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© 2011 Centro di Rieducazione Biofunzionale
XII International Multidisciplinary Formation Course on Headache
III Latin – Mediterranean Workshop on Migraine
Sorrento, 30/31 marzo 2012
Hotel Imperial Tramontano
In collaborazione con AINAT
Presidenti del Corso:
Dott. Michele Feleppa
Direttore U.O. di Neurologia
A.O. "G. Rummo"- Benevento
Prof.Vincenzo Guidetti
Direttore Centro Cefalee-NPI
"La Sapienza” – Roma
30 Marzo 2012
Cefalee del bambino e dell’adolescente
Moderatori: Antonio Pascotto
09:00 Approcci farmacologici e non farmacologici nelle cefalee del bambino
Marco Carotenuto
09:20 Aspetti neuropsicologici nell’emicrania del bambino
Maria Esposito
09:40 Disfunzioni temporomandibolari e cefalee nel bambino
Stefano Vollaro
10:00 Discussione
International Session: Migraine and Daily Chronic Headache
Moderatori: Gabriella Buzzi, Francesco Pierelli
10:30 What’s new in drug treatment
Pierangelo Geppetti
11:00 What’s new in Physiopathology
Alex Siva
11:30 Daily Chronic Headache
Miguel Lainez
12:00 The WOCAH Project: State of Art
Vincenzo Guidetti
12:30 Discussione
13:00 Light Lunch
Dolore neuropatico ed algie facciali
Moderatori: Antonino Pavone, Mauro G. Minervini, Nicola Paciello
14:00 Le algie facciali atipiche
Vincenzo Busillo
14:20 Il dolore neuropatico da ipotensione liquorale spontanea
Enrico Ferrante
14:40 Nevralgia del trigemino cronica: opzioni terapeutiche neurochirurgiche
Giuseppe Catapano
15:00 Dolore alla regione oculare: l'oculista e le sue strategie di fronte al dolore neuropatico
Alfredo Venosa
15:20 Neuronite vestibolare: quadri ORL ee neurologici
Luigi Califano
15:40 Approccio chiropratico al dolore lombare neuropatico
Claudio Santoro
16:00 Discussione
16:20 L’approccio multidisciplinare alle cefalee ed al dolore neuropatico tra gli esperti ospedalieri e del territorio: proposta operativa per una Società Scientifica
Michele Feleppa
16:40 Discussione
17:00 Termine lavori I giornata
31 marzo 2012
Epilessia farmaco-resistente ed Emicrania cronica farmaco-resistente
Moderatori: Enrico Volpe, Maurizio Iazeolla
09:00 Aspetti clinici, disabilità, costi diretti e indiretti dell'emicrania farmaco-resistente
Amedeo D’Alessio
09:20 Terapia nell’attacco dell’emicrania resistente: triptani +FANS, combinazione di triptani o altro?
Domenico Cassano
09:40 Epilessia farmaco-resistente ed Emicrania farmaco-resistente: correlazioni
Francesco Pierelli
10:00 Discussione
Cefalee e Territorio
Moderatori: Pasquale Alfieri, Giacomo Visco, Lucio Grazia Covello
10:20 Criteri di scelta della terapia di profilassi in un Ambulatorio Territoriale
Sergio Allocca
10:40 Criteri di scelta dei triptani e preferenza dei pazienti nella scelta del farmaco
Agostino Galdi
11:00 Cefalea cronica quotidiana di nuova insorgenza
Vincenzo Pizza
11:20 Emicrania trasformata: concetto obsoleto o attuale e come trattarla?
Franco Di Palma
11.40 Cefalea tensiva: strategie terapeutiche
Giuseppe Capo
11:20 Discussione
Casi clinici
Moderatori:Vito Napoletano,Luciana Ciannella
12:30 Caso Clinico 1
Alfonso Leo
12:50 Caso Clinico 2
Biagio Ciccone
13:10 Discussione
13:30 Fine dei lavori
Low back pain with pain radiating into the legs is one of the most common injuries in the United States. Many of the patients with these symptoms along with lower extremity weakness may have a herniated disc. Herniated discs are also called protruding, bulging, ruptured, prolapsed, slipped, or degenerated discs. A disc herniation occurs when the cushion that sits between the spinal bones, or vertabrae, moves from its normal position and enters the spinal canal. This is a problem because this is where the spinal cord and nerve roots are located.
What is the spinal disc?
The soft structure that sits between the each vertabrae is referred to as the spinal disc. The disc is composed of a soft center similar to the center of a jelly donut and referred to as the nucleus pulposus. The nucleus is surrounded by several layers of connective tissue that is composed of material similar to ligaments and tendons called the outer annulus and looks like concentric rings, like the annular growth rings of a tree. This spinal disc becomes more rigid with age. In a young individual, the disc is soft and elastic, but like so many other structures in the body, the disc gradually looses its elasticity and is more vulnerable to injury. As early as 30 a disc may show signs of deterioration and on MRI about 30% of people demonstrate deterioration.
What happens with a ‘herniated disc’?
As we age and the spine becomes less flexible and when this happens the disc may rupture. When a disc ruptures a portion of the nucleus pushes outside of its normal borders and may be completely extruded, outside the disc, this is called a herniation. When this herniation enters the spinal canal pressure can be put on the spinal cord and nerve roots, often referred to as a pinched nerve. There is normal some extra space around the spinal cord but if there is not enough to accommodate the herniation then the nerves are compressed.
What causes symptoms of a herniated disc?
Once the herniation occurs and a nerve is pinched that is when symptoms arise. A herniated disc may occur suddenly in an event such as a fall or an accident, or may occur gradually with repetitive straining of the spine. Often times when a disc is herniated the person may already have spinal stenosis or a narrowing of the spinal canal. This leads to less space for the herniation and increased pain due to further irritation of the nerve.
What are the symptoms of a herniated disc?
When the spinal cord becomes compressed it does not function properly and may lead to a range of symptoms. Abnormal signals may get passed from the compressed nerves, or signals may not get passed at all. There are several common symptoms of a herniated discs. The pressure on the nerve will cause abnormal sensations, commonly experienced as electric shock pains. When the compression occurs in the cervical (neck) region, the shocks go down your arms, when the compression is in the lumbar (low back) region, the shocks go down your legs. Tingling, numbness or pins and needles are often abnormal sensations associated with disc injuries. These symptoms may be experienced in the same region as painful electric shock sensations, but may not be in the area of the actual injury. Because of the nerve irritation, signals from the brain will be interrupted causing muscle weakness. Nerve irritation can therefore be tested by examining reflexes, testing muscle strength, and assessing sensory input. Of all of the symptoms associated with disc problems the most serious is bowel or bladder problems. These symptoms are important because they are signs of cauda equina syndrome, a possible condition resulting from a herniated disc. This is a medical emergency, and your should see your doctor immediately if you have problems urinating, having bowel movements, or if you have numbness around your genitals. These symptoms are all due to compression of the spinal nerves but that may not be the full extent of the damage, as seen in the cauda equina syndrom organs can also be effected leading to issues with breathing, digestion, or even heart problems..
How is the diagnosis of a herniated disc made?
Most often, your physician can make the diagnosis of a herniated disc by physical examination performed by a chiropractor. By testing sensation, muscle strength, and reflexes, your chiropractor can often establish the diagnosis of a herniated disc.
Often this diagnosis will be confirmed using MRI and other advanced imaging. The MRIs is only useful in conjunction with the physical examination and should not be performed by itself. It is normal for a MRI of the lumbar spine to have abnormalities, especially as people age. Patients in their 20s may begin to have signs of disc wear, and this type of wear would be expected on MRIs of patients in their 40s and 50s. This is the reason that your physician may not be concerned with some MRI findings noted by the radiologist.
The diagnosis and treatment of disc issues are dependent on the physical findings and symptoms. Your chiropractor will also take into account the patients experience and asses the imaging studies. Only once this information is put together can a reasonable treatment plan be considered.
Chiropractic Treatment
Chiropractic care is an excellent treatment choice for the management of herniated disc problems. Chiropractic is safe, non-invasive and non-toxic and it also works! Chiropractic care is a modern treatment approach for herniated discs. Typically chiropractic care involves spinal adjustments, physiotherapies, muscle therapies, such as massage and trigger point work, nutritional support and active care rehabilitation.
What is chiropractic “Lumbar Flexion Distraction” technique?
Lumbar flexion distraction technique is used in our clinic, also referred to as Cox flexion distraction. Cox Technic is non-surgical, doctor-controlled, hands-on spinal manipulation performed with the patient lying on The Cox Table a specially designed chiropractic instrument. This table permits an effective decompression adjustment and manipulation. This is a widely used approach to treating symptomatic disc injuries involving back pain and accompanying leg pain. During the treatment the spine is gently distracted or stretches which allows the chiropractor to isolate the area of disc involvement while slightly flexing the spine in a pumping rhythm. There should be no pain involved in the treatment.
The tractioning or distraction of the disc combined with isolation and gentle pumping of the involved area allows the central area of the disc, the nucleus pulposus, to assume its central position in the disc. Flexion distraction is also thought to improve disc height. Well-researched and documented, flexion distraction and decompression help relieve spinal pain and return patients to their desired quality of life by dropping intradiscal pressure, widening the spinal canal foraminal area, reducing pressure on the spinal nerves, and returning motion to the spinal joints. Cox Technique is appropriate for conditions causing low back and leg pain as well as neck and arm pain. It also reduces pain attributable to disc herniation, a slipped disc, a ruptured disc, facet syndrome, stenosis, spondylolisthesis, and other conditions.
(fonte: http://mahler-chiropractic.com)
Sciatica is a term that describes the symptoms of leg pain associated with numbness, tingling, and weakness. Sciatica originates from the low back and travels through the buttock and down the back of the leg into the foot. Sciatic is named for the nerve that it follows the sciatic nerve. sciatica is a symptom of an underlying medical condition and is not a medical condition of its own. There can be several causes for sciatic.
The symptoms of sciatica are constant pain in one, or some times both, sides of the buttock or leg, pain that is worse when sitting, Burning or tingling down the leg, weakness, numbness or difficulty moving the leg or foot, a constant pain on one side of the rear, and a sharp pain that may make it difficult to stand up or to walk.
Sciatic pain varies from infrequent and irritating to constant and incapacitating pain. The symptoms are as varied as the pain and may change in location and severity, depending upon the condition causing the sciatica. Sciatica can be very painful but it is rare that permanent sciatic nerve damage will result.
Sciatic neuritis or sciatica is an irritation and inflammation of the great sciatic nerve. This is the largest nerve in the body. The sciatic nerve originates from the lumbo-sacral spine and travels down the leg all the way to the great toe. Sciatica follows the path of this nerve. The pain quality ranges from dull, sharp, burning or electrical and it may be accompanied by numbness, tingling and the feeling of pins and needles. The symptoms may vary in intensity and in the frequency. Classic sciatic pain radiates from your lower back into to your buttock and down the back of your legs. Sciatica may be accompanied by numbness, tingling, and muscle weakness in the affected leg. It’s likely to be worse when you sit, cough or sneeze.
6 Most Common Causes of Sciatica
When discussing sciatica it is important to understand the underlying cause of the sciatica symptoms. There are six primary problems that are the most common causes of sciatica. The first is a herniated disc (see the post on herniated disc). Another common cause is lumbar spinal stenosis, This condition commonly causes sciatica due to a narrowing of the spinal canal and is relatively common in adults over age 60. Next on the list is degenerative disc disease. While disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica. Degenerative disc is an earlier stage of disc degeneration. A fourth cause of sciatica is isthmic spondylolisthesis which occurs when a small stress fracture allows one vertebral body to slip forward on another vertebral body. The final two are the lest degenerative cause and highly treatable, as well as the most common two reasons for sciatica. The first of which is piriformis syndrome. The sciatic nerve runs under the piriformis muscle in the rear and if the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain. This is not a true radiculopathy, but the leg pain can feel the same as sciatica caused by a nerve irritation. Finally we have sacroiliac joint dysfunction, which is commonly seen and treated by chiropractors. Inflamation or scare tissue in the sacroiliac joint can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain.
Some other common causes of sciatica are pregnancy due to the changes that the body goes through during pregnancy, including weight gain, a shift on one’s center of gravity, and hormonal changes, can cause sciatica during pregnancy. Also sciatica can be caused by scar tissue, muscle strain, and in rare cases spinal tumor or infection.
It is important to know the underlying clinical diagnosis of the cause of sciatica, as treatments will often differ depending on the cause.
Sciatica Symptoms and Nerve Roots
The sciatic nerve is made up of two lumbar nerve roots L4 and L5 and three sacral nerve roots S1, S2, and S3. When all 5 of these nerve roots bundle together they form the sciatic nerve which innervates the leg from the buttocks to the foot. Sciatica symptoms vary based on where the compressed nerve root is located. L4 nerve root sciatica symptoms usually affect the thigh. Patients may feel weakness in straightening the leg, and may have a diminished knee-jerk reflex. While L5 nerve root sciatica symptoms may extend to the big toe and ankle. Patients may feel pain or numbness on top of the foot, and between the big toe and second toe. Finally in S1 nerve root sciatica the outer part of the foot is involved and it may radiate to the little toe. Patients may experience weakness when raising the heel off the ground or trying to stand on tiptoes. If multiple nerve roots are compromised the patient may experience several of these symptoms at once.
In rare cases sciatica symptoms that worsen quickly may require immediate surgery. The following symptoms indicate a need for immediate medical care may be necessary. Sciatica symptoms that continue to get worse rather than improve, which may indicate possible nerve damage, especially if the progressive symptoms are neurological. Symptoms that occur in both legs and cause either bladder or bowel incontinence or dysfunction, which may indicate cauda equina syndrome. Cauda equina syndrome extremely rare but found in 2% of herniated lumbar disc cases.
Patients should seek immediate medical attention if they experience any of the above symptoms.
Chiropractic Approach
The chiropractic approach to sciatica involves adjustments to the spine & lower extremities. Spinal adjustments and manual manipulation performed by appropriately trained chiropractor are focused on providing better spinal alignment, which helps to address a number of underlying causes sciatic nerve pain. Manual manipulation done to address the right indications by appropriately trained chiropractor can create a better healing environment and should not be painful. In addition to chiropractic adjustment your chiropractor will probably use a combination of physiotherapies, decompression, active care rehabilitation, nutritional support, and laser therapy (to reduce inflammation & provide specific nourishment to the peripheral nerves). This approach is safe, non-invasive and non-toxic. If you have been suffering with sciatica call our office to schedule a free, no-obligation consultation. We can sit down together and discuss your case. I look forward to speaking with you soon!
Medical Approach to Sciatica
The medical approach to treating sciatica is with drugs including anti-inflammatories, analgesics and steroids. Drugs will not cure sciatica. They will only temporarily mask symptoms.
The surgical approach to treating sciatica often involves removing part of the disc (discectomy), or cutting away part of the vertebrae (laminectomy). 50% of all spinal surgeries fail (meaning that the patient’s symptoms are unresolved after a 3 year follow-up). There are always risks involved with surgery including complications, infection and even death. Surgery should ALWAYS your last resort, not your first approach.
(fonte: http://mahler-chiropractic.com)
Scoliosis is not a disease it is a descriptive term that refers to an abnormal spinal curve. All spines have curves these are normal in the neck, upper back and lower back it is normal to find anterior to posterior curves. Humans need these spinal curves to help the upper body maintain proper balance and alignment over the pelvis. Scoliotic curves are a right to left translation not an anterior to posterior translation and this leads to weakness and instability in the spine.
Who is at risk?
Scoliosis affects 2% of women and 0.5% of men in the general population. Scoliosis may be caused through several mechanisms, including congenital spine deformities, genetic conditions, neuromuscular problems and limb length inequality. Additional causes of scoliosis include cerebral palsy, spina bifida, muscular dystrophy, spinal muscular atrophy and tumors. Over 80% of scoliosis cases are idiopathic, which meaning we do not know the cause. Most idiopathic scoliosis cases are found in otherwise healthy people.
Idiopathic scoliosis is found in three categories based on age. The first is infantile found in children ages 3 and under. The next type is juvenile scoliosis found in 3-9 years old. Finally we have adolescent scoliosis found in10-18 years old. Not often but in very rare case scoliosis can occur in adult hood due to trauma. The most common form of scoliosis, representing approximately 80% of idiopathic scoliosis cases, is Adolescent Idiopathic Scoliosis (AIS), which develops in young adults around the onset of puberty. Adolescent scoliosis is often due to a rapid growth cycle in which the bones grow faster than the soft connective tissue, tendons and ligaments, and leads to an imbalance from one side to another.
People with a family history of spinal deformity are at greater risk for developing scoliosis and early detection is essential. If a scolioses curve is discovered before the growth plates close in a persons early twenties there is high likely hood of partial or complete correction.
Symptoms
The warning signs of scoliosis are shoulders are different heights, one shoulder-blade is more prominent than the other, head is not centered directly above the pelvis, appearance of a raised, prominent hip, rib cages are at different heights, uneven waist, changes in look or texture of skin overlying the spine, and leaning of entire body to one side. These can all be signs but don mean you have scoliosis you should see your chiropractor for a complete evaluation and remember that x-ray is the best way to diagnose scoliosis.
A standard exam that is often used by chiropractor is called the Adam’s Forward Bend Test. Most children should be tested in the fifth or sixth grade. For this test, the patient is asked to lean forward with his or her feet together and bend 90 degrees at the waist. The examiner can then easily view from this angle any asymmetry of the trunk or any abnormal spinal curvatures. It should be noted that this is a simple screening test scoliosis is usually confirmed with an x-ray of the spine. The curve is then measured by the Cobb Method and is discussed in terms of degrees. Generally speaking, a curve is considered significant if it is greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered severe and often require more aggressive treatment or surgical intervention. The chiropractor may also conduct exams to test reflexes, motor and sensory functions, and breathing ability. After a diagnosis is made, your doctor will suggest a treatment plan.
Once scoliosis has been diagnosed there are several factors to take into account when discussing treatment. Spinal maturity, is the patient’s spine still growing and changing? Degree and extent of curvature, how severe is the curve and how does it affect the patient’s lifestyle? Location of curve, according to the Scoliosis Research Society, thoracic (upper spine) curves are more likely to progress than thoracolumbar (middle spine) or lumbar (lower spine) curves. Potential for progression, patients who have large curves prior to their adolescent growth spurts are more likely to experience curve progression.
After all the test and exams are assessed there are four treatment options for scoliosis: (1) observation, (2) orthopedic bracing, (3) surgery, (4) chiropractic care
Chiropractic Care
Chiropractic care is non-invasive Treatment for scoliosis. This means that when undergoing treatment you do not have to take any prescription drugs or go through a surgical procedure. The process is all natural and drug free. This is because the main principle of chiropractic is to focus on the body’s own natural healing abilities. Chiropractic treatment deals with the adjustment of the spine and according to the research conducted by the National Scoliosis Foundation, chiropractic adjustment has been found to be a good alternative treatment for those who suffering from scoliosis. Chiropractic treatment for scoliosis may involve several procedures depending on the severity of the condition. These treatments may include spinal manipulation, active exercise methods, and postural counseling.
So how can chiropractic treatment help you with your scoliosis? Chiropractic care does not only treat the current problems that are associated with scoliosis but it can also help in alleviating and controlling the symptoms that comes with it. Scoliosis patients who have been treated with chiropractic care have reported to have reduction in the size of the curves, measured using the Cobb Method. This does not happen overnight. Chiropractic care for scoliosis requires multiple visits in order for the patient to experience its full benefits. A chiropractor can also monitor your progress to ensure that you are doing the right thing and to see if the treatment yields favorable results. A chiropractor will recommend you to check with another medical specialist if he or she thinks that is the best course of action for you regarding your condition.
(Fonte: http://mahler-chiropractic.com)Scoliosis is not a disease it is a descriptive term that refers to an abnormal spinal curve. All spines have curves these are normal in the neck, upper back and lower back it is normal to find anterior to posterior curves. Humans need these spinal curves to help the upper body maintain proper balance and alignment over the pelvis. Scoliotic curves are a right to left translation not an anterior to posterior translation and this leads to weakness and instability in the spine.
Who is at risk?
Scoliosis affects 2% of women and 0.5% of men in the general population. Scoliosis may be caused through several mechanisms, including congenital spine deformities, genetic conditions, neuromuscular problems and limb length inequality. Additional causes of scoliosis include cerebral palsy, spina bifida, muscular dystrophy, spinal muscular atrophy and tumors. Over 80% of scoliosis cases are idiopathic, which meaning we do not know the cause. Most idiopathic scoliosis cases are found in otherwise healthy people.
Idiopathic scoliosis is found in three categories based on age. The first is infantile found in children ages 3 and under. The next type is juvenile scoliosis found in 3-9 years old. Finally we have adolescent scoliosis found in10-18 years old. Not often but in very rare case scoliosis can occur in adult hood due to trauma. The most common form of scoliosis, representing approximately 80% of idiopathic scoliosis cases, is Adolescent Idiopathic Scoliosis (AIS), which develops in young adults around the onset of puberty. Adolescent scoliosis is often due to a rapid growth cycle in which the bones grow faster than the soft connective tissue, tendons and ligaments, and leads to an imbalance from one side to another.
People with a family history of spinal deformity are at greater risk for developing scoliosis and early detection is essential. If a scolioses curve is discovered before the growth plates close in a persons early twenties there is high likely hood of partial or complete correction.
Symptoms
The warning signs of scoliosis are shoulders are different heights, one shoulder-blade is more prominent than the other, head is not centered directly above the pelvis, appearance of a raised, prominent hip, rib cages are at different heights, uneven waist, changes in look or texture of skin overlying the spine, and leaning of entire body to one side. These can all be signs but don mean you have scoliosis you should see your chiropractor for a complete evaluation and remember that x-ray is the best way to diagnose scoliosis.
A standard exam that is often used by chiropractor is called the Adam’s Forward Bend Test. Most children should be tested in the fifth or sixth grade. For this test, the patient is asked to lean forward with his or her feet together and bend 90 degrees at the waist. The examiner can then easily view from this angle any asymmetry of the trunk or any abnormal spinal curvatures. It should be noted that this is a simple screening test scoliosis is usually confirmed with an x-ray of the spine. The curve is then measured by the Cobb Method and is discussed in terms of degrees. Generally speaking, a curve is considered significant if it is greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered severe and often require more aggressive treatment or surgical intervention. The chiropractor may also conduct exams to test reflexes, motor and sensory functions, and breathing ability. After a diagnosis is made, your doctor will suggest a treatment plan.
Once scoliosis has been diagnosed there are several factors to take into account when discussing treatment. Spinal maturity, is the patient’s spine still growing and changing? Degree and extent of curvature, how severe is the curve and how does it affect the patient’s lifestyle? Location of curve, according to the Scoliosis Research Society, thoracic (upper spine) curves are more likely to progress than thoracolumbar (middle spine) or lumbar (lower spine) curves. Potential for progression, patients who have large curves prior to their adolescent growth spurts are more likely to experience curve progression.
After all the test and exams are assessed there are four treatment options for scoliosis: (1) observation, (2) orthopedic bracing, (3) surgery, (4) chiropractic care
Chiropractic Care
Chiropractic care is non-invasive Treatment for scoliosis. This means that when undergoing treatment you do not have to take any prescription drugs or go through a surgical procedure. The process is all natural and drug free. This is because the main principle of chiropractic is to focus on the body’s own natural healing abilities. Chiropractic treatment deals with the adjustment of the spine and according to the research conducted by the National Scoliosis Foundation, chiropractic adjustment has been found to be a good alternative treatment for those who suffering from scoliosis. Chiropractic treatment for scoliosis may involve several procedures depending on the severity of the condition. These treatments may include spinal manipulation, active exercise methods, and postural counseling.
So how can chiropractic treatment help you with your scoliosis? Chiropractic care does not only treat the current problems that are associated with scoliosis but it can also help in alleviating and controlling the symptoms that comes with it. Scoliosis patients who have been treated with chiropractic care have reported to have reduction in the size of the curves, measured using the Cobb Method. This does not happen overnight. Chiropractic care for scoliosis requires multiple visits in order for the patient to experience its full benefits. A chiropractor can also monitor your progress to ensure that you are doing the right thing and to see if the treatment yields favorable results. A chiropractor will recommend you to check with another medical specialist if he or she thinks that is the best course of action for you regarding your condition.
(Fonte: http://mahler-chiropractic.com)
