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Background: Trigeminal neuralgia is sudden unilateral severe, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve. Pulsed radiofrequency stimulation (PRF) has been recently introduced to alleviate neural, joint pain, and muscle pain. We tried to use PRF for pain relief in trigeminal neuralgia. The primary objective of our study was to observe the effectiveness and safety of pulsed radiofrequency in the patients of trigeminal neuralgia who are refractory to medical management. The secondary objective was to study the effect of pulsed radiofrequency on the duration of pain relief in these patients. Methodolgy: In this observational study, we enrolled all fresh patients with trigeminal neuralgia attending our pain clinic for the first time and those who had not responded to conservative medical treatment or interventional nerve blocks. All the patients were diagnosed on the basis of signs, symptoms and MRI (CISS sequence). Anatomical landmarks of ophthalamic nerve, maxillary nerve, mandibular nerve were identified and nerve stimulation was done by placing the probe in the affected nerve division. Each point was stimulated with the radiofrequency probe kept for 10 minutes, giving a current of 10 to 30 milli-amperes with a set frequency of 2 Hertz. A total of 10 settings were given on alternate days. Assessment of pain relief, improvement, or deterioration was done using Barrow Neurological Institute Pain Intensity Score and Brief Pain Inventory facial scale scoring. Results: There was a significant reduction in pain scores observed on Barrow neurological institute (BNI) and Brief Pain Inventory-(BPI) pain intensity score (p value of <0.05) before and after pulsed radiofrequency (PRF) application. The duration of pain relief after the application of PRF was up to 180 days in 15 patients, 181-300 days in 8 patients and 300 to 600 days in 7 patients. Only 2 patients had a prolonged pain relief lasting for 601-720 days. One patient had developed exposure keratitis after 4 sittings of pulsed radiofrequency application at the supraorbital foramen. Conclusion: PRF offers short term relief in a majority of patients for a period of 18 months to 24 months. However, it was found that the long term effects of PRF may not be seen in patients with TN. PRF may be used as a short term measure for alleviating severe pain of TN till neurolytic blocks or a definitive surgery is carried out. [ABSTRACT FROM AUTHOR]

Background Multiple sclerosis (MS) is a chronic autoimmune and inflammatory disease of the central nervous system (CNS). There have been only few population/hospital based studies on MS in India, and at the same time there is no data on its profile in Kashmir. Methods A total of 41 MS patients diagnosed on the basis of 2010 Revised Mc Donald criteria were enrolled in this study from Kashmir region of India. Clinical, demographic, radiological and biochemical parameters were analyzed for most of the patients. Results Male to female ratio was found to be 1:3.1 with mean age at the time of analysis 32.26±7.54 (range 18–48) years. The mean disease duration was found to be 3.2±3.6 years. The most common course was relapsing-remitting (RR) present in 87.80% of cases followed by secondary progressive (SP) in 9.76% and primary progressive (PP) in 2.44%. Numbness, weakness of limbs, prickling and tingling sensations, muscle stiffness, and visual disturbances were most common manifestations. Condition of bilateral internuclear ophthalmoplegia (INO) and vertigo was rarely observed. Oligoclonal bands (OCB) were present in cerebrospinal fluid (CSF) of majority of the patients. Symptomatic and steroidal treatment mode was given to majority of the patients (92.68%) and only 7.32% patients were given disease modifying drug. Conclusion This is the first preliminary report on MS profile in Kashmir. The high prevalence of female patients and RR course of MS, low prevalence of progressive cases, predominance of OCB positive cases, insignificant family history in all cases, predominance of cases with low socio-economic status, and high rate of less educated and unemployed cases are the most important findings. By and large MS pattern in Kashmir was found to be relatively similar to West and rest of the Asia. Larger comprehensive studies are mandatory to completely understand MS pattern in Kashmir. There is utmost requirement to maintain a local MS registry in Kashmir so as to get an idea about the actual number of persons suffering from the disease and compare the data with other regions of India. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 20-year-old, unmarried male presented to the emergency department with complaints of severe throbbing headache, neck stiffness, and vomiting for six days. He underwent a series of examinations and was diagnosed to have meningitis retention syndrome (MRS) that is associated with with herpes simplex virus type 2 (HSV-2) meningitis following the development of urinary retention that was administered by catheterization.