Microvascular Decompression for Patient With Coexistent of Trigeminal Neuralgia, Hemifacial Spasm and Glossopharyngeal Neuralgia- a Case Report

Background: Primary trigeminal neuralgia (TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GN) are common diseases of nervous system, with similar pathogenesis and treatment strategies. Coexistent of such disease, especially coexistent of TN-HFS-GN simultaneously, is very rare. To date, only nine cases have been reported.Case Presentation: A 70-year-old male with a history of hypertension and diabetes complained of severe involuntary contraction for about 10 years, knife-like and lighting-like pain, which was restricted to the distribution of the second and third branches of trigeminal nerve and pharynx and root of tongue, for about 2 years. Coexistent of TN HFS and GN was diagnosed and MVD was carried out. After MVD, the patient completely free from symptoms and no recurrence and hypoesthesia were recorded in 18 months follow up.Conclusion: Here we report the tenth and oldest male patient with coexistent of TN-HFS-GN. Despite limited reports, MVD is the preferred choice for such diseases which can free patients from spasm and neuralgia.

Exercise-associated Muscle Cramps in Runners: A Review

Objective: Exercise-associated Muscle Cramp (EAMC) is an intense, painful, and involuntary contraction of skeletal muscles during a physical activity. Runners are more prone to this syndrome than other athletes. The present paper aims to review of the literature on EAMC in runners to determine the reasons and nature of EAMC in this sports field. Methods: A search was conducted for related studies from 1997 to 2021 in MEDLINE/PubMed, EMBASE/SCOPUS, LILACS, CINAHL, CENTRAL, Web of Science, PEDro, Google Scholar as well as MagIran, IranDoc, IranMedex, MedLib using MeSH Keywords. The reference section of the studies were also checked to find more studies. Finally, 15 eligible papers on EAMC in runners were reviewed and findings were reported. Results: Several factors were found to be effective in EAMC among runners, including dehydration, electrolyte deficit, cold, long training or competition period, increased body temperature during training or competition, history of injury or muscle cramp, increased training intensity in short time, and dietary restrictions. Conclusion: The cause of EAMC in runners seems to be multifactorial.

Dysphagia, dyspepsia, and hiccups

Dysphagia, or difficulty swallowing, is a complex problem. Although patients may present with dysphagia as an issue that requires palliation, other patients may develop dysphagia as a complication of progressive disease and increasing debilitation. The diagnosis of dyspepsia requires patients to be experiencing one or more of the following four problems: epigastric pain, epigastric burning, postprandial fullness, or early satiety. Dyspepsia may occur either as a functional disorder where the cause is not clear or as a secondary disorder. Hiccup, or more correctly, singultus, is a problem where patients experience a sharp and involuntary contraction of the muscles of inspiration which cause a sudden sharp inspiration and closure of the glottis. For most, this is a short-lived experience. This chapter discusses the definition, prevalence, pathophysiology, causes, presenting problems, investigations, and management of dysphagia, dyspepsia, and hiccups.

Açaí: potential anticonvulsant agent

Background: Convulsion is an involuntary contraction of skeletal muscles. When considering vulnerable populations exposed to the mentioned pathophysiological situation, it is recognized that many of them will not have access to the indicated pharmacological treatment. Therefore, the ingestion of açai, Euterpe oleracea (EO) attenuates the problem, acting as an anticonvulsant. Objectives: evaluate the EO as an anticonvulsant agent. Design and setting: It is a bibliographic research and the data collection was done from the PubMed and Scielo databases. Methods: The descriptor used was “Euterpe oleracea” and the inclusion criteria adopted were: articles published in the last five years, available in full and publications related to epilepsy. Results: The EO acts on the GABAergic system when interacting occurs with the GABA receptor of cortical neurons and, above all, of astrocytes in an inhibitory mechanism for the uptake of the neurotransmitter GABA, that accumulates in the synaptic cleft, preventing the exaggerated neurotransmission that causes convulsions. In pentylenetetrazol-induced seizure (PTZ), EO showed some results similar to diazepam: reduced duration of tonic-clonic convulsion and increased latencies for the first myoclonic spasm and for the first generalized tonic-clonic seizure. Conclusions: Studies suggest that EO can be classified as an anticonvulsant, considering its inhibitory activity during synapses. Furthermore, the consumption of EO is more viable at a socioeconomic level compared to traditional drug treatments.

Vaginismus and Infertility

Background: Vaginismus described as persistent or reccurent difficulties for woman to allow vaginal entry of a penis, a finger or there is often avoidance and anticipation, fear or experience of pain, along with variable involuntary contraction of pelvic muscle. Reviews: Vaginismus can lead to unconsummated marriage, and also can be hidden caused of infertility. Vaginismus can be categorized as primary (lifelong), patient has never experiences non painful intercourse or secondary (acquired), patient has previously normal but now experience pain. Vaginismus should be considered as part of differential diagnosis in patient who has no satisfaction in sexual intercourse or do not tolerate penetration. Diagnosis is made by making a good history taking. A variety of intervention have been suggested in some case report study. Effective treatment to vaginismus include sex education, psychosexual therapy, systematic desensitization, anxiolytic and Botulinum Toxin (botox). While there are few controlled studies on the management of vaginismus, they are limited and poorly designed. Summary: Goal of treatment is not only to achieve pregnancy but also increase quality of life. Either natural or assisted, vaginismus is still have to be cured. A great teamwork is required to successfull therapy.

Clinical effectiveness of intradetrusor injections of botulinum toxin type a in dose 100 units in multiple sclerosis patients with neurogenic detrusor overactivity

Intravesical injections of botunulinum toxin type A (BTA) demonstrate good results in treatment of detrusor overactivity symptoms in patients with neurogenic low urinary tract dysfunction (NLUTD) when use in recommended doses of 200 and 300 Units. In clinical practice a government insurance dose not cover the price for the 200 BTA Units and only 100 Units may be injected in patients with neurogenic and nonneurogenic detrusor overactivity. The aim was to evaluate the efficiency of intradetrusor injections of BTA in patients with NLUTD. Materials and methods. The study included 28 MS patients with resistant to medical treatment neurogenic detrusor overactivity. All patients received intradetrusor injections of 100 BTA Units. The results were assessed after 1, 3 and 6 months after procedure. Results. Clinical improvement had been achieved in all 28 patients. According to the urodynamic studies three months after BTA injections maximal cystometric capacity increased by 119.9 37.6% (p 0,05), volume at first detrusor involuntary contraction increased by 74.8 21.4% (p 0,05), maximal detrusor pressure at involuntary contraction decreased by 53.5 29.7% (p 0,05). The NBSS total score decreased from 38.04 14.27 to 29.06 14.46 (p = 0,000), mainly because of questions about incontinence and urgency. SF-Qualiveen total score turned from 2.32 0.70 to 1.61 0.85 (p = 0.000). Before procedure 2 patients performed intermittent catheterization, 4 patients catheterized after BTA injections. Conclusion. Intradetrusor injection of 100 BTA Units in MS patients with NLUTD resulted in improvement of urodynamic parameters followed by reduction of clinical symptoms and life quality improvement for 6 months of observation. Using of BTA low dose didnt provide a total abortion of neurogenic detrusor overactivity symptoms but led to the starting of IC only in 2 patients.

Muscle Cramping During Exercise: Causes, Solutions, and Questions Remaining

Muscle cramp is a temporary but intense and painful involuntary contraction of skeletal muscle that can occur in many different situations. The causes of, and cures for, the cramps that occur during or soon after exercise remain uncertain, although there is evidence that some cases may be associated with disturbances of water and salt balance, while others appear to involve sustained abnormal spinal reflex activity secondary to fatigue of the affected muscles. Evidence in favour of a role for dyshydration comes largely from medical records obtained in large industrial settings, although it is supported by one large-scale intervention trial and by field trials involving small numbers of athletes. Cramp is notoriously unpredictable, making laboratory studies difficult, but experimental models involving electrical stimulation or intense voluntary contractions of small muscles held in a shortened position can induce cramp in many, although not all, individuals. These studies show that dehydration has no effect on the stimulation frequency required to initiate cramping and confirm a role for spinal pathways, but their relevance to the spontaneous cramps that occur during exercise is questionable. There is a long history of folk remedies for treatment or prevention of cramps; some may reduce the likelihood of some forms of cramping and reduce its intensity and duration, but none are consistently effective. It seems likely that there are different types of cramp that are initiated by different mechanisms; if this is the case, the search for a single strategy for prevention or treatment is unlikely to succeed.

Selective Cervical Denervation for Cervical Dystonia: Modification of the Bertrand Procedure

BACKGROUND Cervical dystonia, commonly referred to as spasmodic torticollis, is a neurological disorder characterized by aberrant, involuntary contraction of the muscles of the neck and shoulders. One surgical option that can be considered is selective cervical denervation. OBJECTIVE To report our modification of the Bertrand procedure for selective cervical denervation. METHODS Our modification of the Bertrand procedure for selective cervical denervation is reported with intraoperative photographs and schematic depictions of the operative steps. RESULTS We report our modification of the Bertrand procedure for selective cervical denervation, which consists of a combination of C2-6 denervation, myectomy of the splenius capitis and/or semispinalis capitis, myotomy of the levator scapulae when indicated, and myotomy and selection denervation of the sternocleidomastoid. The combination of techniques utilized depends on the subtype and severity of cervical dystonia. CONCLUSION Our modification of the original Bertrand procedure for selective cervical denervation represents an alternative surgical strategy for the treatment of cervical dystonia, with the potential advantages and disadvantages discussed.

Vaginismus treatment with libido increase and practice

Vaginismus is an involuntary contraction of the vaginal muscles which makes sexual intercourse difficult or impossible. It is one of the more common female psychosexual problems. The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. The aim of the report was to share with readers the cases with common presentations and underlying psychological causes.

Inhale to Breathe Away Pelvic Floor Pain and Enjoy Intercourse

Pain during intercourse (dyspareunia) and involuntary contraction of the outer third of the vagina (vaginismus) affect between 6.5% and 45% of women. The behavioral approach often includes exhaling to the pain or anticipated discomfort. The common instruction is to exhale in anticipation or sensing discomfort, which paradoxically increases pelvic floor tension and discomfort. Thus, clinicians need to instruct patients to practice what seems initially counterintuitive. The appropriate breathing strategy is to teach effortless diaphragmatic (abdominal) breathing in which the pelvic floor relaxes and descends during inhalation and begin the insertion during inhalation. Do not press or insert during exhalation, and continue to breathe until the discomfort has faded out; then insert slightly more during the next inhalation phase. For clinicians, it is important to point out that this process is most successful when the person feels safe and is given enough time to allow the pelvic floor to relax as monitored by lower abdominal electromyography. This concept is illustrated in a case report of a young woman who successfully experienced intercourse after more than two years of marriage.