Subject(s)
Carotid Stenosis/therapy , Cerebral Revascularization , Cranial Nerve Injuries/etiology , Cranial Nerve Injuries/psychology , Endarterectomy, Carotid , Postoperative Complications/etiology , Postoperative Complications/psychology , Quality of Life/psychology , Stents , Female , Humans , MaleABSTRACT
OBJECTIVE: Cranial nerve injury (CNI) is the most common neurologic complication of carotid endarterectomy (CEA) and can cause significant chronic disability. Data from prior randomized trials are limited and provide no health-related quality of life (HRQOL) outcomes specific to CNI. Incidence of CNIs and their outcomes for patients in the Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) were examined to identify factors predictive of CNI and their impact on HRQOL. METHODS: Incidence of CNIs, baseline and procedural characteristics, outcomes, and HRQOL scores were evaluated in the 1151 patients randomized to CEA and undergoing surgery ≤30 days. Patients with CNI were identified and classified using case report forms, adverse event data, and clinical notes. Baseline and procedural characteristics were compared using descriptive statistics. Clinical outcomes at 1 and 12 months were analyzed. All data were adjudicated by two neurologists and a vascular surgeon. HRQOL was evaluated using the Medical Outcomes Short-Form 36 (SF-36) Health Survey to assess general health and Likert scales for disease-specific outcomes at 2 weeks, 4 weeks, and 12 months after CEA. The effect of CNI on SF-36 subscales was evaluated using random effects growth curve models, and Likert scale data were compared by ordinal logistic regression. RESULTS: CNI was identified in 53 patients (4.6%). Cranial nerves injured were VII (30.2%), XII (24.5%), and IX/X (41.5%), and 3.8% had Horner syndrome. CNI occurred in 52 of 1040 patients (5.0%) receiving general anesthesia and in one of 111 patients (0.9%) operated on under local anesthesia (P = .05). No other predictive baseline or procedural factors were identified. Deficits resolved in 18 patients (34%) at 1 month and in 42 of 52 patients (80.8%) by 1 year. One patient died before the 1-year follow-up visit. The HRQOL evaluation showed no statistical difference between groups with and without CNI at any interval. By Likert scale analysis, the group with CNI showed a significant difference in the difficulty eating/swallowing parameter at 2 and 4 weeks (P < .001) but not at 1 year. CONCLUSIONS: In CREST, CNI occurred in 4.6% of patients undergoing CEA, with 34% resolution at 30 days and 80.8% at 1 year. The incidence of CNI was significantly higher in patients undergoing general anesthesia. CNI had a small and transient effect on HRQOL, negatively affecting only difficulty eating/swallowing at 2 and 4 weeks but not at 1 year. On the basis of these findings, we conclude that CNI is not a trivial consequence of CEA but rarely results in significant long-term disability.
Subject(s)
Carotid Stenosis/therapy , Cerebral Revascularization , Cranial Nerve Injuries/etiology , Cranial Nerve Injuries/psychology , Endarterectomy, Carotid , Postoperative Complications/etiology , Postoperative Complications/psychology , Quality of Life/psychology , Stents , Aged , Cross-Over Studies , Female , Humans , Incidence , Male , Middle Aged , Risk FactorsABSTRACT
UNLABELLED: The aim of this study was to determine whether pregabalin affects nociceptive behavior and central sensitization in a trigeminal neuropathic pain model. A partial infraorbital nerve transection (p-IONX) or sham operation was performed in adult male rats. Nociceptive withdrawal thresholds were tested with von Frey filaments applied to the bilateral vibrissal pads pre- and postoperatively. On postoperative day 7, the behavioral assessment was conducted before and at 30, 60, 120, and 180 minutes after and 24 hours after pregabalin (.1, 1, 10, 100 mg/kg intraperitoneally) or saline injection. The effects of pregabalin or saline were also examined on the mechanoreceptive field and response properties of nociceptive neurons recorded in the medullary dorsal horn at postoperative days 7 to 10. Reduced withdrawal thresholds reflecting bilateral mechanical allodynia were observed in p-IONX rats until postoperative day 28, but not in sham-operated rats. At postoperative day 7, pregabalin significantly and dose-dependently reversed the reduced mechanical withdrawal thresholds in p-IONX rats. Pregabalin also attenuated central sensitization of the neurons, as reflected in reversal of their reduced activation threshold, increased responses to pinch/pressure, and enhanced stimulus-response function. This study provides the first documentation that pregabalin attenuates the mechanical allodynia and central sensitization that characterize this trigeminal neuropathic pain model, and supports its clinical use for treating craniofacial neuropathic pain. PERSPECTIVE: Trigeminal nerve injury in rats produced facial mechanical hypersensitivity and trigeminal central sensitization of medullary dorsal horn neurons that were markedly attenuated by systemically administered pregabalin, suggesting its potential clinical utility for orofacial neuropathic pain.
Subject(s)
Analgesics/pharmacology , Behavior, Animal/drug effects , Nociception/drug effects , Trigeminal Neuralgia/drug therapy , gamma-Aminobutyric Acid/analogs & derivatives , Animals , Cranial Nerve Injuries/physiopathology , Cranial Nerve Injuries/psychology , Electric Stimulation , Facial Pain/physiopathology , Hot Temperature , Male , Nociceptors/drug effects , Pain Threshold/drug effects , Physical Stimulation , Posterior Horn Cells/drug effects , Pregabalin , Rats , Rats, Sprague-Dawley , Trigeminal Neuralgia/psychology , Vibrissae/innervation , gamma-Aminobutyric Acid/pharmacologyABSTRACT
Objective. To investigate the incidence and type of misconceptions about traumatic brain injuries (TBIs) harboured by university students. Method. A convenience sample of 705 university students were recruited and data were collected using an electronic survey. The link to the survey was sent via e-mail to all registered students at Stellenbosch University. The participants had to complete the Common Misconceptions about Traumatic Brain Injury (CM-TBI) questionnaire. Results. The findings of this study suggest that the students subscribe to misconceptions from each of the 7 categories of misconceptions about TBIs. The mean percentages of misconceptions about TBIs were calculated and the amnesia (mean 49.7) and unconsciousness (mean 46.1) categories were identified as the categories about which the respondents had the most misconceptions; while the mean percentages of misconceptions were lower for the categories of recovery (mean 27.6); rehabilitation (mean 26.56); prevention (mean 20.8); brain injury sequelae (mean 18.7) and brain damage (mean 8.4). Conclusion. Generally; these findings appear to be in keeping with previous literature; which suggests that misconceptions about TBIs are common among the general population. This study's identification of these misconceptions could help create awareness; provide a focus for information provision; and contribute to the development of educational intervention programmes tailored for the South African context
