New Findings In Medical Literature

Central poststroke pain: a review of pathophysiology and treatment

BACKGROUND: Central poststroke pain (CPSP) is a disabling morbidity occurring in 8%-14% of patients with stroke. It is infrequently recognized and difficult to manage. OBJECTIVE: We systematically reviewed the pathophysiology and treatment of CPSP. METHODS: We conducted a Medline search using the key words “central post-stroke pain,” “post-stroke pain,” “CPSP and basic studies,” “CPSP and clinical features,” “CPSP and pharmacological treatment,” “CPSP and nonpharmacological treatment” and “CPSP and treatment guideline.” The articles related to CPSP were categorized into clinical features, pathophysiology and treatment, and then systematically reviewed. RESULTS: Stroke along the spinothalamocortical pathway may result in CPSP after a variable period, usually after 1-2 mo. CPSP may be spontaneous or evoked, variable in intensity and quality. It tends to improve with time. CPSP is associated with mild motor symptoms with relative sparing of joint position and vibration sensations. The pathophysiology of CPSP is not well understood, but central disinhibition, imbalance of stimuli and central sensitization have been suggested. There are few class I and class II studies regarding its management. Amitriptyline and lamotrigine (class IIB) are recommended as first-line and mexiletine, fluvoxamine and gabapentin as second-line drugs. In pharmacoresistant patients, repetitive transcranial magnetic stimulation and deep brain stimulation have been beneficial. CONCLUSIONS: CPSP patients present with diverse sensory symptoms and its pathophysiology is still poorly understood. Amitriptyline and lamotrigine are effective treatments. Further studies are needed to understand the pathophysiology and investigate newer therapeutic modalities.

Insomnia in patients with depression: some pathophysiological and treatment considerations

The almost ubiquitous sleep disturbances in patients with depression commonly, but not always, subside with the remission of depression. Evidence linking insomnia with the risk of relapses in recurrent depression, as well as suicide, makes optimization of the treatment of insomnia associated with depression a priority. However, most antidepressant agents do not adequately address the sleep complaints in depression: their effects on sleep range from sizeable improvement to equally significant worsening. One approach to the management of insomnia associated with depression is to choose a sedating antidepressant agent such as trazodone, mirtazapine or agomelatine. A second approach is to start with a non-sedating antidepressant (e.g. the selective serotonin reuptake inhibitors, bupropion, venlafaxine or duloxetine); those with a persistent or treatment-emergent insomnia can be switched to a more sedating antidepressant, or offered a hypnotic or cognitive-behavioural therapy as adjunctive treatment. The review discusses the advantages and disadvantages of all treatment options, pharmacological and otherwise.

Myasthenia gravis associated with etanercept therapy

Etanercept is an antagonist of tumor necrosis factor alpha that was developed to treat rheumatoid arthritis. In this report we present a patient who developed myasthenia gravis while taking etanercept and had resolution of symptoms after stopping it. This is the first report of this potential side effect and is of additional interest, because etanercept has been proposed as a treatment for myasthenia gravis. Muscle Nerve, 2009.

Channing Tatum Talks About ‘Fighting’

Channing Tatum in ‘Fighting.’

© Rogue Pictures

Channing Tatum reunites with his A Guide to Recognizing Your Saints director Dito Montiel for Fighting, a gritty, intriguing look at underground fighting and mixed martial arts. As the title suggests, Fighting is all fighting, but the strange thing is this film wasn’t originally about that. No, Tatum says when he first heard about the project it revolved around basketball. It wasn’t until Montiel came onboard that street fighting was substituted for hoops action.Tatum recalled the circuitous route they took in getting this film, in its present form, to the screen. “…The funny thing was this was a basketball film. The most hilarious thing was I was like, ‘I don’t want to do a basketball film.’ Way before Dito was even on it, I tried to think of the one director that I know would never do a basketball movie, because they were like, ‘Well, what director do you want?’ I’m like, ‘Dito,’ because I never wanted to do a basketball movie. Next thing I know, lo and behold, a month later he calls me up and he’s like, ‘Hey, I know. I know it’s a basketball movie but just come meet. Come meet, I’ve got a take on it.’”

“I come meet him and he tells me it’s Midnight Cowboy. I’m like, ‘Okay, that’s amazing. I would love to play Joe Buck in Midnight Cowboy, especially your version of Midnight Cowboy.’ Then, all of a sudden, I’m still like, ‘Wait a minute, we haven’t taken basketball out of it. It’s still a basketball movie, Dito. We can’t get away from this.’ He’s like, ‘I know, I know, just trust me. We’ll get it out,’ or, ‘We’ll figure it out.’ He’s like, ‘We’re going to take basketball, like… I don’t know. We’ll get basketball out of it.’ I’m like, ‘We can’t do that.’”

“Finally, throughout all the different versions of what we were doing – and we had less than three weeks to get the movie going – I just suggested let’s just make a fighting film, because the basketball just kept getting more and more violent, knowing Dito. More and more violent, I’m like, ‘Right, let’s just take the basketball out.’ Then [Kevin] Misher, our producer, was just like, ‘I don’t know if I can do that. Let me work on it.’ Then a week later, they did it and it was awesome.”

Tatum and Montiel may actually team up again for a spy movie. “We don’t know if we’re going to do it, but he’s exploring it,” revealed Tatum. “‘It’s sort of just an interesting opportunity. Whoever would have thought that Dito would be doing some international spy type of film? I definitely never thought he’d be into it, but then he had a crazy, cool take on it. We’ve all seen the Bournes and everything. This won’t be a Bourne, I’ll promise you that, because no one can do Bourne better than Bourne.

“You can’t try to remake Bourne,” Tatum explained. “Unless you have a crap load of money, which I don’t think that is even what a Bourne needs. Bourne’s already Bourne, and Bond have kind of done those things about as good as you can do them in that way. You can do something like it, but you’re just going to be chasing that and maybe getting close to it. I don’t think you can beat Bourne at its own game.”

But back to Fighting, Tatum said his dancing background definitely helped him tackle the fight choreography. “I’d say that dancing has helped probably in everything, even in acting. Like you’re comfortable with your body, you can relax. You don’t get tight or tense or even choreography moving with people, staging, knowing your distance and stuff like that. The most dangerous thing is distance when you’re doing those fake fights. You’re swinging with all your might and they have to time you and you always make eye contact so you can’t know exactly how far you’re away because you’re looking in someone’s eyes. Then you swing and you just gotta know.”

That said, accidents happen. Tatum took a hit on his nose that did some damage. “Oh man, it was over here. I’m looking at Kevin Misher because there’s no mirrors around where we were fighting. I’m like, ‘It’s not good, huh?’ Kevin was like [sighing], he didn’t even answer me. And Dito was like, ‘Heh, hoo, right.’ Then Yuri’s ring man was there, thank God, and he goes and puts two spoons in ice and mashes my nose back in. It didn’t swell that bad. My eyes got black a little bit, but nothing we couldn’t cover.”

“He’s just like right, blech, and was just mashing the swelling away,” said Tatum. “They just know how to fix ‘em, man. I mean, it doesn’t feel good but they know how to fix. That and quarters. Two cold quarters and just squeezing, squeezing your nose as hard as you can. Next time it happens, I’m like, ‘I got this, I got this.’”

Tatum described how he got into Fighting shape: “Man, the greatest thing about my career is like I get to be really on and then really off. I go and I’m at home and I’m drinking beer and cheeseburgers and pizza and chocolate cake. Then when I’m on, I get really serious and it’s all the way to the wall. The thing that’s great is I have all day to work out. People that do 9 to 5s don’t, so I wake up and I run for an hour. And then I go and do my training, so when I was doing [that] for Fighting, I’d go and I’d work out for two and a half hours, would fight, just straight up learning how to fight, learning how to be comfortable on the ground, standing up and taking punches and getting punches and blocking them. Then I’d go home and I’d run for another hour and a half or whatever it’d be. So running was a big part of my program, but then eating well as well.”

Channing Tatum in ‘Fighting.’

© Rogue Pictures

Of course fighting was an integral part of the film, but character development was right up there, too. “I guess probably because Dito just does drama and now he’s done commercial drama – I think they’re two different things, commercial and then drama – we really wanted to make a commercial film with decent acting and good characters because I think people just think now, they think commercial film, ‘Oh great, the acting is not going to be that great anymore, just because they don’t care. They just want to see a big huge blow up of a movie.’ That’s really what we want to do. We had an opportunity to bring those characters to a commercial film and we got really excited about it,” said Channing Tatum.

Tatum plays Shawn MacArthur, a hustler who winds up using his fists to make big money. Shawn’s a tough guy who knows how to handle himself, but he’s also got a good heart and treats women well. Asked how difficult it was to balance the tough guy with the nice guy, Tatum replied, “I’m from the South. If I didn’t open up the door for my mom or my sister, I got slapped in the back of the head. That got fixed real quick. I was not about to not do that.”

That helped him find the more gentlemanly side of Shawn. “Yeah, yeah. Well, that’s what Dito really wanted. I remember, they came to Dito and they told him he couldn’t cuss in the movie. Dito was just like, ‘You want me to do an underground fighting movie on a PG-13? I can’t do it. I’m going to go think about it tonight. If I can’t wrap my head around it, then you have to find somebody else to do it.’ We were way down the line on the movie. They waited to tell us that. Then we talked about it. It was really his idea. He was like, ‘Look, no, Shawn just chooses not to cuss. That’s just his upbringing. He went to church. He doesn’t cuss because he chooses to. Harvey’s the same way. He’s old fashioned.’”

‘Harvey’, the street-wise manipulator who manages Shawn’s fighting career, is played by Oscar nominated actor Terrence Howard (Hustle & Flow). And Tatum described his working with relationship with Howard as “love-love.” “I’ve loved watching that guy act since I can remember seeing him in films. It was way before I was even acting or even had any plan to act. Then I met him at Sundance and he had seen Saints. He had all these amazing things to say about Saints and about my performance in it. It literally welled me up because it was the first time that I had a real actor, someone that I really thought of as a great actor, tell me that he liked my work and I just almost couldn’t take it. And then he’s like, ‘I want to do something someday so let’s keep each other in mind.’ And I was just like, ‘Uh, heh, yeah.’ Then he loved Dito so we were always sort of just on the lookout for something. As soon as we just really got to sit and hang out, the guy is like a big brother now,” said Tatum.