Efficacy and tolerability of leflunomide in difficult-to-treat polymyalgia rheumatica and giant cell arteritis: a case series.

Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are related inflammatory rheumatic conditions affecting adults over the age of 50 years. Both conditions respond to initial glucocorticoid (GC) therapy. However, most patients require 12-36 months of a tapering steroid regime. Adverse events at 2 years are seen in up to 65% of patients with PMR and 86% of patients with GCA with over 50% developing serious events. There is also a high incidence of relapse in both diseases -40% within 2 years for GCA and 50% of patients with PMR at some point having a relapse. Effective steroid-sparing adjuvant therapies are urgently required especially in incomplete, poorly sustained or non-responders to glucocorticoids. In this case series, we found that Leflunomide is efficacious, with 22 out of our 23 patients exhibiting a complete or partial response. It was also steroid sparing and well tolerated. It may be a useful adjunctive agent in difficult-to-treat GCA and PMR. Prospective randomised controlled trials of Leflunomide in both GCA and PMR are now required.

Is primidone the drug of choice for epileptic patients with QT-prolongation? A comprehensive analysis of literature.

Sudden unexplained/unexpected death (SUDEP) in epilepsy is a major cause of death accounting for 7-17% of the mortality among epileptic patients. Prolongation of QT-interval has been issued as a major mechanism in SUDEP since it is associated with fatal cardiac arrhythmias. This condition may be further precipitated by anti-epileptic treatment. Despite thorough literature research, we did not find any reports suggesting that primidone is responsible for QT-prolongation. On the contrary, all the retrieved reports addressed that the drug shortened QT-interval and corrected signs and symptoms of the underlying disease.

EMG biofeedback for handwriting disabilities: a critical examination of the literature.

A critical examination of the literature on the use of electromyographic (EMG) biofeedback for problems of handwriting is presented. Examined are the procedures, results and conclusions of clinical treatments of writer's cramp and the habilitation of writing. The major flaws in each study are discussed and conclusions drawn from the review are presented, the primary one being that EMG biofeedback of the muscles of the upper extremity has yet to be demonstrated as a treatment of choice for handwriting disabilities. The lack of a sound foundation of data is seen as the main reason for the paucity of investigations in this particular area. Suggestions for further work are offered.

A cross-modality approach for treatment of chronic pain: a preliminary report.

Three subjects, presenting a variety of chronic pain problems, were treated with a cross-modality feedback technique. Their presenting pain intensity was matched to a pure tone auditory stimulus decibel level and in each session this stimulus was progressively reduced in loudness, with the subjects having the task of reducing their pain to match each new, lower decibel levels. Audiometric measures, responses to pain assessment scales, self-reports, reports from hospital staff, and reductions in pain medications all demonstrated marked pain reduction in all cases. Follow-up assessments revealed that the improvements were maintained long after treatment had been discontinued.

EMG biofeedback with upper extremity musculature for relaxation training: a critical review of the literature.

A critical review is presented of studies utilizing EMG biofeedback for relaxation of upper extremity musculature. Examined are experimental investigations with normal subjects and those with psychological problems, and clinical applications of the methodology for treatment of involuntary movements and anxiety. Articles are reviewed in terms of procedures, controls and results. It is determined that few valid conclusions can be drawn regarding the efficacy of upper extremity EMG biofeedback for relaxation and that further research is required prior to utilizing the technique clinically. Suggestions are offered for areas of investigation.

Experimental foundations of EMG biofeedback with the upper extremity: a review of the literature.

This article reviews the experimental foundations of EMG biofeedback with the upper extremity. Considered are investigations on recruitment and training of single and multiple motor units in both normal and nonnormal subjects, on transfer of training effects from trained to untrained muscles, and on the relationship of reduced muscle output to relaxation. Examined are procedures, results, and conclusions of these basic studies. Problems noted in the research are discussed and suggestions are made for further work in the area.