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Introduction: Headache is one of the most common conditions troubling nearly 68% of the world's population. Tension-type headache (TTH) & migraine are the most common forms of classical headaches, which is nowadays mostly neglected, associated with frequent, severe pain and significant functional impairment. Transcranial direct current stimulation (tDCS), is a non-invasive, painless brain stimulation treatment that uses direct electrical currents to stimulate specific parts of the brain. Various studies demonstrated tDCS as a valued device to treat neuropsychiatric conditions such as chronic headache & associated anxiodepressive condition. Objective: The aim of this the current review was to evaluate the effectiveness of tDCS in the management of TTH and Migraine. Results generated from various studies for the effectiveness of tDCS in TTH & Migraine. Methods: We programmed our search strategy, to identify studies pertaining to use of tDCS and pain management in TTH & migraine, within the Database of the Cochrane Library of Systematic Reviews, & various author manuscripts in PMC, MEDLINE, EMBASE, NLM, PsycINFO, Other indexed citations from inception to December 2021 and potentially relevant studies. Outcomes: The outcomes of interest include: Effective pain management, in terms of headache intensity, frequency, its episodes, associated depression, anxiety, in target population prioritised by the individual reviews. The evidences were mapped and synthesised with appropriate health problem, patient subgroups, intervention type, context and outcome.Conclusions: We found a significant reduction of pain intensity in patients receiving tDCS treatment, also the pain intensity and duration were significantly improved from baseline after tDCS treatment and during a follow-up period. There was a significant reduction of pain intensity by both anodal and cathodal stimulation conditions, with noteworthy decrease in episodic headaches equally by both 1mA and 2mA current intensities. The aforementioned works support the utility of tDCS in the pain management of TTH and migraine offering a hope for patients with this debilitating disease. However, the review shows promising results in the pain management by tDCS, but the included studies must be analysed critically since most of them were pilot studies, with some having adapted an open-label design.

Objectives: This study was conducted to find out knowledge, attitude and practice (KAP) of epilepsy among 12 th -class students in Uttarakhand state. Secondly data of Uttarakhand was compared with KAP study from other parts of the country. Materials and Methods: All 12 th - class students studying in six schools of randomly selected 36 villages in Chakrata block of Dehradun district of Uttarakhand state were provided a printed questionnaire having answer as "yes or no". This questionnaire used was used previously by various authors and validated for KAP analysis. These filled questionnaires were collected by village health workers and medical officer. Results: This study conducted on 219, 12 th -class students revealed that epilepsy was heard by 98%, 74.9% thought epilepsy a mental disease and 4.8% believed that it is contagious. Negative attitude showed as nearly 2/3 rd students stated that epilepsy is hindrance in marriage and occupation. Nearly 41% would use onion or shoe for terminating seizure attack. Ayurvedic treatment was preferred over allopathic drugs. Conclusions: Study on 12 th -class students of Uttarakhand revealed poor knowledge, attitude and practice for epilepsy and needs special education program to dispel these misconceptions.

Byline: Ashwani. Bhat, Deepak. Goel Alzheimer's disease (AD) is the most common cause of dementia worldwide.[1] AD is multifactorial, as both genetic and epigenetic factors have vital roles. Targeting the [...]

Low back pain (LBP) is the most disabling condition worldwide. The point prevalence of LBP in a given adult population is 12% and the overall lifetime prevalence is about 40% and the most common is chronic nonspecific LBP (CNSLBP). Nonpharmacological interventions are the first-line therapies for its treatment. Since there is now long list of different physical and psychological interventions for patients of CNSLBP, the important question is how to select better modality of intervention for a given patient? A variety of studies on nonpharmacological therapies for chronic low back pain (CNSLBP) and chronic low back pain in people older than 18 years old were searched for on Google Scholar, the Cochrane Library, and PubMed between 2014 and 2023. The studies chosen, included outcome criteria of pain intensity and disability. A total of 40 systematic reviews, Cochrane reviews, and meta-analyses were analyzed for various physical and psychobehavioral interventions. Various interventions reviewed were: (1) aerobics exercises, (2) resistance training, (3) motor control exercises (MCE), (4) stabilization techniques, (5) sling, (6) McKenzie, (7) pilates, (8) yoga, (9) traditional Chinese exercises (TCE), (10) manual therapy, (11) massage therapy, (12) global postural re-education, (13) cognitive behavioral therapy, (14) mindfulness-based stress reduction, (15) cognitive functional therapy, and (16) pain education-based therapy. Findings in our review suggested that at present, physical interventions (among aerobic exercises, MCE, Pilates, and TCE) with combination of psychological interventions based on individualized parameters can be the best option for the patients having CNSLBP. [ABSTRACT FROM AUTHOR]

Background: Understanding and dealing with chronic nonspecific pain (CNP) is the important entity at primary care hospital. Chronic nonspecific multiple-site pain [CNMSP] of unknown etiology creates diagnostic and therapeutic challenges for primary care physicians due to lack of guidance regarding evaluation and treatment. Aims and Objectives: To classify and formulate the evaluation, treatment strategies, and prediction of prognosis of patients with CNMSP of unknown etiology. Methods: Patients present with CNMSP of more than 3-month duration without any obvious medical cause. The biopsychosocial [BPS] model with 3P model was applied to see the biological, psychological, and social factors behind persistence. Finally, patients were classified into four groups for evaluation response to treatment and relapse rates in 12-month follow-up. Results: Of the total 243 patients of CNMSP, 243 [96.3%] were females. Sixty [24.7%] patients had short duration, and 183 [75.3%] had long duration. Headache was in 115 [47%], low back pain ± leg pain in 96 [39.4%], cervical pain ± shoulder/arm pain in 83 [34.1%], and diffuse body pain in 50 [20.5%] in various combinations. A total of 155 [63.8%] patients had high somatization--sensitization index (SSI), and 144 [59.3%] had low ferritin level. Group 1 [high SSI and low ferritin] had 37.9% of patients, group 2 [high SSI and normal ferritin] had 25.9% of patients, group 3 [low to medium SSI with low ferritin] had 21.4% of patients, and group 4 [low to medium SSI with normal ferritin] had 14.8% of patients. Response to pain symptoms was better in group 1, and relapse rate was higher in group 2. Conclusion: CNMSP of unknown etiology itself is a heterogeneous entity, and assessment based on the BPS model can be very useful to understand the treatment plan and outcome of these patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stroke is a leading cause of morbidity and mortality worldwide and a leading cause of disability. None of the neuroprotective agents have been approved internationally except edaravone in Japanese guidelines in acute ischemic stroke. We here discuss that there are two types of endogenous defense mechanisms (EDMs) after acute stroke for neuromodulation and neuroregeneration, and if both can be activated simultaneously, then we can have better recovery in stroke. AIMS AND OBJECTIVES: We aimed to study the effect of combination of neuroprotection therapies acting on the two wings of EDM in acute large‑vessel middle cerebral artery (LMCA) ischemic stroke. METHODS: Sixty patients of LMCA stroke were enrolled and randomized within 72 h into two groups of 30 patients each. The control group received standard medical care without any neuroprotective agents while the intervention group received standard medical care combined with oral citicoline with vinpocetine for 3 months with initial 1 week intravenous and edaravone and cerebrolysin injection, started within 72 h of onset of stroke. Patients were assessed on the basis of the National Institutes of Health Stroke Scale, Fugl‑Meyer Assessment Score, Glasgow Coma Scale, and Mini‑Mental Status Examination at admission, discharge, and after 90 days. RESULTS: The intervention group showed significant and early improvements in motor as well as cognitive recovery. CONCLUSION: Combination therapy for neuroprotection which is acting on two pathways of EDM can be useful in functional recovery after acute ischemic stroke. [ABSTRACT FROM AUTHOR]

Background: Literature suggests that non-pharmacological treatments like non-invasive brain stimulation and cognitive behavioural therapy (CBT) may be used as augments in the management of Tension-Type Headache (TTH). Aims and Objectives: To assess the efficacy of Transcranial Direct Current Stimulation (tDCS) and Cognitive Behavioral Therapy (CBT) compared to treatment as usual (TAU) on headache-related disability and the psychological impact of headache on life of patients suffering from TTH. Materials and Methods: Thirty right-handed TTH patients HDI (headache disability index) > 30 were randomly allocated to group A (tDCS + TAU), group B (CBT + TAU), and group C (TAU). While the primary outcome measure was headache related disability (Headache Disability Index(HDI)), somatic symptoms (Somatic Symptom Severity (SSS-8)), anxiety & depression (Hospital Anxiety and Depression Scale (HADS)) and sleep quality (Pittsburgh Sleep Quality Index (PSQI). Assessments were done at baseline, end of the third and sixth month. Results: We found a statistically significant reduction in HDI (F=12.419, p <0.001), SSS-8 (F=4.587, p=0.010), and HADS-anxiety (F=4.810, p=0.002). tDCS showed better efficacy than CBT, while these two were significantly better than TAU on HDI and SSS-8. On HADS-A also both tDCS and CBT were better than TAU, but showed no significant difference between them. Conclusion: Supplementing non-pharmacological techniques like tDCS and CBT will be effective in reducing headache-related disability and associated psychological symptoms. [ABSTRACT FROM AUTHOR]

The standard General Relativity results for precession of particle orbits and for bending of null rays are derived as special cases of perturbation of a quantity that is conserved in Newtonian physics, the Runge-Lenz vector. First, this method is applied to give a derivation of these General Relativity effects for the case of the spherically symmetric Schwarzschild geometry. Then the lowest order correction due to an angular momentum of the central body is considered. The results obtained are well known, but the method used is rather more efficient than that found in the standard texts, and it provides a good occasion to use the Runge-Lenz vector beyond its standard applications in Newtonian physics.

Behavioral and psychological symptoms of dementia (BPSD) are the main reason for medical attention in dementia patients. Most of the time caregivers get attentive toward dementia only after BPSD. The patient's quality of life is dependent on severity and burden of psychological symptoms. Most common BPSD manifestations are agitation/aggression, depression, psychosis, and social disinhibition. We are presenting the current biological understanding and brief review of pharmacological treatment of BPSD. The current review is based on PUBMED search with the following key words "Neuro-cognitive Disorders" AND "BPSD" AND "Pharmacological Treatment," "Antipsychotics," "Antidepressants," "Mood Stabilizers," "Benzodiazepines," "Cognitive Enhancer," "Antihypertensive." We have selected all reviews, systemic reviews, meta-analysis, and randomized trials on pharmacotherapy in BPSD from 2002 to 2021. Brief review on BPSD will help to fill the knowledge gap of clinical decision on pharmacotherapy in BPSD patients. It is not a systemic review but only brief view point or commentary/summary on evidence-based pharmacotherapy in BPSD. [ABSTRACT FROM AUTHOR]

Byline: Ravi. Gupta, Richard. Allan, Ashwini. Pundeer, Sourav. Das, Mohan. Dhyani, Deepak. Goel Background: Restless legs syndrome also known as Willis-Ekbom's Disease (RLS/WED) is a common illness. Cambridge-Hopkins diagnostic questionnaire [...]