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1.
BMJ Case Rep ; 15(1)2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34992059

RESUMO

A 30-year-old woman with active intravenous drug use presented with pain, blue discolouration, paresthesia and lack of grip strength of left hand for 1 week. Physical examination revealed blue discolouration, decreased sensation and cold to touch in the left hand. She had no palpable radial pulse. She admitted Heroin use only but the urine drug screen was also positive for amphetamine. CT angiogram of the left upper extremity was concerning for acute ischaemia due to arterial occlusion. The initial plan was for amputation. However, to salvage the limb with thrombolysis, an interventional radiology angiogram was performed. The angiogram demonstrated diffuse arterial spasm and response to nitroglycerin. She was treated with nitroglycerin drip and transitioned to a calcium channel blocker. She did improve significantly. To ensure no embolic sequelae, the patient was discharged with a month of oral anticoagulation.


Assuntos
Arteriopatias Oclusivas , Isquemia , Adulto , Amputação , Feminino , Mãos , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Espasmo
2.
Pain Manag ; 12(1): 25-33, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34192885

RESUMO

Tolperisone is a nonopioid, centrally acting muscle relaxant in clinical development in the USA for the treatment of symptoms associated with acute, painful muscles spasms of the back. CLN-301, RESUME-1, is a 14-day double-blind, randomized, placebo-controlled, parallel-group Phase III study of the efficacy and safety of tolperisone administered orally three-times daily in 1000 male and female subjects at approximately 70 clinical sites in the USA experiencing back pain due to or associated with muscle spasm of acute onset. Tolperisone is a promising therapeutic for managing acute, painful muscle spasms of the back as it appears to lack the off-target CNS effects often seen with conventional skeletal muscle relaxants. Clinical Trials registration number: NCT04671082.


Assuntos
Relaxantes Musculares Centrais , Tolperisona , Dor nas Costas , Feminino , Humanos , Masculino , Relaxantes Musculares Centrais/uso terapêutico , Espasmo/tratamento farmacológico , Tolperisona/uso terapêutico , Resultado do Tratamento
3.
Med Clin North Am ; 106(1): 131-152, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34823727

RESUMO

Cannabis use in the United States is growing at an unprecedented pace. Most states in the United States have legalized medical cannabis use, and many have legalized nonmedical cannabis use. In this setting, health care professionals will increasingly see more patients who have questions about cannabis use, its utility for medical conditions, and the risks of its use. This narrative review provides an overview of the background, pharmacology, therapeutic use, and potential complications of cannabis.


Assuntos
Cannabis/efeitos adversos , Endocanabinoides/metabolismo , Maconha Medicinal/uso terapêutico , Transtornos Somatoformes/tratamento farmacológico , Adulto , Caquexia/tratamento farmacológico , Endocanabinoides/química , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Legislação de Medicamentos/estatística & dados numéricos , Masculino , Maconha Medicinal/efeitos adversos , Maconha Medicinal/farmacocinética , Maconha Medicinal/farmacologia , Náusea/tratamento farmacológico , Neurobiologia , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Convulsões/tratamento farmacológico , Índice de Gravidade de Doença , Espasmo/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Estados Unidos/epidemiologia
4.
Am J Case Rep ; 22: e934190, 2021 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-34807902

RESUMO

BACKGROUND Kounis syndrome is a hypersensitive coronary disorder triggered by drugs, food, and environmental factors. A 38-year-old male patient with acetaminophen-induced type 1 Kounis syndrome is described. The purpose of this paper is to show that Kounis syndrome is a serious condition that may be linked to a common medication and that it should be recognized earlier in clinical practice. CASE REPORT We report a case of a 38-year-old male patient with chest discomfort, dyspnea, and hypotension following a paracetamol continuous infusion, as well as ST elevation on numerous leads during the episode. The diagnosis of drug-induced Kounis syndrome was made when the patient no longer had angina and the EKG returned to normal after the infusion was discontinued; the coronary angiography also showed no remarkable stenosis. CONCLUSIONS Kounis syndrome is a hypersensitive coronary disease that involves eosinophil and/or mast cell infiltrated coronary stent thrombosis, vasospastic angina, and allergic myocardial infarction. Although acetaminophen is widely used, acetaminophen-induced Kounis syndrome is uncommon and seldom documented. The necessity of detecting the distinct appearance earlier to give more suitable therapy is highlighted in this report.


Assuntos
Vasoespasmo Coronário , Síndrome de Kounis , Acetaminofen/efeitos adversos , Adulto , Vasoespasmo Coronário/induzido quimicamente , Vasoespasmo Coronário/diagnóstico , Vasos Coronários , Humanos , Síndrome de Kounis/diagnóstico , Masculino , Espasmo
5.
Expert Rev Cardiovasc Ther ; 19(10): 917-927, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34633245

RESUMO

INTRODUCTION: Since Prinzmetal first described a 'variant' form of angina pectoris, with predominantly resting episodes of pain and cyclic severity variations, it has gradually become apparent that this clinical presentation is caused by episodes of coronary artery spasm (CAS) involving focal or diffuse changes in large and/or small coronary arteries in the presence or absence of 'fixed' coronary artery stenoses. However, most clinicians have only limited understanding of this group of disorders. AREAS COVERED: We examine the clinical presentation of CAS, associated pathologies outside the coronary vasculature, impediments to making the diagnosis, provocative diagnostic tests, available and emerging treatments, and the current understanding of pathogenesis. EXPERT OPINION: CAS is often debilitating and substantially under-diagnosed and occur mainly in women. Many patients presenting with CAS crises have non-diagnostic ECGs and normal serum troponin concentrations, but CAS can be suspected on the basis of history and association with migraine, Raynaud's phenomenon and Kounis syndrome. Definitive diagnosis requires provocative testing at coronary angiography. Treatment still centers around the use of calcium antagonists, but with greater understanding of pathogenesis, new management options are emerging.


Assuntos
Angina Pectoris Variante , Vasoespasmo Coronário , Angina Pectoris/diagnóstico , Angina Pectoris/etiologia , Angina Pectoris Variante/diagnóstico , Angina Pectoris Variante/terapia , Angiografia Coronária , Vasoespasmo Coronário/diagnóstico , Vasoespasmo Coronário/terapia , Vasos Coronários , Feminino , Humanos , Espasmo
6.
J Vis Exp ; (175)2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34605803

RESUMO

In about a quarter of patients with angina and non-obstructive coronary arteries, no epicardial spasm is noted on coronary arteriography during an angina attack. Since the pressure-rate product is almost identical at rest and the onset of attack in those patients, the decrease in coronary blood flow rather than increased myocardial oxygen consumption is likely to explain myocardial ischemia, indicating a substantial involvement with coronary microvascular spasm (MVS). Myocardial lactate production, which could be defined as a negative myocardial lactate extraction ratio (ratio of the coronary arterial-venous difference in lactate concentration to arterial concentration), is considered indicative of objective evidence to support the emerging myocardial ischemia. Thus, monitoring of the myocardial lactate production and the emergence of chest pain and ischemic electrocardiographic changes during acetylcholine (ACh) provocation testing is of significant value for detecting the entity of MVS. Practically, 1 min after incremental doses of ACh (20, 50, and 100 µg) are administered into the left coronary artery (LCA), paired samples of 1 mL of blood are collected from the LCA ostium and coronary sinus for measurement of lactate concentration by a calibrated automatic lactate analyzer. Then, the development of MVS could be confirmed by negative myocardial lactate extraction ratio despite the absence of angiographically demonstrable epicardial coronary spasm or before its occurrence throughout ACh provocation testing. In conclusion, assessment of myocardial lactate production is essential and valuable for the diagnosis of MVS.


Assuntos
Vasoespasmo Coronário , Ácido Láctico , Acetilcolina , Angiografia Coronária , Vasoespasmo Coronário/diagnóstico , Vasos Coronários/diagnóstico por imagem , Humanos , Espasmo
7.
Int J Cardiol ; 343: 5-11, 2021 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-34499976

RESUMO

BACKGROUND: Functional coronary disorders such as coronary spasm and microvascular dysfunction (including microvascular spasm and impaired microvascular dilatation) are frequent findings among patients with angina and non-obstructed coronary arteries (ANOCA). In this study, we investigated a potential association of coronary spasm and myocardial perfusion abnormalities as well as predictors of such functional coronary disorders in ANOCA patients using a multimodality diagnostic strategy including adenosine stress CMR and intracoronary acetylcholine testing. METHODS: We enrolled 129 patients with ANOCA who underwent acetylcholine testing and adenosine stress perfusion CMR. Patients were allocated to 3 groups according to their spasm testing result with regard to standardized COVADIS criteria: 1) epicardial spasm, 2) microvascular spasm, and 3) no spasm. The myocardial perfusion reserve index (MPRI) was semiquantitatively determined from adenosine stress perfusion CMR. Multivariate regression analyses were performed to identify predictors of coronary functional disorders. RESULTS: Patients with epicardial spasm had lower MPRI than patients without, whereas MPRI was preserved in patients with microvascular spasm. Multivariate analyses revealed age, previous myocardial infarction, LVEF and epicardial spasm as independent predictors of diminished MPRI, whereas previous PCI was associated with epicardial spasm, and female sex was a strong predictor of microvascular spasm. CONCLUSIONS: Our results demonstrate coexistence of different functional coronary disorder endotypes involving the macro- and microvascular level of the coronary circulation in patients with ANOCA. We demonstrate that epicardial spasm is associated with diminished myocardial perfusion reserve and report further predictors of coronary functional disorders.


Assuntos
Acetilcolina , Intervenção Coronária Percutânea , Angiografia Coronária , Circulação Coronária , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Perfusão , Espasmo , Vasodilatadores
8.
Transl Vis Sci Technol ; 10(11): 9, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34491286

RESUMO

Purpose: To determine the utility of root mean squared (RMS) deviations of steady-state accommodation as a noncycloplegic marker for spasm of near reflex (SNR) vis-à-vis regular refractive errors. Methods: Binocular steady-state responses of accommodation, pupil, and vergence of 20 patients with accommodative spasm subtype of SNR (SNR-A; 9-23 years) and 91 with regular refractive errors (29 emmetropes, 41 myopes, 21 hyperopes; 19-38 years) was recorded in the uncorrected refractive error state for 120 seconds using a dynamic (50 frames per second), infrared photorefractor. Mean and RMS deviation of raw data was calculated for three 20-second-long epochs and their diagnostic utility was determined using standard ROC curves. Results: RMS deviations of accommodation increased with mean refractive error in SNR-A (y = -0.23x + 0.38; r2 = 0.69; P < 0.001) and regular refractive error (y = -0.02x + 0.10; r2 = 0.14; P = 0.002) cohorts, albeit with steeper slope and higher y-intercept in the former rather than the latter cohort. RMS deviation of 0.19D reliably distinguished SNR-A from regular refractive errors with a sensitivity and specificity of 95.2% and 92.2%, respectively [mean (±1 SEM) area under ROC curve: 0.98 ± 0.01]. The sensitivity, specificity, and area under ROC curve for RMS deviations of pupil (66.7%, 80%, and 0.70 ± 0.09) and vergence (52.4%, 84.6%, and 0.68 ± 0.08) were smaller than accommodation. Conclusions: RMS deviations of steady-state accommodation is a robust noncycloplegic marker for differentiating SNR-A from regular refractive errors. Pupil and vergence fluctuations have limited utility in this regard. Translational Relevance: RMS deviations of accommodation may be easily obtained using commercial photorefractors, and the cut-off values reported herein may be implemented to identify SNR-A during refractive error screening.


Assuntos
Acomodação Ocular , Miopia , Emetropia , Humanos , Reflexo , Espasmo
9.
BMJ Case Rep ; 14(9)2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493557

RESUMO

Renal transplantation is the treatment of choice for patients with end-stage renal disease. While transplantation improves the quality of life and reduces the mortality risk for most patients when compared with maintenance dialysis, it introduces significant morbidity associated with induction and maintenance immune suppression. Sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, is frequently used as a second-line maintenance immunosuppressive agent in solid organ transplant recipients. Sirolimus may, however, have adverse vascular effects and has previously been shown to induce endothelial cell dysfunction and impaired nitric oxide production in vitro. Sirolimus-eluting coronary artery stents have been associated with rare reports of severe coronary artery vasospasm; however, systemic sirolimus therapy has not previously been associated with vasospastic complications.


Assuntos
Vasoespasmo Coronário , Stents Farmacológicos , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Vasoespasmo Coronário/induzido quimicamente , Vasos Coronários/diagnóstico por imagem , Humanos , Imunossupressores/efeitos adversos , Qualidade de Vida , Diálise Renal , Sirolimo/efeitos adversos , Espasmo , Resultado do Tratamento
10.
Pain Physician ; 24(6): E883-E892, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34554709

RESUMO

BACKGROUND: Paraspinal muscle spasm caused by pain from a lumbar degenerative disc is frequently investigated in patients with low back pain. Radiofrequency ablation (RFA) surgery could alleviate paraspinal muscle spasms. OBJECTIVES: We performed RFA surgery on the high-intensity zone (HIZ) and hypersensitive sinuvertebral and basivertebral nerves to evaluate its outcome. The paravertebral muscle cross-sectional area (CSA) was measured on magnetic resonance imaging (MRI) before and after surgery to evaluate the effect of RFA surgery on the paravertebral muscle. STUDY DESIGN: Prospective cohort study. SETTING: A single spine surgery center. METHODS: A comparative study was performed on 2 different uniportal spinal endoscopic surgery groups; 23 patients who underwent RFA surgery for chronic discogenic back pain and 45 patients who underwent posterior decompression surgery for lumbar spinal stenosis with 12 months of follow-up. Paravertebral muscle cross-sectional area, Schiza grade, Modic type, and HIZ size were measured on pre- and post-operative MRI. An endoscopic video review was performed to evaluate the presence of intraoperative twitching and grade the degree of epidural neovascularization and adhesion. Visual analog scale VAS, modified Oswestry Disability Index, ODI and MacNab's criteria were evaluated for outcome measures. RESULTS: Intraoperative endoscopic video evaluation showed neovascularization and adhesion adjacent to the disc and pedicle. In the RFA surgery group, there were 7 patients (30.43%) with grade 2 and 16 (69.57%) with grade 3 neovascularization; intraoperative twitching was observed in 19 out of 23 patients (82.61%). After performing an RFA on the sinuvertebral and basivertebral nerves for the treatment of discogenic back pain, the results showed significant improvement in pain and disability scores. The mean CSA of the paraspinal muscle in the RFA surgery group was significantly increased after surgery at the L4-L5 and L5-S1 levels (L4-L5: 3901 ± 1096.7 mm² to 4167 ± 1052.1 mm², P = 0.000; L5-S1: 3059 ± 968.5 mm² to 3323 ± 1046.2 mm², P = 0.000) compared to preoperative CSA. LIMITATIONS: This study was limited by its small sample size. CONCLUSION: Hypersensitive sinuvertebral and basivertebral nerves are strongly associated with epidural neovascularization with adhesion and the pathological pain pathway in degenerative disc disease. Epidural neovascularization with adhesion reflects aberrant neurological connections, which are associated with reflex inhibitory mechanisms of the multifidus muscle, which induces spasm. RFA treatment of the region of epidural neovascularization with adhesion effectively treated chronic discogenic back pain and could induce paraspinal muscle spasm release.


Assuntos
Vértebras Lombares , Ablação por Radiofrequência , Dor nas Costas , Humanos , Vértebras Lombares/cirurgia , Estudos Prospectivos , Espasmo , Resultado do Tratamento
11.
Seizure ; 91: 503-506, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34371246

RESUMO

Vigabatrin (VGB) is approved as monotherapy for pediatric patients with Infantile Spasms (IS). Duration of VGB use should be limited because of the risk of retinal and neurotoxicity, but the optimal length of treatment is unknown. Our study aimed to determine the risk of spasms relapse after 6 months of VGB as first-line therapy in IS patients deemed VGB good responders. The participants were 44 infants with IS who demonstrated both absence of clinical spasms and hypsarrhythmia four weeks after starting VGB, obtained from two cohorts: 29 patients from a multicenter prospective cohort and 15 patients from a retrospective single-center cohort. We divided them post hoc into two groups according to the duration of VGB treatment: 6-month group (n=34) and >6-month group (n=10) and compared outcome between the two groups. No patient in either group had a relapse of spasms. For patients with non-identified etiology (NIE) in the 6 months treatment group, no other seizure types were observed. Late epilepsy, in the form of focal seizures, emerged in only 5/37 patients (3/30 in the 6-month treatment group; 2/7 in the extended treatment group); all within the first 6-9 months after VGB initiation. Our study provides substantial evidence that a shortened VGB course of 6 months could be sufficient to treat and prevent relapse of spasms in children with IS, particularly those with NIE.


Assuntos
Espasmos Infantis , Vigabatrina , Anticonvulsivantes/efeitos adversos , Criança , Humanos , Lactente , Estudos Prospectivos , Estudos Retrospectivos , Espasmo/tratamento farmacológico , Espasmos Infantis/tratamento farmacológico , Resultado do Tratamento , Vigabatrina/efeitos adversos
12.
Ugeskr Laeger ; 183(28)2021 07 12.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34356010

RESUMO

Hemifacial spasm (HFS) is a movement disorder affecting the facial muscles and is primarily due to a lesion related to the seventh cranial nerve or the brainstem. In this case report, a 71-year-old man had a rare presentation of acute onset HFS due to non-ketotic hyperglycemia. Type 2 diabetes was diagnosed during hospital admission. A brain magnetic resonance imaging showed a hyperintense lesion in the contralateral basal ganglia. Full remission of symptoms was seen within days after start of antidiabetic agents. Hyperglycaemic induced movement disorder is an important differential diagnosis to HFS and has a good prognosis.


Assuntos
Diabetes Mellitus Tipo 2 , Espasmo Hemifacial , Idoso , Encéfalo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nervo Facial , Espasmo Hemifacial/diagnóstico por imagem , Espasmo Hemifacial/tratamento farmacológico , Espasmo Hemifacial/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Espasmo
14.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 50(3): 361-368, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34402251

RESUMO

To investigate the effect of electro-acupuncture therapy on limb spasm and excitability of motor neurons in stroke rats. Ischemic stroke model was induced with middle cerebral artery embolization in SD rats. Thirty-three modeled rats were randomly divided into model group, electro-acupuncture group, and baclofen group with 11 rats in each group, and another 10 rats were taken as sham operation group. The electro-acupuncture group and the baclofen group were treated with electro-acupuncture and baclofen tablets respectively. The model group and the sham operation group had no intervention. The neural function was evaluated with Bederson's scale and balance beam test; the muscle tension was measured with electrophysiography; the pathological changes of brain tissue was examined with HE staining; the content of glutamic acid (Glu) and γ-aminobutyric acid (GABA) in rat cerebral cortex was analyze with enzyme linked immunosorbent assay (ELISA) method, the expression of metabotropic glutamate receptor 1a () and γ-aminobutyric acid type B receptor subunit 1 () mRNA were detected with RT-qPCR. Compared with the model group, the neurological function scores of the electro-acupuncture group and the baclofen group showed a downward trend at d7 after operation (all >0.05), and the neurological function scores of the electro-acupuncture group and the baclofen group were significantly decreased at d12 after the operation (all <0.05). Compared with sham operation group, the electrophysiological results of model group, electro-acupuncture group and baclofen group were significantly lower (all <0.05), and there was no statistical difference in the electrophysiological results of the model group, electro-acupuncture group and baclofen group at d7 after operation (all >0.05). Compared with the model group, the electrophysiological results of the electro-acupuncture group and baclofen group were significantly increased after operation (all <0.05). The results of HE staining showed that there was no cell edema and degeneration in the sham operation group, no pyknosis of the nucleus, and no bleeding in the interstitium. Cell edema and degeneration and mesenchymal congestion appeared in the model group. Compared with the model group, the cytoplasmic edema and degeneration and the interstitial bleeding in the electroacupuncture group and the baclofen group were reduced. Compared with sham operation group, the Glu content and the relative expression of mRNA was increased in the model group, electro-acupuncture group and baclofen group, while the GABA content and the relative expression of mRNA decreased (all <0.05). Compared with model group, the Glu content and the relative expression of mRNA in the electro-acupuncture group and baclofen group decreased, and the GABA content and relative expression of mRNA increased (all <0.05). Electro-acupuncture may improve limb spasm after stroke through regulating the expression of Glu and GABA in the cerebral cortex and the excitability of motor neurons in rats.


Assuntos
Terapia por Acupuntura , Acidente Vascular Cerebral , Animais , Neurônios Motores , Ratos , Ratos Sprague-Dawley , Espasmo , Acidente Vascular Cerebral/terapia
15.
Spinal Cord Ser Cases ; 7(1): 75, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413287

RESUMO

INTRODUCTION: Abdominal spasms are involuntary contractions that can be caused by denervation due to spinal cord injury. We present a case that benefited from botulinum toxin injections. CASE PRESENTATION: A 42-year-old male patient was followed up due to spinal cord injury that developed secondary to burst fracture in the 6th thoracic vertebra as a result of falling off the train in 1996, was classified as International Standards for Neurological Classification of SCI (ISNCSCI) T8 American Spinal Injury Association Impairment Scale (AIS) grade-B. His complaint of contraction and spasms in his abdominal muscles has been present for 2 years but has escalated significantly in the last 3 months. His complaint of contraction and spasms in his abdominal muscles has been present for 2 years but has escalated significantly in the last 3 months. He used oral baclofen 20 mg three times a day for the complaint of contraction, but his complaints did not completely disappear. The use of a baclofen pump was recommended to the patient in his previous visits, but the patient did not accept it. Due to the lack of alternatives and considering the local nature of the complaints, we planned botulinum toxin injection for the patient's bilateral internal oblique and external oblique abdominal muscles with ultrasonography guidance. He benefited significantly from botulinum toxin injection, and his complaints decreased. CONCLUSION: In selected patients with spinal cord injury, ultrasound guided botulinum toxin injections to external and internal oblique muscles can be a safe alternative.


Assuntos
Toxinas Botulínicas , Fármacos Neuromusculares , Traumatismos da Medula Espinal , Músculos Abdominais Oblíquos , Adulto , Humanos , Masculino , Fármacos Neuromusculares/uso terapêutico , Espasmo/tratamento farmacológico , Espasmo/etiologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/tratamento farmacológico
16.
J Invasive Cardiol ; 33(7): E584, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34224391

RESUMO

A recent guideline has recommended the radial artery as the access site for coronary catheterization due to lower risk of bleeding and vascular complications. However, the transradial approach is not necessarily easy for interventionalists due to the smaller vessel diameter and more frequent occurrence of vasospasm induced by the procedure. By using the measurement in ultrasound, a previous study demonstrated that subcutaneous nitroglycerin injection at the radial artery puncture site dilated the radial artery, and that a patch was also easier and less invasive. The current case suggests the applicability of a nitroglycerin transdermal patch to prevent vasospasm via local transdermal absorption into the arterial wall; its use may lead to a higher success rate for the transradial approach, especially in patients who had experienced radial artery vasospasm.


Assuntos
Nitroglicerina , Artéria Radial , Cateterismo Cardíaco/efeitos adversos , Humanos , Espasmo/etiologia , Espasmo/prevenção & controle , Adesivo Transdérmico , Vasodilatadores/uso terapêutico
17.
Seizure ; 91: 374-383, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34298456

RESUMO

BACKGROUND: Valproate, levetiracetam, benzodiazepines, and topiramate are antiseizure medications (ASMs) considered to have definite efficacy in reducing the frequency of epileptic spasm frequency, apart from ketogenic dietary therapies. Although zonisamide has also been shown to have efficacy as second-line ASM for epileptic spasms, various studies have conflicting results in literature. This systematic review aims to summarize clinical studies regarding the efficacy of zonisamide for epileptic spasms. METHODS: We conducted a systematic literature search collating all available literature. The primary objective was to determine efficacy in terms of proportion with complete spasm resolution, we also intended to determine proportion with at least 50% spasm reduction, hypsarrhythmia resolution, and nature/frequency of adverse effects. All prospective/retrospective, controlled/uncontrolled studies describing the use of zonisamide with epileptic spasms were included in the qualitative review excluding case reports, but for metanalysis pertaining to key outcomes, we included studies with at least 10 participants. RESULTS: A total of nineteen publications were found eligible for inclusion in the qualitative review, out of 101 search items. A total of 401 children with epileptic spasms were tried up to a maximum of 9.9-35 mg/kg/day dose with only mild adverse effects in a few patients. Total 20.8% (95% CI-11.4%-29.2%) and 23.4% (95% CI-17.8%-29.1%) patients had complete cessation of spasms and at least a 50% reduction in total spasm frequency as compared to baseline after starting zonisamide. Similarly, 20.3% (95% CI-10.1%-30.5%) had resolution of hypsarrhythmia in EEG after starting zonisamide. CONCLUSION: Zonisamide can reduce spasms in 21% of children with epileptic spasms, without major adverse effects. But there are only limited studies on epileptic spasms of sufficient quality to give high confidence in meta-analysis. Large controlled trials are needed in this regard to provide high-quality evidence favoring/disfavoring its use in patients with epileptic spasms.


Assuntos
Espasmos Infantis , Anticonvulsivantes/uso terapêutico , Criança , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Espasmo/tratamento farmacológico , Espasmos Infantis/tratamento farmacológico , Zonisamida/uso terapêutico
18.
Epilepsy Behav ; 121(Pt A): 108075, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34077901

RESUMO

OBJECTIVE: Repetitive sleep starts (RSS) are clusters of nonepileptic, spasm-like movements occurring during sleep onset. However, their characteristics have yet to be defined. We conducted a clinicoelectroencephalographic study of children with RSS to clarify their detailed characteristics. METHODS: To differentiate starts from epileptic spasms, we recruited children with brief "crescendo-decrescendo" muscle contractions that simultaneously involved the limbs and trunk without electroencephalogram changes, and that fulfilled the following criteria: (1) repeated occurrence (five or more) and (2) manifestation during sleep stage N1-N2. A total of nine children met these criteria. Their clinical information and video-electroencephalogram data were analyzed retrospectively. RESULTS: The background conditions observed at onset of RSS were perinatal hypoxic-ischemic encephalopathy (n = 4), West syndrome of unknown etiology (n = 1), and traumatic brain injury (n = 1). The age at onset of RSS, the number of starts in a given RSS cluster, the interval between starts, and the duration of surface electromyogram activity were between 3 and 46 months, 5 and 547, <1 and 60 s, and 0.3 and 5.4 s, respectively. None of the median value of these parameters differed between children with and without corticospinal tract injury. During the median follow-up period of 33 months, RSS disappeared spontaneously in five. CONCLUSION: This is the largest case series of RSS clarifying their clinicoelectroencephalographic characteristics reported to date. To avoid unnecessary antiepileptic therapies, clinicians should be aware of RSS and distinguish it from other disorders involving involuntary movements or seizures, especially epileptic spasms.


Assuntos
Transtornos da Transição Sono-Vigília , Espasmos Infantis , Criança , Pré-Escolar , Diagnóstico Diferencial , Eletroencefalografia , Humanos , Lactente , Estudos Retrospectivos , Espasmo/diagnóstico , Espasmos Infantis/diagnóstico
19.
Zhongguo Zhen Jiu ; 41(6): 671-4, 2021 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-34085487

RESUMO

In the guidance of qijie (qi street, path of qi ) theory, the thought on diagnosis and treatment with acupuncture and moxibustion for facial spasm is analyzed. Qijie theory is a summary of the horizontal distribution rule of human body and the conclusion of the characteristics of function and indication in a certain area. In terms of spatial location and functional characteristics, facial spasm is related to "head qijie". In treatment with acupuncture and moxibustion, the local acupoints are predominated. Additionally, the distal acupoints are selected based on the characteristics of qijie in pathological condition, "qijie is unblocked even though the obstruction occurs in minor collateral"; and the acupoints for calming the mind are combined based on the relationship between head qijie and the brain function, aiming to regulating the body, qi and spirit. Regarding the techniques of acupuncture and moxibustion, align with the spatial location and hierarchical location of disease, the depth of filiform needle insertion and needling stimulation are specified and the palpation on the local meridians and acupoints are emphasized before acupuncture specially.


Assuntos
Terapia por Acupuntura , Acupuntura , Meridianos , Moxibustão , Pontos de Acupuntura , Humanos , Espasmo
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