- MeSH
- Adult MeSH
- Drug Therapy, Combination methods MeSH
- Middle Aged MeSH
- Adolescent MeSH
- Infant, Newborn MeSH
- Child, Preschool MeSH
- Aged MeSH
- Muscle Spasticity etiology MeSH
- Tetanus Toxoid therapeutic use MeSH
- Tetanus * prevention & control therapy MeSH
- Trismus etiology MeSH
- Vaccination methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Adolescent MeSH
- Male MeSH
- Infant, Newborn MeSH
- Child, Preschool MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Geographicals
- Armenia MeSH
- Czech Republic MeSH
- Indonesia MeSH
- Canada MeSH
- Costa Rica MeSH
- Morocco MeSH
- Peru MeSH
- Turkey MeSH
- Uganda MeSH
The blink reflex (BR) is integrated at the brainstem; however, it is modulated by inputs from various structures such as the striatum, globus pallidus, substantia nigra, and nucleus raphe magnus but also from afferent input from the peripheral nervous system. Therefore, it provides information about the pathophysiology of numerous peripheral and central nervous system disorders. The BR is a valuable tool for studying the integrity of the trigemino-facial system, the relevant brainstem nuclei, and circuits. At the same time, some neurophysiological techniques applying the BR may indicate abnormalities involving structures rostral to the brainstem that modulate or control the BR circuits. This is a state-of-the-art review of the clinical application of BR modulation; physiology is reviewed in part 1. In this review, we aim to present the role of the BR and techniques related to its modulation in understanding pathophysiological mechanisms of motor control and pain disorders, in which these techniques are diagnostically helpful. Furthermore, some BR techniques may have a predictive value or serve as a basis for follow-up evaluation. BR testing may benefit in the diagnosis of hemifacial spasm, dystonia, functional movement disorders, migraine, orofacial pain, and psychiatric disorders. Although the abnormalities in the integrity of the BR pathway itself may provide information about trigeminal or facial nerve disorders, alterations in BR excitability are found in several disease conditions. BR excitability studies are suitable for understanding the common pathophysiological mechanisms behind various clinical entities, elucidating alterations in top-down inhibitory systems, and allowing for follow-up and quantitation of many neurological syndromes.
- MeSH
- Dystonic Disorders * MeSH
- Hemifacial Spasm * MeSH
- Humans MeSH
- Blinking MeSH
- Facial Pain MeSH
- Peripheral Nervous System MeSH
- Reflex physiology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
BACKGROUND: Neurosteroids are investigated as effective antidotes for the poisoning induced by tetramethylenedisulfotetramine (TMDT) as well as treatments for epileptic spasms during infancy. Both these conditions are quite resistant to pharmacotherapy; thus, a search for new treatments is warranted. METHODS: In this study, we determined the efficacy of two novel neurosteroids, pregnanolone glutamate (PAG) and pregnanolone pyroglutamate (PPG), and tested these drugs in doses of 1-10 mg/kg (ip) against the TMDT syndrome and in our rodent model of infantile spasms. RESULTS: Only PPG in doses 5 and 10 mg/kg suppressed the severity of the TMDT syndrome and TMDT-induced lethality, while the 1 mg/kg dose was without an effect. Interestingly, the 1 mg/kg dose of PPG in combination with 1 mg/kg of diazepam was also effective against TMDT poisoning. Neither PAG nor PPG were effective against experimental spasms in the N-methyl-D-aspartate (NMDA)-triggered model of infantile spasms. CONCLUSIONS: While evidence suggests that PAG can act through multiple actions which include allosteric inhibition of NMDA-induced and glycine receptor-evoked currents as well as augmentation of ɣ-aminobutyric acid subtype A (GABAA) receptor-induced currents, the agent appears to neither have the appropriate mechanistic signature for activity in the infantile spasm model, nor the adequate potency, relative to PPG, for ameliorating the TMDT syndrome. The full mechanisms of action of PPG, which may become a potent TMDT antidote either alone or in combination with diazepam are yet unknown and thus require further investigation.
- MeSH
- Diazepam pharmacology MeSH
- Rodentia MeSH
- Spasms, Infantile * chemically induced drug therapy MeSH
- Glutamic Acid MeSH
- Pyrrolidonecarboxylic Acid MeSH
- N-Methylaspartate toxicity therapeutic use MeSH
- Neurosteroids * MeSH
- Neurotoxicity Syndromes * MeSH
- Pregnanolone adverse effects MeSH
- Spasm MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
- Publication type
- Journal Article MeSH
Introduction: Spasm of the near reflex usually includes accommodative spasm, esophoria/tropia, and different degrees of miosis. Patients usually refer to distance blurred and fluctuating vision, ocular discomfort, and headaches. The diagnosis is established with refraction with and without cycloplegia; most of the cases have a functional etiology. However, some cases require neurological conditions to be ruled out; cycloplegics have an important diagnostic and therapeutic role. Purpose: To describe a case of bilateral severe accommodative spasm in a healthy 14-year-old teenager. Case presentation: A 14-year-old boy with progressive diminished visual acuity attended for YSP consultation. The diagnosis of bilateral spasm of the near reflex was made, based on a gap refraction of 9.75 D between retinoscopy with and without cycloplegia and esophoria with normal keratometry and axial length. The spasm was eliminated with 2 drops of cycloplegic in each eye separated by 15 days; no clear etiology was found other than the start of school. Conclusion: Clinicians should be aware of pseudomyopia, especially in children with acute changes in visual acuity, who are usually exposed to myopigenic environmental factors that induce overstimulation of the parasympathetic third cranial nerve’s innervation.
- MeSH
- Accommodation, Ocular * MeSH
- Atropine administration & dosage therapeutic use MeSH
- Esotropia diagnosis etiology MeSH
- Humans MeSH
- Adolescent MeSH
- Mydriatics MeSH
- Reflex physiology MeSH
- Refraction, Ocular MeSH
- Spasm drug therapy physiopathology MeSH
- Check Tag
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- Keywords
- hyperlordóza,
- MeSH
- Azathioprine administration & dosage MeSH
- Baclofen administration & dosage MeSH
- Dexamethasone administration & dosage MeSH
- Diazepam administration & dosage MeSH
- Diagnosis, Differential MeSH
- Electromyography MeSH
- Middle Aged MeSH
- Humans MeSH
- Lordosis pathology MeSH
- Plasmapheresis MeSH
- Spasm etiology drug therapy therapy MeSH
- Muscle Hypertonia etiology drug therapy therapy MeSH
- Stiff-Person Syndrome * diagnosis drug therapy therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Botulotoxín A (BT-A) sa používa v neurooftalmologických indikáciách ako terapia esenciálneho blefarospazmu a faciálneho hemispazmu, už viac ako 20 rokov. Napriek tomu, že dlhodobý efekt opakovaných aplikácií BT-A bol opakovane potvrdený, názory na vplyv BT-A na produkciu a retenciu sĺz nie sú jednoznačné. V našej práci sme sledovali vplyv lokálne aplikovaného BT-A u pacientov s esenciálnym blefarospazmom a hemifaciálnym spazmom na výsledky Schirmerovho testu a osmolaritu sĺz. Hodnotili sme zmeny vo výsledkoch Schirmerovho testu a osmolarity sĺz pred a 14 dní po lokálnej aplikácií BT-A (Botox inj, Allergan, Irvine, USA) do musculus orbicularis oculi v rámci terapie neurooftalmologických ochorení. Použili sme dávky 16-18 U u unilaterálnej a 32-36 U u bilaterálnej aplikácie. Priemerná hodnota Schirmerovho testu bola pred aplikáciou BT-A 8,38 ± 0,63 mm (n = 50), 2 týždne po aplikácií BT-A bola 7,12 ± 0,6 mm (n = 50). Pred podaním BT-A bola osmolarita sĺz 305,4 ± 9,2 mOsm (n = 13), 14 dní po podaní BT-A ostala osmolarita sĺz na úrovni 305,2 ± 8,6 mOsm (n = 13). Zistili sme signifikantný rozdiel medzi oboma skupinami v kvantite (p < 0,012), ale nie v kvalite sĺz (p > 0,05). Vplyv aplikácie BT-A na výsledky Schirmerovho testu sa prejavil v zmysle zníženia množstva sĺz. Uvedené výsledky potvrdzujú, že empirické klinické skúsenosti vedúce k doporučeniu aplikácie umelých sĺz u pacientov po aplikácii BT-A v neurooftalmologických indikáciách majú racionálny základ.
Botulinum toxin type A (BT-A) is used in the treatment of neuroophthalmologic disorders such as essential blepharospasm and facial hemispasm for more than 20 years. Although the long-term effect of repeated application of the BT-A was confirmed, the BT-A effect on tears production and retention is not clear. In our work we investigated whether applied BT-A in patients with blepharospasm and hemifacial spasm affect tears production. Tears quality was measured with Schirmer’s and tear osmolarity test during neuro-ophthalmologic diseases treatment, which was evaluated before and 14 days after application of BT-A (Botox inj, Allergan, Irvine, USA) into the orbicularis oculi muscle. BT-A doses of 16-18 U with unilateral and 32 to 36 U bilateral applications were used. The mean tear production in Schirmer’s test before BT-A application was 8.38 ± 0.63 mm, and 2 weeks after BT-A application was 7.12 ± 0,6 mm (n = 50). Tear osmolarity was 305.4 ± 9.2 mOsm before BT-A application, and 2 weeks after BT-A application it was 305.2 ± 8,6 mOsm (n = 13). We found significant difference between two groups in tear quantity (p < 0.012), but not quality (p > 0.05). Application of the BT-A reduced the amount of tears measured by Schirmer’s test. These results confirm rational basis of the empirical clinical experience where an artificial tears substitution is recommended for patients with neuro-ophthalmologic disorders treated by BT-A.
- Keywords
- Schirmerův test, suché oko,
- MeSH
- Blepharospasm * therapy MeSH
- Botulinum Toxins * therapeutic use MeSH
- Adult MeSH
- Hemifacial Spasm therapy MeSH
- Clinical Studies as Topic MeSH
- Middle Aged MeSH
- Humans MeSH
- Osmolar Concentration MeSH
- Aged MeSH
- Tears drug effects MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
Cílem pokynů je poskytnout nová doporučení podle nejnovějších poznatků. Účelem správné medikace pacienta před endovaskulárním výkonem, během výkonu a po endovaskulárním výkonu je snížení rizika periprocedurálních a postprocedurálních komplikací na co nejmenší míru.
The aim of these guidelines is to provide new recommendations according to the latest knowledge. The purpose of proper patient medication before endovascular procedure, during procedure and after endovascular procedure is to minimize the risk of periprocedural and postprocedural complications to the minimum.
- MeSH
- Bradycardia etiology prevention & control MeSH
- Chemoprevention methods standards MeSH
- Embolism and Thrombosis prevention & control MeSH
- Endovascular Procedures * methods nursing MeSH
- Coronary Restenosis etiology prevention & control MeSH
- Humans MeSH
- Parasympatholytics therapeutic use MeSH
- Perioperative Care MeSH
- Spasm etiology drug therapy MeSH
- Thromboembolism etiology prevention & control MeSH
- Check Tag
- Humans MeSH
- Publication type
- Practice Guideline MeSH
V léčbě generalizované úzkostné poruchy je nyní stále častěji užíván pregabalin, který dle předpokladů působí snížení excitační neurotransmise prostřednictvím své vazby na α2δ podjednotku P/Q typu napěťově řízeného kalciového kanálu. Prezentovaná kazuistika ukazuje, že může být účinný a bezpečný i u pacientů ve vyšším věku, vést k redukci užívaných benzodiazepinů a ovlivnit rovněž bolestivé syndromy.
Pregabalin is used with an increasing frequency for the treatment of generalized anxiety disorder. It is supposed to decreaseexcitatory neurotransmission by binding to the α2δ subunit of the P/Q-type of voltage-gated calcium channel. This case studypresents its efficacy and safety even in elderly. Moreover, pregabalin reduced the use of benzodiazepines as well as it influencedpain syndrome in our patient.
- MeSH
- Benzodiazepines MeSH
- Complex Regional Pain Syndromes MeSH
- Humans MeSH
- Pregabalin * pharmacokinetics therapeutic use MeSH
- Aged MeSH
- Spasm MeSH
- Anxiety Disorders * drug therapy MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
The safety profile of lenalidomide use in lower-risk myelodysplastic syndromes (MDS) patients with del(5q) is well-established, but less is known in non-del(5q) patients. We provide safety data from a randomized, phase 3 trial evaluating lenalidomide in 239 patients with lower-risk non-del(5q) MDS ineligible/refractory to erythropoiesis-stimulating agents (ESAs). Compared with placebo, lenalidomide was associated with a higher incidence of grade 3-4 treatment-emergent adverse events (TEAEs; 86% vs. 44%), but not risk of infection (p = .817) or hemorrhagic events (p = 1.000). Grade 3-4 non-hematologic TEAEs were rare (the incidence of grade 3-4 pneumonia, e.g. was 5.6% in the lenalidomide group and 2.5% in the placebo group). Common grade 1-2 non-hematologic TEAEs did not require dose modifications or treatment discontinuation. Acute myeloid leukemia and second primary malignancies incidence was similar across treatment groups. Lenalidomide had a predictable and manageable safety profile in lower-risk non-del(5q) MDS patients ineligible/refractory to ESAs. Guidance on managing lenalidomide-related TEAEs is provided to help maintain patients on therapy to achieve maximum clinical benefit. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01029262.
- MeSH
- Chromosome Deletion MeSH
- Adult MeSH
- Exanthema chemically induced MeSH
- Immunologic Factors adverse effects therapeutic use MeSH
- Lenalidomide adverse effects therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Chromosomes, Human, Pair 5 MeSH
- Myelodysplastic Syndromes drug therapy genetics MeSH
- Neutropenia chemically induced MeSH
- Diarrhea chemically induced MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Spasm chemically induced MeSH
- Fatigue chemically induced MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial, Phase III MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
