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)

Intramuscular neutrolysis with phenol has been used for 10 years in the management of spasticity in children. Best results depend on fastidious technique and realistic use of the procedure. Sedation or anesthesia was used in all cases -- 5% phenol in water was used for all procedures. The main indications were spasticity which interfered with function, either actual or potential, or with care. Where uninhibited vestibular or tonic neck reflexes affect muscle tone, or there is dystonia or athetosis, the procedure is less effective than where spasticity alone is present. Duration of relief of spasticity ranged from 1 month to more than 2 years. About one half of the lower extremity muscle treated required tenotomy later. Generally training was required after the procedure to obtain improved function. A representative sample of muscles treated, repeat procedures, and later surgery is discussed. The procedure is recommended for use in the management of spasticity in children as a way of improving function and/or care.
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PMID:Intramuscular neurolysis for spasticity in children. 47 67

Recent successful introduction of selective rhizotomy in the management of lower extremity spasticity in patients with myelodysplasia has prompted us to use it as a means of managing high pressure neurogenic bladders occasionally encountered in myelodysplastic patients. During the last 1 1/2 years 8 children have undergone selective sacral rhizotomy in an attempt to avert urinary diversion or bladder augmentation. Patient age ranged from 6.5 to 18.5 years. The level of the respective lesions was evenly distributed throughout the spine. At spinal surgery each patient had an electrode placed in the detrusor of the bladder via a suprapubic approach, electromyography electrodes were placed in the perineum and slow fill water cystometry was performed throughout the procedure. Standard electrophysiological stimulation of the nerve roots was performed to identify the rootlets that would only affect the detrusor and spare the external sphincter. Postoperative followup has been obtained on all patients. Of the patients 4 have exhibited significant improvement and they have not required augmentation, 2 have not shown any further deterioration in bladder function, 1 has demonstrated deterioration and 1 still lacks urodynamic followup. Postoperative cystometric studies have revealed a bladder capacity increase of 69% for the group. Uninhibited bladder contractions were abated in all but 1 patient. No patient has been rendered incontinent of urine from the procedure and no patient has had a problem with stool continence as a result of the rhizotomy. It appears that selective rhizotomy of the sacral roots has been able to increase bladder capacity as well as compliance in patients who normally would have been relegated to either bladder augmentation or urinary diversion. While these are encouraging results, some further followup is required to ascertain if the early improvements will be long-lasting.
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PMID:Selective sacral rhizotomy in children with high pressure neurogenic bladders: preliminary results. 164 May 38

Dantrolene, a direct acting muscle relaxant used orally for spasticity, has appeared to be effective in the prevention and treatment of malignant hyperthermia in man and animals when administered intravenously. Its pharmacokinetics following intravenous administration have been studied in dogs. Concentrations of dantrolene and its metabolites in plasma, urine, and bile were determined by high-performance liquid chromatography. Recovery of unchanged drug and reduced metabolites was negligible; of the hydroxy metabolite 2% was found in the urine and about 25% in the bile. The half-life of 5-hydroxydantrolene was shorter than that of the parent drug as demonstrated by administration of the metabolite. The apparent renal clearance of 5-hydroxydantrolene was independent of creatinine clearance, urine flow and pH, and appeared to be reduced in the presence of probenecid. Bile to plasma ratios of the hydroxy metabolite were high with biliary concentrations far exceeding the maximum solubility in water. The results of this pilot study indicate that hydroxylation is primarily responsible for the excretion of the dantrolene molecule from the body.
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PMID:Pharmacokinetics of intravenously administered dantrolene and its 5-hydroxy metabolite in dogs. 207 79

The water-soluble benzodiazepine, midazolam, was administered epidurally over the lumbar enlargement 18 times to 9 patients with spasticity due to severe spinal cord injury. Doses of 1.25-3.75 mg produced a rapid decrease of spasticity which lasted 1 h. After the maximal reduction of spasticity, the patients became drowsy. While the results suggest a direct action of midazolam on the spinal cord to reduce spasticity, the effect does not contribute to its usefulness as a therapeutic tool.
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PMID:Direct spinal effect of a benzodiazepine (midazolam) on spasticity in man. 262 5

To compare the effect of walking exercise in water with that in air in cerebral palsied children, we measured in ten subjects oxygen uptake (VO2) during walking for 3-minutes. In 7 children with spastic type of cerebral palsy, VO2 values were significantly lower in exercises in water than in air (p less than 0.05). No significant differences were found in athetotic children. In 5 children with crouched posture VO2 showed a tendency to be lower in exercises in water than in air (0.05 less than p less than 0.1). In contrast, significant differences were not found in 5 children without crouched posture. Children with spasticity or crouched posture may be able to walk in water more than in air.
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PMID:[Comparison of walking exercises in air and in water in children with cerebral palsy]. 280 98

Baclofen (Lioresal, Ciba-Geigy) is an analog of the inhibitory neurotransmitter GABA and is used clinically to control spasticity. Recent studies have demonstrated that this compound produces a marked inhibition of synaptically evoked responses in area CA3 of the hippocampal slice, suggesting that this drug could influence behavior mediated by the limbic system. In the present study, male rats of the Fischer-344 strain were trained on a one-trial passive avoidance task and tested for retention 1 week later. After the training trial, separate groups of rats received either 5 or 10 mg/kg/4 ml IP of baclofen or the distilled H2O vehicle immediately, 10 min, or 60 min after training. One week later, the rats that received baclofen immediately after training reentered the test chamber with a significantly higher frequency than controls, although no differences in vacillatory responses were observed between groups. Similar effects were observed following posttrial administration of chlordiazepoxide. In a separate experiment rats were tested for locomotor activity after receiving the same doses of baclofen. Although baclofen decreased activity during a 30-min period after dosing, rats exposed to baclofen showed no significant change in activity relative to controls 1 week later. These data are consistent with the interpretation that baclofen may interfere with memory consolidation or retention.
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PMID:Baclofen disrupts passive avoidance retention in rats. 281 19

Recent pharmacological investigations have support the hypothesis that spinal modulation of nociception as well as motor coordination is related to the activity of spinal interneurons and that certain spinal transmitters are involved in the control of both regulatory systems. Opioids and benzodiazepines, i.e. endorphin- or GABA-induced mechanisms, may be of importance for spinal treatment of spasticity in the near future. In order to clinically evaluate the interactions of these spinal processes we performed in vitro-experiments, animal studies and clinical investigations on the compatibility and antispastic efficacy of spinally administered opiates and benzodiazepines. Preclinical studies on tissue- and CSF-tolerance of different benzodiazepines (pH, tonometry, turbidimetry, histological findings in animals) are in favour of midazolam, a water-soluble compound, which is active against pharmacologically induced spasms in animals (strychnine application in cats with chronical catheterization of the subarachnoid space) after lumbar intrathecal injection. Using an appropriate dosage of intrathecal midazolam selective blockade of spasticity of the hind legs may be demonstrated with integrated EMG. Clinical investigations (neurological assessment using rating scores for spasticity) in 16 patients, including a double-blind comparison of epidural morphine or midazolam, indicate that both drugs are effective against spinal spasticity of different origin. Efficacy of spinally applied agents depends on the severity of spasms and on the duration and extent of systemic pretreatment.
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PMID:[Spasticity treatment with spinal morphine or midazolam. In vitro experiments, animal studies and clinical studies on compatibility and effectiveness]. 294 90

Local hypothermia was used to manage motor disorders in infantile cerebral paralysis. Ice was applied to muscles being the key factors in the pathologic muscular synergies and determinants of the level of motor disorders at the residual stage of infantile cerebral paralysis. The hypothermic method is given in detail with respect to different pathologic muscle synergies and infantile cerebral paralysis syndrome peculiarities: spastic diplegia varying in severity, hyperkinetic syndrome. EMG investigations yielded results correlating with a positive clinical effect. The EMG data indicated that deprivation of pathologic muscle afferentation not only reduced the muscle spasticity but also led to functional reconstruction in the spinal motoneuron pool.
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PMID:[Artificial local hypothermia in the treatment of children with cerebral palsy]. 319 81

Multiple sulphatase deficiency was studied in 3 siblings--one pair of monozygotic twins and their sister. The children's psychomotor development was arrested at the age of 18 to 24 months, and the hypotonic syndrome combined with signs of spasticity appeared. There was marked hepatosplenomegaly, conspicuously dry scaly skin with the decortication syndrome developing and persisting in the presence of pronounced cachexia. Also present were numerous X-ray abnormalities, metachromatically staining granules in the urine, and Alder- Reilly 's bodies in the blood leukocytes and in specimens of bone marrow. Liver, skin and muscle biopsies performed simultaneously revealed accumulations of water-soluble mucopolysaccharides and deposits of sulphatides in the two twins. Enzyme assays demonstrated arylsulphatase A and B deficiency. The diagnosis was subsequently confirmed at all the three siblings' postmortem examinations.
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PMID:Multiple sulphatase deficiency in homozygotic twins. 642 40

A 12-year-old boy presented with enuresis, leg weakness, and lower extremity spasticity. An initial lumbar water-soluble contrast myelogram disclosed an arachnoid diverticulum. After the insertion of a cystopleural shunt, the patient improved and was dry. However, 2 months later the patient became enuretic and developed weakness. Repeat myelography showed a second arachnoid diverticulum located in the midthoracic region. This second diverticulum was treated by marsupialization of the cyst wall to the subfascial space. The authors stress the need for complete myelography in patients with intradural spinal arachnoid diverticuli and present a brief review of the literature.
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PMID:Multiple intradural arachnoid diverticuli: the need for complete myelography. 644 48


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