Efficacy of individualized homeopathic medicines in treatment of post-stroke hemiparesis: A randomized trial.

BACKGROUND: Hemiparesis is a serious motor impairment following stroke and affecting around 65% of stroke patients. This trial attempts to study the efficacy of individualized homeopathic medicines (IHMs) in comparison with identical-looking placebos in treatment of post-stroke hemiparesis (PSH) in the mutual context of standard physiotherapy (SP). METHODS: A 3-months, open-label, randomized, placebo-controlled trial (n = 60) was conducted at the Organon of Medicine outpatient departments of National Institute of Homoeopathy, West Bengal, India. Patients were randomized to receive IHMs plus SP (n = 30) or identical-looking placebos plus SP (n = 30). Primary outcome measure was Medical Research Council (MRC) muscle strength grading scale; secondary outcomes were Stroke Impact Scale (SIS) version 2.0, Modified Ashworth Scale (MAS), and stroke recovery 0-100 visual analogue scale (VAS) scores; all measured at baseline and 3 months after intervention. Group differences and effect sizes (Cohen's d) were calculated on intention-to-treat sample. RESULTS: Although overall improvements were higher in the IHMs group than placebos with small to medium effect sizes, the group differences were statistically non-significant (all P>0.05, unpaired t-tests). Improvement in SIS physical problems was significantly higher in IHMs than placebos (mean difference 2.0, 95% confidence interval 0.3 to 3.8, P = 0.025, unpaired t-test). Causticum, Lachesis mutus, and Nux vomica were the most frequently prescribed medicines. No harms, unintended effects, homeopathic aggravations or any serious adverse events were reported from either group. CONCLUSION: There was a small, but non-significant direction of effect favoring homeopathy against placebos in treatment of post-stroke hemiparesis. TRIAL REGISTRATION: CTRI/2018/10/016196; UTN: U1111-1221-7664.

Effects of Citrus depressa Hayata Fruit Extract on Thigh Muscles Mass and Composition in Subacute Stroke Patients: A Double-Blind, Randomized, Controlled Pilot Trial.

Objective: This pilot study evaluated the effects of Citrus depressa Hayata fruit extract (CFEx) on thigh muscle cross-sectional area (CSA) and composition in subacute stroke patients with hemiparesis who were undergoing rehabilitation. Design and Intervention: This double-blinded, placebo-controlled, randomized pilot trial included 40 subacute stroke patients with moderate-to-severe hemiparesis, and they were randomly assigned to receive CFEx or placebo supplements for 12 weeks. The thigh muscle CSA was measured by computed tomography as total muscle area defined by Hounsfield units (HU) values of -29 to 150 HU. The total muscle area was divided into muscle area with fat infiltration and normal muscle area to evaluate muscle composition (-29 to 29 and 30 to 150 HU, respectively). Results: At baseline, the total muscle area and normal muscle area in the paretic thigh were lower than those in the nonparetic thigh. The nonparetic normal muscle area was significantly higher in the CFEx group than in the placebo group at 12 weeks, whereas the total muscle area was not different. Conclusions: The thigh muscle CSA and composition in the paretic side have already deteriorated in patients with moderate-to-severe hemiparesis at the subacute stroke stage. CFEx supplementation during rehabilitation might improve the nonparetic thigh muscle composition in subacute stroke patients. Findings of this study are needed to be verified by a large-scale randomized trial since this study was a pilot study with a small sample size. Trial registration: UMIN Clinical Trial Registry (UMIN ID: UMIN000012902).

Ipsilateral Ptosis and Contralateral Ataxic Hemiparesis as Initial Symptoms of Combined Tuberothalamic and Paramedian Artery Infarction.

Thalamic infarcts, accounting for approximately 14% of lacunar infarcts, exhibit varied clinical manifestations due to complex anatomy of nuclei and varying blood supply. Pure and combined types of thalamic infarctions have been summarized in some paper, but information of cerebral angiography was not mentioned. Here we report a rare case of combined tuberothalamic and paramedian artery occlusion presenting with ipsilateral ptosis and contralateral ataxic hemiparesis.

Lead Toxicity due to Ingestion of Lead-Contaminated Opium in a Patient Presenting with Motor Neuropathy and Upper Limb Paresis: A case report.

Opium users may present with central or peripheral nervous system-related symptoms, gastrointestinal complications and anaemia; in such cases, lead poisoning should be suspected and chelation therapy initiated as soon as possible. We report a 64-year-old male patient with a 20-year history of opium addiction who was referred to the Imam Reza Hospital, Birjand, Iran, in 2017 with severe motor neuropathy and paresis in both upper limbs. His primary symptoms were generalised weakness, abdominal and bone pain, constipation and lower limb paraesthesia that had started several months prior. In addition, he reported severe progressive bilateral paresis of the upper limbs of one month's duration. A diagnosis of lead poisoning was confirmed by a blood lead level of 140 µg/dL. The patient underwent chelation therapy after which he improved significantly. At a one-year follow-up visit, he was neurologically intact and symptom-free.

[Clinical study on Yihong Kangnaoshuan capsule in treating lacunar infarction pure motor hemiparesis].

With the treatment of lacunar cerebral infarction with pure motor hemiparesis (PMH) attach importance to the treatment effect, application benefit of Yihong Kangnaoshuan capsule in the treatment of further effect. Treatment of PMH is mainly depending on the thorough discussion on the cause, to determine the clinical value of treatment based on the principle of. Through the research of Zhejiang People's Hospital of Fenghua from 2013 March to 2014 September 178 cases of pure motor hemiparesis were the benefit of Yihong Kangnaoshuan capsule and vedrin capsule treatment, compared the indexes of efficacy after treatment and blood rheology. Finally found the benefits of Yihong Kangnaoshuan capsule in the application process with high safety, efficacy and greater proportion. And in favor of blood lipid and blood rheology indicators of stability, the repair of neurological function is more. Therefore, clinicians should be applied benefit of red brain thrombus capsule in the treatment of PMH. But the overall difference between drugs is need to further comparison, in order to ensure clinical curative effect.

Clinical efficacy and sEMG analysis of a new traditional Chinese medicine therapy in the treatment of spasticity following apoplectic hemiparalysis.

To investigate the clinical effect and surface electromyography (sEMG) of rehabilitation exercise therapy in combination with total glucosides form Shaoyao Gancao decoction in treating spasticity after apoplectic hemiparalysis. Composite spasticity scale (CSS), Fugl-Meyer assessment (FMA) and modified Barthel index were compared between the exercise only group and the combined therapy group before and 1 month after the treatment to scale muscular tension, function and activities of daily living. Meanwhile, integrate EMG and root mean square (RMS) were used to detect the tension of upper limbs (biceps brachii) and ankles (tibialis anterior muscle and gastrocnemius) after the 1-month treatment. In the combined therapy group, the Ashworth and CSS scales were significantly improved compared to before the treatment (P < 0.05) and compared to the patients in the control group (P < 0.05). After the 1-month treatment, the combined therapy group showed significantly higher FMA and BI scores (P < 0.05) compared to the control group. For the combined therapy group, the sEMG was significantly improved at 1 month after the treatment (P < 0.05), while the control group only showed relatively slight improvement in the RMS of the tibialis anterior muscle and the gastrocnemius. The total glucosides form Shaoyao Gancao decoction could significantly improve the efficacy of the rehabilitation exercise therapy in the treatment of spasticity after apoplectic hemiparalysis, and its mechanism might involve the decrease of muscular tension.

[A woman with skin abnormalities and muscle weakness]. / Een vrouw met huidafwijkingen en spierzwakte.

A 54-year-old woman presented to the emergency department with progressive proximal muscle weakness and a symmetric skin rash. Physical examination demonstrated a heliotrope rash, Gottron lesions, mechanic's hands and symmetrical erythema of the face, neck and upper legs. The diagnosis 'dermatomyositis' was established. Subsequently, the patient was successfully treated with prednisolone 1 mg/kg.

[Efficacy of reflexology in the combination with neuroprotective treatment in hemiparetic form of children cerebral palsy].

Sixty patients with the diagnosis of cerebral palsy with hemiparesis at the age from 2 to 7 years were treated. All 60 patients had conventional treatment including massage and exercise therapy. Patients were divided into 2 randomized groups. The patients of the first group were given 3 sets of microcurrent reflexology sessions and 2 courses of treatment with cortexin. Patients of the second group were given reflexology treatments only. The microcurrent reflexology treatment included 15 sessions using the apparatus MAKS. Cortexin was introduced intramuscularly in dosage 10 mg. The bottle content was diluted in 2 ml of 0.5% novocaine. The treatment included 10 injections. This treatment showed the beneficial effects: 29 patients of the first group (97%) and 27 patients of the second group (90%) developed some ambulation skills. The progress in complicated manipulative activity of paralyzed upper extremities under microcurrent reflexology with cortexin was 2.2 times more visible in patients of the first group compared to the second one (11 patients (37%) versus 5 patients (17%), respectively). Positive changes in the encephalon functional status according to electroencephalography results were found in 21 patients (71%) of the first group and in 16 patients (53%) of the second group.

Orthotic functional electrical stimulation following botulinum toxin for a young adult with severe hand impairment due to childhood stroke.

ABSTRACT This case report describes the outcomes of a task-specific training protocol using functional electrical stimulation for a young adult with severe hand impairment from a childhood stroke who had a history of tendon transfer and a recent botulinum toxin injection. A 22-year-old female who had a hemorrhagic stroke at age 5, a tendon transfer at 18, and a botulinum toxin injection 6 weeks before study entry, participated in a home- and clinic-based task-specific training program using a functional electrical stimulation orthosis. Training was 30-90 minutes per day, 4 days per week, for 4 weeks. Stroke-specific outcomes were measured before and after intervention. Increases occurred in the following scores: Action Research Arm Test, Stroke Impact Scale Hand Function Domain, and Canadian Occupational Performance Measure. A task-specific training protocol using orthotic functional electrical stimulation appears to have increased hand function and quality of life for an adult with chronic, childhood-onset stroke. To our knowledge, this is the first study to investigate the efficacy of functional electrical stimulation for such an individual.

A novel functional electrical stimulation treatment for recovery of hand function in hemiplegia: 12-week pilot study.

BACKGROUND: Loss of finger extension is common after stroke and can severely limit hand function. Contralaterally controlled functional electrical stimulation (CCFES) is a new treatment aimed at restoring volitional finger and thumb extension. A previous pilot study showed reductions in hand impairment after 6 weeks of CCFES, but the effect did not persist after end of treatment. OBJECTIVE: This study aimed to evaluate the feasibility of achieving greater and more persistent gains with CCFES by increasing the treatment period to 12 weeks. METHODS: CCFES uses neuromuscular electrical stimulation to open the paretic hand in direct proportion to the degree of volitional opening of the unimpaired contralateral hand, which is detected by an instrumented glove. Three subjects with chronic hemiplegia participated in a 12-week CCFES treatment, which consisted of daily CCFES-assisted active repetitive hand-opening exercises and twice weekly functional task practice with CCFES. RESULTS: Maximum voluntary finger extension increased by 101 degrees and 68 degrees for subjects 1 and 2, respectively, but subject 3 had no improvement in finger extension. Box and Block score increased by 6, 15, and 7 blocks, and upper extremity Fugl-Meyer score increased by 11, 15, and 7 points for subjects 1, 2, and 3, respectively. The finger extension gains declined at the 1-month and 3-month follow-up for subjects 1 and 2, but the gains in Box and Block and Fugl-Meyer scores persisted at follow-up. CONCLUSIONS: Greater reductions in hand impairment were achieved by extending the treatment period. The effect and its longevity may be related to baseline impairment level.

Axonal plasticity is associated with motor recovery following amphetamine treatment combined with rehabilitation after brain injury in the adult rat.

Clinical and laboratory studies have suggested that amphetamine treatment when paired with rehabilitation results in improved recovery of function after stroke or traumatic brain injury. In the present study, we investigated whether new anatomical pathways developed in association with improved motor function after brain damage and amphetamine treatment linked with rehabilitation. Following a unilateral sensorimotor cortex lesion in the adult rat, amphetamine (2 mg/kg) was administered in conjunction with physiotherapy sessions on postoperative days two and five. Physiotherapy was continued twice daily for the first 3 weeks after injury, and then once daily until week six. Performance on skilled forelimb reaching and ladder rung walking was used to assess motor improvement. Our results show that animals with sensorimotor cortical lesions receiving amphetamine treatment linked with rehabilitation had significant improvement in both tasks. Neuroanatomical tracing of efferent pathways from the opposite, non-damaged cortex resulted in the novel finding that amphetamine treatment linked with rehabilitation, significantly increased axonal growth in the deafferented basilar pontine nuclei. These results support the notion that pharmacological interventions paired with rehabilitation can enhance neuronal plasticity and thereby improve functional recovery after CNS injury.

Treating the human bladder with capsaicin: is it safe?

OBJECTIVES: Although human contact with capsaicin has occurred over thousands of years, some uncertainty surrounds its status as a possible carcinogen. This is the first report of bladder biopsies from patients who have been treated with capsaicin over a 5-year period. METHODS: Between 1991 and 1996, 20 patients (9 males, 11 females; mean age 52.5 years, range 40-70 years) with intractable detrusor hyperreflexia have had repeated instillations of intravesical capsaicin (1-2 mmol/l). The number of treatments per patient varied between 1 and 17 (total = 82; average 6/patient). The surveillance programme involved repeated flexible cystoscopy and bladder biopsies before and after capsaicin. Cryostat sections were stained with haematoxylin-eosin and examined by light microscopy. RESULTS: None of the bladder biopsies have shown metaplasia, dysplasia, flat carcinoma in situ, papillary or solid invasive cancer. CONCLUSIONS: No pre-malignant of malignant change has been found in biopsies of patients who had repeated capsaicin instillations for up to 5 years. However, as the morphological effects of chemical carcinogens may not be apparent for 10 years, further surveillance is being continued.