Botulinum toxin treatment for intractable allodynia in a patient with complex regional pain syndrome: A case report

@#The right hand of a 58-year-old female was compressed by a compression machine and subsequently began to show pain. She was diagnosed with complex regional pain syndrome type 2 according to the Budapest criteria. Conventional therapy was ineffective for her allodynia. After subcutaneous injection of botulinum toxin, the subject’s allodynia substantially improved. Subcutaneous injection of botulinum toxin could effectively treat patients with complex regional pain syndrome and intractable allodynia. Clinical studies with larger sample sizes are needed to evaluate the efficacy of and selection of patients for botulinum toxin treatment of complex regional pain syndrome.

Predictors of Depressive Mood in Patients With Isolated Cerebellar Stroke: A Retrospective Study

OBJECTIVE: To identify predictive factors of depressive mood in patients with isolated cerebellar stroke. METHODS: A retrospective chart review was performed in patients who had experienced their first isolated cerebellar stroke during 2002-2014. The patients were classified into two groups by the Geriatric Depression Scale (GDS) (non-depressive group, 0≤GDS≤16; depressive group, 17≤GDS≤30). Data on demographic and socioeconomic factors, comorbidities, functional level, cognitive and linguistic function, and stroke characteristics were collected. Significant variables in univariate analysis were analyzed using logistic regression. RESULTS: Fifty-two patients were enrolled, of whom 55.8% had depressive mood, were older (p=0.021), and had higher hypertension rates (p=0.014). Cognitive and linguistic functions did not differ between the two groups. The depressive group had higher ischemic stroke rates (p=0.035) and showed a dominant right posterior cerebellar hemisphere lesion (p=0.028), which was independently associated with depressive mood in the multiple logistic regression analysis (odds ratio, 5.081; 95% confidence interval, 1.261-20.479). CONCLUSION: The risk of depressive mood after cerebellar stroke was increased in patients at old age, with a history of hypertension, ischemic stroke, and lesion of the right posterior cerebellar hemisphere. The most significant determining factor was stroke lesion of the right posterior cerebellar hemisphere. Early detection of risk factors is important to prevent and manage depressive mood after cerebellar stroke.

Movement Disorders after Traumatic Brain Injury

Traumatic brain injury can cause movement disorders such as tremor, dystonia, myoclonus, parkinsonism and chorea. After the severe traumatic brain injury, movement disorders have been reported in 13 to 66% of patients and 20% of cases combined with weakness, spasticity, cognitive impairment and ataxia. Postural/kinetic tremor, which is the most common type of movement disorder after traumatic brain injury, may be transient or persistent however the other syndromes tend to persist and produce significant impairment in activity of daily living. The symptomatic relief can generally be achieved with medical treatment and some cases with neurosurgical intervention such as functional stereotactic surgery or deep brain stimulation. This article reviews the epidemiology, underlying mechanism, the type and treatment of movement disorders follow traumatic brain injury.