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

Neuromuscular blockade via injection of alcohol, phenol, or botulinum toxin reduces the tone of overactive muscles in order to restore the appropriate balance between agonists and antagonists. Such a restoration allows improved stretch and increased resting length and can reduce the likelihood of contracture. Alcohol or phenol, injected onto the motor nerve, denatures proteins and promotes axonal degeneration. The onset of action is within hours, whereas the duration of action is variable, ranging from 2 weeks to 6 months and beyond. The advantages of alcohol or phenol chemodenervation lie in their low cost and lack of antigenicity. The disadvantages include the technical difficulty of the injections and significant risk for pain as a result of treatment. Botulinum toxins, purified forms of Clostridium botulinum exotoxins, are injected directly into muscle, where they cleave one or more vesicle fusion proteins, thus blocking release of acetylcholine at the neuromuscular junction. Three commercial products--two of serotype A and one of B--are available. Each differs in its unit potency, side effects, and duration of action. On average, botulinum toxin has a clinical onset of action approximately 12 to 72 hours after injection, with a peak effect at 1 to 3 weeks. Effects then plateau for 1 to 2 months, with patients often requiring reinjection approximately every 3 months. Side effects may include local discomfort at the site of the injection and excessive weakness of the injected or nearby muscles, although more distant effects may occur. Antibody formation is a significant clinical concern and eventually obviates treatment benefit in approximately 5% of patients. Switching serotypes may be effective, at least temporarily. Consensus dosing guidelines have been developed and are presented within. Numerous studies have suggested that botulinum toxin has a role in the care of children with spasticity or dystonia related to cerebral palsy, and may improve equinus, gait, upper extremity use, comfort, and care. Evidence of functional improvement remains equivocal in the severely impaired child; however, there is evidence for improvement in less impaired children. The optimal candidate for injectable neuromuscular blockade is one who has a limited number of muscles that need treatment, who does not have fixed contracture, and who retains selective motor control. The ultimate goal of treatment for the hypertonic child is to maximize function, comfort, and independence. Hypertonia is only one aspect of the upper motoneuron syndrome, which includes both positive and negative symptoms. The treatment program, in which chemodenervation is only one tool, requires a multidisciplinary evaluation and individualized plan to address the whole patient.
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PMID:Injectable neuromuscular blockade in the treatment of spasticity and movement disorders. 1367 71

Comfort may be considered as the material aspect of well-being, and its limitation, defined as discomfort, exacerbates both the patient's and caregivers' difficulties. Discomfort results from the interaction of a patient's environment, treatment, and from the nature and severity of elementary deficits, such as spasticity, ranges of motion, pain, postural disorders, motor deficit and fatigue, bladder problems, insufficient ventilatory control, and also psychological difficulties. Although discomfort reduction may represent a major challenge in disabled persons, discomfort is usually underestimated in the assessment of deficiencies, disabilities, handicap, and even in quality of life (QOL) estimations. In this paper, we explain why discomfort may be a crucial problem in severe multiple sclerosis (MS) and argue for a systematic assessment of discomfort in the follow-up of the disease, especially in the following domains: dressing, washing, maintaining posture in a wheelchair and bed, food intake, mastication and swallowing, bowel control, urinary and feces emission, and also sexual life. The way to enhance comfort in MS patients is then analyzed.
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PMID:Comfort care in severely disabled multiple sclerosis patients. 1524 Jan 94

Spasticity is most commonly defined as an inappropriate, velocity dependent, increase in muscle tonic stretch reflexes, due to the amplified reactivity of motor segments to sensory input. It forms one component of the upper motor neuron syndrome and often leads to muscle stiffness and disability. Spasticity can, therefore, be measured through electrophysiological, biomechanical and clinical evaluation, the last most commonly using the Ashworth scale. None of these techniques incorporate the patient experience of spasticity, nor how it affects people's daily lives. Consequently, we set out to construct a rating scale to quantify the perspectives of the impact of spasticity on people with multiple sclerosis. Qualitative methods (in-depth patient interviews and focus groups, expert opinion and literature review) were used to develop a conceptual framework of spasticity impact, and to generate a pool of items with the potential to convert this framework into a rating scale with multiple dimensions. This item pool was administered, in the form of a questionnaire, to a sample of people with multiple sclerosis and spasticity. Guided by Rasch analysis, we constructed and validated a rating scale for each component of the conceptual framework. Decisions regarding item selection were based on the integration and assimilation of seven specific analyses including clinical meaning, ordering of thresholds, fit statistics and differential item functioning. The qualitative phase (17 patient interviews, 3 focus groups) generated 144 potential scale items and a conceptual model with eight components addressing symptoms (muscle stiffness, pain and discomfort and muscle spasms,), physical impact (activities of daily living, walking and body movements) and psychosocial impact (emotional health, social functioning). The first postal survey was sent to 272 people with multiple sclerosis and had a response rate of 88%. Findings supported the development of scales for each component but demonstrated that five item response options were too many. The 144-item questionnaire, reformatted with four-item response options, was administered with four validating instruments to an independent sample of 259 people with multiple sclerosis (response rate 78%). From the responses, an 88-item instrument with eight subscales was developed that satisfied criteria for reliable and valid measurement. Correlations with other measures were consistent with predictions. The 88-item Multiple Sclerosis Spasticity Scale (MSSS-88) is a reliable and valid, patient-based, interval-level measure of the impact of spasticity in multiple sclerosis. It has the potential to advance outcomes measurement in clinical trials and clinical practice, and provides a new perspective in the clinical evaluation of spasticity.
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PMID:Getting the measure of spasticity in multiple sclerosis: the Multiple Sclerosis Spasticity Scale (MSSS-88). 1628 Mar 52

The management of spinal cord injury patients requires a knowledge of several non-urological aspects associated with a risk of particular complications in these patients: pressure ulcers, spasticity and autonomic hyperreflexia. Spinal cord injury patients present a high risk of pressure ulcer, as almost all patients develop at least one pressure ulcer during their lifetime. During a stay in hospital, the medical team must be particularly attentive to prevent these problems, as, once they develop, they can take several months or even years to heal. Autonomic hyperreflexia and spasticity can be due to a urological cause. These two diseases can cause major discomfort for the patient and, in these patients, must be considered to be equivalent to the pain that they can no longer feel due to sensory disorders. The management of spinal cord injury patients must take into account these three particular risk factors: pressure ulcers, spasticity and autonomic hyperreflexia.
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PMID:[Clinical specificities of spinal cord injury patients (pressure ulcers, autonomic hyperreflexia, spasticity)]. 1762 76

Spasticity and other forms of muscle overactivity caused by cerebral palsy may impair function or ease of care or may cause discomfort or poor body image. The treatment program for a child with spasticity may include allied health therapy, exercise, casting, constraint-induced therapy, oral medications, chemodenervation, intrathecal baclofen, selective dorsal rhizotomy, and orthopedic surgery. Techniques may be combined for greater efficacy and better tailoring to the needs of the child. This article provides an overview of each approach, with a review of significant research findings in support of each.
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PMID:Management of spasticity in children with cerebral palsy. 1950 36

Spasticity is a common complication of CNS injury and a cause of considerable discomfort and disability for the patient and difficulty for caregivers. It is estimated that over half a million people in the USA are affected by spasticity. In recent years, advances in the treatment of spasticity include the use of intrathecal baclofen, addition of tizanidine to oral medication and the introduction of intramuscular botulinum toxin injections. This review aims to give an overview of one of those advances, the use of botulinum toxin. The term spasticity refers only to a type of increased muscle tone due to overactive stretch reflexes, but there are other forms of muscle overactivity that follow brain or spinal cord injury which cause problems. Generally, however, the clinical picture is dominated by the neurological deficits that result from CNS injury. A useful concept in understanding the motor consequences of injury to the CNS is that of the upper motor neuron syndrome.
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PMID:Botulinum toxin treatment of adult spasticity. 1981 Aug 80

Twenty patients with chronic intractable spinal spasticity were implanted with a totally implantable programmable pump for intrathecal administration of baclofen. The objective of this study was to evaluate the relationship between pump and the host. Clinical efficacy of the therapy was evaluated by the Ashworth Scale, the Spasms Frequency Scale, and the Functional Independence Measure (FIM) motor scores. All patients were asked to reply to 10 questions regarding discomfort of their refills, the ease of rehabilitation after therapy, their fear of pump failure and onset of alarm signals, their discomfort due to a metallic foreign body (the pump), the attitude of their relatives and other persons regarding their pump system, whether they would undergo this therapy again, and whether, in the absence of public health insurance, whether they would be willing to pay for their pump and therapy. The Ashworth scale, the Spasms Frequency Scale, and the FIM motor score showed a significant improvement in all patients after the onset of therapy with baclofen. The refill procedure was not a problem in all patients while four patients (20%) considered the number of refills "uncomfortable." Rehabilitation was no problem after the pump was implanted in all patients, 10 patients (50%) feared pump failure, while six patients (30%) feared their alarm signals. Three patients (15%) had some discomfort from their pumps rubbing against their belts; two patients (10%) stated that other people were aware of their pumps; all but two patients (10%) were ready to have their implants again; three patients (15%) would pay for the pump in case of absence of public health insurance for the therapy. We conclude that the implant of pumps for chronic intrathecal baclofen infusion is, today, a known effective procedure. Refill of the pump system was not a problem in our patient population, while the number of refills did cause some discomfort in some patients. It was shown by our study that the pump did facilitate rehabilitation in our patients, and a certain degree of dependence on the pump did exist. Fifty percent of the patients were afraid of pump failure and 30% were afraid of their alarm signals going off. The fact that most patients would undergo this therapy again and some would even pay for it directly in the absence of public insurance for the therapy were indices of patient satisfaction with the procedure. Because this was a small study, we believe that larger studies are necessary to corroborate our findings.
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PMID:Chronic Intrathecal Baclofen Infusion for Spasticity: Relationship between Pump and Host. 2215 Dec 71

We experienced an anesthetic management with rocuronium and neurostimulator for a surgical patient with amyotrophic lateral sclerosis. A 61-year-old man was scheduled for intrathecal baclofen pump implantation as treatment for his spasticity under general anesthesia. After oxygenation and totally intravenous induction with propofol and remifentanil, we administered 10 mg of rocuronium repeatedly monitoring with neurostimulator. When dosage of rocuronium reached 20 mg, train-of-four count reached 1 and his trachea was intubated without coughing or moving. Anesthesia was maintained intravenously. Train-of-four ratio recovered to 95%, 22 minutes after the first administration of rocuronium. Operation was accomplished uneventfully with no additional rocuronium. Bispectral index value recovered to 98 and the patient awoke and breathed spontaneously 19 minutes after termination of administration of anesthetic agents. We could confirm his stable and adequate respiration and trachea was extubated without reversal of rocuronium. In the postanesthesia care unit, he showed no discomfort and was returned to the ward. His symptoms did not deteriorate postoperatively and he was discharged on the 36th postoperative day.
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PMID:[Anesthetic management for a patient with amyotrophic lateral sclerosis; the neuromuscular monitoring was useful to determine appropriate dosages of rocuronium]. 2274 22

Background. Long-term splinting, using static orthoses to prevent contractures, is widely accepted in stroke patients with paresis of the upper limb. A number of stroke patients complain about increased pain and spasticity, which leads to the nonuse of the orthosis and a risk of developing a clenched fist. Objectives. Evaluating long-term use of static hand-wrist orthoses and experienced comfort in chronic stroke patients. Methods. Eleven stroke patients who were advised to use a static orthosis for at least one year ago were included. Semistructured telephone interviews were conducted to explore the long-term use and experienced comfort with the orthosis. Data were analyzed using descriptive statistics. Results. After at least one year, seven patients still wore the orthosis for the prescribed hours per day. Two patients were unable to wear the orthosis 8 hours per day, due to poor comfort. Two patients stopped using the orthosis because of an increase in spasticity or pain. Conclusions. These pilot data suggest that a number of stroke patients cannot tolerate a static orthosis over a long-term period because of discomfort. Without appropriate treatment opportunities, these patients will remain at risk of developing a clenched fist and will experience problems with daily activities and hygiene maintenance.
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PMID:Long-term use of a static hand-wrist orthosis in chronic stroke patients: a pilot study. 2353 61

This detailed medical charts' data collection study conducted at a multiple sclerosis (MS) clinic in Germany evaluated the effectiveness of tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray in patients with resistant MS spasticity. Over a 15-month timeframe, THC:CBD spray was initiated in 166 patients. Mean follow-up was 9 months. In all, 120 patients remained on treatment for a response rate of 72%. THC:CBD spray was used as add-on therapy in 95 patients and as monotherapy in 25 patients to achieve best-possible therapeutic results. Among responders, the mean spasticity 0-10 numerical rating scale (NRS) score decreased by 57%, from 7.0 before treatment to 3.0 within 10 days of starting THC:CBD spray. The mean dosage was 4 sprays/day. Most patients who withdrew from treatment (40/46) had been receiving THC:CBD spray for less than 60 days. Main reasons for treatment discontinuation were: adverse drug reactions, mainly dizziness, fatigue and oral discomfort (23 patients; 13.9%); lack of efficacy (14 patients; 8.4%); or need for a baclofen pump (9 patients; 5.4%). No new safety signals were noted with THC:CBD spray during the evaluation period. In this routine clinical practice setting at an MS clinic in Germany, THC:CBD spray was effective and well tolerated as add-on therapy or as monotherapy in a relevant proportion of patients with resistant MS spasticity.
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PMID:Clinical experience with THC:CBD oromucosal spray in patients with multiple sclerosis-related spasticity. 2439 12


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