Muscle Paresis Research Articles

Laryngeal Myasthenia Gravis in Voice Patients: Clinical, Serologic, and Neuromuscular Characterization of Seronegative Patients for Antibodies Against the Acetylcholine Receptor and Muscle-Specific Kinase

OBJECTIVELaryngeal myasthenia gravis (MG) is a focal manifestation of MG, and most patients are seronegative for antibodies against the acetylcholine receptor (AChR) and muscle specific kinase (MuSK). The purpose of this study was to determine the incidence of anti-AChR and anti-Musk antibodies in voice patients and to characterize the clinical and neuromuscular profiles of these patients in order to guide the diagnosis of laryngeal MG. STUDY DESIGNThis was a retrospective case-control study that included patients over the age of 18 who underwent laryngeal electromyography as part of their evaluation for neuromuscular junction dysfunction. METHODSCases and controls were evaluated serologically, for the anti-AChR, anti-MuSK, and anti-striational muscle antibodies, and neuromuscularly using the Tensilon test in some patients, repetitive nerve stimulation (RNS) test, and a treatment trial of pyridostigmine bromide. Cases were defined as either (1) positive anti-AChR or anti-MuSK, or (2) a positive Tensilon test or positive pyridostigmine bromide trial. RESULTSTwo hundred and eleven patients were screened; 61 (29%) patients were identified with laryngeal MG, and 77 (36%) patients were selected as controls. All case and control patients were seronegative for the anti-AChR and anti-MuSK antibodies with no significant difference between case and control status for seropositivity for anti-striational muscle antibodies. Of the case patients with an electrically positive Tensilon test (80.6%) who completed a treatment trial, 100% had symptom improvement. Of the case patients with a symptomatically positive Tensilon test (16.1%), only 60% of patients had improvement with a treatment trial. The RNS was more likely to be positive in case patients than control patients, and cases had a higher severity of paresis in all laryngeal muscles with LEMG evaluation. CONCLUSIONSLaryngeal MG is an underrecognized condition in the otolaryngology community owing in part to its seronegative presentation. Electrical improvement with a Tensilon test, or electrical or substantial symptomatic improvement with pyridostigmine bromide represent the most robust diagnostic criteria in these patients.

Rare case of postherpetic abdominal pseudohernia in a patient on peritoneal dialysis

Patients affected by chronic kidney disease, especially those requiring maintenance dialysis therapy, are particularly susceptible to infections, including reactivation of herpes zoster and are also at increased risk of herpes zoster complications. Postherpetic abdominal pseudohernia is a rare sequela of the infection, caused by motor neuropathy with muscle paresis, that manifests as an abdominal protrusion. In patients receiving peritoneal dialysis who may often present slight abdominal distension, the diagnosis of this complication may be challenging. We present a case of this rare neurological complication in a patient on peritoneal dialysis and discuss its etiology and management. To the best of our knowledge, this is the first report of postherpetic abdominal pseudohernia in a patient receiving kidney replacement therapy.

Transorbital neuroendoscopic surgery for treatment of sphenoid wing meningiomas extending to the cavernous sinus: clinical implications and a technical illustration.

The aim of this study was to evaluate the efficacy and safety of transorbital neuroendoscopic surgery (TONES) in the management of sphenoid wing meningiomas (SWMs) with cavernous sinus and orbital invasion. The authors conducted a retrospective review of 32 patients with SWMs treated at Gazi University using TONES from October 2019 to May 2023. The study includes clinical applications to elucidate the endoscopic transorbital approach. Surgical techniques focused on safe subtotal resection, aiming to minimize residual tumor volume for subsequent radiosurgery. Data were collected on patient demographics, tumor characteristics, surgical procedures, complications, and postoperative outcomes, including radiological imaging and ophthalmological evaluations. Surgical dissections delineated a three-phase endoscopic transorbital approach: extraorbital, intraorbital, and intracranial. In the clinical application, gross-total resection was not achieved in any patient because of planned postoperative Gamma Knife radiosurgery. The mean follow-up period was 16.3 months. Of 30 patients with preoperative proptosis, 25 experienced postoperative improvement. No new-onset extraocular muscle paresis or visual loss occurred postoperatively. The average hospital stay was 1.15 days, with minimal complications and no significant morbidity or mortality. Total resection of SWMs invading the cavernous sinus and orbit is associated with substantial risks, particularly cranial nerve deficits. TONES offers a minimally invasive alternative, reducing morbidity compared with transcranial approaches, and represents a significant advancement in the surgical management of SWMs, especially those extending into the cavernous sinus and orbit. The approach provides a safe, effective, and patient-centric approach, prioritizing subtotal resection to minimize neurological deficits while preparing patients for adjunctive radiosurgery. This study positions TONES as a transformative surgical technique, aligning therapeutic efficacy with neurovascular preservation and postoperative recovery.

Torques in the human upper ankle joint level and their importance in conservative and surgical treatment

The paper deals with the torques of external muscles acting on the upper ankle joint under weight-bearing conditions and their importance in diagnosing and treating the human foot. Experimental data were collected and calculations were performed. Based on the experiments with the biomechanical model of the foot and upper ankle joint, it was shown how the changes in the force arms of the external muscles of the foot under weight-bearing conditions, change the torque. The real values of muscle forces and torques of the external muscles of the foot were calculated. Taking into account the distance of the lines of muscle action from the axis of rotation of the upper ankle joint the rotational force of the muscles was calculated. The influence of changing the force arm on the rotational efficiency of the muscle balancing the moment of gravity was shown. Knowledge of muscle torque under weight-bearing conditions is crucial for correctly assessing foot biomechanics. It has been shown that torque (gravitational and muscular), not pure force, is crucial when assessing the rotational capacity of the analyzed joint. A change in the approach to diagnostics and treating paresis or weakness of extrinsic foot muscles was proposed through the manipulation of the distance of their action line from the axis of joint rotation.

Anatomical aberration of posterior part of circle of Willis with special reference to third nerve palsy

Due to the close anatomical proximity, aneurysm of posterior communicating artery may cause oculomotor nerve palsy, which is a common manifestation and it may present with pupil involving extra ocular muscle paresis. The onset may be acute due to sudden aneurysm dissection along with subarachnoid hemorrhage. This may warrant urgent lifesaving surgical intervention along with the options of interventional radiological procedures.Normally, the occipital lobe is supplied by the posterior cerebral artery (PCA). When the pre-communicating portion of the PCA is larger than the posterior communicating artery (PCA), the occipital lobe is primarily supplied by the vertebrobasilar artery. Sometimes the pre-communicating portion of the PCA may be smaller than the PCoA in which the occipital lobe is primarily supplied by the internal carotid artery.Understanding the posterior circulation anomalies of Circle of Willis. This study involved 50 fetal brains belonging to perinatal age group and 30 adult brains of human cadavers by dissection. The PCoA was missing in 14% of the samples. The difference between the outer diameters of the P1 portion of the PCA and the PCoA was very significant.So, a detailed anatomical understanding of Circle of Willis and manifestation of the third nerve palsy is sometimes equivocal for a clinician for better management and patient outcome.

A Case Study Photobiomodulation As The Solution For Bell's Palsy

Often affecting one side, Bell's palsy, also known as "acute facial palsy of unknown cause," is a common cranial neuropathy that results in abrupt, complete paralysis or face muscle paresis. Over the period of 48 hours, the condition may get worse. It is brought on by damage or inflammation to the 7th cranial nerve, the face nerve, or any of its branches along its course, primarily in the bony canal. This results in dysfunction of the facial nerve. It is equally prevalent in both sexes and has no age restriction, however as people age, so does the incidence. A increased risk is associated with diabetes, hypertension, obesity, pregnancy, and upper respiratory tract infections. It is mainly believed to be idiopathic and is diagnosed by ruling out other potential causes. Bell's palsy sufferers and their family may experience severe consequences, including psychological and physical problems. Therefore, a timely cause determination and early diagnosis are essential to efficient treatment. However, the exact etiology of Bell's palsy remains unknown, which affects the course of treatment. To adopt a customized therapy strategy, however, a comprehensive examination and a comprehensive history are necessary to determine the likely cause and risk factors. Most patients heal on their own in less than three weeks, even without treatment. Still, there's always a chance of lingering paresis after therapy or recovery.

Pattern of pareses in 5q-spinal muscular atrophy.

This prospective study investigates the pattern of pareses in 5q-associated spinal muscular atrophy (SMA) to identify disease-specific characteristics and potential differences from amyotrophic lateral sclerosis (ALS) and spinobulbar muscular atrophy (SBMA). Detailed knowledge about pareses patterns in SMA facilitates differential diagnosis and supports therapeutic monitoring. Between January 2021, and June 2021, 66 SMA patients (59.1% male, aged 33.6 ± 15.2 years) were included in the study. Most patients had SMA type II (n = 28) or SMA type III (n = 28), seven patients had SMA type I, and three patients had SMA type IV. We analyzed the pattern of pareses using the UK Medical Research Council (MRC) scoring system. In both, upper and lower limbs muscle weakness was less pronounced in distal (upper limbs: MRC median 3.0 (interquartile range 1.5-3.5); lower limbs: 1.5 (0.5-3.0)) compared to proximal muscle groups (upper limbs: 2.0 (1.5-2.6); p < 0.001; lower limbs: 0.5 (0.5-1.5); p < 0.001). Thenar muscles were stronger than other small hand muscles (3.0 (2.0-3.5) vs 3.0 (1.5-3.5); p = 0.004). Muscles had more strength in upper (2.3 (1.5-3.1)) compared to lower limbs (1.1 (0.5-2.3); p < 0.001) and in flexors compared to extensors. We identified a specific pattern of muscle paresis in SMA which is different from the pattern of paresis in ALS and SBMA. As a rule of thumb, the pattern of pareses is similar, but not identical to ALS in distal, but different in proximal muscle groups.

A rare case of a large tumour located under the facial nerve trunk

Aim: to introduce a technique of total parotidectomy sparing the facial nerve branches based on a clinical case. The article presents a clinical case of a large parotid tumour located under the facial nerve trunk, the stages of its surgical removal, and the postoperative course. Parotidectomy is one of the most complicated operations in maxillofacial surgery. When performing this surgical intervention, a surgeon must observe the principles of ablastics, consider individual peculiarities of the facial nerve anatomy structure and relations of nerve and tumour, and be ready to expand the scope of the operation from subtotal to total parotidectomy. Conclusions. To improve the treatment outcomes of patients with benign parotid tumours and to reduce the number of such postoperative complications as paresis and paralysis of the mimetic muscles caused by facial nerve injury, one should know and follow the technique of parotidectomy, especially in the case of a neoplasm located under the trunk or branches of facial nerve. The research was adhered to the principles of the Declaration of Helsinki. The patient informed consent was obtained for the study. No conflict of interests was declared by the authors.

Робототехнические средства реабилитации двигательной активности пациентов в постинсультном периоде

Stroke prevalence is one of the most acute problems in the medical and social aspects of society: strokes are the second most common in the mortality statistics of the population. In the Russian Federation, stroke occurs annually in almost 500,000 people and is the first among the causes of death from neurological diseases and the second most common cause of death after heart disease. The most common consequences of stroke are motor disorders of varying severity, manifested as changes in muscle tone, paresis and paralysis, and impaired walking function. This paper is an overview of the current state of robotic rehabilitation devices used for post-stroke limb paresis and of expected trends of their development. The existing variants of their construction, conditions of kinesiotherapy sessions for obtaining the greatest effect are considered. The authors are of the opinion that the nearest prospect for the development of high-tech devices of this type is not only complex stationary universal complexes for clinics, but also simple mobile specialized simulators with remote medical control for outpatient use.

Neurolymphomatosis in Non-Hodgkin's Lymphoma

non-Hodgkin's lymphomas (NHLs) are a heterogeneous group of hematopoietic puffins, with diphun B-velicocyclotinous lymphoma accounting for 25% of all NHLs and having the greatest midline to axis growth (Leeuwenуе et al., 2014). Of all NHLs, the central and peripheral nervous systems are most often affected in diphytic B-lycocytic lymphoma (Padala, &amp; Kallam, 2022. Liu, &amp; Barta, 2019). In NHL, infiltration of cranial and peripheral nerves can be detected - neurolymphomatosis (NL) emerges. NL is a very rare condition and occurs in about 0.2% of patients with NHL (Baehring, Damek, Martin, Betensky &amp; Hochberg, 2003). These infiltrations can manifest with detection of mononeuropathy, multiple neuropathy, symmetric neuropathy or plexopathy (Grisold W., Grisold A., Marosi, Meng, &amp; Briani, 2015). The aim of the work was to study the features of the clinical course, diagnosis and treatment of neurolymphomatosis in the form of lesions of the trigeminal, facial cranial nerve and the left ulnar nerve in diffuse B-bollichelial non-Hodgkin lymphoma based on a clinical case. We present a review of a clinical case of peripheral nervous system involvement in a patient born in 1977 with diffuse B-cell non-Hodgkin's lymphoma. The diagnosis was established on the basis of clinical manifestations of lesions of the branches of the trigeminal and left facial nerves, the left ulnar nerve, magnetic resonance imaging of the head and brain, electroneuromyography, and immunohistochemical examination of the infiltrate biopsy from the affected buccal branch of the left facial nerve. In March 2022, the patient developed moderate peripheral paresis of the mimic muscles on the left side, burning pain with impaired tactile and pain sensitivity of the dorsum, wing of the nose, and left instep. A week later there was a decrease in the strength, tactile and pain sensitivity, and patience of the fourth and fifth fingers of the left hand. Within a month, the burning pain had spread to the left cheek, periorbital, and chin areas of the face. In 2021, the patient was diagnosed with B-bollichelial non-Hodgkin's lymphoma with involvement of the right axillary, supraclavicular lymph nodes, left breast, followed by chemotherapy and clinical remission. Magnetic resonance imaging of the head revealed a perineural lesion of the third branch of the right trigeminal nerve, the second branch of the left trigeminal nerve, and the cheek branch of the left facial nerve. Electroneuromyography revealed an axonal lesion of the left ulnar nerve. The results of examination of the infiltrate biopsy from the affected buccal branch of the facial nerve specimens confirmed non-Hodgkin's diffuse B-cell lymphoma, GCB-phenotype and nerve damage due to NHL. Treatment of multiple neuropathy with glucocorticosteroids, nonsteroidal anti-inflammatory drugs, acelicholinesterase inhibitors, and specific chemotherapy resulted in limited therapeutic effect. Prescribing pregabalin resulted in decreased reduction of neuropathic facial pain. Thus, neurolymphomatosis is a rather rare manifestation of non-Hodgkin's lymphomas, the use of magnetic resonance imaging of the head and brain as well as immunohistochemical examination of the affected nerve infiltrate biopsy is important to confirm the diagnosis.&#x0D; In the Ukrainian scientific medical literature, there are few descriptions of cases of neurolymphomatosis in NHL, although they occur in patients, and it is necessary to describe in more detail the peculiarities of the collicular course of the diagenesis and treatment in these cases.

A RARE CASE OF UNILATERAL TRANSIENT MYDRIASIS AFTER BOTULINUM TOXIN INJECTION FOR COSMETIC PROCEDURE

Introduction: Botulinum toxin A (BTX-A) was first used for the aesthetic purposes in 1990 to reduce wrinkles caused by facial muscle. Its effect starts 3 to 4 days after application and lasts for 4 to 6 months. All the medical doctors, from plastic surgeons to dermatologists can administer botulinum toxin A injection effectively and safely. Ophthalmologists are also performing this procedure for blepharospasm. Case Report: A 35 year old female present to emergency department with complain of sudden onset of right eye blurred vision with tingling sensation of the right side of the face. Patient has been injected with BTX-A for a cosmetic procedure about a 2 weeks ago. On presentation, her right pupil measured 9 mm and was fixed, with no direct or consensual response to light, and her left pupil was 3 mm and had a normal light response. CT brain and cranial MRI revealed no optic nerve or cerebral dysfunction. Patient was counselled that the mydriasis would not be permanent. In follow up after 10 days her mydriasis was improved. Discussion: Botulinum neurotoxins inhibit the release of acetylcholine and act primarily at the peripheral cholinergic synapses. These agents act at the neuromuscular junction in skeletal muscle, causing transient muscle paresis. Botulinum toxins could therefore cause pupil dilatation by uptake into the parasympathetic neurons at the level of the ciliary ganglion or the parasympathetic neuromuscular junctions in the sphincter pupillae of the iris. Conclusion: Before botulinum injection for cosmetic purposes or to treat blepharospasm, patients should be warned about the possibility of developing toxin-induced ptosis and mydriasis.

Elongating achilloplasty and the original tenorraphy technique for cerebral palsy

BACKGROUND:In cerebral palsy, shortening of the triceps muscle of the lower leg leads to impaired coordination and gait and orthopedic consequences that disrupt the quality of life and complicate rehabilitation. Many surgical techniques are aimed at eliminating contractures and restoring ankle joint movements. However, treatment results are not always satisfactory, and the number of complications remains high, such as recurrence of deformation and failure of the tendon suture after tenotomy.&#x0D; AIM:To analyze the results of calcaneal tendon lengthening plastic surgery with the original tendon suture technique in patients with cerebral palsy complications and consider the features of surgical technique onaclinical example.&#x0D; MATERIALS AND METHODS:This study describes the lengthening plastic surgery of the calcaneal tendon with the original tendon suture technique performed in four patients with complications of cerebral palsy. The clinical observations of the surgical treatment ofa30-year-old patient with spastic paresis of the triceps muscle of the left tibia were presented. The treatment results were followed from 1 to 12 months postoperatively. The amplitude of active and passive movements in the joints, muscle tone, presence and nature of postoperative complications, and functional outcome were evaluated.&#x0D; RESULTS:The results 1 year after the operation were evaluated as good in two initially more severe cases and excellent in two cases. In all patients, decreased pain level, restoration of movements, decreased hypertension, and hypotrophy of the triceps muscle of the lower leg were observed, and no complications were noted.&#x0D; CONCLUSIONS:The results revealed data on the pathogenetic validity of calcaneal tendon elongation in patients with spastic paralysis of the triceps muscle of the lower leg. The proposed original method of surgical treatment ensures the correct anatomical comparison and density of the contact of the tendon ends, reduces the tone of the calf-flounder complex, preserves joint physiological mobility, begins early rehabilitation, and reduces the likelihood of relapse.

Rare Case of C4 Perineurinoma with Lambdatic Parieto-occipital Neuroma in Von Recklinghausen Disease in a 5 Years Old Child: A Case Report

Neuro fibromatosis groups together distinct diseases that most often share only certain cutaneous signs. Neurofibromatosis (NF) is a neurocutaneous syndrome characterized by the development of tumors of the central or peripheral nervous system including the brain, spinal cord, organs, skin, and bones. Prineurinoma is a relatively rare tumour that has been shown to be a proliferation of perineural cells with an incomplete basal lamina and no onion bulb appearance. Neuroma also known as traumatic neuroma or amputation neuroma or stump neuroma, is a focal non-neoplastic area of proliferative hyperplastic reaction secondary to peripheral nerve damage that commonly occurs after a focal trauma (acute or chronic) or surgery, such as amputation or partial transection; We report an extremely rare clinical case of a 5 year old child with neurfibromatosis congenita type 1 with asyntomatic medullary comrepssion and incidental discovery of a left intraductal C4 perineurinoma during the exploration of an occipital-parietal neuroma associated with a dehiscence of the lambda suture. He was operated on, with the postoperative course marked by paresis of the cervical muscles, which was in the process of recovery by physiotherapy.

Graves' Disease and Muscle Paresis

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The Neuroanatomical Basis of Unfamiliar Presentations of Herpes Zoster: A Review and A Case Report

Herpes zoster (HZ, shingles) is caused by reactivated varicella zoster virus, that travels along the peripheral branches from its dormant location in neurons of spinal and cranial sensory ganglia. HZ is well known for its skin vesicular eruptions and severe sensory neuropathy. Over the years, reports have described the occurrence of segmental paresis of skeletal muscles and the involvement of the large and small intestine, clinically resembling intestinal obstruction.

A Preclinical Study Comparing the Activity and Potency of OnabotulinumtoxinA and PrabotulinumtoxinA.

The goal of this study was to compare the unit-to-unit biological activity of the vacuum-dried formulation of prabotulinumtoxinA (prabotA) and onabotulinumtoxinA (onabotA) in preclinical assays. Reconstituted 100 U vials of prabotA and onabotA were tested in 3 distinct assays: plate-capture light chain activity (PC-LCA), measuringlight chain enzymatic activity after recovery of toxin from reconstituted product using a proprietary toxin capture step; cell-based potency assay (CBPA), measuring the intoxication steps of binding, translocation, and light chain activity (synaptosomal-associated protein 25 [SNAP25] cleavage); and mouse Digit Abduction Score (DAS), evaluating muscle paresis. Each assay tested 3 separate prabotA and onabotA lots on several independent test dates. Multiple orthogonal assays established that when assessed on a unit-to-unit basis, the biological activity of prabotA is lower than that of onabotA.In the PC-LCA and CBPA assays, onabotA displayed 1.51 ± 0.14-fold higher (mean ± SD) and 1.33 ± 0.07-fold higher (mean of pooled lots ± SEM) activity than prabotA, respectively. Similarly, the mouse DAS data showed that onabotA had 1.4 ± 0.1-fold higher (mean ± SEM) potency than prabotA. Results of all 3 assays demonstrated differences in potency, efficacy, and duration of action between onabotA and prabotA on a unit-to-unit basis. Preclinical assays established differences in the biological activity of onabotA and prabotA, supporting that the units of biological activity are not interchangeable.

Restoring the function in neuralgic shoulder amyotrophy by modified Somsak nerve transfer

Background and ObjectivesNeuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is a rare and acute neuropathy of the shoulder and/or arm. It is characterized by sudden pain attacks, followed by patchy muscle paresis in the upper extremity. The frequency of remaining neurological deficits varies in the literature between 10% and 66%. In addition to other therapeutic strategies, nerve branch transposition might be a possible treatment option to improve muscle strength and reduce pain symptoms. Transposition of the first motor triceps branch to the axillary nerve was first described in 2003 to regain the deltoid muscle function in patients with C5 (C6) root injury.To our knowledge, this is the first description of nerve transfer for treating permanent paresis in NA. MethodsWe present the case and the surgical treatment of a 16-year-old male with loss of axillary nerve function due to NA on both upper extremities. Neurological examination before surgery, 6 and 12 months after surgery included analysis of the upper extremity range of motion and muscle strength evaluated using the Medical Research Council Scale. ResultsShoulder function and muscle strength improved significantly 12 months after surgery. The range of motion of arm abduction improved from 90° preoperatively, to as high as 120° at 6 months, and to 130° at 12 months. Muscle strength was strength grade 2/5 preoperatively, 3/5 at 6 months, and 4+/5 at 12 months. Subjectively, the patient also has a significantly improved quality of life. ConclusionNerve transfer is a promising treatment method for patients suffering from NA.

Neurotization of the facial nerve as an effective way to treat paralysis of mimic muscles

Pathologies of the facial nerve are one of the most common types of pathology of the peripheral nervous system. In the structure of lesions of the cranial nerves, this pathology occupies the first place. The clinical picture of facial nerve damage of various genesis is rather monotonous and manifests itself as persistent paresis or paralysis of the facial muscles. The literature describes a large number of different highly effective techniques aimed at restoring the function of the facial nerve and mimic muscles, examples of which are numerous conservative and surgical methods for the treatment of facial nerve neuropathy. The review presents the most common method of mimic muscles paralysis surgical treatment facial nerve neurotization. The essence of this surgical intervention is in suturing to the affected facial nerve the trunk or a portion of individual fibers of the intact nerve-neurotic, which can be the hypoglossal, masticatory, phrenic, accessory, glossopharyngeal nerves, as well as the descending branch of the hypoglossal nerve and the anterior branches of the C2C3 cervical nerves. Currently, options for the combined use of various donor nerves and autoextensions are gaining popularity among neurosurgeons, due to more favorable results in restoring the function of the facial nerve, as well as with an individual approach to each patient. The main stages of neurotization of the facial nerve include the isolation and intersection of the facial nerve, the isolation and intersection of the trunk or individual fibers of the neurotizer, the execution of the suture of the nerve in the end to end or end to side method. Particular attention should be paid to the most innovative method of facial nerve neurotization facial nerve cross-plasty, during which an anastomosis between the damaged and intact facial nerves using autotransplants from the gastrocnemius nerve or a free muscle graft, including the tender muscle and the anterior branch of the obturator nerve is performed. The process of restoring facial nerve function and regressing characteristic symptoms takes a long period of time and requires specialized restorative treatment.

Botilinum toxin in the treatment of strabismus

Introduction: Strabismus is an oculomotor imbalance that occurs in 0.5 to 5% of the population. There are various etiopathogenetic theories and several modalities of treatment. One of these modalities is the application of botulinum toxin intramuscularly. This chemodenervation causes temporary muscle paresis which acts as a recession while its antagonist contracts. This achieves a temporary correction of strabismus. However, further research is needed. The aim of the paper was evaluation of published research studies on botulinum toxin as a treatment option in strabismus, as a primary and adjuvant therapy and as a preventive therapy in patients with abducens nerve palsy. For this purpose, we searched the major databases of the medical publications Medline and Pubmed, using keywords: strabismus, botulinum toxin. We found more than 50 articles related to our search for the last 30 years, 30 of which have been used for this review. In this review paper we have presented the most important insights from the literature, as well as our opinions and insights on the topic. Although further studies are needed regarding dosing as well as avoiding side effects, botulinum toxin has been shown to be a good alternative and adjunctive therapy to strabismus surgery, with the downside being that the effect is temporary. Positive effects and faster recovery have also been shown in patients with abducens nerve palsy.

КЛИНИЧЕСКИЕ ОСОБЕННОСТИ ОСТРЫХ РЕФЛЕКТОРНЫХ И КОМПРЕССИОННЫХ СИНДРОМОВ ШЕЙНОГО ОСТЕОХОНДРОЗА

Pain syndromes of cervical osteochondrosis are among the most common in neurological practice. The complex anatomic and physiological features of the cervical spine result in a variety of clinical syndromes in case of cervical osteochondrosis. The clinical features of the formation of refl ex and compression syndromes of cervical steochondrosis were identifi ed as a result of the examination. In patients with refl ex pain syndromes, the distribution of pain over the sclerotome and myotome areas (myosclerotome pain)&#x0D; and the absence of motor and sensory disorders were characteristic. Patients with compression radicular syndrome featured the distribution of pain sensation over dermatome areas, motor disturbances in the form of muscle paresis or hypotonia, corresponding myotome, decrease or absence of corresponding tendon refl exes, and sensory disturbances in the dermatome area of the aff ected radicle.