Ömer Karadaş

The effectiveness of triamcinolone acetonide vs. procaine hydrochloride injection in the management of carpal tunnel syndrome: a double-blind randomized clinical trial.

Objective: Corticosteroid injection into the carpal tunnel is frequently used for the treatment of carpal tunnel syndrome (CTS). Steroids are usually mixed with local anesthetics, which have positive effects that can aid the treatment of CTS by inhibiting the spontaneous discharge ability of excitable cells. The aim of this study was 3-fold: (1) to determine the efficacy of triamcinolone acetonide injection in the treatment of CTS, (2) to determine the efficacy of procaine hydrochloride (HCl) in the treatment of CTS, and (3) to compare the efficacy of triamcinolone acetonide and that of procaine HCl in the treatment of CTS. Design: This prospective, randomized, double-blind clinical trial included 99 patients (120 median nerves) with clinical and electrophysiologic evidence of CTS. The 120 median nerves were randomly assigned to one of three groups: group 1 received 40 mg of triamcinolone acetonide, group 2 received 4 ml of 1% procaine HCl, and group 3 received both 40 mg of triamcinolone acetonide and 4 ml of 1% procaine HCl. Clinical and electrophysiologic evaluations were performed at the study onset and at 2 and 6 mos after treatment. Results: At the study onset, there were no statistically significant differences between the groups with respect to distal motor latency, compound motor action potential, compound sensory action potential, sensory nerve conduction velocity, or visual analog scale score; however, distal motor latency, compound sensory action potential amplitude, sensory nerve conduction velocity, and visual analog scale scores improved significantly in each group 2 mos after treatment (P < 0.05), and these improvements persisted at 6 mos after treatment (P < 0.05). Significant differences were not observed between groups 1 and 2 or between groups 1 and 3 with respect to electrophysiologic findings at baseline or 2 or 6 mos after treatment (P > 0.05). Group 3 had better compound sensory action potential amplitude and sensory nerve conduction velocity scores than group 2 did at 6 mos (P < 0.05) and better visual analog scale scores than group 2 did at 2 and 6 mos (P < 0.05). Conclusions: Local procaine HCl injection and steroid injection effectively reduced the symptoms of CTS and equally improved electrophysiologic findings. As such, procaine HCl can be used in CTS patients in whom steroid use is contraindicated.

Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache

BackgroundThe present study aimed to evaluate the efficacy of local lidocaine injections into the myofascial trigger points (TPs) located at the pericranial muscles in patients with episodic tension-type headache (ETTH).MethodsThe study included 108 patients with frequent ETTH that were randomized into 4 groups. One injection of saline (NaCl 0.9%) was administered to group 1 (nu2009=u200927), 1 injection of lidocaine (0.5%) was administered to group 2 (nu2009=u200927), group 3 (nu2009=u200927) received 5 injections of saline (NaCl 0.9%), and group 4 (nu2009=u200927) received 5 injections of lidocaine (0.5%); on alternate days 2xa0mL for each muscle was injected into the frontal, temporal, masseter, sternocleidomastoid, semispinalis capitis, trapezius and splenius capitis muscles bilaterally. The frequency of painful days per month (FPD) and the patients’ visual analogue scales (VAS) were evaluated before treatment, and 2, 4 and 6xa0months after treatment.ResultsMean age of the patients was 36.28u2009±u20099.41xa0years (range: 18–54xa0years). FPD scores improved significantly in group 2, 3 and 4 at 2xa0months posttreatment compared to pre- treatment (all Pu2009<u20090.05), and also VAS scores improved significantly in group 2 and 4 at 2xa0months posttreatment (Pu2009<u20090.05) but this improvement insisted at the 6xa0month only in group 4. Group 2 had better VAS and FPD than group 1 only at 2. and 4. months after treatment (for VAS Pu2009<u20090.0121, Pu2009=u20090.0232; for FPD Pu2009=u20090.0003, Pu2009=u20090.0004, respectively). Group 4 had better scores than group 3 at the 2., 4. and 6. months after treatment in both parameters (all Pu2009<u20090.05). Group 2 had better scores than group 1 in FPD at the 2. and 4. months posttreatment (Pu2009=u20090.0003, Pu2009=u20090.0004, respectively), but not at the 6. month.ConclusionLocal lidocaine injections into the myofascial TPs located in the pericranial muscles could be considered as an effective alternative treatment for ETTH.

Effects of steroid with repetitive procaine HCl injection in the management of carpal tunnel syndrome: An ultrasonographic study

BACKGROUND AND AIMnWith the use of musculoskeletal ultrasonography (MSUS), morphological changes in the median nerve have been recently reported in patients with carpal tunnel syndrome (CTS). On the other hand, the literature still lacks the information whether those changes are further altered with steroid and local anesthetic injection which is a widely used treatment in this group of patients. Therefore, the aim of our study was to explore in-vivo the effects of steroid with repetitive procaine HCl injection on the median nerve of patients with CTS.nnnMATERIALS AND METHODnThis prospective clinical trial followed-up patients for 2 months. 22 patients (37 median nerves) with clinical and electrophysiological evidence of CTS were included in the study. All patients received both 40 mg of triamcinolone acetonide once and 4 ml of 1% procaine HCl twice a week for 2 weeks with the same technique. Clinical, functional, electrophysiological and ultrasonographic evaluations were performed at the study onset, and 2 months after the last injection.nnnRESULTSnElectrophysiological, ultrasonographic findings (median nerve anterior-posterior diameter, transverse diameter and cross sectional area in the proximal carpal tunnel and volar bulging,) VAS scores, Boston carpal tunnel symptom and function assessment scale improved significantly (P<0.05).nnnCONCLUSIONnSteroid injection with repetitive procaine HCl injection effectively reduced the symptoms of CTS, improved the Boston carpal tunnel symptom and function assessment scale and also electrophysiological and ultrasonographic findings. Long term effects remain to be studied. Indisputably, the use of MSUS seems to be promising in this regard.

Can triptans safely be used for airplane headache

A few cases of airplane headache (AH) have been reported in the literature. Treatment strategies of AHs are also controversial. We followed-up five patients with AH. They were symptom-free during the daytime. Their physical, neurological, and ear-nose-throat examinations were all normal. Blood chemistries, cerebral magnetic resonance imaging, cerebral magnetic resonance imaging angiography, and paranasal sinus tomography studies of the patients were also normal. We preferred triptans because of the possible effect on the mechanism of AH. Patients were recommended to use single-dose of their drugs half an hour prior to flights. All of the patients had a good response to single dose triptan treatment and became headache-free during flights. This is the first study which puts forward the usefulness of the triptans as a safe treatment choice for airplane AH.

Spectrum of surgical complications of temporal lobe epilepsy surgery: a single - center study.

AIMnAlthough surgery is the most effective means of eliminating or reducing seizures in cases of medically refractory epilepsy, the expected or unexpected surgical complications must also be kept in mind in order not to decrease patients quality of life. The aim of this present study was to assess the surgical complications of temporal lobe epilepsy surgery and their effects on the disease course in patients with intractable epilepsy arising from the temporo-mesial structures.nnnMATERIAL AND METHODSnThe records of 58 patients who underwent temporal lobectomy and/or selective amygdalahippocampectomy at Gülhane Military Medical Academy between January 2000 and August 2010 were reviewed for peri- and post-surgical complications.nnnRESULTSnPost-surgical complications were detected in 7 patients (12%). The most common complication of ES was infection in 2 patients (2.9%). Other complications were hemorrhagic infarction, paresis of the frontal branch of the left facial nerve, subdural effusion, anxiety disorder, depressive disorder and late-onset psychosis.nnnCONCLUSIONnThe results of our study suggest the importance of post-operative care and long-term follow up in order to achieve favorable seizure outcome after epilepsy surgery.

Efficacy of Local Lidocaine Application on Anxiety and Depression and Its Curative Effect on Patients with Chronic Tension-Type Headache

Background: Tension-type headache (TTH) is a primary headache disorder. In this study, the efficacy of local lidocaine application on anxiety and depression and its curative effect in patients with chronic TTH was investigated. Methods: Forty-eight patients (24 local lidocaine injection, 24 local saline injection group) with chronic TTH were enrolled in our study. Injections were applied to the trigger points of the muscles that are innervated by C1-C3 and the trigeminal nerve, exit points of the fifth cranial nerve, and around the superior cervical ganglion. Each patient underwent one session every 3 days. Patients were evaluated before and 3 months after the treatment. Results: In both groups, the number of painful days in a month, visual analogue scale values, amount of analgesic use in a month, Hamilton depression score, and Hamilton anxiety score decreased after the treatment. As a result, all of the parameters were found to have improved in both groups (p < 0.05), the results were statistically significant, and the lidocaine groups response to the treatment was better than the placebo group (p < 0.001). Conclusion: Our findings suggest that local lidocaine administration can be an effective method in the treatment of chronic TTH.

Airplane headache in pediatric age group: report of three cases

Headache disorders in children and adolescents are common disabling problem with a significant impact on the quality of life of both children and parents [1, 2]. Airplane headache (AH) is a rare form of headache disorders associated only with airplane travel; in particular, with an onset of the pain during taking-off or landing or both [3]. In the literature, AH cases have been reported only in adults so far. Currently, we represent three AH cases in pediatric age group with their clinical manifestations, treatment strategies and 12-month follow-up results.

Nocturnal headache associated with melatonin deficiency due to a pineal gland cyst

The cyclic nature of some of headache disorders is closely related to melatonin, which is secreted by the pineal gland. We report a 29-year-old male patient with a 2.5-year history of headaches that woke him in the middle of the night. These headaches were pulsatile and continued until sunrise. During these attacks he also suffered from allodynia over the scalp, bilateral conjunctival hyperemia, and nervousness. His brain MRI showed a 5mm by 4mm neuroepithelial cyst in the pineal gland. The peak plasma melatonin level that was measured at 2 am was 28 pg/mL. The patient underwent oral melatonin treatment (6 mg/day). After 1 month he experienced a 70% reduction in his symptoms. When the melatonin dosage was increased to 10mg/day he became headache-free, and 5 months after the treatment began, had no complaints. His 5-month follow-up plasma melatonin level at 2 am was 61 pg/mL. To our knowledge this is the first report of a patient with nocturnal headache associated with a low level of melatonin due to a neuroepithelial cyst in the pineal gland.

[Botulinum neuro-toxin aype-A in the treatment of chronic tension type headache associated with pericranial tenderness].

OBJECTIVESnBoth peripheral and central nociceptive mechanisms are responsible in chronic TTH. Analgegics are used in the acute treatment of chronic TTH and antidepressants are used in prophylactic treatment. However, further studies are needed to bring out new treatment options. The aim of our study is to investigate the effectiveness of Botulinum Neuro-toxin Type-A (BoNTA) in the treatment of chronic TTH associated with pericranial tenderness (PT).nnnMETHODSn14 patients with chronic TTH with PT were included in the study. 50 units Botox(®) injection was applied to the pericranial muscles (5 units for each muscles bilaterally: frontal, temporal, semispinalis capitis, spenius capitis and trapezius muscles) for each patient. Severity of headache was evaluated by VAS (Visual Analogue Scale) and number of days with headache per month were recorded before treatment and 2nd and 4th months after treatment.nnnRESULTSnNumber of days with headache per month were 19.57 ± 3.25 before treatment, 15.28 ± 4.37 at the 2nd month after treatment and 15.78 ± 3.90 at the 4th month after treatment. Severity of headache was 65.71 ± 9.16 before the treatment, 50.71 ± 13.56 at the 2nd month after treatment and 54.28 ± 10.35 at the 4th month after treatment (p<0.05). Frequency and severity of headache before treatment were significantly decreased at the 2nd month after treatment and this significance continued at the 4th month after treatment (p<0.05).nnnCONCLUSIONnBoNTA treatment may be usefull in the treatment of patients with chronic TTH associated with PT.

The Effects of Topiramate Therapy on Cerebral Metabolism in Migraine with Aura Patients

AIMnTopiramate is an antiepileptic drug with multiple mechanisms of action that is also used for migraine prophylaxis. This study aimed to investigate the efficacy of topiramate therapy for migraine prophylaxis, based on vasomotor reactivity ([VMR] an indicator of cerebral autoregulation), and to identify changes in cerebral hemodynamics during the treatment.nnnMATERIAL AND METHODSnWe included 20 migraine (with aura) patients (group 1) and 20 healthy controls (group 2) in the study. Transcranial Doppler monitoring was performed in both groups with patients in the supine and resting position. Using a two-sided temporal window at depths of 45-60 mm for the middle cerebral artery (MCA) and depths of 60-70 mm for the posterior cerebral artery (PCA), basal flow rates and VMR values were measured. Group 1 initially received 25 mg/d of topiramate orally, and then the dose was increased 25 mg every week. At the fourth week; the optimal dose was increased to 50 mg b.i.d. and the treatment was continued at this dose. Transcranial Doppler parameters were re-evaluated 2 months after treatment. In addition, the number of attacks per month, duration of pain, and visual analog scale (VAS) scores obtained before the treatment and 2 months after the treatment in group 1 were compared.nnnRESULTSnBasal flow rates and VMR values recorded from the right and left MCA in group 1 were significantly higher than those in the control group (P < 0.05). Flow velocities obtained from the right and left MCA, and the VMR values in group 1 after topiramate treatment did not differ significantly from those in the control group (P > 0.05). In addition, the number of attacks, duration of pain, and VAS scores in group 1 were significantly lower after the treatment than before the treatment (P < 0.05).nnnCONCLUSIONnTopiramate is an effective prophylactic treatment in migraine with aura patients and appeared to play a positive role in the regulation of cerebrovascular autonomic control.