Muscular Rigidity Research Articles

Effectiveness of Myofascial Release (MFR) vs. High-Frequency Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief and Functional Improvement in College Students With Trapezius Myalgia.

The pain in the trapezius muscle is known as trapezius myalgia. The patient often complains of trapezius muscle soreness and tightness. Musclesoreness usually lasts for a few days, if not longer. This muscular rigidity and stiffness cause spasms inupper trapezius fibres, culminating in neck discomfort in the posterior side of the neck and shoulder area. This protocol was designed to describe the study to evaluate the effect of myofascial release (MFR) versus high-frequency transcutaneous electrical nerve stimulation (TENS) for pain relief and functional improvement in subjects with trapezius myalgia. Methods: Forty-five subjects with trapezius myalgia meeting inclusion criteria were selected for the study. Two groups were created, with group A undergoing MFR therapy and group B undergoing high-frequency TENS. The procedure was completed within four weeks. Regular assessments were carried out in the first week and fourth week of the rehabilitation. Throughout the recovery process, we evaluated pain, functional improvement, and range of motion of the neck at regular intervals. The outcome measures taken were the Numerical Pain Rating Scale (NPRS) and Neck Disability Index (NDI). Discussion: The intervention's efficacy was assessed by looking at pain alleviation using the outcome measures. The study's findings strongly supported the application of these approaches and modalities in the rehabilitation of myalgia patients.

Assessing the Effect of 12 Weeks of Pilates and Aquatic Exercise on Muscle Strength and Range of Motion in Patients with Mild to Moderate Parkinson’s Disease

Background: Parkinson's disease is a chronic, progressive and degenerative disorder of the central nervous system with four main symptoms of bradykinesia, tremor, muscular rigidity, and postural instability. Objectives: The effect of 12 weeks of Pilates and aquatic exercise on muscle strength and range of motion (ROM) in male patients with Parkinson's disease was assessed in this article. Methods: In this quasi-experimental study, 25 male patients reporting to Al-Zahra Hospital, Isfahan, were selected randomly and grouped in Pilates (n = 7), Aquatic exercise (n = 10), and Control (n = 8). The experimental groups received 1-hour sessions of training three times a week for 12 weeks. Muscle strength and ROM of each patient was measured through the Biodex Isokinetic System 3 before entering the study and after the final assigned session. Results: Pilates and Aquatic exercise groups had a significant improvement in ROM, while no significant difference was observed in the control group. Muscle strength and ROM increased significantly in the experimental groups compared to the control group (P < 0.05). The effect of Pilates on muscle strength was not significant (P < 0.05). Conclusions: Non-pharmacological modalities could be contributive in the patients with Parkinson's disease recovery and lead to significant improvements in their physiological parameters of muscle strength and ROM. Next to the pharmacological treatments, patients could benefit from inexpensive and readily available options like Pilates and aquatic exercises to alleviate the disease symptoms. Further studies should be run to reveal the aforementioned and plausible benefits of these complementary activities.

EVALUATION OF PROTECTIVE ACTION OF SESAME SEED OIL ON CHLORPROMAZINE ASSOCIATED EXTRAPYRAMIDAL SIDE EFFECTS IN EXPERIMENTAL ANIMALS

Sesame plant (sesamum indicum Lin.) Belonging to family Pedaliaceae. Sesame seed oil also known as queen of oil which contains number of phytochemicals like thiamine, riboflavin, niacin, pyridoxine, folic acid, vitamin B12, ascorbic acid, stearic acid, linoleic acid, palmitic acid and Various lignance like sesamolin, pinoresinol, sesamin, Sesamol, tocopherols which are potent antioxidants and has reported neuroprotective action therefore, Sesame seed oil (SSO) was used in present study to investigate its protective action on chlorpromazine (CPZ) associated extrapyramidal side effects (EPSE) in animal model. The study was designed by giving CPZ (3mg/kg ip) for 21days to induce EPSE in animals. CPZ significantly induce EPSE (Catalepsy, muscular rigidity and hypolocomotion) in a period of 21 days. The effect of SSO on CPZ induced EPSE in rat was evaluated using doses 200mg/kg and 400mg/kg PO. Syndopa (10mg/kg) was used as standard drug. During 21 days of study animals behavioral parameters were evaluated after each 7 days of interval by block test (catalepsy), Rotarod test (muscular rigidity) and Actophotometre (locomotors activity). Animals showed significantly reduced catalepsy score, increased fall of time and increased locomotors activity in dose dependant manner. Biochemical estimation of dopamine (DA) and antioxidant parameters were also evaluated. SSO treated animal groups showed significant increase in level of DA, Catalase and reduced glutathione preferably at higher dose. Thus present study validates that SSO has an antioxidant and protective effect on CPZ associated EPSE.

A decision support system for automated diagnosis of Parkinson’s disease from EEG using FAWT and entropy features

Parkinson's disease (PD), a neurodegenerative disorder characterized by rest tremors, muscular rigidity, and bradykinesia, has become a global health concern. Currently, a neurologist determines the diagnosis of Parkinson's disease by taking into account several factors. An automated decision-making system would enhance patient care and improve the outcomes for the patient. Biomarkers, such as electroencephalograms (EEGs), can aid in the diagnosis process as they have proven useful in detecting abnormalities in the brain. This study presents a novel algorithm for the automated diagnosis of Parkinson's disease from EEG signals using a flexible analytic wavelet transform (FAWT). First, these acquired EEG signals are preprocessed before decomposition into five frequency sub-bands based on the FAWT method. Several entropy parameters are computed from the decomposed sub-bands and ranked based on their significance level in detecting PD through analysis of variance (ANOVA). Various classifiers are used to identify appropriate feature sets, including support vector machines (SVM), logistics, random forests (RF), radial basis functions (RBF), and k-nearest neighbors (KNN). The proposed approach is evaluated using data collected from two centers in Malaysia (Dataset-I) and the United States (Dataset-II). In dataset-I, the KNN classifier produces accuracy, specificity, sensitivity, and area under the curve of 99%, 99.45%, 99.12%, and 0.991, respectively, while in dataset-II, these values are 95.85%, 95.88%, 96.14%, and 0.959. The proposed system would be extremely useful for neurologists during their diagnostic process, as well as for current clinical practices.

Evaluation of Anti-Parkinson Activity of Aqueous Extract of Barleria prionitis

AIM- The aim of the preset investigation is Evaluation of Anti-Parkinson Activity of Aqueous Extract of Barleria prionitis. MATERIAL & METHODS- The whole plant of Barleria prionitiswere collected from the surrounding areas of Erode district, Tamilnadu, India during the month of December. Coarsely powdered whole plant of Barleria prionitis were extracted with water for 48 hours at room temperature. After extraction the extracts were evaporated by using rotary evaporator and dried at room temperature. The obtained crude extracts were weighed and stored at 4ᵒC for the further analysis. Male Swiss albino mice 3 month of age, and 25-30 g body weight were offered. All the rats were kept at room temperature and allowed to acclimate in standard conditions less than 12 hr light/ 12 hr dark cycle in the animal house. The MPTP was purchased from sigma chemicals, Mumbai, India and was stored according to the manufacturer label (370C) to prevent its decomposition. The length of time (duration) the animal stay on the rod without falling, gives a measure of their coordination, balance, physical condition and motor-planning. RESULTS- The grip strength of treated rats were found to be increased in the rats as compared to untreated rats. Similarly, Locomotor activity were also significantly increased in the rats treated in rats as compared to untreated rats. DISCUSSION- From the results the Actophotometer readings (locomotor activity) of animals of vehicle-treated control group (Group I) was found to be 386.33±1.56 and 396±1.15 counts/5 min for all 7 days of treatment. MPTP treatment to animals of Group II showed a significant reduction in locomotor activity every week. The actophotometer readings decreased to 186±2.30 counts/ 5 min. on the 7th day, went down to 145.33±0.23 counts/5 min. Thus, there was a significant decline in the locomotor activity of rotenone treated control animals (Group III) when compared to vehicle-treated control group (Group I). CONCLUSION- From the present study, it can be considered that the aqueous extract of Barleria prionitis exhibited significant anti-parkinsonism activity in MPTP model in mouse and rats respectively.
 KEYWORDS- Anti-Parkinson Activity, Aqueous Extract, Barleria prionitis, Parkinson Disease, Muscular rigidity, Bradykinesia

Neuroleptic Malignant Syndrome: A case report and a literature review

IntroductionNeuroleptic malignant syndrome (NMS) may be a life-threatening neurologic crisis primarily emerging as an idiosyncratic reaction to antipsychotic agent use, and characterized by a particular clinical syndrome of mental status alter, rigidity, fever and dysautonomia. Mortality results straightforwardly from the dysautonomic manifestations of the disease and from systemic complications.ObjectivesTo describe an unusual clinical case in order to determine the management regarding medication and electroconvulsive therapy (ECT), and provide an overview of NMS for the general practitioner with the most up-to-date information on etiology, workup, and management.MethodsWe report a case involving a 55-year-old man with paranoid schizophrenia disorder who presented with hyperthermia, hemodynamic instability, miosis, muscular rigidity, urinary incontinence, catatonic signs and mutism after combining several antipsychotics at the same time: long-acting injectable form of paliperidone, aripiprazol and haloperidol.ResultsGuidelines for specific medical treatments in NMS are based upon case reports and clinical experience. Generally used agents are dantrolene, bromocriptine, and amantadine. A conceivable approach is to start with benzodiazepines along with dantrolene in moderate or severe cases, followed by the addition of bromocriptine or amantadine. ECT is generally reserved for patients not responding to other treatments.ConclusionsNMS is an uncommon adverse drug reaction, with a multifactor pathophysiology and manifestation. Early diagnosis and interruption of antipsychotic therapy is the first-line treatment, followed by supportive care and pharmacotherapy. ECT is an effective treatment when supportive treatment together with pharmacotherapy fails. It could be considered first line in severe life-threatening situations. It is advisable to consider maintenance ECT due to the high risk of relapse.DisclosureNo significant relationships.

Aerobic exercise improves motor function and striatal MSNs-Erk/MAPK signaling in mice with 6-OHDA-induced Parkinson's disease.

In Parkinson’s disease (PD) state, with progressive loss of dopaminergic neurons in the substantia nigra, the striatal dopamine (DA) and glutamate (Glu) levels change, resulting in dysfunction of basal ganglia motor regulation. The PD patient presents motor dysfunction such as resting tremor, bradykinesia, and muscular rigidity. To investigate the mechanism of aerobic exercise to improve PD-related motor dysfunction, in the current study, 6-hydroxydopamine (6-OHDA) was used to induce the PD mice model, and the motor function of PD mice was comprehensively evaluated by open-field test, rotarod test, and gait test. The co-expression of prodynorphin (PDYN) and proenkephalin (PENK) with extracellular signal-regulated kinase (Erk1/2) and phosphorylation Erk1/2 (p-Erk1/2) were detected by double-labeling immunofluorescence. The results showed that a 4-week aerobic exercise intervention could effectively improve the motor dysfunction of PD mice. Moreover, it was found that the expressions of Erk1/2 and p-Erk1/2 in the dorsal striatum (Str) of PD mice were significantly increased, and the number of positive cells co-expressed by Erk1/2, p-Erk1/2, and PENK was significantly higher than PDYN. The above phenomenon was reversed by a 4-week aerobic exercise intervention. Therefore, this study suggests that the mechanism by which aerobic exercise improves PD-related motor dysfunction may be related to that the aerobic exercise intervention alleviates the activity of extracellular signal-regulated kinase/mitogen-activated protein kinases (Erk/MAPK) signaling pathway in striatal medium spiny neurons expressing D2-like receptors (D2-MSNs) of PD mice by regulating the striatal DA and Glu signaling.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00221-022-06360-4.

Insightful Valorization of Biological Activities of Flax Seed (Linum usitatissimum) through Experimental and Computer Aided Mechanisms

Flax also known as common flax or linseed, is a flowering plant, Linum usitatissimum, in the family Linaceae. The current study used haloperidol-induced catalepsy and reserpine antagonism to investigate in vivo anti- Parkinson's activity and in silico approaches like docking studies (schrodinger software), Ramchandran plot (procheck), ADME and biological activity score using (molinspiration) online software. The n-hexane extract of Linum usitatissinum (HELU) (flax seeds) exhibited various phytochemical constituents like carbohydrates, lignans, alkaloids, phenolic compounds, flavonoids, fatty acids, coumarin derivatives and sterols. Pharmacological tests were studied at 200 mg/kg bd.wt and 400 mg/kg bd.wt, using in vivo behavioural effects like muscular rigidity, tremors, akinesia, grip strength, and locomotory activity. The experiment was designed by giving haloperidol to induce catalepsy and Reserpne to induce Parkinson’s disease-like symptoms. The increased cataleptic scores were significantly decreased by HELU (200 and 400 mg/kg bd.wt., p.o.) in reserpine antagonism model. Docking studies for natural chemicals against PDB ID: 4I6B, 7JOZ, 4XUD, 4OYX were conducted to better understand the ligand-binding affinity of the extract's active ingredients. The results revealed that D-xylose, D-arabinose, L-rhamnose, L-fucose, hesperidin, herbacetin, β-carboline, isoquinoline, ferulic acid, eicosapentanoic acid, docosahexaenoic acid, beta sitosterol, niacin, aesculetin and standard drug levodopa, carbidopa had shown highest glide scores with all the selected proteins which indicate a stronger receptor-ligand binding affinity. Our findings revealed that Linum usitatissimum n-hexane extract has strong anti Parkinson's action.

A hacked kitchen scale-based system for quantification of grip strength in rodents

BackgroundAssessment of neuromuscular function is critical for understanding pathophysiological changes related to motor system dysfunction in many rodent disease models. Among methods used for quantification of grip performance in rodents, gauge-based grip strength meters provide the most reliable results, however, such instruments are unaffordable by many laboratories. The present aim was to demonstrate how to build a rodent grip strength apparatus from scratch using a digital kitchen scale, an empty cage, and a microcontroller, with both hardware and software being completely open-source to enable maximal modularity and flexibility of the instrument in concordance with the principles of open-source bioinstrumentation. MethodsNodeMCU ESP-32S was connected to a hacked digital kitchen scale-based platform and load cell data were acquired using custom open-source scripts. Data were analyzed in R using semi-automatic analysis algorithms implemented in the ratPASTA package. griPASTA system was tested by quantifying muscular rigidity in the rat model of Parkinson's disease (PD) induced by bilateral intrastriatal administration of 6-hydroxydopamine (6-OHDA). ResultsIn contrast to commercial instruments, the flexibility and modularity of the proposed platform enable collecting raw data and controlling for potential confounding effects on the grip strength. Muscular rigidity is significantly increased in the rat model of PD regardless of the dose used or reboxetine pretreatment. Neither trial speed nor animal weight was recognized as an important confounder.Conclusions: griPASTA provides a cheap, easy, precise, and reliable way to measure grip strength in rodents using widely available equipment and open-source software.

Antiparkinsonian activity of Tabebuia impetiginosa bark and biochemical analysis of dopamine in rat brain homogenates

Improving economy and well-being in developing nations like India has expanded life expectancy and changed the attention from transmittable to non transmittable diseases such as Parkinson's disease. Tabebuia impetiginosa has been utilized by cultivators as a general tonic, immunostimulant, adaptogen and also in motor disorders. The present investigation was to explore the antiparkinsonian activity of Tabebuia impetiginosa bark by experimental methods. Control group-I was served with distilled water. Group-II was considered as pathological control [1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) 2mg/nostrils i.n, Reserpine 40mg/kg s.c, Haloperidol 0.5mg/kg, i.p]. Group-III served with standard drug (Apomorphine 40mg/kg, s.c). Group IV and V received aqueous extract of Tabebuia impetiginosa bark in doses of 300 and 500mg/kg/day respectively. Tremor, hypokinesia, muscular rigidity, catatonia, postural immobility, postural instability and catalepsy were assessed for antiparkinsonian activity. The bark extract served group exhibited the increased levels of dopamine (5700±1.84ng/g) when compared to control groups (4300±3.17ng/g). The extract at both the doses displayed a significant reduction in postural flexion, moderate decrease in tremor, muscular rigidity and postural immobility scores but do not exhibit significant lowering of hypokinesia score in reserpine induced Parkinsonian model. The reduction in catatonia and catalepsy scores is more remarkable in case of high dose of extract (500mg/kg) compared to standard drug in Neuroleptic induced Parkinsonism. The findings demonstrate that Tabebuia impetiginosa bark extract has significant anti-cataleptic potentials and the antioxidant effect of the bark may also be a significant contributor to its antiparkinsonian activity.

Effects of osteopathic manipulative treatment vs. osteopathic cranial manipulative medicine on Parkinsonian gait.

Sixty thousand people are diagnosed with Parkinson's disease (PD) each year, making it the second most common neurodegenerative disorder. PD results in a variety of gait disturbances, including muscular rigidity and decreased range of motion (ROM), that increase the fall risk of those afflicted. Osteopathic manipulative treatment (OMT) emphasizes the central role of the musculoskeletal system, which could be ideal for addressing the somatic dysfunction associated with neurodegeneration in PD. The close anatomical relationship of structures implicated in PD within the skull and the increased frequency of strain patterns raise the question of whether osteopathic cranial manipulative medicine (OCMM) can improve gait performance by improving circulation to the affected nervous tissue. However, there have been few studies in recent years that explore the effects of a standardized OMT protocol on Parkinsonian gait characteristics, and there have been few studies that include OCMM techniques. This study aims to determine whether a single session of OMT or OMT+OCMM can improve the gait of individuals with PD by addressing joint restrictions in the sagittal plane and by increasing ROM in the lower limb. The following study is a two-group, randomized controlled trial in which individuals with PD (n=45) and age-matched healthy control participants (n=45) were recruited from the community. PD participants were included if they were otherwise healthy, able to stand and walk independently, had not received OMT or physical therapy (PT) within 30days of data collection, and had idiopathic PD in Hoehn and Yahr stages 1.0-3.0. PD participants were randomly assigned to one of three experimental treatment protocols: a 'whole-body' OMT protocol (OMT-WB), which included OMT and OCMM techniques; a 'neck-down' OMT protocol (OMT-ND), including only OMTtechniques; and a sham treatment protocol. Control participants were age-matched to a PD participant and were provided the same OMT experimental protocol. An 18-camera motion analysis system was utilized to capture 3-dimensional (3D) position data in a treadmill walking trial before and after the assigned treatment protocol. Pretreatment and posttreatment hip, knee, and ankle ROM were compared with paired t-tests, and joint angle waveforms during the gait cycle were analyzed with statistical parametric mapping (SPM), which is a type of waveform analysis. Individuals with PD had significantly reduced hip and knee extension in the stance phase compared to controls (32.9-71.2% and 32.4-56.0% of the gait cycle, respectively). Individuals with PD experienced a significant increase in total sagittal hip ROM (p=0.038) following a single session of the standardized OMT-WB treatment protocol. However, waveform analysis found no significant differences in sagittal hip, knee, or ankle angles at individual points of the gait cycle following OMT-WB, OMT-ND, or sham treatment protocols. The increase in hip ROM observed following a single session of OMT-WB suggests that OCMM in conjunction with OMT may be useful for improving gait kinematics in individuals with PD. Longitudinal studies over multiple visits are needed to determine the long-term effect of regular OMT and OMT+OCMM treatments on Parkinsonian gait characteristics.

Inspiratory laryngeal stridor as the main feature of progressive encephalomyelitis with rigidity and myoclonus: a case report and literature review

BackgroundProgressive encephalomyelitis with rigidity and myoclonus (PERM) is an acute, potentially life-threatening, yet curable neuro-immunological disease characterized by spasms, muscular rigidity, and brainstem and autonomic dysfunction. The clinical features of glycine receptor (GlyR) antibody-positive PERM may be overlooked, particularly with some unusual symptoms.Case presentationA 52-year-old man was admitted to the hospital for evaluation of tension headache for 20 days and mild dysarthria. These symptoms were followed by panic, profuse sweating, severe dysarthria, dizziness, unsteady gait, and paroxysmal muscle spasms. Brain magnetic resonance imaging and cerebrospinal fluid analysis were normal. The patient’s condition steadily deteriorated. He repeatedly presented with rigidity, panic attacks, severe anxiety, paroxysmal inspiratory laryngeal stridor, cyanosis of the lips, and intractable epilepsy. Electromyography showed multiple myoclonic seizures, a single generalized tonic-clonic seizure, and a single generalized tonic seizure. Screening for autoimmune encephalitis antibodies revealed anti-GlyR antibodies in his cerebrospinal fluid. Immunomodulatory pulse therapy with steroids and immunoglobulin resulted in expeditious improvement of the symptoms within 2 weeks, and a follow-up at 5 weeks showed consistent clinical improvement.ConclusionOur case highlights that inspiratory laryngeal stridor is an important symptom of PERM. Our observation widens the spectrum of the clinical presentation of anti-GlyR antibody-positive PERM, where early identification is a key to improving prognosis.

GaitForeMer: Self-Supervised Pre-Training of Transformers via Human Motion Forecasting for Few-Shot Gait Impairment Severity Estimation.

Parkinson's disease (PD) is a neurological disorder that has a variety of observable motor-related symptoms such as slow movement, tremor, muscular rigidity, and impaired posture. PD is typically diagnosed by evaluating the severity of motor impairments according to scoring systems such as the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Automated severity prediction using video recordings of individuals provides a promising route for non-intrusive monitoring of motor impairments. However, the limited size of PD gait data hinders model ability and clinical potential. Because of this clinical data scarcity and inspired by the recent advances in self-supervised large-scale language models like GPT-3, we use human motion forecasting as an effective self-supervised pre-training task for the estimation of motor impairment severity. We introduce GaitForeMer, Gait Forecasting and impairment estimation transforMer, which is first pre-trained on public datasets to forecast gait movements and then applied to clinical data to predict MDS-UPDRS gait impairment severity. Our method outperforms previous approaches that rely solely on clinical data by a large margin, achieving an F1 score of 0.76, precision of 0.79, and recall of 0.75. Using GaitForeMer, we show how public human movement data repositories can assist clinical use cases through learning universal motion representations. The code is available at https://github.com/markendo/GaitForeMer.

Common Conditions Associated with Long Term Opioid Usage

Opioids are drugs that are used to manage wide range of chronic painful diseases. They are classified as broadspectrum analgesics. They are frequently prescribed to manage cancer and chronic pain, post-operative pain among certain other conditions. However, there is a well-known phenomenon of psychological addiction that can develop with the use of opioids leading to prolonged use, abuse and misuse which undermines their clinical efficacy associated with their use. Although in some conditions long-term opioid therapy is needed. According to clinical recommendations, long-term opioid therapy involves taking opioids every day for more than three months. The criteria for defining long-term opioid therapy in clinical settings and research, however, vary. Certain conditions are associated with its long-term use including impaired cognitive effects, sedation, constipation, nausea, vomiting, physical dependence, tolerance, and respiratory depression which are quite common with the opioid treatment. Clinical concerns regarding addiction may hinder appropriate prescribing, resulting in insufficient pain management. Delay in stomach emptying, hyperalgesia, immunologic and hormonal abnormalities, muscular rigidity, and myoclonus are examples of less prevalent effects reported with long-term opioid use. Opioid induced constipation is commonly reported in long-term use and may get severe enough to necessitate stopping the opioids and cause underdosing and insufficient analgesia. Respiratory and sleep disorders also frequently observed in longterm users of opioids. Also, incidence of new episode of depression is quite commonly linked to the chronic use of opioid. The purpose of this research is to review the available information about common conditions associated with long term opioid usage.

Dissociative stupor in young adults. Challenges in differential diagnosis and treatment management

Dissociative stupor is a rare psychiatric condition, included in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) among Other Specified Dissociative Disorders, as an acute dissociative reaction to a stressful event. Like other acute pathological dissociative presentations, it is primarily related to traumatic experiences. Aim. This article aims at presenting the case of dissociative stupor in a 21-year-old male who presented firstly with mixed symptoms of tonic seizures and catatonia. Method. Before the present admission, the patient had two previous emergency department presentations, upon which he presented altered consciousness, muscular rigidity, unresponsiveness to external stimuli, alternated with episodes of psychomotor agitation and visual hallucinations, symptoms partially remitted after the administration of propofol, levetiracetam and solumedrol. During the presentation, the patient’s mother revealed that the patient may have seen the dead body of his grandfather, with whom he had a previously close relationship, and found out in this manner that he passed away during the previous night. Urinary tox-screen was positive for tetrahydrocannabinol (THC). Also, complete blood count (CBD), basic metabolic panel (BMP), cerebrospinal fluid (CSF) analysis, cerebral magnetic resonance imaging (MRI), both native and angiographic sequence, and electroencephalogram (EEG) were performed, with results within normal range. The treatment with selective serotonin reuptake inhibitors (SSRI’s; sertraline) and second-generation antipsychotics (SGA; olanzapine) was initiated. Discussion. From a psychiatric point of view, the patient needs to be reevaluated periodically regarding the psychopharmacologic therapy; also, cognitive-behavioral therapy (CBT) or hypnosis may be an option in this case. Conclusions. The diagnosis and therapeutic management of dissociative stupor represents a real challenge due to the need of excluding other psychiatric or somatic conditions and the fact that there are no available data regarding the psychopharmacological treatment. However, there is much ongoing research in the neurobiology of trauma-related altered states of consciousness and the promising results of them are the basis of future psychopharmacological strategies.

Age-Specific Clinical Features of Pediatric Malignant Hyperthermia: A Review of 187 Cases Over 60 Years in Japan.

Malignant hyperthermia (MH) is an inherited muscle disorder induced by volatile anesthetics and depolarizing muscle relaxants. While the incidence of MH is high in young, there are few reports on the clinical features of pediatric MH. In this study, we selected pediatric cases from an MH database and analyzed the clinical findings by age group. We hypothesized that there would be age-related differences in the clinical characteristics. A retrospective analysis of MH data collected in our database during 1960 to 2020 was performed to identify pediatric subjects (≤18 years) with a Clinical Grading Scale of ≥35, indicating "very likely" or "almost certain" MH. We compared clinical characteristics among the 0 to 24 month, 2 to 12 year, and 13 to 18 year (youngest, middle, and oldest, respectively) age groups. Data were available for 187 patients: 15 in the youngest age group, 123 in the middle-aged group, and 49 in the oldest age group. Of these, 55 patients (29.4%) had undergone muscle biopsy and muscle contracture test. The mortality rates during the study period were 13.3%, 13.8%, 20.4%, and 15.5% in the youngest, middle, and oldest cohorts and overall, respectively. In contrast, the overall mortality rate from 2000 to 2020 was 8.8%. The most frequent initial symptoms of MH were elevated temperature (46.7%) and generalized muscular rigidity (26.7%) in the youngest cohort, masseter spasm (35.0%) and generalized muscular rigidity (19.5%) in the middle cohort, and elevated end-tidal carbon dioxide (26.5%) and tachycardia (22.4%) in the oldest cohort. Physical examination revealed that elevated temperature, sinus tachycardia, and respiratory acidosis occurred frequently in all groups. The middle cohort had high frequencies of masseter spasm (58.4%; P = .02) and dark urine (75.5%; P = .01) compared to those in the oldest groups, and had a higher peak creatine kinase level compared to those in the 3 groups. Skeletal muscle symptoms tended to be more common in patients administered succinylcholine (generalized muscular rigidity, P = .053; masseter spasm, P < .0001; dark urine, P < .0001). In particular, masseter spasm and dark urine were more common in the middle cohort when succinylcholine was administered (masseter spasm: versus youngest cohort, P = .06, versus oldest cohort, P = .027; dark urine: versus youngest cohort, P = .0072, versus oldest cohort, P = .0015). The clinical characteristics of pediatric patients with MH vary according to age group. The difference in initial symptoms of MH depending on age group is noteworthy information for the early diagnosis of MH.

S2777 A Rare Case of Progressive Encephalomyelitis With Rigidity and Myoclonus Related to Hepatitis E Virus

Introduction: We present an unusual case of progressive encephalomyelitis with rigidity and myoclonus (PERM) caused by hepatitis E viral illness. Case Description/Methods: A 42-year-old male with a past medical history of left nephrectomy donation, hypertension, and chronic kidney disease presents with sudden onset of numbness of his tongue. He complains of intermittent dizziness (positional), hearing changes (including voices and music) as well as double/blurry vision, global fatigue, and visual hallucinations. The patient denies any extremity weakness, difficulty swallowing, or headache. No facial droop is noted, but right eye droop is noted. The patient is ambulating with a steady gait. The patient has elevated liver enzymes (AST 178, ALT 616) with elevated alkaline phosphatase (ALP 323). The patient has no recent exposures or ingestion. He is diagnosed with PERM following the onset of symptoms managed with high-dose steroid therapy and plasmapheresis. Symptoms persisted with dysphagia requiring feeding tube placement, tracheostomy, along with progressively worsening transaminase levels with ALP 742, AST 342, ALT 1,062. Hepatology was consulted with negative autoimmune work-up, hepatitis B and C screening. Hepatitis E IgM was obtained and found to be positive. A liver biopsy was obtained showing mild portal tract inflammation with ductal reaction, focal pericentral macrophages, and hepatocyte dropout reflective of viral hepatitis. He was recommended to start ribavirin 200 mg twice daily given persistently elevated transaminase levels. Repeat evaluation with HEV testing after two months of therapy was negative. Treatment for the PERM included steroids, intravenous immunoglobulin, plasmapheresis, and rituximab with improvement in symptoms. Most recent liver enzymes were normal on ribavirin treatment. Discussion: PERM is a rare disorder characterized by muscular rigidity, muscle spasms, abnormal posture, and is caused by inflammation in the brainstem and spinal cord. PERM can be diagnosed clinically or if the patient is positive for anti-HEV IgM and has symptomatology characteristic of stiff-person plus syndrome. Symptoms can be explained by the interruption of glycinergic synaptic transmission in the spinal cord and brainstem. Antibodies present against glycine receptors in the serum and CSF suggest antibody-mediated pathogenesis, possibly responsive to immunotherapy. Ribavirin is commonly prescribed for HEV clearance and amelioration of HEV-associated neurologic symptoms.

Appendicular Tuberculosis as Manifestation of Gastrointestinal Tuberculosis: A Case Report

Introduction: Gastrointestinal tuberculosis (GI TB) is quite rare with 3% incidence of all extrapulmonary involvement. Appendicular TB may occur in 0.1 - 3% of cases. Diagnosis is often difficult because the patient usually complains about chronic abdominal pain and fever. A definite diagnosis is based on histopathological examination of resected specimens from the appendectomy procedure.Case: We present a 37-year-old male patient admitted to the hospital with chronic abdominal pain, fever, nausea, and loss of body weight. The patient never had a persistent cough, hemoptysis, or night sweating. Physical examination showed pain and muscular rigidity in the right iliac area during palpation with Blumberg's sign and Rovsing's sign positive. Abdomen ultrasound imaging showed an appendicular abscess. The patient underwent appendectomy afterwards with histopathology result showing TB. The patient was treated with first category anti-tuberculosis drugs (ATD).Discussion: Diagnosis of appendicular TB is difficult due to unspecific clinical presentations. Appendicular TB patients often complain of signs and symptoms which are similar to acute appendicitis. These conditions can delay ATD treatment because the definitive diagnosis could be made after histopathological examination.Summary: Appendicular TB is a rare case of extrapulmonary TB. It can present as acute appendicitis. The definitive diagnosis is based on the histopathological examination. It is recommended to check the appendicectomy specimens histopathologically to exclude TB or other diseases.

Effects of dry needling on gait and muscle tone in Parkinson's disease: a randomized clinical trial.

Alterations in gait and muscular rigidity are common and disabling in persons with Parkinson's disease (PD). The aim of this study was to determine whether a single dry needling (DN) session can promote changes in gait and muscle tone in the lower extremities as well as in the evolution of the disease in persons with PD. A randomized double-blind clinical trial was designed. Participants were randomly assigned to an intervention group (IG) that received a session of DN over the semitendinosus, medial gastrocnemius, soleus and rectus femoris muscles, or to a control group (CG) that received a session of sham DN in the same muscles. The effects of DN were assessed using the timed up and go test (TUG), 10 meter walk test (10MWT), 6 minute walk test (6MWT) and myotonometry before, immediately after, and 7 days after the intervention. Thirty-three participants were analyzed aged 69.9 ± 7.2 years (mean ± SD; 39% female). There were no significant differences between the IG and CG for any outcomes. Significant differences were observed when comparing the Pre and Follow-up values in the IG for functional mobility of gait in the TUG (p = 0.049), gait speed in the 10MWT (p = 0.041) and muscle tone in the lower extremities by myotonometry (frequency (p = 0.027) and stiffness (p = 0.013)). By comparison, there were no significant within-group differences in the CG. A single session of DN had no measurable benefit compared to a single session of sham DN. Within-group changes in the IG suggested improvements in functional mobility of gait and gait speed, as well as changes in the muscle tone in the lower extremities of PD patients, which could be worthy of further exploration by future research.

Evaluation of anticataleptic activity of Hydroxytyrosol on Haloperidol induced Catalepsy in Experimental Animal

Catalepsy is a symptom resulting from problems with the nervous system, and causes muscular rigidity. People with the symptoms may also be less sensitive to touch and have a decreased sensitivity to pain. Catalepsy generally causes people to be unresponsive to speech. It is similar to catatonia, a condition marked by strange movements, lack of movement, and/or general non responsiveness. However, it typically has an underlying physiological cause and does not cause stereotyped movements.&#x0D;