Management strategies for Janu Sandhigata Vata vis-a-vis osteoartheritis of knee: A narrative review.

INTRODUCTION: Ayurveda has described about the pathogenesis and the treatment of various disorders, the incidence of some of which have increased in the present scenario. Janu Sandhigata Vata correlated with osteoarthritis (OA) of the knee joint is one such chronic, degenerative, inflammatory disease which has a great impact on the quality of the life of an individual. Different modalities of treatment have been explained in the classics to tackle the condition effectively. METHODOLOGY: In the present study, an attempt has been made to review the various clinical research works done in the management of OA of the knee, which are registered in various research portal. In AYUSH Research Portal using the keywords Ayurveda-clinical research-musculoskeletal disorders-osteoarthrosis of knee-Janu Sandhigata Vata and in PubMed using clinical research - Ayurveda-OA. The studies reviewed were categorized depending on the treatment used in the management of the condition. RESULTS: Fifty three research works were registered under AYUSH Research Portal with 34 full papers. There were 12 research papers in PubMed, out of which 6 papers which dealt with OA of the knee were reviewed. Among these six, three already existed in AYUSH Research Portal. The results were discussed by categorizing the studies as per the treatment used. CONCLUSION: Among the papers reviewed, most of them dealt with few modalities of treatment rather than the complete classical line of the treatment. The evidence-based research involving multimodality treatment with long-term follow-up covering various aspects of prevention and cure has to be conducted which is the need of the hour.

Autonomic function in reflex and non-reflex epilepsy--an exploratory study.

PURPOSE: Seizures are known to affect diverse areas of the Central Autonomic Network (CAN) resulting in varied autonomic symptoms. The objectives of the study were to characterize neuro-cardiac autonomic regulation in hot water epilepsy (HWE) with or without spontaneous seizure, and to analyze the effect of Carbamazepine (CBZ). METHODS: Seventy patients of HWE [42 drug-naïve 'HWE only' and 28 'HWE with spontaneous complex partial seizure (CPS),' on CBZ] and 40 spontaneous CPS on CBZ were recruited after informed consent. Fifty healthy volunteers served as control. Conventional cardiac autonomic function tests, Heart Rate Variability (HRV), Blood Pressure Variability (BPV), and baroreflex sensitivity (BRS) were performed. RESULTS: Significant dysfunction was evidenced in most of the autonomic function parameters in all the epilepsy subgroups when compared with controls. Significant reduction in the parasympathetic activity in HWE patients was observed. Significant impairment of short-term fluctuation of blood pressure in 'HWE with spontaneous CPS' compared to 'healthy volunteers' was detected. Compared to 'HWE only', 'HWE with spontaneous CPS' showed impaired sympathovagal balance. The BRS were also altered in 'HWE with spontaneous CPS' compared to 'HWE only'. The comparison of 'spontaneous CPS' with 'HWE with spontaneous CPS' and 'HWE only' showed reduced parasympathetic and sympathetic activities. CONCLUSION: Both cardiovascular reflexes and autonomic cardiovascular regulation were altered in HWE, more so in 'HWE with spontaneous seizures'. Compared to those on CBZ, drug naïve had severe effect on vagal tone and CBZ did not alter cardiac autonomic functions in reflex as well as in non-reflex epilepsies.

Evaluation of the motor cortical excitability changes after ischemic stroke.

BACKGROUND: We evaluated progressive changes in excitability of motor cortex following ischemic stroke using Transcranial Magnetic Stimulation (TMS). MATERIALS AND METHODS: Thirty-one patients (24 men, 7 women; age 37.3 ± 8.2 years) were recruited and TMS was performed using Magstim 200 stimulator and a figure-of-eight coil. Resting motor threshold (RMT) was recorded from affected and unaffected hemispheres and motor evoked potential (MEP) was recorded from contralateral FDI muscle. Central motor conduction time (CMCT) was calculated using F wave method. All measurements were done at baseline (2(nd)), 4(th), and 6(th) week of stroke. RESULTS AFFECTED HEMISPHERE: MEP was recordable in 3 patients at baseline (all had prolonged CMCT). At 4 weeks, MEP was recordable in one additional patient and CMCT remained prolonged. At 6 weeks, CMCT normalized in one patient. RMT was recordable (increased) in 3 patients at baseline, in one additional patient at 4 weeks, and reduced marginally in these patients at 6 weeks. UNAFFECTED HEMISPHERE: MEP was recordable in all patients at baseline, and reduced significantly over time (2(nd) week 43.52 ± 9.60, 4(th) week 38.84 ± 7.83, and 6(th) week 36.85 ± 7.27; P < 0.001). The CMCT was normal and remained unchanged over time. CONCLUSION: The increase in excitability of the unaffected motor cortex suggests plasticity in the post-stroke phase.

Effect of a single dose of standard levodopa on cardiac autonomic function in Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is associated with autonomic dysfunction and chronic levodopa therapy has been reported to impair the autonomic control of heart rate. AIM: Our aim was to assess the immediate effect of a single dose of levodopa on heart rate variability (HRV) in idiopathic PD. MATERIALS AND METHODS: Eleven patients of idiopathic PD (F:M =2:9, mean age 57.3±8.6 years, duration of illness 4.1±2.8 years, Hoehn and Yahr stage 2.1±0.2) on stable levodopa dosage were studied. Motor part of unified Parkinson's disease rating scale and resting Lead II electrocardiogram (ECG) recordings were performed at baseline (12 hours off medication) and after two tablets of 100/10 mg of standard levodopa/ carbidopa. ECG was recorded continuously in the first hour (H1) followed by a 15-min recording in second (H2), third (H3) and fourth (H4) hours. Artifact free 5-min segments of the ECG were analyzed offline to obtain the HRV parameters in time domain (ms) and frequency domains (ms 2 ). RESULTS: Significant increase was observed in standard deviation of normal to normal intervals (23.5±2.7-46.2±6.6, P<0.05), root mean square of successive differences of NN intervals (16.3±2.9-30.7±5.1, P<0.01), total power (568.9±125.7-2739±667.5, P<0.01), low frequency power (146.5±40.8-614.1±206.7, P<0.05) and high frequency power (107.4±33.9-332.7±85.9, P<0.05) in H1. CONCLUSION: The results are suggestive of an improvement in the overall variability of the heart rate indicating an enhanced vagal tone.

Subclinical pulmonary dysfunction in spinocerebellar ataxias 1, 2 and 3.

OBJECTIVES: Evaluation of pulmonary function in patients with spinocerebellar ataxias (SCA) 1, 2 and 3 without clinical evidence of pulmonary dysfunction. METHODS: Thirty patients (F:M = 7:23; age: 35 ± 11.3 years; SCA1 - 13, SCA2 - 9 and SCA3 - 8) without clinical manifestations of respiratory dysfunction and 30 controls underwent pulmonary function tests. The percentage predicted values of forced vital capacity (FVC), volume of air exhaled during first second of FVC (FEV1), peak expiratory flow rate (PEFR) and maximal voluntary ventilation (MVV), actual values of maximal inspiratory and expiratory pressures (MIP and MEP in mmHg), and ratios of actual values of FEV1/FVC (%) and FEV1/PEFR (ml/l/min) were analyzed. RESULTS: Compared with controls SCA patients had significant reductions of FVC (71.1 ± 17.5 vs 85.5 ± 18.7; P < 0.01), PEFR (51.5 ± 20.7 vs 77.1 ± 24.9; P < 0.001), MVV (64.4 ± 21.6 vs 97.2 ± 22.7; P < 0.001), MIP (27.7 ± 16.8 vs 50.1 ± 15.1; P < 0.001) and MEP (38.1 ± 18.7 vs 74.7 ± 16.0; P < 0.001), elevation of FEV1/PEFR (10.5 ± 2.8 vs 7.4 ± 2.1; P < 0.001), but no significant change of FEV1 and FEV1/FVC. FEV1/PEFR correlated positively with illness duration and MVV negatively with severity of illness. CONCLUSIONS: The present study showed subclinical restrictive type of pulmonary dysfunction in SCA, and possible presence of upper airway obstruction. Chest physiotherapy and breathing exercises should be introduced early in management of SCA.

Improvement of balance in progressive degenerative cerebellar ataxias after Ayurvedic therapy: a preliminary report.

BACKGROUND: The treatment options for improving the balance in degenerative cerebellar ataxias are very few. Ayurvedic texts have described diverse treatment regimens for this disease. AIMS: To determine the change in balance indices, if any, by dynamic posturography (Biodex Balance System, USA) in progressive cerebellar ataxia following Ayurvedic treatment. MATERIALS AND METHODS: We performed a preliminary open labelled study on ten patients diagnosed with progressive cerebellar ataxia. The patients were treated over a period of one month. Treatment consisted of Shirobasti (therapeutic retention of medicament over the scalp) in male patients and Shirodhara (pouring of a steady stream of medicament on the forehead) in female patients with Dhanvantaram tailam (medicated oil) for 45 minutes daily, followed by Abhyanga (methodical massage) with Dhanvantaram tailam and Bhashpa sweda (steam bath), for 14 days. In addition, the treatment also consisted Abhyantara aushadha (oral medicines) of Maharasnadi kashayam 15ml thrice daily, Dhanvantaram capsules 101 two capsules thrice daily, and Ashwagandha tablet 500 mg one tablet thrice daily, for one month. The patients were assessed on the Biodex balance system before and after the treatment. Results were analyzed using paired samples 't' test. RESULTS: All patients tolerated the treatment well without any adverse events and reported subjective improvement in walking. There was a statistically significant improvement in the overall and anteroposterior balance indices of dynamic stability. CONCLUSIONS: Over the short period of the present study, Ayurvedic therapy was found to be safe and, showed improvement in the balance in patients with progressive degenerative cerebellar ataxia. Further randomized placebo-control double-blind studies are needed to validate the results.