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

Mitochondrial myopathies make up a group of rare disorders whose onset is in childhood or adolescence. Muscle and central nervous system involvement is variable. Mitochondrial respiratory chain complex III deficiency (coenzyme Q - cytochrome C reductase) can manifest as exercise intolerance, myopathy, encephalopathy, and myocardial disease. Approximately 38 patients with complex III deficiency have been described since 1966, yet only a single anesthetic experience (epidural analgesia for cesarean delivery) has been reported. We describe the case of an 11-year-old boy with mitochondrial respiratory chain complex III deficiency, severe myopathy, and moderate encephalopathy who underwent surgery to improve right ischiotibial muscle spasticity. Monitoring included electrocardiography, noninvasive blood pressure, oxygen saturation by pulse oximetry, end-tidal carbon dioxide pressure, esophageal temperature, spirometry, and neuromuscular block (Relaxograph Datex). Midazolam, fentanyl, and propofol were used for anesthetic induction; mivacurium was used during intubation. Anesthetic maintenance was with propofol in continuous infusion and fractionated doses of fentanyl and mivacurium on demand in a mixture of oxygen and air. The boy's response to mivacurium was abnormal but he could nevertheless be extubated in the operating room at a train-of-four ratio of 75% and with no need to reverse the neuromuscular blockade. There were no problems during the anesthetic procedure, so it could be a good technique for these patients, despite of considering individually every case and extension of syntomatology, due to the little experience in anesthesia with deficiency of Complex III.
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PMID:[Anesthesia for a patient with mitochondrial respiratory chain complex III deficiency]. 1729 35

The purpose of the investigation was to study the clinical manifestations of spastic syndrome after injury to the vertebral column and spinal cord and to devise its surgical treatment policy. The investigation included 21 patients with significant spasticity or pain syndrome after severe injury to the vertebral column and spinal cord without any potential of motor recovery. All the patients were observed to have severe inferior paraplegia, cacesthesia following the radicular and conduction with total hypo- or anesthesia. Pain was rated, by using the visual analogue scale and the McGill questionnaire, spasticity was estimated by the Ashworth scale. The patients' motor activity was also evaluated. Bilateral rhizomyeolotomy of the dorsal root entry zone (DREZ) was performed in 10 patients with pain syndrome; posterior partial rhizidiotomy was made in 8 patients with spastic syndrome; 3 patients underwent epidural spinal cord stimulation. Groups with a preponderance of pain (47%) and spastic (53%) syndromes were identified. A clinically equal combination of spastic and pain components occurred rarely. Pain was maximally pronounced, neuropathic, metamerically radicular, in dermatomes from the level of injury. Leg spasticity was more marked and concurrent with contracture. The efficiency of lateral rhizomyelotomy of DREZ in the treatment of pain was 89% in the early period and 63% in the late (as long as 4 years) one. That of bilateral posterior partial rhizodiotomy in the treatment of spasticity was 75 and 75% in the early and late (as long as 2.5 years), respectively. Rhizomyelotomy of DREZ is a pathogenetically grounded and effective procedure when there is a preponderance of neuropathic metamerically radicular pain from the level of injury. Bilateral posterior partial rhizidiotomy is the method of choice in treating significant spasticity.
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PMID:[The specific features of clinical manifestations and surgical treatment of spastic and pain syndromes after injury to the vertebral column and spinal cord]. 1804 Dec 7

During the past three decades, internal fixation has become increasingly popular for fracture management and limb reconstruction. As a result, during their training, orthopaedic surgeons receive less formal instruction in the art of extremity immobilization and cast application and removal. Casting is not without risks and complications (eg, stiffness, pressure sores, compartment syndrome); the risk of morbidity is higher when casts are applied by less experienced practitioners. Certain materials and methods of ideal cast and splint application are recommended to prevent morbidity in the patient who is at high risk for complications with casting and splinting. Those at high risk include the obtunded or comatose multitrauma patient, the patient under anesthesia, the very young patient, the developmentally delayed patient, and the patient with spasticity.
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PMID:Cast and splint immobilization: complications. 1818 Mar 90

At one of the symposia at the 16th congress of the German Society for the Study of Pain in Berlin in 1991 an update on the use of pumps and ports in pain treatment was presented. This article tries to focus on some of the conclusions of this meeding. (1) To avoid neurologial damage only analgesic substances that have been tested in animals and with which we have adequate clinical experience, e.g. opiates, clonidine and baclofen, should be used for spinal anaesthesia. (2) The increasing number of manufactures of pumps, ports, catheters and puncture needles should pay more attention to safety and reliability of their products to avoid technical complications and should try to achieve compatibility between the different accessories such as catheters, needles and connecting pieces. (3) The mode of application (spinal versus epidural, pump versus port or externalized catheter) depends on the predicted period of treatment (spinal application for long-term treatment requires more hygienic precautions) and on differences in the individual care of the patient (4). Spinal opiates for benign pain (in case of failure of less invasive pain regiments) have been tested successfully, but the follow-up is not yet long enough to allow recommendation of this therapy for general use. (5) Local anaesthetics are useful for short-term use. The addition of local anaesthetics for continuous low-flow infusion of opiates requires further comparative studies. (6) Spinal baclofen is effective against pain induced by muscle spasms but not against non-spasticity-related pain syndrome.
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PMID:[Pumps and ports for analgesic therapy.]. 1841 12

This case report reviews the anesthesiological complications of intrathecal baclofen (ITB) therapy. An 11-year-old boy with spasticity and apallic syndrome needed general anesthesia for exchange of a baclofen pump but 2 h later he became increasingly hypothermic, hypotonic with bradycardy and dyspnea. The cause was an intra-operative bolus of ITB. Reduction of the baclofen administration rate caused disappearance of all symptoms without any residual effects. The ITB is an increasingly used therapeutic option for multiple sclerosis and cerebral palsy. Therefore, emergency personal and anesthesiologists must be aware of the possible side effects of this medication.
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PMID:[Intrathecal baclofen therapy. Overdose during replacement of a medication pump]. 1973 Jul 95

Many patients suffer recurrent episodes of temporomandibular joint (TMJ) dislocation due to an excess of muscle contraction or spasticity in the depressor muscles of the jaw. The manual repositioning using the Nelaton maneuver is the first treatment. Occasionally, it may be necessary to use sedation or general anesthesia to achieve the desired muscle relaxation. In case of recurrence, surgical treatment is indicated. One nonsurgical method of treatment is the local infiltration of botulinum toxin type A. We present 4 cases of recurrent TMJ dislocation in patients suffering from conditions of neurologic origin, with considerable motor deterioration, treated with local infiltration of botulinum toxin type A. In conclusion, the injection of botulinum toxin type A is an effective method in cases of neurogenic TMJ dislocation, with low morbididty and side effects, improving patients' quality of life.
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PMID:Neurogenic temporomandibular joint dislocation treated with botulinum toxin: report of 4 cases. 2021 83

Slippage after reduction of atlantoaxial rotatory fixation (AARF) is usually treated with repeated cervical traction and brace immobilization. To date, no data have been published on the management of muscle spasm during treatment. Here, we describe the case of a 7-year-old girl with AARF for 1 month who visited our hospital for treatment. During physical examination, spasm of the sternocleidomastoid muscle was noted. The patient was treated with manipulative reduction, and slippage after reduction was managed with botulinum spasticity block of the sternocleidomastoid and splenius capitis muscles, and repeated manipulation. Cervical orthosis immobilization with a rehabilitation program of isometric contract-relax exercise for the neck was conducted for 3 months. The subject had full recovery from AARF at 1-year follow-up. This report demonstrates that, in selected cases of slippage after reduction from AARF, conservative management with manipulation under anesthesia is a good method, and the muscle components may play a crucial role in AARF.
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PMID:Treatment of atlantoaxial rotatory fixation with botulinum toxin muscle block and manipulation. 2045 47

Oral dantrolene is used widely for the treatment of spasticity in patients with spinal cord injury. A 60-year-old patient in the rehabilitation phase following cervical spine injury presented with generalised weakness and deteriorating respiratory function, requiring intensive care admission, tracheal intubation and ventilation. He had bilateral basal lung collapse and a raised diaphragm and was on high-dose oral dantrolene. The cessation of dantrolene resulted in a dramatic recovery of respiratory function within two days. High-dose oral dantrolene can cause severe respiratory insufficiency and may present difficulties in the differential diagnosis of respiratory failure in patients with high cervical spinal cord injuries.
Anaesthesia 2010 Aug
PMID:Oral dantrolene and severe respiratory failure in a patient with chronic spinal cord injury. 2056 Sep 19

At the beginning of the 20th century, the development of safer anesthesia, antiseptic techniques, and meticulous surgical dissection led to a substantial decrease in operative risk. In turn, the scope of surgery expanded to include elective procedures performed with the intention of improving the quality of life of patients. Between 1908 and 1912, Harvey Cushing performed 3 dorsal rhizotomies to improve the quality of life of 3 patients with debilitating neuralgia: a 54-year-old man with "lightning" radicular pain from tabes dorsalis, a 12-year-old boy cutaneous hyperesthesia and spasticity in his hemiplegic arm, and a 61-year-old man with postamputation neuropathic pain. Symptomatic improvement was seen postoperatively in the first 2 cases, although the third patient continued to have severe pain. Cushing also removed a prominent spinous process from each of 2 patients with debilitating headaches; both patients, however, experienced only minimal postoperative improvement. These cases, which have not been previously published, highlight Cushing's views on the role of surgery and illustrate the broader movement that occurred in surgery at the time, whereby elective procedures for quality of life became performed and accepted.
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PMID:"Fulfilling the chief of his duties as a physician": Harvey Cushing, selective dorsal rhizotomy and elective spine surgery for quality of life. 2125 Aug 16

Intrathecal baclofen (ITB) has been found to be helpful not only for spasticity but also for unconsciousness in a vegetative patient. This is the first case of ITB in Nepal, and here we discuss the effectiveness of ITB for spasticity in a patient in vegetative state. We also discuss about a simple technique for ITB used in Nepal where baclofen pump is not available. Here, we present a case of a 40-year-old male patient who had severe head injury with diffuse axonal injury treated conservatively. He went on to a vegetative state and subsequently developed severe spasticity of all the limbs. ITB was started under the guidance of one of the authors , Prof. Taira. Baclofen was injected to the spinal intrathecal space through a catheter which is used for spinal anesthesia. Spasticity improved significantly and his higher mental function also showed signs of improvement. He finally became fully conscious and well oriented. ITB is very useful in cases of severe spasticity and vegetative condition, a state of unconsciousness lasting longer than a few weeks. Even with a simple technique in the absence of baclofen pump, ITB can be used with its optimum effect.
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PMID:Intrathecal baclofen therapy in severe head injury, first time in Nepal, a technique suitable for underdeveloped countries. 2205 5


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