Osteo-Cutaneous Trophic Changes in Complex Regional Pain Syndrome and their Reversal with Steroids.

Background: Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by autonomic and inflammatory features. There is paucity of data regarding sustained benefits of any treatment modality. We aimed to document the effect of steroids in CRPS on long-term basis. Materials and Methods: We came across five patients of CRPS in Out Patient clinics of super-speciality Institutes in North India. All five cases fulfilled the Budapest criteria for the diagnosis of CRPS. All of them received prednisolone and were prospectively followed up for 2 years. Treatment outcome was carefully recorded in all affected modalities. Results: All five cases were found to have excruciating neuropathic pain in defined regions along with cutaneous manifestations. Osseous changes in the form of surface erosion of underlying bones in four cases and marked marrow edema leading to considerable increase in bone thickness in one case were noted. All these features improved considerably following steroid therapy. Bone marrow edema and bone resorption showed improvement on serial imaging. Conclusion: Apart from pain relief, steroids therapy is capable of reversing the osteo-cutaneous autonomic changes of CRPS type I.

Is Palinopsia in Migraineurs a Phenomenon of Impaired Habituation of Visual Cortical Neurons?

Palinopsia in migraine has been reported recently, which may be due to the dysexcitability of visual cortical neurons. In this cross-sectional study, we report the correlation of neuronal dysexcitability with palinopsia using pattern shift visual evoked potential (PSVEP) in 91 migraineurs and 25 healthy controls. The presence of palinopsia was evaluated using a novel objective method, and revealed more frequent palinopsia in the migraineurs compared to the controls (53 of 91 [58.2%] vs 3 of 25 [12%]; P < .001). Five consecutive blocks of PSVEP were recorded for the evaluation of sensitization and impaired habituation. Amplitudes of N75 and P100 in block 1 were considered for sensitization. Impaired habituation of N75 and P100 was considered if any amplitudes in blocks 2 to 5 were higher than block 1. Impaired habituation was more frequent in migraineurs compared with the controls, and was more marked in wave N75 (81.3% vs 32%; P < .001) than wave P100 (63.7% vs 44%; P = .12). Impaired habituations of wave N75 (81.7% vs 58.9%; P = .008) and wave P100 (71.7% vs 46.4%; P = .008) were more frequent in those with palinopsia compared with those without. There was a lack of suppression of P100 amplitude in block 3 in the palinopsia group compared to the controls. The duration of palinopsia correlated with the extent of impaired habituation of N75. It can be concluded that the impaired habituation of PSVEP waveforms is a biomarker of palinopsia in migraine.

Phonophobia and brainstem excitability in migraine.

Phonophobia in migraineurs may be due to lower hearing threshold (HT) and higher brainstem neuronal excitability. We report the correlation of phonophobia in migraineurs with HT, brain stem auditory evoked potential (BAEP) findings, and auditory triggers. Sixty-one migraineurs and 101 controls were included for HT, of whom 59 migraineurs and 31 controls had BAEP studies. Clinical details, migraine triggers, and headache frequency were noted. Hearing threshold was measured, and amplitudes of waves I to V of BAEP studies were measured. Migraineurs had lower HT compared with controls (41.61 ± 5.25 versus 45.39 ± 6.26 dB; p < 0.001) especially in chronic migraine (40.24 ± 4.81; p < 0.001). Hearing threshold correlated with headache frequency (p < 0.05) and auditory, visual, and tactile (p < 0.05) triggers. Hearing threshold was lower during headache (p < 0.001). Wave II, III, and IV amplitudes of BAEP were higher in migraineurs than the controls. Wave II (p < 0.05) and III (p < 0.05) amplitudes correlated with HT. Migraineurs have lower HT, especially in those having chronic migraine, ictal HT recording, and multiple sensory triggers. Higher amplitudes of BAEP waves in migraineurs and their relationship with the frequency of headache and HT suggest the sensitization of brainstem auditory neurons.

Role of corrected-assisted-synchronized-periodic therapy in post-stroke rehabilitation.

BACKGROUND: Stroke is one of the common causes of chronic disability among neurological disorders. The role of various physiotherapy techniques has been extensively described in the literature. Here, we introduce a new physiotherapy technique, "Corrected-Assisted-Synchronized-Periodic (CASP) therapy." In this study, we aimed to compare CASP therapy with conventional physiotherapies. MATERIALS AND METHODS: This was a prospective, parallel, quasi-randomized, double-blind controlled intervention trial. The study was carried out at a tertiary care teaching and research centre. Sixty-one stroke affected patients with functional modified Rankin Scale (mRS) ranging from 1 to 5 suffering from post-stroke spasticity (grade 1-4) and muscle weakness were included in the study. Patients were randomly allocated into two groups. The first group followed conventional passive stretching exercises and the second group was offered CASP therapy. They were prospectively followed up at 3 monthly intervals for 6 months. The main outcome-measures were improvement in power, reduction in spasticity, and improvement in overall functional outcome. RESULTS: Mann-Whitney U-test for statistical significance was applied. At follow-up, CASP recipients reported improvement on functional scales such as Barthel index of activity of daily living, and modified Rankin scale (mRS), along with reduction in post-stroke spasticity and improvement in muscle power at 3 and 6 months of follow-up. CONCLUSION: CASP therapy has a major role in post-stroke rehabilitation particularly in limiting disability, reducing post-stroke spasticity, and providing an improvement in major functional outcomes.