International Journal of Neurology and Neurosurgery

Lumbar radiculopathy (LR) secondary to disc herniation is the most disabling clinical condition amongst people with low back pain. The objective of this study was to evaluate the efficacy of spinal mobilization in the treatment of patients with LR in addition to standard physiotherapy treatment. Materials and methods: The study is an observerblinded randomized clinical trial with concealed allocation and block randomization performed on 24 patients (13 male, 11 female) with age 51.45 ±12.32 years and 3.83 ± 1.12 years of duration of lumbar radiculopathy. Control group received moist heat therapy and intermittent lumbar traction while the experimental group received spinal mobilization (transverse vertebral pressure) in addition to control treatment. Both groups received back care, postural advice and ergonomic advice. Outcome measures of pain on visual analogue scale (VAS), Quebec back pain disability index (QBPDI) and passive straight leg raise (PSLR) were collected pre-, post-3-days treatment and post-6-weeks follow-up. Two-way ANOVA was used with Bonferonni test for post-hoc analysis using SPSS version 11.5 for Windows at 95% confidence interval. Results: There was significant (p<.05) changes observed in all three measures- VAS (1.67 ± 4.08), QBPDI (7.17 ± 4.31) and PSLR (62.50 ± 5.00) in the experimental group at immediate follow-up. The between-group difference in changes for long-term follow-up was not significant. Conclusion: Spinal mobilization in addition to standard physiotherapy comprising of moist heat and lumbar traction produced significant immediate effects on pain, disability and straight leg raise in patients with LR.

Key words: Maitland’s concept, mobilization/manipulation, manual therapy, physiotherapy, rehabilitation, sciatica. 

Introduction: Diagnosis of primary headaches is based upon clinical symptoms. However, our knowledge regarding biochemical correlation of their symptoms is limited. This study tries to find out whether symptoms during migraine have any association with inter-ictal plasma CGRP concentration. Methods: Fifty migraineurs were included after screening for inclusion and exclusion criteria for this study. Their clinical history was taken in detail and recorded in a semi-structured performa. Blood was drawn from ante-cubital vein (at least after three days of last headache) and separated plasma was stored at -70C. CGRP was analysed with commercially available ELISA kit. Data was analyzed with the help of SPSS V11.0 for Windows. Chi-Square test, independent sample t test, one way ANOVA and multivariate regression analysis was used for statistical analysis. Results: Age of subjects (P=0.02), total duration of illness (P=0.04) and frequency of migraine episode per month (P=0.03) had significant association with inter-episodic plasma CGRP concentration. Other headache characteristics were not related to the plasma CGRP concentration except cranial  autonomic symptoms where higher level was noticed in subjects with bilateral cranial autonomic symptoms with lateralized severity (F = 4.59; P=0.01). Conclusion: Laterality of cranial autonomic symptoms influences the inter-ictal plasma CGRP concentration in migraineurs.

Key Words: Migraine, cranial autonomic symptoms, CGRP, Inter-ictal period 

Background and Purpose of the Study: 50%-65% of stroke survivors have residual motor deficits;principal among them is hemi paretic gait that limits mobility, increases the risk of falls and promoting sedentary life style. Motor imagery (MI) an active process during which a specific action is reproduced within working memory without any real movements. There are evidences for MI training in enhancing motor learning, neural reorganization and cortical activation in stroke patients. However efficacy of Mental practice training involving lower extremity mobility tasks are limited in literature. Aim: To investigate the effects of combining mental practice with physical practice on functional mobility in Chronic stroke subjects. Methodology: Quasi Experimental Study design of 12 chronic hemi paretic subjects who can able to ambulate 10 m and good  imagery ability in KVIQ- 20 e” 60 and Time dependent motor imagery screening test were recruited for the study. All Subjects underwent task orientated training for lower extremity 45 min per day and mental practice program for15 minutes for 3 weeks. Results: All the 12 subjects improved in Functional Gait Assessment  from median score of 20 to 26 and in Timed Up and Go test from mean score of 56.5 to 45 seconds with the pvalue <.05. Discussion: This improvement can be explained by the principles of motor learning which is divided into 3 stages: cognitive, associative and autonomous stages. The cognitive stage is primarily declarative knowledge and must be interpreted through problem-solving. Participants used comparative information for feedback while comparing their task with that of a normal young adult through a five-stage protocol which includes progressive relaxation, external imagery (analysis of task sequences), problem identification, internal imagery and mental rehearsal. Another theoretical hypothesis is that role of mirror neuron system in humans which facilitates the motor learning. Conclusion: Motor imagery with mental practice provides additional benefits to regular physiotherapy to improve functional mobility in chronic stroke.  

Key Words: Chronic Stroke, Motor imagery, Mental Practice, Mobility. 

To describe the pattern of metastatic brain tumors (MBT) at King Abdulaziz University Hospital (KAUH) over the 6 years and Correlate the clinical data and treatment options with the survival rate. Design: retrospective study. Results: 66 patients were reviewed. Overall, the most common MBT was bronchogenic carcinoma. The mean age was 57.7±15.7 years. The survival was affected negatively in correlation with tumor multiplicity (P <.014), numbness (P <.0001), abnormal vision (P <.001) and seizure (P <.00005). The survival was improved by radiotherapy alone (P <.001). Conclusions: Several clinical risk factors may affect the survival of MBT patients.

Keywords: Metastasis, brain tumours, Jeddah, risk factors, western Saudi Arabia