischarges, following motor nerve stimulation. No auto-antibodies were found either in his blood or cerebrospinal fluid. Magnetic resonance imaging of his brain showed small, unspecific, probably postischemic changes. A diagnosis of Morvan’s syndrome was confirmed; immunoglobulin (2g/kg body weight) was applied intravenously, and, subsequently,
    [Show full text]
  • Chronic Cryptogenic Sensory Polyneuropathy Clinical and Laboratory Characteristics
    ORIGINAL CONTRIBUTION Chronic Cryptogenic Sensory Polyneuropathy Clinical and Laboratory Characteristics Gil I. Wolfe, MD; Noel S. Baker, MD; Anthony A. Amato, MD; Carlayne E. Jackson, MD; Sharon P. Nations, MD; David S. Saperstein, MD; Choon H. Cha, MD; Jonathan S. Katz, MD; Wilson W. Bryan, MD; Richard J. Barohn, MD Background: Chronic sensory-predominant polyneu- duration of symptoms of 62.9 months. Symptoms al- ropathy (PN) is a common clinical problem confronting most always started in the feet and included distal numb- neurologists. Even with modern diagnostic approaches, ness or tingling in 86% of patients and pain in 72% of many of these PNs remain unclassified. patients. Despite the absence of motor symptoms at pre- sentation, results of motor nerve conduction studies were Objective: To better define the clinical and laboratory abnormal in 60% of patients, and electromyographic evi- characteristics of a large group of patients with crypto- dence of denervation was observed in 70% of patients. genic sensory polyneuropathy (CSPN) evaluated in 2 uni- Results of laboratory studies were consistent with axo- versity-based neuromuscular clinics. nal degeneration. Patients with and without pain were similar regarding physical findings and laboratory test ab- Design: Medical record review of patients evaluated normalities. Only a few patients (,5%) had no evi- for PN during a 2-year period. We defined CSPN on dence of large-fiber dysfunction on physical examina- the basis of pain, numbness, and tingling in the distal tion or electrophysiologic studies. All 66 patients who extremities without symptoms of weakness. Sensory had follow-up examinations (mean, 12.5 months) re- symptoms and signs had to evolve for at least 3 mained ambulatory.
    [Show full text]
  • Thesis Formatted
    Identifying and Treating Neuropathic Pain in Dogs with Syringomyelia Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Ashley C. Hechler, DVM Graduate Program in Comparative Veterinary Medicine The Ohio State University 2019 Thesis Committee Sarah A. Moore, DVM, MS, DACVIM, Advisor Lynette K. Cole, DVM, DACVD Laurie B. Cook, DVM, DACVIM Eric T. Hostnik, DVM, MS, DACVR Copyrighted by Ashley C. Hechler, DVM 2019 Abstract Syringomyelia (SM) is a debilitating condition in the cavalier King Charles spaniel (CKCS) that results in neuropathic pain and diminished quality of life. Von Frey aesthesiometry (VFA) is a method of mechanical quantitative sensory testing that provides an objective sensory threshold (ST) value and can be used to quantify neuropathic pain and monitor response to therapy. The utility of VFA has been previously established in client-owned dogs with acute spinal cord injury and osteoarthritis but the technique has not been evaluated in dogs with SM. The goal of this study was to evaluate ST, as determined by VFA, in dogs with and without SM, to assess the utility of VFA in quantifying NP in SM-affected dogs. We hypothesized the SM- affected CKCS would have lower ST values consistent with hyperesthesia, when compared to control CKCS. Additionally, we hypothesized that ST values in SM-affected dogs would be inversely correlated with syrinx size on MRI and with owner-derived clinical sign scores. ST values for the thoracic and pelvic limbs differed significantly between SM-affected and control CKCS (p=0.027; p=0.0396 respectively).
    [Show full text]