Involuntary Muscle Research Articles

Vaginismus: Results from Treatment with the PRM Protocol™

Background/Aim: Vaginismus, a condition characterized by involuntary pelvic floor muscle spasms, presents considerable challenges in diagnosis and treatment, impacting sexual health and quality of life. This study evaluates the efficacy of a novel pelvic peripheral nerve block and trigger point injection protocol (the PRM Protocol™) in addressing vaginismus. Materials/Methods: A retrospective chart review of 961 patients diagnosed with vaginismus, aged 18-76, was conducted. Participants underwent a 6-week treatment protocol involving neuromuscular treatment and physical therapy. Results: Outcome measures included the Visual Analog Scale (VAS) pain scale, the Functional Pelvic Pain Scale (FPPS), and the modified Sexual Function Profile (SFP). Post-treatment, there were notable decreases in VAS by 46%, FPPS by 51% and a 25% improvement in SFP. Additionally, opioid use decreased by 22%, ER visits decreased by 18%, and absenteeism and presenteeism decreased by 56% and 68%, respectively. No adverse events were reported. Conclusion: The study highlights the comprehensive efficacy of the PRM Protocol™ in alleviating vaginismus symptoms and improving patient outcomes. Implementation of this protocol offers a transformative opportunity to enhance patient care and optimize resource allocation in managing vaginismus, warranting further research and clinical application.

Bilateral hand dystonia following high-velocity thrust manipulation: a case report.

Thrust manipulation is one of the most commonly used techniques for managing musculoskeletal pain in clinical practice. This involves the application of a high-velocity, low-amplitude force directed to the joints with the intent of achieving joint cavitation. This current case report describes a female in her mid-20s who presented with excessive bilateral and involuntary hand muscle contractions after bilateral thrust manipulation. Dystonia appeared both at rest and during voluntary movements but was aggravated by actions such as finger flexion or spreading and disappeared during sleep. A diagnosis of complex regional pain syndrome (CRPS) type I combined with dystonia was made. Prednisolone administered between 2 and 5 weeks after symptom onset significantly reduced CRPS symptoms, but intramuscular botulinum toxin injection 5 weeks after symptom onset was ineffective at controlling her symptoms. Seven weeks after symptom onset, the patient was administered 2 mg trihexyphenidyl oral twice a day, 2.5 mg diazepam oral twice a day and 5 mg baclofen oral three times a day for 1 month and this significantly reduced dystonia, but complete resolution was not achieved. Clinicians should be aware that dystonia is a rare complication of thrust manipulation.

Characteristics and Management Outcome of Vaginismus

Vaginismus, a common pelvic floor dysfunction characterized by involuntary vaginal muscle spasms, often impedes sexual intercourse and is exacerbated by cultural barriers in Indonesia, where sexual issues are taboo. Healthcare providers' lack of knowledge contributes to patient dissatisfaction with treatments. This study aimed to evaluate risk factors and management outcomes in 36 Indonesian women with vaginismus. Primary data, including demographic details, vaginismus history, severity, and FSFI-6 scores, were collected through interviews and medical records. Results showed that 94.4% of participants were under 40 years old, 66.7% had been married for over two years, and 94.5% were university graduates. Most had normal BMI and no significant illness history. Among them, 77.8% had no history of penetration, with the majority having no medical, social, or psychological risk factor yet reporting good sexual satisfaction. Self-dilation was the primary treatment, with a 29.41% success rate in achieving penetration. Younger age and higher education were notable characteristics among cases, suggesting a need for increased disease awareness. The study highlights that while traditional risk factors were not predominant, self-dilation therapy yielded moderate success, and patient satisfaction with sexual and interpersonal relationships remained high.

Efficacy of the Hegab temporomandibular joint splint in treating patients diagnosed with dystonia with or without systemic involvement: A report of 14 cases

Dystonia is a neurological motor disorder characterised by involuntary and uncontrollable muscle contractions, tension, twisting, and tremors. The aim of the present study was to analyse the improvement in dystonic contractions in patients with dystonia following the use of a Hegab temporomandibular joint splint (HTS). The Fahn-Marsden Dystonia Movement Scale (DMS) and Disability Scale were used in the current study to evaluate dystonia. An HTS with a thickness ranging from 4 to 6 mm was used to treat the patients enrolled in the study. The final sample comprised 14 patients (10 female and four male) with mean (range) ages of 35.64 (18 to 55) years. Pre-treatment DMS ranged from 6.5 to 57 mean (SD) 18.21 (13.38). At the end of the study, DMS ranged from 0 to 15 mean (SD) 3.14 (3.86). Statistical analysis of the differences between pre-treatment and post-treatment DMS showed a significant decrease in DMS at the end of the treatment period (p = 0.0001). Regarding the disability scale, pre-treatment disability scale ranged from 7 to 18 mean (SD) 9.46 (3.02). At the end of the study, DMS ranged from 0 to 3 mean (SD) 1.46 (1.13). There was a statistically highly significant decrease in the Disability Scale at the end of the treatment period (p value ≤ 0.0001). This study suggests that the HTS can be considered an effective treatment modality for dystonia, as it significantly decreases both the DMS and the Disability scale.

Unexpected Falls in Schizophrenia: Clozapine-Induced Negative Myoclonus

Myoclonus, characterized by sudden involuntary muscle contractions, can occur in a variety of conditions, including as a side effect of clozapine, which is used in the treatment-resistant schizophrenia. This case study describes a 48-year-old female patient who developed negative myoclonus, manifested by knee flexion and falls, after starting clozapine. Despite dose reduction and the addition of valproic acid, symptoms persisted, highlighting the dose-dependent nature of clozapine-induced myoclonus and the need for clinicians to recognise this risk.

Awareness of Zika virus Disease Effects on Children, and Attitude towards Infected Unborn Babies, among Caregivers that Visit Immunization Clinic of a Teaching Hospital, Enugu, Nigeria

Aims: To assess caregivers’ awareness of Zika virus disease effects on children, infected by their mother during pregnancy; and attitude towards infected unborn babies. Study Design: This quantitative study, was of observational, descriptive, and cross-sectional design. Place and Duration of Study: The study was conducted in the Immunization unit, Enugu State University Teaching Hospital, Enugu, Nigeria; between November 2016 and February 2017. Methodology: A trained Resident doctor in the department of Community Medicine, interviewed 10 randomly selected female caregivers that brought children to the hospital for immunization. Thirty respondents were interviewed each week for eight weeks, since immunization activity was conducted three days in a week. Sixteen were interviewed on the ninth week; making a total of 256 respondents. Results: A total of 256 women participated in the study, with 89.5% of them being married, and 86.0% falling within the age range of 20 – 39 years. Overall awareness on Zika virus infection effect on children such as failure to thrive, involuntary muscle contractions, learning handicap, visual and hearing impairment, and less functional individual with reduced societal value were poor. None of the total scores were up to 50.0%. In situation where Zika virus is detected in an unborn baby, praying and leaving the outcome to God was the highest selected option (48.8%), while abandoning the baby in the hospital was the least selected option (6.6%). Other options were accepting and caring for the baby (41.8%), and terminating the pregnancy (14.8%). Conclusion: Though the declaration of Zika virus infection by the World Health Organization, as a Public Health Emergency of International Concern was lifted since November 2016; the infection could still be going on undetected, in many low- and middle-income countries. Efforts should be made to improve on the level of awareness on Zika virus, and effects on children.

Urodynamic and Frequency-Volume Chart Parameters Influencing Anticholinergic Resistance in Patients With Neurogenic Detrusor Overactivity.

Neurogenic detrusor overactivity (NDOA) is characterized by involuntary detrusor muscle contractions during bladder filling in patients with neurological disorders. Anticholinergic therapy is the primary treatment; however, the reasons for treatment resistance in NDOA are not well understood. This study aimed to identify predictors of treatment failure by comparing urodynamic and frequency-volume chart data between patients with NDOA who respond and patients who do not respond to anticholinergic therapy. We reviewed the records of 362 patients presenting with lower urinary tract symptoms and selected 85 who had NDOA and were on anticholinergic therapy. Ultimately, 67 patients were analyzed. We categorized these individuals into responders (group R) and nonresponders (group NR) based on clinical and urodynamic improvements. Three-day frequencyvolume charts and urodynamic study results were retrospectively reviewed. Of the 85 initial patients, 12 refused medication, and 6 were lost to follow-up. Pre- to posttreatment changes differed significantly between groups in the number of urgency urinary incontinence (UUI) episodes per 24 hours (P=0.001), maximum cystometric capacity (mL, P=0.003), NDOA frequency (P=0.004), and bladder compliance (mL/cm H2O, P=0.003). Multivariate analysis revealed that NDOA frequency (P=0.014) and UUI episodes per 24 hours (P=0.002) were significant factors associated with treatment failure. NDOA varies according to underlying neurological conditions. The frequencies of UUI episodes and NDOA in urodynamic studies can predict resistance to initial anticholinergic treatment.

Prevalence of Myofascial Trigger Points in Isolated Idiopathic Cervical Dystonia: A Possible Contributor to Pain, Movement and Disability.

Myofascial trigger points (TrPs) are hypersensitive points located in a tight band of muscle that, when palpated, produce not only local pain but also referred (distant) pain. The role of TrPs in patients with cervical dystonia (CD) has not been investigated. To identify the presence of TrPs in patients with isolated idiopathic CD and their association with pain. Thirty-one patients (74.2% women; age: 61.2 years, SD: 10.1 years) participated. TrPs were explored in the sternocleidomastoid, upper trapezius, splenius capitis, levator scapulae, anterior scalene, suboccipital, and infraspinatus muscles. Clinical features of CD were documented as well as the presence of pain. The severity of dystonia and its consequences were assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). The mean number of TrPs for each patient was 12 (SD:3), with no differences between patients with pain (n = 20) and those without pain (n = 11). Active TrPs were only found in patients with pain (mean: 7.5, SD:4). Latent TrPs were found in both groups but were more prevalent (P < 0.001) in patients without pain (mean: 11, SD:3.5) than in those with pain (mean: 5, SD:3.5). The number of active TrPs or latent TrPs was positively associated with the TWSTRS disability subscale and the TWSTRS total score. The number of active, but not latent, TrPs was associated with worse scores on the TWSTRS pain subscale. Active TrPs were present in patients with CD reporting pain, while latent TrPs were present in all CD patients, irrespective of their pain status. The numbers of active/latent TrPs were associated with disability. TrPs could act as pain generators in CD and also contribute to the involuntary muscle contractions characteristic of dystonia.

Spastic Equinovarus Foot Deformity.

Acute brain injuries are caused by a variety of etiologies, each potentially disrupting neurological function. The neurologic impairments are on a spectrum of severity often creating functional barriers to completing activities of daily living. Initial treatment starts immediately upon diagnosis and requires a multimodal approach working to prevent systemic changes. Therapy, bracing treatment, injections, and pharmacologic treatments are the mainstay of early intervention. Worsening upper motor neurological impairment associated with involuntary muscle hyperactivity can lead to a spastic equinovarus foot deformity. Spastic equinovarus foot deformities secondary to anoxic brain injuries or traumatic brain injury pose a challenging situation for orthopaedic surgeons because of associated cognitive impairment, spastic tone, and extensive soft-tissue contractures prohibiting bracing treatment. Tendon releases and transfers in combination with functional bracing treatment are initially attempted, and selective fusions are performed for severe cases. Surgical indications are primarily focused on obtaining a balanced, braceable, functional lower extremity with a plantigrade foot.

Association of medullary reticular formation ventral part with spasticity in mice suffering from photothrombotic stroke

Strokes cause spasticity via stretch reflex hyperexcitability in the spinal cord, and spastic paralysis due to involuntary muscle contraction in the hands and fingers can severely restrict skilled hand movements. However, the underlying neurological mechanisms remain unknown. Using a mouse model of spasticity after stroke, we demonstrate changes in neuronal activity with and without electrostimulation of the afferent nerve to induce the stretch reflex, measured using quantitative activation-induced manganese-enhanced magnetic resonance imaging. Neuronal activity increased within the ventral medullary reticular formation (MdV) in the contralesional brainstem during the acute post-stroke phase, and this increase was characterised by activation of circuits involved in spasticity. Interestingly, ascending electrostimulation inhibited the MdV activity on the stimulation side in normal conditions.Moreover, immunohistochemical staining showed that, in the acute phase, the density of GluA1, one of the α-amino-3 hydroxy‑5 methyl -4 isoxazolepropionic acid receptor (AMPAR) subunits, at the synapses of MdV neurons was significantly increased. In addition, the GluA1/GluA2 ratio in these receptors was altered at 2 weeks post-stroke, confirming homeostatic plasticity as the underlying mechanisms of spasticity. These results provide new insights into the relationship between impaired skilled movements and spasticity at the acute post-stroke phase.

The Morbid Impact of Environmental Toxins on the Human Nervous System: Dystonia Nexus with Organic Solvents, Pesticides, and Heavy Metals

Dystonia is a neurological disorder characterized by involuntary muscle contractions that lead to abnormal movements and postures. This review examines environmental toxins and their etiology and pathogenesis of dystonia. Environmental toxins – organic solvents, pesticides, and heavy metals – disrupt neural pathways and neurotransmitter functions, contributing to the development of dystonia. These toxins induce neurotoxicity through mechanisms involving oxidative stress, inflammatory responses, and interference with neurotransmitter synthesis and release. Organic solvents disrupt neuronal membrane integrity and neurotransmission, while pesticides impair neurotransmitter synthesis and receptor function. Heavy metals alter ion channel function, promote oxidative stress, and trigger inflammatory responses, causing neuronal damage. Diagnosing dystonia requires a thorough medical history, neurological examination, lab work, and specialized tests, including imaging and genetic testing. Treatment strategies focus on symptom management by identifying and eliminating the source of environmental toxin exposure and medications (e.g., dopaminergic agents, anticholinergics, GABAergic agents, and BOTOX injections). These strategies are complemented by physical therapy, nutritional support, regulating monitoring and follow-up, and education and counseling.

Electromyographic Characteristics of Postactivation Effect in Dopamine-Dependent Spectrum Models Observed in Parkinson's Disease and Schizophrenia.

This study aimed to test the hypothesis that the postactivation effect (PAE, involuntary normal muscle tone) is modified by dopaminergic mechanisms. The PAE was tested with surface electromyography (sEMG) in the "off medication" phase in participants with Parkinson's disease (PDoff) and in the "on medication" state in participants with schizophrenia (SZon), which modeled hypodopaminegic conditions, and in participants with PD "on medication" (PDon) and in participants with SZ "off medication" (SZoff) state which modeled the hyperdopaminergic conditions. Healthy age-matched participants constituted the control group (HC, n = 11). In hyperdopaminergic models, PAE was triggered in 71.3% of participants in SZoff and in 35.7% in PDon conditions. In the hypodopaminergic models, PAE was triggered in 12% in SZon and in 21.4% in PDoff conditions. In the HC group, PAE was present in 91% of participants. In the HC and PD groups, the mean frequency and correlation dimension of sEMG at PAE was higher than that during voluntary isometric contraction. In conclusion, in hypodopaminergic models, PAE triggering was inhibited. The manifestations and EMG characteristics of PAE in people with PD or SZ may indicate dopaminergic dysfunction.

Health-Related Quality of Life in Romanian Patients with Dystonia: An Exploratory Study.

Background/Objectives: Dystonia is a neurological movement disorder characterized by involuntary muscle contractions that lead to abnormal movements and postures; it has a major impact on patients' health-related quality of life (HRQoL). The aim of this study was to examine the HRQoL of Romanian patients with dystonia using the EQ-5D-5L instrument. Methods: Responses to the EQ-5D-5L and the visual analogue scale (VAS) were collected alongside demographic and clinical characteristics. Health profiles were analyzed via the metrics of the EQ-5D-5L, severity levels, and age groups. Using Shannon's indexes, we calculated informativity both for patients' health profile as a whole and each individual dimension. Level sum scores (LSS) of the EQ-5D-5L were calculated and compared with scores from the EQ-5D-5L index and VAS. The HRQoL measures were analyzed through demographic and clinical characteristics. Descriptive statistics, Spearman correlation, and non-parametric tests (Mann-Whitney U or Kruskall-Wallis H) were used. The level of agreement between HRQoL measures was assessed using their intraclass correlation coefficient (ICC) and Bland-Altman plots. Results: A sample of 90 patients was used, around 75.6% of whom were female patients, and the mean age at the beginning of the survey was 58.7 years. The proportion of patients reporting "no problems" in all five dimensions was 10%. The highest frequency reported was "no problems" in self-care (66%), followed by "no problems" in mobility (41%). Shannon index and Shannon evenness index values showed higher informativity for pain/discomfort (2.07 and 0.89, respectively) and minimal informativity for self-care (1.59 and 0.68, respectively). The mean EQ-5D-5L index, LSS, and VAS scores were 0.74 (SD = 0.26), 0.70 (SD = 0.24), and 0.61 (SD = 0.21), respectively. The Spearman correlations between HRQoL measures were higher than 0.60. The agreement between the EQ-5D-5L index and LSS values was excellent (ICC = 0.970, 95% CI = 0.934-0.984); the agreement was poor-to-good between the EQ-5D-5L index and VAS scores (ICC = 683, 95% CI = 0.388-0.820), and moderate-to-good between the LSS and VAS scores (ICC = 0.789, 95% CI = 0.593-0.862). Conclusions: Our results support the utilization of the EQ-5D-5L instrument in assessing the HRQoL of dystonia patients, and empirical results suggest that the EQ-5D-5L index and LSS measure may be used interchangeably. The findings from this study highlight that HRQoL is complex in patients with dystonia, particularly across different age groups.

Biomechanical Integrity Score of the Female Pelvic Floor for Stress Urinary Incontinence

Introduction and hypothesisThis study is aimed at developing and validating a new integral parameter, the Biomechanical Integrity score (BI-score) of the female pelvic floor for stress urinary incontinence conditions.MethodsA total of 130 subjects were included in the observational cohort study; 70 subjects had normal pelvic floor conditions, and 60 subjects had stress urinary incontinence (SUI). A Vaginal Tactile Imager (VTI) was used to acquire and automatically calculate 52 biomechanical parameters for eight VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in two planes, relaxation, and reflex contraction). Statistical methods were applied (t test, correlation) to identify the VTI parameters sensitive to the pelvic SUI conditions.ResultsTwenty-seven parameters were identified as statistically sensitive to SUI development. They were subdivided into five groups to characterize tissue elasticity (group 1), pelvic support (group 2), pelvic muscle contraction (group 3), involuntary muscle relaxation (group 4), and pelvic muscle mobility (group 5). Every parameter was transformed to its standard deviation units using the dataset for normal pelvic conditions, similar to the T-score for bone density. Linear combinations with specified weights led to the composition of five component parameters for groups 1–5 and to the BI-score in standard deviation units. The p value for the BI-score has p = 4.0 × 10–28 for SUI versus normal conditions.ConclusionsQuantitative transformations of the pelvic tissues, support structures, and functions under diseased conditions may be studied with the SUI BI-score in future research and clinical applications.

Successful Management of an Acute Dystonic Reaction Induced by an Anesthetic Agent

Acute dystonic reactions (ADRs) are movement abnormalities characterized by involuntary muscle contractions that typically manifest after exposure to a triggering agent, such as a medication. The specific muscle groups affected determine the type of reaction. For instance, an oculogyric crisis primarily affects the ocular muscles, while oromandibular dystonia involves jaw opening and tongue protrusion. We present the rare case of a 68-year-old man with amyotrophic lateral sclerosis who was successfully treated for an ADR. The patient was admitted with loss of consciousness due to respiratory failure. Tracheostomy was promptly performed under sedation with multiple general anesthetic agents. Immediately after tracheostomy, the patient communicated via eye-blinking without any notable abnormalities, just as before the procedure. However, the following day, he became unresponsive to verbal cues and exhibited a decreased level of consciousness, accompanied by tongue dyskinesia, deviation of both eyes to the left, and loss of visual tracking. The patient’s vital signs remained stable. Brain imaging and an electroencephalogram revealed no abnormalities. Treatment with midazolam produced initial improvement; however, due to a significant side effect of hypotension, the treatment was switched to oral diazepam. The patient’s condition gradually improved, and the medication was eventually discontinued without further ADR episodes.

How Essential Oils Affect Children with Congenital Zika Virus Syndrome (CZVS)

Introduction: Within the field of dentistry, essential oils are well-known and extensively researched; eugenol is one of the most used, which until recently characterized the predominant smell of dental offices. Children with congenital Zika virus syndrome (CZVS) have various impairments, and in the dental area, the vast majority exhibit underdevelopment of the stomatognathic system compared to established normality standards. Many use various medications, such as anticonvulsants, muscle relaxants, sedatives, neuroleptics, among others, to control symptoms. These drug interactions can trigger involuntary muscle movements, including bruxism. There are several treatment proposals for teeth grinding and clenching, including appliance therapy, emotional therapies, medication, and also aromatherapy. Material and method: Syndromic and bruxist children were selected through validated questionnaires and clinical examination. A convenience sample of 19 syndromic children from Maceió was divided into two random groups: group 1 received a blend of essential oils, and group 2 received a control oil. They were instructed to apply it topically to the masseter, temples, and cervical area twice a day for two months. Sleep analysis was carried out through a questionnaire with 15 questions plus filling out a sleep chart for three days and collecting saliva in Salivette tubes for cortisol evaluation, with both data sets collected pre and post-use of essential oils. Discussion: Previous studies report that individuals with cognitive difficulties are more prone to bruxism due to spasticity, however, they are not definitive according to other studies. There are other factors such as stress, depression, external environmental stimuli that can influence this condition, in addition to the drug interaction they use to alleviate symptoms such as seizures, drooling, muscle spasms, muscle stiffness, insomnia. The etiology of bruxism is still considered multifactorial, requiring a multidisciplinary clinical team for more effective treatment. The use of essential oils as a stress and insomnia reliever is reported in studies with satisfactory results, being observed in this research. Result: In the finalization phase. Conclusion: Given the above, the proposal was to evaluate the efficacy of using essential oils in syndromic and bruxist children. Although we cannot confirm results yet, there are reports from mothers who evaluated the initiative positively, corroborating in some way the alleviation of symptoms and drug interactions, providing more emotional and physical comfort for those involved. However, more clinical trials are still necessary regarding the safety and efficacy aspects of essential oils.

Epilepsia partialis continua: A review.

Epilepsia partialis continua (EPC) is a rare type of focal motor seizure characterized by continuous, involuntary muscle contractions in a specific part of the body. These contractions usually involve rhythmic, twitching movements and can last for several hours to days. The seizures are usually limited to one part of the body and can be clonic or dystonic. EPC can affect people of all ages but is more common in children and adolescents. The pathophysiology of EPC is complex and depends on the cause. There are several possible causes of EPC including structural brain abnormalities, infections, metabolic and genetic disorders, inflammatory conditions, traumatic brain injury, and vascular causes. The work-up of EPC includes electroencephalography (EEG), magnetic resonance imaging (MRI) of the brain, position emission tomography (PET) scan of the brain, autoimmune antibodies, infection work-up, and metabolic and genetic work-up. The management of EPC can be challenging. Antiseizure medications (ASDs) including benzodiazepines are an integral part of the management of EPC. Immunotherapy trials are recommended in resistant cases. Epilepsy surgery is one of the effective modalities in some surgically amenable cases. This article reviews the topic of EPC and summarizes diagnostic and .treatment recommendations.

White matter structural changes before and after microvascular decompression for hemifacial spasm.

Hemifacial spasm (HFS) is a syndrome characterized by involuntary contractions of the facial muscles innervated by the ipsilateral facial nerve. Currently, microvascular decompression (MVD) is an effective treatment for HFS. Diffusion weighted imaging (DWI) is a non-invasive advanced magnetic resonance technique that allows us to reconstruct white matter (WM) virtually based on water diffusion direction. This enables us to model the human brain as a complex network using graph theory. In our study, we recruited 32 patients with HFS and 32 healthy controls to analyze and compare the topological organization of whole-brain white matter networks between the groups. We also explored the potential relationships between altered topological properties and clinical outcomes. Compared to the HC group, the white matter network was disrupted in both preoperative and postoperative groups of HFS patients, mainly located in the somatomotor network, limbic network, and default network (All P < 0.05, FDR corrected). There was no significant difference between the preoperative and postoperative groups (P > 0.05, FDR corrected). There was a correlation between the altered topological properties and clinical outcomes in the postoperative group of patients (All P < 0.05, FDR corrected). Our findings indicate that in HFS, the white matter structural network was disrupted before and after MVD, and that these alterations in the postoperative group were correlated with the clinical outcomes. White matter alteration here described may subserve as potential biomarkers for HFS and may help us identify patients with HFS who can benefit from MVD and thus can help us make a proper surgical patient selection.

Critical developmental periods of vulnerability in dystonia

Dystonia is a heterogenous movement disorder characterised by involuntary muscle contractions, leading to abnormal postures and movements. Despite being the third most common movement disorder, the pathophysiological mechanisms causing dystonia are incompletely understood. Isolated dystonia is often caused by pathogenic mutations in single genes. An emerging body of evidence suggests that at least some forms of isolated dystonia have a strong developmental component, with pathogenic effects acting within discrete periods of increased vulnerability during neurodevelopment. The extent to which this is a common feature of genetically distinct forms of dystonia, and which developmental mechanisms might be disrupted during these periods, remains unclear. During critical periods of development, neuronal activity is instructive in the maturation of neuronal circuits, and inappropriate levels of activity during this period can lead to permanent defects. This review, with an intentional focus on our work, outlines evidence implicating disruptions to neuronal activity during critical developmental periods as a potential mechanism underlying inherited motor disorders in general, and dystonia in particular.

(227) Vaginismus - Current State of Knowledge

Abstract Introduction Vaginismus is defined as a penetration disorder in which any form of vaginal penetration is often painful or impossible. It has traditionally been referred to as an involuntary contraction of the pelvic floor muscles due to actual or anticipated pain associated with vaginal penetration. Vaginismus is predominantly unknown among clinicians and women. Vaginismus causes women to feel pain, fear and anxiety with penetration attempts. It is a poorly understood and underdiagnosed condition, for which many women do not gain support. This is due to the lack of knowledge of the condition, for the shame and embarrassment felt by vaginismus sufferers which means many do not discuss the issue. Objective Vaginismus is commonly experienced medical issue, affecting about 1–7% of the female population worldwide. Female pain is often viewed not as a medical fact, but as a misimpression or misinterpretation of bodily events. Vaginismus is not the only condition that has been placed in context of neglect. Other sexual pain disorders, such as vestibulodynia, vulvodynia and dyspareunia, have also been met with doubt and disbelief. An examination of the disbelief surrounding female reportage of their own bodily events will not only be beneficial in terms of perception of vaginismus, but also for general women’s health. Methods This systematic review will provide an assessment of the current state of vaginismus. The following databases has been searched from the study inception to July 2023: the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, MEDLINE, Embase, Scopus, Web Of Science, ProQuest, ScienceDirect, UpToDate, Polish Medical Bibliography and consultations of Polish specialists and discussion forums of patients have been used. Results Vaginismus influences the quality of life, in the most serious form it can result in unconsumated marriage, sterility and thus can lead to the separation of a couple. When adequately approached, the problem can mostly be solved. Treatment often involves multimodal approaches such as education, medication, cognitive behavioral therapy, physical therapy and possibly surgery. Conclusions Vaginismus is a common and significant sexual problem that causes distress and frustration for both partners. There are women for whom vaginismus is a serious problem and who are not able to cope with the situation without professional help of specialists. Deepening the specialists knowledge in this field is essential for successful treatment. Vaginismus is a well recognized clinical condition associated with non-consummation and considerable distress in women. It has received little scientific attention, and further well designed studies are needed. Disclosure No.