A Retrospective, Single-Center Study Investigating the Effects of a Novel Miniature Wireless Spinal Cord Stimulation System for the Treatment of Chronic Back and Leg Pain

BACKGROUND: Tietze syndrome is believed to be a result of recurrent microtrauma and characterized by painful localized inflammation and swelling of the chest wall. Chronic inflammatory changes may infiltrate surrounding tissues, leading to nerve root irritation and subsequent neuralgia. Resultant chronic neuropathy has been historically treated with conservative therapies and local nerve blocks, but the role of implantable neurostimulators have not been well described. CASE REPORT: A 73-year-old woman presented with chronic pain in the left paracentral chest area with episodes of burning and tingling, which radiated to the left shoulder, left arm, and left upper side of the jaw and face. Following the implantation of a permanent neurostimulator, the patient reported a near complete resolution of her pain symptoms. CONCLUSION: The role of implantable neurostimulators in the treatment of chronic neuropathy in the setting of Tietze syndrome is promising and their use may become a mainstay option in the future. KEY WORDS: Tietze Syndrome, neuromodulation, spinal cord nerve stimulation, pain management, neuralgia, implantable spinal cord stimulator

Novel Drug-Like Somatostatin Receptor 4 Agonists are Potential Analgesics for Neuropathic Pain

Somatostatin released from the capsaicin-sensitive sensory nerves mediates analgesic and anti-inflammatory effects via the somatostatin sst4 receptor without endocrine actions. Therefore, sst4 is considered to be a novel target for drug development in pain including chronic neuropathy, which is an emerging unmet medical need. Here, we examined the in silico binding, the sst4-linked G-protein activation on stable receptor expressing cells (1 nM to 10 μM), and the effects of our novel pyrrolo-pyrimidine molecules in mouse inflammatory and neuropathic pain models. All four of the tested compounds (C1–C4) bind to the same binding site of the sst4 receptor with similar interaction energy to high-affinity reference sst4 agonists, and they all induce G-protein activation. C1 is the more efficacious (γ-GTP-binding: 218.2% ± 36.5%) and most potent (EC50: 37 nM) ligand. In vivo testing of the actions of orally administered C1 and C2 (500 µg/kg) showed that only C1 decreased the resiniferatoxin-induced acute neurogenic inflammatory thermal allodynia and mechanical hyperalgesia significantly. Meanwhile, both of them remarkably reduced partial sciatic nerve ligation-induced chronic neuropathic mechanical hyperalgesia after a single oral administration of the 500 µg/kg dose. These orally active novel sst4 agonists exert potent anti-hyperalgesic effect in a chronic neuropathy model, and therefore, they can open promising drug developmental perspectives.

Deformities

Deformities are important markers for congenital and hereditary neuromuscular disorders. For example, kyphosis, scoliosis, and pes cavus are common in Charcot-Marie-Tooth (CMT) disease and hereditary ataxias. Deformities such as high feet arches may also result from long-time weakness and asymmetry. Other types of deformities may be related to connective tissue pathology, which can be associated with neuromuscular disorders. Examples include multiple lipomatosis, scleroderma, and nephrogenic systemic sclerosis (NSS). Charcot joint is a result of lack of proprioceptive sensation and is usually associated with severe chronic neuropathy. Deformity of the nose can result from syphilis and leprosy. This chapter shows examples of these deformities and their treatments.

OVERVIEW OF MODERN STUDIES OF COMORBIDITY IN PSORIASIS

Psoriasis is a multifactorial inflammatory skin disease associated with various medical conditions. The article presents an overview associations between psoriasis and ulcerative colitis, diabetes, chronic neuropathy, depressions, lymphomas, malignant processes, especially lymphoproliferation, metabolic syndrome. Patients with psoriasis, particularly if disease is severe, are at increased risk of cardiovascular diseases, such as hypertension, myocardial infarction, and stroke. Have examined the association between psoriasis and glomerulonephritis as well as chronic kidney disease. Factors influencing the course of psoriasis include age, stress, smoking, alcohol, a violation of diet, the presence of chronic obstructive pulmonary disease, sleep apnea, mental disorders The article presents an overview associations between psoriasis and metabolic syndrome. When a subject has three of the five listed criteria, a diagnosis of the metabolic syndrome can be made. The criteria listed include glucose intolerance presenting higher fasting glucose 6,1; increased waist circumference or abdominal obesity (≥ 102 cm for men and ≥ 88 cm for women); raised triglyceride levels ≥ 1.7 mmol/l; reduced high-density lipoprotein < 1.04 mmol/l for men and < 1.30 mmo/l for women; and elevated blood pressure 130/85 mmHg. In patients with psoriasis found a significantly increased prevalence and severity of coronary artery calcification.

Immune-mediated Neuropathies Our Experience over 3 Years

ABSTRACT Introduction: Immune-mediated peripheral neuropathy is the term applied to a spectrum of peripheral nerve disorders where immune dysregulation plays a role. Therefore, they are treatable. We analyzed the cases seen in the past 3 years by us and evaluated the clinical, laboratory, and outcome parameters in these patients. Patients and Methods: Consecutive patients seen by the authors and diagnosed as immune-mediated neuropathy were analyzed for etiology, pathology, and outcome assessed. Results: A total of sixty patients, 31 acute and 29 chronic neuropathies, were identified. Their subtypes treatment and outcome assessed. Males were significantly more in both acute and chronic cases. Miller Fisher 4, AMAN 1, paraplegic type 1, motor dominant type 19, Sensory-motor 1, MADSAM 3, Bifacial 2. Nonsystemic vasculitis was seen in 16 out of 29 chronic neuropathy and HIV, POEMS, and diabetes mellitus one each. Discussion: There is a spectrum of immune-mediated neuropathy which varies in clinical course, response to treatment, etc., Small percentage of uncommon cases are seen. In this group, mortality was nil and morbidity was minimal. Conclusion: Immune-mediated neuropathies are treatable and hence should be diagnosed early for good quality outcome.

Paraproteinemia associated Peripheral Neuropathy

Peripheral Neuropathy can be acute or gradual over the years turning severe and quite debilitating to the patient. Diabetes, Alcohol or Drugs are some of the common causes of neuropathies however a small percentage of patients can present with paraproteinemia. The cause of paraproteinemia in these patients range from benign to serious malignant disorders such as Multiple Myeloma. We here report a case of an elderly patient who had to visit multiple center for over 4 months for his chronic neuropathy. Following extensive workup, he was started on an immunomodulating agent and glucocorticoids. Patient has remained free of disease and symptom free throughout treatment and thereafter.