Fenómenos autónomos referidos por punto gatillo miofacial en el músculo temporal como una respuesta neuropática / Autonomus referred phenomena by myofacial trigger point in temporalis muscle as a neuropathic response

Los puntos gatillo miofaciales (Pgs) son puntos hiperirritables en un músculo esquelético asociado a un nódulo palpable causado por una banda muscular tensa. Los Pgs miofaciales presentan dentro de sus signos y síntomas alteraciones motoras, sensoriales y autonómicas. En este artículo reportamos un caso en el que se presenta un fenómeno autónomo referido a partir de un punto gatillo miofacial y se plantean las vías neuroanatómicas involucradas en esta respuesta, analizando la hipótesis que las respuestas autónomas referidas asociadas al dolor pueden considerarse eventos neuropáticos del sistema nervioso autónomo.

Myofascial trigger points (MTP) are hyperirritable points in skeletal muscle associated with a palpable lump caused by a strained muscle band. MTP presented within signs and symptoms of motor, sensory and autonomic impairment. In this article we report a case in which an autonomous referred phenomena from a myofascial trigger point and raises the neuroanatomical pathways involved in this response, considering the hypothesis that self-related responses associated with neuropathic pain can be regarded as events of the autonomic nervous system. Clinical and experimental evidence discussed in this article indicates that myofascial trigger point pain is an autonomic phenomena associated, that can be systemic and localized, and must be considered in evaluating patients with these diagnosis.

Relationship among end-stage renal disease, hypertension, and sleep apnea in nondiabetic dialysis patients.

BACKGROUND: Cardiovascular diseases (CVD) are responsible for more than 50% of the deaths in patients with end-stage renal disease (ESRD). Sleep apnea (SA) has been recognized as a risk factor for CVD. Previous studies have shown a higher prevalence of SA among patients on dialysis. METHODS: Forty-five nondiabetics patients with ESRD underwent a polysomnographic analysis with concomitant clinical evaluation and laboratory tests. Fourteen patients (31.1%) presented with an apnea/hypopnea index (AHI) more than 5, confirming a high prevalence of SA. We observed abnormal sleep pattern with high percentages of sleep stage 1 and low percentages of sleep stages 3 and 4. RESULTS: Patients with AHI more than 5 presented higher levels of systolic, diastolic, and mean blood pressures (MBP) as compared with those with AHI less than 5 (P < .05). When other variables were compared (age, time of dialytic treatment, cause of ESRD, use of antihypertensive drugs, body mass index, serum levels of hemoglobin, hematocrit, creatinine, KT/V index, pH, bicarbonate, parathormone, and alkaline phosphatase), no differences were found between the two groups. In a logistic regression model, MBP and age more than 40 years were positively related to the presence of SA. CONCLUSIONS: Our study is in agreement with previous works and shows that patients with ESRD have a higher SA index compared to those with normal renal function. In spite of having higher levels of BP no other parameter was different among apneic and nonapneic patients. Hypertension may play a pivotal role linking SA and CVD.