Detelina Nedyalkova-Petkova

Background: Peripheral neuropathy is a common and clinically heterogeneous neurological condition caused by metabolic, inflammatory, toxic, or traumatic factors and is associated with sensory deficits, neuropathic pain, motor impairment, and reduced functional capacity. Management remains challenging and often requires multimodal therapeutic approaches, as pharmacological monotherapy frequently provides incomplete symptom control. Objective: This narrative review explores the conceptual rationale for combining galantamine with iontophoresis and Black Sea brine-based therapy as a potential multimodal strategy for peripheral neuropathy management. Main Findings: Galantamine, a reversible acetylcholinesterase inhibitor and positive allosteric modulator of nicotinic acetylcholine receptors, has demonstrated neuroprotective, neuromodulatory, and anti-inflammatory properties in experimental settings. Iontophoresis may provide a non-invasive method for targeted local drug delivery while reducing systemic exposure. Black Sea brine, widely used in Bulgarian balneological and rehabilitation practice, has been associated with improved circulation, pain reduction, and neuromuscular support. The reviewed evidence suggests biologically plausible complementary mechanisms; however, no direct clinical studies evaluating the combined intervention were identified. Limitations: Current evidence is indirect and derived from separate investigations of galantamine, iontophoresis, and brine-based therapy, as well as heterogeneous historical and regional sources. Therefore, the proposed combination should be considered hypothesis-generating rather than evidence-established. Conclusions: The combination of galantamine, iontophoresis, and Black Sea brine represents a potentially interesting multimodal concept for peripheral neuropathy rehabilitation. Well-designed preclinical and clinical studies are required to determine safety, feasibility, optimal treatment parameters, and therapeutic efficacy.

Compounding pharmacy addresses critical therapeutic gaps in sports medicine by enabling personalized formulations for injury management. This review synthesizes evidence on customized topical medications, particularly for advanced delivery systems, including iontophoresis and phonophoresis, which enhance localized drug delivery while minimizing systemic side effects that impair athletic performance. Frequently prescribed combinations incorporate analgesics, nonsteroidal anti-inflammatory agents, corticosteroids, and muscle relaxants at standardized concentrations. Clinical applications span acute injuries, chronic overuse conditions, and neuropathic pain syndromes, though randomized controlled trials demonstrate variable efficacy, necessitating cautious, patient-specific implementation. Regulatory frameworks differ substantially between jurisdictions, with European models integrating compounding within licensed pharmacy practice through centralized formularies and quality systems, while the United States maintains bifurcated oversight distinguishing traditional compounding from outsourcing facilities. These structural variations fundamentally shape the safety, accessibility, and clinical integration of personalized therapeutic solutions for active populations.

Peripheral nerve injuries can lead to significant functional impairments, and treatment options remain limited. Galantamine, widely used for cognitive disorders, has shown potential effects on the peripheral nervous system, making it a candidate for new therapeutic approaches. The narrative review explores the use of galantamine for peripheral nerve injuries, with a focus on transdermal and iontophoretic delivery methods. Searches in scientific databases revealed no peer-reviewed publications addressing this specific application. As a result, the review expanded to include printed and offline sources and a broader timeframe to capture earlier reports. Available evidence from Bulgaria suggests that galantamine ampules have been applied via iontophoresis for peripheral neuropathy. However, this approach is not documented in established scientific databases, and information on its safety and effectiveness is limited. Overall, research on transdermal galantamine for peripheral nerve injuries is still scarce. More studies are needed to better understand its potential benefits and to optimize safe delivery methods.

Galantamine, a reversible inhibitor of acetylcholinesterase, exhibits both acetylcholinesterase-inhibiting and neuroprotective properties. The FDA (Food and Drug Administration) and EMA ( European Medicines Agency) have approved it for use in the treatment of Alzheimer's disease dementia (AD). The side effects associated with oral administration include gastrointestinal irritation, first-pass hepatic metabolism leading to reduced bioavailability and systemic adverse reactions such as nausea or liver enzyme elevation. These issues have led to the exploration of alternative delivery routes, such as transdermal, intranasal, or buccal. Such routes can bypass the gastrointestinal tract and liver, thereby reducing the risk of digestive discomfort and hepatic strain. The FDA has approved acetylcholinesterase inhibitors, such as rivastigmine, for transdermal administration in the form of patches. Studies on the transdermal administration of galantamine are ongoing. In addition to its use for AD, galantamine is increasingly being investigated for its effects on various conditions, including its potential in treating peripheral nervous system damage. In Bulgaria, a method for depositing galantamine through iontophoresis has been developed and widely used in clinical practice for many years. However, there is a lack of scientific evidence to support its effectiveness according to modern scientific approaches, necessitating further research in this direction.

Elbow stiffness is a relatively common condition and represents a significant disability. A proper clinical history is essential for therapeutic surgical or non-surgical planning. Purpose: The study aims to investigate the possibility of treating and preventing elbow stiffness. Material and Methods: A 63-year-old woman was diagnosed with a fracture of the distal humerus and a fracture of the olecranon process. The fractures were treated in the prone position and with a dorsal approach to the elbow. The distal humerus was fixed with medial and dorsolateral locking plates, while the olecranon process was fixed with Webber osteosynthesis. After the operation, the woman required postoperative soft immobilisation for about 30 days. A seven-day treatment was conducted using a combination of Multiwave Locked System (MLS) laser therapy and kinesiotherapy techniques. Results: On day 1 /T1, after physical examination, the patient was diagnosed with significantly limited range of motion, pain at the end of motion, and swelling of the elbow. On day 7 /T2/ of the seven-day rehabilitation treatment cycle, we observed significant improvement in elbow contracture, range of flexion, reduced swelling, VAS scores, and Mayo Elbow Performance Index scores. Conclusions: The reported improvement in all the monitored indicators gives us reason to conduct a study on the application of a therapeutic protocol in patients with orthopedic implants of the elbow joint. The challenge in the treatment of postoperative contracture with limitation of movement in the elbow joint requires the inclusion of modern physiotherapeutic methods in its complex treatment.

The advancement of technology has led to the development of surgical instruments that aim to assist and improve surgical skills and patient satisfaction after operation. One of the most significant advancements in this field has been the introduction of navigation systems for knee arthroplasty. Computer-assisted orthopedic surgery and navigation applications work towards fusing images with anatomical landmarks in real-time. In addition to being an educational tool for less experienced surgeons, this technology also assists experienced surgeons in planning bone cuts, tunneling, and ligament balancing. Purpose: This study explores the potential benefits of physical therapy methods for patients who have undergone Navigated total knee replacement. Material/Methods: The study comprised ten patients of both sexes aged between 18 and 80 years with an assisted total knee arthroplasty who fulfilled the specified inclusion criteria. The patients underwent navigated total knee arthroplasty, which resulted in postoperative contracture and oedema. Patients are followed up at three-time points and assessed using a knee injury and osteoarthritis outcome score questionnaire, circumference measurements, range of motion and a pain rating scale (visual analogue scale). Results: A significant improvement has been observed in reducing girth measurements and pain rating scale, as measured by (VAS), increase in ROM and a decrease in contracture. Conclusions: Combining the surgical technological revolution with the potential of restorative physical therapy methods is essential for achieving sustainable and fast results.