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Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This series involves 29 patients treated for chronic pain (9 patients) or severe spasticity (20 patients). The surgical technique used was the microsurgical D.R.E.Z.-tomy technique as described by Sindou. In the first group, three patients had malignant pain, while the six others had deafferation pain. In the second group, spasticity involved the upper limb in 13 patients and the lower limbs in 7 patients. Out of 20 patients, one-third suffered from cerebral palsy. In the first group, results one year after surgery were excellent or good in 7 out of the 9 patients. In the group treated for spasticity, a significant decrease in spastic disorders was observed in 16 of the 20 patients over a 1 to 4 year follow-up period. There was also an improvement of voluntary movements in 11 patients and a decrease in pain in 15 patients belonging to this group. A number of complications were noted: cerebrospinal fluid leakage in two cases, painful anesthesia in the C5 to T1 territory in one case, transient paresis of the upper limb in six cases. One patient died as a result of an expansive pneumatocele (3.4% of cases).
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PMID:[Surgery of the radiculo-spinal cord junction in the treatment of chronic pain and incapacitating spasticity. Report of a series of 29 patients]. 226 43

In an attempt to assess quantitatively the effects of selective dorsal rhizotomy on ambulatory patients with cerebral palsy, instrumental gait analysis was used to document and compare changes following surgery. Stride characteristics, dynamic surface electromyography, foot-floor contact patterns and motion of the thigh, knee and ankle were analysed. 14 patients (seven independent ambulators, seven using assistive devices) aged between 4.6 and 23.5 years were tested before surgery and again six to 14 months later. After surgery, the seven independent walkers retained the same level of function and one of the assisted walkers had progressed to independent walking, but the other six still used the same device as before surgery. Selective dorsal rhizotomy reduces spasticity and improves gait dynamics, but does not change patterns of muscle activation during walking.
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PMID:Instrumented gait analysis after selective dorsal rhizotomy. 228 2

The incidence of inguinal hernia among 247 children with cerebral palsy was ascertained. During the first year of life, 20 of the 153 boys developed hernia, as did one of the 94 girls. Among boys with birthweights of 1000 to 2000g the incidence was 31 per cent, which is twice the rate for normal children. The incidence among boys with birthweights greater than 2000g was 8 per cent. A comparison group could not be found, but this incidence appears to be excessive, considering the reported normal incidence of 1 to 4 per cent in boys. The authors recommend routine examination for inguinal hernia, particularly for boys with birthweights less than 2000g and with spastic tetraplegia. Conversely, one should be alert to the possibility of concurrent spasticity in preterm males with inguinal hernia.
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PMID:Incidence of inguinal hernia in children with congenital cerebral palsy. 228 4

Baclofen, the most effective drug for treating spasticity, is a specific agonist of gamma-aminobutyric acid-B receptors, and is very abundant in the superficial layers of the spinal cord. Given orally, baclofen does not easily penetrate the blood-brain barrier, and is distributed equally to the brain and spinal cord. Direct intrathecal administration was given in order to change the distribution of the drug by preferentially perfusing the spinal cord. Eighteen patients presenting a severe spastic syndrome were treated with chronic intrathecal infusion of baclofen in the lumbar cerebrospinal fluid. After clinical preselection, 38 patients were implanted with a lumbar access port allowing long-term trials in order to determine the efficacy of baclofen therapy and the effective 12-hour dose. The 18 patients selected for chronic administration were implanted with a programmable pump. The pathology in these cases was: multiple sclerosis (6 cases), posttrauma spastic syndrome (eight cases), and (one case each) cerebral palsy, ischemic cerebral lesion, spinal ischemia, and transverse myelitis. The mean follow-up period was 18 months (range 4 to 43 months). The clinical results were evaluated according to muscular hypertony on Ashworth's scale (changed for occurrence of painful spasms) and functional improvement. Results were better for spastic syndrome secondary to traumatic medullary lesion than for demyelinating disease. Hypertonia was improved in all cases as confirmed by the registration of the Hoffman (H) reflex. Painful muscular spasms disappeared in 14 of the 16 affected patients. Significant functional improvement was noted in nine patients and was considerable in three. The risk of side effects secondary to overdose (such as excessive hypotonia or central depression) and the absence of a specific baclofen antagonist stresses the necessity for accurate determination of the efficient dose. After an initial titration period and adjustment of the therapeutic dose, the individual doses were from 21 to 500 micrograms/24 hrs (mean 160 micrograms/24 hrs). This new conservative method is very effective, perfectly reversible, and safe when administered in conditions favorable to its use.
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PMID:Chronic intrathecal baclofen administration for control of severe spasticity. 230 74

Fifty-five children with cerebral palsy had multiple-level laminectomies for selective posterior rhizotomies for the relief of spasticity. They were followed up clinically and radiologically to assess their spinal stability and the possible development of post-laminectomy deformity of the spine. The majority of the deformities found were related to cerebral palsy and did not appear to be due to the laminectomy: 16% had scoliosis, 5% kyphosis, 7% lordosis, and 9% spondylolysis/spondylolisthesis. Spondylolysis is the only abnormality that appeared to be more common in this group than in children with cerebral palsy.
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PMID:Incidence of spinal deformity in children after multiple level laminectomy for selective posterior rhizotomy. 231 Nov 12

In a recent study, children with spastic cerebral palsy (median age, five years) were examined before and up to a median of 14 months after 52 operations involving elongation of the tendo Achillis or aponeurotomy of the gastrocnemius. On removal of the cast four weeks postoperatively, strength in the dorsiflexors had increased by more than 50%, as evaluated by the ability to raise a weight from a scale. Postoperative function was correlated with preoperative function. Strength had increased more than 200% by 14 months postoperatively, with no instance of excessive lengthening of the triceps. In 13 cases, the dorsiflexors had been without function preoperatively. Two of those cases again lost the dorsiflexor function achieved postoperatively, when dynamic shortening recurred after one year. The study thus confirms the view that antagonist function improves when spasticity in the agonist is reduced by tendon lengthening.
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PMID:Functional changes in the antagonists after lengthening the agonists in cerebral palsy. I. Triceps surae lengthening. 231 85

In a recent study, 38 patients with spastic cerebral palsy (median age, 5.6 years) were examined before and at a median 13 months after distal lengthening of the hamstrings. Four weeks after operation, the strength of the quadriceps was reduced by a median value of 70%. Seven months after operation, the strength had been regained; by 13 months after operation, it had increased by a median value of 22%. In 20 cases, strength had increased by more than 50%. The present study confirms the theory that quadriceps function is strengthened when the antagonist function is weakened. The study also explains (1) why it often takes six months for gait to become better than before operation and (2) why spasticity of the rectus often increases after the hamstrings are lengthened.
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PMID:Functional changes in the antagonists after lengthening the agonists in cerebral palsy. II. Quadriceps strength before and after distal hamstring lengthening. 231 88

Cerebral palsy is a syndrome characterized by abnormal motor function, with spasticity being one of the most crippling manifestations. Selective dorsal rhizotomy, a neurosurgical procedure, has successfully decreased the degree of spasticity for the child with cerebral palsy. The utilization of this procedure may enable the child with cerebral palsy to demonstrate improved motor function, creating an exciting nursing challenge. This article describes dorsal rhizotomy and the nursing care involved. The protocol of treatment and care provided at Texas Children's Hospital is also described.
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PMID:Selective dorsal rhizotomy: neurosurgical treatment of cerebral palsy. 232 25

To determine whether vaginally born breech infants are at increased risk for morbid events as compared with breech infants delivered by cesarean, we studied 1240 singleton breech infants without congenital anomalies delivered in Northern California Kaiser Permanente Medical Care Program hospitals during 1976-1977. Medical record review provided information on indications for method of delivery, delivery complications and injuries, neonatal complications, and neurologic sequelae up to 4 years of age. The relative risk estimates for asphyxia (1.0; 95% confidence interval 0.7, 1.4), head trauma (1.6; 95% confidence interval 0.2, 17.0), neonatal seizures (0.8; 95% confidence interval 0.1, 7.1), cerebral palsy (1.6; 95% confidence interval 0.2, 17.4), and developmental delay (2.0; 95% confidence interval 0.9, 4.4) for vaginally born compared with cesarean-delivered infants indicated that vaginally born infants were not at increased risk for these outcomes. We used multiple logistic regression to control for confounding variables. The adjusted relative risk estimate for the combined-outcome category of head trauma, neonatal seizures, cerebral palsy, mental retardation, or spasticity was 0.5 in vaginally delivered infants (95% confidence interval 0.1, 3.2). When all morbid outcomes were considered in combination, the adjusted relative risk estimate was 0.9 for vaginally delivered infants (95% confidence interval 0.6, 1.4).
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PMID:Morbidity among breech infants according to method of delivery. 232 65

Two young males in their thirties are reported with a clinical history and examination indistinguishable from typical females with the Rett syndrome. Both had normal early development. The first patient had a regression by the end of the second year. He was late in walking, had prominent hand-wringing from the age of 4 years, and non-progressive dystonia from the age of 14 years. He is still ambulatory. Seizures which started at the age of 18 months have been easily controlled. The second patient has had a severe seizure disorder since the age of 7 months. In his early teens, he lost ambulation and his height and weight fell below the 2nd percentile. He has severe foot dystonia without spasticity. Both patients have a normal head size and no evidence of atrophy on a CT scan of the brain. Both had kyphoscoliosis in their teens. It is difficult to evaluate the incidence of such cases. Little attention being paid to the normal early development, they hide behind vague diagnoses such as cerebral palsy, static encephalopathy, and behavior disorder. Dystonia is often confused with spasticity, the lack of paralysis is not appreciated, apraxia and hand wringing are assumed to be self-stimulatory behaviors.
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PMID:The Rett syndrome in males. 234 22


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