Adverse effect profile of lidocaine injections for occipital nerve block in occipital neuralgia.

To determine whether there are differences in the adverse effect profile between 1, 2 and 5% Lidocaine when used for occipital nerve blocks (ONB) in patients with occipital neuralgia. Occipital neuralgia is an uncommon cause of headaches. Little is known regarding the safety of Lidocaine injections for treatment in larger series of patients. Retrospective chart analysis of all ONB was performed at our headache clinic during a 6-year period on occipital neuralgia patients. 89 consecutive patients with occipital neuralgia underwent a total of 315 ONB. All the patients fulfilled the IHS criteria for Occipital Neuralgia. Demographic data were collected including age, gender, and ethnicity. The average age of this cohort was 53.25 years, and the majority of patients were females 69 (78%). Ethnicity of patients was diverse, with Caucasian 48(54%), Hispanics 31(35%), and others 10 (11%). 69 patients had 1%, 18 patients had 2% and 29 patient were given 5% Lidocaine. All Lidocaine injections were given with 20 mg Depo-medrol and the same injection technique and location were used for all the procedures. Eight patients (9%)had adverse effects to the Lidocaine and Depo-medrol injections, of which 5 received 5% and 3 received 1% Lidocaine. Majority of patients who had adverse effects were female 7(87%), and had received bilateral blocks (75%). ONB is a safe procedure with 1% Lidocaine; however, caution should be exerted with 5% in elderly patients, 70 or older, especially when administering bilateral injections.

Trophic factors and stem cells for promoting recovery in stroke.

BACKGROUND: Stem cell therapy for stroke is in its initial stages as an option to restore lost neurological functions after stroke. OBJECTIVE: To provide a comprehensive review of studies involving stem cells in stroke treatment and to highlight new evidence from the ongoing clinical trials. METHODOLOGY: We performed a systematic study of various published journals in online medical libraries using Pubmed, Sciencedirect, and hajournal. Evidence synthesis is done with specific search words of - stem cell therapy, stroke, trophic factor, neural progenitor cell, pathophysiology, mechanism of action, clinical trial and mesenchymal stem cell in various combinations. Emphasis was given to articles published in year 2000 and onwards. RESULTS: Current research on stem cell therapy for stroke focuses on transplantation and endogenous neurogenesis of stem cells in brain. The sub-ventricular zone in the adult brain is identified as an endogenous resource of neuronal precursors that can be recruited to adjacent lesioned areas. Several factors can increase adult neurogenesis by stimulating formation or improving survival of new neurons, such as FGF-2, EGF, stem cell factor, erythropoietin, BDNF, caspase inhibitors, and anti-inflammatory drugs. Much of the beneficial effects of stem cell in stroke models are related to secretion of trophic factors. CONCLUSION: The complex pathophysiology involving various trophic factors, growth factor and gene modification in animal studies have showed promising result. Future research involving these trophic factors should open up new additional or clinically significant alternative for the treatment of stroke.