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Rehabilitation of : Cephalgia
Merck Online Lab
Diagnosis Therapy < Rehabilitation > Imaging Clinical Laboratory
[Post-encephalitic syndrome in patients with tick-borne encephalitis]
Author(s): Misi; ć Majerus, L; Dakovi; ć Rode, O; Ruzi; ć Sabljić, E
Journal: Acta Med Croatica 2010 Jan 27; Vol. 63, Issue 4; Page(s) 269-78
[Medline ID - 20034327]

BACKGROUND: It was 55 years ago when the first patients with tick-borne encephalitis (TBE) were diagnosed in the Koprivnica-Krizevci County. Since then, we have acquired some new knowledge about the disease. TBE is an endemic disease and the second most common tick-borne disease following Lyme borreliosis in our country, with an average morbidity rate of 12 patients per year and predominance of male individuals older than 50. There are no specific risk groups because such patients have been continuously vaccinated for the past 27 years. In 88.0% of patients, the infection is manifested as aseptic meningitis and meningoencephalitis with a biphasic course. As opposed to detailed descriptions of acute morbidity, there are few reports on the course of disease and its outcome. OBJECTIVES: The aim of the study was to assess the presence of post-encephalitic syndrome (PES) in patients with TBE, to evaluate its incidence and demonstrate its characteristics. PATIENTS AND METHODS: This prospective study was conducted from 1995 to 2008 and enrolled PES patients treated at Department of Infectious Diseases, Dr. Tomislav Bardek General Hospital in Koprivnica during the study period. The study included patients of both sexes older than 14 years with recent TBE virus infection, patients with clear temporal correlation between acute morbidity and PES onset, and patients where any other cause of PES was ruled out. The immunoenzyme linked assay (ELISA) was used for detection of serum IgM and IgG antibodies. Recent TBE virus infection was detected in 133 patients. Nine of these patients refused further cooperation, and the remaining 124 patients, 80 male (64.5%) and 44 female (35.4%), aged 16-76, were included in the study. We longitudinally examined the manifestation and characteristics of PES in each patient during a 3-year period (and longer if necessary). Study patients were divided into three groups of mild, moderate and severe PES based on data collected and entered into specially prepared questionnaire and by qualitative analysis of PES effect on their daily habits and activities. RESULTS: Out of 124 patients included in the study, 60 (48.3%) had no symptoms/signs of PES, or these were mild and of short duration 15 (12.0%). The remaining 49 (39.5%) patients developed moderate (30/47.0%) or severe (19/30.0%) PES lasting for 3-18 months, with significant impact on their daily habits and activities requiring some adjustment. The main characteristics of PES were mental disorders, balance and movement coordination disorders, headache, general malaise, and reduced working ability. PES was recorded in 35 (28.2%) patients with meningoencephalitis and 14 (11.2%) patients with meningoencephalomyelitis. Permanent sequels were left over in 11 (17.1%) patients: spinal nerve paresis in five (4.0%), hearing impairment in six (5.6%), dysarthria in two (1.6%) patients, and severe mental disorder in one (0.8%) patient. In three patients we recorded simultaneous permanent spinal nerve paralysis and permanent deafness. During our longitudinal study three (2.5%) patients died. CONCLUSION: The study undoubtedly confirmed the presence of PES in our patients with TBE. Moderate and severe PES has a significant impact on the patient quality of life, demands patient adjustment, and increases expenses of long-term sick-leave and rehabilitation.

Reliability of thickness measurements of the dorsal muscles of the upper cervical spine: an ultrasonographic study.
Author(s): Lin, YJ; Chai, HM; Wang, SF
Journal: J Orthop Sports Phys Ther 2010 Mar 31; Vol. 39, Issue 12; Page(s) 850-7
[Medline ID - 20026880]

STUDY DESIGN: Clinical measurement, reliability. OBJECTIVES: To examine the intraday intrarater reliability of measuring thickness of the upper dorsal neck muscles at rest, as well as at 50% of maximum voluntary isometric contraction (MVIC), for upper cervical extension. BACKGROUND: Methodology for measuring the thickness of the lower dorsal neck muscles, including semispinalis capitis and multifidus muscles, during contraction using ultrasonography has been establish ed. Thickness measurements for the upper dorsal neck muscles have not been documented. METHODS: Ten subjects (21 to 30 years of age) without neck pain and headache were recruited. Their upper dorsal neck muscles were measured both at rest and during 50% MVIC for upper cervical extension in sitting position using rehabilitative ultrasound imaging (RUSI). Muscles measured included the rectus capitis posterior major, oblique capitis superior, semispinalis capitis, and splenius capitis. All measurements were repeated after 10 minutes of rest, on the same day, by the same rater. Descriptive statistics were supplemented by calculations of intraclass correlation coefficient (ICC3,1), standard error of measurement (SEM), within-subject coefficient of variation (CVw), and minimal detectable change (MDC). RESULTS: ICC3,1 results ranged from 0.87 to 0.99 for thickness measurements made at rest and from 0.90 to 0.98 for thickness measurements made with a 50% MVIC. The SEMs for thickness measurements at rest and at 50% MVIC ranged from 0.11 to 0.46 mm and 0.23 to 0.52 mm, while the CVws ranged from 3.5% to 6.1% and 3.7% to 6.4%, and MDC95 ranged from 0.35 to 1.46 mm and 0.73 to 1.65 mm, respectively. The thickness of all upper dorsal neck muscles measured during a 50% MVIC was greater than when measured at rest (P < .029). CONCLUSION: Thickness measurements of the upper dorsal neck muscles using RUSI were reliable both at rest and during a 50% effort isometric contraction.

Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice.
Author(s): Rosenzweig, S; Greeson, JM; Reibel, DK; Green, JS; Jasser, SA; Beasley, D
Journal: J Psychosom Res 2010 Mar 3; Vol. 68, Issue 1; Page(s) 29-36
[Medline ID - 20004298]

OBJECTIVE: This study compared changes in bodily pain, health-related quality of life (HRQoL), and psychological symptoms during an 8-week mindfulness-based stress reduction (MBSR) program among groups of participants with different chronic pain conditions. METHODS: From 1997-2003, a longitudinal investigation of chronic pain patients (n=133) was nested within a larger prospective cohort study of heterogeneous patients participating in MBSR at a university-based Integrative Medicine center. Measures included the Short-Form 36 Health Survey and Symptom Checklist-90-Revised. Paired t tests were used to compare pre-post changes on outcome measures. Differences in treatment effect sizes were compared as a function of chronic pain condition. Correlations were examined between outcome parameters and home meditation practice. RESULTS: Outcomes differed in significance and magnitude across common chronic pain conditions. Diagnostic subgroups of patients with arthritis, back/neck pain, or two or more comorbid pain conditions demonstrated a significant change in pain intensity and functional limitations due to pain following MBSR. Participants with arthritis showed the largest treatment effects for HRQoL and psychological distress. Patients with chronic headache/migraine experienced the smallest improvement in pain and HRQoL. Patients with fibromyalgia had the smallest improvement in psychological distress. Greater home meditation practice was associated with improvement on several outcome measures, including overall psychological distress, somatization symptoms, and self-rated health, but not pain and other quality of life scales. CONCLUSION: MBSR treatment effects on pain, HRQoL and psychological well-being vary as a function of chronic pain condition and compliance with home meditation practice.

Self-limiting benign paroxysmal positional vertigo following use of whole-body vibration training plate.
Author(s): Amir, I; Young, E; Belloso, A
Journal: J Laryngol Otol 2009 Dec 17; Vol. 124, Issue 7; Page(s) 796-8
[Medline ID - 20003605]

OBJECTIVE: We describe a case of benign paroxysmal positional vertigo which occurred after use of a whole-body vibration training plate. METHOD: Case report and literature review concerning the secondary causes of benign paroxysmal positional vertigo and the physiological effects of whole-body vibration training plates. RESULTS: A 44-year-old woman was referred with classic symptoms of benign paroxysmal positional vertigo following use of a whole-body vibration training plate, a popular form of fitness equipment widely used in sports, rehabilitation and beauty treatments. The condition resolved spontaneously after several days. There have been reports of negative side effects in users of this equipment, such as dizziness, headache and a sensation of imbalance; however, there have been no reported cases involving vertigo. Based on a literature review, this equipment may cause side effects, including vertigo, by generating forces that can increase the original amplitude of internal organs, which may potentially cause labyrinthine trauma or dislocation of otoconia, leading to benign paroxysmal positional vertigo. CONCLUSIONS: We suggest that whole-body vibration training plates may potentially induce benign paroxysmal positional vertigo. Manufacturers may need to make users of this equipment aware of this risk, and remind them to use it with caution.

Contrast echocardiography and migraine in divers with patent foramen ovale.
Author(s): Di Fabio, R; Giugni, E; Angeloni, I; Vanacore, N; Casali, C; Pierallini, A; Vadal; à, R; Pierelli, F
Journal: Can J Neurol Sci 2009 Dec 30; Vol. 36, Issue 6; Page(s) 740-4
[Medline ID - 19960753]

BACKGROUND: It has been proposed that the patent foramen ovale (PFO) may be associated with migraine, in particular migraine with aura. However, it is not clear whether paradoxical embolism triggers crises of headache. Cerebral embolization is provoked in subjects with PFO through contrast echocardiography, a safe method to diagnose the presence of foramen ovale pervium. METHODS: Twenty-four men practicing diving, an activity characterized by increased prevalence of PFO and migraine, underwent trans-thoracic echocardiography with contrast solution, composed of saline and air mixture and checked for the occurrence of migraine in the following 24 hours. RESULTS: A PFO (five of minimal size, i.e. visible only during Valsalva, one of small and two of medium size) was detected in 8/24 divers (33%). No one reported headache over the 24 hours after the procedure. DISCUSSION: Our preliminary data suggest that cerebral micro-embolism, provoked by contrast echocardiography, does not systematically trigger migraine crises when a minimal-to-medium sized patent foramen ovale is present.

[Development and implementation of integrated health care in pain medicine : the nationwide German headache treatment network]
Author(s): G; öbel, H; Heinze, A; Heinze-Kuhn, K; Henkel, K; Roth, A; R; üschmann, HH
Journal: Schmerz 2010 May 4; Vol. 23, Issue 6; Page(s) 653-70
[Medline ID - 19921280]

Integrated care builds interdisciplinary networks across the different healthcare sectors. A conjoint effort toward clearly defined treatment goals is crucial for medically effective and economically efficient care. Allowing creativity in the implementation of integrated care triggers competition for more effective ideas and better solutions. Based on a summary of the development of integrated care and the example of the nationwide German headache treatment network, the successful organization and implementation of this cross-sectoral care within pain medicine is illustrated. An interdisciplinary nationwide network of pain therapists working hand in hand across the sectors, both in the outpatient and inpatient setting, and employing modern treatment regimens results in optimal pain relief. The treatment quality is assessed by continuous accompanying research and sustainable cost efficiency in all sectors of healthcare is confirmed through analysis of both direct and indirect costs. The project was started in May 2007. In the meantime, almost all large statutory health insurance providers in Germany have joined this healthcare project. The large treatment network confirms the significant clinical and economic efficiency of pain medicine. It demonstrates that coordinated modern therapy effectively relieves pain, lowers costs sustainably, and reduces sick leave. Patient satisfaction is very high. The healthcare providers may directly participate in treatment success through risk-sharing.

Widespread sensory hypersensitivity is not a feature of chronic headache in elders.
Author(s): Uthaikhup, S; Sterling, M; Jull, G
Journal: Clin J Pain 2010 Jan 27; Vol. 25, Issue 8; Page(s) 699-704
[Medline ID - 19920720]

OBJECTIVES: To investigate if hypersensitivity is present in elders with pain. Chronic headache was used as a model of chronic pain and mechanical and thermal pain thresholds were measured. METHODS: Ninety-three people with headache and 44 control individuals participated in the study. Headache patients completed a headache questionnaire. Pressure pain thresholds were measured over the forehead, upper neck, and at a remote site (tibialis anterior). Heat and cold pain thresholds were measured over the upper neck. RESULTS: In the headache group, 26 had headaches classifiable as migraine, 10 with tension-type, 24 with cervicogenic, and 33 headaches were unclassifiable. There were no significant differences between the headache groups and controls in pressure and cold pain thresholds (all P > 0.05). Heat pain thresholds were significantly lower in the headache groups (all P < 0.01) but there were no differences between headache types (all P > 0.05). No strong relationships were found between any headache variables and pain thresholds. DISCUSSION: Central hyperexcitability does not seem to be a feature of elders with headache. This may be as a consequence of age-related changes in the sensory system but could also be related to the nature of the stimulus provided. Further research in this area is required to better understand pain processing in elders.

Does exercise therapy improve headache? a systematic review with meta-analysis.
Author(s): Fricton, J; Velly, A; Ouyang, W; Look, JO
Journal: Curr Pain Headache Rep 2010 Feb 25; Vol. 13, Issue 6; Page(s) 413-9
[Medline ID - 19889280]

ABSTRACT NOT AVAILABLE

Giant cell arteritis misdiagnosed as temporomandibular disorder: a case report and review of the literature.
Author(s): Reiter, S; Winocur, E; Goldsmith, C; Emodi-Perlman, A; Gorsky, M
Journal: J Orofac Pain 2010 Jan 27; Vol. 23, Issue 4; Page(s) 360-5
[Medline ID - 19888487]

Giant Cell Arteritis Misdiagnosed as Temporomandibular Disorder: A Case Report and Review of the Literature Shoshana Reiter Ephraim Winocur Carole Goldsmith Alona Emodi-Perlman Meir Gorsky Giant cell arteritis (GCA) is a systemic vasculitis involving medium and large-sized arteries, most commonly the extracranial branches of the carotid artery. Early diagnosis and treatment are essentia l to avoid severe complications. This article reports on a GCA case and discusses how the orofacial manifestations of GCA can lead to misdiagnosis of GCA as temporomandibular disorder. GCA should be included in the differential diagnosis of orofacial pain in the elderly based on the knowledge of related signs and symptoms, mainly jaw claudication, hard end-feel limitation of range of motion, and temporal headache.

Emergency department assessment of mild traumatic brain injury and the prediction of postconcussive symptoms: a 3-month prospective study.
Author(s): Sheedy, J; Harvey, E; Faux, S; Geffen, G; Shores, EA
Journal: J Head Trauma Rehabil 2010 Jan 28; Vol. 24, Issue 5; Page(s) 333-43
[Medline ID - 19858967]

OBJECTIVE: To investigate the utility of a brief emergency department (ED) bedside screen for the prediction of postconcussive symptoms at 3 months following mild traumatic brain injury (MTBI). PARTICIPANTS: One hundred patients with MTBI (78% men; mean age = 33.6 years); 2 control groups (each n = 100), a "minor nonhead injury" group (77% men; mean age = 32.2 years) and an "uninjured ED visitor" group (78% men; mean age = 33.6 years). MAIN MEASURES: Brief measures of neuropsychological functioning, acute pain, and postural stability were collected in the ED; telephone follow-up at 3 months using the Rivermead Post-Concussion Symptoms Questionnaire was undertaken. RESULTS: Neuropsychological deficits, acute pain, and postural instability in the ED were significantly associated with postconcussive symptoms at 3-month follow-up. A regression formula using 3 easily obtainable measures obtained during acute stag e of injury-immediate and delayed memory for 5 words and a visual analog scale score of acute headache-provided 80% sensitivity and 76% specificity for the prediction of clinically significant symptoms at 3 months postinjury. CONCLUSION: A small combination of variables assessable in the ED may predict MTBI patients likely to experience persistent postconcussive symptoms.
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