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)

Propriospinal myoclonus is a rare and relatively little studied complication of spinal cord injury. We report two patients with an extension-producing myoclonus presenting with tetraplegia caused by cervical trauma. Rhythmic extension jerks of the trunk and lower limbs appeared several weeks after their injury in a context of severe spasticity. The characteristics of these jerks were determined by polymyography of 12 muscles. They lasted between 306 and 1127 ms with a frequency of 0.3 to 0.5 Hz. By comparing latencies their origin was found to be in the lumbar cord from which there was a slow (2 m s-1) upward and downward spread. Oral treatment with baclofen and sodium valproate was partially successful in one patient, but ineffective in the other. Intrathecal 75 or 100 micrograms baclofen produced a striking, complete disappearance of myoclonus prompting the implantation and successful use of a baclofen pump in one patient. These two new cases suggest the existence of a lumbar generator in which myoclonic extension jerks originate, and demonstrate a new therapeutic alternative in intrathecal baclofen for patients resistant to oral medication.
Paraplegia 1995 Nov
PMID:Propriospinal myoclonus in tetraplegic patients: clinical, electrophysiological and therapeutic aspects. 858 5

Sixty-seven patients were treated for Pott's paraplegia: 58 were adults and 9 were children. Sixty-four patients had active disease, and 3 had healed disease. All patients had triple chemotherapy with or without decompression surgery. Thirteen patients, including 9 children, were treated conservatively, whereas 54 patients who met the selection criteria for surgery were treated surgically. Fifty-two patients had anterior radical decompression surgery, and for 14 of them, anterior surgery was preceded by posterior instrumental stabilization surgery. Two patients with healed disease had posterior decompressive corpectomy. There was functional recovery in 60 (89.6%) patients, including 13 who had active disease that was treated conservatively. In 47 of the 54 surgically treated patients there was neurologic recovery, and 2 of these recovered incompletely with some residual spasticity. In the remaining 7 patients, there was no recovery. It took 2 to 6 months for recovery for the patients with conservative treatment, whereas it took <2 months for the patients with anterior decompression. The patients who had the combined 2-stage procedure could be mobilized earlier after neurologic recovery than could the patients having the anterior radical surgery and the conservatively treated patients. It was proven that paraplegia of active disease can be treated successfully by conservative or surgical means and that paraplegia caused by healing of fibrosis in the severely deformed spine was difficult to treat successfully, even with radical surgery.
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PMID:Pott's Paraplegia--67 cases. 862 69

A retrospective review was carried out of 34 consecutive traumatic spinal cord damaged patients who have had the Medtronics Programmable, Cordis Secor or Constant Infusion Infusaid intrathecal baclofen drug delivery systems inserted between July 1987 and 1992. The results indicate that whilst this treatment has many benefits there is a significant risk of complications, some potentially fatal. It should only be provided by a skilled and experienced team. The Medtronics Programmable pump is an excellent pump. It is of particular benefit where the therapeutic window is small or fine-tuning required. The Constant Infusion Infusaid is adequate if less precise control and continuous infusion is sufficient. It is of particular benefit in financially disadvantaged countries. The Cordis Secor device is helpful when unpredictable intermittent relief of spasticity is required but is otherwise limited by its complication rate.
Paraplegia 1995 Oct
PMID:Intrathecal baclofen--a multicentre clinical comparison of the Medtronics Programmable, Cordis Secor and Constant Infusion Infusaid drug delivery systems. 884 7

The Stockholm Spinal Cord Injury Study (SSCIS) is an extensive evaluation of a sample of 353 subjects with traumatic SCI, constituting 93% of the known regional prevalence population with this diagnosis. In a previous analysis of this group, symptoms such as pain, incontinence, sexual dysfunction and neurological deterioration, as well as secondary complications, such as decubitus ulcers, urinary tract infections, spinal deformity and fractures, were found to be common. In the present report, we investigate associations between a few commonly used patient characteristics, ie gender, age at injury, duration of injury and extent of neurological compromise, and the occurrence of such problems, to assess differences in vulnerability in SCI subgroups. Results generally indicate an increased vulnerability in subjects with extensive neurological deficits, as well as a cumulation of complications with the increasing duration of injury. However, some exceptions are found, possibly indicating differences in temporal patterns of the occurrence of various complications, as well as certain gender-, age-, and lesion-associated variations in vulnerability. Symptoms directly related to the spinal cord lesion, eg neurogenic pain and neurological deterioration, seem to present rather soon post-injury. Males are more prone to experience excessive spasticity and sexual problems. Females experience more fractures and spinal deformity. Younger age at injury is associated with more spinal deformity but less severe pain problems. Higher age at injury is not found to be associated with more medical problems, with the exception of neurogenic pain, among post-acute, post-discharge survivors. The latter finding does not, however, preclude more such problems in the acute stage, since the present study neither addresses the pre-discharge period, nor includes information about mortality. Finally, the ASIA/IMSOP Impairment Scale Grade E-rated subjects were found to report problems to an extent that underlines the restricted sensorimotor sense in which this rating reflects recovery.
Paraplegia 1995 Oct
PMID:The Stockholm Spinal Cord Injury Study: 2. Associations between clinical patient characteristics and post-acute medical problems. 884 13

The torque generated during a passive movement of the knee joint was used to quantify muscle tone in normal able-bodied subjects and spastic and flaccid spinal cord injury (SCI) subjects using a computerized isokinetic dynamometer. Maximum peak (Tmax) and the sum of four consecutive peaks (Tsum) were calculated for each velocity (30, 60, 120 degrees/s) and for each phase (flexing or extending) separately and compared statistically using a one-way ANOVA. Statistical significance between groups was found in Tmax FLEXION (FLX) at 60 and 120 degrees/s. Scheffe's tests revealed that the spastic group was significantly less than both the flaccid and normal groups, although the flaccid and normal groups were not significantly different from each other. The slopes of the linear regression curve of the torque-velocity data were found and compared statistically using a t-test for parallelism. In all parameters, the data increased in a linear fashion with increasing velocity of knee motion. The slope of the regression curve for the spastic group was significantly lower than that of the normal group for Tmax and was significantly lower than that of the flaccid group for Tsum while the slopes for the flaccid and normal groups were not significantly different. The ability of the entire set of variables to classify subjects into three groups (normal, spastic, and flaccid) was tested using discriminant analysis. By taking into account 7 of the 12 original variables, this multivariate technique correctly classified 100% of the spastic, 90% of the normal, but only 67% of the flaccid subjects. Separation of observations was between spastic and normal subjects was good, except for only one case. This feature could be useful when dealing with assessment of individual responses to therapeutic interventions aimed at modification of spasticity.
Paraplegia 1996 Jan
PMID:Quantifying muscle tone in spinal cord injury patients using isokinetic dynamometric techniques. 884 23

A review of 1300 patients with spinal cord injury (SCI), over a period of 14 years, revealed 12 patients with an 'acute abdomen'. Seven events occurred during the initial admission, ranging from 10 days to 9 months from injury, and five during readmission of 'chronic' SCI patients. Four were in the acute stage 10-30 days from injury, all with peptic ulcer perforations. The remainder had either an intestinal obstruction, appendicitis or peritonitis. All of the neurological levels were above T6 except for one patient who had a low level paraplegia. The classical signs of an 'acute abdomen' may be missing in such patients thus delaying diagnosis by 1-4 days. The most important signs were autonomic dysreflexia, referred shoulder tip pain, abdominal pain, abdominal distension, increased spasticity and abdominal pain with nausea and vomiting. Less importance was given to the classical signs of abdominal tenderness, abdominal muscle rigidity, rebound, fever and of leukocytosis. Prompt diagnosis and treatment will minimise morbidity and mortality.
Paraplegia 1995 Dec
PMID:The acute abdomen in spinal cord injury individuals. 892 9

The results of omental transposition in chronic spinal cord injury have been reported in 160 patients operated upon in the United States, Great Britain, China, Japan, India and Mexico, with detailed outcomes reported in few studies. Recovery of function to a greater degree than expected by natural history has been reported. In this series, 15 patients with chronic traumatic spinal cord injury (> 1.5 years from injury) underwent transposition of pedicled omentum to the area of the spinal cord injury. Of the first series of four patients who were operated upon in 1988, one died, one was lost to follow-up and two were followed with sequential neurological examinations and Magnetic Resonance Imaging (MRI) scans preoperatively, at 1 year post injury and 4 1/2 years post injury. Another 11 patients were operated in 1992 and underwent detailed neurological and neurophysiological examinations and had MRI scans preoperatively and every 4 months for at least 1 year after surgery. All patients completed a detailed self-report form. Of the total of 13 operated patients in both series followed for 1-4 1/2 years, six reported some enhanced function at 1 year and five of these felt the changes justified surgery primarily because of improved truncal control and decreased spasticity. MRI scans showed enlargement of the spinal cord as compared to preoperative scans in seven patients. Increased T2 signal intensity of the spinal cord was found by 1 year after surgery in eight of 13 operated patients. Neurophysiological examinations of 11 patients in the second series agreed with self-reports of increases or decreases in spasticity (r = 0.65, P < 0.03). Somatosensory evoked potentials and motor evoked potentials at 4 month intervals up to 1 year in these patients showed no change after surgery. Neurological testing, using the American Spinal Injury Association (ASIA) and International Medical Society of Paraplegia (IMSOP) international scoring standards, failed to show any significant changes when the 1-year post operative examination was compared to the first preoperative examination except for decreased sensory function after surgery which approached statistical significance. When the 11 patients in the second series were compared to eight non-operated matched patients, followed for a similar length of time, no significant differences were found. Complications encountered in the operated patients from both series included one postoperative death from a pulmonary embolus, one postoperative pneumonia, three chronic subcutaneous cerebrospinal fluid (CSF) fistulae requiring wound revision, and one patient who developed biceps and wrist extensor weakness bilaterally requiring graft removal. We conclude that the omental graft remains viable over time and this operation can induce anatomical changes in the spinal cord as judged by MRI. Some patients reported subjective improvement but this was not supported by objective testing. We, therefore, find no justification for further clinical trials of this procedure in patients who have complete or sensory incomplete lesions. Further testing in motor incomplete patients would seem appropriate only with compelling supportive data.
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PMID:Omental transposition in chronic spinal cord injury. 907 74

Suppression of increased muscle tone by epidural spinal cord stimulation, an invasive method for treating spasticity, increases segmental concentrations of inhibitory amino acid neurotransmitters, particularly glycine. The role of glycine in spasticity and spinal shock was explored further in rabbits with ischemic spinal cord injuries that produced spastic paraparesis or flaccid paraplegia. H-reflexes were monitored following posterior tibial nerve stimulation and plantar surface recording. Spasticity was quantified by using H/M ratios. Spastic animals were intrathecally infused with 100 mmol/l solutions of glycine and related compounds. Glycine agonists suppressed tone whereas glycine antagonists increased tone. In addition, microdialysis sampling from the cord was done in injured, non-infused animals and aspartate, GABA, glutamate, glycine and taurine were measured. Flaccid animals had glycine levels two-three times higher than spastic or control animals. High concentrations of glycine within spinal cord segments is associated with spinal shock. Glycine and related compounds may be useful as treatment for excessive tone.
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PMID:The role of glycine in spinal shock. 923 88

The purpose of this study was to compare the bone mineral density in children with spinal cord injury (SCI) with age- and sex-matched controls in three anatomic areas of the proximal hip. In addition, post hoc analysis looked for differences in bone density between sub-groups considering several factors associated with spinal cord injury: the presence or absence of spasticity, the level of injury and the presence or absence of pathologic fractures. Fifty-one pediatric patients with spinal cord injury between the ages of 3 and 20 underwent bone density measurements using dual photon absorptiometry. Before pooling the data across age groups, all measurements were normalized to age- and sex-matched controls because of increasing bone density with growth and higher bone density in males. The results revealed lower bone densities in subjects with SCI as compared with their non-disabled peers, ranging from 56 percent to 65 percent of normal across the three anatomic regions. On the average, subjects who had a previous history of fractures had significantly lower bone density measurements than those without fractures. At the intertrochanteric region, a 10.6 percent difference was noted between subjects with tetraplegia versus those with paraplegia. At the femoral neck and Ward's Triangle, an 8.5 percent difference was noted between subjects with and without spasticity. No conclusions could be drawn from the analyses at the other sites. Together these results begin to characterize bone density levels of the pediatric SCI population.
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PMID:Characterization of the bone mineral density of children with spinal cord injury. 923 92

Direct intrathecal administration of baclofen in the treatment of severe spasticity was proposed in 1984 by Richard Penn with the objective to carry out a selective spinal distribution of the active principle thus avoiding supraspinal side effects. We presented our first results at the French Language Association of Neurosurgery in 1985 within the framework of a report on "Functional neurosurgery of cerebral palsy" (Neurochirurgie, 1985, 31 (suppl 1): 1-118). This study aims to specify the selection criteria and current indications of this method for the treatment of severe chronic diffused spasticity of spinal and cerebral origin in adults and in children. This report relates to our experience concerning 60 patients (10 children) that benefit from the use of a totally implantable system for chronic administration. The total follow-up of all patients was 48 months (from 3 to 140 months). The initial effective daily amount of baclofen was 156 micrograms/24 hours and progressed in time to reach in the long run 280 micrograms/24 hours, with a very broad interindividual variability from 36 to 1050 micrograms/24 hours. All the patients benefited from a reduction in muscular hypertonicity as well as painful muscular spasms. On the other hand, the functional improvement was very variable from one patient to another and depended primarily on the initial clinical state and the etiology of the spasticity. The results observed were more significant in post-traumatic paraplegia than those secondary to demyelination disease even if they were stabilized with regard to spasticity of spinal origin. This mode of administration currently plays a significant role in the treatment of spasticity of cerebral origin, in particular in children presenting a motor disorder of cerebral origin with spastic prevalence. The current limitations of this type of treatment are technical because of the frequent catheter malfunctions, but are due essentially to the importance and constraint of the multi-disciplinary organization needed for the out-patient follow-up.
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PMID:[Treatment of spasticity with the intrathecal administration of baclofen]. 982 37


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