Arun Aggarwal

A Postmarket Surveillance Study on Electro-Neuro-Adaptive-Regulator Therapy

The Electro-Neuro-Adaptive-Regulator (ENAR) device is a hand-held electrotherapy which is applied using energetic medicine principles and aspects of acupuncture theory. The aim of this paper is to report the findings of a postmarket survey of persons who have used the ENAR device. The conditions for which the therapy was used and its perceived effectiveness are discussed. A web-based survey of Australian recipients of ENAR therapy was completed by 481 respondents. Most (76%) used ENAR exclusively for pain relief for musculoskeletal disorders, especially back, shoulder, and neck pain; 8% used ENAR exclusively for nonmusculoskeletal disorders; while 16% used ENAR for both. Respondents reported a mean reduction in pain of 70% (t(423) = 38.73, P < .001) and functional improvement of 62% (t(423) = 10.45, P < .001) using 11-point numerical rating scales. Following ENAR treatment, medication reduction was reported by 91% of respondents. Most respondents reported high satisfaction following ENAR therapy, with between 15 and 20% achieving complete pain relief. The self-delivery of ENAR may, in part, account for the high level of satisfaction.

Dopa-responsive parkinsonism secondary to right temporal lobe haemorrahage.

A 46‐year‐old man developed a symmetrical parkinsonian syndrome 7 weeks after large right temporal intracerebral haemorrhage resulting from a ruptured arteriovenous malformation. His signs included bradykinesia, rigidity, start hesitation, and poor postural reflexes, without a resting tremor. He also had signs of a Parinauds syndrome. Computed tomography and magnetic resonance imaging of the brain demonstrated changes in the right temporal lobe associated with the haemorrhage but no abnormality of the basal ganglia or midbrain. Levodopa therapy produced a dramatic improvement within a few days of commencement. We postulate that the parkinsonism resulted from midbrain compression secondary to transtentorial herniation. Although parkinsonism is a rare complication of lobar intracerebral haemorrhage, it is important to recognise as it may be potentially treatable.

Age dependent penetrance of three different superoxide dismutase 1 (sod 1) mutations.

The age of onset of motor neuron disease in Cu/Zn superoxide dismutase 1 (SOD1) mutation carriers are variable, commencing at any time from the second decade. The authors performed a retrospective analysis of family information in pedigrees dating back to the 1780s, to determine the age-dependent penetrance of three different SOD1 mutations: Glu100Gly, Ile113Thr, and Val148G1y. The penetrance of symptomatic MND in these three SOD1 mutations was greater than 95% by the age of 78. The affected family members with the Val148Gly mutation had the worst prognosis, with a mean age of death of 46.1 years, compared to 54.2 years for the Glu100Gly mutation and 59.9 years for Ile113Thr mutation. Kaplan-Meier survival curves showed that survival of the 3 SOD1 mutation families, when combined, was reduced by nearly 10 years with the mean age of death for all SOD1 mutation carriers being 52.6 years compared to 62.5 years for the control individuals. The SOD1 mutation group also resulted in earlier death compared to sporadic MND, which from natural history studies is 61.4 years. This may reflect that the SOD1 mutation is associated with more progressive and rapid disease, as the age of onset of disease was not earlier. This information would have important implications for genetic counseling of members of individual SOD1 mutation carrier families.

Familial colloid cyst of the third ventricle.

We describe the cases of a mother and son who presented one year apart with a colloid cyst of the third ventricle. The mother was symptomatic and had complete resolution of her symptoms after surgical intervention. Her son was asymptomatic. There have been several reported instances of a familial association of colloid cysts of the third ventricle. The probability of a colloid cyst occurring in the same family coincidentally is possible, but highly unlikely (1 x 10(10)). The increasing number of reports of the familial incidence of colloid cysts would suggest the possibility of an autosomal dominant inheritance pattern, but to date, a familial pattern of inheritance has not been recognised. If there is a potential genetic link, then screening of asymptomatic relatives may be indicated. With non-invasive imaging techniques, such as computed tomography and magnetic resonance imaging scanning, accurate diagnosis and effective elective treatment is possible. This may result in preventing future complications as a result of hydrocephalus or sudden unexpected death, and also reduce morbidity as surgery can be done electively rather than as an emergency procedure.

Handgrip Maximal Voluntary Isometric Contraction Does Not Correlate with Thenar Motor Unit Number Estimation

In slowly progressive conditions, such as motor neurone disease (MND), 50–80% of motor units may be lost before weakness becomes clinically apparent. Despite this, maximal voluntary isometric contraction (MVIC) has been reported as a clinically useful, reliable, and reproducible measure for monitoring disease progression in MND. We performed a study on a group of asymptomatic subjects that showed a lack of correlation between isometric grip strength and thenar MUNE. Motor unit number estimation (MUNE) estimates the number of functioning lower motor neurones innervating a muscle or a group of muscles. We used the statistical electrophysiological technique of MUNE to estimate the number of motor units in thenar group of muscles in 69 subjects: 19 asymptomatic Cu, Zn superoxide dismutase 1 (SOD 1) mutation carriers, 34 family controls, and 16 population controls. The Jamar hand dynamometer was used to measure isometric grip strength. This study suggests that MUNE is more sensitive for monitoring disease progression than maximal voluntary isometric contraction (MVIC), as MUNE correlates with the number of functional motor neurones. This supports the observation that patients with substantial chronic denervation can maintain normal muscle twitch tension until 50–80% of motor units are lost and weakness is detectable.

Motor unit number estimation in asymptomatic familial amyotrophic lateral sclerosis.

Publisher Summary This chapter reviews that sporadic amyotrophic lateral sclerosis (ALS) is a degenerative disease of motor neurones, resulting in progressive loss of voluntary muscle strength. It is probable that familial ALS is genetically heterogeneous and can be caused by mutations in more than one gene. Individuals, who are known SOD1 mutation carriers, constitute a unique opportunity to study pre-clinical ALS. The chapter discusses that patients with substantial chronic denervation could maintain normal muscle twitch tension until loss of about 70%–80% of motor units occur when collateral reinnervation was unable to provide further compensation. This indicates that considerable (>70%) motor neurone loss could occur before the onset of symptoms or weakness in ALS patients. It reviews that in order to determine if significant loss of motor neurones occur years before the onset of disease, a cross-sectional study is performed at risk asymptomatic individuals— that is, no neurological symptoms or signs as determined by a neurologist.

Low Vitamin B12 Syndrome in Trigeminal Neuralgia

Trigeminal neuralgia (tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. The International Association for the Study of Pain (IASP) defines trigeminal neuralgia as a sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve. Typically, brief attacks of pain are triggered by talking, chewing, brushing teeth, and shaving, applying make-up or even a slight breeze. Generally, it is a clinical diagnosis, although imaging may be necessary to exclude other pathology.

Detection of pre-clinical motor unit loss in familial amyotrophic lateral sclerosis.

Publisher Summary This chapter describes amyotrophic lateral sclerosis (ALS) as a progressive degenerative disease of motor neurones. There is a family history in approximately 10% of cases, but only 20% of such families have point mutations in the Cu, Zn superoxide dismutase 1 (SOD1) gene. It discusses that presymptomatic loss of motor neurones has been identified SOD1 mice. Motor neurone loss was biphasic with initial loss in the presymptomatic phase followed by a period of stabilisation and then gradual loss at the time of clinical weakness that progressed to death. The chapter reviews that in human familial ALS there was no detectable difference in the number of motor units in asymptomatic SOD1 mutation carriers compared to their SOD1 negative family controls. This may indicate that mutation carriers have undetectable loss of motor neurones until rapid and widespread cell death of motor neurones occur coinciding with the onset of clinical features. This implies that the disease is not an end result of the slow attrition of motor neurones. In order to determine the time course of motor neurone loss prior to the clinical onset of disease in human ALS, a longitudinal study of 19 at-risk asymptomatic individuals was performed using motor unit number estimation (MUNE) techniques.

Neuropathic pain medication update-2015

We used two different biofeedback devices to measure pain reduction, BMI [body mass index] to measure fat reduction and blood cortisol levels to measure stress reduction. The Amethyst BioBelt and the Amethyst BioMat reduced pain by 18% and reduced BMI by 10% and reduced Stress by 82% of 12 subjects in 3 months as validated by Pre and Post Biofeedback Brain Scans as well as fasting blood test to measure the stress hormone cortisol.

Quadraparesis following Chiropractic Manipulation: A Case Report

Chiropractic manipulation is a popular form of alternative therapy used in the treatment of acute and chronic pain. Neurological complications are uncommon, occurring in 1 per million cervical manipulations. We report a case of a 35-year old man who developed a C3/C4 quadraparesis, shortly after chiropractic manipulation to his neck for acute on chronic neck pain. A CT scan of his cervical spine showed a large central disc protrusion at C3/4 causing severe cord compression and underwent urgent C3/4 cervical decompression with fusion. He improved neurologically and after a period of inpatient rehabilitation he has discharged home, 3 weeks after presentation, independent in mobility and self care with minimal residual upper limb weakness, which resolved over the next few months. Even though neurological complications of spinal manipulation are well recognised, our case demonstrates the dangers of this popular form of alternative therapy that is generally seen to be benign. Lessons: Chiropractic manipulation is a popular form of alternative therapy used in the treatment of acute and chronic pain and neurological complications are uncommon, occurring in 1 per million cervical manipulations. Even though neurological complications of spinal manipulation are well recognised, our case demonstrates the dangers of a therapy that is generally seen to be benign. If the complication is identified as a neurological emergency, excellent functional recovery occurs. This case highlights the potential pitfalls of this form of treatment and the need for more strict medical control to minimise the risk of complications, especially at the cervical level. Introduction: Chiropractic spinal manipulation involves a high-velocity thrust to rapidly adjust joints and correct spinal misalignment and relieve pressure on nerves to allow them to function. Neurological complications of cervical manipulations are considered rare, occurring in 1 per million cervical manipulations [1]. Most complications reported of this therapy are case reports of vertebral artery dissection [2], disc herniation [3] and cervical fracture [4], but there have been reports of Brown-Sequard syndrome due to cord contusion [5], acute paraplegia due to ischaemia [6] and hemiplegia due to a spinal epidural haematoma [7]. Even though neurological complications of spinal manipulation are well recognized [8,9] our case demonstrates the dangers of this popular form of alternative therapy.