Peripheral nerve block provides some with long-lasting pain relief for severe facial pain

A new study has shown that use of peripheral nerve blocks in the treatment of Trigeminal Neuralgia (TGN) may produce long-term pain relief.

TGN is a condition involving sudden episodes of severe facial pain that significantly reduces quality of life in those affected. When medication fails to control the pain, some patients turn to invasive procedures that require a high level of expertise and can result in long-standing numbness. Peripheral Trigeminal Nerve Blocks (PTNB), a procedure in which a numbing medication is injected at the sites where the problem nerve reaches the face, is a promising alternative to the riskier, ganglion-level procedures, although its efficacy in both short-term and long-term management of TGN has not been well studied.

In a case series in this week’s American Journal of Emergency Medicine, Michael Perloff, MD, assistant professor of neurology at Boston University School of Medicine, examines nine patients with TGN treated with PTNB. He finds that all nine had immediate relief of their pain after the procedure, with most reporting that they were pain-free. In addition, six of the nine patients noted continued pain relief from a range of one to eight months following the procedure, with two of them having complete resolution of their pain months after the injections.

Perloff, also a neurologist at Boston Medical Center, sees these results as a promising step for treating patients with TGN. “PTNB can be a simple, safe alternative compared to opioids, invasive ganglion level procedures or surgery.”

These findings appear in the American Journal of Emergency Medicine.

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Discovery presents treatment hope for Alzheimer’s and other neurodegenerative diseases

There is new hope for the treatment of Alzheimer’s and other neurological diseases following a ground-breaking discovery made by an Australian-Chinese research collaboration.

Researchers from the University of South Australia and the Third Military Medical University in China have discovered a signal pathway within cells, and also invented a potential drug that could stop degeneration and actually improve learning and memory in affected patients.

UniSA’s Professor Xin-Fu Zhou and colleagues have been investigating tauopathies — which refers to a class of diseases caused by misfolding of the tau protein inside nerve cells that results in cell damage and eventually cell death.

These diseases include Alzheimer’s, Parkinson’s and Motor Neuron Disease, all of which presently have no cure.

Specifically, the team has looked into frontotemporal lobe degeneration (FTLD), a term representing a group of clinical syndromes related to cognitive impairment, behavioural abnormalities and speech disorders.

Professor Zhou says that previously it was unknown how the gene mutation was responsible for causing cell death or damage — referred to generally as neurodegeneration, and dementia in patients with FTLD and other motor neuron diseases. “Right now there is no treatment available at all,” Prof Zhou says. “We have been investigating how these tauopathies (diseases) have some common pathology, including a particular tau protein that plays a critical role in nerve cell function.”

Tau protein is a protein that stabilises microtubules and it is specifically abundant in neurons of the nervous system, but not in elsewhere.

“Our research found that in both the animal model and human brains, the signal of neurotrophins and receptors is abnormal in brains with FTLD,” Prof Zhou says.

“We discovered an increase in the neurotrophin signalling pathway that is related to life and death of nerve cells, known as proNGF/p75, and then found blocking its functions was shown to reduce cell damage.

“Thus, in this paper we not only discovered a signaling pathway but also invented a potential drug for treatment of such diseases.”

Given this strong evidence now available, the next stage is a clinical trial and South Australian biotech company Tiantai Medical Technology Pty Ltd has recently acquired a licence to further develop and commercialise this medical technology.

Professor Zhou says this industry involvement means there is an opportunity to translate the discovery into a treatment of Alzheimer’s disease and other tauopathies.

The paper published in Molecular Psychiatry is a collaborative work between two laboratories led by Professor Xin-Fu Zhou, University of South Australia and Professor Yanjiang Wang, the Third Military Medical University.

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Who made the error? The brain distinguishes causes of errors to perform adaptation

Practice is necessary to improve motor skills. Even if one performs poorly at first, one’s athletic performance improves through repeated exercise due to the reduction of motor errors as the brain learns.

However, it’s important to remember that there are two types of errors: motor errors caused by poor motor control and target errors caused by unexpected target movements.

For example, if you swung a bat aiming at a ball coming straight to the middle of the strike zone and missed your swing 10 cm over the ball, the missed swing was caused by your motor error. So, the connection between your intention and your movement control needs to be adjusted downward.

On the other hand, if you missed the ball because it suddenly moved downwards 10 cm below the center of the strike zone after going through the center, the missed swing was caused by unexpected movement of the target. So, when it comes to these target errors, it would be better to learn using a system to predict the target’s move instead of changing the connection between intention and movement control.

Using the monkey parietal lobe, two researchers at Osaka University, Shigeru Kitazawa and Masato Inoue, examined (1) brain regions to detect motor and target errors, and (2) whether error signals from these regions were really used for learning. Their research results were published in Current Biology.

They found that the parietal lob of the cerebral cortex, the region in which signals of visual, acoustic, and somatic sensations are perceived, distinguished the causes of motor errors in arm reaching movements and provided signals to compensate for these errors. They also revealed that Brodmann area 5 detected self-generated motor errors and provided signals for adaptation and that Brodmann area 7 detected target errors caused by target movements and provided error signals for adaptation.

This study verified that the brain does not automatically detect the discrepancy between the hand and target positions, i.e., error, but the brain distinguishes motor error from target error and performs adaptation using the two distinctive systems.

This discovery will lead not only to the development of effective learning of sports, but also to the improvement of autonomous driving systems and the development of effective learning methods for robot control.

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