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Research & Reviews: A Journal of Neuroscience

Contents

1. Effectiveness of Dry Needling on Release of Myofascial Trigger Points in Acute Piriformis Syndrome: A Case Report Manisha Uttam, Harshita Yadav

2. Entropy Analysis of EEG between Alcoholic and Control Subjects during Visual Stimulus Perception Materpal Jakhar, Puneet Mishra, Sunil Singla

3. Quality of Life and Economical Burden on Caregivers of Patients with Brain Tumor Maninder deep kaur, Manisha Nagi, Ashok Kumar, Sandhya Ghai, M.K Tiwari

4. Non-compliance to Antiepileptic Drugs in Tertiary Hospital: Factors and Outcomes Latika Bajaj, Ankita Sandal, Neha Kumari, Sudarshana, Saraswati, Sanjeev Shah, Sandhya Ghai, Manish Modi

5. Obsessive-Compulsive Disorder and Marijuana P. Flaer, M. AlRubaie

Research and Reviews: Journal of Neuroscience ISSN: 2277-6427(online), ISSN: 2348-7925(print) Volume 6, Issue 3 www.stmjournals.com

Effectiveness of Dry Needling on Release of Myofascial Trigger Points in Acute Piriformis Syndrome: A Case Report Manisha Uttam*, Harshita Yadav Department of Physiotherapy, R.P. Inderaprastha Institute of Medical Sciences, Karnal, Haryana, India Abstract Piriformis syndrome (PS) is a peripheral neuritis of the sciatic nerve caused by trauma or increased muscle demands on the piriformis. The aim of this case report was to determine the effectiveness of dry needling (DN) for the release of trigger points in a patient with acute PS. The case was a 27-year-old male presented with a history of left buttock pain since 10 days. The patient received one session of DN along with cold pack and mild stretching of piriformis muscle. Outcome measures such as pain, was measured by visual analog scale (VAS) and hip abduction as well as internal rotation was measured by universal goniometer. All the measurements were performed before the session, immediately and 15 min after the end of DN and other treatment. Results revealed an immediate improvement in VAS scores and hip abduction and internal rotation ROM. The present case study concluded that single session of DN along with mild stretching and cold pack is effective in releasing myofascial trigger point in acute PS patient. Keywords: Intramuscular manual therapy, buttock pain, low back pain, neuropathy

INTRODUCTION Piriformis syndrome (PS) is a neuromuscular disorder characterized by cluster of symptoms arising from entrapment of one or both divisions of sciatic nerve as they pass the sciatic notch [1]. The symptoms include pain in hip or buttock region which may refer to lower back and thigh as well as pain gets exaggerate while walking, sit to standing, stair climbing or during lower limb functional activities [2]. PS may affect individuals of all occupations with different lifestyles. Its incidence rate with lower back pain may widely vary from 5 to 36%. PS is more common among women due to the biomechanics associated with the wider Q angle in the pelvis of women [3]. PS may be caused by anatomic abnormalities of the piriformis muscle, trauma that affects the pelvis, leg length discrepancy and Piriformis myositis [4]. One of the most common causes of PS might be related to spasm in piriformis muscle that may further develop myofascial trigger points in response to altered muscle demands [5]. Myofascial trigger points are

defined as hyperirritable nodules located within a taut band of skeletal muscle and produce local pain, sensitivity as well as diffuse and radiating pain along the sciatic nerve root [6]. Trigger points can be located by palpation at the level of greater sciatic notch or on the belly of piriformis muscle [7]. Clinical diagnosis of PS requires thorough history and physical examination by some special tests like Freiberg’s sign, FAIR test, Lasègue sign and Beatty test [8, 9]. The pharmacological management of PS includes NSAIDs, neuropathic pain agents and muscle relaxants whereas non-pharmacological management is the mainstay treatment for PS, which includes various manual therapy techniques, stretching of piriformis muscle and kinesio taping [4]. However, dry needling (DN) is the emerging minimally invasive maneuver indicated mainly to target and deactivate myofascial trigger points in different parts of the muscle and helps in reducing local and referred acute pain [10]. The American physical therapy association describes dry needling as a skilled intervention

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Research and Reviews: Journal of Neuroscience ISSN: 2277-6427(online), ISSN: 2348-7925(print) Volume 6, Issue 3 www.stmjournals.com

Entropy Analysis of EEG between Alcoholic and Control Subjects during Visual Stimulus Perception Materpal Jakhar1,*, Puneet Mishra1, Sunil Singla2 1

Department of Biomedical Engineering, GJ University of Science and Technology, Hisar, Haryana, India 2 Department of Electrical and Instrumentation, Thapar University, Patiala, Punjab, India

Abstract The purpose of this paper is to examine the variation in the EEG signal recorded from a group of individual, who were subjected under the effect of alcoholism while comparing them to non-alcoholic or controlled state. For the purpose, EEG from individuals was processed while subjects were perceiving visual picture stimulus from Snodgrass and Vanderwart picture set. A total of 10 trials for each subject have been considered in matched/non-matched condition of picture stimuli. Interestingly, the frontal lobe of the brain has been found to be responsible for instantaneous response against visual stimulus, for the sake of the same, two electrode positions namely Fp1 and Fp2 have been considered for the study. Entropy analyses such as approximate entropy and spectral entropy have been extracted to understand the underlying responses of randomness of the signal due to instantaneous responses from alcoholic/non-alcoholic subjects. Results obtained after proper signal conditioning and feature extraction have shown promising evidences in recorded responses of alcoholics whose values significantly decrease from that of non-alcoholic/control person. Hence, it may be inferred that entropy study may be used for discrimination of subjects under the effect of alcoholism or any other internal/external environmental changes. Keywords: Approximate entropy, EEG, ERP, spectral entropy, visual stimulus

INTRODUCTION Electroencephalogram (EEG) measures the electrical activity from the surface of the scalp, evoked by number of neurons [1, 2]. It is a non-invasive procedure and it could be performed on children, adults, any healthy/unhealthy human being. The potential generated through EEG is complex and possess random behavior which makes it difficult to analyze. Thus, it is important to particularly identify (artifact free signal) and condition the signal in order to get the correct information. This paper discusses the effect of alcoholism on the human brain and related reaction as compared to controlled state with the help of event related potential (ERPs) generated during visual stimulus. The ERPs are the potential that are measured as brain response against specific task to a specific sensory, cognitive or motor event. The stimulus to generate ERPs was taken from Snodgrass and

Vanderwart picture set consisting of pictures of objects from day to day activities [3]. The effect of alcoholism has a very complex and heterogeneous disorder amongst genetic and environmental determinants to analyze endophenotypic marker to study molecular genetics of alcoholism [4]. In another study, non-linear characteristics of EEG were done to differentiate among alcoholics and control people to study the uncertainty of the brain [5, 6]. In year 1981, Propping et al. studied the resting EEG in alcoholic subjects and their relatives too. This study reported number of differences in the EEG when compared to male alcoholics and age matched control [7]. The differences between alcoholics and nonalcoholics differ in some characteristic way, while making a balance between inhibition and excitation process inside the brain of alcoholics [8]. In another study, it has been found that some individuals with a pre

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Research and Reviews: Journal of Neuroscience ISSN: 2277-6427(online), ISSN: 2348-7925(print) Volume 6, Issue 3 www.stmjournals.com

Quality of Life and Economical Burden on Caregivers of Patients with Brain Tumor Maninder deep kaur1,*, Manisha Nagi1, Ashok Kumar1, Sandhya Ghai2, M.K Tiwari3 1

Clinical Instructor, National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India 2 Principal, National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India 3 Professor, Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India

Abstract Family caregivers of brain tumor patients face many challenges, which impact their quality of life and wellbeing and also causing burden to them economically. Whether challenged physically, emotionally, socially or spiritually, distress in one area may compound challenges in other areas. Caregiving affects a caregiver’s work and family financials, such as balancing a job and providing care to family members. A study was conducted to evaluate the quality of life and economical burden of brain tumor caregivers. 50 caregivers of patients who were diagnosed with brain tumor in department of neurosurgical of PGIMER, Hospital Chandigarh participated in the study. Data were collected by using a demographical proforma and quality of life Index-Cancer scale (CQOLC) was used to assess the quality of life of caregivers of brain tumor and to measure the financial burden of caring for an cancer patient, the financial cost dimension of the Cost of Care Index was used. It was determined that the majority of caregivers were young and male. Almost all the participants had life quality of life lower than normal with mean of 88.9±10.6. 30% of the family caregivers agreed that caregiving for the care receiver was causing them to dip into savings. Again, 15% of the family caregivers indicated that they and their families could not afford those little extras because of the expenses to care for the care receiver. Over a one third (35%) indicated that their family or they had to give up necessities because of the expense to provide care. Another 20% of the caregivers indicated that caring for the care receiver was too expensive. Keywords: Brain tumor, caregivers, financial distress, quality of life

INTRODUCTION The rapid start and progression of a brain tumor, cognitive and behavioral changes, psychiatry and prognosis are issues well known. Brain tumor is a life-threatening and chronic medical disease, which causes agony and may be a chief disturbance to both the patient and the family caregiver. Caregivers of patients with cancer may experience loads of problems, such as depression, hopelessness, worry, anxiety anger, fear and burden. Quality of life is a concept that encompasses the multidimensional wellbeing of a person and reflects an individual's overall satisfaction with life. Quality of life is a broad term that involves several dimensions, including physical or functional status, emotional wellbeing, and social wellbeing [1].

Caregivers of brain tumor patients face various challenges, which impact their quality of life and wellbeing. Whether challenged physically, financially, socially or spiritually, mentally in one area may affect the other areas. Each cancer patient's journey is mutually shared by their caregivers who may be as really affected by the diagnosis and prognosis [2]. The American Cancer Society defines a caregiver as a family member, friend, loved one or other support person who lends physical, emotional or other support to someone at any time during the cancer journey [3]. Functional expectations of caregivers are often enormous with numerous responsibilities such as family tasks, emotional support, providing transportation and symptom management [4]. Psychological morbidity or psychiatric symptomatology

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Research and Reviews: Journal of Neuroscience ISSN: 2277-6427(online), ISSN: 2348-7925(print) Volume 6, Issue 3 www.stmjournals.com

Non-compliance to Antiepileptic Drugs in Tertiary Hospital: Factors and Outcomes Latika Bajaj1,*, Ankita Sandal2, Neha Kumari3, Sudarshana4, Saraswati5, Sanjeev Shah6, Sandhya Ghai7, Manish Modi8 1–7

Department of Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India 8 Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India

Abstract Background: Epilepsy is a neurological disease characterized by epileptic seizures. As epilepsy is a treatable disease and antiepileptic drugs are used to treat epilepsy which demand strict adherence to the drug regimen. Objective: To identify the factors affecting non-compliance to antiepileptic drugs and to assess their outcomes among patients with Epilepsy attending Neurology OPD at tertiary care centre in Northern India. Material and Methods: It was a descriptive study and included 191 epileptic patients. Sampling technique was total enumeration and included all subjects willing to participate and between the age of 15 and 45 years. A written informed consent from the patients was taken. Institutional ethical clearance was obtained. Morisky medication adherence scale was used to differentiate compliant and non-compliant patients and a self-structured interview schedule was used for assessing the factors affecting non-compliance to antiepileptic drugs and to assess their outcomes. Results: The mean age of the patients was (in years) 28.72±11.57 ranged between 13 and 65 years. Out of total subjects, 100 were non-compliant to antiepileptic drugs. Majority of them reported longer waiting duration (93%) and skipping of drugs due to event of forgetfulness (81%). More than two third (78%) had more fluctuation in health because of the treatment. More than one tenth of them had always experienced increased economic burden (15%). Conclusion: As adherence to the antiepileptic treatment is only the source to cure this disease and to improve the quality of life, it becomes immensely vital for health care personnel to encourage patients and their caregivers to be compliant to the treatment so that these patients can lead a better life with a reduction in disease burden globally. Keywords: Antiepileptic drugs, epilepsy, factors, non-compliance, outcomes

INTRODUCTION Epilepsy is a neurological disorder marked by sudden recurrent episode of sensory disturbance, loss of consciousness or convulsions associated with abnormal electrical activity in the brain [1]. Modestly, it can also be classified as group of neurological diseases characterized by epileptic seizures [2]. Nearly 1% of people worldwide (65 million) have epilepsy [3] and about 80% of cases occur in developing countries. Antiepileptic drugs (AEDs) are the foremost treatment for people with epilepsy. Up to 70% (7 in 10) people with epilepsy could have their seizures completely controlled with AEDs. There are around 26

AEDs that are used to treat seizures and different AEDs work for different seizures. Some of the Antiepileptic drugs are acetazolamide, carbanzapine, elonazepam, ethosuximide, phenobarbitol, phenytoin, sodium valproate, etc. Various studies had assessed the factors that affect non-compliance to antiepileptic drugs and broadly identified as patient centred factors, health care system factors, social and economic factors and disease related factors [4]. This became more apparent in a study (N = 203) that recognized most common reason for non-compliance as high cost of antiepileptic drugs 126 (62.1%) followed by unemployment 58 (28.6%),

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Research and Reviews: Journal of Neuroscience ISSN: 2277-6427(online), ISSN: 2348-7925(print) Volume 6, Issue 3 www.stmjournals.com

Obsessive-Compulsive Disorder and Marijuana P. Flaer1,*, M. AlRubaie2 1

Oral Medicine Section, Florida Institute for Advanced Dental Education, Miami, FL 33127, USA 2 Private Practice of Dentistry, Fort Myers, FL 33903, USA

Abstract Obsessive-compulsive disorder (OCD) has both negative and positive attributes. Those with OCD find themselves genetically endowed with traits that will help them succeed in life-creativity, a sense of detail/symmetry, tenacious motivation, and a propensity for achievement in the arts, writing, and education. Without one major caveat though, OCD would be a strong quality for general success--the life of one with OCD may be overly complex and mentally tortuous. In this condition, 24/7, the patient with OCD is in an almost constant battle with frustrating obsessive thoughts (bringing on anxiety, guilt, or depressive moods).The other side of the OCD coin is dealing with not only the onerous obsessions themselves but the actions of subsequent behavioral compulsions. Obsessive thoughts bring on compulsive activities in the form of hand washing, counting for distraction, and/or checking behaviors (e.g., repeatedly checking the door locks or seeing if anyone left the stove burner on). Cannabis/marijuana contains high concentrations of two primary substances: delta 9-THC and CBD. Delta 9-THC is responsible for the intoxication and euphoria usually associated with marijuana. On the contrary, cannabidiol (CBD), making up to 40% of the contents of some strains of marijuana, acts as a virtual antagonist to delta 9-THC. Furthermore, CBD is not intoxicating and therapeutically suppresses compulsive activity in OCD. The pharmacological actions of CBD may bring about OCD remission or lives with a less debilitating form of the disorder. Keywords: Obsessive-compulsive disorder, anxiety disorders, marijuana, Cannabis, cannabidiol (CBD), delta 9-THC

INTRODUCTION Obsessive-compulsive disorder (OCD) is a mentally crippling “anxiety-related” disorder with no known cure according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [1]. Epidemiologically, comorbid risk factors for OCD include a history of depression and substance abuse [2]. OCD is time-consuming to the patient and uses a lot of conscious effort and energy. Avoidance is not an effective tactic in living with the disorder because the mind automatically and repeatedly reverts into the obsessive-compulsive behavior. Learning to cope with OCD is the best therapy and is the primary goal of ongoing psychotherapy. The individual with OCD or comorbid bipolar OCD may exhibit “fear of contamination”, i.e., contaminating oneself by touching selfdeemed “poisons” or germ-filled areas coupled with subsequent fears or guilty feelings of contaminating or poisoning others. OCD thoughts, fears, feelings, or images may create severe anxieties that are only relieved (albeit

temporally) by compulsions [3]. Removal of anxious feelings, fear, or guilt in OCD may be augmented by ritualistic or repeated performance of compulsions [3]. In OCD, anxiety caused by obsessive thoughts is relieved by time-consuming compulsive behaviors such as repetitive hand washing, cleaning activities, counting, or checking [4]. Excessive hand washing (a.k.a., the Pontius Pilot syndrome) and other compulsive activities like diversionary counting to control mental activity or repeated checking-type behavior dominates actions occurring in response to obsessive thoughts [4]. Mental confusion may be quite elevated when OCD is severe. Disrupted thought processes and actions may dominate even the conduct of everyday tasks.

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