Brain stimulation for patients with multiple sclerosis: an umbrella review of therapeutic efficacy.

Multiple sclerosis patients often experience various symptoms that can greatly impact their quality of life. There are various brain stimulation techniques that have been evaluated for their ability to reduce the symptoms of multiple sclerosis. However, there is inconsistency in the specific stimulation methods used and the symptoms targeted in the existing research. This umbrella review conducted in order to evaluate the effectiveness of brain stimulation and identify limitations and gaps for further research. In this umbrella review, we conducted a searched on Web of Knowledge, PubMed, and Scopus database. We specifically looked for reviews, with or without meta-analyses, that have investigated the effects of brain stimulation methods on symptoms of multiple sclerosis. All articles were examined by AMSTAR 2 (A Measure Tool to Assess Systematic Review 2). We identified 155 articles, of which 14 were eligible for inclusion. Of those, five were qualitative studies and nine were meta-analyses. Among the included studies, four examined the use of deep brain stimulation, while ten investigated the therapeutic potential of noninvasive brain stimulation. Considering the heterogeneity of studies, the current evidence suggests that repetitive transcranial magnetic stimulation may be effective in treating pain and improving motor function, while transcranial direct current stimulation may be useful in alleviating fatigue and enhancing certain aspects of cognitive performance. Deep brain stimulation, on the other hand, appears to be effective in reducing tremors. However, further research is warranted to validate these findings and address the existing limitations in the field.

A case report on POEMS syndrome with high parathyroid hormone and repeated surgery, a rare presentation of a rare disease.

INTRODUCTION: Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes (POEMS) syndrome is a rare multisystemic disease that is named for its constellation which can easily be mistaken for other disorders. CASE PRESENTATION: In present study we evaluated a 39-year-old man with hypercalcemia and parathyroid hormone. He underwent two failed surgeries for parathyroid adenoma but due to the presence of other features of the syndrome, a diagnosis of POEMS syndrome was made. His symptoms were multiple peripheral neuropathies, monoclonal plasma cell proliferative disorder, multiple bony lesions alongside endocrinopathy, lymphadenopathy, extravascular volume overload, mildly hypocellular marrow with polymorphic population, trilineage hematopoiesis, and progressive maturation less than 5 % plasma cell in bone marrow biopsy and aspiration. Patient was treated with the administration of Pomalidomide and autologous stem cell transplantation after which his symptoms improved and laboratory test results normalized. DISCUSSION: POEMS syndrome is a rare disorder that is challenging to diagnose due to its variable clinical presentation and similarity to other disorders. However, specific criteria can help distinguish it from other syndromes. In this case, we witness the comorbidity of Ganglioneuroma. Also, hyperglycemia with hypercalcemia and high PTH in this patient are not common endocrine disorders in POEMS syndrome which there are some possible explanations for these symptoms' presentation. CONCLUSION: Although endocrine disorders are an important part of POEMs syndrome, some characteristic of this disease is unknown, and it becomes more difficult to diagnose in early stages, that in these cases, thorough physical examinations and laboratory results may help with the early diagnosis.

Functional brain changes after alternative pharmacological interventions in posttraumatic stress disorder: A systematic review of clinical trials.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a complex and heterogeneous mental health condition that can develop after exposure to a traumatic event. Clinical trials have used alternative pharmacological agents to treat PTSD, but their associated neural correlates remain unclear. The present systematic review aims to summarize the changes in brain function associated with the use of these alternative pharmacological agents in PTSD. METHODS: Clinical trials using functional magnetic resonance imaging, either at rest or during the performance of tasks, were included if they compared the effects of alternative pharmacological agents between PTSD patients and either trauma-exposed controls or never-exposed healthy controls. RESULTS: Sixteen studies were included, of which 11 used intranasal oxytocin, 2 used hydrocortisone, and 3 used delta-9-tetrahydrocannabinol (THC). Oxytocin administration was associated with the normalization of functional connectivity between the ventromedial prefrontal cortex and amygdala as well as enhanced the function of brain regions specifically involved in emotion processing (e.g., amygdala), working memory (e.g., dorsolateral prefrontal cortex), and reward (e.g., putamen). Hydrocortisone did not influence brain function at rest or during the performance of an autobiographical memory task, whereas THC was associated with the reduction of the amygdala and increased medial prefrontal cortex activation. CONCLUSIONS: This systematic review identified preliminary evidence for normalizing brain function after the use of alternative pharmacological agents. Importantly, sex-specific differences were noted, in particular when using oxytocin, that will require further investigation.