Remotely Monitored Home-Based Neuromodulation With Transcranial Alternating Current Stimulation (tACS) for Mal de Débarquement Syndrome

Objective: To determine whether remotely-monitored transcranial alternating current stimulation (tACS) may be a viable and safe treatment option for Mal de Débarquement Syndrome (MdDS).Background: Mal de Débarquement Syndrome is a neurotological disorder characterized by persistent oscillating vertigo that is triggered by entrainment to passive oscillatory motion such as occurs during water-based travel. Treatment options for MdDS are limited, variably effective, and can be undone by further travel.Design and Methods: This was a remotely-monitored open-label optional extension phase of a double-blind randomized onsite study of tACS for medically refractory MdDS. The primary goal was to determine safety, feasibility, and blinded participant feedback. The secondary goal was to determine efficacy. Thirteen participants (all women), aged 22–67 years, experiencing a duration of illness of 11–72 months, were a subset of 24 individuals who participated in an on-site study of tACS. They had either not responded to the on-site protocol or had relapsed after travel home. Treatment accessories and a tablet controlled tACS stimulator (Pulvinar XCSITE-100) were mailed to participants. Three teaching sessions were performed via webcam followed by on-going remote monitoring of treatment logs and participants' reports through a daily on-line diary and weekly questionnaires. Treatment continued until an effective protocol was administered for 4 weeks and then tapered over 4 weeks. Participants completed a blinded feedback survey and a debriefing interview at the completion of the entire study.Results: Treatment duration ranged from 4 to 31 weeks followed by a 4-week taper accounting for 578 verified sessions. Of the 13 total participants, seven agreed or agreed strongly in the blinded survey that tACS treatment was beneficial; 2) Twelve were comfortable utilizing tACS on their own; 3) Eleven preferred stimulation above their individual alpha frequency; 4) Side effects were generally mild and typical of tACS. In the debriefing interview completed 2–9 months after the last stimulation, five participants reported doing “great,” with no to minimal symptoms, four reported doing “good,” with moderate symptoms, and four reported no change compared to pre-study baseline.Conclusion: Remotely-monitored tACS may be a safe treatment option for MdDS with the potential for lasting outcomes, increased accessibility, and reduction in travel-related treatment reversal.

Treating chronic migraines with botulinum toxin

Migraine is a common condition that causes significant morbidity. It is often divided into acute and chronic, but there can be overlap between those who have variable frequency acute episodes and those who have chronic migraine with 15 headache-associated days per month. Botulinum toxin is a prophylactic treatment licensed for chronic migraine, where it has been shown to be an effective and safe treatment. It requires approximately 200 units per treatment session, usually at 3-month intervals. The protocols allowing NHS treatment strictly limit its use. Patients may seek this on a private basis, and suitably qualified aesthetic clinicians who are Care Quality Commission-registered could reasonably treat patients.

A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF SHUNTHYADI GUGGULU AND TRAYODASHANGA GUGGULU IN GRIDHRASI

Gridhrasi is a pain predominant Nanatmaja Vata Vyadhi characterised by radiating pain through Sphik, Kati, Prishtha, Uru, Janu, Jangha and Pada in a sequential pattern. A number of medicines are available in market to treat this condition, but are associated with their side effects too. Hence, there arises a need for an effective, yet safe treatment for the suffering population to ease their problems of pain. In light of these considerations a comparative clinical study was planned to assess and compare the efficacy of two formulations, namely Shunthyadi Guggulu and Trayodashanga Guggulu. Statistically significant changes were observed in the symptoms like Ruk, Stambha, Toda, Muhuspandana, Tandra, Gaurava, Aruchi, Time taken to cover the distance of 50ft, SLR Active and Passive test (Affected leg). Keywords: Gridhrasi, Shunthyadi Guggulu, Trayodashanga Guggulu, Sciatica.

A Case of Exfoliative Vesiculobullous Prurigo Pigmentosa Cured by Doxycycline and Topical Tacrolimus

Prurigo pigmentosa is a rare inflammatory skin disease characterized by an unexpected onset of diffuse erythematous papules and macules usually on the chest, neck, and back. These generally resolve, leaving reticular hyperpigmentation. Rarely, vesicular or bullous forms have been reported. We present a case of exfoliative vesiculobullous prurigo pigmentosa in a 13-year-old boy. He presented with symmetrical eruption of papules and vesicles on his back, neck, and chest in the last 10 days, causing pruritis and prickling sensation. Within a few days, the bullous lesions and all affected areas of the skin showed exfoliation. Histological study and clinical findings indicated the condition to be vesiculobullous prurigo pigmentosa with exfoliation. Treatment with doxycycline 200 mg/day and topical tacrolimus ointment showed a good response. The lesions resolved, leaving a light-brown reticulated hyperpigmentation. In conclusion, this was a case of exfoliative vesiculobullous prurigo pigmentosa in an adolescent man successfully treated with doxycycline and topical tacrolimus as an effective and safe treatment option.