Internationale Zeitschrift für Neurorehabilitation

The neurovascular theory explains migraine to be a result of complex pathophysiological changes leading to activation of trigeminal nociceptors by several inflammatory mediators. Different classes of drugs have been used to control migraine where specific class of drugs inhibit only specific mediators while sparing others, resulting into suboptimal treatment response. Migraine is also reported by a significant proportion of patients suffering with various metabolic syndrome related conditions. The chronic inflammation caused by metabolic disruptions has been the leading cause that contributes in inducing and worsening migraine attacks. Treating these patients for conditions such as obesity and insulin resistance has resulted in significant improvement in alleviating migraine episodes. These findings provide opportunities to devise a comprehensive migraine treatment regimen that combines pharmacotherapy with metabolic corrections, lifestyle changes and diet therapy to achieve improved treatment outcome.

Background: Retinal Angiomatous Proliferations (RAP) is a subgroup of exsudative or “wet” Age-related Macular Degeneration (wAMD) with devastating reduction of visual acuity in later stages. Intravitreal Ranibizumab provides a good therapy, but is considered to be not as effective in this class of neovascularization compared to choroidal neovascularization (CNV). We investigated the efficacy of Ranibizumab in late stage III RAP with retino-choroidal anastomosis compared to the outcome of CNV lesions. Methods: Retrospective analysis of the data of all for wAMD with Ranibizumab treated patients. Patients were divided into groups depending on the lesion type into RAP (identified and selected clinically, proven by fluorescein angiography) and CNV types (identified by fluorescein angiography only) named occult, minimally and predominantly classic groups. Best-corrected visual acuity (BCVA) was obtained before (“diagnosis”), during (1st, 2nd and 3rd injection) and after upload (“1st control”). Results: Before first injection the visual acuity decreased in all groups (0.73 to 0.78 logMAR for all CNV, 0.95 to 1.02 logMAR for RAP). During upload there is no further decline in visual acuity but no improvement as well up to the 1st control visit in the RAP group (1.02 to 1.03 logMAR), but a statistically significant increase in all other groups (0.78 to 0.67 logMAR). Conclusion: Clinically identified late stage III RAP lesions with retino-choroidal anastomosis respond worse to treatment with monthly Ranibizumab than all other lesion types regardless of their severity. Treatment results in stabiliziation of visual acuity, but – in contrast to other forms of CNV – no further improvement. Therefore, patients with this special form need to be identified and treated as early as possible.

A lot of research findings support that curcumin (diferuloyl methane) has antioxidant, anti-inflammatory and antitumor activity. In India, curcumin has a widespread use as food additive and herbal medicine for human diseases without any side effect. Though curcumin is well established as an anticancer agent but there are a few reports about its promising role against amyloid diseases. According to recent finding curcumin play a crucial inhibitory role in pathophysiology of Alzheimer’s disease (AD). Oral administration of curcumin or its metabolites has shown the inhibition of Aβ deposition, Aβ oligomerization and tau phosphorylation in the brain of AD animal model including behavioural improvement. But still it is unknown whether the curcumin is directly involved in those processes or enhance those mechanisms. Thus in this review we want to focus on overall mechanism of curcumin in AD. Some strategies to overcome the problem of low absorption and fast clearance of curcumin nanoparticles have also been proposed.

This commentary considers the implications of the findings related to the effect of a study related to coronary heart disease (CHD) risk assessment in individuals with a chronic spinal cord injury (SCI). The findings from the study suggest that there is poor agreement in CHD risk assessment between the previously used guidelines, the National Cholesterol Education Program (NCEP) Guidelines, and coronary artery calcium scores (CACS). Since this publication, a new atherosclerotic cardiovascular disease (ASCVD) risk estimator has been developed. This has not been used in any study with SCI participants. The study also showed that 18 (47.4%) of the participants had some element of CAC, indicating the presence of CHD. Many previous articles have discussed CHD risk factors and mortality in the SCI population. Despite this, there have been very few interventions to decrease the CHD risk in the chronic SCI population.

We are able to read this because of quantum and thermodynamic principles that via an inorganic proton gradient, possibly generated 4.2 billion years ago, gave rise to a system that has an awareness of time and space by using energy to integrate information. Life can be described as a dissipative system driven by an energy gradient that uses information to positively reinforce its self-sustaining structure, which in turn increases its non-linear decisional capacity. Key in the evolution of life has been stress coupled to natural selection, which usually meant an increased demand for energy. As hormesis describes the adaptive response to stress, we propose that hormesis embraces not only the evolution of life, but that of intelligence itself, as natural selection would favour systems that enhances its efficiency. A component of the hormetic response in eukaryotes is the mitochondrion, which itself relies on quantum effects such as tunnelling. This suggests that quantum effects control the stability of individual cells as well as long-lived cellular networks. Hormesis, which can be anti-inflammatory, is therefore key in maintaining the functional stability of complex systems, including the brain. In contrast, a lack of classical hormetic factors, such as physical activity, plant polyphenols, or calorie restriction, will lead to accelerated cognitive decline, which is associated with increased inflammation. However, there may be another previously unidentified factor that could also be considered hormetic, and that is thinking itself. Here we propose that the process of “thinking”, and managing complex movement, induces “stress” in the neuronal system and is therefore in itself part of maintaining cognitive health and reserve throughout life. In effect, the right amount of thinking and information processing can beneficially induce adaptation, and this itself could be explainable by quantum thermodynamics.

With regard to whiplash injury (WI) patients, some studies documented mild attention problems and a reduced speed of information processing. Most patients showed problems with sustained and/or divided attention. However, some patients had also problems with focused and alternating attention. Regarding memory, some studies detected mild (auditory-verbal and/or visuospatial) memory difficulties. Visuospatial and executive functions appeared mostly preserved. In mild traumatic brain injury (MTBI) patients, mild impairments in speed of information processing, (sustained, divided, focused and/or alternating) attention and (auditory-verbal and/or visuospatial) memory have been found. Furthermore, mild deficits could also be seen on tests measuring executive functions whereas visuospatial functioning seemed to be preserved. Until today, only two studies were devoted to evaluate possible differences in cognitive functioning between WI and MTBI patients. In these studies, both patient groups did not differ significantly with regard to measurements of attention, memory, and visuospatial and executive functions. Therefore, these authors conclude that MTBI patients do not perform more poorly on cognitive tests than WI patients, as might be expected from severity of trauma.

A female 49 years old patient with vestibular schwannoma developed normal pressure hydrocephalus. Patient complained about gait disturbance, urinary incontinence and memory impairment. Investigation of clinical parameter and measurement of kynurenic acid in the cerebrospinal fluid (CSF) and serum in patients with normal pressure hydrocephalus and in corresponding controls (CO; N=15) were performed. Within investigated parameters significant increase of protein and IgG levels in CSF were found in patient with normal pressure hydrocephalus. Furthermore, kynurenic acid was increased in the CSF by 60% and in the serum by 40%, comparing to CO subjects. Kynurenic acid level in CO was in the CSF and serum 2.77 ± 0.23 and 53.4 ± 4.0 nM, respectively. Three lumbar punctures were applied to patient with normal pressure hydrocephalus and clinical parameters partially normalized and lowering of kynurenic acid levels in CSF and serum were observed. Patient was improving after each lumbar puncture but the effect was transient, therefore permanent CSF shunting was recommended. After that a complete remission of symptoms occurred. Revealed data indicate a significant advantage of single punctures in management of treatment for normal pressure hydrocephalus. Increase of kynurenic acid in CSF represents interesting parameter. It is questionable if occurrence of cognition impairment and/or dementia in patients with normal pressure hydrocephalus might be related to an enhancement of kynurenic acid in the CNS.

Health professionals are hesitant to recommend psychiatric service dogs (PSD) to veterans with post-traumatic stress disorder given that there is no scientific evidence to support their effectiveness. In recent years, new dog training schools for PSD have emerged in the community with different approaches. The objective of this study is to propose a logic model that examines how service dogs assist veterans with post-traumatic stress disorder and that shows concerns related to PSD. A participatory design through a consultation with stakeholders across Canada was realized (dog trainers=12, veterans having a PSD=2, veterans from advocate organizations=4, medical doctors=3, Canadian general standard board=1). They were interviewed in February 2015 via a phone qualitative interview. Questions were about tasks for which the dog should be trained to help the veteran, disadvantages, difficulties and concerns related to having a PSD, promotion and standardization of PSD, difficulties regarding the evaluation process, dog allocation and follow-up/abandonment of the dog. A qualitative thematic content analysis was achieved with the interview’s materiel. A logic model was created to classify the theory related to diagnosis and treatment for post-traumatic stress disorder as well as the results of the consultation (n=30 themes). These included 4 dog roles (detection and intervention when the veteran is anxious, contributing to a feeling of safety, promoting a sense of relaxation, socialisation), 2 potential major undesirable events with the PSD, 9 potential effects of the PSD, 3 potential organizational impacts of the service dog and 12 co-factors affecting the accessibility and efficacy of the intervention with PSD. Some themes contradict the legal acceptance in the literature. Testimonies about the reported efficacy of PSD are enthusiastic compared to what was found in the literature. Future research is needed to validate how and when PSD’s roles and task make the differences in everyday life of the veterans with PSTD.

Tunnelled catheter endocarditis is a frequent and sever situation among hemodialysis patients. The management should be fast and multidisciplinary. Case report: We report the case of a 36 year old woman with a history of systemic erythematous lupus, discovered at the age of twenty. She profited from a tunneled catheter because of exhaustion of her venous capital. One year later, the patient had an endocarditis of the tricuspid valve. An echocardiogram demonstrated mobile and friable 8 mm vegetation in the tricuspid valve. Blood cultures were positive for pseudomonas and klebsiella. The catheter was removed at the fifth day of the infection. The patient received antibiotic treatment which was changed on several occasions in front of multiresistant strains. Ten days later, the blood culture showed Candida albicans. The echocardiogram demonstrated an increase of the size of the vegetation to 15 mm. A chest CT carried out in front of a respiratory distress showed pulmonary septic emboli. Tricuspid valve replacement was performed. Culture of native valve was positive for multiresistant candida famata. The patient developed a pulmonary embolism causing her death. Discussion: Endocarditis with permanent catheter is a severe situation with high mortality and poor prognosis among hemodialysis patients. Immune suppression due to a renal failure and auto immune disease can support the development of multiresistant strains difficult to treat. Conclusion: Endocarditis on tunneled catheter is a serious infection. Nephrologists, cardiologists and infectiologists must collaborate in order to provide adequate therapy.