Volume 3 Issue 3

Editorial: Topical Analgesia: Transdermal or 'Intradermal' Mechanisms of Action?

Jan M. Keppel Hesselink*, and David J. Kopsky

Topical analgesics are recommended in guidelines for treating the pain of both osteoarthritis and neuropathy. Topical analgesics are defined as therapies applied to body surfaces to treat pain, and are either rubbed onto the skin or made into patches or plasters that are adhered onto the skin. Under the header of topical analgesics, we find both transdermal as well as intradermal formulations. This differentiation in terminology is recommendable, as transdermal topicals act via adequate drug concentrations in the blood, while intradermal formulations act via mechanisms in the skin and do not need to penetrate into the blood. This will be demonstrated based on examples of amitriptyline and phenytoin gels and creams.

Cite this Article: Keppel Hesselink JM, Kopsky DJ. Topical Analgesia: Transdermal or 'Intradermal' Mechanisms of Action?. Sci J Neurol Neurosurg. 2017;3(3): 068-071.

Published: 04 November 2017

Case Report: Homolateral Extremity Synkinesia after the Stroke

Huseyin Buyukgol*, Muzaffer Gunes and Fatma Aysen Eren

The incidence of involuntary movement disorders has not yet been clearly known. It has been reported in studies that it is observed in 4% of stroke patients. Hemikore, hemiballismus, dystonic tremor, and myoclonus cases have been reported after the stroke. Synkinesia is a rare disorder which is characterized with voluntary movements that are observed together with involuntary movement coordination. In this case study, since it is a rare event, we reported a case with homolateral extremity synkinesia after the stroke.

Cite this Article: Buyukgol H, Gunes M, Eren FA. Homolateral Extremity Synkinesia after the Stroke. Sci J Neurol Neurosurg. 2017;3(3): 066-067.

Published: 14 October 2017

Mini Review: Entraining Melatonergic Pulses Instead of Long-Acting Drugs: Resynchronization Rules For Depression with Circadian Etiology

Rudiger Hardeland*

Several types of depression such as bipolar disorder, seasonal affective disorder and subforms of major depressive disorder are known to be associated with deviations in the circadian system, alterations that are crucial to the etiology of these pathologies. Therefore, entrainment of circadian rhythms is regarded as a promising basis for treatment. The rules for successful synchronization by melatonin are outlined. Differences of phase resetting within the phase response curve are emphasized. Moreover, deviations from classic pharmacological thinking are underlined. When appropriately timed, relatively low doses are sufficient for entrainment, whereas increases of doses may reduce rather than improve the success of resynchronization. Immediate-release formulations are sufficient and recommendable, since they generate synchronizing signals that are favorable with regard to their time structure, whereas extended actions as desired in classic pharmacology of antidepressants may prevent successful entrainment. The assessment of circadian deviations prior to the development of an individual therapeutic strategy is of utmost importance for knowing whether phase advances or delays are required and also for avoiding concomitant symptomatic treatment with drugs that cause opposite effects, such as lithium, which extends the circadian period and should not be used in patients who anyway have developed an abnormally long period.

Cite this Article: Hardeland R. Entraining Melatonergic Pulses Instead of Long-Acting Drugs: Resynchronization Rules For Depression with Circadian Etiology. Sci J Neurol Neurosurg. 2017;3(3): 059-065.

Published: 13 October 2017

Review Article: Early Diabetic Neuropathy

Juan Manuel Duarte*

Diabetic neuropathy is one of the major complications in patients with type-1 and type-2 Diabetic Mellitus (DM). This disorder is the main contributing factor to the increased risk of foot ulceration an amputation in such patients [1], together with higher mortality rate as well as a huge economic burden. In older adults with type-2 DM, the risk of falling is higher than those without DM, resulting in deleterious consequences such as hospitalization and injury-related death: neuropathy is strongly linked to falling [2].

Cite this Article: Duarte JM. Early Diabetic Neuropathy. Sci J Neurol Neurosurg. 2017;3(3): 052-058.

Published: 28 September 2017

Research Article: Surgical Management of Patients with Cerebellopontine Angle Meningiomas in a 15 Year Period

Manochehr Shirvani*, Mohammadreza Shahmohammadi, Nima Mohseni Kabir and Yasaman Arjmand

Background: Cerebellopontine Angle (CPA) meningiomas comprise 10% of all intracranial meningiomas and due to their location, are producing different surgical challenges. This study is evaluating surgical management and clinical outcome of CPA meningiomas operated during 15 years.
Materials and Methods: In a 15year period, 29 patients with definite CPA meningioma enrolled in the study. Most of the patients underwent suboccipital retrosigmoid approach (n=24), followed by combined retrolabyrinthine-retrosigmoid and translabyrinthine (n=5). Demographic data as well as neurological status and imaging features were recorded and analyzed in pre and postoperative period.
Results: Headache (n=17), hearing loss (n=15) and facial hyposthesia (n=10) were the most common presenting symptoms. Gross total resection (GTR) and subtotal resection was achieved in 79.3% and 17.2% respectively. Trigeminal (V) nerve function was significantly improved after operation (62% vs. 34.4%, p value < 0.05). Vestibulocochlear (VIII) nerve function was also significantly improved in postoperative assessment (51.72% vs. 20%, P value<0.05). 1 patient discharged with multiple cranial nerve deficits and another patient expired after operation. Postoperative complications included cerebrospinal fluid leakage, pneumonia, deep vein thrombosis and hydrocephalus. Tumor volume > 2.5 cm3 was significantly associated with higher incidence of postoperative neurological deficits.
Conclusion: CPA meningiomas are challenging to excise. Selection of appropriate surgical approach as well as GTR may decrease postoperative neurological complications and increase survival in this group of patients.

Cite this Article: Shirvani M, Shahmohammadi M, Kabir NM, Arjmand Y. Surgical Management of Patients with Cerebellopontine Angle Meningiomas in a 15 Year Period. Sci J Neurol Neurosurg. 2017;3(3): 048-051.

Published: 28 September 2017

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