With the continued surge in Lyme disease cases, post-treatment Lyme disease syndrome (PTLDS) is becoming a more pressing health concern. The aim of this review is to identify comprehensive treatment strategies for PTLDS patients. Unfortunately, universal guidelines for diagnosing and treating PTLDS do not currently exist. Consequently, physicians cannot adequately address concerns of possible PTLDS patients. Patients are left suffering and searching for answers, and their activities of daily living and quality of life are adversely impacted. This review highlights that PTLDS clinical trials have focused mainly on treatment with antibiotics, yielding challenging results that lack consistency in inclusion criteria across trials. It will remain exceedingly difficult to extrapolate the outcomes of such studies if a standard for PTLDS diagnosis is not well-established. By focusing on treatment trials rather than establishing diagnostic criteria, research in this field ignores a critical step in investigating PTLDS. The first significant step is to create comprehensive guidelines for the diagnosis of PTLDS, which can generate uniformity and validate PTLDS treatment trials.
There is a well-documented correlation between epilepsy and sleep deprivation. For decades, preclinical and clinical studies have shown that sleep deprivation can lead to an increased risk of epileptic seizures. Additionally, sleep deprivation has been used clinically as a diagnostic tool for epilepsy by triggering epileptiform activity. However, an underlying mechanism for this relationship is yet to be confirmed. Interestingly, a decrease in gamma-aminobutyric acid (GABA)-mediated tonic inhibition has been shown in both epilepsy and sleep deprivation. This review focuses on the role of sleep deprivation in the induction of epileptic seizures and the possible role of reduced GABA receptor expression in the sleep-deprived state.
Osteochondral lesions of the talus (OLTs) represent 50% of ankle sprains and are most common in athletes who play competitive sports or are on active military duty. OLTs can cause significant physical damage if left untreated and may inflict financial burdens and mental health issues. Over the years, replacement surgeries, mainly autologous osteochondral transplantation (AOT) and osteochondral allograft transplantation (OAT), have become instrumental in treating OLTs. However, these procedures' effectiveness in returning to full fitness to resume competitive sports or active duty has not been well-established. This systematic review attempts to help this population cohort better understand OLTs and highlight the existing clinical evidence on AOT and OAT effectiveness in treating such patients. We performed a literature search between March 2022 through September 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Of eligible studies evaluating surgical outcomes of AOT and OAT in sportspeople and active-duty military personnel, 86% of patients who received AOT returned to competitive sports or active duty compared to 61% who received OAT. Additionally, on average, patients who underwent AOT returned to full fitness in five months rather than in 16 months for those who underwent OAT. As highlighted in this review, the limited evidence indicates that AOT may lead sportspeople and active-duty military personnel to return to pre-injury levels and resume athletic activities sooner. It is challenging to assume the same for OAT, given the limited studies in athletic cohorts with OLTs. Nevertheless, AOT and OAT are crucial surgical options that can significantly benefit competitive sportspeople and military personnel in resuming their careers.
Trigeminal neuralgia (TN) refers to sudden shooting pain in areas innervated by trigeminal nerves originating from the Gasserian ganglion. Physicians initially manage it by prescribing drugs, such as carbamazepine. Surgical intervention is the next best option if patients do not respond to drug treatments. These procedures include microvascular decompression, rhizotomy, balloon compression, and gamma knife surgery. However, less optimal patient outcomes, recurrences, adverse effects, and high costs have necessitated alternative surgical interventions to treat such patients. Radiofrequency thermocoagulation (RFT) has emerged as a minimally invasive, safer, and effective surgical option in treating TN patients. Despite research showing RFT’s safety and effectiveness, neurosurgical healthcare providers do not frequently use it to treat TN patients. Lack of universal standardized protocol, and minimal awareness of its efficacy in specific cohorts, such as geriatric patients, may lead to RFT underutilization. Hence, this review highlights RFT's advancement as a robust alternative to traditional surgical approaches in treating TN patients. In addition, it identifies RFT’s areas of improvement and its safety and effectiveness in treating elderly TN patients. We followed the Systematic Reviews and Meta-Analyses guidelines for systematic reviews and conducted a literature search between July 2022 and March 2023. Our findings indicate that RFT has evolved significantly over the last decade and a half as a minimally invasive and effective treatment procedure for TN patients. It is more effective as a combined continuous and pulsed RFT than its other subtypes in treating primary TN patients. Moreover, RFT via a transverse puncture through the supraorbital foramen results in lesser inter- and post-procedural complications. Further, there is a slightly lesser incidence of post-procedural adverse effects and complications with RFT through the foramen rotundum. Besides, RFT, performed at a lower temperature of 65 degrees Celsius and a voltage between 64.51 and 79.29 volts, effectively provides pain relief and long-term patient satisfaction. RFT is safe and effective in patients over 60 with primary TN. Interestingly, it is also safe and effective in treating patients over 70 with poor fitness standards of Class II or higher. Despite these remarkable findings, there is still a substantial gap in the literature, specifically concerning the standardized protocol for temperature, voltage, and puncture methods of RFT. Despite the sufficient evidence of combined continuous and pulsed RFT’s superiority in efficacy and safety, most researchers still utilize either pulsed or continuous RFT. Studies vary in not only these aspects but also the patient cohorts. For instance, most researchers focus solely on evaluating RFT’s efficacy and safety in patients with primary TN, excluding a critical patient population suffering from secondary TN. Nevertheless, sufficient clinical evidence shows that RFT has come of age in treating primary TN...
Multiple Sclerosis is a chronic inflammatory disease. It is characterized by demyelinating lesions throughout the central nervous system. Patients suffering from multiple sclerosis constitute a vulnerable population to coronavirus disease-2019. This review focuses on the effects of coronavirus disease-2019 on relapse and symptom exacerbation in multiple sclerosis patients and their treatment. It highlights how the blood-brain barrier may be compromised by severe acute respiratory syndrome coronavirus 2, allowing inflammatory mediators and lymphocytes to infiltrate the central nervous system. This may increase the risk of relapse in multiple sclerosis patients. Also, in patients who did not have a prior history of multiple sclerosis, coronavirus disease-2019 has been found to impact multiple sclerosis onset and pathogenesis. However, more comprehensive research is required to fully understand the interplay between multiple sclerosis and coronavirus disease-2019.
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