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

Tropical spastic paraparesis (TSP) is a chronic neurological syndrome of gradual onset involving the pyramidal tracts and upper motor neurons, resulting in weakness and stiffness of the lower extremities, hyperactive tendon reflexes, spasticity, low back pain, and urinary disturbances. Clusters of endemic TSP have been noted in Africa, the Seychelles Islands, Colombia, and the Caribbean. Recently, studies have linked human T-lymphotrophic virus type-I (HTLV-I) with the endemic form of the disease. In Japan a very similar clinical syndrome has been identified as HTLV-I-associated myelopathy and may be a non-tropical version of the same disease. The purpose of the present review is to examine the role HTLV-I may play in the pathogenesis of these myelopathies from a neuroepidemiological point of view.
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PMID:Neuroepidemiology of human T-lymphotrophic virus type-I-associated tropical spastic paraparesis. 278 58

A Case of ossified yellow ligaments in thoraco-lumbar region is reported. A 47-year-old-male complained low back pain with suddenness in August, 1984. One month later, he noticed dyesthesia on his right lower extremity and gait disturbance. These symptoms progressed slowly. In June, 1985, he admitted to The Jikei University Hospital. On neurological examinations, he was noticed an intermittent claudication, spastic paraparesis and stocking type sensory loss in his lower extremities. Plain lumbar X-ray films showed ossified yellow ligaments (OYL) in the posterior half of the spinal canal from the level of 10th thoracic to second lumbar vertebrae. Magnetic resonance imaging disclosed marked indentations of the spinal cord at the same level. The wide laminectomy was carried out and OYL were removed totally in gentle manner. Postoperative course was uneventful. His sensory disorders improved remarkably and he gained good muscle strength in his lower extremities, but a considerable spasticity remained still. OYL is closely related to the developmental canal stenosis, the spondylosis and the other degenerative disorders such as ossification of posterior longitudinal ligaments. This allows more complicated neurological signs and symptoms in the case of OYL. When OYL is suggested, it is recommended to performed whole spinal radiological survey. The surgical consideration should be done. From this point of view, MRI would be a most useful weapon.
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PMID:[A case of ossified yellow ligaments (ossified ligamenta flava) of the thoraco-lumbar region and magnetic resonance imaging]. 309 73

The clinical presentation of tethered spinal cord and the results of tethered cord release were examined in a group of 30 low motor level (L3 and below) children with a history of myelomeningocele without concomitant CNS complications. Changes in orthopedic and/or neurologic status formed the basis of consideration for tethered cord release. Clinically, these patients presented with a new onset or recently progressing scoliosis, spasticity with or without contractures, decrease in motor function and low back pain at the site of closure. One or more of these findings was present in all cases and led to the suspicion of tethered spinal cord. The diagnosis of tethered cord was confirmed in all cases by MRI or CT myeolography. In order to isolate tethering as the etiology for the patients' clinical deterioration, patients with concomitant CNS complications, e.g. shunt dysfunction or hydromyelia were excluded from the study. Twenty-nine such patients, of an initial 59, who would have otherwise been considered, were excluded on the basis of this criteria of concomitant CNS complications. The results of release 1 year after the procedure were as follows: regarding scoliosis, in 75% of cases the curve either remained stable or decreased by more than 10 degrees, with 25% experiencing curve progression of > 10 degrees. The most recent follow-up in this group revealed that 11.8% experienced a decrease in curvature of >10 degrees; 47.1% remained stable, and 41.2% ultimately progressed 10 degrees. In the group with spasticity, 43.8% improved; 56.3% remained stable, and none worsened. Most (78.6%) of the children who had experienced a decline in motor function improved postoperatively, and all those with back pain experienced complete resolution. In conclusion, tethered cord release in symptomatic low lumbar and sacral level children with myelomeningocele appears to be of benefit, especially with respect to stabilization of scoliosis in selected patients, back pain at the site of closure, and prior decline in motor function. Results in the cases with spasticity were more equivocal.
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PMID:Tethered cord syndrome in low motor level children with myelomeningocele. 934 49

X-linked adrenoleukodystrophy (X-ALD) is a sex-linked, inherited, metabolic disorder affecting the nervous system and endocrine organs. At least 20 to 50% of female carriers develop neurological deficits. Identification of female carriers is important, among other reasons because unnecessary new cases of this disorder, which is frequently lethal in boys, can be prevented by prenatal diagnosis. Furthermore, affected male offspring can be screened for adrenocortical insufficiency, which is treatable, or for early signs of cerebral involvement in which case bone marrow transplantation may be considered. Whether or not someone is a carrier can be investigated by determining the concentrations of saturated very-long-chain fatty acids in the plasma or cultured skin fibroblasts, by looking for the presence of X-ALD protein in cultured fibroblasts and by carrying out mutation analysis. Spasticity, painful muscular cramps, lumbago and arthralgias can be treated symptomatically with the same agents used for other aetiologies. A clinical geneticist can provide advice on heredity and the possibilities of prenatal diagnosis and pre-implantation techniques.
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PMID:[Carrier state of x-linked adrenoleukodystrophy]. 1100 48

We report a case of a 23-year-old male with thoracic spondylosis at the T2/3 level. He complained of lumbago and gait disturbance (spastic paraparesis and sensory disturbance below the T4 level). Preoperative CT myelography showed a posterolateral spur at the left paramedian site which was compressing the spinal cord. We performed drilling of the spur using the posterolateral approach, and decompressed the spinal cord. After surgery, the motor weakness and sensory disturbance gradually improved and spasticity was reduced. Postoperative CT showed complete decompression of the spinal cord and no spur. In cases of upper thoracic lesions, there are various kinds of posterolateral approaches for decompression of the ventral side of the spinal cord. We adopted transverso-arthropediculectomy for this case, because this approach is minimally invasive of the costotransverse joint and the spinal cord. We discuss the other posterolateral approaches, in terms of merits and demerits for the vertebra and spinal cord.
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PMID:[A case report of transverso-arthropediculectomy for thoracic spondylosis]. 1185 43

The impressive pain relief experienced by sufferers of dystonia and spasticity from intramuscular injections of botulinum toxin suggested that patients with other chronic, musculoskeletal pain conditions also may benefit. However, there have been relatively few placebo-controlled studies of botulinum toxin in such non-neurologic conditions as myofascial pain syndrome, chronic neck and low back pain, and fibromyalgia; the results of these studies have not been impressive. One explanation for the lack of positive findings may be the lack of clinically evident muscle spasms (overactivity), despite the presence of muscle tenderness, tightness, or trigger points. Clinical observations of pain relief from injections of botulinum toxin for dystonia and spasticity and its apparent efficacy in treating migraine suggest an anti-nociceptive action independent of its neuromuscular junction-blocking action. Evidence from animal experiments supports this notion, and other data provide plausible physiologic mechanisms in the periphery and central nervous systems. These involve modulation of the activity of the neurotransmitters glutamate, substance P, calcitonin gene-related peptide, enkephalins, and others. However, even if botulinum toxin is firmly established as an analgesic, there is insufficient clinical evidence of its efficacy in treating non-neurologic, chronic, musculoskeletal pain conditions.
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PMID:Botulinum toxin for the treatment of musculoskeletal pain and spasm. 1241 5

The paper is a review of current experience with use of gabapentin--a new antiepileptic drug--in neurologic conditions others than epilepsy. Mechanism of action of the drug is not fully elucidated yet. However it proved to be effective in therapy of chronic pain, especially in neuropathic pain, neuralgia, low back pain, reflex sympathetic dystrophy and erythromelalgia. Gabapentin is also effective in pain and spasticity in multiple sclerosis. Clinical studies of gabapentin in movement disorders, such as Parkinson disease, essential tremor and atrophic lateral sclerosis are discussed in the paper. It can be summarized that gabapentin is a valuable medication and the use thereof in neurology is not limited to epilepsy.
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PMID:[GABApentin--new therapeutic possibilities]. 1252 21

Chronic low back pain is the second most common illness reported by patients in the United States and accounts for substantial morbidity and health-care resource utilization. Many back and spine stressors can contribute to tissue injury, resulting in acute or chronic pain. In response to injury, biochemical processes that cause inflammation and nerve sensitization increase pain levels and contribute to a cycle of reactivity that further heightens patients' sensitivity to pain stimuli. Treatment of back pain depends on its severity, duration, and underlying cause. Traditional therapeutic options include exercise, oral anti-inflammatory or analgesic medication, antidepressants, physical therapy and, in severe cases, surgery. Unfortunately, dissatisfaction with treatment of back pain is common. Oral medications may not completely alleviate symptoms, and opioid analgesics must be used with caution because of their addictive properties. Surgery does not always produce relief and, in some cases, may even exacerbate the problem. Botulinum toxin, which has already been shown to alleviate pain associated with cervical dystonia and other conditions characterized by muscle spasticity, is now being studied for the treatment of back pain. Preliminary evaluations have shown that this treatment is safe and has the advantage of providing local relief directly to the site of injury or pain, without causing systemic side effects. Initial data from small trials also suggest that botulinum toxin is effective, alleviating back pain in selected patients. On the basis of these promising results, additional study in larger trials is warranted.
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PMID:A focused review of the use of botulinum toxins for low back pain. 1256 63

Botulinum toxin, the most potent known biological neurotoxin, holds great promise in the therapy of many diseases. It has been used effectively to treat strabismus, dystonias and other movement disorders, and spasticity. However, a number of potential new therapeutic indications have emerged and attracted a considerable amount of interest from the scientific community. These emerging indications included treatment for conditions associated with pain (e.g. headaches, myofascial pain, chronic low back pain), hypersecretion of glands (e.g. hyperhidrosis, sialorrhea, intrinsic rhinitis), and excessive or dyssynergic muscle contraction, and for cosmesis (e.g. myokymia, bruxism, anal fissure). There is a need for more controlled clinical trials, dose-ranging studies to determine optimal treatment, validated clinical scales and studies developed to assess the value of electromyographic guidance and skill of investigators on the outcome of treatment for some of these diseases. The long-term cost effectiveness of treatment and immunoresistance from repeated injections are also important clinical issues to address.
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PMID:Emerging therapeutic applications of botulinum toxin. 1260 5

Previously known only as a deadly bacterial poison responsible for severe paralysis, botulinum toxin is now a well-recognized therapeutic agent used to relieve involuntary movements, dystonia-related functional impairments, spasticity, and autonomic disorders such as hyperhidrosis. Musculoskeletal pain in patients with rheumatic disorders is among the emerging indications for botulinum toxin therapy. Preliminary data have been obtained in patients with cervical or thoracolumbar myofascial pain syndrome, chronic low back pain, piriformis muscle syndrome, tennis elbow, and stiff person syndrome. At present, the effects of botulinum toxin and its use for pain relief remain controversial. Carefully designed prospective trials are needed to investigate the efficacy and safety of botulinum toxin in pain disorders.
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PMID:New indications for botulinum toxin in rheumatology. 1699 3


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