Abstract
Background: spasticity affects up to 90% of multiple sclerosis (MS) patients, being a major cause of disability. Repetitive transcranial magnetic stimulation (rTMS) appears to be a potential treatment, but literature is scarce. Objectives: to evaluate the effects of combined rTMS and physical therapy for spasticity in MS patients. Methods: relapsing-remitting MS patients suffering from lower limb spasticity were included. The rTMS protocol consisted of 20 sessions of 18 trains of 50 stimuli at 5Hz and at 100% of rest potential threshold, with 10 seconds per train and 40 second pauses, amounting for 900 pulses (15 minutes) with a Neurosoft- MS/D double coil. Optimal coil positioning was determined by motor responses in the contralateral soleus muscle. The physical therapy protocol included active exercising – stationary bicycle, step climbing with partial weight suspension – followed by mild gradual resistance exercising for knee extension and hip and foot flexion, proprioceptive exercises and active stretching. The primary outcome was improvement on the Modified Ashworth Scale (MAS) score at baseline and 4 weeks after treatment. Results: five female patients were recruited. At the 4-week follow-up, 4 out the 5 patients had a significant improvement regarding spasticity. There was a reduction in mean MAS score from 2.30 to 1.42. Patient 1 had a MAS score reduction from 2 to 1 (50%). Patient 2 from 3 to 1 (66%), patient 3 from 4 to 3 (25%) and patient 4 from 0.5 to 0.125 (75%). Conclusion: combined rTMS and physical therapy protocols presents as a beneficial treatment modality for MS spasticity.
Highlights
Capsaicin is able to induce mast cell degranulation, an event probably related to the pathophysiology of a migraine attack
The present review study aimed to address the mechanisms of action of capsaicin and other chemical inducers in mast cell degranulation and an interaction of nerves and events that happen in the dura mater with the activation of mast cells
Conclusion: the analyzed data indicate that the polymorphisms contributed to the susceptibility to Parkinson’s disease (PD), further studies related to the polymorphisms and their relationship to PD are still needed for more ethnic groups, and early diagnosis is possible
Summary
Capsaicin is able to induce mast cell degranulation, an event probably related to the pathophysiology of a migraine attack. Methods: A literature review and an observational, descriptive and transversal data collect on treatment for acute demyelinating polyradiculoneuritis, available at DATASUS from January 2008 to December 2020, and articles available at Scielo and PubMed. Results: There were 7,917 hospitalizations, representing a total expenditure of R$ 9,392,552.04, 2009 being the year with the highest number of hospitalizations (809) and 2017 with the highest amount spent during the period (R$ 967,284.65). Methods: A literature review and an observational, descriptive and transversal data collect on surgical treatment was carried out, available from January 2008 to December 2020 and articles available in Scielo, Lilacs and PubMed. Results: There were 15,148 hospitalizations for surgical procedures for the treatment of chronic subdural hematoma, representing a total expenditure of R$ 45,365,258.21, with 2018 being the year with the highest number of hospitalizations (1,418) and with the highest amount spent during the period (R$ 4,570,334.28). Conclusions: The “Coca-Cola Bottle sign” is a classic sign of Graves’ disease, some signs, such as, unilateral and single orbital musculature involvement, may be suggestive of involvement by other etiologies, suggesting the benefit of an early expanded investigation
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