[Real Time Fuctional Magnetic Resonance Imaging Biofeedback: a New Generation of Neurotherapy].

The review summarizes the data related to the potential of the real time fMRI biofeedback (the rt-fMRI), a novel technology implementing instructing patients to modify the neural activity in the certain brain regions related to the disordered function. The recent positive results were gained for a treatment of the post-stroke impairments, the Parkinson disease, the pain syndrome, the tinnitus, the alcohol and nicotine abuse, the major depression, and phobias of contamination and spiders. The intervention Was found to be less promising for schizophrenia and nearly ineffective for the criminal antisocial personality disorder. The reliability of the results is mostly poor due to suboptimal study designs, lack of the control groups, and insufficient sample sizes. The article deals with biological basis of the technology, its current applications and perspectives; and also its method- ologicdl and methodical problems.

[Cluster headache and brain imagery]. / Algie vasculaire de la face : place de l'imagerie.

Cluster headache is defined on clinical international criteria developed by International Headache Society (IHS, 2013). The realization of a brain MRI with arterial angio-MRI is required according to the French recommendations (Donnet et al., 2014) based on recent the literature. Numerous causes or diseases can mimic typical or atypical AVF (Edvardsson, 2014). Identification of these causes allows an appropriate treatment in addition with symptomatic treatment.

Differential diagnostics of pain in the course of trigeminal neuralgia and temporomandibular joint dysfunction.

Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment. The objective of the paper is to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest.

The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice.

The postsynaptic fibers of the pterygopalatine or sphenopalatine ganglion (PPG or SPG) supply the lacrimal and nasal glands. The PPG appears to play an important role in various pain syndromes including headaches, trigeminal and sphenopalatine neuralgia, atypical facial pain, muscle pain, vasomotor rhinitis, eye disorders, and herpes infection. Clinical trials have shown that these pain disorders can be managed effectively with sphenopalatine ganglion blockade (SPGB). In addition, regional anesthesia of the distribution area of the SPG sensory fibers for nasal and dental surgery can be provided by SPGB via a transnasal, transoral, or lateral infratemporal approach. To arouse the interest of the modern-day clinicians in the use of the SPGB, the advantages, disadvantages, and modifications of the available methods for blockade are discussed.▪

Effect of ischemic pressure using a Backnobber II device on discomfort associated with myofascial trigger points.

OBJECTIVE: The purpose of this study was to assess the effectiveness of ischemic pressure on myofascial trigger point (MTrP) sensitivity. DESIGN: Randomized, controlled study with the researcher assessing MTrP sensitivity blinded to the intervention. PARTICIPANTS: Twenty-eight people with two MTrPs in the upper back musculature. INTERVENTION: The sensitivity of two MTrPs in the upper back was assessed with a JTECH algometer. One of the two MTrPs was randomly selected for treatment with a Backnobber II, while the other served as a control. OUTCOME MEASURES: Pre- and post-test pressure-pain thresholds of the MTrPs RESULTS: There was a significant difference between the pre- and post-test sensitivities of the treated and non-treated MTrPs (p=0.04). CONCLUSIONS: The results of this study confirm that the protocol of six repetitions of 30-s ischemic compression with the Backnobber II rendered every other day for a week was effective in reducing MTrP irritability.

The effect of cetylated fatty esters and physical therapy on myofascial pain syndrome of the neck.

Participants with Myofascial Pain Syndrome (MPS) of the neck were randomly assigned into 2 groups of the double-blinded study: topical cetylated fatty ester complex (CFEC) cream application plus physical therapy (CF-PT; n=37), and placebo cream application plus physical therapy (PL-PT; n=35). There were 3 visits during 4 weeks of treatment. Physical Therapy (PT), given twice/week, included Ischaemic Compression, Deep Pressure Trigger Point Massage and Myofascial Releases. Topical cream [CFEC cream (5.6%) and 1.5% menthol] or placebo cream [1.5% menthol, in a cream base] was applied twice/day. CF-PT provided the fastest and most effective study treatment modality. The addition of CFEC cream to PT resulted in statistically significant improvements, compared to PL-PT, for reduction of pain, neck disability and life quality indicators. Our results indicate that cetylated derivatives of fatty acids can effectively reduce pain and symptoms associated with neck MPS, when combined with physical therapy.

[The role of therapeutic exercises in the combined treatment and rehabilitation of patients with pain syndrome associated with the dysfunction of temporomandibular joint].

In a group of patients with pain syndrome associated with the dysfunction of temporomandibular joint positive results of combined therapy and rehabilitative treatment including remedial gymnastics persisted significantly longer than in controls (p < 0.01). Results of long-term follow-up confirmed the desirability of rehabilitation based on therapeutic exercises. This approach permits to enhance the effectiveness of therapy and rehabilitation of patients with pain syndrome associated with the dysfunction of temporomandibular joint, reduce the number of the patients' visits for repeated treatment and its total duration during a year.

Altered regional brain morphology in patients with chronic facial pain.

BACKGROUND: Persistent idiopathic facial pain (PIFP) is defined as a persistent, unilateral facial pain, not associated with sensory loss or other physical signs and with no obvious structural abnormalities that would sufficiently explain pain experience. OBJECTIVE: We were interested whether there is evidence of altered brain morphology in patients with PIFP as it has been described in other chronic pain conditions. METHODS: Using voxel-based morphometry we investigated regional gray matter volume in 11 PIFP patients and 11 age- and sex-matched healthy controls. Furthermore we calculated lateralization indices (LI) to investigate differences in interhemispheric gray matter asymmetries. RESULTS: We report a decrease in gray matter volume in the left anterior cingulate gyrus and left temporo-insular region, as well as in the left and right sensory-motor area, projecting to the representational area of the face. Analyses of LI values demonstrated an increased rightward asymmetry in the middle-anterior insular cortex in patients in comparison with healthy controls. CONCLUSION: Our data support previous findings showing that chronic pain states are display-altered brain morphology in brain regions know to be part of the pain system.

Myofascial pain syndrome affecting the quadratus femoris.

The quadratus femoris is an external rotator of the hip. Quadratus femoris injury can accompany damage to the surrounding muscles. Guided by the clinical symptoms, the injection technique described here can facilitate accurate diagnosis in selected cases.

Length of the styloid process and anatomical implications for Eagle's syndrome.

The styloid process is a bony projection, located just anterior to the stylomastoid foramen, the normal length of which is approximately 20-25 mm. Elongation of the process may cause various clinical symptoms such as neck and cervicofacial pain, described as Eagle's syndrome. The present study aimed to determine the mean length of the styloid process on cadavers, panoramic radiographs, and dry skulls, and to investigate the incidence of the elongated styloid process, while assessing the elongation in relation to Eagle's syndrome. When the measurements from the panoramic radiographs were assessed, the mean length of the styloid processes in males and females on the right and left sides were found to be the following: 25.78 + or - 5.68 mm; 22.69 + or - 3.68 mm, 25.80 + or - 5.75 mm; and 22.75 + or - 3.65 mm, respectively. The males had greater styloid process lengths than the females, and the differences in length on both the right and left sides were statistically significant. Descriptive statistics and comparison results according to age groups were determined. There was no statistically significant difference between right or left styloid process lengths according to age groups. The mean length of the styloid process of the cadavers and dry bones was 22.54 + or - 4.24, and there was no significant difference between the right and left sides of the cadavers and dry bones. The incidence of the elongated styloid process was determined as 3.3%, and the elongations revealed a female dominance. The average length of the elongated styloid process was 36.06 + or - 6.12 mm, while the mean length of the styloid processes of the subjects reporting Eagle's syndrome was 40 + or - 4.72 mm. The results of this morphological study will assist clinicians in the diagnosis of Eagle's syndrome.

Exertional headache as unusual presentation of the syndrome of an elongated styloid process.

We present the case of a 34-year-old man with a 2-year history of pain related to efforts in heavy lifting, beginning in the right ear and radiating to the neck and to the vertex. He underwent multiple negative neuroimaging examinations, until a 3-dimensional computerized tomography scan of the pharyngeal region evidenced an elongated styloid process. A diagnosis of Eagle's syndrome was made. The excision of the elongated styloid process was performed, resulting in complete and lasting pain relief. We focus on Eagle's syndrome and in particular on this atypical presentation.

Chronic high frequency stimulation of the posteromedial hypothalamus in facial pain syndromes and behaviour disorders.

Chronic high frequency stimulation (HFS) of the posteromedial hypothalamus (PMH) has been the first direct therapeutic application of functional neuroimaging data in a restorative reversible procedure for the treatment of an otherwise refractory neurological condition; in fact, the target coordinates for the stereotactic implantation of the electrodes have been provided by positron emission tomography (PET) studies, which were performed during cluster headache attacks. HFS of PMH produced a significant and marked reduction of pain attacks in patients with chronic cluster headache (CCH) and in one patient with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). The episodes of violent behaviour and psychomotor agitation during the attacks of CCH supported the idea that the posteromedial hypothalamus could be also involved in the control of aggressiveness; this has been previously suggested, in the seventies, by the results obtained in Sano's hypothalamotomies for the treatment of abnormal aggression and disruptive behaviour. On the basis of these considerations, we have performed HFS of the PMH and controlled successfully violent and disruptive behaviour in patients refractory to the conventional sedative drugs. Finally, we also tested the same procedure in three patients with refractory atypical facial pain, but unfortunately, they did not respond to this treatment.

Painful sweating.

OBJECTIVE: The authors report a case of spontaneous and gustatory facial pain and sweating. METHODS: The patient had frequent episodes of pain, sweating, and flushing bilaterally in the hairless skin of the ophthalmic and maxillary distributions of the trigeminal nerve. Gustatory stimuli (e.g., orange juice, pickled onions) reliably evoked episodes, but episodes also frequently came on spontaneously. The problem had begun during adolescence, about the time of topical treatment and then electrocauteries for facial warts. The patient reported benefit from tricyclic antidepressants, guanethidine, and trospium chloride (an anti-cholinergic quaternary amine used in Europe for urinary urgency). There was no pain or excessive sweating in other body areas, nor pain with exercise. RESULTS: Administration of edrophonium IV evoked pain and sweating, and ganglion blockade by IV trimethaphan eliminated pain and sweating and markedly attenuated responses to edrophonium. Trospium chloride also prevented edrophonium-induced pain and sweating. Bicycle exercise produced the same increment in forehead humidity as in a spontaneous episode but did not evoke pain. Tyramine infusion did not bring on pain or sweating, whereas iontophoretic acetylcholine administration to one cheek evoked pain and sweating bilaterally. Topical glycopyrrolate cream eliminated spontaneous, gustatory, and edrophonium-induced episodes. CONCLUSIONS: The findings indicate that facial pain and sweating can result from occupation of muscarinic cholinergic receptors after acetylcholine release from local nerves. The authors propose that after destruction of cutaneous nerves, aberrant regenerant sprouting innervates sweat glands, producing gustatory sweating as in auriculotemporal syndrome (Frey syndrome), and innervates nociceptors, producing pain.

No sympathetic nerve sprouting in rat trigeminal ganglion following painful and non-painful infraorbital nerve neuropathy.

Following sciatic nerve injury sympathetic invasion and basket formation is seen in dorsal root ganglia. We examined whether this phenomenon occurs in trigeminal ganglion (TG) following axotomy (IOAx) or chronic constriction injury to the infraorbital nerve (IOCCI). The IOCCI rats developed hyperresponsiveness to pinprick stimulation consistent with this model and the IOAx rats remained hyporesponsive for most of the study period. Immunocytochemistry employing antibodies to tyrosine hydroxylase showed no sympathetic invasion or basket formation 2 and 7 weeks post surgery. This study confirms previous work that found no sympathetic invasion of TG following injury, and shows that this finding is unaffected by the presence or absence of nerve injury induced hyperresponsiveness.

Greater superficial petrosal nerve: anatomy and MR findings in perineural tumor spread.

We report a case of perineural spread of adenoid cystic carcinoma along the greater superficial petrosal nerve. The anatomy of this nerve also is reviewed.

Neuropatía facial periférica: Correlación clínica y neurofisiologíca de factores pronósticos en 32 pacientes

Siendo la parálisis facial periférica una unidad frecuente en la consulta externa neurológica, se estudiaron prospectivamente 32 pacientes (19 mujeres y 13 varones) cuyas edades fluctuaron entre 16 y 71 años (edad promedio 35.5) y que cursaban entre el quinto y decimoquinto día del inicio de sus síntomas, estableciendo una correlación entre la clínica, hallazgos neurofisiológicos, evolución y pronóstico a corto plazo. Se realizó: estimulación eléctrica del nervio y registro de su respuesta en los músculos frontal, orbicular de los párpados, orbicular de los labios y nasalis, comparando latencias y amplitudes con el lado sano, y electromiografía con aguja bipolar en los tres primeros músculos mencionados. El parámetro de mayor valor resultó la respuesta muscular al estímulo eléctrico, correlacionándose significativamente con el hallazgo electromiográfico y su mejor pronóstico a las seis semanas (p<0.03). La modificación de las latencias fue el parámetro menos importante, no así la amplitud del potencial de acción, que sí tuvo balor en la predicción del pronóstico.

Progressive leptomeningeal fibrosis: a clinico-pathological case report.

A female patient developed persistent facial pain beginning at age 19 years. Intermittent motor and sensory disturbances referable to one hemisphere began nine years later and by the age of 41 she had developed signs of increased intracranial pressure. Exploratory craniotomy revealed replacement of the leptomeninges by thick, fibrous tissue. The histological appearance was that of a chronic, benign and minimally infiltrative process with a mild, non-specific inflammatory component, underlying cortical ischaemic changes, and white matter oedema. The lesion resembled nodular fasciitis, a soft tissue process. No cause of the reactive fibrosis of the meninges in this case is known.

Optic neuropathy and paratrigeminal syndrome due to Aspergillus fumigatus.

Chronic Aspergillus meningitis and cerebral vasculitis occurred in a 67-year-old man. He experienced periorbital pain that increased in severity during a ten-month period. Although no focal neurologic deficits were initially present, oculosympathetic paresis, corneal hypesthesia, and optic neuropathy developed. This is the first report, to our knowledge, of paratrigeminal syndrome with optic neuropathy due to aspergillosis. The case was also unusual because it was chronic and there was no extracerebral infection or predisposing factors, such as underlying malignancy or collagen vascular disease.

The effects of extreme cold on sensory nerves.

The effects of extreme cold on sensory nerves are discussed and a clinical application of these effects is proposed. The structural changes observed following the freezing of sensory nerves in the rat are described and correlated with the clinical results in patients with chronic facial pain treated by cryogenic peripheral nerve blockade. It is suggested that this technique offers features which are not shown by any other method for interrupting peripheral pain pathways and provides a useful alternative to existing methods of treatment for chronic pain.

Etiology and treatment of idiopathic trigeminal and atypical facial neuralgias.

In a series of sixteen patients with idiopathic trigeminal neuralgia and twenty-one patients with atypical facial neuralgia, it was found that the painful phenomena associated with both disorders were, in nearly all instances, closely related to the presence of maxillary or mandibular bone cavities at previous tooth extraction sites. Standard oral surgical procedures for curettage of the cavities, together with administration of antibiotics, were employed in the successful treatment of both the trigeminal and atypical facial neuralgias, with complete pain remissions for periods varying from 2 months (for most recently treated cases) up to 9 years. The observations and results of this study suggest that dental and oral disorders may play a role in the genesis of trigeminal and atypical facial neuralgias.