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

A male patient developed leg numbness and weakness, and bowel, bladder, and erectile dysfunction. Examination revealed an isolated thoracic myelopathy, with lower-extremity spasticity, decreased vibration and position sense, hyperreflexia, and Babinski's signs. Serum and CSF showed antibody reactivity to human T-cell lymphotropic virus type I or II (HTLV-I/II), suggesting HTLV-I-associated myelopathy. Antibody reactivity to a unique HTLV-I recombinant protein provided definitive diagnosis of HTLV-I infection.
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PMID:HTLV-I-associated myelopathy in a Californian: diagnosis by reactivity to a viral recombinant antigen. 170 92

A questionnaire study on sexual problems occurring with multiple sclerosis (MS) was carried out with 217 patients who had previously participated in the University of Washington Multiple Sclerosis Project. More than one-half of the participating subjects were ambulatory without aids and nearly 75% did not use a wheelchair. Sexual dysfunction was reported by 56% of the women and 75% of the men. Among the women, the most commonly occurring sexual symptoms (in decreasing order of frequency) were fatigue, decreased sensation, decreased libido, decreased frequency or loss of orgasm and difficulty with arousal. Men reported the most common problem was erectile dysfunction, followed by decreased sensation, fatigue, decreased libido, and orgasmic dysfunction. Although loss of mobility, weakness and depression are not significantly associated with sexual dysfunction, spasticity and bladder dysfunction appear to be associated. However, even where these symptoms were absent, sexual dysfunction was perceived in at least 50% of the cases. The data indicate that sexual dysfunction can be anticipated in at least 50% of the women and about 75% of the men affected by MS, regardless of mobility level. It is most likely to occur in patients with spasticity and bladder dysfunction.
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PMID:Sexual dysfunction in multiple sclerosis. 670 86

We began this study to determine the efficacy and safety of intrathecal baclofen (ITB) delivered by a programmable pump for the treatment of severe spasticity of spinal cord origin. One hundred fifty two patients with severe spasticity of spinal origin, refractory to oral baclofen, or who experienced intolerable side-effects were given a test dose of ITB. Only those who had a satisfactory response were considered to be appropriate for pump implantation. All but one of the 152 patients had a satisfactory response, and the pump was implanted in 131 patients. Pre- and postoperative spasticity scores were compared and analyzed. The mean Ashworth score for rigidity decreased from 4.2 preoperatively to 1.3 (p < 0.0005) on ITB. The spasm score decreased from a mean of 3.4 to 0.6 (p < 0.0005). Reduction of spasticity resulted in improved levels of physical activity, decreased pain, and augmentation of sleep. Drug-related complications included constipation, muscular hypotonia, urinary retention, erectile dysfunction, nausea, dizziness, drowsiness, hypotension and bradycardia as well as tolerance to baclofen. Some patients experienced post-spinal puncture headaches. Catheter-related problems included occlusions, breaks, punctures, and dislodgments. Superficial pump pocket infection, pocket erosion, cerebrospinal fluid (CSF) leak, post-spinal puncture headache, and meningitis were some of the procedure-related complications. Two pumps flipped and another pump valve was stuck. We conclude that long-term intrathecal baclofen by an implanted programmable pump is a safe and effective method of treating severe intractable spinal spasticity.
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PMID:Continuous intrathecal baclofen infusion by a programmable pump in 131 consecutive patients with severe spasticity of spinal origin. 2215 77

Sexual dysfunction (SD) is a common feature of men with multiple sclerosis. SD is often unrecognized as patients and physicians are reluctant to discuss these problems. Rates of symptoms range from 50% to 90% and include erectile dysfunction, ejaculatory dysfunction, orgasmic dysfunction and reduced libido. SD can arise at any stage of the disease, even without severe disability. While erectile dysfunction is thought to be related to impairment of the pathways in the spinal cord, fatigue, spasticity, bladder and bowel dysfunction, and pain, contribute to SD. Psychosocial and cultural issues also need evaluating, and include depression, performance anxiety, lowered self-esteem. A comprehensive assessment of all theses aspects must be taken into account. Erectile dysfunction can be treated with phosphodiesterase inhibitors and intracavernous injections, with good efficacy. Ejaculatory dysfunction is managed through penile vibratory stimulation and midodrine. Concerning fertility issues, the effects of or immunomodulating drugs on semen quality are largely unknown, whereas many immunosuppressive therapies have a negative effect on semen quality that may be definitive. Advanced methods of assisted reproduction may sometimes be the only option for conception. Physicians' awareness of this problem may help to bring about appropriate treatments, and improve the quality of life for these patients.
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PMID:Sexual disorders in men with multiple sclerosis: evaluation and management. 2495 43

Multiple sclerosis (MS) can affect patients' sexuality and sexual relationships in many ways. Sexual dysfunctions (SDs) are highly prevalent in MS patients and include diminished desire, arousal/erectile dysfunction, and orgasmic/ejaculatory dysfunction. SDs can be caused by damage to the brain, to the spinal cord areas, and to the peripheral neurons engaged in sexual response; by specific MS symptoms (e.g., spasticity, fatigue, incontinence) that interfere with sexual functioning, and finally by the psychosocial impact of the chronic illness (especially mood disorders, cognitive impairment, and couple issues). SDs are highly underdiagnosed in MS patients and have a negative influence on their quality of life. Talking with patients about their sexual issues may bring considerable benefits and reinforce the therapeutic alliance. Many interventions such as education and some coping strategies can be implemented by all healthcare providers. Whenever possible, patients should be referred to a specialist for more specific treatments or counseling. Other important interventions include diagnosing and treating mood disorders, as well as tailoring other MS treatments so that they interfere as little as possible with sexual functioning.
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PMID:Sexual dysfunction in patients with multiple sclerosis. 2600 54

Erectile dysfunction (ED) is a frequent and disabling condition in patients with spinal cord injury (SCI). Spasticity can negatively affect sexual intercourse, as it may interfere with positioning, mobility, and muscle activation and strength, leading to ED. The aim of our study was to evaluate the feasibility and efficacy of muscle vibration (MV) applied to the pelvic muscles in improving ED in men with SCI. Ten adult men with traumatic SCI were submitted to 15 sessions of MV, applied on the perineum and the suprapubic and sacrococcygeal areas, using a pneumatic vibrator. MV was performed three times a week for five consecutive weeks, each session lasting 30 min. Muscle tone and sexual function were assessed before and after MV using the Modified Ashworth Scale (MAS) and International Index of Erectile Function (IIEF). We assessed the cremasteric and bulbocavernosus reflexes, as well as the electrophysiological bulbocavernosus reflex (eBCR) and pudendal nerve somatosensory-evoked potential (PSEP). MV was safe and well tolerated. All the patients reported an improvement in MAS and IIEF, with better reflexive responses, and a significant increase in eBCR and PSEP amplitude. In conclusion, MV of the pelvic floor is a promising method to reduce segmental spasticity and improve ED in men with incomplete SCI. However, our findings require confirmation through a randomized clinical trial with a larger sample size and longer trial period to examine long-term after effects.
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PMID:Improving Sexual Function by Using Focal Vibrations in Men with Spinal Cord Injury: Encouraging Findings from a Feasibility Study. 3108 43

Multiple sclerosis (MS) pathology progressively affects multiple central nervous system (CNS) areas. Due to this fact, MS produces a wide array of symptoms. Symptomatic therapy of one MS symptom can cause or worsen other unwanted symptoms (anticholinergics used for bladder dysfunction produce impairment of cognition, many MS drugs produce erectile dysfunction, etc.). Appropriate symptomatic therapy is an unmet need. Several important functions/symptoms (muscle tone, sleep, bladder, pain) are mediated, in great part, in the brainstem. Cannabinoid receptors are distributed throughout the CNS irregularly: There is an accumulation of CB1 and CB2 receptors in the brainstem. Nabiximols (a combination of THC and CBD oromucosal spray) interact with both CB1 and CB2 receptors. In several clinical trials with Nabiximols for MS spasticity, the investigators report improvement not only in spasticity itself, but also in several functions/symptoms mentioned before (spasms, cramps, pain, gait, sleep, bladder function, fatigue, and possibly tremor). We can conceptualize and, therefore, hypothesize, through this indirect information, that it could be considered the existence of a broad "Spasticity-Plus Syndrome" that involves, a cluster of symptoms apart from spasticity itself, the rest of the mentioned functions/symptoms, probably because they are interlinked after the increase of muscle tone and mediated, at least in part, in the same or close areas of the brainstem. If this holds true, there exists the possibility to treat several spasticity-related symptoms induced by MS pathology with a single therapy, which would permit to avoid the unnecessary adverse effects produced by polytherapy. This would result in an important advance in the symptomatic management of MS.
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PMID:The Broad Concept of "Spasticity-Plus Syndrome" in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms. 3225 40