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)

We reported a rare case who had hypoxic-encephalopathy causing frontal apraxia of gait. The patient, a 34-year-old female, was admitted in July, 1994, complaining of difficulty in walking after anoxic brain damage caused by ventricular arrhythmia. She had difficulty in raising her feet, which appeared to be rooted to the floor. There was no evidence of motor paralysis, spasticity, rigidity or sensory loss, but she did show frontal lobe signs such as foot grasp reflex and Gegenhalten. Cranial MRI showed slight atrophy of the frontal lobe. On T2 weighted image, high-intensity areas were detected at the posterior internal capsule and corona radiata. Single photon emission CT (123I-IMP) demonstrated a low perfusion area which included the inferomedical part of the frontal lobe. After 8 months of hospitalization, her postural instability and unsteady gait slowly improved without treatment as frontal signs such as foot grasp reflex disappeared. We speculate that her apraxia of gait may result from grasp reflex and Gegenhalten.
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PMID:[A case of frontal gait apraxia caused by hypoxic encephalopathy]. 916 59

A 57-year-old woman presented with a slowly progressive gait disturbance in 1992 (53 years of age). Over the next year, she gradually began to talk less, but her speech itself became more rapid than before. He speech was frequently too fast even for family members to understand. In 1997, she was admitted to our hospital. On admission, the patient was disoriented but able to follow simple verbal commands, to name things, and to write simple words. Neither apraxia, aphasia, hemispatial neglect, nor a corpus callosum disconnection syndrome was observed. There was no muscle weakness or atrophy. She showed a positive Babinski sign with mild spasticity in the legs and Gegenhalten, but no rigidity. Her speech was monotonous and abnormally fast (cluttering-like speech). Her speech became faster and faster toward the end of sentences, skipping several syllables or even words. She was unable to speak slowly and clearly, even when efforts were made to pace her speech to the speed set by the examiner. She was able to stand only with a wide base of support and body flexion. When standing, she was unable to place one foot directly beside the other; as she tried to have one foot near the other, the former repelled the latter. She had great difficulties in taking her first step forward, and showed rapid freezing of gait even when she managed to succeed in starting. She was able to imitate walking or bicycling with her legs unloaded, indicating that her gait disturbance was a kind of apraxia of gait. Her intelligence was somehow difficult to assess because of her peculiar speech disturbance. However, her family members had noticed her memory disturbance and personality change (offensiveness) since 3 to 4 years before the admission. Moreover, she was defective not only on Hasegawa Damentia Scale-Revised but also on Raven's Colored Progressive Matrices which estimates non-verbal intelligence. It was also noted that she was inattentive and lazy in thinking on questionnaires. Thus we considered that she was at least mildly demented and the type of dementia was of frontal pathology. Laboratory data were all normal except for the head MRI, which demonstrated prominent and thinness of the corpus callosum from the anterior part of the body to splenium without any other brain lesions that could cause the thinness secondarily. Our case resembles two cases reported by Sunohara et al in 1985, together comprising a unique clinical feature. Although Sunohara et al did not refer to the thinness of the corpus callosum in their cases, the clinical profiles in our case and theirs raise the possibility that they form a new disease entity. A further study in a large number of similar cases, including autopsies will provide a conclusion.
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PMID:[A case report of dementia with cluttering-like speech disorder and apraxia of gait]. 1042 42

Spasticity is usually observed along with paralysis, hyperreflexia, Babinski sign and abnormal associated movements associated with dysfunction of central motor tracts. In spasticity, exaggeration of the stretch reflex results in increased resistance during passive movements. Therefore, spasticity is pathophysiologically described as increased muscle tone whose pathognomonic sign is decreased passivity. Resistance is more strongly felt during rapid passive movements than during slow movements. The resistance felt at the beginning of the passive movement abruptly diminishes, which is well known as the clasp-knife phenomenon. Another character of spasticity is the distribution of the increment in the muscle tone. Not only rigidity, dystonia, and muscle stiffness demonstrating increased muscle tone, but also Gegenhalten and contracture of joint with normal muscle tone should be differentiated. No neurophysiological parameters reflect the degree of spasticity in a strictly parallel fashion. However, neurophysiological examinations provide some supportive objective data. Surface electromyography is useful to distinguish spasticity from rigidity and other conditions with increase muscle tone. The increased amplitude ratio and the decreased threshold ratio of the H-wave to the M-wave, and increased amplitude and persistence of the F-wave are observed the patients with spasticity. Magnetic stimulation is a useful tool to detect corticospinal tract lesions that induce leading to spasticity. Transcranial magnetic stimulation, magnetic brainstem stimulation, and magnetic spinal motor root stimulation are used to examine the entire motor pathway. Since positive correlation between spasticity and shortening of the silent period is reported, many investigations including paired-pulse magnetic stimulation will be necessary for understanding pathophysiology of spasticity. Patients with mild and reversible spasticity are usually treated with medications. Significant variations exist in the use of these therapies, because the treatments often depend on the clinicians' experience. It will be necessary to clarify the action mechanism of drugs, to develop new effective drugs, and to perform randomized controlled trails so that clinicians can select the optimal medication based on evidence.
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PMID:[Clinical signs, neurophysiological evaluation, and medication of spasticity--review]. 1911 Jul 51

Many years after its initial description, paratonia remains a poorly understood concept. It is described as the inability to relax muscles during muscle tone assessment with the subject involuntary facilitating or opposing the examiner. Although related to cognitive impairment and frontal lobe function, the underlying mechanisms have not been clarified. Moreover, criteria to distinguish oppositional paratonia from parkinsonian rigidity or spasticity are not yet available. Paratonia is very frequently encountered in clinical practice and only semi-quantitative rating scales are available. The purpose of this study is to assess the feasibility of a quantitative measure of paratonia using surface electromyography. Paratonia was elicited by performing consecutive metronome-synchronized continuous and discontinuous elbow movements in a group of paratonic patients with cognitive impairment. Goniometric and electromyographic recordings were performed on biceps and triceps brachii muscles. Facilitatory (mitgehen) and oppositional (gegenhalten) paratonia could be recorded on both muscles. After normalization with voluntary maximal contraction, biceps showed higher paratonia than triceps. Facilitatory paratonia was higher than oppositional on the biceps. Movement repetition induced increased paratonic burst amplitude only when flexion and extension movements were performed continuously. Both facilitatory and oppositional paratonia increased with movement repetition. Only oppositional paratonia increased following faster movements. This is the first study providing a quantitative and objective characterization of paratonia using electromyography. Unlike parkinsonian rigidity, oppositional paratonia increases with velocity and with consecutive movement repetition. Like spasticity, oppositional paratonia is velocity-dependent, but different from spasticity, it increases during movement repetition instead of decreasing. A quantitative measure of paratonia could help better understanding its pathophysiology and could be used for research purposes on cognitive impairment.
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PMID:Electromyographic assessment of paratonia. 2799 92