Successful treatment of urodynamic detrusor over-activity in a young patient with Myasthenia gravis using pretibial nerve stimulation with follow-up to two years

Background: The cannabinoid system may be involved in the humoral mechanisms at the neuromuscular junction. Ultramicronized-palmitoylethanolamide (μm-PEA) has recently been shown to reduce the desensitization of Acetylcholine (ACh)-evoked currents in denervated patients modifying the stability of ACh receptor (AChR) function. <p> Objective: To analyze the possible beneficial effects of μm-PEA in patients with myasthenia gravis (MG) on muscular fatigue and neurophysiological changes. <p> Method: The duration of this open pilot study, which included an intra-individual control, was three weeks. Each patient was assigned to a 1-week treatment period with μm-PEA 600 mg twice a day. A neurophysiological examination based on repetitive nerve stimulation (RNS) of the masseteric and the axillary nerves was performed, and the quantitative MG (QMG) score was calculated in 22 MG patients every week in a three-week follow-up period. AChR antibody titer was investigated to analyze a possible immunomodulatory effect of PEA in MG patients. <p> Results: PEA had a significant effect on the QMG score (p=0.03418) and on RNS of the masseteric nerve (p=0.01763), thus indicating that PEA reduces the level of disability and decremental muscle response. Antibody titers did not change significantly after treatment. <p> Conclusion: According to our observations, μm-PEA as an add-on therapy could improve muscular response to fatigue in MG. The possible modulation of AChR currents as a means of eliciting a direct effect from PEA on the conformation of ACh receptors should be investigated. The co-role of cytokines also warrants an analysis. Given the rapidity and reversibility of the response, we suppose that PEA acts directly on AChR, though further studies are needed to confirm this hypothesis.

Download Full-text

Five-Year Follow-up of a Case of Radical Robotic Excision of Clear Cell Thymic Carcinoma Associated with Thymoma and Myasthenia Gravis

Indian Journal of Surgery ◽

10.1007/s12262-021-02847-6 ◽

2021 ◽

Author(s):

Stefano Bongiolatti ◽

Alberto Salvicchi ◽

Camilla E. Comin ◽

Luca Voltolini

Keyword(s):

Myasthenia Gravis ◽

Thymic Carcinoma ◽

Clear Cell

Download Full-text

Efficacy of Manual Therapy and Transcutaneous Electrical Nerve Stimulation in Cervical Mobility and Endurance in Subacute and Chronic Neck Pain: A Randomized Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm10153245 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3245

Author(s):

Belén Díaz-Pulido ◽

Yolanda Pérez-Martín ◽

Daniel Pecos-Martín ◽

Isabel Rodríguez-Costa ◽

Milagros Pérez-Muñoz ◽

...

Keyword(s):

Primary Care ◽

Neck Pain ◽

Manual Therapy ◽

Nerve Stimulation ◽

Transcutaneous Electrical Nerve Stimulation ◽

Sagittal Plane ◽

Chronic Neck Pain ◽

Post Intervention ◽

Electrical Nerve Stimulation

Neck pain is a frequent health problem. Manual therapy (MT) and transcutaneous electrical nerve stimulation (TENS) are recommended techniques for treatment of mechanical neck disorders (MND) in Spanish Public Primary Care Physiotherapy Services. The aim of this study was to compare the efficacy of MT versus TENS in active mobility and endurance in cervical subacute or chronic neck pain. Ninety patients with MND were randomly allocated to receive ten 30-min sessions of either MT or TENS, in a multi-centered study through 12 Primary Care Physiotherapy Units in the Madrid community. Active cervical range of motion (CD-ROM) and endurance (Palmer and Epler test) were evaluated pre- and post-intervention and at 6-month follow-up. A generalized linear model of repeated measures was constructed for the analysis of differences. Post-intervention MT yielded a significant improvement in active mobility and endurance in patients with subacute or chronic MND, and at 6-month follow-up the differences were only significant in endurance and in sagittal plane active mobility. In the TENS group, no significant improvement was detected. With regard to other variables, MT improved mobility and endurance more effectively than TENS at post-intervention and at 6-month follow-up in the sagittal plane. Only MT generated significant improvements in cervical mobility and endurance in the three movement planes.

Download Full-text

Percutaneous tibial nerve stimulation for idiopathic and neurogenic overactive bladder dysfunction: a four-year follow-up single-centre experience

Scandinavian Journal of Urology ◽

10.1080/21681805.2021.1885486 ◽

2021 ◽

Vol 55 (2) ◽

pp. 169-176 ◽

Cited By ~ 1

Author(s):

K. Andersen ◽

H. Kobberø ◽

T. B. Pedersen ◽

M. H. Poulsen

Keyword(s):

Overactive Bladder ◽

Nerve Stimulation ◽

Bladder Dysfunction ◽

Tibial Nerve ◽

Percutaneous Tibial Nerve Stimulation ◽

Single Centre ◽

Tibial Nerve Stimulation ◽

Single Centre Experience

Download Full-text

Myasthenia gravis in children: analysis of 18 patients

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2001000500005 ◽

2001 ◽

Vol 59 (3B) ◽

pp. 681-685 ◽

Cited By ~ 13

Author(s):

Maria da Penha A. Morita ◽

Alberto A. Gabbai ◽

Acary S.B. Oliveira ◽

Audrey S. Penn

Keyword(s):

Myasthenia Gravis ◽

Intravenous Immunoglobulin ◽

Acetylcholine Receptor ◽

Nerve Stimulation ◽

Chest Ct ◽

Clinical Severity ◽

Myasthenic Crisis ◽

Repetitive Nerve Stimulation ◽

Follicular Hyperplasia ◽

Receptor Antibodies

Myasthenia gravis (MG) in childhood is rare comprising 10 to 20 % of all myasthenic patients. We studied 18 patients with MG whose first symptoms started from 1 to 12 years of age, followed at the Department of Neurology of the UNIFESP-EPM, from January 1983 to August 1997. There were 10 girls and 8 boys (1.2:1). Eleven patients (61%) presented moderate or severe generalized disease and 4 (22%) had at least one myasthenic crisis. EMG with supramaximal repetitive nerve stimulation was diagnostic in 8 (47%) out of 17 patients, and chest CT was normal in 14 patients. Seropositivity to acetylcholine receptor antibodies was found in 81.6% (9 out of 11 tested) and the levels had no relation to clinical severity. Nine out of 16 patients (56%) worsened with pyridostigmine alone and were treated with prednisone. Four out of those nine continued worsening despite steroids and were subjected to thymectomy (all showed thymic lymphoid follicular hyperplasia). Three patients (75%) improved markedly after thymectomy and one (25%) worsened, eventually getting better with intravenous immunoglobulin and oral azathioprine. MG treatment, using all resources available, has to be individualized for each child.

Download Full-text