Case Report: Ziprasidone induced neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is a well-recognized neurologic emergency. It presents with classic features including hyperthermia, autonomic instability, muscle hypertonia, and mental status changes. The syndrome is potentially fatal and is associated with significant morbidity due to complications such as rhabdomyolysis, acute kidney injury, and ventricular arrhythmias due to the trans-cellular electrolyte shift. NMS is conventionally associated with the first-generation antipsychotic agents, however, has been described with the use of atypical and novel antipsychotics including Ziprasidone. A case of NMS with Ziprasidone use at the therapeutic dose is reported here.

Idiopathic coccygodynia as a ‘mask’ of lesions caused by overload in sports associated with the art of movement

In this study, we analyzed specific manifestations of idiopathic coccygodynia in children and adolescents involved in rhythmic gymnastics and choreography. The experimental group consisted of 34 individuals aged 10 to 14 years with complaints of discomfort and/or pain in the pelvis, sacrum, coccyx, and hip joints, increasing during professional movements and who had no history of injuries. The control group comprised 12 healthy adolescents from the same teams. We evaluated local muscle hypertonia, pain severity (using a visual analog scale) in all study participants. In addition to that, they have undergone sports and choreographic testing and isokinetic examination (using the multiarticular complex ‘Biodex System 4 Pro’). Individuals in the experimental group had a 2-week rehabilitation course that included modification of training; intramuscular injections of 2.0 mL of 0.1% lidocaine solution into the area of muscle hypertonia; application of ointment (2.2 mL); manual therapy; special exercises to relax spasmed muscles). We identified significant difference in pain severity when performing basic choreographic elements between the two groups in the beginning of the study. We also observed a significant decrease in pain in the experimental group after the rehabilitation course. We obtained an indirect proof of the hypothesis that local muscle hypertonia is the leading cause of discomfort and pain. The results of isometric examination suggest that the number of patients with a bilateral difference (according to two of the three parameters studied) significantly differed between participants in the experimental group after a course of physical rehabilitation and controls. This fact can serve as an indirect evidence that hypertonia affects functional activation of muscles, and a 2-week course of physical rehabilitation is not sufficient. The introduction of the concept of ‘sports coccygodynia’ will allow orthopedic traumatologists and sports medicine doctors to focus on several therapeutic and diagnostic measures and to avoid unnecessary instrumental examination, which will significantly increase the effectiveness of patient rehabilitation. Key words: children and adolescents, muscle hypertonia, coccygodynia, lesions caused by overload, choreography, rhythmic gymnastics

Differential chemoreactome analysis of synergistic combinations of tolperisone and nonsteroidal anti-inflammatory drugs

The concurrent use of muscle relaxants and nonsteroidal anti-inflammatory drugs (NSAIDs) is a promising treatment for painful muscle hypertonia and convulsive states.Objective: to identify the most effective and safe synergist combinations of tolperisone and NSAIDs.Material and methods. A differential chemoreactome analysis was employed to evaluate the effects of the muscle relaxant tolperisone and five NSAIDs (dexketoprofen, etoricoxib, meloxicam, naproxen, and diclofenac). The biological activities of the molecules under study were assessed in five sections: 1) inhibition of the proteins of prostaglandin and leukotriene metabolism; 2) inhibition of the effects of the transcription factor nuclear factor kappa, tumor necrosis factor-, and other anti-inflammatory mechanisms; 3) inhibition of excessive blood coagulation and platelet aggregation; 4) vasodynamic effects; 5) antitumor properties on cell lines in culture.Results and discussion. Based on the differences in the pharmacological activity profiles of tolperisone and NSAIDs under study, the investigators identified the most promising synergistic combinations, in which both active ingredients complemented each other as effectively and safely as possible. The obtained estimates of the degree of synergism of various combinations of tolperisone and NSAIDs hold that the most promising antithrombotic, and antitumor effects.Conclusion. The results of this study will help adequately choose combinations of muscle relaxants and NSAIDs in patients with muscle hypertonia, which will be able to improve the efficiency and safety of treatment.