Interval neurophysiological changes in non septic critically ill mechanically ventilated patients.

Peripheral nerve changes in critically ill patients are common, sepsis being the most important risk factor. The aim of our study is to investigate interval neurophysiological changes in non septic mechanically ventilated critically ill patients, a group who has not been the focus of previous studies. Consecutive non septic mechanically ventilated critically ill patients were included. Baseline nerve conduction studies (NCS) were done within 3 days of intensive care unit admission, and 48 hours after the initiation of mechanical ventilation, and were followed up 7-8 days later. Sural and ulnar sensory, and median and peroneal motor nerves were tested. Nine patients were studied, five (56%) showed significant changes in their NCS compared to baseline. The peroneal and sural nerve amplitudes significantly dropped in all of the five affected patients, with drop of those of the median motor nerves in two, and ulnar sensory nerves in three patients. In conclusion, interval changes in peripheral nerves can exist in critically ill mechanically ventilated non septic patients. The pattern is similar to critically ill patients with sepsis. Theories of possible pathophysiology of critical illness neuropathy should not merely depend on the presence of sepsis as a trigger and other mechanisms should be investigated.

Prevalence and risk factors of muscle complications secondary to statins.

INTRODUCTION: The aim of the study was to investigate the prevalence and risk factors of muscle complications among patients using statins. METHODS: We conducted a prospective comparative study on 345 patients receiving statins and compared the findings with an age- and gender-matched control group of 85 subjects. Univariate and multivariate analyses with logistic regression models were used to study the association of different patient and disease characteristics with muscle complications. RESULTS: Adverse reactions were reported by 21% of patients and 5.9% of controls (P = 0.0013). Objective weakness was found in 15% of the patients who reported muscle symptoms (3.2% of the total cohort), but not in controls. Older age, longer duration of statin use, diabetes, stroke, and lower body mass index were associated with increased risk of developing these symptoms. CONCLUSIONS: Adverse reactions to statins may be more common than previously reported, and they may be affected by specific patient and disease characteristics.

A case report of cranial polyneuropathy in Behcet's disease.

Behcet's disease (BD) is a multisystem relapsing inflammatory disorder. Nervous system involvement is the most serious manifestation of BD. Neuro-Behcet's disease (n-BD) is classified into parenchymal meningoencephalitis pattern and non-parenchymal vascular patterns. Isolated meningitis is rarely the sole presenting feature of n-BD. We report a 19-year-old man with BD who presented with cranial polyneuropathy secondary to aseptic meningitis. He made a gradual though incomplete recovery with steroid therapy. Cranial polyneuropathy secondary to meningeal involvement can be a presentation of n-BD, and Behcet's disease should be a consideration in patients with idiopathic cranial polyneuropathy.

Prevalence of Parkinson's disease in Northern Jordan.

BACKGROUND: The prevalence of Parkinson's disease (PD) in Jordan is not known. This study describes the prevalence and clinical characteristics of PD in Northern Jordan. METHODS: Patients with the diagnosis of PD seen at neurology clinics in three major hospitals in Northern Jordan during the period of March 2007 to April 2008 were enrolled. PD diagnosis was established using predefined clinical diagnostic criteria. RESULTS: A total of 102 patients were included in the analysis (64 males; 63%, 38 females 37%). The mean age (SD) of patients was 63.3 (10.1) years and the mean age for onset of symptoms (SD) was 59.5 (12.1) years. The crude prevalence rate of PD was estimated to be 59/100,000. Clinical presentations of PD at onset of disease included; rest tremor (79.2%), bradykinesia (28.7%), rigidity (6.9%), gait problem (5%), and postural instability (2%). Eleven patients (10.9%) had a family history of PD. There was no association between the age of symptom onset, the presence of tremor, bradykinesia, or rigidity at onset, with stage of PD measured by Hoehn and Yahr scale. CONCLUSION: PD is a moderately prevalent disease in Jordan. The clinical characteristics of PD patients are similar to those reported in other countries.

Botulinum toxin A injections for the treatment of Schwartz-Jampel syndrome: a case series.

Schwartz-Jampel syndrome is a rare autosomal recessive disorder characterized by myotonia and skeletal dysplasia. Botulinum toxin A is emerging as a therapeutic option for patients with this syndrome. This study describes the use of botulinum toxin A in 4 children with Schwartz-Jampel syndrome. The response to this therapeutic modality was limited and variable.

Treatment of sialorrhea in children with cerebral palsy: a double-blind placebo controlled trial.

OBJECTIVES: To prospectively study the efficacy and safety of intraparotid gland injection of Botulinum neurotoxin serotype A (Dysport) for the treatment of sialorrhea (drooling) in children with cerebral palsy (CP). PATIENTS AND METHODS: Twenty-four children, ages 21 months to 7 years, were recruited and randomized to receive either treatment with 100U Botulinum toxin or placebo. Rating scales for the frequency and severity of drooling were performed at the time of injection, at 1 month, and at baseline prior to the second injection. A second set of injections of either 140U of drug or placebo was given 4 months later, and the same rating scales were used. Eight patients declined the second injection. Due to high dropouts in the placebo group in second set of injections, statistical analysis was performed for the results of the initial injection only. RESULTS: Scores of the median frequency (p=0.034) and severity (p=0.026) of drooling were reduced in the treatment group. Median total score also declined in the treatment group (p=0.027). After the second injection, five out of nine patients injected with the drug showed a decline in the total score; including three patients who did not respond to the first injection. Only two patients experienced transient increase in drooling after the treatment with the drug. CONCLUSION: Botulinum toxin is an effective and safe treatment option for drooling in children with CP.