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)

The reproducibility of coronary vasospasm was assessed in nine patients with complete remission of vasospastic angina by medical treatment by reexamination at intervals of mean [+/-SD] 5.7 +/- 0.9 years. Twenty-one segments were defined as spastic, demonstrating more than 90% narrowing after acetylcholine injection at the initial angiography. The degree of spasticity, type of spasm (diffuse or focal) and coronary artery diameter in these segments at the initial and follow-up studies were compared. Of the 21 segments, 17 (81%) still had some spasticity (> 25%) at the follow-up study and 8 (38%) of these 17 showed spasticity with greater than 90% narrowing. On the other hand, spasm was not reprovoked in 4 (19%) segments. Luminal diameter of the spastic segments decreased significantly at the follow-up study (2.52 +/- 0.83 vs 2.26 +/- 0.62 mm, p = 0.01), but percentage stenosis was not different between the initial and follow-up studies (9.1 +/- 7.2 vs 10.3 +/- 8.0%, NS). The reproducibility of the type of spasm provoked was 83%. Coronary vasospasticity persists to some extent in spite of complete remission of angina by medical treatment, and the type of spasm provoked has high reproducibility. Therefore, the cessation of drug treatment should be done carefully.
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PMID:[Reproducibility of spasm in patients with long-term remission of vasospastic angina by medical treatment]. 917 79

Twelve consecutive patients with severe spasticity and hypertonia following acquired brain injury were treated with continuous intrathecal infusion of baclofen via an implanted, programmable infusion pump-catheter system for a minimum of 3 months. In every case intrathecal baclofen therapy resulted in a statistically significant reduction in upper- and lower-extremity tone, spasm frequency, and reflexes, contributing to improved functional abilities. There were no untoward side effects or complications associated with treatment. This preliminary assessment indicates that intrathecal administration of baclofen is effective in treating the disabling spasticity caused by acquired brain injury in selected patients.
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PMID:Prospective assessment of continuous intrathecal infusion of baclofen for spasticity caused by acquired brain injury: a preliminary report. 928 8

Severe, uncontrolled spasticity resulting from spinal cord injury (SCI) and multiple sclerosis (MS) can have a profound effect on the patient's ability to function and thus, their quality of life. Spasticity can be dramatically reduced by the continuous infusion of baclofen into the lumbar subarachnoid space using a drug delivery system. The aim of this study was to explore the effect of reduced spasticity on quality of life using intrathecal baclofen therapy. Twenty-five patients with intractable spasticity treated with intrathecal baclofen participated in this prospective study. Spasticity was measured using the Ashworth and spasm scales. Quality of life was measured using the Ferrans and Powers Quality of Life Index (QLI) and the Sickness Impact Profile (SIP). The mean spasm score decreased significantly from 2.6 at baseline to 0.5 after one year (Friedman test; p = 0.000017). The mean Ashworth score decreased significantly from 3.78 at baseline to 1.48 after one year, (Friedman test; p = 0.00000014). Though total QLI scores were not significantly different when comparing baseline with one year, the SIP revealed significant changes in the total score as well as the physical and psychosocial subscales. It is likely the QLI did not demonstrate improvement in quality of life due to the emphasis of this tool on nonphysical domains. A qualitative analysis of two open-ended questions revealed positive statements about the change in quality of life when spasticity is well-controlled. Measuring changes in quality of life after specific interventions is a difficult task, requiring an accurate operational definition of the concept and valid instruments for measurement.
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PMID:Quality of life: effect of reduced spasticity from intrathecal baclofen. 960 22

The author reviews the current opinions on the treatment of spasticity with special consideration given to the new method of treatment with local injections of botulinum toxin A into the spastic muscles. Botulinum toxin is the treatment of choice in focal dystonias and hemifacial spasm. The mechanism of action of the toxin is unique and is a result of dose-dependent and partial chemical denervation of the muscles, with preservation of tonus and thus its function. Recent reports have confirmed the safety and effectiveness of the method in spasticity, especially when it is focal, not diffuse or severe and without concomitant severe paresis. The author describes also the basic data of the pathophysiology of spasticity and reviews other therapeutic options and practical problems concerning the injections of botulinum toxin.
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PMID:[Botulinum toxin in spasticity treatment]. 960 56

Remitting hemiplegic spasticity in apoplexy (HSA) is an important problem in today's clinical study. Through teaching and clinical practice, the authors summed up the effective acupuncture methods for remitting HSA: puncture deeply the acupoints on the superior-spasm side (SSS) by filiform needles so as to obtain the intensive needling sensations in the deep tissues (ISDT) until the superior spasm is immediately remitted; tap the skin on the inferior-spasm side (ISS) by skin needles until the corresponding muscle contracts. The methods have showed a significant immediate and long-term therapeutic effect.
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PMID:Acupuncture methods for hemiplegic spasm. 1043 14

Mammalian tissues contain at least two types of cannabinoid receptor, CB1 and CB2, both coupled to G proteins. CB1 receptors are expressed mainly by neurones of the central and peripheral nervous system whereas CB2 receptors occur in certain non-neuronal tissues, particularly in immune cells. The existence of endogenous ligands for cannabinoid receptors has also been demonstrated. The discovery of this endogenous cannabinoid system has been paralleled by a renewed interest in possible therapeutic applications of cannabinoids, for example in the management of pain and in the suppression of muscle spasticity/spasm associated with multiple sclerosis or spinal cord injury. It has also prompted the development of a range of novel cannabinoid receptor ligands, including several that show marked selectivity for CB1 or CB2 receptors. This review summarizes current knowledge about the in vitro pharmacological properties of important CB1 and CB2 receptor ligands. Particular attention is paid to the binding properties of these ligands, to the efficacies of cannabinoid receptor agonists, as determined using cyclic AMP or [35S]GTPgammaS binding assays, and to selected examples of how these pharmacological properties can be influenced by chemical structure. The in vitro pharmacological properties of ligands that can potently and selectively oppose the actions of CB1 or CB2 receptor agonists are also described. When administered by themselves, some of these ligands produce effects in certain tissue preparations that are opposite in direction to those produced by cannabinoid receptor agonists and the possibility that the ligands producing such inverse cannabimimetic effects are inverse agonists rather than pure antagonists is discussed.
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PMID:Pharmacology of cannabinoid receptor ligands. 1046 84

Toxins are increasingly being used as valuable tools for analysis of cellular physiology, and some are used medicinally for treatment of human diseases. In particular, botulinum toxin, the most poisonous biological substance known, is used for treatment of a myriad of human neuromuscular disorders characterized by involuntary muscle contractions. Since approval of type-A botulinum toxin by the US Food and Drug Administration in December 1989 for three disorders (strabismus, blepharospasm, and hemifacial spasm), the number of indications being treated has increased greatly to include numerous focal dystonias, spasticity, tremors, cosmetic applications, migraine and tension headaches, and other maladies. Many of these diseases were previously refractory to pharmacological and surgical treatments. The remarkable therapeutic utility of botulinum toxin lies in its ability to specifically and potently inhibit involuntary muscle activity for an extended duration. The clostridia produce more protein toxins than any other bacterial genus and are a rich reservoir of toxins for research and medicinal uses. Research is underway to use clostridial toxins or toxin domains for drug delivery, prevention of food poisoning, and the treatment of cancer and other diseases. The remarkable success of botulinum toxin as a therapeutic agent has created a new field of investigation in microbiology.
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PMID:Clostridial toxins as therapeutic agents: benefits of nature's most toxic proteins. 1054 1

It is now known that there are at least two types of cannabinoid receptors. These are CB1 receptors, present mainly on central and peripheral neurones, and CB2 receptors, present mainly on immune cells. Endogenous cannabinoid receptor agonists ('endocannabinoids') have also been identified. The discovery of this 'endogenous cannabinoid system' has led to the development of selective CB1 and CB2 receptor ligands and fueled renewed interest in the clinical potential of cannabinoids. Two cannabinoid CB1 receptor agonists are already used clinically, as antiemetics or as appetite stimulants. These are D 9 - tetrahydrocannabinol (THC) and nabilone. Other possible uses for CB1 receptor agonists include the suppression of muscle spasm/spasticity associated with multiple sclerosis or spinal cord injury, the relief of chronic pain and the management of glaucoma and bronchial asthma. CB1 receptor antagonists may also have clinical applications, e. g. as appetite suppressants and in the management of schizophrenia or disorders of cognition and memory. So too may CB2 receptor ligands and drugs that activate cannabinoid receptors indirectly by augmenting endocannabinoid levels at cannabinoid receptors. When taken orally, THC seems to undergo variable absorption and to have a narrow 'therapeutic window' (dose range in which it is effective without producing significant unwanted effects). This makes it difficult to predict an oral dose that will be both effective and tolerable to a patient and indicates a need for better cannabinoid formulations and modes of administration. For the therapeutic potential of cannabis or CB1 receptor agonists to be fully exploited, it will be important to establish objectively and conclusively (a) whether these agents have efficacy against selected symptoms that is of clinical significance and, if so, whether the benefits outweigh the risks, (b) whether cannabis has therapeutic advantages over individual cannabinoids, (c) whether there is a need for additional drug treatments to manage any of the disorders against which cannabinoids are effective, and (d) whether it will be possible to develop drugs that have reduced psychotropic activity and yet retain the ability to act through CB1 receptors to produce their sought-after effects.
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PMID:Cannabis and cannabinoids: pharmacology and rationale for clinical use. 1057 83

We assessed the repetitive movement (RM) test for measuring the effect of a trial bolus dose of intrathecal baclofen on spasticity. The RM test measures passive range of motion (ROM) by electrogoniometry and stretch reflex activity (SRA) of the flexors and extensors of the knee and ankle by surface electromyography. The SRA has a dynamic component (dynamic stretch reflex, DSR) and a tonic component (tonic stretch reflex, TSR). Four hypotheses were formulated: (a) RM results show a negative relationship between SRA and ROM; (b) values on the RM test are correlated with clinical scores of tonus and spasticity; (c) RM results show a reduction in SRA after administration of the clinically optimal dose of baclofen; and (d) RM results show a dose-dependent effect of intrathecal baclofen on SRA. Twenty-four patients were selected because they had impairments and disabilities caused by intractable spasticity. A bolus of baclofen was administered with incremental doses (25-150 micrograms) until an optimal effect or no effect was obtained. The main outcome measures were RM test and clinical assessments of the Ashworth and spasm score. The results were (a) For the ankle a negative correlation was found between ROM and TSR of the flexor and extensors; for the knee a significant negative correlation was found only with the DSR of the biceps femoris. (b) A positive correlation was found between the Ashworth score and TSR of the extensors and between the spasm score and DSR and TSR of the gastrocnemius muscle. (c) Significant differences were found between baseline measurements and the optimal dose of baclofen for all measures. (d) A significant dose-dependent effect of intrathecal baclofen on the level of SRA was observed. The RM test is thus a useful clinical tool for objectively measuring the effect of intrathecal baclofen administration on spasticity in patients with an upper motor neuron syndrome.
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PMID:Measurement of the effect of a bolus dose of intrathecal baclofen by a repetitive movement test. 1063 42

The current popular model of spasticity is that the abnormalities are primarily due to increased sensitivity of the reflex are at the segmental level of the spinal cord. Neurosurgical procedures, such as open selective dorsal rhizotomy for the reduction of spasticity, have been based on this assumption. We describe two patients with hip flexor spasm of different origin treated with radiofrequency lesions of the dorsal root ganglion.
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PMID:Radiofrequency lesions of the dorsal root ganglion in the treatment of hip flexor spasm: a report of two cases. 1072 7


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