Neuropatía ciática en pediatría: presentación clínica y seguimiento a largo plazo / Pediatric sciatic neuropathy: clinical presentation and long term follow up

Resumen: Introducción: La neuropatía ciática es una entidad infrecuente y de difícil diagnóstico en Pediatría. Su evolución a largo plazo no ha sido claramente definida. Objetivo: Analizar la presentación clínica y evolución de un grupo de niños con neuropatía ciática. Pacientes y Método: Análisis retrospectivo de las características clínicas de pacientes pediátricos con neuropatía ciática atendidos en 2 hospitales de Santiago, entre 2014-2018. Se evaluó examen motor, trofismo muscular, reflejos osteotendíneos, marcha, sensibilidad y dolor. Se estudió neuroconducción de nervio ciático, electromiografía (EMG) y en 3 pacientes, Resonancia Magnética (RM). Resultados: Se incluyeron 6 pacientes, edad promedio 11,8 años. Hubo 2 causas traumáticas, 2 compresivas, 1 vascular y 1 tumoral. Los 6 pa cientes debutaron con pie caído e hiporreflexia/arreflexia aquiliana; 5 pacientes presentaron dolor neuropático severo. La EMG mostró en todos los casos compromiso en nervios y musculatura de pendientes del nervio ciático. En 2 casos se realizó RM de cintura pélvica y extremidades inferiores, mostrando compromiso muscular selectivo en pierna en territorio ciático. En 1 caso, se realizó RM de plexo lumbosacro, y luego estudio histológico, que concluyeron un tumor neural benigno. En los 3 pacientes que tuvieron seguimiento mayor a un año, se observaron secuelas motoras, con marcha alterada. Conclusión: La neuropatía ciática en este grupo fue secundaria a diversas etiologías, predominando las traumático-compresivas. En los 3 casos que tuvieron seguimiento a largo plazo se observaron secuelas motoras significativas. En la mayoría la lesión se asoció a causas prevenibles como accidentes y posicionamiento en niños con compromiso de conciencia, lo que resulta fundamental en la prevención de una patología con alto grado de secuelas.

Abstract: Introduction: Sciatic neuropathy is rare and difficult to diagnose in pediatrics, and its long-term course has not been completely understood. Objective: To analyze the clinical presentation and evolution of a group of pediatric patients with sciatic neuropathy. Patients and Method: Retrospective anal ysis of the clinical characteristics of pediatric patients with sciatic neuropathy treated in two hospitals of Santiago between 2014 and 2018. Locomotor examination, muscle trophism, deep tendon reflexes, gait, sensation, and pain were assessed. Sciatic nerve conduction study and electromyography (EMG) were performed, and magnetic resonance imaging (MRI) in three patients. Results: Six patients were included with an average age of 11.8 years. The etiologies were traumatic (N = 2), by compression (N = 2), vascular (N = 1), and tumor (N = 1). All of the 6 patients presented foot drop and Achilles tendon hyporeflexia/areflexia, and 5 patients presented severe neuropathic pain. The EMG showed involvement of the sciatic nerve rami and dependent muscles. In two patients, a pelvic girdle and lower limbs MRI was performed, showing selective muscle involvement in sciatic territory. One patient underwent a lumbosacral plexus MRI, and subsequently histological study showing a benign neural tumor. Out of the three patients who were followed-up longer than one year presented motor sequelae and gait disorder. Conclusion: Sciatic neuropathy in the study group was secondary to different causes, predominantly traumatic and compressive etiologies. The three patients that were ina long-term follow-up presented significant motor sequelae. In most of the cases, neural injury wasassoci- ated with preventable causes, such as accidents and positioning in unconscious children, which is crucial in the prevention of a pathology with a high sequelae degree.

Analgesic and side effects of intravenous recombinant Ph alfa 1 beta

Background: Intrathecal injection of voltage-sensitive calcium channel blocker peptide toxins exerts analgesic effect in several animal models of pain. Upon intrathecal administration, recombinant Phα1β exerts the same analgesic effects as the those of the native toxin. However, from a clinical perspective, the intrathecal administration limits the use of anesthetic drugs in patients. Therefore, this study aimed to investigate the possible antinociceptive effect of intravenous recombinant Phα1β in rat models of neuropathic pain, as well as its side effects on motor, cardiac (heart rate and blood pressure), and biochemical parameters. Methods: Male Wistar rats and male Balb-C mice were used in this study. Giotto Biotech® synthesized the recombinant version of Phα1β using Escherichia coli expression. In rats, neuropathic pain was induced by chronic constriction of the sciatic nerve and paclitaxel-induced acute and chronic pain. Mechanical sensitivity was evaluated using von Frey filaments. A radiotelemeter transmitter (TA11PA-C10; Data Sciences, St. Paul, MN, USA) was placed on the left carotid of mice for investigation of cardiovascular side effects. Locomotor activity data were evaluated using the open-field paradigm, and serum CKMB, TGO, TGP, LDH, lactate, creatinine, and urea levels were examined. Results: Intravenous administration of recombinant Phα1β toxin induced analgesia for up to 4 h, with ED50 of 0.02 (0.01-0.03) mg/kg, and reached the maximal effect (Emax = 100% antinociception) at a dose of 0.2 mg/kg. No significant changes were observed in any of the evaluated motor, cardiac or biochemical parameters. Conclusion: Our data suggest that intravenous administration of recombinant Phα1β may be feasible for drug-induced analgesia, without causing any severe side effects.

Analysis of the muscle tissue of Wistar rats submitted to the sciatic nerve compression model and cryotherapy / Análise do tecido muscular de ratos Wistar submetidos ao modelo de compressão do nervo isquiático e à crioterapia

ABSTRACT Objective: To evaluate the effects of right sciatic nerve compression and cryotherapy on muscle tissue. Methods: We used 42 male Wistar rats, subdivided in the following Groups Control, Injury 3, Injury 8 and Injury 15 submitted to nerve compression and euthanized in the 3rd, 8th and 15th day after surgery. The Cryotherapy Injury 3 was entailed treatment with cryotherapy by immersion of the animal in recipient for 20 minutes during 1 day, then animals were euthanized at the 3rd day after surgery, and the Cryotherapy Injury 8 and the Cryotherapy Injury 15 was treated for 6 days, and euthanized at the 8th and 15th day after surgery. Functional evaluation was performed by the grasping strength of the right pelvic limb. The right tibialis anterior muscles were evaluated for mass, smaller diameter and cross-sectional area. In the Cryotherapy Injury 8 and the Cryotherapy Injury 15 groups, the hydroxyproline was dosed in the right soles. Results: In the compression there was a significant difference in the Injury Groups compared with the Control Group (p<0.05). In the smaller diameter, the compression in Control Group was higher than Injury 8 (p=0.0094), Injury 15 (p=0.002) and Cryotherapy Injury 15 (p<0.001) groups. The comparison between groups with euthanasia in the same post-operative period, a significant difference (p=0.0363) was seen in day 8th after surgery, and this result in Cryotherapy Injury Group was greater than Injury Group. In the fiber area, Control Group was also higher than the Injury 8 (p=0.0018), the Injury 15 (p<0.001) and the Cryotherapy Injury 15 (p<0.001). In hydroxyproline, no significant difference was seen between groups. Conclusion: Nerve damage resulted in decreased muscle strength and trophism, the cryotherapy delayed hypotrophy, but this effect did not persist after cessation of treatment.

RESUMO Objetivo: Avaliar os efeitos da compressão nervosa do isquiático direito e da crioterapia no tecido muscular. Métodos: Foram utilizados 42 ratos Wistar machos, subdivididos nos Grupos Controle, Lesão 3, Lesão 8 e Lesão 15, submetidos a compressão nervosa e eutanasiados, respectivamente, no 3°, 8° e 15° dias pós-operatório; Lesão Crioterapia 3, tratado com crioterapia, por imersão durante 20 minutos, por 1 dia, e eutanasiados no 3° dia pós-operatório; e Lesão Crioterapia 8 e Lesão Crioterapia 15, tratados durante 6 dias e eutanasiados no 8° e 15° dias pós-operatório. A avaliação funcional foi realizada pela força de preensão do membro pélvico direito. Os músculos tibiais anteriores direitos foram avaliados quanto a massa, menor diâmetro e área de secção transversa. Em Lesão Crioterapia 8 e Lesão Crioterapia 15, foi dosada a hidroxiprolina nos sóleos direitos. Resultados: Na preensão, houve diferença significativa nos Grupos Lesão quando comparados ao Grupo Controle (p<0,05). No menor diâmetro, o Grupo Controle foi maior que Lesão 8 (p=0,0094), Lesão 15 (p = 0,002) e Lesão Crioterapia 15 (p<0,001). Na comparação entre os grupos com eutanásia no mesmo pós-operatório, houve diferença significativa (p=0,0363) no 8° pós-operatório, sendo Lesão Crioterapia maior que Lesão. Na área das fibras, o Grupo Controle também foi maior que Lesão 8 (p=0,0018), Lesão 15 (p<0,001) e Lesão Crioterapia 15 (p<0,001). Na hidroxiprolina, não houve diferença significativa entre os grupos. Conclusão: A lesão nervosa resultou na diminuição da força e em trofismo muscular, e a crioterapia retardou a hipotrofia, porém este efeito não se manteve após o tratamento cessar.

Jumping in aquatic environment after sciatic nerve compression: nociceptive evaluation and morphological characteristics of the soleus muscle of Wistar rats / Salto em meio aquático após compressão de nervo isquiático: avaliação nociceptiva e características morfológicas do músculo sóleo de ratos Wistar

ABSTRACT Objective To evaluate the effect of jumping in aquatic environment on nociception and in the soleus muscle of trained and not trained Wistar rats, in the treatment of compressive neuropathy of the sciatic nerve. Methods Twenty-five Wistar rats were distributed into five groups: Control, Lesion, Trained + Lesion, Lesion + Exercise, and Trained + Lesion + Exercise. The training was jumping exercise in water environment for 20 days prior to injury, and treatment after the injury. Nociception was evaluated in two occasions, before injury and seven after injury. On the last day of the experiment, the right soleus muscles were collected, processed and analyzed as to morphology and morphometry. Results In the assessment of nociception in the injury site, the Control Group had higher average than the rest, and the Lesion Group was larger than the Trained + Lesion and Lesion + Exercise Groups. The Control Group showed higher nociceptive threshold in paw, compared to the others. In the morphometric analysis, in relation to Control Group, all the injured groups showed decreased muscle fiber area, and in the Lesion Group was lower than in the Lesion + Exercise Group and Trained + Lesion Group. Considering the diameter of the muscle fiber, the Control Group had a higher average than the Trained + Lesion Group and the Trained + Lesion + Exercise Group; and the Lesion Group showed an average lower than the Trained + Lesion and Lesion + Exercise Groups. Conclusion Resistance exercise produced increased nociception. When performed prior or after nerve damage, it proved effective in avoiding hypotrophy. The combination of the two protocols led to decrease in diameter and area of the muscle fiber.

RESUMO Objetivo Avaliar os efeitos do salto em meio aquático, na nocicepção e no músculo sóleo, em ratos Wistar treinados e não treinados, no tratamento de neuropatia compressiva do nervo isquiático. Métodos Foram distribuídos em cinco grupos 25 ratos Wistar: Controle, Lesão, Treinado + Lesão, Lesão + Exercício e Treinado + Lesão + Exercício. O treino foi com exercício de salto em meio aquático durante 20 dias, prévio à lesão, e o tratamento ocorreu após a lesão. Foram realizadas avaliações da nocicepção, sendo uma pré-lesão e sete pós-lesão. No último dia de experimento, os músculos sóleos direitos foram coletados, processados e analisados por meio de morfologia e morfometria. Resultados Na avaliação da nocicepção no local da lesão, o Grupo Controle apresentou média maior que os demais, e o Grupo Lesão foi maior que os Grupos Treinado + Lesão e Lesão + Exercício. O Grupo Controle apresentou limiar nociceptivo na pata maior com relação aos demais. Nas análises morfométricas, em relação ao Grupo Controle, todos os grupos lesionados apresentaram diminuição da área da fibra muscular; o Grupo Lesão apresentou-se menor que os Grupos Treinado + Lesão e Lesão + Exercício. No diâmetro da fibra muscular, o Grupo Controle apresentou média maior que os Grupos Treinado + Lesão e Treinado + Lesão + Exercício, e o Grupo Lesão apresentou média menor que os Grupos Treinado + Lesão e Lesão + Exercício. Conclusão O exercício físico resistido produziu aumento da nocicepção. Quando realizado previamente ou após a lesão nervosa, mostrou-se eficaz em evitar a hipotrofia. A associação dos dois protocolos levou à diminuição do diâmetro e da área da fibra muscular.

possible protective role of ginseng on the sciatic nerve neuropathy induced experimentally by acrylamide in adult male albino rat: a histological and morphometric study

Ginseng's active compounds exert beneficial effects on central and peripheral nervous system disorders. The sciatic nerve was used as a model to study the possible protective effect of ginseng on peripheral neuropathy induced by acrylamide. The study was carried out on 35 adult male albino rats. The animals were divided into three groups: group I [control], group II treated daily with acrylamide [30 mg/kg body weight] orally for 4 weeks, and group III [protective] treated with acrylamide at same dose, route, and duration as in group II concomitantly with ginseng [20 mg/kg body weight]. After 4 weeks, rats were sacrificed. Samples from sciatic nerve were taken and processed for light and electron microscopic and morphometric studies. Light and electron microscopic observations of group II revealed infoldings, splitting, and degeneration of myelin. Changes in axons included degeneration, compression, irregularity, and shrinkage with swollen mitochondria. Large vacuoles and swollen mitochondria were seen inside the Schwann cells. Changes in the myelin and axons in group III were much less frequent than those observed in group II. Only mild splitting and irregular thickening of the myelin with few swollen mitochondria were observed in some axons and Schwann cells. Morphometric study revealed a highly significant reduction [89.6%] in the mean g-ratio [axon/fiber ratio] and body weight in group II compared with the control and group III. Ginseng protected the sciatic nerve from the harmful effect of acrylamide to a great extent

Effects of low intensity pulsed ultrasound on healing of denervated Tibial fracture in the rabbit

Low intensity pulsed ultrasound [LIPUS] has been shown in healing of fractures. This study investigates the effect of LIPUS as a fracture-healing adjunct on the denervated tibial fractures in rabbit model. Twenty four male Dutch rabbits were randomly divided into four groups including two control and two ultrasound-treated [US-treated] groups. A standardized mid-tibial osteotomy was performed in the right tibia. Ipsilateral sciatic nerve was cut two centimeter above the right knee. After three days, the rabbits of US-treated groups received the therapeutic dose [100 mW/cm[]] of ultrasound for 15 minutes per day until the 6th and 8th week and the control groups did not receive any treatment. The rabbits were sacrificed at weeks 6th and 8th post surgery and the external fixator and tibia were carefully removed. Radiographs were taken by lateral and anteroposterior views. Mechanical testing of rabbit's tibiae was used. The specimens were taken from callus of fracture for histomorphometric study of trabecula in the fractured area. Immunohistochemical staining for ki67 was used to evaluate cellular proliferation. Radiographs showed the callus was visible indicating the ossification of the callus tissue without any significant difference between US- treated and control groups. Biomechanical, histomorphic and immunohistochemical evaluations had no significant difference between control and US-treated groups after 6 and 8 weeks postoperation. These finding suggest that ultrasound therapy with features which applied in this study had no significant effect on denervated tibial fracture repair in rabbits

Antinociceptive effect of elaeagnus angustifolia fruits on sciatic nerve ligated mice

The role of Elaeagnus angustifolia fruit as an analgesic agent in acute pain has been proved earlier. In this study, the effects of aqueous extracts of three parts of this fruit [pericarp, medulla and seed] on chronic pain were investigated in mice. A partial nerve injury was made using a tight ligature around the sciatic nerve, then doses [0.5, 1, 1.5 g/kg, i.p.] of pericarp, medulla and seed extracts were injected in nerve ligated mice. The effect of different doses of three parts of this fruit on chronic pain was examined 14 days after sciatic nerve ligation using the hot-plate test. Controls received saline [5 ml/kg, i.p.] and imipramine [40 mg/kg]. In the hot plate test, intraperitoneal injection of different doses of three parts of this fruit showed considerable analgesic effect on nerve ligated mice that was dose dependent with duration of action of 120 min. Administration of the aqueous extracts of pericarp, medulla and seed of E. angustifolia fruit indicated significant analgesic effect on chronic pain in nerve ligated animals

Ultra-som terapêutico contínuo térmico em modelo experimental de ciatalgia / Continuous thermic therapeutic ultrasound in sciatica experimental model

O ultra-som é um recurso fisioterapêutico que pode atuar na redução dos sintomas da ciatalgia. O objetivo deste estudo foi verificar a eficácia do ultra-som terapêutico, no modo contínuo, em duas diferentes densidades de potência (0,5W/cm2 e 1 W/cm2), na redução do quadro álgico em ratos submetidos a modelo experimental de ciatalgia. Foram utilizados 20 ratos, divididos em 3 grupos: G1 (n=6) submetido à ciatalgia e a tratamento placebo; G2 (n=7) submetido à ciatalgia e tratado com ultra-som com 0,5 W/cm2; e G3 (n=7) submetido à ciatalgia e tratado com ultra-som com 1 W/cm2. A ciatalgia foi provocada por lesão cirúrgica de compressão do nervo no membro posterior direito de todos os animais. O tratamento na região do procedimento cirúrgico, iniciado no 3º dia pós-operatório, consistiu em 10 sessões diárias de 5 minutos. Verificou-se a dor pelo do tempo de elevação da pata (TEP) durante a marcha, medido pré-cirurgia e em mais cinco momentos. Os resultados mostram aumentos no TEP em todos os grupos após a lesão; e, naqueles tratados com ultra-som terapêutico, houve diminuição significativa da TEP, restaurando-se os valores iniciais, sendo mais precoce e intensa em G2. Conclui-se que a entrega na forma continua do ultra-som terapêutico foi eficaz na redução da dor ciática...

Therapeutic ultrasound is a physical therapy resource for relieving sciaticpain. The aim of this study was to assess the effectiveness of continuous therapeutic ultrasound in two different power densities (0,5 W/cm² and 1 W/cm²), on reducing pain in rats submitted to a sciatica experimental model. Twenty rats were used, divided into 3 groups: G1 (n=6) submitted to sciatica and placebo treatment; G2 (n=7) submitted to sciatica and treated with 0.5 W/cm² ultrasound; and G3 (n=7), submitted to sciatica and treated with 1 W/cm² ultrasound. Sciatica was provoked by surgical nerve compression on the right posterior limb of all animals. Treatment on the surgical procedure region consisted in ten daily 5-minute sessions, starting on the 3rd postoperative day. Pain was inferred by the time of paw elevation (TPE) during gait, measured before the surgery and on five further moments. Results showed TPE increase in all groups after surgery; but in both groups actually treated with ultrasound a significant TEP decrease was noticed, practically reaching initial values, the decrease being more precocious and intense in G2. Continuous ultrasound such as was delivered was hence effective in reducing sciatic pain...