Chronic migraine is a potentially debilitating condition that can be detrimental to someone’s quality of life. Clinical data has proven OnabotulinumtoxinA (BoNT-A) to be an effective prophylactic treatment for chroni...Chronic migraine is a potentially debilitating condition that can be detrimental to someone’s quality of life. Clinical data has proven OnabotulinumtoxinA (BoNT-A) to be an effective prophylactic treatment for chronic headache types, and it is now regularly employed by headache treatment centers. The PREEMPT injection protocol has become the standard treatment regimen surrounding Botox injections for chronic migraine treatment since it was granted approval by the FDA in 2010. This retrospective chart review of patients treated for chronic migraine at Maine Comprehensive Pain Management in Scarborough, Maine, presents an alteration to the standard PREEMPT injection paradigm that reinforces the efficacy of Botox for chronic migraine treatment. We will discuss our Modified PREEMPT injection paradigm, which yields a positive clinical response rate of 95% of patients achieving at least 50% improvement in their migraine headaches. This appears to be the highest established response rate in the literature to date.展开更多
This retrospective case study investigates the clinical presentation of a 53-year-old female who underwent mantle field radiotherapy roughly 26 years ago. This patient presents with diffuse muscle atrophy and weakness...This retrospective case study investigates the clinical presentation of a 53-year-old female who underwent mantle field radiotherapy roughly 26 years ago. This patient presents with diffuse muscle atrophy and weakness in the cervical musculature, as well as sensory deficits in the upper extremities. We sought to compare our patient’s symptoms with other patients who had been formally diagnosed with Dropped Head Syndrome (DHS) by reviewing the existing literature. We found that the clinical presentation under investigation was consistent with other patients who had received radiotherapy for Hodgkins’s disease and were then diagnosed with DHS. Electromyography (EMG), nerve conduction studies, and a cervical MRI were unable to identify a separate neurological cause for the symptoms, but the MRI did confirm the presence of diffuse muscle atrophy in the cervical musculature. After reviewing the existing literature and imaging results, we compared our patient’s symptoms to those that define DHS, and both the time of onset, presenting symptoms, and progressing course are consistent with a diagnosis of Dropped Head Syndrome.展开更多
Cervical dystonia (CD) is a condition that typically presents with cervical muscle spasm, producing head tilt and cervical rotation. CD is most often idiopathic, however, in a small number of patients, CD occurs withi...Cervical dystonia (CD) is a condition that typically presents with cervical muscle spasm, producing head tilt and cervical rotation. CD is most often idiopathic, however, in a small number of patients, CD occurs within one day to one year after mild to severe trauma. This type of CD is further classified as posttraumatic CD. OnabotulinumtoxinA (Botox) injections are considered to be a controversial treatment for posttraumatic CD and have produced variable result. This report describes the case of a 32-year-old female presenting with a two year history of posttraumatic CD and associated head, neck, and shoulder pain after obtaining a severe head injury during a motorcycle accident. OnabotulinumtoxinA was used to successfully treat her posttraumatic CD muscle spasms and associated chronic pain. Three months after her first and second ONA treatments, the patient reported at least 50% improvement in her overall pain symptoms and a noticeable reduction in cervical paraspinal muscle spasms.展开更多
文摘Chronic migraine is a potentially debilitating condition that can be detrimental to someone’s quality of life. Clinical data has proven OnabotulinumtoxinA (BoNT-A) to be an effective prophylactic treatment for chronic headache types, and it is now regularly employed by headache treatment centers. The PREEMPT injection protocol has become the standard treatment regimen surrounding Botox injections for chronic migraine treatment since it was granted approval by the FDA in 2010. This retrospective chart review of patients treated for chronic migraine at Maine Comprehensive Pain Management in Scarborough, Maine, presents an alteration to the standard PREEMPT injection paradigm that reinforces the efficacy of Botox for chronic migraine treatment. We will discuss our Modified PREEMPT injection paradigm, which yields a positive clinical response rate of 95% of patients achieving at least 50% improvement in their migraine headaches. This appears to be the highest established response rate in the literature to date.
文摘This retrospective case study investigates the clinical presentation of a 53-year-old female who underwent mantle field radiotherapy roughly 26 years ago. This patient presents with diffuse muscle atrophy and weakness in the cervical musculature, as well as sensory deficits in the upper extremities. We sought to compare our patient’s symptoms with other patients who had been formally diagnosed with Dropped Head Syndrome (DHS) by reviewing the existing literature. We found that the clinical presentation under investigation was consistent with other patients who had received radiotherapy for Hodgkins’s disease and were then diagnosed with DHS. Electromyography (EMG), nerve conduction studies, and a cervical MRI were unable to identify a separate neurological cause for the symptoms, but the MRI did confirm the presence of diffuse muscle atrophy in the cervical musculature. After reviewing the existing literature and imaging results, we compared our patient’s symptoms to those that define DHS, and both the time of onset, presenting symptoms, and progressing course are consistent with a diagnosis of Dropped Head Syndrome.
文摘Cervical dystonia (CD) is a condition that typically presents with cervical muscle spasm, producing head tilt and cervical rotation. CD is most often idiopathic, however, in a small number of patients, CD occurs within one day to one year after mild to severe trauma. This type of CD is further classified as posttraumatic CD. OnabotulinumtoxinA (Botox) injections are considered to be a controversial treatment for posttraumatic CD and have produced variable result. This report describes the case of a 32-year-old female presenting with a two year history of posttraumatic CD and associated head, neck, and shoulder pain after obtaining a severe head injury during a motorcycle accident. OnabotulinumtoxinA was used to successfully treat her posttraumatic CD muscle spasms and associated chronic pain. Three months after her first and second ONA treatments, the patient reported at least 50% improvement in her overall pain symptoms and a noticeable reduction in cervical paraspinal muscle spasms.
