1/6. Electromyographic (EMG) biofeedback in the comprehensive treatment of central pain and ataxic tremor following thalamic stroke.Peripheral pain and ataxic tremor can appear suddenly following thalamic stroke and can significantly alter a patient's psychological, social, and physical functioning. The present paper reports the case of a 70-year-old Caucasian female who sustained an acute left posterior cerebral artery infarction involving the thalamus and left mesiotemporal regions. She subsequently developed Central Poststroke pain and ataxic movement of her right arm and hand in addition to a significant right-side claudication. She was treated over 16 weeks (6 weeks of EMG biofeedback and 10 weeks of psychotherapy) with a combination of EMG biofeedback, progressive muscle relaxation, behavioral pain coping skills training, Forced Use Therapy, and Cognitive Behavioral Therapy 7 years after her initial cerebral accident. The case demonstrates the utility of biofeedback when combined as part of a comprehensive treatment program to address the multiple complications associated with thalamic stroke.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Infantile tremor syndrome and zinc deficiency.Infantile tremor syndrome is characterized by coarse tremors, mental and physical retardation, light colored brown hair, skin pigmentation and anemia. Amongst the theories proposed for the etilogy of the disorder, the nutritional theory is most accepted. In this case report, we have presented a fourteen-month-old male child with ITS and documented zinc deficiency. Though most of the previous workers have proposed vitamin-B12 deficiency as the etimology for ITS, our report suggests that zinc deficiency could also have a causative role.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/6. Treatment of tremors in complex regional pain syndrome.A 14-year-old girl presented with Complex Regional pain syndrome, Type I (CRPS-1) of the left ankle after a remote history of sprain. Allodynia, pain, temperature and color changes, and swelling were successfully treated with physical therapy, transcutaneous electrical nerve stimulation (TENS), gabapentin, amitriptyline, and tramadol. Five weeks later, she presented with a continuous, involuntary, intermittent coarse tremor of the left foot causing increased pain. The electromyogram showed rhythmic discharges of 3 Hz frequency lasting 20-80 milliseconds in the left tibialis, peroneus and gastrocnemius, suggestive of either basal ganglia or spinal origin. Tremor and pain were controlled with epidural bupivacaine, but the tremor reappeared after discontinuing epidural blockade. carbidopa/levodopa 25/100 (Sinemet) was started and the tremor disappeared after two days. With continued physical therapy, pain and swelling resolved within two months and carbidopa/levodopa was discontinued after five weeks with no recurrence of the tremor. Our success in the treatment of CRPS-associated tremor in this young girl with carbidopa/levodopa suggests that this patient may have had underlying movement disorder which was unmasked by the peripheral injury.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/6. Case study of a young man with tremor.PURPOSE: To provide the clinician with an opportunity to review the most common causes of tremor in young adults. DATA SOURCES: Extensive review of international scientific literature on tremors and other movement disorders, supplemented by a recent case study. CONCLUSIONS: essential tremor (ET) is the most common tremor disorder in the world. In contrast to common expectations, the 2nd decade of life represents a period of peak incidence. The early presentation may be so mild that the tremor goes unnoticed by patients and clinicians for many years. The most important movement disorder to rule out in the workup of patients with tremors is Parkinson's disease. IMPLICATIONS FOR PRACTICE: The diagnosis of ET is generally made on clinical grounds. A comprehensive history and careful physical examination that rules out cerebellar or extrapyramidal disease is required. The clinician must distinguish between resting tremors and action tremors. If the appropriate diagnosis is unclear, a tremor recording (electromyogram) may assist in this distinction. Referral to a neurologist may be warranted.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Vertebrobasilar ischemia and spinal manipulation.OBJECTIVE: To examine cerebral arterial blood flow in 2 patients exhibiting signs of vertebrobasilar arterial ischemia (VBI) before and after spinal manipulative therapy. CLINICAL FEATURES: Two patients had a repetitive/resting tremor, one from a spastic torticollis with the onset immediately after self-manipulation by the patient 6 months earlier, and the second one with a generalized resting tremor, hip clonus, dizziness, and presyncope. The diagnosis of vertebrobasilar ischemia was established by continuous wave Doppler ultrasound and physical examination. INTERVENTION AND OUTCOME: Nonrotary cervical manipulation and diversified technique to the thoracic spine were performed. In the first patient, the spastic tremor improved by 80%. The repeat Doppler performed 13 months later showed an improvement in the arterial flow in the right external carotid artery peak flow from 0.7 kHz to 1.75 kHz. In the second patient, the resting tremor diminished in 4 days, with the right common carotid artery peak systolic flow improving from 1.0 kHz to 1.9 kHz and the left vertebral artery flow improving from 0.175 kHz to 0.5 kHz. The symptoms of VBI and objective Doppler findings improved following spinal manipulation. Both cases had impaired vertebral arterial flow. CONCLUSION: Spinal manipulation may have a normalizing effect on the sympathetic nervous system, allowing for a change in vasospastic cerebral vascular arteries.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Gamma-hydroxybutyrate: an emerging drug of abuse that causes physical dependence.Gamma-hydroxybutyrate (GHB) is a compound found in mammalian brain which meets many criteria of a neurotransmitter. GHB has been investigated as a tool for inducing absence (petit mal) seizures, for use as an anesthetic, and for treatment of narcolepsy, alcohol dependence and opiate dependence. Since 1990 GHB has been abused in the united states for euphoric, sedative and anabolic effects. coma and seizures have been reported following abuse of GHB, but dependence liability has received little attention. The neuropharmacology, potential therapeutic uses and acute adverse effects of GHB are reviewed, followed by a case series of eight people using GHB. Adverse effects of GHB may include prolonged abuse, seizure activity and a withdrawal syndrome. This withdrawal syndrome includes insomnia, anxiety and tremor; withdrawal symptoms resolve in 3-12 days. GHB has the potential to cause a significant incidence of abuse and adverse effects. Prolonged use of high doses may lead to a withdrawal syndrome, which resolves without sequelae. Educational efforts should address the narrow therapeutic index, possible physical dependence and dangers of combining GHB with other drugs of abuse.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |