Neurology Research International

Aim. Neuropathic pain affects 7–10% of the population, with most of the patients receiving inadequate and incomplete treatment. Owing to the high financial burden and the poor quality of life of the patients and their caretakers, there is a dire need to address the challenges in diagnosing and treating chronic neuropathic pain. Methods. This literature review was conducted to review novel treatments and related challenges through a systematic search from sources such as PubMed, Google Scholar with the combination of MESH words such as neuropathic pain, management of neuropathic pain. Articles from non-English literature, reports without human subjects, animal studies, and abstracts/posters were excluded. However, human studies and studies published in English were included. Result. This review article discusses novel treatment modalities while acknowledging the challenges medical workers face while encountering neuropathic pain. Despite the recent advances in diagnosis and treatment modalities, several challenges still exist. Hence, there is still a need to explore the various treatment modalities, emphasizing the cause and underlying pathophysiology of neuropathic pain. Conclusion. We recommend integrated multimodal treatment with the current treatment facility, including various medical disciplines. However, a personalized approach would work the best depending on the ’patient’s medical history. Therefore, this article recommends an integrated, cause-specific, cost-effective approach to address this problem of chronic neuropathic pain.

Background. Since heart failure (HF) and ischemic stroke have common risk factors, their concurrent occurrence is likely. Strokes in HF patients could be life-threatening and lead to severe disabilities, longer hospitalization time, and mortality. The present study aims to investigate the prevalence of HF and its severity based on ejection fraction (EF) in patients with acute ischemic stroke. Methods. The present cross-sectional study included acute ischemic stroke patients admitted to Shahid Rajaei hospital in Karaj in 2020–2021. The diagnosis of HF was based on transthoracic echocardiography within 48 hours of symptom onset, and HF was classified into two groups: 41–49% as mildly reduced EF (HFmrEF) and ≤40% as reduced EF (HFrEF). Patients who did not complete cardiac studies were excluded. Results. 257 acute ischemic stroke patients (62.6% male) were included. Among stroke patients, the prevalence of HF, including HFrEF and HFmrEF, was 30.0% (95% CI: 21.4–38.6). HFmrEF and HFrEF was diagnosed in 32 (12.5%) and 45 (17.5%) patients, respectively. HF was significantly associated with older age, hypertension, past myocardial infarction (MI), and arrhythmia. A history of previous MI significantly increased the odds of heart failure (OR: 3.25, 95% CI: 1.82–5.81). Conclusion. There is a high prevalence of HF among acute ischemic stroke patients. Older patients with a history of hypertension and previous MI are at higher risk. Since patients with HF have a higher mortality and morbidity rate after experiencing an ischemic stroke, close cooperation between the neurology and cardiology specialists for providing advanced care for survivors is required.

As a noninvasive neuromodulation technique, transcranial magnetic stimulation (TMS) has already exhibited a great impact in clinical application and scientific research. This study presents a finite element method-based simulation of the Halo-V assembly (HVA) coil placed on the five-shell spherical human head model to examine the distributions of induced electric and magnetic fields. The performance of the designed HVA coil is evaluated by comparing the simulation results with the commercially available Halo-FO8 (HFA) assembly coil and standard single coils including the Halo and V coils. The simulation results indicate that the HVA coil shows an improved focality in terms of electric field distribution than the other single and assembly stimulation coils. Additionally, the effects of a magnetic shield plate and magnetic core on the designed HVA coil are investigated. Results indicate that the magnetic shield plate and magnetic core are proficient in further improving the stimulation focality. Therefore, the HVA TMS coil results in a safe and effective stimulation with enhanced focality of the target region as compared to the existing assembly coil.

There has been an increasing incidence of stroke cases among SARS-CoV-2 (COVID-19) patients who were deeply sedated and underwent proning positioning. We reviewed the association of proning and sedations used to the development of stroke, including demographic profiles of patients with COVID-19 infection in the critical care unit. There was a significant association seen among COVID-19 patients in the ICU who underwent proning to the development of stroke, with up to 15 times risk of having stroke ( value = 0.007) than those who were not proned during their course of ICU stay. Patients who were given propofol and fentanyl as sedation during proning for more than 24 hours was significantly associated with the development of stroke ( value = 0.004). Patient risk factors were also studied (age variability, hypertension, diabetes, smoking, and alcoholism) and showed that patients who were alcoholic beverage drinkers were significantly associated to the development of stroke during proning ( value = <0.001). The usual risk factors for stroke in the general population (hypertension, diabetes, and cigarette smoking) were not associated with stroke development during proning, strengthening the fact that proning during COVID-19 infection is an independent risk factor for the development of stroke thus needing stroke surveillance during the duration of proning.

Background and Objectives. Amyotrophic lateral sclerosis (ALS) is a lethal neurodegenerative disease, characterized by gradual paralysis and muscle atrophy. Riluzole, the only approved treatment in Norway, increases mean survival by 3–6 months. The use of off-label medications and nutritional supplements is common in other serious conditions, such as Parkinson’s disease and dementia. The aims of this study were to investigate to what extent Norwegian ALS patients use supplements and off-label medications and whether this is related to their health-related quality-of-life (HRQOL). Materials and Methods. A cross-sectional questionnaire study was performed, where 41 ALS patients reported their use of off-label treatments, as well as self-perceived HRQOL using the RAND-12 questionnaire. Results. A majority of respondents used riluzole. Of the 41 respondents, 18 (43.9%) reported use of off-label medications and 18 (43.9%) used nutritional supplements. Low-dose naltrexone was the most commonly used off-label medication, whereas vitamins accounted for most of the nutritional supplements. The respondents’ RAND-12 component scores were significantly lower than those of the general population. Low-dose naltrexone and vitamin B were associated with a better physical component score. Conclusions. Most of the respondents in our study adhere to the recommended treatment protocols, as less than half of them reported using off-label medications or nutritional supplements against ALS. Positive correlations between physical HRQOL and use of low-dose naltrexone or vitamin B were demonstrated. These results warrant further investigations.

Background. Tourette’s syndrome (TS), a chronic, often disabling neuropsychiatric disorder characterized by motor and vocal tics, is frequently misdiagnosed, or patients are delayed in diagnosis. There is severe deficiency of research about Tourette’s syndrome (TS) in the Middle East region. Objectives. To evaluate the knowledge and attitude of medical students and primary care physicians (PCPs) about TS and tic disorders. Methods. IRB approved, cross-sectional study. A total of 316 medical students of King Saud bin Abdulaziz University and 59 primary care physicians of Riyadh participated. Convenient, cluster sampling was used. A validated, self-administered questionnaire was used. Sum of all knowledge questions was calculated. Data were analyzed using SPSS software. Results. Survey was completed by 375 students and physicians, of whom 253 (67.5%) were men. Mean general knowledge score was 61.5 (±12.04) out of 100. Majority (66.1%) knew the diagnostic criteria for TS; only 46.1% considered antipsychotics as effective treatment. Only 25.1% had ever heard of habit reversal; 70% wanted to learn more. Only 10% of physicians had treated a patient with TS. There was no difference in knowledge between men and women (). Board-certified physicians had a higher knowledge score (). Family physicians demonstrated higher level of knowledge compared to other physicians (). There was no difference between knowledge of students of different years () or between students and physicians (). Conclusion. There was alarming lack of knowledge about Tourette syndrome at various level of medical training and practice including students and physicians. Those who achieved board certification and practiced as family physicians fared better in knowledge about Tourette’s syndrome.