Deep brain stimulation and other surgical modalities for the management of essential tremor.

INTRODUCTION: Surgical treatments are considered for essential tremor (ET) when patients do not respond to oral pharmacological therapies. These treatments mainly comprise radiofrequency (RF) thalamotomy, gamma knife radiosurgery (GKRS), deep brain stimulation (DBS), and focused ultrasound (FUS) procedures. AREAS COVERED: We reviewed the strengths and weaknesses of each procedure and clinical outcomes for 7 RF studies (n = 85), 11 GKRS (n = 477), 33 DBS (n = 1061), and 13 FUS studies (n = 368). A formal comparison was not possible given the heterogeneity in studies. Improvements were about 42%-90% RF, 10%-79% GKRS, 45%-83% DBS, 42%-83% FUS at short-term follow-up (<12 months) and were about 54%-82% RF, 11%-84% GKRS, 18%-92% DBS, and 42%-80% FUS at long-term follow-up (>12 months). EXPERT OPINION: We found DBS with inherent advantages of being an adjustable and reversible procedure as the most frequently employed surgical procedure for control of ET symptoms. FUS is a promising procedure but has limited applicability for unilateral control of symptoms. RF is invasive, and GKRS has unpredictable delayed effects. Each of these surgical modalities has advantages and limitations that need consideration when selecting a treatment for the ET patients.

Hypolipidemic effect of Rukshana Upakrama in the management of dyslipidemia - A case study.

An elevated total or low-density lipoprotein (LDL) cholesterol levels or low levels of high-density lipoprotein (HDL) cholesterol is defined as dyslipidemia which is an important risk factor for coronary artery diseases (CADs) and strokes. It is estimated that abnormal cholesterol levels in the blood lead to cause about 18% of cardio vascular diseases (CVDs) and 56% of the ischemic heart diseases at global level. In comparison with others, South Asians have the highest incidence rate of CADs. Acharya Charaka has mentioned Rukshana Upakrama (a type of management which induces dryness) as one amongst the Shad-Upakrama (six principles of management) and can be considered as the best for the reduction of increased Kapha Dosha, Meda Dhatu (adipose tissue) and their related morbid factors. A 42-year-old female patient visited the OPD of the department of Basic Principles, IPGT and RA, Jamnagar, Gujarat, with the complaints of weight gain, heaviness in the body and lethargy. After investigation, she was diagnosed as a case of dyslipidemia due to abnormality in cholesterol levels. She was treated with Takra-Siddha Yavagu (gruel prepared with buttermilk) and Udvartana (dry powder massage) for 30 days. After completion of treatment, hematological investigations revealed that her serum cholesterol level was decreased to 147 mg/dl from 223 mg/dl and serum LDL was reduced to 91 mg/dl from 153 mg/dl. Her weight also reduced to 82 kgs from 88 kgs. Hence, it can be concluded that Rukshana Upakrama in the form of Takra-Siddha Yavagu and Udvartana is effective in the management of dyslipidemia for normalization of lipid in the blood as it possesses Shoshana (absorption) and Kapha-Medohara (alleviation of vitiated Kapha and Meda) properties.