ABSTRACT
AIM: It has been suggested that the repetitive transcranial magnetic stimulation could be useful as a non-pharmacological treatment for spasticity. The aim of this study was to evaluate the clinical and neurophysiological effects of high-frequency intermittent theta burst stimulation (iTBS) on lower limb spasticity in patients with relapsing multiple sclerosis in a randomized, double-blind placebo controlled trial. PATIENTS AND METHODS: Seventeen patients in the remitting phase of the disease were randomly allocated to sham or magnetic therapy group and underwent iTBS over contralateral motor cortex of the most affected leg once a day for two weeks. Each session consisted of 10 bursts containing three pulses at 50 Hz repeated at 200 ms intervals (5 Hz) every 10 s for a total of 600 stimuli. The iTBS effect was assessed by using clinical (such as the Modified Ashworth Scale) and neuro-physiological (H/M amplitude ratio and cortical silent period duration) parameters. RESULTS: Two-week iTBS over motor cortex of the most affected leg did not produce any significant clinical effect on spasticity. However, it decreases the H/M amplitude ratio and increases duration of cortical silent period but not significantly, in patients with relapsing multiple sclerosis. CONCLUSION: The stimulation protocol used in this study does not have significant therapeutic effect. Therefore, we do recommend further studies as neurophysiological changes were evident.
TITLE: Estimulacion magnetica transcraneal theta-burst intermitente para el tratamiento de la espasticidad en pacientes con esclerosis multiple recurrente: resultados de un ensayo clinico aleatorizado doble ciego.Objetivo. La estimulacion magnetica transcraneal repetitiva podria ser util como tratamiento no farmacologico para la espasticidad. El objetivo de este estudio es reevaluar el efecto clinico y los cambios neurofisiologicos que produce la estimulacion theta-burst intermitente (ETBi) sobre la espasticidad de las extremidades inferiores en pacientes con esclerosis multiple recurrente en un ensayo aleatorizado, doble ciego, controlado con placebo. Pacientes y metodos. Diecisiete pacientes en la fase remitente de la enfermedad fueron aleatoriamente asignados al grupo placebo o al grupo de tratamiento activo mediante estimulacion magnetica transcraneal repetitiva con protocolo ETBi sobre la corteza motora contralateral de la pierna mas afectada. El procedimiento consistio en 10 sesiones diarias durante dos semanas. Cada sesion consistio en 10 rafagas que contenian tres pulsos a 50 Hz repetidos a intervalos de 200 ms (5 Hz) cada 10 s para un total de 600 estimulos. El efecto de ETBi se evaluo mediante el uso de parametros clinicos (como la escala de Ashworth modificada) y neurofisiologicos (ratio de amplitud H/M y duracion del periodo cortical silente). Resultados. Dos semanas de ETBi sobre la corteza motora de la pierna mas afectada no produjeron ningun efecto clinico significativo sobre la espasticidad en pacientes con esclerosis multiple recurrente. Sin embargo, aunque de forma no significativa, se observo disminucion de la ratio de amplitud H/M y un aumento de la duracion del periodo cortical silente. Conclusion. El protocolo de estimulacion utilizado en este estudio no parece tener un efecto terapeutico significativo. Sin embargo, recomendamos estudios adicionales, ya que los cambios neurofisiologicos fueron evidentes.
Subject(s)
Multiple Sclerosis/complications , Muscle Spasticity/etiology , Muscle Spasticity/therapy , Transcranial Magnetic Stimulation/methods , Adult , Aged , Double-Blind Method , Female , Humans , Male , Middle Aged , Prospective Studies , Recurrence , Treatment OutcomeABSTRACT
Two cases of multiple compartment syndrome in two male patients with history of drug and alcohol abuse are here reported. The clinical picture, course, therapy and sequelae are described and a special emphasis is placed on triggering causes. Given the increasing number of patients presenting to the Emergency Departments with history of overdose and in comatose status, an early clinical suspicion of these pictures is worth noting to avoid severe sequelae which, if not treated early, are irreversible and lead to permanent disability.
