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

Electromyographic (EMG) recordings from multiple muscle groups with surface electrodes during systematic evaluation of phasic and tonic stretch reflexes, cutaneomuscular reflexes, long loop reflexes, postural reflexes, and volitional activation have been used to provide a neurophysiologic basis for selection of the appropriate treatment for spasticity, and to gain further insights into the general mechanisms of spasticity. Pharmacologic methods are useful as a temporary measure. Hypertonia of a single muscle can be effectively treated with 40% alcohol injections to the motor points and hypertonia of a muscle group with partial denervation through 6% phenol in water injected into the nerve trunk. Hypertonia of several muscle groups can be treated by chemical or surgical rhizotomy or myelotomy. Generalized hypertonia involving limb and trunk muscles can be modified through chronic epidural stimulation of the spinal cord. Modification of reciprocal antagonistic muscle activity may be achieved through electrical stimulation of the involved nerve trunks.
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PMID:Spasticity: medical and surgical treatment. 699 92

Forty-nine open phenol nerve injections were performed for acquired spasticity during a five-year period. The most common etiology of acquired spasticity was closed head injury (70%). Thirteen phenol injections to the musculocutaneous nerve were performed for excessive elbow flexion. The immediate results were absence of biceps and brachialis muscle activity, and an average gain of 43 degrees in extension. The effects of the nerve block subsided within six months. Nine nerve blocks were followed for more than one year. In two patients the upper extremities were almost normal. In the remaining seven the upper extremities were nonfunctional. Twenty-eight phenol injections to the posterior tibial nerve were performed for uncontrolled excessive plantar flexion and/or fixed equinus. The immediate result was cessation of gastrocnemius and soleus activity. Twenty-seven ankles attained a neutral position. The effects of the nerve block subsided within six months. Thirteen patients with 19 blocks were followed for more than eight months. Nine patients underwent lengthening of the Achilles tendon and six patients required orthotic devices for control of plantar flexion spasticity. In general, patients with acquired spasticity who require open phenol nerve blocks are unlikely to have normal functioning extremities when the effects of the nerve block have subsided.
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PMID:Current uses of open phenol nerve block for adult acquired spasticity. 707 63

The use of phenol motor nerve blocks is advantageous in the early period of acquired spasticity (ie, that occurring following traumatic brain injury or incomplete spinal cord injury), when increased muscle tone is often the most severe. Because acquired spasticity is dynamic and usually improves slowly, a temporary treatment method used to ameliorate increased muscle tone is desirable. Phenol nerve infiltration provides a temporary motor nerve block that lasts for weeks or months. It allows passive limb mobilization in a comprehensive rehabilitation program that attempts to prevent fixed soft tissue contractures. Permanent or irreversible methods such as operative tendon lengthening, muscle release or recession, or neurectomy are usually best delayed until the spasticity has become static, when the need for surgical correction becomes more firmly indicated, and outcomes of operative intervention are more predictable. Although phenol nerve blocks were initially administered at the spinal cord level to control spasticity, the potential side effects have caused a loss of popularity of this method of administration. The safer and more common use of phenol infiltration at the peripheral nerve level is now more accepted for brain injury and spinal cord injury patients. This report reviews the indications, current concepts, and development of the different methods used to administer phenol nerve blocks. Comparisons to other methods to control spasticity are discussed.
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PMID:Treatment of acquired muscle spasticity using phenol peripheral nerve blocks. 774 50

CVA is a very common problem that can lead to lower extremity complications. Impairment in gait pattern occurs often due to spasticity and less frequently due to prolonged flaccidity. This problem is manifested by equinus, varus, equinovarus, and toe flexion deformities. Therefore, prevention or elimination of spasticity must be achieved. Various modalities have been used, both conservative and surgical. Nonsurgical interventions include range of motion and strengthening exercises, pharmacologic agents, local anesthetic and phenol motor point blocks, and the use of orthoses. Surgical intervention should be considered after conservative treatment has failed. The goal of treatment is to reduce the deforming force as a result of spasticity and to allow for almost normal function to be achieved. This includes tendon transfers, tendon lengthenings, tenotomies, and arthrodeses of small toe joints. Preoperatively, the extent and progression of spasticity must be determined because this may affect the rate of recurrence of the deformity following surgical correction. The combination of arthrodeses of the interphalangeal joints and flexor tendon release is the best option in the presence of a spastic deformity. Arthrodesis provides for stability at the joint, whereas a flexor release eliminates the deforming force. Failure to address the plantar-flexor force of the long flexors can lead to instability at the fusion site. This may in turn lead to nonunion and recurrence of flexion contracture as shown in the case report in this article.
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PMID:Stroke and its manifestations in the foot. A case report. 781 9

To eliminate severe leg spasms of 15 quadriplegics, 0.3 ml 10% phenol-glycerin was injected into the subarachnoid space at the T12/L1 interspace. The effectiveness for leg spasm was evaluated by the Penn spasticity and Ashworth rigidity scales. Three patients remained completely flaccid; however three had slight, six had moderate and three had complete recurrence of spasms in a follow up period of observation for 1 to 22 (average 13) months. The result of selective intrathecal phenol block was significantly valuable, improving the activities of daily living (ADL) of quadriplegic patients. There were no systemic side effects nor disturbance of bladder, bowel or sexual functions.
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PMID:Selective intrathecal phenol block to improve activities of daily living in patients with spastic quadriplegia. A preliminary report. 797 Aug 51

Potential advantages of intramuscular botulinum toxin for the treatment of spasticity include the lack of sensory effects, ability to target specific muscle groups, ability to weaken muscles in a graded fashion and absence of caustic chemicals such as phenol. We describe the use of botulinum toxin for the treatment of severe lower extremity spasticity in two subjects with multiple sclerosis. Both subjects showed an improvement in spasticity, as measured by the modified Ashworth scale, and in functional status. Both subjects exhibited reductions in muscle tone not only in injected muscles, but also in noninjected muscles in the region. These more distant clinical effects have not been emphasized in previous studies after therapeutic injections of botulinum toxin. Further research is needed to clarify the cause and prevalence of these regional motor effects, as well as to further examine the safety and efficacy of botulinum toxin for spasticity treatment.
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PMID:Botulinum toxin for the treatment of spasticity in multiple sclerosis. New observations. 826 Jan 29

Intramuscular phenol neurolysis is a well-known procedure used to decrease spasticity and improve function in patients who have failed to respond to more conservative forms of intervention. Traditionally, this approach has been limited to spasticity reduction in limb muscles, and its use in managing spasticity of the facial muscles has not been described in the literature. This case report describes a new and previously unreported application of intramuscular neurolysis for managing severe unrelenting facial muscle spasticity in a postanoxic encephalopathic patient. Prior to the procedure, hypertonicity in the orbicularis oris muscle was so profound that it limited speech and affected cosmetic, hygienic, and nutritional status. After intramuscular phenol neurolysis of the orbicularis oris muscle, the patient's level of functioning improved.
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PMID:Attenuation of facial muscle spasticity with intramuscular phenol neurolysis. 843 Nov 9

Clinically, phenol is used often as a neurolytic agent to treat pain and spasticity. The purpose of this study was to examine the time course of denervation and recovery in several hindlimb muscles following application of a 5% aqueous solution of phenol to the sciatic nerve. Phenol was applied to the sciatic nerve of adult female rats either by intraneural or perineural injection. Axonal degeneration was evident within the sciatic nerve 2 days following phenol application, although variable amounts of damage were observed. By 2 weeks, the soleus and tibialis anterior had atrophied to 63% and 51% of control. Reinnervation of hindlimb muscles occurred between 2 and 4 weeks following the nerve block. Following denervation, the soleus became slower in that all of the fibers expressed the slow myosin heavy chain (MHC). At 5 months, maximum tension of the soleus was 74% of control and the muscle consisted of more fast fibers on average, some of which expressed IIx MHC. These data suggest that 5% phenol causes an injury to the nerve that is more severe than a crush injury, and that reinnervation of denervated muscles may be by motoneurons other than those that originally innervated the muscles.
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PMID:Time course of muscle atrophy and recovery following a phenol-induced nerve block. 862 29

Neuromuscular blocking agents-45% alcohol, 4% to 6% aqueous phenol, local anesthetics, and botulinum A toxin-have been used for many years in the evaluation and management of spasticity and movement disorders in children with cerebral palsy. Recent reports suggest that longer-acting neuromuscular blocking agents may impact positively on the natural history of dynamic deformity and improve health-related quality of life. This review includes the mechanism of action, techniques, indications, complications, and clinical outcomes associated with these agents.
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PMID:Neuromuscular blockade in the management of cerebral palsy. 895 58

Spasticity is a velocity-dependent increase in stretch reflex activity. It is one of the forms of muscle overactivity that may affect patients with damage to the central nervous system. Spasticity monitoring is relevant to function because the degree of spasticity may reflect the intensity of other disabling types of muscle overactivity, such as unwanted antagonistic co-contractions, permanent muscle activity in the absence of any stretch or volitional command (spastic dystonia), or inappropriate responses to cutaneous or vegetative inputs. In addition, spasticity, like other muscle overactivity, can cause muscle shortening, which is another significant source of disability. Finally, spasticity is the only form of muscle overactivity easily quantifiable at the bedside. Under the name pharmacological treatments of spasticity, we understand the use of agents designed to reduce all types of muscle overactivity, by reducing excitability of motor pathways, at the level of the central nervous system, the neuromuscular junctions, or the muscle. Pharmacologic treatment should be an adjunct to muscle lengthening and training of antagonists. Localized muscle overactivity of specific muscle groups is often seen in a number of common pathologies, including stroke and traumatic brain injury. In these cases, we favor the use of local treatments in those muscles where overactivity is most disabling, by injection into muscle (neuromuscular block) or close to the nerve supplying the muscle (perineural block). Two types of local agents have been used in addition to the newly emerged botulinum toxin: local anesthetics (lidocaine and congeners), with a fully reversible action of short duration, and alcohols (ethanol and phenol), with a longer duration of action. Local anesthetics block both afferent and efferent messages. The onset of action is within minutes and duration of action varies between one and several hours according to the agent used. Their use requires resuscitation equipment available close by. When a long-lasting blocking agent is being considered, we favor the use of transient blocks with local anesthetics for therapeutic tests or diagnostic procedures to answer the following questions: Can function be improved by the block? What are the roles played by overactivity and contracture in the impairment of function? Which muscle is contributing to pathologic posturing? What is the true level of performance of antagonistic muscles? A short-acting anesthetic can also serve as preparation to casting or as an analgesic for intramuscular injections of other antispastic treatment. Alcohol and phenol provide long-term chemical neurolysis through destruction of peripheral nerve. Experience with ethanol is more developed in children using intramuscular injection, while experience with phenol is greater in adults with perineural injection. In both cases, there are anecdotal reports of efficacy but studies have rarely been controlled. Side effects are numerous and include pain during injection, chronic dysesthesia and chronic pain, and episodes of local or regional vascular complications by vessel toxicity. In the absence of controlled studies, a theoretical comparison of neurolytic agents with botulinum toxin is proposed. Neurolytic agents may be preferred to botulinum toxin on a number of grounds, including earlier onset, potentially longer duration of effect, lower cost, and easier storage. Conversely, pain during injection, tissue destruction with chronic sensory side effects, and lack of selectivity on motor function with neurolytic agents may favor the use of botulinum toxin. Neurolytic agents and botulinum toxin may be used in combination, the former for larger proximal muscles and the latter for selective injection into distal muscles. In the future, neurolytic agents may prove more appropriate in very severely affected patients for whom the purposes of the block are comfort and hygiene. (ABSTRACT TRUNCATED)
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PMID:Traditional pharmacological treatments for spasticity. Part I: Local treatments. 982 83


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