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Biomedical subjects

G Barolat-Romana

Publications and source records attributed to G Barolat-Romana.

14 recordsLinked to original sources
PubMed1988

Femoral obturator and sciatic neurectomy with iliacus and psoas muscle section for spasticity following spinal cord injury.

The treatment of severe refractory spasticity following spinal cord injury may raise challenging therapeutic problems. Classical approaches involve various types of myelotomies, rhizotomies and intrathecal injections of neurolytic substances. Alternative approaches include percutaneous rhizotomies and, more recently, the possible use of electrical stimulation of the spinal cord. Certain cases, however, may not be amenable to commonly accepted techniques. An operative technique is presented which involves a suprapubic incision for an infraperitoneal approach to a femoral and obturator neurectomy and an incision of the iliacus and psoas muscles bilaterally. This may be followed, when indicated, by a bilateral infragluteal section of the sciatic nerves. This technique offers a viable surgical alternative to the treatment of spasticity following spinal cord injury in cases where other traditional methods are contraindicated or have failed.

Adolescent↗
PubMed1987

Spinal cord stimulation for amelioration of spasticity: experimental results.

Fourteen cats underwent 500-g/cm dorsal impact injuries to the spinal cord and the placement of stimulating electrodes above and below the level of injury at T8. After recovery from the surgical procedure and the development of spasticity, each animal participated in several trials of spinal cord stimulation (SCS). Cord stimulation was provided above or below the level of injury using currents of less than 0.75 mA at 100 Hz. Electromyogram changes in hamstring and quadricep muscles (during spasms induced by dorsiflexion of the paw) were monitored. All animals showed complete paraplegia and, at 3 weeks, severe spasms. Spasticity was aggravated by SCS delivered above the level of injury. Spasms were markedly suppressed by monopolar stimulation delivered below the level of the lesion. Effects were maximal with the negative electrode applied to the cord and were slightly less with reversal of polarity. Muscle excitation was seen before diminution of spasms when bipolar currents were used. All effects lasted only as long as currents were delivered. These animal trials suggest that the effects of SCS are directly related to the current and its type. Beneficial effects were seen only when currents were delivered below the level of injury; this suggests that SCS activates local inhibitory processes or depolarizes local excitatory pathways. The poor results with bipolar stimulation do not support action on a multisynaptic cord system in short term stimulation.

Animals↗
PubMed1985

Immediate effects of spinal cord stimulation in spinal spasticity.

Six patients with intractable spasms after spinal cord injury underwent implantation of an epidural spinal cord stimulation system. All the patients experienced good relief postoperatively. In three patients spinal cord stimulation consistently produced immediate inhibition of the spasms. This was evident within less than 1 minute of stimulation. Conversely, the spasms reappeared within less than 1 minute after cessation of the stimulation. The clinical observations were confirmed by polygraphic electromyographic recordings.

Adult↗
PubMed1984

Influence of stimulus location and limb position on motor responses in the comatose patient.

Motor responses to standardized stimuli were evaluated in 18 comatose patients with abnormal motor reactions. Painful stimuli were applied to three areas: the supraorbital, sternal, and medial aspects of the arm. Stimulations were carried out with the upper limbs first flexed and then extended. The initial position of the arm significantly influenced the posturing pattern. With the arm initially flexed there was a significantly higher percentage of abnormal flexor reactions, and the opposite occurred with the arm initially extended. Supraorbital stimulation yielded a significantly higher number of extensor responses. Arm stimulation, instead, caused a higher percentage of abnormal flexor reactions. When painful stimulation was applied to an arm initially flexed, the percentage of extensor responses was extremely low. Conversely, supraorbital stimulation with the arms extended yielded the highest percentage of extensor responses. The study shows that, within the frame of abnormal motor responses, the same patient can exhibit different reactions according to the site of stimulation and initial position of the upper extremities. These patterns are fairly constant and should be borne in mind in the evaluation of comatose patients.

Adult↗
PubMed1983

Spinal intradural extraarachnoid metastasis.

A case of carcinomatous metastasis at the L2-3 level localized in the intradural extraarachnoid space is presented. The anatomy of the subarachnoid angle where the transition occurs from peripheral nerve to nerve root is reviewed. Anatomic evidence suggests that the spread of the tumor to the potential intradural extraarachnoid space might be via the perineural sheath.

Arachnoid↗
PubMed1980

Chronic cerebellar stimulation for cerebral palsy--five-year study.

Two hundred sixty-two patients were implanted with cerebellar stimulator systems since February 1974. Cerebral Palsy (CP) patients constituted 88% (230) of this series. The age range was 3 to 53 years with 70% under 20 years of age. Half the CP series were severely affected with the rest being moderately to mildly involved. Athetosis was present in 50%. The primary effect of CCS has been a lowering of spastic muscle tone in 90% of the patients. Improvements in control of immature reflexes such as startle response, head control, scissoring, balance and sitting occur in the first month. Athetosis progressively decreases to a 50% level. In the moderate mild CP group abilities improve over the first six months leading to better feeding, dressing, and ambulation with clearer speech and less drooling. After six months, 25 of 48 patients were out of wheelchairs, walking. A further 47 patients were ambulating better. No deaths from surgery. Five have died during the 5 years from other causes. Eleven patients (4%) have had infected systems. Equipment problems especially with malfunctioning radio receivers (40%) have served as blind controls--spasticity returning and abilities decreasing. Replacements with another receiver or with a totally implantable lithium powered pacemaker (May 1979) have lead to a return of benefits. Post-mortem findings indicate the low current levels (0.8 uC/sqcm) applied intermittently produced no appreciable damage to the cerebellar cortex.

Adolescent↗
PubMed1978

Surgical treatment of spasticity in cerebral palsy.

Since 1971, we have surgically treated spasticity in 109 cases of cerebral palsy with posterior rhizotomy. The best results have been obtained with functional posterior rhizotomy, an original modification of Foerster's technique, in which the selection of the roots/rootlets to be sectioned is based on functional exploration of the spinal circuits involved in the maintenance of spasticity, using intraoperative electrostimulation on dorsal roots. This method makes selective sections possible, thereby saving a larger number of normal proprioceptive afferents, with consequent reduction in negative side effects. No recurrencies have been observed in our 3-year follow-up. The main indication is Little's disease.

Cerebral Palsy↗
PubMed1976

[Functional posterior radiculotomy, in the treatment of cerebral spasticity. peroperative electric stimulation of posterior roots and its use in the choice of the roots to be sectioned].

The authors present a modification of Foerster's Rhizotomy for the treatment of spasticity in cerebral palsy: functional posterior rhizotomy. The selection of the roots/rootlesses to be sectioned, is accomplished on functional data, based upon the analysis of the reflex responses to the intraoperative lumbar dorsal roots stimulation. With this method it is possible to selectively interfere with the pathological circuits responsible for hypertonia, saving proprioceptive afferences necessary for motor reeducation. The clinical results on hypertonia are the same as for total or partial rhizotomies, but sides effects (ataxia, hypotonia) are considerably reduced.

Cerebral Palsy↗