Koncuy Sivrioglu

Effectiveness of low-level laser therapy in temporomandibular disorder

Objective: To investigate the effectiveness of low‐level laser therapy in the treatment of temporomandibular disorder and to compare treatment effects in myogenic and arthrogenic cases. Methods: Thirty‐five patients were evaluated by magnetic resonance imaging and randomly allocated to active treatment (n=20) and placebo treatment (n=15) groups. In addition to a daily exercise program, all patients were treated with fifteen sessions of low‐level laser therapy. Pain, joint motion, number of joint sounds and tender points were assessed. Results: Significant reduction in pain was observed in both active and placebo treatment groups. Active and passive maximum mouth opening, lateral motion, number of tender points were significantly improved only in the active treatment group. Treatment effects in myogenic and arthrogenic cases were similar. Conclusion: Low‐level laser therapy can be considered as an alternative physical modality in the management of temporomandibular disorder.

Effectiveness of Physical Therapy and Epidural Steroid Injections in Lumbar Spinal Stenosis

Study Design. Randomized single-blind controlled trial. Objective. We aimed to compare the effects of epidural steroid injections and physical therapy program on pain and function in patients with lumbar spinal stenosis (LSS). Summary of Background Data. LSS is one of the most common degenerative spinal disorders among elderly population. Initial treatment of this disabling painful condition is usually conservative including analgesics, nonsteroidal anti-inflammatory drugs, exercise, physical therapy, or epidural steroid injections. Owing to lack of sufficient data concerning the effectiveness of conservative treatment in LSS, we aimed to compare the effectiveness of epidural steroid injections and physical therapy program in a randomized controlled manner. Methods. A total of 29 patients diagnosed as LSS were randomized into 3 groups. Group 1 (n = 10) received an inpatient physical therapy program for 2 weeks, group 2 (n = 10) received epidural steroid injections, and group 3 (n = 9) served as the controls. All study patients additionally received diclofenac and a home-based exercise program. The patients were evaluated at baseline, 2 weeks, 1 month, 3 months, and 6 months after treatment by finger floor distance, treadmill walk test, sit-to-stand test, weight carrying test, Roland Morris Disability Index, and Nottingham Health Profile. Results. Both epidural steroid and physical therapy groups have demonstrated significant improvement in pain and functional parameters and no significant difference was noted between the 2 treatment groups. Significant improvements were also noted in the control group. Pain and functional assessment scores (RMDI, NHP physical activity subscore) were significantly more improved in group 2 compared with controls at the second week. Conclusion. Epidural steroid injections and physical therapy both seem to be effective in LSS patients up to 6 months of follow-up.

Botulinum Toxin in Poststroke Spasticity

Poststroke hemiparesis, together with abnormal muscle tone, is a major cause of morbidity and disability. Although most hemiparetic patients are able to reach different ambulatory levels with rehabilitation efforts, upper and lower limb spasticity can impede activities of daily living, personal hygiene, ambulation and, in some cases, functional improvement. The goals of spasticity management include increasing mobility and range of motion, attaining better hygiene, improving splint wear and other functional activities. Conservative measures, such as positioning, stretching and exercise are essential in spasticity management, but alone often are inadequate to effectively control it. Oral antispastic medications often provide limited effects with short duration and frequent unwanted systemic side effects, such as weakness, sedation and dry mouth. Therefore, neuromuscular blockade by local injections have become the first choice for the treatment of focal spasticity, particularly in stroke patients. Botulinum toxin (BTX), being one of the most potent biological toxins, acts by blocking neuromuscular transmission via inhibiting acetylcholine release. Currently, focal spasticity is being treated successfully with BTX via injecting in the spastic muscles. Two antigenically distinct serotypes of BTX are available on the market as type A and B. Clinical studies of BTX used for spastic hemiplegic patients are reviewed in this article in two major categories, upper and lower limb applications. This review addresses efficacy in terms of outcome measures, such as muscle tone reduction and functional outcome, as well as safety issues. Application modifications of dose, dilutions, site of injections and combination therapies with BTX injections are also discussed.

Low-dose botulinum toxin with short-term electrical stimulation in poststroke spastic drop foot: a preliminary study.

Bayram S, Sivrioglu K, Karli N, Ozcan O: Low-dose botulinum toxin with short-term electrical stimulation in poststroke spastic drop foot: A preliminary study. Am J Phys Med Rehabil 2006;85:75–81. Objective:To compare low-dose botulinum toxin injections followed by short-term electrical stimulation with high-dose botulinum toxin for poststroke spastic drop foot. Design:Twelve patients with spastic drop foot were randomly assigned to two treatment groups. The first group (n = 6) received low-dose (100 units) botulinum toxin injection to the posterior tibial muscle in combination with short-term electrical stimulation, and the second group (n = 6) received a total of 400 units of botulinum toxin injections in equal doses to the posterior tibial, soleus, medial, and lateral gastrocnemius muscles. The patients were evaluated before and 2, 4, 8, and 12 wks after the treatment by the following variables: resting position angle, active and passive ankle range of motion, Modified Ashworth Scale, time walking 10 m, clonus score, Brace Wear Scale, and Global Assessment of Spasticity Scale. Results:Improvement was recorded in both groups for all variables except brace wear. No significant difference was found between the study groups after treatment. The effects lasted shorter in the first group, whereas more side effects were seen in the second group. Conclusions:Our preliminary single-blind study was unable to find a difference in terms of effectiveness between low-dose (100 units) botulinum toxin combined with short-term electrical stimulation and high-dose (400 units) application in spastic drop foot.

Reliability and validity of the Geriatric Depression Scale in detection of poststroke minor depression

Objective: The aim of this study was to assess the validity and reliability of the 30-item Geriatric Depression Scale (GDS) as a screening tool for minor depression in poststroke patients. Method : Literate patients older than 18 years of age, diagnosed to have stroke, were eligible for the study. Standardized Mini Mental Status Examination (S-MMSE) and GDS were applied to all patients. The GDS was readministered 7 days later for retest reliability. Results: A total of 85 participants—49 nondepressed and 36 with minor depression—were eligible for the study. Cronbachs alpha coefficient was .89 in internal consistency analysis. The GDS scores were significantly higher (p < .001) in the depressed participants reflecting a high discriminant validity. The highest sum of sensitivity and specificity values of 1.44 (sensitivity = .69, specificity = .75) and 1.45 (sensitivity = .66, specificity = .79) were obtained for cutoff scores of 10/11 and 11/12, respectively. The area under receiver operating characteristics curve was .82. The test–retest reliability analysis revealed a high Pearson correlation coefficient (r = .75). Conclusion: Our findings suggest that the 30-item GDS has high discriminant validity, internal consistency, and test–retest reliability and reasonably useful cutoff scores; thus it can be used as a screening tool for minor depression in the poststroke population.

A Placebo-Controlled, Multicenter, Randomized, Double-Blind, Flexible-Dose, Two-Way Crossover Study to Evaluate the Efficacy and Safety of Sildenafil in Men With Traumatic Spinal Cord Injury and Erectile Dysfunction

Abstract Background/objective: To show the efficacy, safety, and tolerability of sildenafil in men with erectile dysfunction (ED) associated with complete or incomplete spinal cord injury (SCI) and to assess its effects onquality of life (Qol) using the Life-Satisfaction Check List. Methods: This was a placebo-controlled, multicenter, randomized, double-blind, flexible-dose, 2-way crossover study with a 2-week washout period between each phase. Patients with ED attributable to SCI(Sexual Health Inventory-Male score ≤21) received 50 to 100 mg sildenafil (n = 24) or placebo (n = 26). Results: Compared with placebo, sildenafil produced higher levels of successful sexual stimulation,intercourse success, satisfaction with sexual life and sexual relationship, erectile function, overall sexual satisfaction, and an improved Erectile Dysfunction Inventory of Treatment Satisfaction score, with no clinically relevant effects onvital signs. Sildenafil seemed more effective in patients with incomplete SCI than in those with complete SCI, producing significant improvements, compared with placebo, in a number of measures only in patients with incomplete SCI. All patients who expressed a preference selected sildenafil over placebo, although the drug had no effect on patient Qol. Sildenafil was well tolerated, with a profile comparable to that of placebo. Conclusions: Compared with placebo, treatment with oral sildenafil safelyand effectively improved erectile function in patients with ED attributable to SCI, especially in those with incomplete injury, and was theagent of choice in those who expressed a preference.

Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis.

Abstract Objectives. To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). Methods. A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. Results. Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 ± 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. Conclusions. Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS.

Hypoparathyroidism: a rare cause of spondyloarthropathy

Hypoparathyroidism is characterized by hypocalcaemia, hyperphosphataemia, and low levels of parathyroid hormone (PTH). Skeletal abnormalities as well as ectopic calcifications are among the wellknown features, and the main symptoms such as leg cramps and generalized muscle weakness result from neuromuscular irritability due to hypocalcaemia (1). Rare cases in association with spondylitis and diffuse idiopathic skeletal hyperostosis (DISH) have been reported in the literature (2–5). Two spondyloarthropathy cases associated with idiopathic hypoparathyroidism (IHP) are presented here.

Correct terminology for electrodiagnostic studies

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