Exploding Head Syndrome as Aura of Migraine with Brainstem Aura: A Case Report

This article reports a case of exploding head syndrome (EHS) as an aura of migraine with brainstem aura (MBA). A middle-aged man presented with intermittent episodes of a brief sensation of explosion in the head, visual flashing, vertigo, hearing loss, tinnitus, confusion, ataxia, dysarthria, and bilateral visual impairment followed by migraine headache. The condition was diagnosed as MBA. Explosive head sensation, sensory phenomena, and headaches improved over time with nortriptyline. This case shows that EHS can present as a primary aura symptom in patients with MBA.

Sensory neuropathic symptoms in idiopathic Parkinson's disease: prevalence and impact on quality of life

BACKGROUND

Neuropathic symptoms are commonly reported in Parkinson's disease (PD), but robust data on the epidemiology of such symptoms are lacking. The present study sought to investigate the prevalence and determinants of peripheral sensory neuropathic symptoms (PSNS) in idiopathic PD (IPD) and ascertain the effects of such symptoms on the patients' quality of life (QoL).

METHODS

Patients with IPD and age-matched and gender-matched controls were screened for neuropathic symptoms using the Michigan Neuropathy Screening Instrument. The impact of neuropathic symptoms on QoL was investigated using the 36-Item Short Form Survey.

RESULTS

Fifty-two patients and 52 age-matched and gender-matched controls were recruited. PSNS were reported more frequently in patients with IPD than in the control subjects (57.7 versus 28.8%, p = 0.003). No significant relationships were found between PD-related clinical characteristics (i.e. disease severity and duration, duration of exposure to levodopa) and the presence of PSNS. Significant correlations were found between the number of PSNS and physical functioning (Spearman's Rho - 0.351), even after adjusting for age, gender and Hoehn and Yahr score.

CONCLUSION

Our results support the notion of a greater prevalence of PSNS in IPD patients as compared to the general population, which, at least in part, may be secondary to large and/or small fibre peripheral neuropathy. This warrants further investigation in larger studies that include detailed neurophysiological assessments.

Sufentanil Alleviates Intrathecal Lidocaine Induced Prolonged Sensory and Motor Impairments but not the Spinal Histological Injury in Rats

Spinal anesthesia has evolved into a safe and widely accepted method of anesthesia. Synergy between opioids and local anesthetics further increases the quality of analgesia and decreases the dose requirement of both local anesthetics and opioids. However, over the last decades compelling evidence suggested that lidocaine could be more neurotoxic than other commonly used local anesthetics. Whether opioids can modify the local anesthetics-induced neurotoxicity is largely unexplored. Here, we investigated the effect of sufentanil on the neurotoxicity induced by intrathecal lidocaine in a rat model. Our data showed that 5 µg/ml sufentanil didn't deteriorate nor reduce the histopathological injuries induced by intrathecal application of 10% lidocaine in a rat model. However, it did alleviate sensory and motor function impairments induced by 10% lidocaine. Repeated intrathecal injection of 5 µg/ml sufentanil also decreased the paw withdraw threshold compared to the baseline. An increase in expression of activating transcription factor 3, a stress response gene, as a marker for injured neurons, was also detected in lidocaine-induced neurotoxicity, while 5 µg/ml sufentanil inhibited lidocaine-induced the upregulation of activating transcription factor 3. These results suggest that sufentanil alleviates lidocaine induced sensory and motor impairments, and did not worsen histopathological injury induced by intrathecal lidocaine.

Can postural abnormality really respond to levodopa in Parkinson's disease?

OBJECTIVE

Abnormal postures affect motor function in Parkinson's disease (PD), potentially compromising the quality of life. The clinical efficacy of dopaminergic medications remains uncertain. Knowing what type of abnormal posture clearly responds to dopaminergic medication would facilitate the clinical management of PD. We investigated whether abnormal posture responded to dopamine challenge testing.

METHODS

We studied 24 consecutive patients with PD who had anterior trunk flexion (ATF) (n=13), antecollis (n=4), or lateral trunk flexion (LTF) (n=7). Levodopa was infused intravenously over the course of 30min. Before and after the levodopa infusion, the angle of the posture was measured with the use of "Image J" software.

RESULTS

After the infusion of levodopa, the angle of the overall abnormal posture significantly decreased (p<0.001). The angle of the abnormal posture significantly decreased in both natural position (p<0.001, p=0.002) and in a position with the back averted (p=0.003, p=0.029) in patients with ATF or antecollis, but did not change significantly in patients with LTF (p=0.099). The change in the angle differed significantly between patients with ATF and those with antecollis (p=0.017) and between patients with antecollis and those with LTF (p=0.008), but did not differ significantly between patients with ATF and those with LTF (p=0.052). The change in the angle in patients with abnormal posture related to the 'off' state was significantly greater than that in patients without abnormal posture related to the 'off' state (p<0.001).

CONCLUSION

Patients with LTF and some patients with ATF poorly respond to levodopa. Two phenotypes of levodopa-responsiveness exist in patients with abnormal posture, and this observation is associated with an 'off' state, especially in patients with ATF.

[Subacute autonomic and sensory neuropathy closely related to cytomegalovirus infection preceded by frequent syncopal attacks]

A 73-year-old woman who had hypertension developed a slight fever and general malaise with laboratory-proven hepatic dysfunction as well as frequent syncopal attacks 3 months before admission to our hospital. One month later, she developed urinary retention and distal limb numbness. Upon admission, her neurological examination showed reduced limb tendon reflexes, glove and stocking-type numbness, and diminished senses of touch, temperature, pain, and distal leg vibration and position. Serum cytomegalovirus (CMV) IgM antibody and CMV IgG antibody were elevated on admission, and both decreased thereafter, confirming CMV infection. No serum anti-ganglioside antibody was detected. Cerebrospinal fluid revealed a mild pleocytosis and elevated proteins. Compound muscle action potential (CMAP) amplitudes of the tibial and peroneal nerve were slightly reduced. Sensory nerve action potential (SNAP) amplitudes of the median and ulnar nerves were reduced, and sural SNAP was not evoked. Systolic blood pressure dropped 48 mmHg when the patient assumed a standing position from a supine one, demonstrating orthostatic hypotension, and a cold pressor test was abnormal, both indicating an obvious hypofunction of the sympathetic nerve. The postganglionic autonomic nerve appeared to be damaged because the accumulation of [(123)I] meta-iodobenzylguanidine was reduced on myocardial scintigraphy. These findings combined together led us to make a diagnosis of subacute autonomic and sensory neuropathy associated with CMV infection in this case. Following an eventless administration of oral fludrocortisones, intravenous immuno-globulin (IVIg) was given after one month of the hospitalization with a remarkable reduction of the syncope. This case is instructive in two points. One is that there may be a couple of months with syncope alone before the sensory disturbance appearance, and the other is that IVIg may be considerably effective for the patient-annoying syncopes. To our knowledge, this is the first report of subacute autonomic and sensory neuropathy caused by CMV infection.

A new ten-item questionnaire for assessing sensitive skin: the Sensitive Scale-10

Sensitive skin is common but until now there has been no scale for measuring its severity. The Sensitive Scale is a new scale with a 14-item and a 10-item version that was tested in 11 countries in different languages on 2,966 participants. The aim of this study was to validate the pertinence of using the Sensitive Scale to measure the severity of sensitive skin. The internal consistency was high. Correlations with the dry skin type, higher age, female gender, fair phototypes and Dermatology Life Quality Index were found. Using the 10-item version appeared to be preferable because it was quicker and easier to complete, with the same internal consistency and the 4 items that were excluded were very rarely observed in patients. The mean initial scores were around 44/140 and 37/100. The use of a cream for sensitive skin showed the pertinence of the scale before and after treatment.

Ameliorative effect of Sida cordifolia in rotenone induced oxidative stress model of Parkinson's disease

Present study focused on the evaluation of aqueous extract of Sida cordifolia (AESC), and its different fractions; hexane (HFSC), chloroform (CFSC) and aqueous (AFSC), against rotenone induced biochemical, neurochemical, histopathological and behavioral alterations in a rat model of Parkinson's disease (PD). An estimation of the level of thiobarbituric acid reactive substances (TBARS), glutathione (GSH) and catalase (CAT) along with superoxide anion generation (SAG) in different brain regions (cortex, midbrain and cerebellum) was carried out to assess biochemical changes. Behavioral evaluation tests (catalepsy, rearing behavior and posture instability) and neurochemical estimations (norepinephrine, dopamine and serotonin level) along with histopathological evaluations of different brain regions were also performed. The varying doses (50, 100, 250mg/kg; p.o.) of different test treatments (AESC, HFSC, CFSC and AFSC) were co-administered along with rotenone (2mg/kg; s.c.), for a period of 35 days to rats of various groups and compared with rotenone per se (negative control) and l-deprenyl (positive control; 10mg/kg; p.o.) treated groups for the above mentioned parameters. The increase in catalepsy and posture instability along with decrease in rearing behavior observed due to rotenone treatment was significantly attenuated by co-treatment with varying doses of AESC and AFSC. Results of the histopathological studies of different brain regions of rats showed eosinophilic lesions in the mid brain region due to rotenone treatment. The eosinophilic lesions were significantly attenuated in co-treated groups of AESC-100mg/kg and AFSC-100mg/kg. Rotenone induced oxidative damage, revealed by increased level of TBARS, SAG and decreased level of GSH and CAT in mid brain region of rats, was attenuated by the co-treatment of AESC and AFSC. The rotenone induced decrease of dopamine level in the midbrain region of rats was also attenuated by co-treatment of AESC-100mg/kg and AFSC-100mg/kg. The maximum effect in all the above activities was observed in AFSC (100mg/kg) treated group, which was comparable to l-deprenyl treated group. The HFSC and CFSC co-treatment failed to show significant attenuation of rotenone induced damage. These results indicate the possible therapeutic potential of most polar fraction of AESC i.e. AFSC in PD by virtue of its antioxidative actions.

Sudden loss of milk supply following high-dose triamcinolone (Kenacort) injection

Endogenous corticosteroids are involved in breast development, initiation and maintenance of milk production. Animal studies have shown that exogenous corticosteroids diminish milk production and milk ejection. A high dose depot injection of triamcinolone resulted in dramatic reduction in milk production in an established lactation. Domperidone and frequent expression restored milk production. Lower dose depot injection of betamethasone into the shoulder joint did not noticeably reduce milk production.

[Sensory symptoms in Parkinson's disease]

INTRODUCTION

In addition to the motor disturbances experienced by the patients suffering from Parkinson's disease (PD), several non-motor symptoms also affect the PD patients: neurobehavior symptoms (dementia, depression, anxiety, psychosis), autonomic (postural hypotension, urinary symptoms, gastro intestinal symptoms, diaphoresis), sleep disorders (insomnia, somnolence, REM sleep behavior disorder, apnea), sensitive-motor (fatigue, diplopia, restless legs syndrome), and sensory symptoms.

DEVELOPMENT

We review the most relevant about sensory symptoms in PD: visual dysfunction, olfactory dysfunction, taste, hearing loss, and pain and other sensitive associate symptoms.

CONCLUSIONS

Pain is frequently observed in patients with PD, being its prevalence high and probably infra diagnosed. Its identification and classification is very important for a correct treatment. Hyposmia is a common symptom in PD and could be a predictor of future PD. Visual dysfunction and hearing dysfunction among others must be considered in patients with PD.

Idiopathic trigeminal neuropathies: a presentation of 15 cases

PURPOSE

The aim of this study is to present a clinical series of patients with trigeminal neuropathy and their treatment.

PATIENTS AND METHODS

We present a retrospective study of 15 cases of idiopathic trigeminal neuropathies, with unilateral involvement of 1 or more divisions of the trigeminal nerve. The clinical, radiologic, and laboratory data of the patients, in addition to the treatment and clinical evolution, were reviewed. The patients were followed up for a mean of 34.4 months (range, 12-120 months).

RESULTS

The study consisted of 11 women and 4 men. The numbness was predominantly located in the innervated mental area and extended in some cases to the first and second trigeminal divisions. Seven patients had slight continuous discomfort in association with the numbness, one of whom had added bouts of typical neurogenic pain. Of the 15 cases, 8 (53%) had acute idiopathic trigeminal neuropathies and fully recovered within 3 months and 7 (47%) were chronic cases, without full recovery after 3 months. Mild pain was felt by 57% of the chronic patients and 37% of the acute patients; treatment with amitriptyline achieved complete or partial improvement in over half of these patients.

CONCLUSION

Of the idiopathic trigeminal neuropathies, half were acute and half were chronic. Mild pain presented more frequently in the chronic patients and was relieved with amitriptyline.

Diabetic painful and insensate neuropathy: pathogenesis and potential treatments

Advanced peripheral diabetic neuropathy (PDN) is associated with elevated vibration and thermal perception thresholds that progress to sensory loss and degeneration of all fiber types in peripheral nerve. A considerable proportion of diabetic patients also describe abnormal sensations such as paresthesias, allodynia, hyperalgesia, and spontaneous pain. One or several manifestations of abnormal sensation and pain are described in all the diabetic rat and mouse models studied so far (i.e., streptozotocin-diabetic rats and mice, type 1 insulinopenic BB/Wor and type 2 hyperinsulinemic diabetic BBZDR/Wor rats, Zucker diabetic fatty rats, and nonobese diabetic, Akita, leptin- and leptin-receptor-deficient, and high-fat diet-fed mice). Such manifestations are 1) thermal hyperalgesia, an equivalent of a clinical phenomenon described in early PDN; 2) thermal hypoalgesia, typically present in advanced PDN; 3) mechanical hyperalgesia, an equivalent of pain on pressure in early PDN; 4) mechanical hypoalgesia, an equivalent to the loss of sensitivity to mechanical noxious stimuli in advanced PDN; 5) tactile allodynia, a painful perception of a light touch; and 5) formalin-induced hyperalgesia. Rats with short-term diabetes develop painful neuropathy, whereas those with longer-term diabetes and diabetic mice typically display manifestations of both painful and insensate neuropathy, or insensate neuropathy only. Animal studies using pharmacological and genetic approaches revealed important roles of increased aldose reductase, protein kinase C, and poly(ADP-ribose) polymerase activities, advanced glycation end-products and their receptors, oxidative-nitrosative stress, growth factor imbalances, and C-peptide deficiency in both painful and insensate neuropathy. This review describes recent achievements in studying the pathogenesis of diabetic neuropathic pain and sensory disorders in diabetic animal models and developing potential pathogenetic treatments.

A preliminary study of the efficacy of ondansetron in the treatment of ataxia, poor balance and incoordination from brain injury

BACKGROUND

Ataxia is caused by a variety of conditions leading to imbalance, incoordination and other disabilities. Current treatment is largely symptomatic. Ondansetron (a 5-HT3 antagonist) has been established as an anti-emetic in cancer patients, but has recently been shown to improve vertigo and cerebellar tremor in some patients.

HYPOTHESIS

Ondansetron can improve symptoms of ataxia, imbalance and incoordination in four brain-injured patients.

DESIGN

Placebo-controlled, double blind, crossover, 'n of 1' study, A-B-A design.

SUBJECTS

Four patients with ataxia from traumatic brain injury.

METHODS

Four patients underwent five separate tests of ataxia under three different conditions in a double blind fashion.

RESULTS

For all subjects, there was little difference in scores in the five areas tested, with some improvement in tests of lower limb ataxia (10.4% for 4 mg and 10.7% for 8 mg ondansetron vs baseline).

CONCLUSION

Ondansetron use showed a trend towards improvement in tests of lower extremity ataxia but did not consistently improve scores in four patients.

[Hyperalgesia with loss of temperature sensation in one side of the body due to pinpoint infarction of contralateral spinothalamic tract]

We report a 67-year-old man who presented sudden loss of temperature sensation associated with hyperalgesia in the left trunk and extremities. No abnormal lesions were found on routine magnetic resonance image (MRI) in the brain and spinal cord. He did not show common manifestations of the lateral medullary syndrome including vertigo, nystagmus, ataxia, Horner's syndrome and ipsilateral facial sensory loss. We however suspected this syndrome, because he complained of characteristic, severe pain and electrical sensations in one side of his body. Reexamined, thinly sliced T2-weighted MRI showed a very small high intensity spot in the right medulla, corresponding to the location of lateral spinothalamic tract. Oral carbamazepine was partially effective to ameliorate the intractable central poststroke pain.

[Comparable efficacy between twice and three times daily for treatment of balance system disturbances]

In spite of detailed examinations it is impossible to find reasons for balance system disturbances in more than 25 per cent of patients. Therefore doctors have to treat symptoms but not the reasons for balance system disturbances. One of the most frequently administered medicine in treatment of both central and peripheral balance system disturbances is betahistine dihydrochloride (Betaserc). The aim of the study was to evaluate the influence of Betaserc an balance system disturbances with reference to dosage.

MATERIAL AND METHODS

Patients were divided into two groups. The first group (Group I) was treated with Betaserc three times a day: 16 mg for minimum 4 weeks and 8 mg for minimum 8 weeks. The second group (Group II) was treated with Betaserc twice a day: 24 mg for maximum 4 weeks and next 12 mg for minimum 8 weeks. The data from interviews and additional examinations (videonystagmography and posturography) were considered.

RESULTS

The latter group more often showed smaller balance system disturbances and vertigo than the first group both after 4 and 12 weeks. After 12 weeks of treatment more patients from the second group reported "a complete disappearance" of the symptoms. A substantial improvement of results was observed in videonystagmography and posturography examinations.

CONCLUSION

The treatment with 24 mg for 4 weeks and 12 mg for 8 weeks twice daily was better tolerated and gave higher positive effects than the treatment three times a day with 16 mg for 4 weeks and 8 mg for 8 weeks.

Should tactile sensation impairment be considered in pharmacotherapy of pervasive developmental disorders? A case report

It is a case report of improvement of tactile defensiveness after taking sertraline in a woman with major depressive disorder and Asperger's syndrome.

Cannabinoid receptor antagonists counteract sensorimotor gating deficits in the phencyclidine model of psychosis

Clinical and laboratory findings suggest that cannabinoids and their receptors are implicated in schizophrenia. The role of cannabinoids in schizophrenia remains however poorly understood, as data are often contradictory. The primary aim of this study was to investigate whether the cannabinoid CB1 receptor antagonists rimonabant and AM251 are able to reverse deficits of sensorimotor gating induced by phencyclidine and to mimic the 'atypical' antipsychotic profile of clozapine. The prepulse inhibition (PPI) of the startle reflex was used to measure deficits of sensorimotor gating. PPI-disruptive effects of phencyclidine and their antagonism by rimonabant, AM251, and clozapine were studied in rats. The effects of rimonabant were carefully examined taking into account dose ranges, vehicle, and route of administration. We also examined the ability of rimonabant to reduce the PPI-disruptive effects of dizocilpine and apomorphine. Rimonabant as well as AM251 significantly counteracted the phencyclidine-disruptive model of PPI, comparable to the restoring effect of clozapine; no augmentation effect was observed with rimonabant and clozapine as cotreatment. Rimonabant also significantly attenuated the PPI disruptive effects of dizocilpine and apomorphine. Taken together, our results indicate that CB1 receptor antagonists do produce 'atypical' antipsychotic profile mimicking that of clozapine in the phencyclidine disruption of sensorimotor gating. Our findings further suggest that CB1 receptor antagonism may be involved in restoring disturbed interactions between the activity of the endocannabinoid system and glutamate neurotransmitter system implied in schizophrenia.

Facial burning in women with leprosy, physiological or pathological?

INTRODUCTION

Eight peri-menopausal women, five with borderline lepromatous leprosy and three with borderline tuberculoid leprosy, self-referred complaining of 'burning of the face. Four were seen in 1993, three having been treated as 'menopausal'without betterment and four were seen in 1997.

METHODS

Eight peri-menopausal women who self-referred because of facial burning', and seven women who self-referred for other problems had a careful review of clinical records and were assessed fully for leprosy including graded sensory skin testing of the face, and standard nerve function tests.

RESULTS

On examination three in each group of four complaining of facial burning were found to have major loss of facial sensation and one had generalised neuritis without significant facial involvement. Treatment with antileprotics and steroids resulted in recovery of facial sensation, although one later became blind. Of the seven who self-referred without facial burning, five had no facial sensory loss and two had slight loss of facial sensation.

Otoacoustic emissions, ear fullness and tinnitus in the recovery course of sudden deafness

OBJECTIVE

This study aimed to investigate how the symptoms of ear fullness, tinnitus and otoacoustic emissions (OAE) change in relation to the recovery course of pure tone audiometry thresholds (PTA) in sudden deafness (SD).

METHODS

This study analyzed follow-up data on ear fullness, tinnitus and otoacoustic emissions of eight SD patients with good hearing improvement (Group A) and eight SD patients with poor hearing improvement (Group B) in an attempt to elucidate the behavior of these symptoms in their recovery course. This study was done until there was no change in the PTA for more than 1 week and hearing recovery was no longer expected.

RESULTS

All patients from both groups had ear fullness and tinnitus in association with the onset of SD. However, these symptoms improved only in Group A. showing a significant relationship between PTA recovery and the improvement of ear fullness annoyance (P<0.05), presence of tinnitus (P<0.01), improvement in tinnitus loudness (P<0.01) and in tinnitus annoyance (P<0.01). No patients (Group A or B) had OAE responses at their first examination. In Group A, OAE responses appeared simultaneously with improvement of hearing levels in five patients (63%) and it appeared later than hearing levels improvement in the other three patients (37%) from Group A. No patient from Group B showed OAE response on follow-up.

CONCLUSION

SD patients with good hearing improvement (Group A) tended to have OAE responses and the sensations of the ear fullness and tinnitus improved almost simultaneously with hearing level improvement. Their PTA improvement occurred primarily in the low to mid frequencies, with high frequencies showing less recovery. When hearing recovery was not full, OAEs did not reappear for these frequencies. Patients with poor hearing improvement tended to have absent OAEs and persistent ear fullness and tinnitus.

Open-label study of valacyclovir 1.5 g twice daily for the treatment of uncomplicated herpes zoster in immunocompetent patients 18 years of age or older

BACKGROUND

Herpes zoster (shingles) is a common disease caused by a reactivation of the latent varicella-zoster virus (chickenpox), which resides in the dorsal root ganglia. Valacyclovir HCl, the L-valyl ester of acyclovir, is an antiviral drug that is used to accelerate the resolution of the herpes zoster rash and associated pain and reduce the duration of postherpetic neuralgia.

OBJECTIVE

To demonstrate the safety and efficacy of oral valacyclovir 1.5 g twice daily (bid) for the treatment of uncomplicated herpes zoster in immunocompetent patients over 18 years of age. The dosing schedule of bid versus three times daily is desirable for enhancing patient compliance and to subsequently reduce the incidence of viral resistance.

METHODS

One treatment group of 125 patients was administered oral valacyclovir 1.5 g bid for 7 days. Administration of the first dose occurred within 72 hours after onset of rash. Patients were seen and assessed for cutaneous healing, zoster-associated pain (ZAP), and/or zoster-associated abnormal sensations (ZAAS). Patients under 50 years of age were followed for 4 weeks and patients 50 years of age and older were followed for a total of 24 weeks. Patients >or= 50 years were also asked to record a daily diary on pain and abnormal sensations throughout the 24-week study period. Responses to resource use and quality of life questions were also collected. Safety was monitored by means of routine hematologic and biochemical assessments and reporting of adverse experiences.

RESULTS

Data from this study were compared with historical control groups both for three times daily antiviral therapy and for placebo. The results showed that twice-daily dosing was as safe and effective as three times daily dosing for the reduction of ZAP and ZAAS. Adverse-effect profiles were similar between the two different regimens, and both treatment groups showed better outcomes than the historical placebo group. Because it is standard of care to administer antivirals for the treatment of acute herpes zoster, a placebo-controlled trial is not possible, necessitating the use of historical controls.

CONCLUSION

Oral valacyclovir 1.5 g bid is safe and effective for the treatment of uncomplicated herpes zoster in immunocompetent patients over 18 years of age. Twice-daily dosing may help increase patient compliance and therefore increase the effectiveness of treatment of the acute herpes zoster rash and the prevention of ZAP.

Pyridoxine and pyridostigmine treatment in vincristine-induced neuropathy

Vincristine is a commonly used antineoplastic drug and frequently causes neurotoxicity. Here the authors report a 4-year-old boy with acute lymphoblastic leukemia in whom vincristine-induced peripheral and cranial neuropathy developed during remission induction therapy. The patient seemed to benefit from pyridoxine and pyridostigmine therapy greatly and this therapy is recommended in patients with severe vincristine-induced neuropathy.

Neurobehavioral and immunological consequences of prenatal immune activation in rats. Influence of antipsychotics

Increasing evidence suggests that pre- or perinatal events that influence the immune system contribute to the development of behavioral or neuropsychiatric disorders. For instance, exposure of pregnant rats to the bacterial endotoxin lipopolysaccharide (LPS) disrupts sensorimotor information processing, as assessed by the prepulse inhibition test (PPI), and also the immune function in adult offspring, which might be of particular relevance as regards schizophrenia. However, the consequences of maternal LPS exposure during pregnancy on synaptic functioning in adult offspring and, more importantly, the therapeutic opportunity to re-establish PPI and immune function have still to be demonstrated. In this work, we analyzed the consequences of prenatal LPS exposure on dopaminergic neurotransmission and presynaptic markers in adult brain areas related to PPI circuitry. In addition, we tested whether oral treatment with the typical antipsychotic drug haloperidol (HAL) could reinstate PPI performances and cytokine serum levels in six-month-old male rats with prenatal LPS exposure. Both sensory information processing deficits and immune anomalies induced by prenatal exposure to LPS were accompanied by changes in dopaminergic neurotransmission and synaptophysin expression. It is important to note that PPI disruption and serum increases in cytokines induced by prenatal LPS exposure were both reversed by HAL. Taken together, these results demonstrate the critical influence of prenatal immune events on the functioning of adult nervous and immune systems, in association with the putative role of the immune system in the development of behavior relevant to schizophrenia.

Postural control, gait, and dopamine functions in parkinsonian movement disorders

Balance impairments and falls, which are common in patients who have parkinsonian movement disorders, are a serious threat to the health of these individuals. However, the underlying mechanisms cannot be fully explained by presynaptic dopaminergic denervation, because balance impairment is at least responsive to L-dopa therapy. This article reviews the latest clinically relevant literature relating postural control, gait, and dopamine in patients who have parkinsonian movement disorders.

Neurotrophic modulation of myelinated cutaneous innervation and mechanical sensory loss in diabetic mice

Human diabetic patients often lose touch and vibratory sensations, but to date, most studies on diabetes-induced sensory nerve degeneration have focused on epidermal C-fibers. Here, we explored the effects of diabetes on cutaneous myelinated fibers in relation to the behavioral responses to tactile stimuli from diabetic mice. Weekly behavioral testing began prior to streptozotocin (STZ) administration and continued until 8 weeks, at which time myelinated fiber innervation was examined in the footpad by immunohistochemistry using antiserum to neurofilament heavy chain (NF-H) and myelin basic protein (MBP). Diabetic mice developed reduced behavioral responses to non-noxious (monofilaments) and noxious (pinprick) stimuli. In addition, diabetic mice displayed a 50% reduction in NF-H-positive myelinated innervation of the dermal footpad compared with non-diabetic mice. To test whether two neurotrophins nerve growth factor (NGF) and/or neurotrophin-3 (NT-3) known to support myelinated cutaneous fibers could influence myelinated innervation, diabetic mice were treated intrathecally for 2 weeks with NGF, NT-3, NGF and NT-3. Neurotrophin-treated mice were then compared with diabetic mice treated with insulin for 2 weeks. NGF and insulin treatment both increased paw withdrawal to mechanical stimulation in diabetic mice, whereas NT-3 or a combination of NGF and NT-3 failed to alter paw withdrawal responses. Surprisingly, all treatments significantly increased myelinated innervation compared with control-treated diabetic mice, demonstrating that myelinated cutaneous fibers damaged by hyperglycemia respond to intrathecal administration of neurotrophins. Moreover, NT-3 treatment increased epidermal Merkel cell numbers associated with nerve fibers, consistent with increased numbers of NT-3-responsive slowly adapting A-fibers. These studies suggest that myelinated fiber loss may contribute as significantly as unmyelinated epidermal loss in diabetic neuropathy, and the contradiction between neurotrophin-induced increases in dermal innervation and behavior emphasizes the need for multiple approaches to accurately assess sensory improvements in diabetic neuropathy.

Neuroprotective effect of tyrosol on transient focal cerebral ischemia in rats

Tyrosol (2-(4-hydroxyphenyl)ethanol) is a well-known phenolic compound with antioxidant properties that is present in wine, olive oil, and other plant-derived products. The purpose of this study was to determine the neuroprotective effect of tyrosol in a stroke animal model. By using the transient middle cerebral artery occlusion rat model (2 h of occlusion, 22 h of reperfusion), we investigated the effects of tyrosol on infarct volume and sensory motor function deficit by performing 2,3,5-triphenyltetrazolium chloride staining and behavior tests after ischemia. Tyrosol showed a dose-dependent neuroprotective effect that peaked at 64.9% in rats treated with 30 mg/kg of tyrosol. In rotarod, beam balance, and foot fault tests, tyrosol exhibited protective effects against the sensory motor dysfunction. In conclusion, our results suggest that tyrosol is an appropriate candidate to be used in stroke therapy.

Lewis-Sumner syndrome in hepatitis C virus infection: a possible pathogenetic association with therapeutic problems

A patient with chronic hepatitis from hepatitis C virus (HCV) infection developed Lewis-Sumner syndrome (LSS). The neuropathy worsened after intravenous immunoglobulins, remitted after intravenous methylprednisolone, relapsed during interferon-alpha, but responded again to steroids continued for 68 weeks with clinical remission and without worsening of hepatitis. We are not aware of other reports of HCV infection and LSS. This association may be coincidental or related to a virus-triggered immune-mediated process. Although the coexistence of a dysimmune neuropathy with hepatitis makes problematic the choice of treatment, we emphasize that the patient's condition during treatment with steroids and the 46 following weeks without therapy has been excellent.

Functional recovery of chronic complete idiopathic transverse myelitis after administration of neurotrophic factors

STUDY DESIGN

Case report.

OBJECTIVE

To evaluate the functional recovery of chronic complete idiopathic transverse myelitis (ITM) after administration of acidic fibroblast growth factor (aFGF).

METHODS

A 28-year-old woman presented with a 4-year history of spastic paralysis, sensory level at T10, urinary retention and constipation due to ITM. In all, 20 microg aFGF bolus injection was applied via intradural lumbar puncture, which was repeated every 5 months for 15 months.

RESULTS

At 3 weeks after first injection, the patient experienced vague sensation at approximately T12-L1 dermatomes. At 2 months after the second injection, muscle activities and gait pattern were recorded in bilateral gluteus and hip abductors as she ambulated with long leg brace and axillary crutches. Increased walking speeds, reduced pelvic tilting and reduced compensatory trunk rotation during the swing phase were also demonstrated as compared to the initial gait analysis. At 18 months after injection, motor evoked potentials were obtained in hip abductors of both legs.

CONCLUSIONS

aFGF may increase the efficacy of spinal reactivation/regeneration and is a potential remedy for chronic transverse myelitis.

Granulocyte colony-stimulating factor induces sensorimotor recovery in intracerebral hemorrhage

Granulocyte colony-stimulating factor (G-CSF) has been used in the treatment of neutropenia in hematologic disorders. The neuroprotective and anti-inflammatory effects of G-CSF were reported in various neurological disease models. In this study, we examined whether G-CSF induces functional recovery after intracerebral hemorrhage (ICH). ICH was induced using collagenase injection in adult rats. Either G-CSF (50 microg/kg, i.p.) or saline was given from 2 h after ICH and every 24 h for 3 days. 72 h after ICH induction, the rats were sacrificed for histological analysis and measurement of brain edema. Behavioral tests were performed before and 1, 7, 14, 21, 28, and 35 days after ICH. We also measured the blood-brain barrier (BBB) permeability using Evans blue dye injection method. G-CSF-treated rats recovered better on rotarod and limb placing tests, starting from 14 days throughout 5 weeks after ICH. The brain water content and BBB permeability of G-CSF-treated group decreased in the lesioned hemispheres compared with those of ICH-only group. In G-CSF-treated group, the number of TUNEL+, myeloperoxidase+, and OX42+ cells was smaller than that of ICH-only group in the periphery of hematoma. These findings suggest that G-CSF induces long-term sensorimotor recovery after ICH with reduction of brain edema, inflammation, and perihematomal cell death.

Brain Gamma-Aminobutyric Acid Levels Are Decreased in Patients With Phantageusia and Phantosmia Demonstrated by Magnetic Resonance Spectroscopy

BACKGROUND

Olfactory and gustatory hallucinations (phantosmias and phantageusias, respectively) are sensory distortions that commonly follow losses of olfactory and gustatory acuity (hyposmia and hypogeusia, respectively). The biochemical basis of these hallucinations is unclear. Functional magnetic resonance imaging has been used previously to demonstrate widespread and robust central nervous system (CNS) activation to memories of these sensory distortions in patients with these symptoms. In this study, possible CNS mechanisms responsible for these distortions were evaluated using magnetic resonance spectroscopy, because this technique has been used to measure various CNS metabolites in patients with neurologic disorders.

METHODS

Forty-seven subjects were studied: 28 normal volunteers (13 men and 15 women) and 19 patients (8 men and 11 women) with persistent oral global phantageusia and/or birhinal phantosmia studied before any treatment. Four patients (1 man and 3 women) were studied before and after pharmacologic treatment that reduced the severity of their sensory distortions. All subjects were studied in a Signa 1.5-T magnetic resonance scanner with a quadrature head coil using a modified standard 2-dimensional J-point resolved excitation in the steady state (PRESS) sequence by which gamma-aminobutyric acid (GABA), glutamic acid, choline, N-acetylaspartate, and creatine (Cre) were measured in various CNS regions. Results were expressed using Cre as a denominator to determine ratios for each measurement. Differences were defined between normal subjects and patients before treatment and in patients before and after successful pharmacologic treatment.

RESULTS

Before treatment, GABA levels in several CNS regions were lower in patients than in normal volunteers and were the only biochemical changes found; significantly lowered GABA levels were found in the cingulate, right and left insula, and left amygdala. No differences between patients and normal volunteers were found in any of the metabolites in the posterior occipital region. After treatment that inhibited sensory distortions, CNS GABA levels increased in the cingulate, insula, and amygdala but significantly only in the left insula and in the right and left amygdala. After this successful treatment, no change in any biochemical parameter was found in the posterior occipital region.

CONCLUSIONS

These results indicate that decreased brain GABA levels can serve as biochemical markers of phantageusia and/or phantosmia in patients with these distortions and are the first biochemical changes in the CNS that reflect these sensory changes. After successful treatment of these distortions, CNS GABA levels increased to levels at or near normal, consistent with functional remission of these symptoms. These results substantiate a role for CNS GABA in the generation and inhibition of these sensory hallucinations. Although the underlying biochemical mechanism(s) for the generation of these decreased GABA levels are complex, because similar types of sensory hallucinations occur as auras or prodromata of epileptic seizure and migraine activity, these results suggest that there may be common biochemical changes among these disorders.

Efficacy of steroid treatment for sensory impairment after orthognathic surgery

PURPOSE

Steroid hormones are therapeutic for motor and/or sensory dysfunctions caused by nerve injury. However, the timing for giving such medicine is unclear. This study aimed to estimate the efficacy of steroid treatment and determine an appropriate start time after sensory impairment.

PATIENTS AND METHODS

Twenty-seven patients with sensory impairment who received orthognathic surgery were classified into groups called 1W (n = 6), 3W (n = 6), or 6W (n = 8) group on the basis of start time for steroid treatment, being 1 week, 3 weeks, or 6 weeks after surgery, respectively, and a no steroid treatment (NST) group (a control group) (n = 6) that did not receive treatment for 10 to 12 weeks after surgery. Sensory impairment was diagnosed if postoperative first week mechanical-touch threshold was over 4.0 as measured by Semmes aesthesiometer. Prednisolone treatment was administered orally to patients at 30 mg for 7 days, 15 mg for 4 days, and 5 mg for 3 days. Mechanical-touch threshold and thermal perceptions were compared before and after treatment.

RESULTS

At 1 week postoperatively, there were no significant differences in mechanical-touch threshold among the 4 groups (analysis of variance, P >.05). Changes in mechanical-touch threshold in the 1W group showed no significant improvement (analysis of variance, P >.05), but in the 3W and 6W groups, there were significant differences compared with the NST group (Dunns methods, P <.05).

CONCLUSIONS

Steroid treatment for sensory impairment after orthognathic surgery has the potential to accelerate recovery and it appears desirable to start treatment later than 1 week postoperatively.

Therapeutic outcome in neuropathic pain: relationship to evidence of nervous system lesion

Treatment outcome in patients with neuropathic pain (NP) is often variable and disappointing. We tested the hypothesis that patients with clear evidence of nervous system lesion respond better to pharmacological treatment with documented effect on NP than patients with poor or no evidence of nervous system lesion. Furthermore, we examined whether specific symptoms or signs were associated with treatment outcome. A total of 214 patients with suspected non-cancer NP were divided into four groups with graded evidence of nervous system lesion based on medical history, bedside sensory examination, quantitative sensory tests, electrophysiology, and neuroimaging. Patients were treated with imipramine guided by plasma-drug concentrations. Gabapentin 2400 mg/day was given in case of treatment failure or if imipramine treatment was not possible. Two hundred patients completed the study. Global pain relief was similar in the four groups. There was no association between evidence of nervous system lesion and treatment outcome. Classical NP signs: abnormal temporal summation, cold and brush allodynia, and abnormal sensibility to temperature were also unrelated to outcome. Treatment outcome was similar in peripheral and central definite NP. Neither definite evidence of nervous system lesion nor abnormal sensory phenomena seems to predict for good outcome of therapy with imipramine or gabapentin in patients with suspected neuropathic pain.

Prostaglandin E1 in lipid microspheres ameliorates diabetic peripheral neuropathy: clinical usefulness of Semmes-Weinstein monofilaments for evaluating diabetic sensory abnormality

We investigated the effect of Prostaglandin E1 in lipid microspheres (Lipo-PGE1) on diabetic peripheral neuropathy from view of symptoms, neurological examinations including sensory threshold evaluated with Semmes-Weinstein monofilaments (SWM). Type 2 diabetic patients with diabetic peripheral neuropathy were participated in this study. The patients were randomly assigned to two groups, 11 Lipo-PGE1-treated patients and 16 control patients. Lipo-PGE1 at a dose of 10mg in 20ml of saline was injected intravenously as a bolus once daily for 2 weeks. Before and, 1, 2 and 4 weeks after the start of treatment with Lipo-PGE1, sensory threshold was evaluated with Semmes-Weinstein monofilaments at total 18 touch sites on the feet. Administration of Lipo-PGE1 improved subjective symptoms especially in items of numbness and imperception. Such improvement in subjective symptoms correlated well with the improvement in Semmes-Weinstein monofilaments examination, whereas the improvement was not recognized in motor nerve conduction velocity (MCV), sensory nerve conduction velocity (SCV) and coefficient variation of R-R interval on ECG (CVR-R). The improvement lasted for at least 6 months. This study demonstrated that Lipo-PGE1 has long term amelioration effects on diabetic neuropathy especially in symptoms and sensory threshold, and that Semmes-Weinstein monofilaments examination is a simpler, more valid and quantitative tool for assessing the clinical effect of Lipo-PGE1 on diabetic peripheral neuropathy.

Alpha-7 nicotinic receptor agonists: potential new candidates for the treatment of schizophrenia

RATIONALE AND OBJECTIVE

Auditory sensory gating, a biological measurement of the ability to suppress the evoked response to the second of two auditory stimuli, is diminished in people with schizophrenia. Deficits in sensory gating are associated with attentional impairment, and may contribute to cognitive symptoms and perceptual disturbances. This inhibitory process, which involves the alpha(7) nicotinic receptor mediated release of gamma-aminobutyric acid (GABA) by hippocampal interneurons, represents a potential new target for therapeutic intervention in schizophrenia.

METHOD

This paper will review several lines of evidence implicating the nicotinic-cholinergic, and specifically, the alpha(7) nicotinic receptor system in the pathology of schizophrenia and the evidence that alpha(7) nicotinic receptor agonists may ameliorate some of these deficits.

RESULTS

Impaired auditory sensory gating has been linked to the alpha(7) nicotinic receptor gene on the chromosome 15q14 locus. Single nucleotide polymorphisms of the promoter region of this gene are more frequent in people with schizophrenia. Although nicotine can acutely reverse diminished auditory sensory gating in people with schizophrenia, this effect is lost on a chronic basis due to receptor desensitization. Clozapine is able to reverse auditory sensory gating impairment, probably through an alpha(7) nicotinic receptor mechanism, in both humans and animal models with repeated dosing. The alpha(7) nicotinic agonist 3-2,4 dimethoxybenzylidene anabaseine (DMXBA) can also enhance auditory sensory gating in animal models. DMXBA is well tolerated in humans and improves several cognitive measures.

CONCLUSION

Alpha-7 nicotinic receptor agonists appear to be reasonable candidates for the treatment of cognitive and perceptual disturbances in schizophrenia.

Premonitory sensory phenomenon in Tourette's syndrome

We administered a questionnaire designed to probe for premonitory sensations associated with motor tics to 50 patients with Tourette's syndrome (TS). Premonitory sensations were reported by 46 (92%) patients, and the most common sensation was an urge to move and an impulse to tic ("had to do it"). Intensification of premonitory sensations, if prevented from performing a motor tic, was reported also in 37 patients (74%), 36 patients (72%) reported relief of premonitory sensations after performing the tic, and 27 of 40 (68%) described a motor tic as a voluntary motor response to an involuntary sensation, rather than a completely involuntary movement. The "just right" sensation correlated with the presence of co-morbid obsessive-compulsive disorder. We conclude that premonitory sensations are an important aspect of motor tics and some patients perceive motor tics as a voluntary movement in response to an involuntary sensation.

The prognostic importance of detecting mild sensory impairment in leprosy: a randomized controlled trial (TRIPOD 2)

This study was designed to investigate whether leprosy patients diagnosed with mild sensory impairment have a better prognosis when treated with steroids than similarly impaired patients treated with placebo. A multi-centre, randomized, double-blind, placebo-controlled trial was conducted in Nepal and Bangladesh. Patients were eligible if they had a confirmed leprosy diagnosis, were between 15 and 50 years old, had mild sensory impairment of the ulnar or posterior tibial nerve of less than 6 months duration and did not require steroids for other reasons. 'Mild impairment' was defined as 'impaired on the Semmes-Weinstein monofilament test, but testing normal on the ballpen sensory test'. Subjects were randomized to either prednisolone treatment starting at 40 mg per day, tapering over 4 months, or placebo. Nerve function was monitored monthly. Any patient who deteriorated was taken out of the trial and was put on full-dose steroid treatment. Outcome assessment was done at 4, 6, 9 and 12 months from the start of the treatment. Outcome measures were the proportion of patients needing full-dose prednisolone and the Semmes-Weinstein sum scores. Each patient contributed only one nerve to the analysis. Seventy-five patients had nerves eligible for analysis, of whom 41 (55%) and 34 (45%) were allocated to the prednisolone and placebo arms, respectively. At 4 months, three patients in the prednisolone arm (7%) and six in the placebo arm (18%) had an outcome event requiring full dose steroids. At 12 months, these proportions had almost reversed, 11 (27%) and 6 (18%) in the treatment and placebo arms, respectively. In the latter group, 75% had recovered spontaneously after 12 months. Prednisolone treatment of sensory impairment of the ulnar and posterior tibial nerves detectable with the monofilament test, but not with the ballpen test, did not improve the long-term outcome in terms of recovery of touch sensibility, not did it reduce the risk of leprosy reactions or nerve function impairment beyond the initial 4-month treatment phase. Two unexpected main findings were the strong tendency of mild sensory impairment to recover spontaneously and the fact that patients with mild sensory impairment without any other signs or symptoms of reaction or nerve function impairment are relatively rare.

Treatment with corticosteroids of long-standing nerve function impairment in leprosy: a randomized controlled trial (TRIPOD 3)

Some leprosy patients with long-standing nerve function impairment (NFI) appear to have responded favourably to treatment with corticosteroids. This study investigated whether patients with untreated NFI between 6 and 24 months duration and who are given standard regimen corticosteroid therapy, will have a better treatment outcome than a placebo group. A multicentre, randomized, double-blind placebo-controlled trial was conducted in Nepal and Bangladesh. Subjects were randomised to either prednisolone treatment starting at 40 mg/day, tapered by 5 mg every 2 weeks, and completed after 16 weeks, or placebo. Outcome assessments were at 4, 6, 9, and 12 months from the start of treatment. 92 MB patients on MDT were recruited, of whom 40 (45%) received prednisolone and 52 (55%) placebo treatment. No demonstrable additional improvement in nerve function, or in preventing further leprosy reaction events was seen in the prednisolone group. Overall, improvement of nerve function at 12 months was seen in about 50% of patients in both groups. Analysis of subgroups according to nerve (ulnar and posterior tibial), duration of NFI, and sensory and motor function, also did not reveal any differences between the treatment and placebo groups. There was however, indication of less deterioration of nerve function in the prednisolone group. Finally, there was no difference in the occurrence of adverse events between both groups. The trial confirms current practice not to treat long-standing NFI with prednisolone. Spontaneous recovery of nerve function appears to be a common phenomenon in leprosy. Leprosy reactions and new NFI occurred in a third of the study group, emphasizing the need to keep patients under regular surveillance during MDT, and, where possible, after completion of MDT.

Study of the afferent nervous system and its evaluation in women with impaired detrusor contractility treated with bethanechol

OBJECTIVES

To study the effects of subcutaneous bethanechol on the afferent nervous system and correlate these with the efficiency of this treatment in women with impaired detrusor contractility and to evaluate whether patients likely to respond to bethanechol can be identified before treatment through sensation evaluation.

METHODS

Eighteen women with impaired detrusor contractility were given subcutaneous bethanechol for 10 days, and the flow pattern and postvoid residual urine volume were monitored. The afferent nervous system was studied before and after therapy by evaluating the sensation of filling during cystometry and by determining the bladder electrical perception threshold (EPT).

RESULTS

At the end of therapy, 61% voided without a postvoid residual volume. In these women, the sensation of filling and electrical sensitivity were significantly increased compared with before treatment. In women who still voided with a postvoid residual volume, the sensation of filling had increased to a lesser extent and no change in EPT was found. Women in whom bethanechol was unsuccessful had a higher pretreatment EPT than women who were successful. No such difference was found for the sensation of filling.

CONCLUSIONS

An increase in bladder sensitivity correlated with improvement in bladder emptying and can be evaluated by studying the sensation of filling and EPT. Patients likely to respond to bethanechol can be identified before treatment on the basis of the EPT level. Therefore, it would be valuable to initiate EPT measurement in the diagnosis of patients with impaired detrusor contractility.

Cognitive function in post-treatment Lyme disease: do additional antibiotics help?

BACKGROUND

It is controversial whether additional antibiotic treatment will improve cognitive function in patients with post-treatment chronic Lyme disease (PTCLD).

OBJECTIVE

To determine whether antibiotic therapy improves cognitive function in two randomized double-blind placebo-controlled studies of patients with PTCLD.

METHODS

A total of 129 patients with a physician-documented history of Lyme disease from three study sites in the northeast United States were studied. Seventy-eight were seropositive for IgG antibodies against Borrelia burgdorferi, and 51 were seronegative. Patients in each group were randomly assigned to receive IV ceftriaxone 2 g daily for 30 days followed by oral doxycycline 200 mg daily for 60 days or matching IV and oral placebos. Assessments were made at 90 and 180 days after treatment. Symptom severity was measured from the cognitive functioning, pain, and role functioning scales of the Medical Outcomes Study (MOS). Memory, attention, and executive functioning were assessed using objective tests. Mood was assessed using the Beck Depression Inventory and Minnesota Multiphasic Personality Inventory.

RESULTS

There were no significant baseline differences between seropositive and seronegative groups. Both groups reported a high frequency of MOS symptoms, depression, and somatic complaints but had normal baseline neuropsychological test scores. The combined groups showed significant decreases in MOS symptoms, higher objective test scores, and improved mood between baseline and 90 days. However, there were no significant differences between those receiving antibiotics and placebo.

CONCLUSION

Patients with post-treatment chronic Lyme disease who have symptoms but show no evidence of persisting Borrelia infection do not show objective evidence of cognitive impairment. Additional antibiotic therapy was not more beneficial than administering placebo.

Gabapentin for the management of hot flushes: a case series

OBJECTIVE

To audit the effectiveness of the anticonvulsant gabapentin on hot flushes in postmenopausal women.

DESIGN

This was an open case series involving 11 postmenopausal women who were willing to take gabapentin for the relief of their hot flushes and were willing to keep a diary recording the number and intensity of their hot flushes, both before and during treatment. Gabapentin was started at a dose of 300 mg, to be taken at night, and the women were instructed to increase the dose up to 1,200 mg, according to symptom behavior.

RESULTS

Eleven women agreed to participate for on average 53.22 days (range, 2-79 days), but two discontinued participation-one before starting treatment and one after 2 days-so there are complete data sets for nine women. Gabapentin was found to be extremely effective in reducing hot flush activity (P < 0.001; Fig. 1). A significant reduction in symptoms was observed with a dose of 300 mg/day (P < 0.001). Scores on the Green Climacteric Scale were significantly improved from a mean of 25.72 (range, 12-42) to 19.25 (range, 13-31; P < 0.001). Palpitations (P = 0.001), panic attacks (P = 0.0001), mood (P = 0.023), muscle and joint pains (P = 0.021), and paresthesias and loss of sensation in the extremities (P = 0.001) were also shown to improve with treatment.

CONCLUSIONS

In the present case series, gabapentin was well tolerated and could be a valuable alternative for the treatment of hot flushes in women with contraindications to hormonal replacement therapy. It would be particularly beneficial for women in whom aches and pains and paresthesias are also a significant feature of the climacteric syndrome.