In tetanus patients Levodopa and Carbidopa combination (which is usually used to relieve the signs of extrapyramidal) causes respiratory muscles spasm relief thereby the need for sedatives is decreased and patient saved later on via central nervous system mechanism, by providing the inhibitory neurotransmitters at Anterior Horn cells.

The pandemic is treating everybody equal. Current rise in Co-vid-19 cases in USA has taught that no country is a super power or leading now. Nobody is as educated as we think. We all are proving failures. Even the wealthiest are hiding and isolating. Riches having less immunity is a weaker and most vulnerable class. Lack of tissues rolls, grocery, medical supply, health insurance and food has driven the upper class crazy. The poor class is actually more on the safer side where having no money is a blessing in disguise. Their strong will powers and immunity is shielding them.

In Freud’s times, there were no theoretical developments from other disciplines on the proper name to support his own findings.Nowadays, although in the matter of linguistics and philology the studies are still incipient, in other social disciplines such as anthropology, there is plenty of ethnographic material from which psychoanalysis could take valuable lessons. Only from anthropology -Frazer, specifically- is from which Freud took a number of contributions in order to consider the importance of the name.

At birth we humans are in a situation of absolute deviation, to survive we depend on the physical and psychic care that is provided to us. The state of helplessness resulting from the immaturity with which we are born, is compensated by the devoted care of the mother, who, with the support of her partner, family and society in general, lends the baby a kind of external nesting that subjudges this first catastrophe called birth.

Epilepsy is one of the oldest ailments that have been affecting the human beings. As per World Health Organization (WHO), epi-lepsy is a chronic non communicable brain disease that may affects people of all ages. It is characterized by two or more provoked seizures, which are brief episodes of involuntary movement that may involve the whole body or a part of the body. Near about 50 mil-lion people is suffering from epilepsy worldwide, and approximately 5 million people are diagnosed with epilepsy each year making it the most common neurological disease globally. Discrimination and social stigma is still associated with epilepsy in the world and it impact on the patient’s quality of life and their families as well. Most of epilepsy patients live in developing countries and unable to get the proper treatment for the disease. In Unani system of medicine, epilepsy is described as Sar‘. Classification of epilepsy in this ancient system of medicine has been done on the basis of temperament, predominance of humor involved, internal and external factors etc. In this paper an attempt has been made to explore the concept of epilepsy in Unani medicine, its type, etiology and management through various modes of Unani treatment. This article will help in reducing the burden of this common neurological problem and development of new intervention for the disease.

The COVID-19 predominantly affects the respiratory system, causes alveolar damage, edema, and inflammation [1]. However, many experimental studies and case reports on coronaviruses (CoVs) highlighted their potential neurotropism. The neuro-invasive propensity has been illustrated as a common feature of CoVs. The SARS-CoV and SARS-CoV-2 showed the greater similarity, it is quite possible that they also possess similar potential. The neurotrophic viruses may enter the brain by direct infection injury, hypoxic injury, blood circulation pathway, immune-mediated injury, neuronal pathway, and include other mechanisms [2]. After the invasion, the impact of SARS-CoV-2 on neurological manifestation and complications can be seen in central and peripheral nervous system. The reported central nervous system manifestations include encephalopathy, Acute Hemorrhagic Necrotizing Encephalopathy (ANE), Acute myelitis, cerebrovascular accident, Encephalitis, headache, and dizziness [3-7]. The Peripheral nervous system included skeletal damage, anosmia, and chemosensory dysfunction and Guillain Barre Syndrome (GBS)

The birth of a premature baby is a decisive factor in determining long-term consequences on cognitive development. Considering the Wechsler Intelligence Scale for Children (WISC) as a reference, there are several evidences resulting from numerous studies that show a variation in the cognitive profile: preterm-born children have been shown to have an increased risk of cognitive impairment and have consistently shown lower results than control groups on standardized tests of general intellectual functioning. In our study we expand the sample age and evaluate the cognitive profile of adolescents and understand if cognitive abilities had specific effects, comparing a group of adolescents born preterm (group 1) with a group of adolescents born on term (group 2). Broadening the study population age, we may conclude that the impairment of WM’s abilities persists during the course of development, and therefore subjects with a preterm birth history continue to present difficulties in global cognitive functioning, also impacting lifestyle.

Inflammatory Pseudotumours (IPT) are mostly benign lesions, mimicking malignant lesions and affecting almost all organ systems and are characterised by fibrotic ground tissue and polyclonal mononuclear infiltrate on histopathology. It is a disease of unknown pathogenesis and the brain is a rare site of occurrence. Here we present one such case we operated recently in our department.

Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. In 2017, there were an estimated 46.6 million adults aged 18 or older in the United States with mental disorder. Young adults aged 18-25 years had the highest prevalence of mental disorder (25.8%) compared to adults aged 26-49 years (22.2%) and aged 50 and older (13.8%). In low and middle-income countries, between 76% and 85% of people with mental disorders receive no treatment for their disorder.Unani system of medicine is the only system which intervenes with six essential factors (Asbab-e-Sitta Zarooriya) especially by Bodily AND Psychic movement (Harkat wa Sukoon Nafsani) and sleep AND wakefulness (Naum wa yaqza). In this regard, Tadeel-e-Ruh is the basic concept to keep away mental disorders. Equilibrium between these two causes of health (Asbab-e-Sehat) is enough to keep away mental problems. In spite of that there are a number of Unani single (Mufradat) and compound (Murakkabat) drugs for examples Sedative (Musakkinat), exhilarants (Mufarrihat), Mubrridat (cold inducers) and brain strengthener (Muqwaiy-e-Demagh) keep away mental disorder such as Dementia, Insomnia, Headache, Depression and other mental disorders.

Background: Anterior cervical discectomy and fusion (ACDF) means removing the symptomatic disc by an anterior approach with placement of a bone graft or a synthetic cage. Many studies have shown the procedure to be effective, but associated with complications.Objective: To document and record the type and incidence of complications associated with ACDF, and to find any predisposing factors or associated medical illnesses and other demographic factors or conditions that increase the complications.Patients and Methods: A prospective review of 48 patients who underwent an anterior cervical discectomy and fusion between (May\2012 - July\2014) in two hospitals with an average 6 months follow up.Results: The sample of patients was classified according to age, gender, diagnosis, complications, associated medical illnesses, level of the operation. Then the complications were analyzed according to these parameters trying to find any predisposing factors or associations. Hoarseness of voice was 79%, Dysphagia 54%, Neurapraxia 14.6%, Other medical illnesses 12%, Infection 4%, Reopening 4%, wrong diagnosis 4%, worsening 4% and Death 2%.Conclusion: The complication rate for ACDF is low in experienced hands. Hoarseness is the most common reported complication. Dysphasia, laryngeal edema or a sensation of a lump in the throat are also reported. Associated medical illnesses especially asthmatics and smokers and any patient with chronic cough or respiratory problems are the major cause of complication. Also there is marked association of complications in patients with multisystemic chronic diseases.

The Covid-19 has been a great challenge. At this time, it is interesting to approach patients with severe COVID who have required prolonged admission to the Critical Care Unit (ICU), intubation with connections to mechanical respiration, even connection to the extracorporeal oxygenation membrane (ECMO), because our hospital (Virgen de la Arrixaca, University Hospital, in Murcia), is reference for connection to ECMO.We have elaborated a process/protocol for offering physical and psychological care (assessment, diagnosis and treatment) from the hospital environment and specifically from Rehabilitation Service. This constitutes a challenge and we consider that it will have a significant improvement in both physical and psychological symptoms. We are working in the context to Post ICU Syndrome.The sample is reduced by the severity of the patients.We cannot offer results due to the recent pandemic and because in our region it occurred one month later than in the rest of the most affected regions in Spain (Madrid, Barcelona, Bilbao). We are in the first medical and psychological evaluations and treatment in the actuality.

DuringthepresentpandemicofCOVID-19disease,interesthasshiftedfromtherespiratorysystemaffectationtoinvolvementof other organs and systems. Recently pre-eminence of neurological symptoms and signs has emerged. We have done a comprehen-sive review of the literature published as open access in various databases with the purpose of increasing our understanding of the disease and aid in the identification of patients with these neurological conditions. We have reviewed articles reporting neurologic manifestations in young individuals and children. Although there is not enough data to establish prevalence of the conditions affecting pediatric population,as the number of world widecases increases,we expect to find a higher frequency of these casereports. It is considered of utmost importance to urge clinicians to document symptoms and neurological signs in the context of the disease in order to contribute to a better understanding of Neurocovid and to generate a body of knowledge that influences the optimization of the diagnosis and approach of this entity, taking as a premise that the early installation of individualized and reasoned treatments will translate in a better survival rate of those affected and lower the occurrence of eventual ongoing deficits.

Duchenne Muscular Dystrophy (DMD) is a slow, progressive and fatal X-linked neuromuscular disorder due to loss of dystrophin that links the contractile apparatus to the sarcolemma via the dystrophinassociated protein complex (DPC). The NOD (Nitric Oxide Donor) causes release of Nitric Oxide (NO) by nitric oxide synthase (NOS) and then via 10,000-fold effect NOR (Nitric Oxide Receptor) it acts to release cGMP thus modulates DPC and improves the skeleton muscle functionality. We have used intrathecal sodium nitroprusside to activate the 10000-fold effect to modulate the retrograde neuroregulation in DMD (diagnosed by muscle biopsy) and oral Tadalafil as NODs and well checked by AL-TENS (acupuncture like transepidermal neural stimulation) in pre ITSNP and post ITSNP phase.

Background: The role of thalamus in the pathogenesis of visual and auditory hallucinations has been described as “Peduncular Hallucinosis”. This kind of hallucinations has been reported to be associated with thalamic injury joined to midbrain structures damage. Hallucinations are filled with vivid images of animals and colorful characters in motion and in many cases are associated with sleep disorders. Despite these characteristics, patients generally distinguish them as not real. Case Report: The present case has the distinction of having characteristics somewhat different from those described in published cases. In the first place, it is the case of the longest duration published up to date, 5 years, secondly, contrary to what usually happens, the patient does not criticize the objects and understands them as realConclusions: We present an updated review about literature published and redefinition of the concept the particular characteristics of this rare syndrome. When facing hallucinatory cases of an organic type, especially in patients with cardiovascular risk factors, it is important to rule out rare syndromes such as Charles Bonnet or hallucinations of thalamic origin.

Estrogen is the major sex hormone formed in both males and females and is responsible for development of reproductive organs as well as secondary sexual characters. In females, its major function is to maturation and regulation of ovaries and uterus. Its major forms are Estrone (E1), Estradiol (E2), and Estriol (E3), but E2 is the most effective form of estrogen and is formed from cholesterol (steroid) ring. Most of the estrogen formed along with other hormones like progesterone is utilized in maintenance of menstrual cycle, uterine health and pregnancy by number of feedback mechanisms. Major detoxification of this chemical messenger occurs in liver by two phase mechanism: hydroxylation and methylation and usually take 2-OH pathway of detoxification which is the safest and the most efficient at molecular levels. This pathway also reduces the chances of formation of estrogen adducts which leads to abrupt DNA processing, mutation, and base exclusion. 4-OH and 16-OH pathways of detoxification is usually neglected but if there is disturbances in feedback mechanisms and estrogen load increases it might leads to blockage of energy channels by overlapping them with steroid hormone.

Introduction: Neurogenic bladder is a condition causing significant effect on the quality of life of the patient. Sacral nerve stimula-tion (SNM) has a good role in these patients. We report our experience with sacral neuromodulation. Methods: 15 patients with refractory urinary bladder were included in this study. The aetiology of the neurogenic bladder included 7 spinal cord injury, 3 meningomyelocele, 2 failed back surgery syndromes, two multiple sclerosis and one mixed bowel/bladder (aetiology unknown). All 15 underwent test stimulation.Results: Only 10 out the 15 had a positive trial and proceeded to the next stage of implantation. The 3 patients with failed trial were all patients with complete cord injury or injuries below T12 (vertebral level) and more than 8 years duration. Of the other two one was a meningomyelocele and other was a case of advanced multiple sclerosis. Follow up period was upto four years; all 10 patients doing well. One of early cases had lead migration and had to be repositioned. One patient used to develop shock like sensation in perineum; the stimulation was stopped for six weeks and restarted at lower frequency. Conclusion: SNM is a very effective therapy for neurologic bladder in selected patients. Detailed preoperative assessments and trial are very important in this selection.

Background:Neuromyelitis optica (NMO) has evolved from Devic’s classical description to a broader disease spectrum of NMO Spectrum Disorder (NMOSD), from monophasic illness to a polyphasic illness with multiple recurrences, disease confined to optic nerve and spinal cord to now brain stem, cerebrum and even with endocrinopathy due to hypothalamic involvement [1], coexisting infections [2] and a variety of autoimmune diseases, including non-organ specific autoimmune diseases and co-existent autoantibodies without diseases [3].Objectives:To report, the epidemiological characteristics, clinical presentations, recurrence rate, treatment and response to therapy in 23 patients with NMO spectrum disorder among the Indian population.Materials and Methods:An observational, retrospective analysis of our prospectively maintained data base of patients during the period of May 2018 - June 2018 who satisfied International Panel for NMO Diagnosis (IPND) revised criteria [4] of NMOSD was done.

Few cases of co-existing chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and seropositive myasthenia gravis (MG) were reported. However, there is no reports on co-existence of CIDP with seronegative MG or on the responses to treatment of both diseases. We report two cases with diagnosis of CIDP and MG. The first case is 38-year-old African American female with initial diagnosis of CIDP and later onset bulbar symptoms. She was diagnosed with seronegative MG by clinical suspicion and single fiber electromyography (SFEMG). The other case is a 65-year-old British male who initially diagnosed as seropositive MG then he devel-oped paresthesia and difficult walking a few months later. CIDP was confirmed by electrodiagnostic study and albuminocytologic dissociation in cerebrospinal fluid analysis. The first case underscores the importance of performing SFEMG on cranial muscles in cases of CIDP with cranial nerve involvement even if serological testing for MG is negative. In both cases, bulbar symptoms were more responsive to immunomodulatory treatment than limb symptoms.

Chondromyxoid fibroma is a rare benign cartilaginous bone tumor that is uncommonly found in the spine. To date, among 13 cas-es reported in the cervical spine, only two cases involve the C2 vertebra and all arise from the body. We report the first case occurring in the odontoid process of a 26-year-old woman. Firstly, because of the craniocervical instability, fusion from the occipital condyles to the posterior elements of C1 through C3 was performed. Secondarily, an expansile tumor of the C2 odontoid process was resected along with phenolization and synthetic processed bone grafting via a transoral approach. The postoperative course was uneventful without recurrence at 3-year-follow up. Then, she has returned to full-time employment.

Periodic lateralised epileptiform discharges are electrophysiological biomarkers of acute and sometimes chronic brain injury. A major controversy through the years has been whether PLEDs are truly ictal or just interictal or postictal epiphenomenon, and whether these discharges warrant any treatment. In this review, we aimed to critically analyze this issue of whether to actively treat or wait and watch PLEDs in various situations. We conclude that the etiology of PLEDs, depth of encephalopathy and presence of clinical seizures is associated with poor outcome rather than presence of PLEDs per se. Continuous EEG monitoring is warranted to recognise ictal or high risk interictal EEG patterns akin to NCSE before treating aggressively with antiepileptic drugs.

The COVID-19 predominantly affects the respiratory system, causes alveolar damage, edema, and inflammation [1]. However, many experimental studies and case reports on coronaviruses (CoVs) highlighted their potential neurotropism. The neuroinvasive propensity has been illustrated as a common feature of CoVs. The SARS-CoV and SARS-CoV-2 showed the greater similarity, it is quite possible that they also possess similar potential. The neurotrophic viruses may enter the brain by direct infection injury, hypoxic injury, blood circulation pathway, immune-mediated injury, neuronal pathway, and include other mechanisms [2]. After the invasion, the impact of SARS-CoV-2 on neurological manifestation and complications can be seen in central and peripheral nervous system.