Functional end-plate recovery in long-term botulinum toxin therapy of hemifacial spasm: a nerve conduction study.

Botulinum toxin type-A is currently thought to be effective and safe for hemifacial spasm (HFS). The pre-synaptic block of acetylcholine release at the neuromuscular junction induces depression of orbicularis oculi muscle compound motor action potential (CMAP). The aim of our study was to evaluate at what extent end-plate functional recovery is possible even in botulinum toxin treatments lasting up to 15 years. We examined 81 outpatients with primary HFS (mean treatment duration = 7.2 ± 4.2 years) who underwent neurophysiologic study, once clinical effect of the previous treatment had vanished. The mean CMAP amplitude, mean rectified amplitude of response 1 (R1) of the blink reflex and area of response 2 (R2) of treated orbicularis oculi muscle were measured in comparison to the controlateral side. Mean amplitude of the above mentioned parameters was slightly lower (about 20%; p < 0.001) in the treated side at the end of the follow-up period (4.7 ± 1.7 months). The CMAP amplitude reduction weakly correlated with the interval from last treatment, while other neurophysiologic parameters did not change due to treatment duration or total toxin amount. Our study demonstrates that botulinum toxin affects compound motor action potential and blink-reflex responses for at least 4-5 months in HFS patients. The residual block is slight and does not increase with repeated injections after several years of treatment. Our study, beside confirming the long-term efficacy of botulinum toxin treatment for HFS, provides neurophysiologic evidence that therapeutic effect may be obtained without hindering the regenerative potential of the nerve-muscle complex.

Going for a stroll on lurasidone: Considerations on an atypical case of acute compartment syndrome of both legs.

Non-traumatic acute bilateral compartment syndrome is a rare condition that may lead to limb ischemia. We describe a case of this syndrome occurring after a five-kilometer walk in a young woman receiving chronic treatment with lurasidone, leading to a bilateral foot-drop and rhabdomyolysis of the anterolateral compartment of both legs. Due to her late presentation in the emergency department, we opted for a conservative approach, closely monitoring her renal function. We noticed a subsequent clinical and biochemical improvement over the following days, with the patient returning to her daily routine in a matter of weeks, despite a persisting bilateral foot drop. Since atypical antipsychotics are known to be associated with rhabdomyolysis, while possibly exerting a toxic effect on mitochondria, we hypothesize that a mild aerobic physical exertion might have triggered the event, in the context of an iatrogenic muscle susceptibility to oxidative distress.

Corrigendum to "Going for a stroll on lurasidone: Considerations on an atypical case of acute compartment syndrome of both legs" [Heliyon 9(4) (April 2023) e15047].

[This corrects the article DOI: 10.1016/j.heliyon.2023.e15047.].

OnabotulinumtoxinA in elderly patients with chronic migraine: insights from a real-life European multicenter study.

INTRODUCTION: Although migraine prevalence decreases with aging, some older patients still suffer from chronic migraine (CM). This study aimed to investigate the outcome of OnabotulinumtoxinA (OBT-A) as preventative therapy in elderly CM patients. METHODS: This is a post hoc analysis of real-life prospectively collected data at 16 European headache centers on CM patients treated with OBT-A over the first three treatment cycles (i.e., Cy1-3). We defined: OLD patients aged ≥ 65 years and nonOLD those < 65-year-old. The primary endpoint was the changes in monthly headache days (MHDs) from baseline to Cy 1-3 in OLD compared with nonOLD participants. The secondary endpoints were the responder rate (RR) ≥ 50%, conversion to episodic migraine (EM) and the changes in days with acute medication use (DAMs). RESULTS: In a cohort of 2831 CM patients, 235 were OLD (8.3%, 73.2% females, 69.6 years SD 4.7). MHDs decreased from baseline (24.8 SD 6.2) to Cy-1 (17.5 SD 9.1, p < 0.000001), from Cy-1 to Cy-2 (14.8 SD 9.2, p < 0.0001), and from Cy-2 to Cy-3 (11.9 SD 7.9, p = 0.001). DAMs progressively reduced from baseline (19.2 SD 9.8) to Cy-1 (11.9 SD 8.8, p < 0.00001), to Cy-2 (10.9 SD 8.6, p = 0.012), to Cy-3 (9.6 SD 7.4, p = 0.049). The 50%RR increased from 30.7% (Cy-1) to 34.5% (Cy-2), to 38.7% (Cy-3). The above outcome measures did not differ in OLD compared with nonOLD patients. CONCLUSION: In a population of elderly CM patients with a long history of migraine OBT-A provided a significant benefit, over the first three treatment cycles, as good as in non-old patients.

Oral flora of children with "nursing bottle caries".

S. mutans averaged about 60% of the total cultivable flora of dental plaque obtained from caries lesions, white spot margins of these lesions, or clinically-sound areas of upper anterior teeth, and averaged about 27% in plaque from mostly clinically-sound areas of posterior teeth of six children with nursing bottle caries; its concentrations in saliva averaged about 10% of the total cultivable flora. Nearly all of 107 isolated S. mutans strains belonged to the serotype group c/e/f. The proportion of S. sanguis, in contrast to those of S. mutans, were very low in plaque from upper anterior teeth and higher in plaque from posterior teeth. The proportions of S. salivarius in saliva were unusually low, and this organism was not detected in the saliva of most subjects. Lactobacilli were found in nearly all plaque samples; plaque and carious material from cavities contained higher levels than plaque associated with white spots or clinically-sound tooth surfaces. The findings provide further support for the role of S. mutans in the initiation of human dental caries. In the case of lactobacilli, they support other evidence suggesting only the limited involvement of these organisms in the initiation of caries lesions, but a more extensive role in their progression. In addition, they clearly illustrate the marked effect of diet on the dental plaque flora.

The prevalence of multiple sclerosis in Sicily. II: Agrigento city.

The prevalence of probable multiple sclerosis in Agrigento city on the south-west coast of Sicily is at least 2 per 100 000. This is likely to be a considerable underestimate of the true prevalence because the study presented particular difficulties in that the city is far from the neurological centres of Palermo. Catania, and Messina. There is no neurological department at either the general or the psychiatric hospital in Agrigento and there was a low awareness of the disease among the doctors in the city. Most of the patients were diagnosed in other centres. Agrigento is a good example of the difficulties of studying multiple sclerosis in a rural city which has no special interest in neurological problems and is far from a neurological centre. Studies in such centres must be pursued with great enthusiasm and over a long period of time, and all available sources of information in the city, medical and lay, and in other cities, must be utilised if a high proportion of the patients is to be found.

Biochemical assay of collagen and elastin in the normal and varicose vein wall.

Alterations of the connective tissue in the varicose vein wall have been noted by several investigators; however, the cause of the vein dilatation has still not been established. The aim of this study was to find a biochemical explanation to the development of varices by evaluating sensitive biochemical markers of collagen and elastin in the varicose vein wall. 4-L-Hydroxyproline (HYP), as a marker of collagen content, and desmosine (DES) and isodesmosine (IDES), as markers of elastin, were measured in 47 macroscopically dilated and 32 nondilated segments of 20 varicose saphenous veins collected from 20 patients with varices. The same measurements were made in 24 fragments of normal saphenous veins collected from 14 patients in whom the vein was removed to be used for graft procedures. HYP (collagen) and DES and IDES (elastin) were determined with a colorimetric method and HPLC, respectively. ANOVA test was used to compare mean values (+/- SD). HYP and collagen content were similar in varicose and normal veins. There was a significant reduction of both DES and IDES in dilated segments of varicose veins (P < 0.05 vs normal veins and nondilated segments); the ratio of elastin to collagen was lower in varicose than normal veins (P < 0.05), and this reduction was most significant in the dilated segments (P < 0.01 vs normal veins). These results suggest that dilatation of the varicose vein wall may be related to some defect of elastin metabolism. Further studies on the metabolic activity of vein muscle cells are required.