Ayurvedic Management of Alternate Hemiplegia of Childhood - A Case Report

Alternate hemiplegia of childhood is a rare condition characterized by recurrent temporary episodes of hemiplegic attacks that affect one or the other side of the body. The clinical manifestations may begin at the neonatal period up to the age of 4 years. The reported prevalence is estimated at 1/100000 in children under 16 years old. There are, as of yet, no specific therapies that are uniformly effective in eliminating the episodes associated with AHC. AHC childhood can be correlated with Ayurvedic concept of Skandagraha. Here a case of 8 year old male child had come to our hospital with recurrent hemiplegic attacks having history of involuntary movements. At the end of 10days of IP treatment which included Panchakarma procedures along with internal medication resulted in 5-10% improvement in the overall effect of therapy. Followed by Shamanachikitsa 30-40% improvement was observed. Hence a humble attempt has been made to explore the case.

Clinical characteristics of orobuccal involuntary movements induced by anticholinergic agents in patients with Parkinson′s disease and literature review / 中华神经科杂志

Objective:To study the clinical characteristics of orobuccal involuntary movements (OB) induced by anticholinergic agents.Methods:The clinical characteristics of patients with OB induced by anticholinergic agents in Qilu Hospital (Qingdao) from April 2018 to October 2021 and cases reported in the literature were analyzed in combination with literature review.Results:Seven patients in Qilu Hospital (Qingdao) and 10 cases in the literature were analyzed. Of these 7 patients, 6 were elderly female, with involuntary, repetitive, stereotypical movements of the lips, tongue, and sometimes of the jaw after intake of anticholinergic medication with the latency 21-60 days and the involuntary movements improved 7-30 days after discontinuation of anticholinergic medication. Of 10 cases reported in the literature, 7 were elderly female and 8 only with OB and 2 patients had extremities dyskinesia plus OB. Involuntary movements appeared after latency of 3-93 days following the introduction of anticholinergic drugs and resolved after latency of 2-60 days following their withdrawal.Conclusions:OB induced by anticholinergic agents mostly occur sub-acutely during the treatment of Parkinson′s disease, and can resolve in a short time after withdrawal, which is independent of the dose of levodopa and anticholinergic agents. The aging, female, and anxiety and depression may be the risk factors.

Effectiveness of melatonin in tardive dyskinesia / Efectividad de la melatonina en la discinesia tardía

Tardive Dyskinesia (TD) is a movement disorder associated with the clinical administration of antipsychotics. It is believed that TD is due, among other factors, to an increase in the oxidative damage produced by free radicals. Antioxidants, like vitamin E, have been used in the treatment of TD but there is no evidence of their effectiveness. Melatonin (MEL) is 6 to 10 times more effective, as an antioxidant, than vitamin E and it has been used with an apparent higher effectiveness in the treatment of TD, although the results have not been conclusive. A randomized, double blind, placebo controlled design was used to determine the effectiveness of MEL (20mg/day) during 12 weeks in 7 patients with TD. Six patients with TD were treated with placebo. The Abnormal Involuntary Movement Scale (AIMS) was chosen to assess the severity of TD initially and after 4, 8 and 12 weeks. The psychiatric evaluation was done following the Brief Psychiatric Rating Scale. In two patients treated with MEL a significant improvement (more than 60%) of the values of AIMS was detected. In the remainder five, as well as in the patients treated with placebo, no difference was observed during the 12 weeks. When compared the AIMS score in all the MEL-treated patients with the values in the placebo-treated patients, no significant differences were detected during the 12 weeks of the study. However, the significant clinical improvement observed in two patients must be considered before reaching a final conclusion on the usefulness of MEL in TD.

La Discinesia Tardía (DT) es un trastorno de los movimientos asociado al uso crónico de antipsicóticos que parece producirse, entre otros factores, por un incremento en los procesos oxidativos. La vitamina E se ha utilizado en su tratamiento, pero no hay evidencia de su efectividad. Como la melatonina (MEL) es 6 a 10 veces más efectiva como antioxidante que la vitamina E, se ha utilizado con una aparente mayor efectividad, aunque los resultados no han sido concluyentes. Se realizó un estudio doble ciego, al azar y controlado con placebo, para determinar la efectividad de la administración de la MEL durante 12 semanas en 7 pacientes con DT. Seis pacientes con DT fueron tratados con placebo. La Escala de Movimientos Involuntarios Anormales (AIMS) se usó para evaluar la evolución de los movimientos al inicio y a las 4, 8 y 12 semanas de tratamiento. La evaluación clínica psiquiátrica se hizo con la Escala Breve de Evaluación Psiquiátrica. En dos pacientes tratados con MEL se observó una mejoría clínica superior al 60% pero en los restantes, así como en los tratados con placebo los valores de la AIMS no variaron significativamente en el transcurso de las 12 semanas. Cuando se compararon los valores de la AIMS de la totalidad de los pacientes tratados con MEL, con los del grupo placebo, no se detectó ninguna diferencia significativa. Sin embargo, la mejoría clínica significativa de dos de los pacientes estudiados debe considerarse para llegar a una conclusión sobre la utilidad de la MEL en la DT.

A ultrassonografia transcraniana como método diagnóstico em neurologia. Parte II: revisão da literatura / Transcranial Ultrasonography as diagnostic method in neurology. Part II: Literature review

A ultrassonografia transcraniana (USTC) é um método de neuroimagem baseado na física acústica. Nos indivíduos com janela acústica temporal adequada, o exame permite a visualização de estruturas encefálicas, principalmente o mesencéfalo, núcleos da base, tálamos e segmentos do sistema ventricular. A técnica já foi utilizada em pesquisas de diversas doenças neuropsiquiátricas. Em cerca de 90% dos portadores da doença de Parkinson, observa-se um aumento da área ecogênica da substância negra visualizada à USTC. O presente artigo é a segunda parte de uma revisão bibliográfica sobre o tema.

Transcranial sonography (TCS) is a neuroimaging technique that uses physical acoustic principles. A good acoustic temporal bone window allows sonographic depiction of encephalic structures as the mesencephalon, basal ganglia, thalami and fragments of the ventricular system. The technique has been used in researches of different neuropsychiatric diseases. In 90% of Parkinsonïs disease patients an enlargement of the substantia nigra echogenic area is found by TCS. This paper is a review on the subject.

The Effects of Midazolam on Propofol-Induced Involuntary Movement, Pain on Injection and Maintenance Dose / 대한마취과학회지

BACKGROUND: This study examined the effects of midazolam on the propofol-induced involuntary movements, pain on injection, the maintenance dose of propofol, and recovery characteristics. METHODS: In a double-blind, randomized study, 30 children (2 8 yr of age, ASA physical status I or II) undergoing short duration of ENT procedures received midazolam 0.06 mg/kg (Group M) or an equal volume of placebo (Group P) intravenously 3 min before the injection of propofol. At induction of anesthesia an independent anesthesiologist graded the incidence, severity of involuntary movements, and pain on injection. RESULTS: Both groups were similar in age, sex, weight, propofol dose, duration of surgery and anesthesia. Incidence of involuntary movements showed no significant difference between two groups. But, there were significant difference in severity between two groups (P < 0.05). There was significant decrease in pain on injection in group M than group P and no significant differences in open eyes on command, time to extubation and time to discharge. CONCLUSION: Our result demonstrated that midazolam 60 microgram/kg compared with placebo did not reduce the incidence of involuntary movement, but reduced the severity of involuntary movement without delayed recovery. And there was significant reduction of pain on injection in midazolam 60 microgram/kg administration.