Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Baclofen, a derivative of g-aminobutyric acid (GABA) has been known for many years to be a useful drug in the treatment of spinal spasticity. However, when the spasticity is severe, the systemic administration has to be increased, often without therapeutic effects but frequently with central side-effects. Baclofen given intrathecally however, in microgram doses has been previously reported to be effective and safe. A personal experience is reported of 9 severely spastic patients residing in chronic care facilities who were treated from July 1984 to March 1986 with intrathecal baclofen. The spasticity was causing significant nursing care problems, and 6 patients were reduced to a completely bedridden state. Each patient initially received a percutaneous intrathecal drug injection of 0.2-0.7 mg of baclofen to test its efficacy. A subcutaneous intrathecal system for further injections was placed in 6 patients. In 3 patients a decreased level of consciousness was observed. In the 3 cases of multiple sclerosis, intrathecal baclofen resulted in significant reduction of spasticity for 24 to 48 hours after each injection. The spasticity was improved in only one of the 2 cases of posttraumatic paraplegia. The effect was not convincing in the 2 cases of spinal cord tumour, and in the case of cerebral palsy the effect was improvement in spasticity, but also significant drowsiness. Baclofen, in comparison with some other drugs such as morphine or midazolam, also tried intrathecally by the authors, is the most effective in reducing spasticity. Its use however warrants caution, for it can cause decreased consciousness, and there is currently no antagonist.
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PMID:Intrathecal application of baclofen in the treatment of spasticity. 347 75

20 patients with movement disorders and spasticity were treated with SCS to decrease tonus and improve impaired motor function. 12 patients with multiple sclerosis had gait disorders and slight up to considerable increase in tonus. We observed quantitative changes in diminution of spasticity, voluntary motor function, bladder function, lessening of ataxia and pain relief. During a follow-up of up to 4 years no deterioration in the patients' condition could be observed. 11 patients reported a more fluent gait in 6 cases accompanied by a decrease in tonus. Increase in tonus and deterioration of gait pattern were observed after break down of the stimulation. Although the indications for electrostimulation still remains uncertain in some cases with definite diagnosis without any progressive character of the disease and without severe neurological disturbances improvement can be obtained.
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PMID:Application of SCS for movement disorders and spasticity. 349 59

Dantrolene sodium acts primarily by affecting calcium flux across the sarcoplasmic reticulum of skeletal muscle. Recently, dantrolene has been used very successfully in the treatment of several rare hypercatabolic syndromes which have previously been associated with high mortality rates. In malignant hyperthermia, where early diagnosis and treatment usually with intravenous dantrolene in association with other supportive measures (and often subsequent dantrolene therapy) is performed, recovery is seen in virtually 100% of patients. There is a rapid resolution of hyperthermia, dysrhythmias, muscle rigidity, tachycardia, hypercapnia, mottled or cyanotic skin, and metabolic acidosis, and a slower normalisation of myoglobinuria and elevated serum creatine phosphokinase levels. In patients with family history or previous episodes of malignant hyperthermia, prophylactic treatment with dantrolene prior to anaesthesia prevents the syndrome occurring in most cases. Where malignant hyperthermia has developed patients have been successfully treated with further dantrolene therapy. Dantrolene has also been used successfully in the treatment of a few cases of heat stroke and the neuroleptic malignant syndrome--both of which have many similarities to malignant hyperthermia. Dantrolene is well established in the treatment of patients with muscle spasticity where it generally improves at least some of the components of spasticity (i.e. hyper/hypotonia, clonus, muscle cramps and spasms, resistance to stretch and flexor reflexes, articular movement, neurological and motor functions and urinary control). However, in some patients, particularly those with multiple sclerosis, dantrolene may not be effective, and in many cases muscular strength may diminish. Long term dantrolene therapy has been associated with hepatic toxicity and may cause problems in patients treated for disorders of muscle spasticity. Thus, dantrolene offers a unique advance in the therapy available for the treatment of hypercatabolic disorders and is also useful in the treatment of muscle spasticity of various aetiology.
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PMID:Dantrolene. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in malignant hyperthermia, the neuroleptic malignant syndrome and an update of its use in muscle spasticity. 352 59

The anti-spastic effect of a new drug, tizanidine, was compared with that of baclofen in a double-blind clinical trial; 40 seriously handicapped patients with multiple sclerosis (MS) were randomly allocated treatment with one or the other drug for a 6-week period. The antispastic effect was evaluated by clinical criteria. The optimal daily dose of both drugs varied considerably from patient to patient, and was on the average 23 mg for Tizanidin and 59 mg for baclofen. To the extent an antispastic effect was observed, the 2 drugs appeared to be equally effective when given at a 1:2 ratio (mg tizanidine: mg baclofen). Side effects of both drugs were sleepiness, muscular weakness and dry mouth. Tizanidine had a mild depressive effect on blood pressure. Sudden withdrawal of both drugs was accompanied by a transient relative increase of spasticity in approximately half the patients. There were no other changes suggesting physical or psychological dependence. The present study underscores that neither baclofen nor tizanidine are ideal antispastic drugs, and emphasize the need for further research.
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PMID:The treatment of spasticity in multiple sclerosis: a double-blind clinical trial of a new anti-spastic drug tizanidine compared with baclofen. 355 79

Thirty-two patients with spasticity due to multiple sclerosis were entered into a randomized, double-blinded, placebo-controlled crossover trial of the gamma-aminobutyric acid agonist, progabide. Each patient was treated with a maximum of 45 mg/kg of progabide during each of two four-week treatment periods, separated by a two-week washout. Twenty-five participants completed the study; seven failed to complete the study due to adverse events. Progabide was associated with lessened spasticity. There was no loss of motor power associated with progabide. The physician, patients, and study nurse coordinator all declared preferences for progabide for treatment of spasticity. Ten participants (40%) chose to remain on progabide in an open, long-term follow-up protocol. Seven serious adverse events occurred. One consisted of fever and weakness without infection; the other six consisted of elevated aspartate aminotransferase and alanine aminotransferase levels, four of which were asymptomatic. All adverse events resolved entirely when the drug was stopped. Progabide is an effective antispastic agent and its antispastic effect is not accompanied by increased motor weakness. The use of the drug, however, is associated with a high incidence of adverse events, which will likely limit progabide's therapeutic usefulness.
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PMID:The GABA-agonist progabide for spasticity in multiple sclerosis. 363 75

Spasticity is an important cause of physical impediment in multiple sclerosis. Only drug therapy offers useful (but not universal) relief. Dantrolene sodium and/or baclofen are the drugs of choice, being both effective and clinically suitable in over half of cases when carefully titrated and monitored.
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PMID:Muscle relaxants in multiple sclerosis. 368 Jan 9

The intrathecal administration of baclofen by way of an implanted subcutaneous drug delivery system is described in a patient with a severe spastic paraparesis due to multiple sclerosis. Intrathecally-administered baclofen is proposed as another therapeutic dimension and adjunct to physical therapy in the management of patients with severe spasticity that is unresponsive to antispasticity agents administered by mouth.
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PMID:Intrathecal baclofen for severe spasticity. 377 34

Paroxysmal sensorimotor phenomena of spinal cord origin are well documented in the literature dealing with multiple sclerosis, but have seldom been identified in other conditions. These seizures are characterized by tonic spasm in the extremities, often accompanied by painful dysesthesias, and are fleeting, usually lasting no more than two minutes. Although they may occur spontaneously, they are commonly precipitated by tactile stimulation or movement of the extremity. These episodes must be clinically differentiated from spasticity as they have been shown to be responsive to anticonvulsants such as carbamazepine (Tegretol). We present two patients admitted to our rehabilitation facility with a diagnosis of idiopathic transverse myelopathy. Clinical and diagnostic evaluation revealed no evidence of multiple sclerosis and follow-up studies for two and one-half years in case 1 and one year in case 2 continued to support the admitting diagnoses. Each patient developed focal sensorimotor phenomena relatively early in the course of the disease which interfered with rehabilitation. Effective treatment was obtained with administration of carbamazepine. Subsequently, both patients developed signs and symptoms of multiple sclerosis. The complication of spinal cord seizures may become a limiting factor in the rehabilitation of patients with idiopathic transverse myelopathy unless the disorder is recognized and appropriate anticonvulsant therapy initiated. It may also be the first indicator that multiple sclerosis rather than "idiopathic" transverse myelopathy is present.
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PMID:Spinal cord seizures in transverse myelopathy: report of two cases. 395 64

Drug therapy is now the preferred method of treatment for spasticity, and several effective agents have been developed. The safety and efficacy of these drugs has been established in short-term studies. Overall, due to its low incidence of sedation and serious side effects, baclofen appears to be the drug of choice in the treatment of spinal cord-related spasticity. It is, however, not without its side effects due to both its administration and abrupt withdrawal. This case illustrates some significant problems associated with the abrupt withdrawal of long-term baclofen therapy in a patient with multiple sclerosis.
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PMID:Adverse effects secondary to baclofen withdrawal. 400 20

Rehabilitation of the multiple sclerosis patient must be individualized because of the varied manifestations and fluctuating course of the disease. The activity schedule must be modified to compensate for muscle weakness and fatigability. Spasticity and the preventable complication of joint contractures may be treated with joint ranging, medications, motor-point blocks and surgical intervention. Mobility problems, such as foot drop, may be improved with an ankle-foot orthosis, but ultimately a patient may require a wheelchair. Measures to prevent pressure sores include position change, pressure release, incontinence management and special equipment.
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PMID:Multiple sclerosis: Part I. Common physical disabilities and rehabilitation. 405 Jun 40


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