ABSTRACT
Background: Neurologic literature on therapeutic effect of subcutaneous corticosteroids in patients with migrainous chronic daily headache is scarce. The aim of this research is to assess the therapeutic effects of this management in such patients
Methods: Consecutive patients with migrainous chronic daily headache enrolled a prospective before-after therapeutic study during 2010-2013. Methylprednisolone 40 mg was divided into four subcutaneous injection doses. Two injections were administered in the right and left suboccipital area [exactly at retromastoid cervicocranial junction] and the other two injections in the lower medial frontal area [exactly at medial right and left eyebrows]. A daily headache diary was filled out by the patients before and one month after the intervention. The severity of pain was classified based on a pain intensity instrument using numeric rating scale from 0-10 point scale. Paired t-test and Chi-square test were used for statistical analysis
Results: 504 patients [378 females, 126 males] with migrainous chronic daily headache were enrolled in the study. Dramatic, significant, moderate, mild, or no improvements respectively constituted 28.6%, 33.3%, 23.8%, and 14.3% of the post treatment courses. Therapeutic effect of intervention on mean pain scores was significant; t=7.38, df=20, P=0.000. Two cases developed subcutaneous fat atrophy in frontal injection site and three cases experienced syncope during injection
Conclusion: Subcutaneous corticosteroids could be used as an adjunct therapy in patients with migrainous chronic daily headache
Subject(s)
Humans , Male , Female , Adult , Steroids , Injections, Subcutaneous , Prospective Studies , Headache , Subcutaneous FatABSTRACT
Introduction: The aim of this research was to systematically review all the randomized controlled trials that have evaluated the effect of transcranial direct current stimulation [tDCS] on post-stroke dysphagia
Methods: Three electronic databases were searched for relevant articles that were uploaded from their inception to March 2015: PubMed, Cochrane Library [Cochrane Central Register of Controlled Trials], and Scopus. All data was that was related to the location of the cerebrovascular accident [CVA], the parameters of tDCS, post-stroke time to commencement of tDCS, the stimulated hemisphere, stimulation dose, any outcome measurements, and follow-up duration were extracted and assessed. Finally, a number of observations were generated through a qualitative synthesis of the extracted data
Result: Three eligible randomized controlled trials were included in the systematic review. All three trials reported that, in comparison to a placebo, tDCS had a statistically significant effect on post-stroke dysphagia
Discussion: The results of our systematic review suggest that tDCS may represent a promising novel treatment for post-stroke dysphagia. However, to date, little is known about the optimal parameters of tDCS for relieving post-stroke dysphagia. Further studies are warranted to refine this promising intervention by exploring the optimal parameters of tDCS
Conclusion: Since brainstem swallowing centers have bilateral cortical innervations, measures that enhance cortical input and sensorimotor control of brainstem swallowing may facilitate recovery from dysphagia
ABSTRACT
Background and Aim: Stroke is one of major causes of disability. Therefore, it is important to introduce and develop new treatment approaches in order to improve and enhance post-stroke recovery process for medical, social, and economical purposes. The present study aimed at determining the effect of mirror therapy on walking ability of patients with stroke regarding the muscular power of the affected leg
Materials and Methods: This semi-experimental study was done on 50 stroke patients that were hospitalized in Mashhad Imam Reza and Quaem hospitals. They were randomly classified into two equal groups of control and mirror therapy[experimental group]. For the experimental group, twenty 30 -minute sessions were daily held, so that every patient did the range of motion of lower extremitiy of the healthy side in front of a mirror and observed just its mirror image. In addition to mirror therapy, the routine program physiotherapy was performed for both groups. Power of muscle in the affected leg was assessed on the basis of a 5-score scale and every patient`s walking ability was assessed before, during, and after intervention using function ambulation classification. Finally, the obtained data was analyzed by means of SPSS software [V:11.5], using independent T, paired T, Mann-Whitney and Wilcoxon statistical tests
Results: The two groups showed no significant difference in terms of walking ability regarding the muscular power of the affected leg and confounding variables before intervention [P=0.210]. Walking ability of the affected leg in mirror therapy group did not significantly improve.in comparison with the control group after intervention [P=0.756]. But the walking ability regarding the muscular power of the affected leg in mirror therapy group was significantly improved in comparison with the control group in the 10[th] session [P=0.038]
Conclusion: Mirror therapy can improve walking ability of patients with stroke as a simple, inexpensive and a patient-oriented treatment
ABSTRACT
Background: Intravenous Valproate [IVVP] has been used in the treatment of migraine in some studies; however, it is far better known in the management of status epilepticus
Methods: Consecutive patients with migraine in our Headache Clinic were enrolled in this prospective, randomized clinical trial in 2011. The patients were randomized into two therapeutic groups, one receiving 900 mg IVVP [Orifil] and the other 16 mg IV Dexamethasone [IVDEX] diluted in 150 CC normal saline and infused for 10 minutes. Worst severity of pain before treatment and least severity at 3 hours after the infusion using a 0-10 point numeric rating scale were recorded. An interview with the patient was performed 72 hours after treatment to detect a possible relapse of headache
Results: Thirty-one migraine status patients, comprising 28 women and 3 men at a mean +/- SD age of 33.355 +/- 12.373 SD, were investigated. Differences in the therapeutic effects of IVVP [Orifil] and IVDEX on pain score were not significant between the two groups [t=0.933, df=29; P=0.358]. Relapse of headache occurred in 68.42% of the IVVP [Orifil] group and 66.67% of the IVDEX group. Distribution of relapse was not significantly different between the two therapeutic groups of patients [P=0.870]
Conclusion: IVVP [Orifil] was similar in efficacy to IVDEX as abortive therapy in patients with migraine status. IVVP [Orifil] appears to offer a safe and well-tolerated abortive treatment. Trial Registration Number: IRCT13891146234N2
ABSTRACT
Stroke in young adults causes morbidity in this socioeconomically-active age group. Etiologic frequency of ischemic stroke in young adults is different around the world. This study was conducted to determine the causes of stroke in Iranian young adults. The study population consisted of 314,000 young adult residents in the Southern Khorasan Province, East of Iran. All the patients with stroke, admitted to Vali-e-Asr Tertiary Care Hospital, entered this study. Demographic data, clinical presentation, and investigations of consecutive patients aged 15 - 45 years, presented with ischemic stroke, were registered in Southern Khorasan Stroke Database between 2000 and 2005. All the patients underwent a standard battery of diagnostic investigations by a stroke neurologist. Etiologic classification of stroke in the patients was made based on the Practical Iranian Criteria. One hundred and twenty-four patients [60 females and 64 males] were prospectively investigated during a 5-year period. The incidence of ischemic stroke in young adults was 8/100,000 per year. Cardioembolic mechanism constituted 54% of all stroke etiologies in young adults. Rheumatic valvular heart disease was present in 32% of the patients and caused 2.5 preventable stroke cases per 100,000 young adults per year. Rheumatic valvular heart disease is the most common cause and a preventable etiology of stroke in Iranian young adults