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)

Of nine hemiplegic patients having foot-drop who were test-treated with the Philips functional electronic peroneal stimulator, only three who tolerated continued use of the stimulator for five weeks had improvement in function. Findings in these cases indicate that to be selected for trial use of a stimulator a hemiplegic patient should fulfill the following criteria: (1) be in the hospital, (2) be ambulant with or without a cane and/or short leg brace, (3) have no severe contracture of the ankle joint, (4) have no severe spasticity, (5) have no obvious lower motor neuron lesions, (6) be cooperative and intelligent, (7) have no severe manual difficulty (he should be able to put on the stimulator without assistance), and (8) be able to tolerate the discomfort from the stimulation.
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PMID:Peroneal nerve stimulator in rehabilitation of hemiplegic patients. 107 17

Even in patients with complete loss of sensation and paraplegia after cervical spinal trauma, abdominal operations usually require general or spinal anesthesia due to spasms and increased muscle tone. Both anesthetic types have serious drawbacks under these circumstances, e.g. hyperkalemia induced by relaxation or the impossibility of adequate monitoring of the level of spinal blockade. After an onset time of 1-2 h the intrathecal injection of approx. 100 micrograms baclofen, a spinally acting GABAB-agonist, led to complete and long-lasting suppression of surgically induced spasticity. This could be demonstrated by neurological examination (spasticity scores: Ashworth score, spasm score, clonus score) during 5 neurosurgical operations in 3 patients with paraplegia. Except for slight sedation, the patients had no discomfort during operation. Intrathecal baclofen was also effective against autonomic hyperreflexia, i.e. vegetative dysregulation such as bradycardia or hypertension, provoked by catheterization or bladder surgery.
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PMID:[Intraoperative suppression of spasticity using intrathecal baclofen]. 230 48

Urodynamic studies of 25 women between eleven and forty-five years of age whose history included frequent urinary tract infections disclosed urethral activity different from that of women with pure stress incontinence. Often the former had associated symptoms of urge, although the latter did not. Not all symptoms of infections were documented by culture, hence could have been related to tension in the pelvic floor rather than to bacteriuria. Urodynamic studies showed spasticity of the urethral musculature. The women with frequent urinary tract infections uniformly had hyperactive urethral striated muscle, those with the most severe form of urge showing varying resting tension in the urethral sphincter. In all cases, discomfort or urge was proportional to the elevation in urethral sphincter pressure and dramatically diminished with drop in closure tonus. In many cases relief of urge occurred only with voiding-when relaxation of the pelvic floor musculature could be induced by the patient. Urethral symptoms result from physiologic imbalance in urethral activity and may predispose to urinary tract infection. Thus, physicians treating urge complaints in young women should be aware that both entities have to be treated.
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PMID:Urethral syndrome or urinary tract infection? 697 21

Spasticity may be a major obstacle to rehabilitation of patients with spinal cord injury. It may cause discomfort, interfere with existing functions, or result in additional complications. Many techniques-physical, chemical, and surgical- exist for modulation of spasticity. Prevention of nociception and establishment of an effective daily stretching program are the foundation on which all other managements are based. Antispasticity medications may be added: benzodiazepines, dantrolene sodium, and baclofen are effective in selected patients. Motor point blocks may partially dampen spasticity in selected muscles of some patients. Chemical and surgical neurolytic procedures are used if the first two tiers of management are inadequate. Each technique can be rationally applied by use of a pyramidal management system.
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PMID:Management of spasticity in spinal cord injury. 727 73

The purpose of this open study was to find out whether botulinum toxin A (BTX-A) relieves the signs and symptoms of chronic limb spasticity. The study comprised 40 patients, aged 12-82 years, with moderate to severe spasticity of the upper (13) or lower limbs (27) refractory to conventional physical and medical treatments. Outcome measures were clinical and blinded videotape assessments of spasticity and motor function. Electromyography guided BTX-A injections were given in one or two sessions at total doses averaging 175 U in the upper limb (range 70-270 U) and 221 U in the lower limb (range 100-500 U). Thirty four patients (85%) derived worthwhile benefit, with improved limb posture and increased range of passive motion in 31, pain reduction in 28 of 31 with pain, and improved function in 16. Side effects were limited to local and usually mild discomfort from the injections (19), symptomatic local weakness (one), and local infection (one). Preliminary experience indicates that BTX-A is a promising adjunctive treatment for selected patients with spasticity.
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PMID:Treatment of chronic limb spasticity with botulinum toxin A. 853 Sep 58

This symposium is concerned with the treatment of spasticity and, in particular, with results from studies of tizanidine as a treatment for patients with MS and spinal cord injury. In this article, the definitions and pathophysiologies of spasticity are reviewed, and the issue of when and if to treat spasticity is evaluated. The merits of newer pharmacologic and invasive therapies are discussed relative to reduction of patient discomfort and the possibility of restored function.
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PMID:Spasticity: a review. 896 Jul 62

Children with cerebral palsy who receive selective dorsal rhizotomy (SDR) for treatment of spasticity may show suprasegmental changes in upper limb function and control of speech musculature. Anecdotal reports suggest that supra-segmental effects may extend to cognitive functions such as attention and language. This study examined the performance of 16 children with spastic diplegic cerebral palsy on tests of visual attention and other cognitive functions 1 day prior to and 6 months following SDR. Children undergoing SDR were compared with 9 children with spastic diplegia, matched for severity of cerebral palsy and amount of therapy, who did not receive SDR, and 24 age- and sex-matched normal children tested at initial and 6-month follow-up sessions. Children with cerebral palsy treated with SDR showed disproportionately greater improvement in specific attentional and cognitive operations than either of the other groups. These results document cognitive changes following SDR which heretofore were reportedly anecdotally. This improvement may be due to improved mood, reduced physical discomfort, increased therapeutic intervention, or possible cortical effects of SDR.
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PMID:Changes in cognitive performance in children with spastic diplegic cerebral palsy following selective dorsal rhizotomy. 855 98

Neuromuscular stimulation may facilitate motor recovery after stroke or brain injury, reduce shoulder pain associated with hemiplegia, and reduce cerebral spasticity. However, the discomfort of surface neuromuscular stimulation significantly limits the clinical implementation of this modality for persons with hemiplegia. The study contained herein tests the hypothesis that stroke and brain injury survivors with chronic hemiplegia (>6 mo) and intact sensation tolerate percutaneous intramuscular stimulation better than surface stimulation. Four stroke and two traumatic brain injury survivors participated in the study contained within this article. Each subject received three pairs of percutaneous and surface stimulations of the paretic finger extensors. The order of the type of stimulation within each pair was randomly assigned. The stimulation parameters for each type of stimulation were normalized to produce the same torque at the metacarpophalangeal joint. Subjects rated their perceived level of discomfort using a 10-cm visual analog scale and the McGill Pain Questionnaire. A blinded evaluator administered the pain measures. Percutaneous stimulation was associated with significantly lower discomfort as reflected by the visual analog scale (0.74 v 3.3; 95% confidence interval of difference, -3.84, -1.28). The McGill Pain Questionnaire produced similar results with percutaneous stimulation associated with a significantly fewer number of words chosen to describe the discomfort (0.87 v 3.30; 95% confidence interval of difference, -3.50, -1.30) and significantly lower Pain Rating Index (1.47 v 6.27; 95% confidence interval of difference, -7.77, -1.83). Data suggest that percutaneous intramuscular stimulation is significantly better tolerated than surface stimulation and that percutaneous stimulation may enhance patient compliance with neuromuscular stimulation treatments.
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PMID:Comparison of discomfort associated with surface and percutaneous intramuscular electrical stimulation for persons with chronic hemiplegia. 986 39

Spasticity is a common and disabling symptom for many patients with upper motor neuron dysfunction. It results from interruption of inhibitory descending spinal motor pathways, and although the pathophysiology of spasticity is poorly understood, the final common pathway is overactivity of the alpha motor neuron. Therapy for spasticity is symptomatic with the aim of increasing functional capacity and relieving discomfort. Any approach to treatment should be multidisciplinary, including physical therapy, and possibly surgery, as well as pharmacotherapy. It is important that treatment be tailored to the individual patient, and that both patient and care giver have realistic expectations. Pharmacotherapy is generally initiated at low dosages and then gradually increased in an attempt to avoid adverse effects. Optimal therapy is the lowest effective dosage. Baclofen, diazepam, tizanidine and dantrolene are currently approved for use in patients with spasticity. In addition, clonidine (usually as combination therapy), gabapentin and botulinum toxin have shown efficacy, however, more studies are required to confirm their place in therapy. Intrathecal baclofen, via a surgically implanted pump and reservoir, may provide relief in patients with refractory severe spasticity.
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PMID:Drugs used to treat spasticity. 1077 31

Baclofen (Lioresal), a lipophilic analogue of c-aminobutyric acid (GABA), and carisoprodol (Soma), a central nervous system depressant with an unknown mechanism of pharmacologic action, are categorized as muscle relaxants. Baclofen is used clinically in the management of spasticity and its sequelae secondary to severe chronic disorders such as multiple sclerosis and other types of spinal cord lesions. Carisoprodol is used for discomfort associated with acute and painful musculoskeletal conditions. Intoxication from these drugs occurs in both humans and animals necessitating a need for their detection in plasma/serum, tissue, and gastrointestinal contents samples. A sensitive and specific analytical method for detection and quantitation of these compounds using liquid chromatography with positive atmospheric pressure chemical ionization-mass spectrometry was developed. A rapid extraction procedure for both analytes from fortified bovine sera is described. Chromatographic separation was carried out on a C(18) reverse-phase column with a gradient elution of acetonitrile and 0.25% acetic acid. The effluent was directed to the mass spectrometer with fragmentation information for baclofen and carisoprodol obtained in a scan monitoring mode. Linear standard curves for baclofen and carisoprodol were constructed based on at least two corresponding extracted ions over a concentration range of 0.1-50 micro g/mL. The analysis of fortified sera samples demonstrates good accuracy and precision for the method with a limit of detection of 0.5 micro g/mL for carisoprodol (n = 3) and 1 micro g/mL for baclofen (n = 4) and a limit of quantitation of 2 micro g/mL for both compounds. Recoveries at the limit of quantitation were between 75 and 95% for both analytes, with a 4.8-9.3% range in standard deviation.
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PMID:Direct and rapid determination of baclofen (Lioresal) and carisoprodol (Soma) in bovine serum by liquid chromatography-mass spectrometry. 1290 40


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