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

Ischemic spinal cord injury with resulting postoperative paraplegia is an inherent risk for operations on the thoracic aorta. The mechanism of injury is not clearly understood, and numerous adjuncts to avoid this complication have been suggested, with conflicting clinical results. A new technique of hypothermic regional perfusion of the spinal cord is described. Fifteen female pigs weighing 21 to 39 kg were used for the experiment. The control group consisted of 5 animals in which the thoracic aorta was clamped at the distal arch for 30 minutes. All of these animals sustained postoperative neurological damage. Eighty percent sustained postoperative paraplegia, and 20% had severe spasticity of the hind legs that precluded normal ambulation. The experimental group consisted of 10 animals in which hypothermic regional perfusion was performed for 30 minutes after cross-clamping of the distal arch. Perfusion cooling was followed by 30 minutes of ischemia in 5 animals and 45 minutes of ischemia in the remaining 5. All animals that underwent hypothermic regional perfusion were able to walk postoperatively, and no evidence of ischemic injury was found at postmortem examination of the spinal cords. This technique proved to be simple and effective in protecting the spinal cord for up to 45 minutes of ischemia in the experimental group. The clinical implications of this concept are promising for patients undergoing operations on the thoracic aorta.
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PMID:Hypothermic regional perfusion for protection of the spinal cord during periods of ischemia. 359 34

Obturator neurectomy was performed in 35 patients with severe spasticity of the lower limbs. Immediate release of excessive spasticity in the adductor group of muscles was observed and confirmed by E.M.G. In most cases, a beneficial reduction of spasticity in other groups of muscles in the lower limbs was also observed. As a result, rehabilitation of the patients was improved.
Paraplegia 1987 Oct
PMID:Clinical and electromyographic evaluation of obturator neurectomy in severe spasticity. 368 23

The centrally active, alpha-2 adrenergic receptor agonist clonidine was given to 12 spinal cord injury patients with problematic spasticity not adequately controlled by recognized spasmolytic drug therapy. Five patients had an excellent reduction and 2 patients had some reduction in clinical spasticity (average dose 0.39 mg daily). Four of the 7 responders discontinued clonidine because of adverse reactions after an average of ten weeks of therapy. Three responders have continued to tolerate the drug well with excellent control of spasticity for 18 to 34 months. Five patients had no change in clinical spasticity (average dose of 0.24 mg daily). Three of the non-responders discontinued clonidine because of adverse reactions after an average of three weeks of therapy. Significant associated adverse reactions included syncopal seizures (3), cerebrovascular accident (1), deep vein thrombosis (1), autonomic hyperreflexia (3), lethargy/drowsiness (3), and nausea/vomiting (1). Possible mechanisms of action for clonidine to affect spasticity and the unstable cardiovascular system of quadriplegics is discussed. While spinal cord injured patients with severe spasticity may benefit from clonidine, great caution is recommended during its use until further study establishes safe parameters of administration and efficacy is confirmed on controlled studies.
Paraplegia 1986 Jun
PMID:Early clinical experience with clonidine in spinal spasticity. 374 98

This review deals with the long-term results of selective peripheral neurotomy (SPN) of the tibial nerve and selective posterior rhizotomy (SPR) in 123 cases of severe spastic syndromes in the limbs. The microtechniques and preoperative electrostimulation for identification of the nervous structures responsible for the spastic components give to these methods an advantage of a substantial reduction of the harmful spasticity, without suppressing the useful muscle tone and impairing the residual motor and sensory functions. The results were effective, with a 1- to 13-year follow-up, in 89% of 47 SPN of the tibial nerve for spastic foot, in 92% of 53 SPR for paraplegia and in 87% of 23 SPR for hemiplegia.
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PMID:Microsurgical selective procedures in peripheral nerves and the posterior root-spinal cord junction for spasticity. 383 53

Intraspinal rhizotomy alone or in combination with excision of the scarred conus medullaris distal to the level of the cord anomaly was used in thirteen patients with myelomeningocele at the thoracolumbar level whose care was complicated by recurrent deformity of the lower extremities that was caused by persistent spasticity. When examined at an average follow-up of 5.3 years, all patients were free of spasticity, had manageable lower extremities, and were able to sit in a wheelchair with ease. Twelve patients had no change in the status of the urinary tract, but one patient noted an adverse change in urinary status with increased wetness between intermittent catheterizations. Intraspinal rhizotomy alone or in combination with distal cordectomy should be used only in patients with congenital paraplegia in whom reflex motor activity has caused recurrent deformity of the lower extremities that cannot be controlled by the use of braces or operations on the lower extremities, or both.
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PMID:Intraspinal rhizotomy and distal cordectomy in patients with myelomeningocele. 394 Nov 23

Intractable lower extremity spasms after spinal cord injury is a significant source of morbidity. A case of refractory spasticity in paraplegia was successfully converted to flaccid paraplegia by intrathecal injection of phenol and glycerin in metrizamide. This chemical rhizolysis is simple and effective, and the presence of metrizamide allows both fluoroscopic guidance for accurate intrathecal phenol placement and good miscibility with cerebrospinal fluid. A brief comparative review of alternative therapeutic modalities is presented.
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PMID:Intrathecal phenol and glycerin in metrizamide for treatment of intractable spasms in paraplegia. Case report. 400 62

The authors report five patients with detrusor inactivity in suprasacral spinal cord lesions with perineal spasticity. In all of these cases with cervical or high thoracic lesions treatment with an alpha-blocking drug (Phenoxybenzamine) allowed bladder activity to return. These results suggest that the sacral parasympathetic centre is under the inhibitory influence of the sympathetic nervous system.
Paraplegia 1985 Aug
PMID:Detrusor inhibition in suprasacral spinal cord injuries: is it due to sympathetic overactivity? 404 10

The Moto-Stand is a motorised vehicle to propel paraplegics in the upright position. It safely allows handicapped persons a wide range of working capabilities and extends mobility far beyond the limits of a wheelchair. Twenty adults with spinal lesions were evaluated for using the Moto-Stand. The levels of lesion ranged from C6 to L1. The tetraplegics studied had incomplete lesions and they could get on the Moto-Stand but needed some assistance. All the paraplegics studied were able to use the Moto-Stand independently. The Moto-Stand was found to be superior for kitchen activities, especially when handling hot objects and reaching objects at different levels. As it turns in its own space it offers superior maneuverability in the limited space of a kitchen, workshop or even a trailer home. Subjects with moderate to severe spasticity appear to have difficulty in using the Moto-Stand, It was found to be safe and comfortable by the majority of subjects studied.
Paraplegia 1985 Aug
PMID:Evaluation of Moto-Stand a new vehicle for upright ambulation in paraplegics. 404 14

The efficacy of alpha-adrenolytic treatment with oral phenoxybenzamine chloride (40 mg per day during three to four months) has been assessed both clinically and urodynamically among 249 patients with neurogenic bladder function. The results were significantly better in patients with autonomous (n = 95) than in the ones with automatic (n = 154) bladders (urethral sphincter spasticity and detrusor sphincter dyssynergia dominating the clinical picture in the latter event). A further striking difference was noticed when the data were analysed with regard to the patient's age, a far better therpeutic response being regularly recorded in subjects below age 35, while minimal and inconsistent improvements were observed in the older age group. No major side effects were encountered. Caution is however required in tetraplegics where phenoxybenzamine may aggravate orthostatic hypotension. On the other side the drug proves highly beneficial in these same patients in that it markedly lowers the incidence of dysreflexic states.
Paraplegia 1980 Aug
PMID:Clinical and urodynamic assessment of alpha-adrenolytic therapy in patients with neurogenic bladder function. 610 20

Nashold et al. (1972) have developed a surgically implantable system for activating the micturition reflex in the paraplegic by electrical stimulation of the spinal cord at the conus level. This communication describes the long-term course in a paraplegic patient who has used conus stimulation to achieve bladder emptying for 7 years. A 42-year-old man sustained a complete transverse lesion at the C6 level. Ten months after the accident he developed some spasticity in his legs but his urinary bladder remained completely flaccid. A device for electrical stimulation of the conus was implanted. This enabled the patient to empty his bladder without significant residual urine. His bladder remained flaccid. Seven years after the implant he developed reflex micturition and he is no longer dependent upon electrical stimulation.
Paraplegia 1984 Apr
PMID:Electrical stimulation of the conus medullaris for bladder emptying in a paraplegic. 661 32


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