Assessment of the Effect of Raga Therapy & Nisha Amalaki Churna on Prehypertension - A clinical study

Background: Prehypertension is classified as elevated blood pressure above normal by American medical classification. JNC 7 suggested systolic between 120 to 139 mmHg or diastolic 80 to 89 mmHg should be consider as Pre-hypertension. Oxidative stress develops due to stress and anxiety is recognized as main risk factor for initiation of hypertension. The Nada Yoga (sound based yoga) practices has been reported to decreases stress and anxiety. Nisha Amalaki Churna the combination of Amalaki (Indian gooseberry) and Haridra (turmeric) powder also reported to effectively reduces oxidative stress. Aim - To assess the combined effect of Indian Classical Raga Ahirbhairav and Hindol along with Nisha Amalaki Churna on Prehypertension. Material and method- It was clinical study. Total 48 patients selected by purposive sample technique and then divided into 2 groups (n = 24 each) randomly. Assessment was done by criteria of pre hypertension given by JNC 7. Result - In present study group A (Raga Ahirbhairav, Raga Hindol and Nisha Amalki Churna) patients the mean score of Systolic B.P. had decreased from 135.50 to 120.76 (Mean difference 14.74) with extremely significance (p <0.0001) compare to group B (only Nisha Amalki Churna orally) and mean score of Diastolic B.P. had decreased from 88.61 to 79.706 (Mean difference 8.904) with extremely significant (p <0.0001) compare to group B. Relief in mild headache 31.94% (p<0.01), relief in Anxiety 52.67% (p<0.0001) and relief on stress was reported 34.56% (p<0.0001) in Group A were reported, compare to Group B. Conclusion- result of study indicating that Raga therapy with Nisha Amalaki Churna had potential in the management of pre hypertension.

The effect of potent CYP2D6 inhibition on the pharmacokinetics and safety of deutetrabenazine in healthy volunteers

Purpose Deutetrabenazine is a deuterated form of tetrabenazine with a confirmed lower rate of CYP2D6 metabolism of the active metabolites, α- and β-HTBZ. In this study, we assessed the effect of paroxetine, a potent CYP2D6 inhibitor, on the pharmacokinetics and safety of deutetrabenazine and its metabolites. Methods In this open-label sequential drug-drug-interaction study, 24 healthy adults who were CYP2D6 extensive or intermediate metabolizers received a single deutetrabenazine 22.5-mg oral dose on days 1 and 11 and a single paroxetine 20-mg oral daily dose on days 4–12. Pharmacokinetics of deutetrabenazine and its metabolites were assessed on days 1–4 and 11–14. Paroxetine trough concentrations were obtained pre-dose on days 9–13. Safety examinations occurred throughout the study. Results Paroxetine administered under steady-state conditions, increased exposure of the deuterated active metabolites, α-HTBZ (1.2-fold Cmax and 1.8-fold AUC0–∞) and β-HTBZ (2.1-fold Cmax and 5.6-fold AUC0–∞), and correspondingly, 1.6-fold Cmax and threefold AUC0–∞ for total (α + β)-HTBZ. Sixteen subjects reported 45 adverse events and most were mild. Headache was the most common AE reported 8 times by 7 subjects (5 following paroxetine alone; 2 following deutetrabenazine + paroxetine). Conclusions Paroxetine-induced increases in exposure to the active deutetrabenazine metabolites were less than those previously reported for tetrabenazine, a finding expected to reduce the burden of drug interaction. In addition, single doses of 22.5 mg deutetrabenazine, when given alone or in the presence of steady-state paroxetine (20 mg daily), were safe.

One-and-a-half Syndrome Associated with Multiple Sclerosis in a 14-year-old Girl

Purpose: To report the case of a 14-year-old female patient with one-and-a-half syndrome subsequently diagnosed with multiple sclerosis involving the pons.Case summary: A 14-year-old girl without any underlying disease presented with difficulty focusing and mild headache for 5 days. The patient showed conjugate gaze palsy to the left, limited adduction in the left eye, and abducting nystagmus in the right eye, which indicated one-and-half syndrome. T2 fluid-attenuated inversion recovery brain magnetic resonance imaging revealed multiple punctate hyperintensities in the pontine tegmentum, bilateral cerebral white matter, and cerebellum. Cerebrospinal fluid examination revealed oligoclonal bands and multiple sclerosis was diagnosed. The patient was treated with intravenous steroids and beta-interferon. Seven weeks later, limitation of eyeball movement and nystagmus had resolved completely.Conclusions: At the young age of 14 years, a patient presenting with one-and-a-half syndrome was diagnosed with multiple sclerosis. Children with multiple sclerosis may experience severe physical and cognitive impairments, and brainstem involvement predicts an especially poor prognosis. Early diagnosis and active treatment may help to prevent poor outcomes.

Vestibular neuronitis of idiopathi origin: a case report

Vestibular Neuronitis is a neuronal condition characterized by spontaneous and unilateral vestibular loss suddenly with preserved hearing and no signs of brain stem dysfunction. According to large population studies, it is the sixth cause of vertigo with an incidence of 8%. Here is the case report of VN which was observed in a super speciality hospital. A 42 years old male patient was admitted in a private super speciality hospital with the chief complaints of history of vomiting 4 episodes, neck pain, mild headache and gaint imbalance since 5 days. Complete analysis of diagnostic reports was done and appropriate treatment given. This case emphasizes the importance of periodic evaluation and reporting of vestibular neuritis cases accumulating clinical knowledge. In this particular type of cases it is difficult to identify the etiology and pathophysiology, hence it is vitally important to conduct such studies.

Acute-onset diplopia from intracranial hypertension due to torcular herophili obstruction by an hemorrhagic intradiploic epidermoid cyst

Background: Epidermoid cysts are benign slow-growing congenital lesions, constituting approximately 1% of all cranial tumors. Most of these lesions are located intradurally, while about 10–25% of them are located within the diploic spaces. Intradiploic epidermoid cysts are usually discovered incidentally and may remain asymptomatic for many years, but in rare instances, they may grow intracranially and produce brain compression. Sometimes, intradiploic epidermoid cysts may occlude the main cranial venous sinuses causing intracranial hypertension. Case Description: We present the case of a 24-year-old male harboring a paramedian right occipital intradiploic cyst with erosion of both outer and inner bony tables, which occluded the torcular herophili producing a worsening symptomatology with acute-onset diplopia from right sixth cranial nerve palsy; the patient also presented bilateral papilledema, but only reported mild headache and dizziness. Neuroradiological studies evidentiated a lesion compatible with intradiploic epidermoid cyst with intralesional hemorrhagic component, overlying and almost completely occluding the torcular herophili. Considering the fast worsening of symptomatology and the evidence of intracranial hypertension, the patient was operated on immediately after completion of clinical and radiological assessment. The lesion was radically removed with almost immediate reversal of signs and symptoms. Histopathology confirmed the diagnosis of epidermoid cyst with intralesional hemorrhagic components. Conclusion: Intradiploic epidermoid cysts may cause intracranial hypertension by occlusion of main cranial venous sinuses; intralesional hemorrhage may act as precipitating factor in occlusion of the torcular herophili, producing rapidly worsening intracranial hypertension, which requires prompt surgical treatment to reverse symptomatology. Radical surgical resection is necessary to avoid recurrence.

BEYOND PSEUDO-ACCOMODATIVE CORNEA LASIK (PAC LASIK). A PERSONAL INSIGHT

Laser in-situ keratomieleusis (LASIK) is a common intervention for young, active, ametropic individuals to improve their visual acuity. pseudo-accommodative cornea (PAC), a variant of LASIK, to correct ametropia among presbyopic patients is proven in maintaining good distant vision; yet, the satisfactory spectacle free reading vision is limited to the ageing progression. However, successful treatments do not guarantee patient’s satisfaction. Assesment of the objective topographic indicators, visual acuity, higher order abrasion, and contrast sensitivity; revealed the clarification of a mild headache as a personal subjective experience after the treatment. The role of the persistent, dominant eye, the brain perception, seems to be critical factor to a patient’s satisfaction. To a certain degree, the interplay amongst the optical part and it’s supporting tissue, within and between the eyeballs, as well as its relationship to the neurosensory parts of the visual systems after Lasik surgery have not yet been assessed and reported elsewhere.

Case Study of a 22-year-old student suffering from crippling migraine attacks

A 22 year old patient with symptoms of intense migraine with history of headaches that sometimes lasted upto 2 days have made her bedridden completely. The patient ignored the mild headache which were started 4 years back. Slowly the episodes started increasing in intensity and duration ultimately culminating in a fear psychosis as the attacks did not have any fixed pattern and could strike anywhere at any time. The patient consulted many consulted several doctors for many months and had even tried acupressure but failed to find any relief from the headache. The patient approached Rudraksh Ashtang Yoga Center and enrolled herself for Yoga therapy. After 6 months of Yoga intervention the patient was back to her normal routine life.

Severities in persistent mild traumatic brain injury related headache is associated with changes in supraspinal pain modulatory functions

Emerging evidence suggests mild traumatic brain injury related headache (MTBI-HA) is a form of neuropathic pain state. Previous supraspinal mechanistic studies indicate patients with MTBI-HA demonstrate a dissociative state with diminished levels of supraspinal prefrontal pain modulatory functions and enhanced supraspinal sensory response to pain in comparison to healthy controls. However, the relationship between supraspinal pain modulatory functional deficit and severity of MTBI-HA is largely unknown. Understanding this relationship may provide enhanced levels of insight about MTBI-HA and facilitate the development of treatments. This study assessed pain related supraspinal resting states among MTBI-HA patients with various headache intensity phenotypes with comparisons to controls via functional magnetic resonance imaging (fMRI). Resting state fMRI data was analyzed with self-organizing-group-independent-component-analysis in three MTBI-HA intensity groups (mild, moderate, and severe) and one control group (n = 16 per group) within a pre-defined supraspinal pain network based on prior studies. In the mild-headache group, significant increases in supraspinal function were observed in the right premotor cortex (T = 3.53, p < 0.001) and the left premotor cortex (T = 3.99, p < 0.0001) when compared to the control group. In the moderate-headache group, a significant (T = −3.05, p < 0.01) decrease in resting state activity was observed in the left superior parietal cortex when compared to the mild-headache group. In the severe-headache group, significant decreases in resting state supraspinal activities in the right insula (T = −3.46, p < 0.001), right premotor cortex (T = −3.30, p < 0.01), left premotor cortex (T = −3.84, p < 0.001), and left parietal cortex (T = −3.94, p < 0.0001), and an increase in activity in the right secondary somatosensory cortex (T = 4.05, p < 0.0001) were observed when compared to the moderate-headache group. The results of the study suggest that the increase in MTBI-HA severity may be associated with an imbalance in the supraspinal pain network with decline in supraspinal pain modulatory function and enhancement of sensory/pain decoding.

Comparison of efficacy and safety of three drugs levetiracetam, sodium valproate, and nortriptyline in the prevention of migraine headache

Background and Aim: Headache is the most common cause of referral to a physician. Two approaches of the migraine treatment include: treat the acute attacks and prevent future attacks. In this regard, the aim of this study was to investigate the effect of three drugs lutiracetam, sodium valproate and nortriptyline in the control of migraine headaches in patients with migraine in Birjand Neurology Clinic. Materials and Methods: This study is a quasi-experimental study. According to the physician, 120 migraine patients were divided into one of three groups: Lutiracetam with a daily dose of 250 mg, sodium valproate 500 mg and nortriptyline 25 mg for 4 weeks. Patientschr('39') information was collected through a questionnaire. Then the data were analyzed by SPSS) Version 16) software by using chi-square, paired t-test, and ANOVA. Results: 120 patients were divided into three groups of 40 patients. The mean age of the subjects was 33±11 years, 53.3% of them were female and 46.7% of them were male. In total, 46.7% of patients had severe headache before taking these three drugs. None of them had severe headache after taking the drug and 77.5% of them had mild headache. Lutiracetam group showed the greatest decrease in headache intensity. (P=0.01). Conclusion: Levetiracetam appears to be more effective than the other two drugs, especially sodium valproate, in reducing different degrees of headache.

Pain freedom after 2 hours should be the primary outcome in controlled trials treating migraine attacks

Background Pain freedom after 2 hours is the recommended primary endpoint by the International Headache Society in randomized trials investigating drug treatment of acute migraine attacks. In order to demonstrate an early effect of a drug, some drug companies, however, have promoted headache relief (improvement from severe or moderate pain to mild or no pain) at earlier time points than 2 hours as outcome parameter. Methods and results We analyzed the relationship between pain freedom and headache relief in acute migraine trials and observed that persistent mild headache constituted 90% of headache relief after 0.5 hour and 40% of headache relief after 2 hours. Conclusion Headache relief at 2 hours should in our view only be used as an outcome measure for comparison with historic data. Prior to 2 hours, headache relief varies with time from intake and the therapeutic gain is very small. Therefore, pain freedom should be used at these early time points.