Sergio Díaz

Beneficial effects of botulinum toxin type A in trigeminal neuralgia

Botulinum toxin has been thoroughly studied as a potential tool in the treatment of several pain syndromes. Therefore, we assessed the clinical effects of botulinum toxin type A injections in 12 patients with otherwise unresponsive idiopathic trigeminal neuralgia. Patients were infiltrated with 20-50 units of botulinum toxin in trigger zones. Those who presented with mandibular involvement were also infiltrated in the masseter muscle. The patients were assessed on a weekly basis using the Visual Analogic Scale for pain. Ten of our patients reported a significant benefit from botulinum toxin injections, with reduction or even disappearance of pain, and remained pain free for as long as 60 days. Our findings suggest that botulinum toxin may represent a useful therapeutic tool in the management of patients with this entity.

Use of complementary and alternative therapies in outpatients with Parkinson's disease in Argentina†

We interviewed 300 patients (54.7% male; mean age was 65.8 ± 9.5) attending the Movement Disorders Clinic at the Buenos Aires University Hospital to determine the prevalence of CATs use and their association with demographic, social, or disease‐specific characteristics among patients with Parkinsons disease (PD) in Buenos Aires, Argentina. We found that 25.7% of the PD patients interviewed (77/300) stated they had used CATs to improve their PD symptoms whereas 38.0% (114/300) had used some CATs without any relation to PD, at least once in life. At the moment of the interview, CATs prevalence use was 50.6% in the former group and 25.0% in the latter. The use of CATs was much more frequent among women and more common in the 50‐ to 69‐year age group. Friends and neighbors of the patients had most frequently recommended these therapies. No major association was observed between CATs use and the duration of the disease, side of initial involvement, PD phenotype, or the Hoehn and Yahr staging. Acupuncture, homeopathy, yoga, and therapeutic massage were the most widely used therapies. After the initiation of conventional treatment the use of massage, yoga, and acupuncture in patients using CATs to improve PD significantly increased. Neurologists should be aware and inquire about the use of CATs to rule out potentially harmful effects.

Acute Treatment of Trigeminal Neuralgia With Onabotulinum Toxin A

AbstractA double-blind, randomized, placebo-controlled study of patients with essential trigeminal neuralgia and treatment with a single injection of onabotulinum toxin A (BTX) was carried out. The efficacy, safety, and tolerability of either 1 mL 0.9% saline plus 50 U of BTX or only 1 mL of 0.9% saline injected subcutaneously in the affected area were evaluated. Cases with involvement of the third branch of the trigeminal nerve also received intramuscularly either 10 U of BTX or matching placebo in the masseter muscle, ipsilateral to the pain location. Pain was assessed with the visual analog scale (VAS). Twenty subjects were administered BTX, and 16 subjects received placebo. Two months after the intervention, a trend to statistical significance was observed for the VAS mean values in subjects treated with BTX and those who received placebo (VAS 4.9 vs 6.63, t test, P = 0.07). Three months after the injection, significant differences were observed in the average VAS score for subjects treated with BTX and those treated with placebo (VAS 4.75 vs 6.94, respectively; t test, P = 0.01). Onabotulinum toxin A was well tolerated and seems to be a safe and useful therapy for patients with essential trigeminal neuralgia.

Treatment of primary progressive freezing of gait with high doses of selegiline.

We report the case of a 76-year-old, right-handed woman with progressive primary freezing of gait. Despite several therapeutic strategies, she continued to worsen to the point that she became confined to a wheelchair. Treatment with selegiline in doses up to 20 mg/d led to marked improvement of the gait disorder. This case illustrates that selegiline can be an option for patients with freezing of gait other than those with Parkinsons disease.

Delayed onset limb dystonia following electric injury

It has been recognized that head trauma can induce movement disorders including tremor, dystonia, parkinsonism and tics. Likewise, lesions involving the peripheral nervous system have been held responsible for such extrapyramidal manifestations, However, involuntary movements secondary to electric injury have seldom been described. Here we report a patient who developed limb dystonia 6 years after receiving an electric discharge in the ipsilateral limb. Although imaging and laboratory studies failed to ascribe the lesion either to the central or peripheral nervous system, initial symptoms such as local bruises, edema and pain would favor peripheral damage. Botulinum toxin injections markedly improved dystonia. Analysis of cases of dystonia following electric injury reported to date suggest that: (a) dystonia may be expected to develop immediately or even years after the electric insult; (b) dystonia usually develops in or adjacent to the area initially injured; (c) dystonia remains limited to a distinct body segment; (d) severity of dystonia as well as the interval between injury and the onset of the movement disorder fails to correlate with trauma severity; (e) no evidence supports the hypothesis that previous history of movement disorders or neuroleptic exposure are predisposing factors; and (f) botulinum toxic provides symptomatic relief.

Blefaroespasmo. Distonía oromandibular

El blefaroespasmo es una distonia focal que compromete el orbicularis oculi, que en casos severos produce una ceguera funcional. Hemos evaluado las caracteristicas clinicas y perfil neurofarmacologico en 100 casos consecutivos estudiados en los ultimos 9 anos en el Hospital Universitario de Buenos Aires, Argentina. La poblacion estuvo compuesta por 69 mujeres y 39 hombres cuyas edades oscilaron entre 29 y 78 anos. El 61 por ciento presento blefaroespasmo mientras que el resto tenia una distonia oromandibular asociada. La gran mayoria comenzo en la 5ta. decada y el comienzo fue unilateral en el 12 por ciento pero en todos los casos evoluciono a una forma bilateral. Solo el 60 por ciento habia sido previamente diagnosticado en forma correcta, mientras que en el 40 por ciento restante el diagnostico se difirio hasta varios anos el tratamiento mas efectivo fue la infiltracion del orbicular de los parpados con toxina botulinica (88 por ciento) seguido por el lisuride en dosis bajas que beneficio al 56 por ciento y el trihexifenidilo en el 54.5 por ciento de los tratados. Nuestros resultados sugieren que el cuadro puede ser manejado con exito luego de hacer un correcto diagnostico. Las infiltraciones con toxina botulinica debieran ser efectuadas por neurologos con experiencia en movimientos anormales.

Remission of concomitant Henoch-Schöenlein purpura and Sydenham chorea after intravenous corticosteroids.

We report a young girl who developed Henoch-Schoenlein purpura at the age of 11 years. Two weeks later she developed severe asymmetric choreic movements and behavioral disturbances. Sydenham s chorea was diagnosed based on the laboratory evidence and she was given intravenous methylprednisolone for five consecutive days. Both behavioral and movement disorder rapidly resolved. She was asymptomatic at three years of follow-up. The rapid resolution of choreic movements and behavioral disturbances in our patients suggests, intravenous corticosteroids may be an option in the treatment of Sydenhams chorea, more so when the movements are disabling.