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

Fourteen patients with spinal cord damage were treated with Ba-34647 (Lioresal, Ciba-Geigy), a new antispasticity drug. The treatment was initiated for excessive skeletal muscle spasticity and voiding difficulty. Seven of the patients had been wearing indwelling catheters and seven were catheter-free. The former were given trials at voiding after removal of catheters; the usual assistive methods common to most bladder training regimens were administered. Despite this, the trials were unsuccessful in reducing residual urine to acceptable levels. With addition of therapeutic doses of the drug without the training regimen, voiding trials were also unsuccessful excepting the response of one patient. The drug plus the training regimen was effective in reducing residual urine to acceptable levels in all patients. On discontinuing or decreasing the dosages of the drug, there was gradual but rapid build-up of residual urine despite the active training regimen. Restoration of effective dosage again led to satisfactory voiding function in all patients. The catheter-free group suffered from frequency, nocturia, and bed-wetting owing to excessive residual urine despite the employment of active training regimens. With addition of optimal dosages of Ba-34647, these problems were markedly reduced. They increased with drug discontinuation or dosage decrease and again improved upon restoration of effective doses. Bladder training, including active assistance to the expulsion of urine, is essential to the evaluation of antispasticity drugs for their effect on voiding.
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PMID:Bladder training: its role in evaluating the effect of an antispasticity drug on voiding in patients with neurogenic bladder. 120 Aug 14

The authors report their experience using dorsal longitudinal myelotomy in treating spasticity in 20 patients with complete spinal cord injuries. These patients suffered from severe painful flexor/extensor spasms that prevented them from wheelchair ambulation and/or their decubitus ulcers healing. All were receiving large doses of various oral drugs, including baclofen, which had failed to control their spasticity, and all underwent a modification of a posterior T-myelotomy as first described by Bischof. All 20 patients enjoyed immediate complete relief of their painful spasms, although two (10%) eventually experienced return of their spasms and are thus classified as long-term failures. Seventeen patients succeeded in markedly reducing, or being completely weaned from, their antispasmodic medications. In 11 of 14 patients, nonhealing decubitus ulcers subsequently healed with treatment. Bladder function was unchanged from the preoperative status in all patients. Chronic intrathecal baclofen infusion has recently been reported as an effective treatment of the spasticity of paraplegia. The results of this study, along with previous reports advocating dorsal longitudinal myelotomy, suggest that this approach is an efficacious alternative to chronic baclofen infusion in reducing spasticity for complete paraplegics. Considering the cost of the infusion pump, along with the fact that chronic intrathecal baclofen therapy necessitates long-term medical supervision, it appears that myelotomy is superior for this select group of patients who have no hope of regaining voluntary motor function.
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PMID:Efficacy of dorsal longitudinal myelotomy in treating spinal spasticity: a review of 20 cases. 186 41

Forty-nine patients with complete and incomplete injuries of the spinal cord or cauda equina who had undergone anterior decompression at a minimum of 3 months after injury were examined. Follow-up was from 12 months to 19 years. Postoperative neurologic improvement occurred in 46.5% of patients with incomplete injuries. If the surgery was performed less than 2 years after injury, neurologic improvement occurred in 68% with an improvement in Frankel grade of 32%. Bladder function improved in 27% of patients and if operated on less than 2 years after injury improvement occurred in 43%. Conus medullaris decompression resulted in a 50% improvement. There was an 83% improvement in the pattern of pain after decompression. Of 23 patients with preoperative spasticity, 10 improved but 6 were worse after surgery.
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PMID:Delayed anterior decompression in patients with spinal cord and cauda equina injuries of the thoracolumbar spine. 225 87

Multiple sclerosis is a chronic, often progressive disease of the central nervous system which can produce visual, sensory, motor, and genitourinary dysfunction. Although there is no cure, many disabling symptoms can be ameliorated. Baclofen is the treatment of choice for spasticity and is usually given in doses of 30 to 80 mg/day, although higher doses may be used. Bladder symptoms in multiple sclerosis generally fall into the categories of failure to store, failure to empty, and mixed types. Most patients can be managed after obtaining a urine culture and sensitivity and post-voiding residual. A variety of anticholinergic agents plus intermittent self-catheterisation is usually the most effective treatment for bladder dysfunction. Prevention of infection is accomplished by urinary acidifiers or low-dose antibiotics. There is no evidence that long term use of corticosteroids has a beneficial effect on the outcome of multiple sclerosis, although they appear to be useful in hastening the recovery time from an acute exacerbation. There are a number of experimental therapeutic agents which are used to modulate the immune response, which may prove to be of use in slowing or arresting the progression of multiple sclerosis.
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PMID:Multiple sclerosis. Current concepts in management. 298 64

Fifty consecutive spinal injury patients who underwent simultaneous EMG of the peri-urethral and perianal striated muscles along with cystometrogram on a multiple channel recorder are analysed. Bladder filling, voiding and also influence of spasticity on the EMG activity of both perianal and periurethral striated muscles were compared. Periurethral striated EMG along with CMG has a better diagnostic value (95 per cent) as compared to perianal EMG-CMG which was diagnostic in 72 per cent patients.
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PMID:Urodynamic evaluation: periurethral striated EMG versus perianal striated EMG. 742 44

Out of a regional traumatic spinal cord injury population consisting of 379 individuals, 353 (93.1%) participated in the present study. Subjects were individually interviewed using semi-structured protocols. In addition, previous medical records were available for over 96% of subjects, and were used in all these cases to minimise recall bias. Cause of injury, prevalence of present medical symptoms and occurrence of medical complications in the post-acute, post-discharge phase were recorded. Neurological classification was verified by physical examination according to ASIA/IMSOP standards. Many subjects had experienced complications since discharge from initial hospitalisation, especially urinary tract infections, decubitus ulcers, urolithiasis, and neurological deterioration. Prevalence of medical symptoms was also high. More than 41% of subjects with spastic paralysis reported excessive spasticity to be associated with additional functional impairment and/or pain. Almost two-thirds of subjects reported significant pain, with a predominance of neurogenic-type pain. Bladder and bowel dysfunction were each rated by nearly 41% of subjects as a moderate to severe life problem. As expected, sexual dysfunction was also commonly reported. Prevalence of reported symptoms by general systems review was high, particularly fatigue, constipation, ankle oedema, joint and muscle problems, and disturbed sleep. However, lack of adequate normative data precludes comparison with the general population. The frequent occurrence of reported medical problems and complications support advocacy of comprehensive, life-long care for SCI patients. The commonly reported problems of neurogenic pain and neurological deterioration, in particular, require more attention, as these symptoms are not seldom ominous, either by virtue of their impact on quality of life, or because of underlying pathology.
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PMID:The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population. 764 55

Patients with spina bifida present with multifarious problems requiring multi-disciplinary approach for their rehabilitation. 172 patients of spina bifida attending the Department of Physical Medicine and Rehabilitation at A.I.I.M.S., New Delhi, were studied retrospectively to ascertain the problems posed by them while presenting for rehabilitation. Male:female ratio was 1.23:1. Lumbo-sacral lesion comprised 41.3% followed by lumbar (26.1%) and sacral (22.1%). Common spinal deformities observed were Kyphoscoliosis (62.2%) and increased lumbar lordosis (19.2%). Clinically, active signs and symptoms of hydrocephalus were found in 47.7% associated with mental subnormality in 22.1%. Varying degrees of weakness of the muscles of lower limbs were detected in 98.3% cases, spasticity was found in 10.5% and ataxia in 2.9%. Improvement of muscle power was noticed in 45.3% during first three years and deterioration in 10.5% due to various complications. Foot deformities were commonest amongst deformities. Mobility was affected in 55.8% while 62.2% could attain independence. Bladder symptoms were present in 75% cases and bowel symptoms in 26.7%. Anxiety and guilt amongst parents was high in the families. Main hindering factors in vocational rehabilitation were bladder control, ambulation and pressure sores.
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PMID:Rehabilitation of patients with spina bifida. 1112 85

A spinal cord lesion above the sacral micturition center results in a loss of voluntary control and development of bladder sphincter dysynergia with hyperreflexia of the detrusor and spasticity of the sphincter. Sacral rhizotomy and implantation of an anterior sacral root stimulator appears as an effective method for the treatment not only of voiding dysfunction but also of defecation and sexual disturbance. The surgical technique is described as are the clinical and electrophysiological controls. The results of our series of operated patients with intradural implantation and sacral deaffentation show a constant improvement. 90% have satisfactory continence and no longer require an incontinence appliance. Bladder capacity and compliance have increased to 120% and urethral closure pressure has decreased. 80% have complete voiding or a post-void residue of not more than 50 ml. So, urinary infection rate is dramatically decreased.
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PMID:Dorsal rhizotomy with anterior sacral root stimulation for neurogenic bladder. 1237 3

A spinal cord lesion (traumatic or not) above the sacral micturition center may induce hyperreflexia of the detrusor, spasticity of the sphincter and vesico-sphincter dyssynergia. Eventually, alterations in the upper urinary tract can be associated with increased mortality in this patient population. Sacral rhizotomies combined with implantation of an anterior sacral root stimulator appear to be an effective method not only for the treatment of voiding dysfunction but also for defecation and sexual disorders. The clinical and electrophysiological checks and the surgical technique are described. In most series, the results show a constant improvement in the patient's functional status. Ninety percent of patients gain satisfactory continence and no longer require an incontinence appliance. Bladder capacity and compliance increase dramatically. As a consequence, urinary infection rate decreases. The majority of patients remain dry, and more than 80% have a complete voiding or a post-void residue of less than 50ml and do not require any catheterization. Anterior sacral root stimulation combined with sacral posterior rhizotomy is a valuable method to restore bladder function in spinal cord-injured patients suffering from hyperactive bladder.
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PMID:Dorsal rhizotomy combined with anterior sacral root stimulation for neurogenic bladder. 1769 93

This is a prospective longitudinal descriptive study to prospectively evaluate quality of life (QoL) in the spinal cord injury (SCI) population in Northern India and identify any association between clinical variables and QoL; and, finally, to see the impact of remedial measures taken to improve QoL over time. Fifty persons with SCI were surveyed for medical problems, neurological status and social adjustments in Northern India. QoL was determined on the Global QoL scale (Visual Analogue Scale) and follow-up assessment was performed 6 months later to examine the impact of remedial measures over time. Thirty-six (72%) men and 14 (28%) women participated. Mean age and duration of injury were 37.7 and 3.7 years, respectively. Bladder problems (44%), bedsores (36%), gastrointestinal problems (56%), neuropathic pain (42%) and spasticity (60%) were the most common medical problems. Age, education, marital status and duration of injury were not associated with significant difference on QoL scores. Female sex, employment, mobility, autonomy, cordial partner relations and good social adjustment were associated with higher scores of QoL. Mean Global QoL scores were 54.3 and 63.7 at the initial survey and at the 6-month follow-up survey, respectively. In a community-based sample of SCI in Northern India, a good-to-fair QoL was found. It is reasonable to believe that understanding and taking appropriate remedial measures through more comprehensive rehabilitation programmes will play a vital role in enhancement of QoL in persons with SCI.
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PMID:Quality of life of people with spinal cord injury in Northern India. 1870 48


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