Acupuncture treatment for idiopathic trigeminal neuralgia: A longitudinal case-control double blinded study.

OBJECTIVE: To evaluate the treatment effect of acupuncture on patients with idiopathic trigeminal neuralgia (ITN) by case-control longitudinal blinded study. METHODS: Sixty ITN patients and 30 healthy subjects were included. The ITN patients were randomly assigned to acupuncture group (15 cases), sham-acupuncture group (15 cases) and carbamazepine group (30 cases), respectively. Clinical orofacial evaluation (including pain intensity and medication doses), research diagnostic criteria for temporomandibular disorders (RDC/TMD) and Helkimo indexes (for functional evaluation of the masticatory system), and quantitative sensory testing for sensory thresholds (gustative, olfactory, cold, warm, touch, vibration and superficial and deep pain) were evaluated before treatment, immediately after treatment, and 6 months after treatment. RESULTS: The mean pain intensity by the Visual Analogue Scale only decreased in the acupuncture group at the last evaluation (P=0.012). Patients in the sham-acupuncture group had an increase in carbamazepine doses according to the prescriptions (P<0.01). There was a reduction in secondary myofascial pain and mandibular limitations at the acupuncture and sham-acupuncture groups, however only the acupuncture group kept the changes after 6 months (P<0.01, P=0.023). There was a decrease in mechanical thresholds in the acupuncture group (tactile, P<0.01; vibration, P=0.027) and an increase in deep pain thresholds in both acupuncture and sham-acupuncture groups (P=0.013). CONCLUSIONS: Acupuncture can be an option in the treatment of ITN due to its analgesic effect in both ITN and secondary myofascial pain associated with it.

Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls.

OBJECT: Idiopathic trigeminal neuralgia (iTN) is a neurological condition treated with pharmacotherapy or neurosurgery. There is a lack of comparative papers regarding the outcomes of neurosurgery in patients with iTN. The objective of this study was to investigate sensory thresholds and masticatory function in 78 patients with iTN who underwent microvascular decompression (MVD) or balloon compression (BC), and compare these treatments with carbamazepine and 30 untreated healthy controls. METHODS: The authors conducted a case-controlled longitudinal study. Patients were referred to 1 of 3 groups: MVD, BC, or carbamazepine. All patients were evaluated before and after treatment with a systematic protocol composed of a clinical orofacial questionnaire, Research Diagnostic Criteria for temporomandibular disorders, Helkimo indices, and a quantitative sensory-testing protocol (gustative, olfactory, cold, warm, touch, vibration, superficial, and deep pain thresholds). RESULTS: Both MVD and BC were effective at reducing pain intensity (p = 0.012) and carbamazepine doses (p < 0.001). Myofascial and articular complaints decreased in both groups (p < 0.001), but only the patients in the MVD group showed improvement in Helkimo indices (p < 0.003). Patients who underwent MVD also showed an increase in sweet (p = 0.014) and salty (p = 0.003) thresholds. The sour threshold decreased (p = 0.003) and cold and warm thresholds increased (p < 0.001) in patients after MVD and BC, but only the patients who underwent BC had an increase in touch threshold (p < 0.001). CONCLUSIONS: Microvascular decompression and BC resulted in a reduction in myofascial and jaw articular complaints, and the impact on masticatory function according to Helkimo indices was greater after BC than MVD. MVD resulted in more gustative alterations, and both procedures caused impairment in thermal thresholds (warm and cold). However, only BC also affected touch perception. The sensorial and motor deficits after BC need to be included as targets directly associated with the success of the surgery and need to be assessed and relieved as goals in the treatment of iTN.

Functional and sensory evaluation of patients with idiopathic trigeminal neuralgia: comparison with controls.

BACKGROUND: Idiopathic trigeminal neuralgia (ITN) can be associated with orofacial and sensory comorbidities. OBJECTIVE: To evaluate the masticatory functional and sensory characteristics of patients with ITN compared with controls. METHODS: We enrolled 119 patients and 30 healthy controls. They were evaluated with a systematic protocol: clinical orofacial evaluation questionnaire; a systematic approach of the mandibular function and the investigation of musculoskeletal comorbidities by the research diagnostic criteria for temporomandibular disorders (RDC/TMD) and the Helkimo indexes; and quantitative sensory testing (corneal reflex and gustative, olfactory, thermal, mechanical and pain thresholds). RESULTS: The study group had more loss of vertical dimension than the controls (p=0.011) and restriction of the maximum mouth opening (p=0.024); they had more pain on mandibular movements (p=0.001), limitation of mandibular function (p<0.001), masticatory discomfort (p<0.001) and myofascial pain (p=0.001). Occlusion Helkimo index was lower in controls than patients. The study group had high tactile (p=0.025), warm (p=0.020) and cold (p=0.003) thresholds. CONCLUSION: ITN may cause severe mandibular limitations that can be associated with the pain episodes and with sensory abnormalities. These findings indicate the affection of small and large nerve fibers and support the neuropathic nature of ITN. Sensory alterations can be part of the natural history of ITN and can be associated with the previous treatments including medication. They cause a high impact in quality of life.

Acidentes por queda de laje na infância registrados no Hospital Estadual do Grajaú em 2005 / Roof fall cases in childhood recorded in Hospital Estadual do Grajaú during 2005

Os acidentes têm aumentado as taxas de morbimortalidade infantil, tornando-se importante problema de saúde pública. Pouco precisos, os dados epidemiológicos dificultam odirecionamento das medidas preventivas. A finalidade deste estudo é determinar a freqüência dos acidentes por queda de laje em menores de 13 anos internados no Hospital Estadual doGrajaú em 2005, e propor ações preventivas na região. Realizou-se estudo retrospectivo, avaliando-se os atendimentos infantis por trauma, em especial as quedas de laje, quecorresponderam a aproximadamente 9% do total de quedas, excluindo-se aquelas com traumatismo crânio encefálico grave. Cerca de 13% dos casos de queda internados foram porquedas de laje, o que é significativo pela possibilidade de prevenção. Esses acidentes ocorreram principalmente em finais de semana e férias, sendo os escolares os mais envolvidos. A maioria(78%) era do sexo masculino pela grande exposição à atividades de risco. As baixas condições sócio-econômicas, refletindo na construção das moradias e no cuidado com as crianças, podemter influenciado nos acidentes. Programas de prevenção baseados na educação devem ser adotados, conscientizando a comunidade da importância de alterações no comportamento e na área física das moradias, para se evitar tais ocorrências...

Accidents have increased childhood mortality rates turning it into an important problem in public health. As epidemiologic data is not so precise, preventive measures become even moredifficult. This study aims at determining the frequency of accidents involving cases of underage 13 who fell off roofs in the Hospital Estadual do Grajaú in 2005 as well as providing some preventive actions for the region. Some retrospective study was made in which childhood assistance, specially in cases of roof fall (which corresponded to 9% of the total number of falls) except those with encephalic traumatism, was assessed. About 13% of the cases were caused by roof falls, which is an important factor for the possibility of prevention. The accidents occurred mainly during weekends and holidays and schoolchildren were the most affected. Most of them (78%) weremales, which can be explained by the great exposure to risky activities. Low social economic conditions reflecting in housing and childcare may have influenced on the accidents. Preventiveprograms based on education must be adopted to make the population conscious of the importanceof behavior and housing alterations to avoid the occurrence of such accidents...