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Downloaded from aim.bmj.com on January 5, 2010 - Published by group.bmj.com Letters REFERENCES in order to identify if the facial spasms in transcutaneous electrical nerve stimulation), 1. Sator-Katzenschlager SM, Scharbert G, Kozek- Sydenham’s chorea can leave to a temporo- the symptoms improved after a single Langenecker SA, et al. The short- and long-term mandibular joint dysfunction. acupuncture session and did not return benefits in chronic low back pain through adjuvant At the examination, the patient was calm within one year follow up period. electrical vs manual auricular acupuncture. Anesth Analg 2004;98:1359–64 without any signs of anxiety. The patient Evidently, a placebo effect cannot be 2. Sator-Katzenschlager SM, Szeles JC, Scharbert G, et presented involuntary movements at the excluded through this case report, thus al. Electrical stimulation of auricular acupuncture points temporo-mandibular joint. On palpation of further studies must be performed to vali- is more effective than conventional manual auricular the area, moderate tension was found in the date our current findings with a larger acupuncture in chronic cervical pain: a pilot study. region of LU19 and TE21. Despite the fact number of patients and a control group. Anesth Analg 2003;97:1469–73. that the patient did not show any obvious Although numerous approaches have been signs of apprehension, it was decided to described for this condition, acupuncture is approach both, the muscle-joint component increasingly being used as an alternative to Acupuncture in the treatment of of the temporo-mandibular disorders and conventional treatment. In this single case the psychological factor. Acupuncture treat- report, the relation between time and treat- temporo-mandibular disorders in ment was started at the first appointment. ment solution suggests that the acupuncture Sydenham’s chorea patient: a The patient was seated comfortably and contributed to its resolution. Expectation upright in a dental chair. The skin surface may also have played a role. This report is case report was prepared with alcohol swabs. Local the first known published description of the A case report for a woman with Sydenham’s points (tender spots in temporo-mandibular use of acupuncture in the treatment of chorea is presented, and suggests that this joint) were needled first at the ST6, ST7, temporo-mandibular disorders in a patient treatment may be worth trying in other LU19, TE21 and VG20 acupuncture points. with Sydenham’s chorea. patients with this condition. Disposable filiform needles (0. There are several factors in this case that 3 mm625 mm) were inserted at relevant favour causality rather than coincidence. points until de qi sensation (soreness, numb- First, spontaneous improvement or resolu- CASE HISTORY ness, distension or heaviness) was achieved, tion in less than 1 year from presentation is A 33-year-old woman, a housewife with two with rotation clockwise and anti-clockwise rare. The second reason to attribute the daughters, initially presented at the acupunc- for 3–5 s and left in situ for 20 min without improvement to acupuncture is a plausible ture clinic with rapid, irregular and aimless any stimulation. Various distal points were involuntary movements of the arms and legs, physiological mechanism. The gate control used in an attempt to improve the effective- theories and modern pain physiology try to trunk and facial muscles. The medical history ness of the treatment, as is a common revealed that at age of four the patient provide a scientific ground for the actions of practice in traditional Chinese acupuncture. acupuncture. Acupuncture acts as a pain- developed her first episode of rheumatic fever, The distal LI4, LR3 and ST36 were used on without obsessive-compulsive behaviour. reliever by stimulating the acupuncture both sides. points, which affect the A-b nerve fibres. However, the patient showed symptoms On the following visit a week later, the compatible with Sydenham’s chorea such as With the constant twirling of the needle, a patient claimed that her symptoms steady stream of non-pain impulses is choreiform movements, hypotonia, motor improved. In addition, the involuntary agitation, loss of coordination, gait distur- transmitted to the substantia gelatinosa movements in the hands were also reduced causing the gate to close. Once the gate is bances and impediment of speech, associated and the patient was able to go back to her with joint pain, most prominent in at the closed, subsequent pain impulses coming embroidery. The patient received a similar temporo-mandibular joint. The patient has from the slow conducting C fibres cannot acupuncture treatment on her second visit, been treated since then with haloperidol. pass through. Thus, no pain is felt. The and on the third appointment she claimed to Therefore, during the two pregnancies she impulses from the A-b fibres can be relayed be still improving. In view of her continued presented an exacerbation of her previous to the thalamus, which serves as the final improvement, it was decided to provide symptoms of Sydenham’s chorea, which is a gate. Once the gate in the thalamus is subsequent treatment in a weekly basis, to very common finding, reporting mainly limita- closed, analgesia is produced on the entire
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