Anyone with ME/CFS would probably agree that their muscles are not working properly. There is pain (this is the ‘myalgia’ part of ‘Myalgic Encephalomyelitis’) and there is also tiredness and weakness of the muscles. And for some people with ME/CFS there is unfortunately an additional symptom: muscle spasms and twitching. Your doctor may consider low doses of muscle relaxant medications such as baclofen/Lioresal and Clonazepam, but the latter especially can have unpleasant side effects and it has a potential for dependence. However we know that several local people with ME/CFS have found baclofen helpful. If muscle spasm and twitching are a problem, then perhaps natural remedies can be tried before resorting to medication. Remember that you should check with your doctor before using any alternative or complementary remedy. Muscle spasm in ME/CFS is not the same as the cramps and muscle spasms experienced by athletes during training. Some natural remedies, such as massage, could make painful muscles more painful, whilst having no bearing on the neurological origin of the condition. However it is certainly worth trying homely remedies before resorting to medication. Nutrition
The first thing to check is whether your diet could be improved. The three main nutrients involved here are calcium (which needs vitamin D) magnesium and potassium. Calcium as such is not usually such a problem as people might think, even on dairy free diets, since it is the most common mineral found in all foods. But to keep the calcium balance correct it is important to get enough vitamin D either from fish or from fortified foods such as cereals, or supplements. Sunlight is the most important single source of Vitamin D for humans and some people think that a deficiency of the vitamin is a ‘hidden’ deficiency which should be researched more fully. Vitamin D supplements seem to have helped a lot of people with ME/CFS but this is one of the vitamins that should be treated with caution. If you buy a supplement, choose a purified form (rather than from fish oil which you may not be able to tolerate) and take only the lowest recommended dose, testing your reaction carefully. (The role of this vitamin in ME/CFS is currently being researched at the University Hospital of Dundee.) Good sources of magnesium include dark green leafy vegetables, peas, nuts, and whole grains. Potassium is found in most vegetables and fruits but especially bananas and potatoes. Eat fruits and vegetables raw (perhaps juiced) where possible, and cook only lightly, and ideally never fry any food. Herbal Remedies
Lemon thyme (Thymus citriodorus) is used for easing a tight chest as well as for muscle spasms. Make a tea (an ‘infusion’) with 2 teaspoons of the dried herb (or a quarter of a
cup of fresh) and let it stand for five minutes. Drink once a day for ten days, and then skip a week before resuming if it has been helpful (do not drink a herbal infusion continuously). If symptoms are very bad you can drink it up to three times a day, but only for four days. This is not because the herb is dangerous, but because over time the effect diminishes. Cramp bark (Viburnum opulus) has antispasmodic properties as well as anti- inflammatory, sedative and nervine (calming and soothing) properties. Be aware though that it is not suitable for people intolerant of aspirin and in very large doses it can also lower the blood pressure and induce menstruation. However it should be safe to take a cup of cramp bark infused in hot water, up to three times a day, and this could also help if you have Irritable Bowel Syndrome or painful periods with abdominal cramps. If you buy a tincture of cramp bark, take the lowest dose to start with, and if you are extremely intolerant of alcohol do not take the tincture at all. Both of the above remedies are safe in regular doses, but people with ME/CFS, as usual, should take any new remedy with sensible caution. You may find it difficult to buy them from local herbalists but both are available from the Nutricentre, telephone phone 0845 602 6744. Peppermint tea can bring relief to tired and cramped muscles, and a bunch of garden thyme in a warm bath is also recommended. Homeopathy
The classic remedy for wayward muscles is magnesium phosphate (mag.phos.) However, it is never fully effective to treat yourself with homeopathy. A homeopath would conduct a full consultation and prescribe a particular remedy to suit your symptoms and personal profile. Massage and body treats/treatments A very gentle massage can help soothe and retrain over-stressed muscles. Reflexology can have the same effect. There are particular essential oils, such as chamomile, rosemary and lavender, which are helpful for tired muscles, either on their own or in a blend. Always proceed with caution when using essential oils directly on the skin. A warm bath is wonderful for the muscles. Drying can be a chore, so on bad days, wrap yourself in towels and get straight under the covers for a lovely snooze. Visualisation
Take three deep breaths and imagine your muscles encased in blocks of ice. Picture the ice melting, and as it melts feel the muscles relax. When all the ice has melted, the discomfort will be gone…
Síndrome neuroléptico maligno en una paciente con trastorno afectivo M. Henry Benítez * , C De las Cuevas Castresana * y J. L.González de Rivera ** Psiquis, 1989; 10: 391-394 Introducción El síndrome neuroléptico maligno (SNM) es un El síndrome neuroléptico maligno (SNM) es un trastorno poco frecuente pero grave, con una alta trastorno poco frecuente pero
GRADING SYSTEM As we know grading is an essential and sensitive part of the learning process. The European Credit transfer and accumulation System (ECTS) is recently adopted in Tbilisi State Medical University. The ECTS is a student centered system based on the student workload required to achieve the objectives of a program of study. The ECTS is based on the principle that 60 credits cor