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

Fifty hemiparetic subjects were selected from a population of 250 patients according to criteria forsuitable candidates for peroneal stimulation. The patients received from 10 to 120 hours of treatment during 2--5 weeks. The therapeutic results obtained were classified into four groups, ranging from none to excellent improvement of voluntary movement and reduction of spasticity. The clinical results were correlated to different variables where time from lesion, spasticity, and extent of treatment appeared to be the most important ones. The percentage of excellent results decreased with increasing time from lesion and spasticity, and increased with increasing treatment. Orthotic validity (i.e. the beneficial effect of the orthosis) was observed in 76% of the selected cases and in most of them it was very significant. Preliminary tests performed on 9 subjects showed that in cases with orthotic validity the peroneal brace slightly reduces the oxygen consumption of patients and improves their motivation. This work gives a more quantitative perspective of the validity of functional peroneal stimulation and a better indication of criteria for patient selection. The overall validity of an electronic peroneal brace appears to apply to 15% of the total ambulatory hemiparetic population and its therapeutic value is relevant in two-thirds of such cases if sufficient treatment is provided. Application of functional electrical stimulation to non-ambulatory subjects in the acute phase may however lead to a higher percentage of cases of therapeutic validity.
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PMID:Clinical experience of electronic peroneal stimulators in 50 hemiparetic patients. 31 98

Six cases of paraplegic, post-traumatic spasticity, alleviated by percutaneous epidural neurostimulation with temporary or permanent implanted neuroelectrodes from the L1 to L4 intervertebral levels are presented. Modulation of this spasticity and secondary beneficial physiological effects were achieved, including regulation of bowel regimens, production of sweating and piloerection below the level of the lesion, and morning erections. The main advantages of percutaneous epidural neurostimulation in modulating spasticity are the avoidance of destructive neurosurgical procedures, the regulation of secondary physiological and autonomic responses, the avoidance of antispasticity medications, and the reversibility of the neurostimulation procedure.
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PMID:Percutaneous epidural neurostimulation in modulation of paraplegic spasticity. Six case reports. 31 66

Dantrolene sodium or dantrolene1 is 1([5-(nitrophenyl)furfurylidend] amino) hydantoin sodium hydrate. It is indicated for use in chronic disorders characterised by skeletal muscle spasticity, such as spinal cord injury, stroke, cerebral palsy and multiple sclerosis. Dantrolene is believed to act directly on the contractile mechanism of skeletal muscle to decrease the force of contraction in the absence of any demonstrated effects on neural pathways, on the neuromuscular junction, or on the excitable properties of the muscle fibre membranes. Controlled trials have demonstrated that dantrolene is superior to placebo in adults or children with spasticity from various causes, as evidenced by clinical assessments of disability and daily activities, and by muscle and reflex responses to mechanical and electrical stimulation. It is somewhat less effective in patients with multiple sclerosis than in those with spasticity from other causes. There has been a general clinical impression in controlled trials that dantrolene caused less sedation than would have been expected from therapeutically comparable doses of diazepam. In 2 controlled trials, there was no significant difference between dantrolene and diazepam in terms of reductions in spasticity, clonus, and hyperreflexia, but side-effects such as drowsiness and inco-ordination occurred significantly more frequently on diazepam. Long-term studies have indicated continuing benefit for patients taking dantrolene, though the incidence of side-effects has often been high and there has been a suggestion of exacerbation of seizures in children with cerebral palsy. Dantrolene may be of value in the medical treatment of spasm of the external urethral sphincter due to neurological and non-neurological disease, and animal studies suggest a potential use in the management of malignant hyperpyrexia. Chemical evidence of liver dysfunction may occur in 0.7 to 1% of patients on long-term treatment with dantrolene, with symptomatic hepatitis in 0.35 to 0.5% and fatal hepatitis in 0.1 to 0.2%. The drug commonly causes transient drowsiness, dizziness, weakness, general malaise, fatigue and diarrhoea at the start of therapy. Muscle weakness may be the principal limiting side-effect in ambulant patients, particularly in those with multiple sclerosis, and therapy could be hazardous in patients with pre-existing bulbar or respiratory weakness. The dosage of dantrolene has been fixed in most controlled trials, though long-term studies have indicated the need for individualisation of dosage. The initial dose is usually 25mg once daily, increasing to 25mg two, three or four times daily, and then by increments of 25mg up to as high as 100mg two, three or four times daily. The lowest dose compatible with optimal response is recommended.
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PMID:Dantrolene sodium: a review of its pharmacological properties and therapeutic efficacy in spasticity. 31 89

In 19 patients with multiple sclerosis and 1 with subacute sclerosing panencephalitis the mean increase in muscle tonus was found to be 3.1 (range 1--4 according to Burke-Ashwort). In 10 controls with multiple sclerosis the mean spasticity was 2.4. Dantrium was given in doses up to 800 mg for 14--16 days and it caused a greater reduction of spasticity than placebo (p less than 0.05). In 12 patients (60%) varying degrees of muscle tonus reduction was observed. In 11 patients the efect of Dantrium was compared with that of other drugs (Clonazepam, Tetradiazepam, Carisoprodol and Lyoresal). In 6 cases Dantrium was a more effective drug than other muscle relaxants and in 5 cases no difference was observed or other drugs were superior to Dantrium.
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PMID:[Dantrium in the treatment of increased muscle tonus in patients with multiple sclerosis]. 32 Apr 94

Contrary to a prevalent belief, the rebound phenomenon of Gordon Holmes is not a sign of cerebellar disease. It is elicited by having the patient attempt to move a limb against resistance. When the resistance is suddenly removed, the limb normally moves a short distance in the desired direction and then rebounds (jerks back in the opposite direction). Gordon Holmes pointed out that the rebound phenomenon is (1) present in normal libs, (2) exaggreated in spastic limbs, and (3) absent in limbs affected by cerebellar disease. An awareness of Holmes's observations may be helpful in the diagnosis of both cerebellar disease and spasticity.
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PMID:The rebound phenomenon of Gordon Holmes. 32 Sep 70

Today's prescriptions for treating spasticity may include pharmacological, surgical, or physical procedures. All derive their rationale from the classical concepts of decerebrate rigidity and of brain organization as discussed in Part I. This paper describes the advantages and disadvantages of these current treatment procedures and proposes that recent discoveries about the "recovery" capabilities of the central nervous system may influence the means for managing spasticity in the future.
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PMID:Spasticity: its physiology and management. Part IV. Current and projected treatment procedures for spasticity. 32 59

A double-blind, five-week, multicenter trial was conducted to compare the effect of baclofen, a unique amino acid derivative, with that of placebo in the treatment of 106 patients with spasticity secondary to multiple sclerosis. A spasticity assessment method that included a neurological examination, physicians' clinical impressions of changes during treatment, and a patient's self-evaluation was used to determine efficacy. This method showed baclofen (70 to 80 mg daily maximum, titrated) is effective relative to placebo in relieving symptoms of spasticity, such as flexor spasms, pain and stiffness, resistance to passive joint movements, and tendon stretch reflexes. Patient self-evaluation results also showed a significant reduction in clonus. Side effects were generally mild and transient.
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PMID:Baclofen, a new antispastic drug. A controlled, multicenter trial in patients with multiple sclerosis. 32 87

For frequently associated spasticity with involuntary movements in cerebral palsy operations on cerebellar nuclei or on the pulvinar of the thalamus are recommended. We combined both approaches in 45 patients. The combination was possible after experiences with transtentorial dentatotomy, in which the electrodes are introduced into the deep structures of the cerebellum from a burr-hole on the lambdoid suture. The same lambdoid approach may equally well be applied for introducing electrodes into the pulvinar of the thalamus. The lesion in the pulvinar may moreover be combined with the target in the centrum medianum or in the nuclei VIM-VCP or VOP. Lesions are always asymmetric and multilocular. Their influence on the clinical picture is quite favourable.
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PMID:Combined transtentorial dentatotomy with pulvinarotomy in cerebral palsy. 33 5

122 Patients suffering from spasticity and/or dyskinesias underwent a total of 171 operations: 88 stereotactic dentatolyses, 24 posterior partial rootlet section D12-S1 or L1-S1, 16 posterior partial root section D12-S1 or L1-S1, 16 posterior cervical rhizotomies, 21 stereotactic pulvinolyses, 6 stereotactic associated V.L. thalamolysis and pulvinolysis. Results and indications are discussed.
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PMID:Neurosurgical treatment of spasticity and dyskinesias. 33 6

In the 60's stereotactic electrocoagulation of the dentate nucleus became a promising approach in the neurosurgical treatment of muscular hypertonicity, particularly when spasticity was evident. A relatively satisfactory improvement of spasticity has been reported earlier as a result and the authors were supporting these clinical results in previous publications. A long-term assessment of the results obtained in a large series of patients would permit a better evaluation of the effect of the operation. Analysing 109 stereotactic electrocoagulations of the dentate nucleus on 50 patients mainly in cases of cerebral palsy over a period of more than 10 years (most patients underwent a bilateral dentatotomy), the authors give a more realistic appreciation of the results, which depend on the criteria chosen. In 30% of the cases a clear improvement in the spasticity was obtained, and in 50% of all cases, nursing and rehabilitation were facilitated. The stereotactic dentatotomy never completely cured the spasticity and spectacular results were never observed, but the operation can be performed without complications and an unexpected neurological deficit did not occur. The role of the stereotactic dentatotomy and other neurosurgical methods in the treatment of spasticity has to be evaluated more critically.
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PMID:Long-term assessment of stereotactic dentatotomy for spasticity and other disorders. 33 8


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