Frontal sympathetic skin responses (F-SSRs) were recorded to investigate sympathetic nervous system activity in migraine headache (MH). Thirty-five patients with unilateral MH and 10 healthy volunteers were studied by evoking bilateral F-SSRs with electrical stimulation of the median nerve in attack, post-attack and interictal periods. The mean latencies were longer and the maximum amplitudes were smaller on the symptomatic side compared with the asymptomatic side (P < 0.05 for both amplitude and latency) in attack and in interictal periods. In five patients, F-SSRs were absent bilaterally, in four patients the responses were absent only on the symptomatic side during the attack period. In the post-attack period, F-SSRs on the symptomatic side had higher amplitudes and shorter latencies compared with the asymptomatic side (P < 0.01 for both amplitude and latency). There is an asymmetric sympathetic hypofunction on the symptomatic side in attack and interictal periods, whereas there is a hyperfunction in the post-attack period.
Our aim was to compare the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) over supplementary motor area with that of sham stimulation in restless legs syndrome (RLS). In this prospective study, patients were randomly assigned to either real stimulation group (11 patients), or sham stimulation group (8 patients) in a double-blinded fashion. Five patients, who were initially in the sham stimulation group, received real stimulation 1 month after the sham stimulation. One session of intervention was performed once every 3 days and total of ten sessions were done in each group. The International RLS-Rating Scale (IRLS-RS) was assessed at baseline and after 5th and 10th sessions in both groups and also in five patients in whom both sham and real stimulation were performed. A statistically significant difference was seen in the IRLS scores between real (n = 11) and sham stimulation (n = 8) after 5th and 10th sessions. The real stimulation significantly improved the IRLS-RS scores although they were unaffected by the sham stimulation. In five patients, in whom both sham and real stimulation were performed, a statistically significant improvement was seen in the IRLS-RS scores with the real stimulation and a statistically significant difference was seen in the IRLS scores between real and sham stimulation after 10th session. In conclusion, this method is safe and non-invasive, and the results of this pilot study may support that rTMS has the potential to be used in the treatment of RLS, which should be verified in larger series.
Transcutaneous electrical nerve stimulation application to the posterior tibial nerve has the potential to be an alternative treatment option for chronic anal fissure patients who seek noninvasive treatment modality.
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