Peripheral Nervous System Disorders Research Articles

Peripheral nervous system and neuromuscular disorders in the emergency department: A review.

Acute presentations and emergencies in neuromuscular disorders (NMDs) often challenge clinical acumen. The objective of this review is to refine the reader's approach to history taking, clinical localization and early diagnosis, as well as emergency management of neuromuscular emergencies. An extensive literature search was performed to identify relevant studies. We prioritized meta-analysis, systematic reviews, and position statements where possible to inform any recommendations. The spectrum of clinical presentations and etiologies ranges from neurotoxic envenomation or infection to autoimmune disease such as Guillain-Barré Syndrome (GBS) and myasthenia gravis (MG). Delayed diagnosis is not uncommon when presentations occur "de novo," respiratory failure is dominant or isolated, or in the case of atypical scenarios such as GBS variants, severe autonomic dysfunction, or rhabdomyolysis. Diseases of the central nervous system, systemic and musculoskeletal disorders can mimic presentations in neuromuscular disorders. Fortunately, early diagnosis and management can improve prognosis. This article provides a comprehensive review of acute presentations in neuromuscular disorders relevant for the emergency physician.

Electrodiagnostic reporting preferences of referring physicians: An exploratory survey.

Electrodiagnostic (EDX) studies play a crucial role in the evaluation of patients with peripheral nervous system disorders. Accurate and succinct communication of test results is critical to patient safety and clinical decision-making. The objective of this study was to explore EDX reporting preferences of referring physicians to improve quality of communication and patient care. An online survey was developed, and a purposive sampling strategy was used to recruit physicians in the authors' professional networks. Quantitative and qualitative survey data underwent frequency and thematic analyses, respectively. There were 40 respondents, including: 21 non-surgical specialists, 12 surgical specialists, and 7 family physicians. Sections rated as most critical were diagnostic impression (97%) and summary/interpretation (72%). Only 18% reported numeric data as critical to their needs, preferring this data to be formatted as bullet points or tables without nerve conduction study waveforms. Regarding the format of the data summary and diagnostic impression sections, the majority of respondents preferred bullet points rather than paragraphs. The results of this exploratory survey suggest that physicians who refer patients for EDX studies prefer reports that emphasize the interpretation of EDX data and a clear diagnostic impression, particularly in bullet point format. This project highlights important preferences and how they compare to recommended reporting guidelines, which may help improve communication and ultimately patient care. Future efforts should explore larger sample sizes with all key stakeholders in the EDX process to better understand reporting styles and preferences with greater nuance and context.

18F-ASEM PET/MRI targeting alpha7-nicotinic acetylcholine receptor can reveal skeletal muscle denervation

BackgroundThe increased expression of the nicotinic acetylcholine receptor (nAChR) in muscle denervation is thought to be associated with electrophysiological acetylcholine supersensitivity after nerve injury. Hence, we investigated the utility of the 18F-ASEM alpha7-nAChR targeting radiotracer as a new diagnostic method by visualizing skeletal muscle denervation in mouse models of sciatic nerve injury.MethodsTen-week-old C57BL/6 male mice were utilized. The mice were anesthetized, and the left sciatic nerve was resected after splitting the gluteal muscle. One week (n = 11) and three weeks (n = 6) after the denervation, 18F-ASEM positron emission tomography/magnetic resonance imaging (PET/MRI) was acquired. Maximum standardized uptake values (SUVmax) of the tibialis anterior muscle were measured for the denervated side and the control side. Autoradiographic evaluation was performed to measure the mean counts of the denervated and control tibialis anterior muscles at one week. In addition, immunohistochemistry was used to identify alpha7-nAChR-positive areas in denervated and control tibialis anterior muscles at one week (n = 6). Furthermore, a blocking study was conducted with methyllycaconitine (MLA, n = 5).Results18F-ASEM PET/MRI showed significantly increased 18F-ASEM uptake in the denervated tibialis anterior muscle relative to the control side one week and three weeks post-denervation. SUVmax of the denervated muscles at one week and three weeks showed significantly higher uptake than the control (P = 0.0033 and 0.0277, respectively). The relative uptake by autoradiography for the denervated muscle was significantly higher than in the control, and immunohistochemistry revealed significantly greater alpha7-nAChR expression in the denervated muscle (P = 0.0277). In addition, the blocking study showed no significant 18F-ASEM uptake in the denervated side when compared to the control (P = 0.0796).ConclusionsOur results suggest that nAChR imaging with 18F-ASEM has potential as a noninvasive diagnostic method for peripheral nervous system disorders.

A patient with bilateral neuralgic amyotrophy and hepatitis E virus infection: an educational communication.

Neuralgic Amyotrophy, a peripheral nervous system disorder, is characterized by severe pain and muscle weakness, which can have a significant impact on patients' quality of life. The exact cause of neuralgic amyotrophy is unknown, but it may be linked to immunopathological mechanisms. Recent research has found an association between neuralgic amyotrophy and hepatitis E virus infection. This communication aims to expand knowledge on the clinical phenotype of patients with neuralgic amyotrophy and hepatitis E virus infection, presenting the case of a 55-year-old man diagnosed with bilateral neuralgic amyotrophy and hepatitis E virus infection.

Attenuation of Streptozotocin-Induced Diabetic Neuropathic Allodynia by Flavone Derivative Through Modulation of GABA-ergic Mechanisms and Endogenous Biomarkers.

Diabetic neuropathic pain is one of the most devasting disorders of peripheral nervous system. The loss of GABAergic inhibition is associated with the development of painful diabetic neuropathy. The current study evaluated the potential of 3-Hydroxy-2-methoxy-6-methyl flavone (3-OH-2'MeO6MF), to ameliorate peripheral neuropathic pain using an STZ-induced hyperglycemia rat model. The pain threshold was assessed by tail flick, cold, mechanical allodynia, and formalin test on days 0, 14, 21, and 28 after STZ administration accompanied by evaluation of several biochemical parameters. Administration of 3-OH-2'-MeO6MF (1,10, 30, and 100mg/kg, i.p) significantly enhanced the tail withdrawal threshold in tail-flick and tail cold allodynia tests. 3-OH-2'-MeO6MF also increased the paw withdrawal threshold in mechanical allodynia and decreased paw licking time in the formalin test. Additionally, 3-OH-2'-MeO6MF also attenuated the increase in concentrations of myeloperoxidase (MPO), thiobarbituric acid reactive substances (TBARS), nitrite, TNF-α, and IL 6 along with increases in glutathione (GSH). Pretreatment of pentylenetetrazole (PTZ) (40mg/kg, i.p.) abolished the antinociceptive effect of 3-OH-2'-MeO6MF in mechanical allodynia. Besides, the STZ-induced alterations in the GABA concentration and GABA transaminase activity attenuated by 3-OH-2'-MeO6MF treatment suggest GABAergic mechanisms. Molecular docking also authenticates the involvement of α2β2γ2L GABA-A receptors and GABA-T enzyme in the antinociceptive activities of 3-OH-2'-MeO6MF.

A MEDICAL AND NEUROPSYCHIATRIC MANAGEMENT SURVEY IN A BRAZILIAN COHORT OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD).

Inflammatory bowel disease (IBD) can be accompanied by several neurological disorders. Since 2004, we started a Brazilian cohort to assess neuropsychiatric complications in IBD patients. Changes in therapeutic strategy and differences in the prevalence and relevance of neuropsychiatric disorders have been reported in the literature. We conducted a short patient-reported survey about the medical management of IBD (with a special focus on neuropsychiatric management) and its complications. During the enrollment period (9/1/2021 to 8/31/2022), 279 patients with IBD answered the survey (128 patients with ulcerative colitis and 151 with Crohn's disease). This is the first medical management survey aimed to verify the level of perception of IBD patients about their neuropsychiatric conditions. We found a high prevalence of neurologic (59%), psychiatric (32%), and neuropsychiatric co-morbidities (69%). There is a marked discrepancy between the findings of neurological disorders reported in our studies over the first 10 years of the cohort in comparison with the current perception/knowledge among the patients registered in the present management survey. Patients tend to have a better understanding of central rather than peripheral nerve conditions. • What is already known? • The prevalence and spectrum of neuropsychiatric co-morbidities varies among different epidemiologic studies. • What is new here? • Patients self report a high percentage of neuropsychiatric diseases but tend to better recognize central rather than peripheral nervous system disorders. • How can this study help patient care? • This study may guide practioners to educate IBD patients about their neuropsychiatric co-morbidities.

[Role and place of ipidacrine in the therapy of diseases of the peripheral nervous system. The resolution of the expert council].

The resolution of the expert council is devoted to discussing aspects of the use of ipidacrine for the treatment of mononeuropathies, polyneuropathies and radiculopathies of various etiologies. Specialists prepared recommendations for ipidacrine's application in treating peripheral nervous system disorders.

Neurologic Complications of Cancer Immunotherapy.

Immunotherapeutic approaches have revolutionized cancer treatment with immune checkpoint inhibitors and adoptive T-cell therapy now approved to treat a variety of solid and hematologic malignancies. This article summarizes the distinctive neurologic side effects of these therapies as well as their management. Neurologic immune-related adverse events are rare but potentially serious complications of immune checkpoint inhibitors. Both peripheral and central nervous system disorders have been described, often necessitating a pause or cessation of immunotherapy. Immune effector cell-associated neurotoxicity syndrome is a potentially serious complication of chimeric antigen receptor T-cell therapy. While symptoms may be mild and self-limited, delirium, encephalopathy, seizures, focal neurologic deficits, and fulminant cerebral edema can be seen. Close neurologic monitoring is imperative. The mainstay of treatment for neurologic complications includes high-dose corticosteroids, although other immunomodulatory strategies may be used in severe or refractory cases. The spectrum of neurologic complications of cancer immunotherapy is broad, encompassing both central and peripheral nervous system disorders, indolent as well as fulminant clinical presentations, and wide-ranging severity with variable response to treatment. Early identification and multidisciplinary management are crucial to balance neurologic recovery and antitumor control.

Post-Transplant Pain and Paralysis: Neurologic Amyotrophy As an Atypical Cause of Shoulder Dysfunction Following Hematopoietic Stem Cell Transplant

Introduction: Neuralgic amyotrophy (NA), also known as Parsonage-Turner Syndrome, brachial neuritis, or idiopathic brachial plexopathy, is a rare inflammatory peripheral nervous system disorder affecting the brachial plexus, typically presenting as sudden and abrupt unilateral shoulder pain followed by progressive painless weakness and occasionally reflex and sensory abnormalities. Diagnosis is clinical - based on history and detailed neuromuscular physical examination. Electrodiagnostic studies (EDX) and advanced imaging are supportive to confirm diagnosis and exclude alternative etiologies. While the pathogenesis is not entirely understood, the idiopathic form is thought to be secondary to immune or vascular mediated effects with only a few case reports after hematopoietic stem cell transplantation (HCT). Given under recognition and misdiagnosis, a high degree of suspicion is necessary in patients developing acute onset of shoulder pain after HCT. While no curative treatment is available, early diagnosis will result in appropriate management, patient education, pain control, and timely focused rehabilitation. Methods: We retrospectively collected demographics, HCT details, clinical characteristics, imaging studies, and EDX on patients with acute shoulder pain post-HCT at a single institution. Descriptive statistics were utilized to summarize the collected data. Results: Between 8/2020 -7/2022, nine patients (44% male, median age 60 years) were diagnosed with NA following autologous (n=4, for multiple myeloma (n=2), non-Hodgkin lymphoma (n=1), or germ cell tumor (n=1)) or allogeneic HCT (n=5, for myelodysplastic syndrome (n=3) and acute myelogenous leukemia (n=2)). Each patient acutely developed severe shoulder pain at a median of 9 days (range 1-21) mean. Shoulder pain was bilateral in 3 patients. Neurological weakness involving the shoulder (s) was observed on average 5.1 days after pain onset (range 1-15 days). All but one patient developed sensory deficits in the affected upper extremity. Shoulder pain subsided after a median of 23 days (range 8-40 days). MRI of the shoulder and/or brachial plexus was performed in all patients and showed periscapular muscle edema, atrophy and enhancement in six patients. These signal abnormalities were observed in varying distributions including supraspinatus, infraspinatus, deltoid, teres minor, serratus anterior and intercostals (Figure 1). Of the 6 patients who had EDX, findings were consistent with NA in 5 patients (axillary neuropathy in 2 patients, upper trunk plexopathy in 1 patient, bilateral posterior cord plexopathy in 1 patient and diffuse bilateral brachial plexopathy in 1 patient). All patients were treated with pain medications and received optimal rehabilitative care including consult with physical medicine and rehabilitation physicians and physical and occupational therapy. Upon long term follow up (>1 year), three patients experienced full or near-full resolution of symptoms, four patients partially recovered, and two patients had little to no improvement of their neurological symptoms. Conclusion: Patients undergoing HCT are susceptible to neurological insults, potentially driven by immune-mediated mechanisms. In individuals experiencing acute shoulder pain accompanied by neurological symptoms early post-HCT, it is important to maintain a high level of suspicion for the diagnosis of NA. A timely diagnosis is essential to facilitate early intervention and ensure optimal functional recovery. MRI of the shoulder and/or brachial plexus and EDX are valuable diagnostic tools for assessing the presence and distribution of neuromuscular involvement. While recovery is possible, comprehensive long-term follow-up is necessary to ascertain the extent of symptom resolution and functional restoration.

Mortality Attributed to Central and Peripheral Nervous System Disorders: A Five-years Comprehensive Review from Turkey

Objective: This study aims to provide a comprehensive overview of deaths related to central and peripheral nervous system (CNS and PNS, respectively) disorders in Turkey over a 5-year period. The objective is to identify patterns in mortality rates, investigate regional prevalence, and analyze demographic factors contributing to fatal outcomes. Additionally, we aim to critique existing data collection methodologies. Materials and Methods: Utilizing cross-sectional analysis, data were obtained from the Turkish Statistical Institute (TUIK). Mortality rates were calculated using population estimates from the TUIK, with age- and sex-specific rates, and age-standardized rates (ASRs) derived from the world standard population. Causes of death were classified according to the World Health Organization's International Classification of Diseases, Tenth Revision (ICD-10). Results: The data revealed distinct patterns in mortality rates for CNS and PNS disorders from 2018 to 2022, with significant variations between male and female populations. A prominent upward trend in deaths attributed to CNS and PNS diseases was observed after 2018, despite a decline in the population growth rate. The highest mortality rates were particularly notable in 2020 and 2021. Conclusion: This study identified a significant increase in deaths related to CNS and PNS disorders amid the backdrop of the COVID-19 pandemic. A potential correlation between COVID-19 and the prevalence of neurological disorders has been suggested. With potential underdiagnosis due to the absence of routine post-mortem diagnostic autopsies, this study underscores the need for improved diagnostic capabilities and medical practices.

Infectious Neuropathies.

This article discusses the clinical manifestations and management of infectious peripheral neuropathies. Several infectious etiologies of peripheral neuropathy are well-recognized and their treatments are firmly established. The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with several central and peripheral nervous system manifestations, including peripheral neuropathies. Additionally, some COVID-19 vaccines have been associated with Guillain-Barré syndrome. These disorders are an active area of surveillance and research. Recent evidence-based guidelines have provided updated recommendations for the diagnosis and treatment of Lyme disease. Infectious agents of many types (primarily bacteria and viruses) can affect the peripheral nerves, resulting in various clinical syndromes such as mononeuropathy or mononeuropathy multiplex, distal symmetric polyneuropathy, radiculopathy, inflammatory demyelinating polyradiculoneuropathy, and motor neuronopathy. Knowledge of these infections and the spectrum of peripheral nervous system disorders associated with them is essential because many have curative treatments. Furthermore, understanding the neuropathic presentations of these disorders may assist in diagnosing the underlying infection.

Assessment of neurophysiological parameters of the nervous system in non-ferrous foundry workers

A comprehensive assessment of the health status includes the functional exploration of the central and peripheral nervous systems. Results of the neurophysiological examination allow elaboration of effective personified therapeutic and preventive programs for the core personnel of non-ferrous metal industry. Our objective was to study functional disorders of the central and peripheral nervous systems in smelter operators for further development of risk-based rehabilitation programs for workers engaged in production of non-ferrous metals. Two cohorts of male workers were examined. The case cohort included 60 smelter operators of a large metallurgical plant situated in the Sverdlovsk Region and the control cohort consisted of 50 unexposed employees. The cohorts were matched by age and years of work experience. The mean age of smelter operators was 37.8 ± 7.9 years and their mean length of current employment was 4.1 ± 4.6 years, while the total length of work under hazardous occupational conditions was 7.1 ± 6.0 years. The case cohort included 39 operators of refinery boilers (mean age: 35.6 ± 7.2 years, mean length of employment: 4.2 ± 4.7 years) and 21 operators of the ore thermal furnace (mean age: 41.9 ± 7.6 years, mean length of current employment: 3.9 ± 4.4 years). All subjects underwent a neurocognitive examination (higher brain function testing), electroneuromyography, the somatosensory evoked response test, and electroencephalography. The results of examining the higher brain function enabled us to form the neurocognitive profile of the workers. We revealed signs of mild cognitive impairment in 30 % and a decrease in the cognitive reserve in 35 % of the cases. The diagnosed peripheral nervous system disorders included distal sensory polyneuropathy of the upper and lower extremities, carpal and cubital tunnel syndromes, cervical and lumbar radiculopathy. The comprehensive neurophysiological examination helps detect early changes in the central and peripheral nervous systems. The findings should be taken into account when developing personal medical rehabilitation programs.

Economic Trends in Commonly Used Drugs for Spinal Fusion and Brain Tumor Resection: An Analysis of the Medicare Part D Database.

With the incidence of central and peripheral nervous system disorders on the rise, neurosurgical procedures paired with the careful administration of select medications have become necessary to optimize patient outcomes. Despite efforts to decrease the over-prescription of common addictive drugs, such as opioids, prescription costs continue to rise. This study analyzed temporal trends in medication use and cost for spinal fusion and brain tumor resection procedures. The Medicare Part B Database was queried from 2016 to 2020 for data regarding spinal fusion and brain tumor resection procedures, while the Part D Database was used to extract data for two commonly prescribed medications for each procedure. Pearson's correlation coefficient and linear regression were completed for the analyzed variables. The results showed a significant negative correlation between the number of spinal procedure beneficiaries and the cost of methocarbamol, as well as between the annual percent change in spinal beneficiaries and the annual percent change in oxycodone cost. Linear regression revealed that oxycodone cost was the only parameter with a statistically significant model. Moving forward, it is imperative to combat rising drug costs, regardless of trends seen in their usage. Further studies should focus on the utilization of primary data in a multi-center study.

External magnetic field non-invasively stimulates spinal cord regeneration in rat via a magnetic-responsive aligned fibrin hydrogel

Magnetic stimulation is becoming an attractive approach to promote neuroprotection, neurogenesis, axonal regeneration, and functional recovery in both the central nervous system and peripheral nervous system disorders owing to its painless, non-invasive, and deep penetration characteristics. Here, a magnetic-responsive aligned fibrin hydrogel (MAFG) was developed to import and amplify the extrinsic magnetic field (MF) locally to stimulate spinal cord regeneration in combination with the beneficial topographical and biochemical cues of aligned fibrin hydrogel (AFG). Magnetic nanoparticles (MNPs) were embedded uniformly in AFG during electrospinning to endow it magnetic-responsive feature, with saturation magnetization of 21.79 emu g−1. It is found that the MNPs under the MF could enhance cell proliferation and neurotrophin secretion of PC12 cells in vitro. The MAFG that was implanted into a rat with 2 mm complete transected spinal cord injury (SCI) effectively enhanced neural regeneration and angiogenesis in the lesion area, thus leading to significant recovery of motor function under the MF (MAFG@MF). This study suggests a new multimodal tissue engineering strategy based on multifunctional biomaterials that deliver multimodal regulatory signals with the integration of aligned topography, biochemical cues, and extrinsic MF stimulation for spinal cord regeneration following severe SCI.

Lactobacillus paracasei L9 affects disease progression in experimental autoimmune neuritis by regulating intestinal flora structure and arginine metabolism

BackgroundAutoimmune neuropathies are common peripheral nervous system (PNS) disorders. Environmental influences and dietary components are known to affect the course of autoimmune diseases. Intestinal microorganisms can be dynamically regulated through diet, and this study combines intestinal microorganisms with diseases to open up new therapeutic ideas.MethodsIn Lewis rats, a model of EAN was established with P0 peptide, Lactobacillus were used as treatment, serum T-cell ratio, inflammatory factors, sciatic neuropathological changes, and pathological inflammatory effects on intestinal mucosa were detected, and fecal metabolomics and 16 s microbiome analysis were performed to further explore the mechanism.ResultsIn the EAN rat model, Lactobacillus paracasei L9 (LP) could dynamically regulate the CD4+/CD8+T balance in serum, reduce serum IL-1, IL-6 and TNF-α expression levels, improve sciatic nerve demyelination and inflammatory infiltration, and reduce nervous system score. In the rat model of EAN, intestinal mucosa was damaged. Occludin and ZO-1 were downregulated. IL-1, TNF-α and Reg3γ were upregulated. LP gavage induced intestinal mucosa recovery; occludin and ZO-1 upregulation; IL-1, TNF-α and Reg3γ downregulation. Finally, metabolomics and 16 s microbiome analysis were performed, and differential metabolites were enriched with an important metabolic pathway, arginine and proline metabolism.ConclusionLP improved EAN in rats by influencing intestinal community and the lysine and proline metabolism.

Therapy of chronic pain in cancer patients: Tafalgin use experience. Case report

Background. Chronic pain is the most common and severe condition associated with cancer, causing peripheral and central nervous system disorders Inadequate pain control can be destructive and negatively affect patients' quality of life and daily activity. Therefore, developing new drugs for complete pain control during antitumor therapy and palliative care is an urgent problem in modern oncology. One of these directions is the search for selective molecules that interact with 1-opioid receptors without many side effects of opioids.
 Aim. To evaluate the effectiveness of a new selective 1-opioid analgesic, Tafalgin, in treating chronic pain in a patient with pancreatic cancer.
 Materials and methods. Tafalgin was used to control chronic pain in a 60-year-old patient with stage IV pancreatic cancer, pT2 N0M1, with liver metastases, state after 10 cycles of polychemotherapy, and distal subtotal resection of the pancreas with splenectomy, progression in October 2022, liver metastases; state after 4 cycles of polychemotherapy, severe chronic pain.
 Results. The initial pain severity was evaluated using a visual analog scale: 7 points at rest and 9 points on exertion. The patient developed pain during FOLFIRINOX polychemotherapy, for which he received tramadol at a daily dose of 400 mg in combination with paracetamol, with an effect for 1.5 months. The pain severity increased with breakthrough pain. The patient was prescribed long-acting morphine at 60 mg/day, with good effect. However, the patient experienced nausea and vomiting. The morphine dose was reduced to 20 mg, thus resolving side effects and decreasing the effectiveness. Tafalgin was administered at a dose of 4 mg TID. The pain severity decreased to 11.2 points. No adverse events were reported. The patient has been receiving the drug for 52 days. His sleep and appetite have improved, physical activity has increased, and no weight loss has been reported.
 Conclusion. When switching a patient to Tafalgin, continuous adequate pain control is maintained, not inferior to morphine. Tafalgin is associated with a favorable safety profile.

Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain.

Myofascial pain syndrome is featured by the presence of myofascial trigger points (TrPs). Whether TrPs are primary or secondary phenomena or if they relate to central or peripheral nervous system disorders is controversial. Referred pain, a cardinal sign of TrPs, is a central phenomenon driven by peripheral input. In 2021, the International Association for the Study of Pain (IASP) proposed a clinical criteria and grading system for classifying patients with pain on nociceptive, neuropathic, or nociplastic phenotypes. Myofascial TrP pain has been traditionally categorized as a nociceptive phenotype; however, increasing evidence supports that this condition could be present in patients with predominantly nociplastic pain, particularly when it is associated with an underlying medical condition. The clinical response of some therapeutic approaches for managing TrPs remains unclear. Accordingly, the ability to classify myofascial TrP pain into one of these phenotypes would likely be critical for producing more successful clinical treatment outcomes by a precision medicine approach. This consensus paper presents evidence supporting the possibility of subgrouping individuals with myofascial TrP pain into nociceptive, nociplastic, or mixed-type phenotype. It is concluded that myofascial pain caused by TrPs is primarily a nociceptive pain condition, is unlikely to be classified as neuropathic or nociplastic, but can be present in patients with predominantly neuropathic or nociplastic pain. In the latter cases, management of the predominant central pain problem should be a major treatment goal, but the peripheral drive from TrPs should not be ignored, since TrP treatment has been shown to reduce sensitization-associated symptomatology in nociplastic pain conditions, e.g., fibromyalgia.

ATUAÇÃO FISIOTERAPÊUTICA EM UM PACIENTE COM SÍNDROME DE GUILLAIN-BARRÉ: RELATO DE CASO

Summary: Guillain-Barré Syndrome is an autoimmune disorder of peripheral nervous system presenting as demyelinating neuropathy with ascending centrifugal progression. GBS is usually preceded by an infection that induces a disordered autoimmune response, targeting peripheral nerves and spinal nerve roots. Physiotherapy is of fundamental importance in the rehabilitation of GBS, with the main objective focused on the return and inclusion in the individual's social participation. Objective: To report the physiotherapeutic performance in a patient with a chronic condition of GBS. Methodology: This research is a case report study and it was made by Clínica Escola de Fisioterapia do Centro Universitário Dr. Leão Sampaio, with the patient J.W.F.B.J., whom was 34 years old, male and was diagnosed in November 2021 with Guillain-Barré Syndrome. Case report: Patient has symmetrical paraparesis, predominantly in the distal region of the lower limbs, has mild to moderate tactile hypoesthesia, for pain and temperature up to the level of the malleolus, reduced ROM for dorsiflexion and plantar flexion, change in balance and clipping gait. Case report: Patient has symmetrical paraparesis, predominantly in the distal region of the lower limbs, has mild to moderate tactile hypoesthesia, for pain and temperature up to the level of the malleolus, reduced ROM for dorsiflexion and plantar flexion, change in balance and clipping gait. The treatment was based on stretching, balance and strengthening training and gait training. The objetives and treatment used aim at the social reintegration of the patient, relating the exercises to daily activities, re-stimulating their social participation with a return to work and leisure. Final considerations: After eight months of physiotherapeutic treatment, satisfactory results were obtained in the evolution of the patient's clinical condition. So it is concluded that the performance of physiotherapy is extremely important for the improvement of the case.

Potential role of saffron and its components on miRNA levels in various disorders, a comprehensive review.

The potential therapeutic benefits of saffron and its active constituents have been investigated for the treatment of numerous illnesses. In this review, the impacts of saffron and its essential components on the levels of microRNAs (miRNAs) in different diseases have been delineated. Relevant articles were obtained through databases such as PubMed, Web of Sciences, Scopus, and Google Scholar up to the end of November 2022. miRNA expression has been altered by saffron and its active substances (crocin, crocetin, and safranal) which has been of great advantage in treating diseases such as cardiovascular, type 2 diabetes, cancers, gastrointestinal and liver disorders, central and peripheral nervous system disorders, asthma, osteoarthritis, ischemic-reperfusion induced injury conditions, and renal disorder. This study uncovered the potential restorative advantages of saffron and its derivatives, in miRNA imbalances in a variety of diseases.

Initial observations on sexual dysfunction as a symptom of chemotherapy-induced peripheral neuropathy.

Peripheral neuropathy (PNP) in feet and/or hands and sexual dysfunction are common side effects of cancer therapies. In patients with other diseases, there is evidence of an association between peripheral nervous system disorders and sexual dysfunction due to the impact of impaired neuronal control on genital organ sensitivity. In cancer patient interviews, it has now been observed that PNP and sexual dysfunction may be related. The aim of the study was to investigate the potential association between PNP, sexual dysfunction, and physical activity behavior. Ninety-three patients with PNP of the feet and/or hands were interviewed in August/September 2020 in a cross-sectional study regarding medical history, sexual dysfunction and functionality of the genital organs. Thirty-one persons who participated in the survey provided seventeen evaluable questionnaires (four men, thirteen women). Nine women (69%) and three men (75%) reported sensory disorders of the genital organs. Three men (75%) had erectile dysfunction. All men who had sensory symptoms of the genital organs received chemotherapy, and one man also received immunotherapy. Eight women were sexually active. Five (63%) of them reported genital organ symptoms and mainly lubrication disorders. Four (80%) of the five sexually inactive women reported genital organ symptoms. Eight of the nine women with sensory symptoms of the genital organs received chemotherapy, and one woman received immunotherapy. Our limited data suggest genital organ sensory symptoms in chemotherapy and immunotherapy patients. Genital organ symptoms do not appear to be directly related to sexual dysfunction, and the association between PNP and genital organ symptoms appears to be more pronounced in sexually inactive women. Chemotherapy could cause sensory symptoms of the genital organs and sexual dysfunction by damaging genital organ nerve fibers. Chemotherapy and anti-hormone therapy (AHT) could trigger a disturbance of the hormone balance, which in turn could be causative for sexual dysfunction. It remains open whether the cause of these disorders is the symptomatology of the genital organs or the altered hormone balance. The significance of the results is limited due to the small number of cases. To our knowledge, this study is the first of its kind in cancer patients and allows a better understanding of the association between PNP, sensory symptoms of the genital organs, and sexual dysfunction. In order to be able to narrow down the cause of these initial observations in cancer patients more precisely, larger studies are needed that can relate the influence of cancer therapy-induced PNP, physical activity level and hormone balance to sensory symptoms of the genital organs and sexual dysfunction. The methodology of further studies should take into account the frequent problem of low response rates in surveys on sexuality.