Autoimmune Peripheral Nervous System Hyperexcitability

A 25-year-old man was seen for assessment of progressive pain. He had a distant history of Guillain-Barré syndrome at age 8 years, at which time he had symmetrical proximal and distal weakness of the upper and lower extremities with loss of ambulation. No facial weakness, dysarthria, dysphagia, ptosis, diplopia, or respiratory weakness occurred. At his initial evaluation there was touch hypersensitivity of the muscles and skin. He had no weakness or cognitive involvement, although the pain made it difficult for him to concentrate. His creatine kinase value improved with hydration, but pain and muscle twitching persisted. On examination, he had diffuse extremity and truncal fasciculations and myokymia and reported pain in not only the areas of twitching but also other areas of his extremities and trunk. On neurophysiologic testing, fibular and tibial motor compound muscle action potentials were decreased in amplitude, with normal ulnar and median motor responses. Needle electromyography of muscles proximally and distally showed diffuse spontaneous firing of muscles ranging in frequency with waxing and waning characteristics. These findings were thought to be consistent with a primary hyperexcitable disorder of muscles with a superimposed old polyradiculoneuropathy and possibly a myopathy. Expanded autoimmune neuroimmunologic testing of serum identified immunoglobulin G-directed cerebellar molecular staining consistent with voltage-gated potassium channel autoantibodies. Radioimmunoprecipitation assay identified voltage-gated potassium channel-immunoglobulin Gs and led to reflex testing for contactin-associated protein 2-immunoglobulin G; autoantibodies were positive. Computed tomography of the chest with contrast was performed, and lymphadenopathy was identified. The patient was clinically diagnosed with contactin-associated protein 2 - immunoglobulin G–positive Isaacs syndrome. A trial of high-dose gabapentin was attempted, with only mild benefits. Next, intravenous immunoglobulin was initiated. Diabetes developed, and he was hospitalized requiring initiation of insulin. His condition is now managed variably with intravenous immunoglobulin and scheduled daily gabapentin. The immune system has long been recognized to help regulate pain via non- immunoglobulin G–mediated mechanisms. Specifically, cytokines decrease the nociceptive nerve fiber thresholds and are released after diverse tissue insults. This allows for speeded healing by increased blood flow and protection of the region by pain guarding mechanisms. It is now recognized that, in rare cases, immunoglobulin G-mediated autoimmunity can lead to otherwise idiopathic pain disorders.

Management of chronic idiopathic pain in patients with dental implant without a clear pathological lesion: A retrospective study

Non-nociceptive, persistent idiopathic facial pain (PIFP) is a poorly localized, continuous dull pain that occurs even in the absence of apparent pathological lesions or clinical neurologic deficiency. This study aimed to investigate the disease characteristics of PIFP that developed after dental implant treatments. The clinical characteristics of pain as well as treatment method and outcomes were retrospectively analyzed in 20 patients diagnosed with PIFP. The patients developed pain either after implant fixation or prosthetic treatment. In most of the patients, the pain persisted not only around the implant region but also at a distant site from the related implant (13/20, 65%). Many patients desired removal of the implants to manage the pain although the pain was not considered to be related to the implant treatment itself. In 12 patients, the related implants were removed but 67% (n = 8/12) of the patients still experienced chronic pain after implant removal. Medication helped decrease the pain in most patients (n = 17). Pregabalin and clonazepam showed relatively higher efficiency than other medications for controlling the pain. The results showed that although the onset of PIFP was related to dental implant treatment, implant removal could not be considered a reliable option for the management of PIFP. Although medication controls the pain at least partially, complete pain control with medication should not be expected. These results demonstrate that an accurate diagnosis of PIFP is important for the selection of appropriate treatment.

Common malabsorption syndromes in different pediatrics age

The process of digestion involve many organs that include the small intestine, pancreas, gall bladder, related blood vessels and lymphatics. The small intestine which constitutes a large surface area of the gastrointestinal tract (GIT). The presence of the villi, absorptive spaces and enzymes directly contribute to the absorption of almost all elements. On the contrary, malabsorption syndromes is a condition that prevent the absorption of certain nutrients and fluids. Our present literature review mainly aimed to discuss the common malabsorption syndromes and their related etiologies in pediatric patients. We have classified our discussion based on the deficient nutrients for easy delivery and based on the specification of the etiology per each nutrient. Many studies have shown that some disease have been previously commonly reported with the development of different malabsorption syndromes such as inflammatory bowel diseases, celiac disease, autoimmune enteropathies and other congenital disorders. Furthermore, patients with malabsorption syndromes usually present with diarrhoea, steatorrhea and other GIT symptoms such as idiopathic pain and flatulence, but there are no specific symptoms associated with any of these syndromes. Efforts should be directed to understand more about the pathophysiology of some disorders, especially the congenital and idiopathic ones in order to achieve a better management and to enhance the prognosis of the affected patients.

Non-surgical Treatment of Coccygodynia with Manual Therapy - Case Report

Introduction: Coccygodynia - pain in the coccyx and tissues lying in its immediate vicinity is a known problem, however, little examined and assessed. The problem affects only 1% of people with spinal problems. This may be for many reasons - from organic to functional, to a number of extra-local causes. Introduction: Coccygodynia - pain in the coccyx and tissues lying in its immediate vicinity is a known problem, however, little examined and assessed. The problem affects only 1% of people with spinal problems. This may be for many reasons - from organic to functional, to a number of extra-local causes. Study aim: The aim of the study is to present the diagnostic process and course of non-surgical - physiotherapeutic treatment - of a 12-year-old boy with idiopathic coccyx pain syndrome using the methodology of manual therapy proposed by Rakowski, with an assessment of immediate and final treatment points. Materials and methods: Research was carried out among a group of 13,793 subjects at the Manual Therapy Centre in Sierosław near Poznań. From this group, individuals with tailbone pain were extracted, which accounts for 1.15% of the remaining participants. The following case report is a representative example selected from the above group. Diagnostics were based on subjective assessment and medical examination (performed at a children's hospital), including medical examination with access through the anus and physiotherapeutic manual examination. Results and conclusions: Coccygodynia requires detailed imaging and functional diagnostics, with particular attention being paid to the structures directly related to the sacro-coccygeal region, as well as to the place lying outside the area of the experienced ailments. The solution to idiopathic pain syndrome in the coccygeal region is targeted manual therapy, taking selected elements of the musculoskeletal structures into account. The described procedure is in line with the methods created by Rakowski, along with local and non-local therapeutic interventions. In the described case, total alleviation of the ailments was achieved, both in short-term assessment and 3 years after completion of treatment.

Maintenance of the Neuroprotective Function of the Amino Group Blocked Fluorescence-Agmatine

Agmatine, an endogenous derivative of arginine, has been found to be effective in treating idiopathic pain, convulsion, stress-mediated behavior, and attenuate the withdrawal symptoms of drugs like morphine. In the early stages of ischemic brain injury in animals, exogenous agmatine treatment was found to be neuroprotective. Agmatine is also considered as a putative neurotransmitter and is still an experimental drug. Chemically, agmatine is called agmatine 1-(4-aminobutyl guanidine). Crystallographic study data show that positively-charged guanidine can bind to the protein containing Gly and Asp residues, and the amino group can interact with the complimentary sites of Glu and Ser. In this study, we blocked the amino end of the agmatine by conjugating it with FITC, but the guanidine end was unchanged. We compared the neuroprotective function of the agmatine and agmatine-FITC by treating them in neurons after excitotoxic stimulation. We found that even the amino end blocked neuronal viability in the excitotoxic condition, by NMDA treatment for 1 h, was increased by agmatine-FITC, which was similar to that of agmatine. We also found that the agmatine-FITC treatment reduced the expression of nitric oxide production in NMDA-treated cells. This study suggests that even if the amino end of agmatine is blocked, it can perform its neuroprotective function.