Acupuncture for patients recovering from lacunar infarction: A protocol for systematic review and meta-analysis.

BACKGROUND: Lacunar infarction (LI) is the mild type in the classification of ischemic stroke, mostly occurs in the middle-aged and elderly, with mild hemiplegia and partial sensory disorder as the main manifestations. In the treatment of LI, acupuncture is often regarded as dominant therapy in the convalescence period. However, acupuncture for treatment of LI in the recovery period lacks high-quality reports and evidence-based medical evidence. Thus, we aim to evaluate the curative effect and safety of acupuncture for LI objectively. METHODS: Pubmed, Cochrane Library, Web of Science, EBSCO, Springer, China National Knowledge Infrastructure, Chinese Scientific and Technical Journals Database (VIP), Wan-fang Database, Chinese Biomedical Literature Database, Chinese Science Citation Database, and other electronic databases will be retrieved from the inception to May, 2021. Randomized controlled trials related to this subject will be searched. The inclusion criteria are established and a detailed literature search strategy is designed through discussion. Article retrieval, screening, excluding repetitive studies, assessment of quality, and data processing will be conducted by 2 reviewers independently using EndNote (X9) and Review Manager (5.3.5). The outcome measures include primary outcome measures (total effective rate, National Institute of Health Stroke Scale score, and Fugl-Meyer Assessment score), secondary outcome measures (blood pressure, plasma glucose, and blood lipid), and safety outcome measures. We will perform a meta-analysis, descriptive analysis, and subgroup analysis based on data conditions. RESULTS: The study of total effective rate, National Institute of Health Stroke Scale score, Fugl-Meyer Assessment score, blood pressure, plasma glucose, blood lipid, and adverse effects will provide evidenced outcome for high-quality synthesis and descriptive analysis. CONCLUSION: This systematic review will kindly provide evidence of whether acupuncture is an effective and safe intervention for LI in the recovery period. INPLASY REGISTRATION NUMBER: INPLASY202150060 (DOI:10.37766/inplasy2021.5.0060).

Effect of noisy galvanic vestibular stimulation in community-dwelling elderly people: a randomised controlled trial.

BACKGROUND: Balance disorders are a risk factor for falls in the elderly. Although noisy galvanic vestibular stimulation (nGVS) has been reported to improve balance in young people, randomised control trials targeting community-dwelling elderly people have not been conducted to date. We aimed to assess the influence of nGVS on COP sway in the open-eye standing posture among community-dwelling elderly people in a randomised controlled trial. METHODS: A randomised controlled trial of 32 community-dwelling elderly people randomly assigned to control (sham stimulation) and an nGVS groups. All participants underwent centre of pressure (COP) sway measurements while standing with open eyes at baseline and during stimulation. The control group underwent sham stimulation and the nGVS group underwent noise stimulation (0.4 mA; 0.1-640 Hz). RESULTS: In the nGVS group, sway path length, mediolateral mean velocity and anteroposterior mean velocity decreased during stimulation compared with baseline (P < 0.01). The effect of nGVS was large in participants with a high COP sway path length at baseline, but there was no significant difference in COP sway in the control group. CONCLUSIONS: We conclude that nGVS decreases the COP sway path length and mean velocity of community-dwelling elderly people when standing with open eyes. This suggests that nGVS could be effective for treating balance dysfunction in the elderly.

Un algoritmo de tratamiento farmacológico para el dolor neuropático localizado / A pharmacological treatment algorithm for localised neuropathic pain

No disponible

Using Plantar Electrical Stimulation to Improve Postural Balance and Plantar Sensation Among Patients With Diabetic Peripheral Neuropathy: A Randomized Double Blinded Study.

OBJECTIVE: People with diabetic peripheral neuropathy (DPN) often exhibit deteriorations in motor-performance mainly due to lack of plantar-sensation. The study explored effectiveness of plantar electrical-stimulation therapy to enhance motor-performance among people with DPN. DESIGN AND METHODS: Using a double-blinded model, 28 volunteers with DPN (age: 57.8 ± 10.2 years) were recruited and randomized to either intervention (IG: n = 17) or control (CG: n = 11) group. Both groups received identical plantar-stimulation devices for six weeks of daily use at home; however, only the IG devices were set to deliver stimulation. Balance (ankle, hip, and center of mass [COM] sway) and gait (stride velocity [SV], stride time [ST], stride length [SL], and cadence) were measured using validated wearable sensors. Outcomes were assessed at baseline and at six-week. Clinical assessment including vascular as measured by ankle-brachial-index (ABI) and plantar-sensation as quantified by vibratory plantar threshold (VPT) were also measured at baseline and six weeks. RESULTS: No difference were observed between groups for baseline characteristics ( P > .050). Posttherapy, ankle and COM sway with eyes open were significantly improved ( P < .05, Cohen's effect size d = 0.67-0.76) in the IG with no noticeable changes in CG. All gait parameters were significantly improved in the IG with highest effect size observed for cadence ( d = 1.35, P = .000). Results revealed improvement in VPT ( P = .004, d = 1.15) with significant correlation with stride velocity improvement ( r = .56, P = .037). ABI was improved in the IG in particulate among those with ABI>1.20 ( P = .041, d = 0.99) Conclusion: This study suggests that daily home use of plantar electrical-stimulation may be a practical means to enhance motor-performance and plantar-sensation in people with DPN.

Somatosensory pain is not reliably modulated by weak acoustic stimuli.

BACKGROUND: Pain induced by electrical stimuli has been found in previous research to be reduced by brief, weak electrical pulses, termed prepulses, presented 40 to 60ms prior to the painful electrical stimulus. METHODS: The present experiment investigated the generality of this effect by presenting weak acoustic stimuli simultaneously with, or 80 or 1000ms prior to, painful electric shocks. In the second half of the experimental session, each participant (N=119) was told that the acoustic stimuli would either increase or decrease the pain induced by the electric shock, to investigate automatic and controlled cognitive processes in the modulation of pain. RESULTS: Acoustic stimuli presented simultaneously with painful stimulation increased pain slightly (4mm on a 100mm scale). Acoustic stimuli presented 80 and 1000ms prior to painful stimuli had no effect on pain. Information that acoustic stimuli would increase pain did so in females, but only when the acoustic stimulus was presented 80ms prior to the painful stimulus. CONCLUSIONS: The effect of the acoustic stimuli and of information was weak. Failure to replicate previous findings of decreased pain by weak prepulses was most likely due to the sensory modality of the prepulse stimuli. It is recommended that further studies of pain modulation by brief stimulation use electrical and not acoustic prepulse stimuli.

Microstimulation: Principles, Techniques, and Approaches to Somatosensory Neuroprosthesis.

The power of movement of electrically charged particles has been used to alleviate an array of illnesses and help control some human body parts. Microstimulation, the electrical current-driven excitation of neural elements, is now being aimed at brain-machine interfaces (BMIs), brain-controlled external devices that improve quality of life for people such as those who have lost the ability to use their limbs. This effort is motivated by behavioral experiments that indicate a direct link between microstimulation-induced sensory experience and behavior, pointing to the possibility of optimizing and controlling the outputs of BMIs. Several laboratories have focused on using electrical stimulation to return somatosensory feedback from prosthetic limbs directly to the user's central nervous system. However, the difficulty of the problem has led to limited success thus far, and there is a need for a better understanding of the basic principles of neural microstimulation. This article provides a review of the available literature and some recent work at Downstate Medical Center and Columbia University on microstimulation of the primate and rodent somatosensory (S1) cortex and the ventral posterolateral thalamus. It is aimed at contributing to the existing knowledge base to generate good behavioral responses and effective, BMI-appropriate somatosensory feedback. In general, the threshold for the particular brain tissue in response to current-amplitude has to be determined by rigorous experimentation. For consistently reproducible results, hardware and thresholds for microstimulation have to be specified. In addition, effects on motor functions, including unwanted side effects in response to the microstimulation of brain tissue, must be examined to take the field from bench to bedside.

Stellate Ganglion Block, Compared With Xenon Light Irradiation, Is a More Effective Treatment of Neurosensory Deficits Resulting From Orthognathic Surgery, as Measured by Current Perception Threshold.

PURPOSE: The aim of this study was to evaluate the relative effectiveness of stellate ganglion blockade (SGB) versus xenon light irradiation (XLI) for the treatment of neurosensory deficits resulting from orthognathic surgery as determined by a comparison of prospective measurements of electrical current perception thresholds (CPTs) and ranged CPTs (R-CPTs). MATERIALS AND METHODS: CPT and R-CPT in the mental foramen area were measured during electrical stimulation at 98 different sites on the body in patients who had undergone orthognathic surgery. After surgery, patients were assigned to the SGB group or the XLI group. CPT and R-CPT of the 2 groups were measured at stimulation frequencies of 2,000, 250, and 5 Hz before surgery, 1 week after surgery, and after 10 treatment sessions. Furthermore, the influence of surgical factors, such as genioplasty and a surgically exposed inferior alveolar nerve (IAN), was examined in the 2 groups. RESULTS: Patients' CPT and R-CPT values indicated a considerable amount of sensory disturbance in most cases after surgery. The change in magnitude of all CPT and R-CPT values for the SGB group decreased considerably compared with that for the XLI group after treatment. There was no correlation between CPT or R-CPT values and surgical factors (eg, genioplasty and exposure of the IAN). CONCLUSION: SGB of the IAN could be an effective method for treating neurosensory deficits after orthognathic surgery on the IAN.

Adjunctive deep touch pressure for comorbid anxiety in bipolar disorder: mediated by control of sensory input?

Previous studies have shown that individuals with autism spectrum disorders and attention- deficit/hyperactivity disorder (ADHD) experience sensory over-responsivity (SOR) in which a heightened response is evoked by stimuli in the environment. These individuals also display symptoms of anxiety such as irritability, avoidance, and sweating. Deep touch pressure, a technique in which firm touch is applied to the body either by the self or by a machine, has been shown to improve functioning and reduce symptoms of anxiety in these populations. A patient presenting with bipolar I disorder and comorbid anxiety, ADHD, and dyslexia was taught deep touch pressure strategies to alleviate severe symptoms of sensory over-responsivity and anxiety. The patient reported that the techniques were helpful as they allowed her to cope with potentially overwhelming situations in her environment. Clinician-rated functioning also improved over the course of treatment. This case study suggests that deep touch pressure may be useful in patients with bipolar disorder who have SOR and anxiety as comorbid conditions.

A systems biology approach to studying Tai Chi, physiological complexity and healthy aging: design and rationale of a pragmatic randomized controlled trial.

INTRODUCTION: Aging is typically associated with progressive multi-system impairment that leads to decreased physical and cognitive function and reduced adaptability to stress. Due to its capacity to characterize complex dynamics within and between physiological systems, the emerging field of complex systems biology and its array of quantitative tools show great promise for improving our understanding of aging, monitoring senescence, and providing biomarkers for evaluating novel interventions, including promising mind-body exercises, that treat age-related disease and promote healthy aging. MATERIAL AND METHODS: An ongoing, two-arm randomized clinical trial is evaluating the potential of Tai Chi mind-body exercise to attenuate age-related loss of complexity. A total of 60 Tai Chi-naïve healthy older adults (aged 50-79) are being randomized to either six months of Tai Chi training (n=30), or to a waitlist control receiving unaltered usual medical care (n=30). Our primary outcomes are complexity-based measures of heart rate, standing postural sway and gait stride interval dynamics assessed at 3 and 6months. Multiscale entropy and detrended fluctuation analysis are used as entropy- and fractal-based measures of complexity, respectively. Secondary outcomes include measures of physical and psychological function and tests of physiological adaptability also assessed at 3 and 6months. DISCUSSION: Results of this study may lead to novel biomarkers that help us monitor and understand the physiological processes of aging and explore the potential benefits of Tai Chi and related mind-body exercises for healthy aging.

Prospective randomized double-blind study of temporary sacral nerve stimulation in patients with rectal evacuatory dysfunction and rectal hyposensitivity.

OBJECTIVE: Prospective randomized double-blind placebo-controlled crossover trial of 14 female patients (median age 52 [30-69] years) with proctographically defined evacuatory dysfunction (ED) and demonstrable rectal hyposensitivity (elevated thresholds to balloon distension in comparison with age- and sex-matched controls). BACKGROUND: Sacral nerve stimulation (SNS) is an evolving treatment for constipation. However, variable outcomes might be improved by better patient selection. Evidence that the effect of SNS may be mediated by modulation of afferent signaling promotes a role in patients with ED associated with rectal hyposensation. METHODS: SNS was performed by the standard 2-stage technique (temporary then permanent implantation). During a 4-week period of temporary stimulation, patients were randomized ON-OFF/OFF-ON for two 2-week periods. Before insertion (PRE), and during each crossover period, primary (rectal sensory thresholds) and secondary (bowel diaries, constipation, and GIQoL [gastrointestinal quality of life] scores) outcome variables were blindly assessed. RESULTS: Thirteen patients completed the trial. Following stimulation, defecatory desire volumes to rectal balloon distension were normalized in 10 of 13 patients (PRE: mean 277 mL [234-320] vs ON: 163 mL [133-193] vs OFF: 220 mL [183-257 mL]; P = 0.006) and maximum tolerable volume in 9 of 13 (PRE: mean 350 mL [323-377] vs ON: 262 mL [219-305] vs OFF: 298 mL [256-340 mL]; P = 0.012). There was a significant increase in the percentage of successful bowel movements (PRE: median 43% [0-100] vs ON: 89% [11-100] vs OFF: 83% [11-100]; P = 0.007) and Wexner constipation scores improved (PRE: median 19 [9-26] vs ON: 10 [6-27] vs OFF: 13 [5-29]; P = 0.01). There were no significant changes in disease-specific or generic quality of life measures. Eleven patients progressed to permanent stimulation (9/11 success at 19 months). CONCLUSIONS: Most patients with chronic constipation secondary to ED with rectal hyposensitivity responded to temporary SNS. The physiological results presented support a mechanistic role for rectal afferent modulation.

Modulation of somatosensory profiles by spinal cord stimulation in primary Raynaud's syndrome.

BACKGROUND AND GOAL: Spinal cord stimulation (SCS) is an effective antinociceptive treatment for various neuropathic pain syndromes. Apart from antinociceptive action, it may modulate overall somatosensory perception. This case report targets the question of whether SCS may alter quantitative sensory testing (QST) in a patient with primary Raynaud's syndrome. MATERIALS AND METHODS: We report on a 44-year-old female patient with primary Raynaud's syndrome who had SCS via cervical and lumbar electrodes. QST was performed in a standardized manner assessing cold detection threshold (CDT) and warm detection threshold (WDT), cold pain threshold (CPT) and heat pain threshold (HPT), mechanical detection threshold (MDT) and mechanical pain threshold (MPT) thresholds, and vibration detection threshold (VDT) and pressure pain thresholds (PPT). We tested at the dorsum of the right/left hand of the patient with engaged and disengaged SCS. Test results were compared with a control group of 80 subjects. RESULTS: Without SCS, the patient showed a sensory decrease in CDT, MDT, MPT, and VDT. SCS influenced the perception of cold, warm, and tactile detection thresholds, whereby CDT, WDT, and VDT were impaired and MDT was improved. CONCLUSION: SCS significantly modulated the somatosensory profile in a patient with primary Raynaud's syndrome. These effects were pronounced in qualities involving Aß, C, and A∂ nerve fibers. Further investigations may help to understand the mechanisms of action of SCS.

Influence of pain reduction by transcutaneous electrical nerve stimulation (TENS) on somatosensory functions in patients with painful traumatic peripheral partial nerve injury.

Following peripheral nerve injury sensory loss is taken as a sign of denervation. However, based on reports of improved sensitivity following relief of pain it has been suggested that a functional block produced by the activity in the nociceptive system itself may be responsible for at least part of the sensory aberrations. The aim was to examine if pain reduction by high-frequency TENS influenced somatosensory functions in patients with long-term unilateral painful traumatic peripheral partial nerve injury. Eighteen patients with spontaneous ongoing pain and a touch sensation in the innervation territory of the injured nervous structure of at least 5 on an intensity 11-point Likert rating scale compared with contralaterally, participated. Before and following 80 Hz TENS with a stimulus intensity generating non-painful paresthesiae in the painful areas during 30 min the pain intensity was rated on a numerical rating scale and bedside examination of somatosensory functions (BE) and quantitative sensory testing (QST) were performed in the same areas. Before and following TENS there was no difference in sensory functions between nine patients with ≥ 50% pain reduction and nine patients with a smaller or no reduction in pain. Compared to baseline, only minor TENS-induced alterations in somatosensory functions were found at BE in conjunction with decreased sensitivity to light touch at QST (p < 0.01) in both groups alike. In conclusion ≥ 50% pain reduction by TENS did not alter sensory functions differentially compared to a smaller or no reduction in pain.

Increased pinch strength in acute and subacute stroke patients after simultaneous median and ulnar sensory stimulation.

BACKGROUND: Peripheral nerve stimulation may induce cortical adaptations as it improves pinch strength in chronic stroke patients immediately after stimulation. OBJECTIVE: Test the effects of peripheral sensory stimulation on pinch strength in patients with acute and subacute stroke. METHODS: Stroke patients (N = 20) who had onset less than 6 months previously and could voluntarily pinch the thumb to the index finger participated in a randomized, single-blinded, controlled study. Ten patients received 2 hours of simultaneous electrical stimulation over the median and ulnar nerves at the wrist to the level of appreciating paresthesias (peripheral sensory stimulation group). Ten control patients received stimulation to the level of perception (sham-control group). Pinch strength of the thumb pad to tip and to lateral side of the index finger of the paretic hand and the Action Research Arm test were tested before and immediately after the stimulation. RESULTS: Lateral and tip pinch strength were significantly increased in both groups (P < .05). Mean +/- SD of increased lateral pinch strength of peripheral sensory stimulation and sham-control groups were 1.24 +/- 0.54 pounds and 0.20 +/- 0.28 pounds, respectively. Mean +/- SD of increased tip pinch strength of peripheral sensory stimulation and sham-control groups were 1.00 +/- 0.72 pounds and 0.37 +/- 0.36 pounds, respectively. Increase pinch strength of the peripheral sensory stimulation group was greater than the sham-control group, with significant difference (P < .05). The Action Research Arm test was not significantly changed after stimulation in both groups (P > .05). CONCLUSION: Peripheral sensory stimulation of the paretic hand may increase pinch strength of acute and subacute stroke patients immediately after stimulation.

The effect of monochromatic infrared energy on transcutaneous oxygen measurements and protective sensation: results of a controlled, double-blind, randomized clinical study.

Monochromatic infrared energy has been reported to restore protective sensation by increasing circulation. A controlled, double-blind, quasi-experimental, randomized clinical study was conducted to 1) examine the effects of monochromatic infrared energy treatments on tissue perfusion, 2) determine the effects of a published monochromatic infrared energy neuropathy protocol on sensation on the feet of patients with diabetes and a loss of protective sensation; 3) examine monochromatic infrared energy's effect on pain; and 4) examine the relationship between transcutaneous oxygen levels and loss of protective sensation. The study was conducted at a wound and hyperbaric treatment center in Norwalk, Conn; 18 adults (12 men, six women; mean age 65 +/-13 years, range 39 to 86 years) with diabetes and loss of protective sensation were recruited using convenience sampling methods. All patients served as their own control. Pre- and post treatment tests assessed sensation, pain, and transcutaneous oxygen measurements on two sites per foot. Participants underwent a series of 30-minute monochromatic infrared energy treatments (one foot active treatment, one foot sham). Monochromatic infrared energy was delivered at the manufacturer pre-set level of energy of 1.5 J/cm(2)/min at a wavelength of 890 nm; sham units delivered no energy. Scores were analyzed using paired t-tests and Pearson's correlation coefficient. No significant differences were observed between active and sham treatments for transcutaneous oxygen values, pain, or sensation. Both active and sham monochromatic infrared energy-treated feet had significantly improved sensation when compared to pretest baseline scores (P <0.05). No statistical relationship was found between transcutaneous oxygen and sensation. This small study did not demonstrate any effects of monochromatic infrared energy treatment on transcutaneous oxygen measurements, pain, or sensation in adults with diabetes and loss of protective sensation.

Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control.

The receptors in the cervical spine have important connections to the vestibular and visual apparatus as well as several areas of the central nervous system. Dysfunction of the cervical receptors in neck disorders can alter afferent input subsequently changing the integration, timing and tuning of sensorimotor control. Measurable changes in cervical joint position sense, eye movement control and postural stability and reports of dizziness and unsteadiness by patients with neck disorders can be related to such alterations to sensorimotor control. It is advocated that assessment and management of abnormal cervical somatosensory input and sensorimotor control in neck pain patients is as important as considering lower limb proprioceptive retraining following an ankle or knee injury. Afferent information from the cervical receptors can be altered via a number of mechanisms such as trauma, functional impairment of the receptors, changes in muscle spindle sensitivity and the vast effects of pain at many levels of the nervous system. Recommendations for clinical assessment and management of such sensorimotor control disturbances in neck disorders are presented based on the evidence available to date.

[Clinical observation on catgut implantation at acupoint for treatment of somatic form disorders].

OBJECTIVE: To compare therapeutic effects of catgut implantation at acupoint plus small dose of Paroxetine Hydrochloride and simple Paroxetine Hydrochloride. METHODS: Eighty-eight cases of such disease were divided into 2 groups, a treatment group (n=54) and a control group (n=34). The treatment group were treated with catgut implantation at main points Dazhui (GV 14), Zhongwan (CV 12), Tianshu (ST 25), Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), etc., plus oral administration of small dose of Paroxetine Hydrochloride; and the control group were treated with simple Paroxetine Hydrochloride. They were treated for 6 weeks. Hamilton Depression Rating Scale (HAMD) was used for assessment of the therapeutic effect. RESULTS: The effective rate was 92.6% in the treatment group and 85.3% in the control group with a significant difference between the two groups (P < 0.05); at the end of the first week and the second week of treatment, the score for HAMD in the treatment group significantly decreased as compared with that in the control group (P < 0.01). CONCLUSION: Catgut implantation at acupoint plus small dose of Paroxetine Hydrochloride has a better therapeutic effect on somatic form disorders.

Occupational therapy using a sensory integrative approach: a case study of effectiveness.

OBJECTIVE: This article presents a case report of a child with poor sensory processing and describes the disorders impact on the child's occupational behavior and the changes in occupational performance during 10 months of occupational therapy using a sensory integrative approach (OT-SI). METHOD: Retrospective chart review of assessment data and analysis of parent interview data are reviewed. Progress toward goals and objectives is measured using goal attainment scaling. Themes from parent interview regarding past and present occupational challenges are presented. RESULTS: Notable improvements in occupational performance are noted on goal attainment scales, and these are consistent with improvements in behavior. Parent interview data indicate noteworthy progress in the child's ability to participate in home, school, and family activities. CONCLUSION: This case report demonstrates a model for OT-SI. The findings support the theoretical underpinnings of sensory integration theory: that improvement in the ability to process and integrate sensory input will influence adaptive behavior and occupational performance. Although these findings cannot be generalized, they provide preliminary evidence supporting the theory and the effectiveness of this approach.

Improvement of sensory impairment in patients with peripheral neuropathy.

OBJECTIVE: To report the findings in 27 patients with peripheral neuropathy (21 with lower extremity sensory impairment associated with diabetic peripheral neuropathy and 6 with other causes), who received treatment with monochromatic near-infrared photoenergy (890 nm) delivered by the Anodyne Therapy System (ATS). METHODS: All enrolled patients exhibited abnormal sensory perception (either hyperesthesia or hypoesthesia) based on a qualifying examination with the Neurometer CPT (current perception threshold) (baseline CPT). The patients received 10 ATS treatments (each lasting 40 minutes) during a 2-week period and then underwent CPT retesting to determine the extent of improvement of sensory impairment in myelinated and unmyelinated sensory fibers of the peroneal nerve. RESULTS: All patients obtained improvement in sensory impairment in comparison with baseline CPT measures, and 16 of the 27 patients achieved normal sensory responses in all nerve fiber subpopulations. Ten patients had been tested previously (initial CPT) and did not exhibit spontaneous improvement in sensory impairment during a mean period of 27 months before baseline CPT. After receiving the ATS treatments, however, this group of patients showed improvement in comparison with both initial CPT results and baseline CPT. CONCLUSION: On the basis of the data from this study, the ATS seems to be a safe and effective treatment to improve sensory impairment associated with peripheral neuropathy due to diabetes and other causes.

Functional constipation with impaired rectal sensation improved by electrical stimulation therapy: report of a case.

Patients with intractable constipation often complain of social, physical, and psychologic stress. Recently, biofeedback therapy has been widely used for the management of intractable constipation, particularly in cases of constipation associated with pelvic floor dyssynergia. However, some constipated patients often complain of absent or diminished sense of wanting to defecate. It is unclear whether impaired rectal sensation is a cause or outcome of constipation and what specific treatment is available for these patients. We treated a 25-year-old female patient who complained of intractable constipation for ten years. Colon transit time study and defecography showed nonspecific findings. Her anorectal manometric findings were within normal ranges with the exception of impaired rectal sensation. Rectal sensory threshold volumes for desire and urge to defecate and maximal tolerated volume were greatly increased. She was treated by electric stimulation therapy for the purpose of improving impaired rectal sensory function. After 14 sessions of electric stimulation therapy, her constipated symptoms improved dramatically. Furthermore, the desire and urge threshold volumes were remarkably decreased. We report this case of constipation with impaired rectal sensation possibly treated by electric stimulation therapy.

Motor cortex stimulation in a patient with intractable complex regional pain syndrome type II with hemibody involvement. Case report.

The authors describe the effectiveness of motor cortex stimulation (MCS) in a patient with complex regional pain syndrome (CRPS) Type II, formerly known as causalgia, with hemibody allodynia. During MCS, a subjective sensation of warm paresthesia developed in the painful hand and forearm and spread toward the trunk. Pain and allodynia in the areas associated with this sensation were alleviated significantly. The analgesic effect of stimulation proved to be long lasting and was still present at the 12-month follow up. The authors speculate that MCS might exert its effect through the modulation of thalamic activity in this particular case of CRPS with hemisensory deficit. A central mechanism associated with functional disturbance in noxious-event processing in the thalamus might have an important role in the pathogenesis of the condition.