Archive for December, 2017

Home of the Parkinson's Improvement Programme

Surgery for Trigeminal Neuralgia


·  An improved microvascular decompression in treating trigeminal neuralgia: application of nest-shaped Teflon fibers

Original Research Article

  • World Neurosurgery        Available online 28 September 2017
  • Yingbin Jiao, Zhiyong Yan, Shusheng Che, Chao Wang, Jianpeng Wang, Xin Wang, He Wang, Weiguo Qi, Yugong Feng



The aim of this study was to develop an improved Microvascular decompression (MVD) surgery using nest-shaped Teflon fibers. Eighteen consecutive trigeminal neuralgia (TN) patients who underwent MVD using nest-shaped Teflon fibers between January 2012 and December 2013 were included in this investigation. During the surgery, the nest shape of Teflon was formed by gently pushing Teflon prosthesis at the center position toward the periphery. Immediate postoperative outcome was evaluated using numerical rating scale (NRS) score, then patients were followed up for recurrence. Pain was completely relieved in 16 (88.9%) cases immediately after the surgery, and 2 cases (11.1%) achieved partial pain relief. Seven (38.9%) patients developed postoperative complications. All complications were successfully mitigated before discharge. The patients were followed up for 2.0 to 3.4 years. During follow-up, recurrence was observed in 2 patient (11.1%). No Teflon adhesion or Teflon-induced granuloma was found. The nest-shaped Teflon fibers in MVD surgery for TN is safe and applicable. The long-term outcomes and the comparison between hollow nest-shaped implants and the standard cigar-shaped implants should be assessed in the future investigation with a large sample size.




New in Rheumatoid Arthritis

Autonomic Neuroscience

Available online 13 September 2017

Cardiovascular autonomic regulation, inflammation and pain in rheumatoid arthritis



Rheumatoid arthritis (RA) is a chronic inflammatory condition characterised by reduced heart rate variability (HRV) and increased pain.

Animal studies have demonstrated reciprocal relationships between parasympathetic activity and inflammatory cytokines, however this has not been assessed in humans with RA.

This is the first study to demonstrate that in RA low HRV was associated with increased serum inflammatory cytokine concentrations, and independently associated with increased reported pain.

  • In our patients with RA, reductions in HRV were not compounded by the presence of hypertension.



Rheumatoid arthritis (RA) is a chronic inflammatory condition characterised by reduced heart rate variability (HRV) of unknown cause. We tested the hypothesis that low HRV, indicative of cardiac autonomic cardiovascular dysfunction, was associated with systemic inflammation and pain. Given the high prevalence of hypertension (HTN) in RA, a condition itself associated with low HRV, we also assessed whether the presence of hypertension further reduced HRV in RA.


In RA-normotensive (n = 13), RA-HTN (n = 17), normotensive controls (NC; n = 17) and HTN (n = 16) controls, blood pressure and heart rate were recorded. Time and frequency domain measures of HRV along with serological markers of inflammation (high sensitivity C-reactive protein [hs-CRP], tumour necrosis factor-α [TNF-α] and interleukins [IL]) were determined. Reported pain was assessed using a visual analogue scale.


Time (rMSSD, pNN50%) and frequency (high frequency power, low frequency power, total power) domain measures of HRV were lower in the RA, RA-HTN and HTN groups, compared to NC (p = 0.001). However, no significant differences in HRV were noted between the RA, RA-HTN and HTN groups. Inverse associations were found between time and frequency measures of HRV and inflammatory cytokines (IL-6 and IL-10), but were not independent after multivariable analysis. hs-CRP and pain were independently and inversely associated with time domain (rMMSD, pNN50%) parameters of HRV.


These findings suggest that lower HRV is associated with increased inflammation and independently associated with increased reported pain, but not compounded by the presence of HTN in patients with RA.

Corresponding author at: College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.

© 2017 Published by Elsevier B.V.


Giant viruses

·  Evidence of giant viruses of amoebae in the human gut

Review Article

  • Human Microbiome Journal
  • Philippe Colson, Sarah Aherfi, Bernard La Scola



The study of the gut microbiome and virome has developed dramatically since the beginning of the 21st century. Nevertheless, giant viruses of amoebae, which are emerging viruses first described in 2003, have been largely neglected in virome investigations because they are bigger than classical viruses and devoid of ribosomal DNA. Dozens of these viruses have been isolated between 2003 and 2016, which were classified in 7 lineages including 3 new recognized virus families. These viruses challenge previous paradigms on viruses and share many characteristics with intra-cellular microbes. We reviewed here findings about the presence of these giant viruses of amoebae in the human gut, whose microbiota has been extensively studied during the last decade. Contrasting with what is currently done for classical viruses, many studies investigating the presence of giant viruses of amoebae have been conducted by culture on amoebae in first intention. To date, a mimivirus and a marseillevirus have been isolated from human feces, which indicates that they can still replicate after a stay in the gut. Besides, sequences related to giant viruses of amoebae have been detected in several metagenomes generated from human feces. Water is a likely source of human exposure to giant viruses of amoebae. The clinical or biological significance of the presence of these viruses in the human gut remains to be determined. Taken together, available findings warrant searching more extensively and systematically for giant viruses of amoebae in the human gut, along with in other body sites.



After much trial we have reformulated PIPmix – the PD tonic so it should be more effective in more cases.

The new formulation for a 40 day supply of PIPmix N is:

Palmitoyl Ascorbate    93gm

Trehalose                    93gm

EV olive oil                   20ml

EV rapeseed oil            78ml

Lemon fish oil             200ml


This is taken as one dose of 10 ml (a dessertspoonful) or twice daily as 5ml (a teaspoonful). Some users find the twice daily regime gives longer lasting results.


For holiday use Palmitoyl ascorbate (aka. E-304 or ascorbyl palmitate) can be supplied in sachets of powder each 2.4gm – the daily intake of the main ingredient in PIPmix. This is acceptable at airports and is sufficient to maintain the PIPmix effect for the duration of the holiday.


PIPmix is supplied free of charge to trial participants.


E-304 (aka. Palmitoyl ascorbate or ascorbyl palmitate) is to be used in a clinical trial as a remedy for the intractable pain of Trigeminal Neuralgia (TN). Up to now it has shown itself to be a 100% success even in cases where there has been TN pain for 30 years or more. There are no other remedies anywhere near so successful and most have unpleasant side-effects. In due course savings to the NHS will be in the order of tens of millions of £ per year.