In patients with distal symmetric polyneuropathy we assessed non-nociceptive Aβ- and nociceptive Aδ-afferents to investigate their role in the development of neuropathic pain. We screened 2240 consecutive patients with sensory disturbances and collected 150 patients with distal symmetric polyneuropathy (68 with pain and 82 without). All patients underwent the Neuropathic Pain Symptom Inventory to rate ongoing, paroxysmal and provoked pains, a standard nerve conduction study (NCS) to assess Aβ-fibre function, and laser-evoked potentials (LEPs) to assess Aδ-fibre function. Patients with pain had the same age (P > 0.50), but a longer delay since symptom onset than those without (P < 0.01). Whereas the LEP amplitude was significantly lower in patients with pain than in those without (P < 0.0001), NCS data did not differ between groups (P > 0.50). LEPs were more severely affected in patients with ongoing pain than in those with provoked pain (P < 0.0001). Our findings indicate that the impairment of Aβ-fibres has no role in the development of ongoing or provoked pain. In patients with ongoing pain the severe LEP suppression and the correlation between pain intensity and LEP attenuation may indicate that this type of pain reflects damage to nociceptive axons. The partially preserved LEPs in patients with provoked pain suggest that this type of pain is related to the abnormal activity arising from partially spared and sensitised nociceptive terminals. Because clinical and neurophysiological abnormalities followed similar patterns regardless of aetiology, pain should be classified and treated on mechanism-based grounds.
A case of eosinophilic granuloma of the lesser wing of the sphenoid bone is reported. The patient was a 5-year-old white male, with left temporal-frontal headache, left III cranial nerve palsy, left exophthalmos and ptosis caused by an osteolytic lesion of the anterior clinoid process extending to the left optic canal and cavernous sinus. The patient underwent surgical resection of pathologic tissue. Pathologic diagnosis was eosinophilic granuloma of the sphenoid bone. Surgical management, postoperative prognosis and differential diagnosis of eosinophilic granuloma of the skull base are discussed along with a review of the literature.
Background: Despite being widely prescribed, relatively few controlled trials have been conducted on the class of neurotrophic/antinociceptive nutraceuticals. While performing a search in the literature, we came across an old registration study on micronized palmitoylethanolamide in patients with low back pain – sciatica by Guida and colleagues. Methods: We contacted the authors of the article and obtained all the original material, which allowed us to reanalyze the study. We assessed its clinical relevance by calculating the numbers needed to treat for pain (visual analog scale) and function (Roland-Morris Questionnaire). After excluding patients for whom the information available was insufficient, we assigned each patient to one of the five categories of increasing probability of neuropathic pain: pure lumbago, lumbago with projecting pain to surrounding regions (e.g. gluteus or groin), lumbago with projecting pain to the thigh or leg, pure sciatica and radiculopathy, and investigated any correlations (Spearman) between the improvement in pain and function with these five classes. Results: Compared with placebo, palmitoylethanolamide 600 mg/die yielded a number needed to treat of 1.7 (95% confidence interval: 1.4-2) for pain, and 1.5 (95% confidence interval: 1.4-1.7) for function. The correlation between the five categories was highly significant for pain relief (P <0.0001), though not significant for reduced dysfunction. Conclusion: Palmitoylethanolamide was extremely effective on pain and function in a large cohort of patients with low back pain – sciatica. Although, the multiple mechanisms of action of palmitoylethanolamide are ideal for mixed pain conditions such as low back pain – sciatica, the correlation between pain relief and the likelihood of neuropathic pain suggests that this drug exerts a predominant action on the neuropathic pain component.
Clinicopathologic data from 59 patients with primary gastric non-Hodgkin's lymphoma (NHL) were reviewed. Lymphomas in 13 patients were limited to the gastric wall, in the remaining cases nodes or adjacent organs were involved. Thirty-five patients had low-grade malignancy tumors and 24 were affected by high-grade lymphomas. The overall operative mortality rate was 12%. Nineteen patients received postoperative chemotherapy. At follow-up 24 patients had died, 20 as a result of disease progression; 4 were lost to survey. The 5-year survival rate was 75% after nonextended and 33% after extended radical resections. Three-year survival rate was 60% for patients who underwent radical surgery not followed by adjuvant therapy and 86% for cases who had chemotherapy after radical resection. Surgery in conjunction with chemotherapy should represent the therapeutic approach for primary gastric NHL rather than surgery alone.
Abstract Background It is widely agreed that carbamazepine and oxcarbazepine are highly effective in the long‐term treatment of trigeminal neuralgia. However, the tolerability of these drugs across the different aetiologies of trigeminal neuralgia is still undetermined. Methods In this retrospective, real‐world study, we assessed the effectiveness and tolerability of carbamazepine and oxcarbazepine in a large cohort of patients with classical (254 patients), secondary (60 patients) and idiopathic (40 patients) trigeminal neuralgia. We analysed data using a propensity score analysis to account for selection bias; frequencies of side effects associated with carbamazepine and oxcarbazepine were calculated by adjusting data with the inverse probability of treatment weighting. Results The initial proportion of responders was 88.3% with carbamazepine, and 90.9% with oxcarbazepine. The number of refractory patients was significantly higher in idiopathic (15%) and secondary forms (27%) than in classical trigeminal neuralgia (6%; p < .05). In 53 patients treated with carbamazepine (29.6%) and in 22 treated with oxcarbazepine (12.6%), major side effects caused treatment interruption or dosage reduction to an unsatisfactory level. Side effects occurred more frequently in patients treated with carbamazepine (43.6%) than with oxcarbazepine (30.3%, p < .0001). The frequency of treatment discontinuation was higher in patients with secondary and idiopathic forms than in those with classical trigeminal neuralgia ( p < .05). Conclusions Our real‐world study shows that carbamazepine and oxcarbazepine are effective in most patients with trigeminal neuralgia; nevertheless, side effects are still a major issue, particularly in patients with secondary and idiopathic trigeminal neuralgia. Significance Although carbamazepine and oxcarbazepine are effective in most patients with trigeminal neuralgia, their side effects are still a major issue, thus necessitating the development of better‐tolerated drugs.
Abstract Background In the neurophysiological assessment of patients with neuropathic pain, laser evoked potentials ( LEP s), contact heat evoked potentials ( CHEP s) and the evoked potentials by the intraepidermal electrical stimulation via concentric needle electrode are widely agreed as nociceptive specific responses; conversely, the nociceptive specificity of evoked potentials by surface concentric electrode ( SE ‐ PREP s) is still debated. Methods In this neurophysiological study we aimed at verifying the nociceptive specificity of SE ‐ PREP s. We recorded LEP s, CHEP s and SE ‐ PREP s in eleven healthy participants, before and after epidermal denervation produced by prolonged capsaicin application. We also used skin biopsy to verify the capsaicin‐induced nociceptive nerve fibre loss in the epidermis. Results We found that whereas LEP s and CHEP s were suppressed after capsaicin‐induced epidermal denervation, the surface concentric electrode stimulation of the same denervated skin area yielded unchanged SE ‐ PREP s. Conclusion The suppression of LEP s and CHEP s after nociceptive nerve fibre loss in the epidermis indicates that these techniques are selectively mediated by nociceptive system. Conversely, the lack of SE ‐ PREP changes suggests that SE ‐ PREP s do not provide selective information on nociceptive system function. Significance Capsaicin‐induced epidermal denervation abolishes laser evoked potentials ( LEP s) and contact heat evoked potentials ( CHEP s), but leaves unaffected pain‐related evoked potentials by surface concentric electrode ( SE ‐ PREP s). These findings suggest that unlike LEP s and CHEP s, SE ‐ PREP s are not selectively mediated by nociceptive system.
