Marihuana as a therapeutic agent for muscle spasm or spasticity.
Explore the source record for details and available documents.
Adult↗
SEARCH · PubMed Health
Results for “Muscle Spasticity”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A technique for recording muscle contractions in spastic patients.
Explore the source record for details and available documents.
Electric Stimulation↗
Relationship between static muscle strength deficits and spasticity in stroke patients with hemiparesis.
The purpose of this retrospective investigation was to determine whether a relationship exists between static strength deficits in the shoulder medial (internal) rotator and elbow flexor muscles and spasticity in these muscles or their antagonists. We reviewed the records of the first 50 stroke patients with hemiparesis who met the entry criteria for the study and who were admitted over a four-month period of time. Static muscle strength was measured by hand-held dynamometry. Spasticity was graded on the Ashworth scale. Kendall's tau correlations were calculated between static muscle strength deficits and spasticity. Static strength deficits of the shoulder medial rotator and elbow flexor muscles were correlated (p less than .01) with the agonist muscles' spasticity, but not with the antagonist muscles' spasticity. Muscle group spasticity and strength deficits, therefore, appear to be covarying manifestations of cerebrovascular accidents. Clinicians, thus, may interpret an agonist muscle's capacity for force production in light of its own tone rather than that of its antagonist.
Adult↗
Cannabinoids in the treatment of pain and spasticity in multiple sclerosis.
There is a large amount of evidence to support the view that the psychoactive ingredient in cannabis, delta9-tetrahydrocannabinol (delta9-THC), and cannabinoids in general, can reduce muscle spasticity and pain under some circumstances. Cannabinoid (CB1) receptors in the CNS appear to mediate both of these effects and endogenous cannabinoids may fulfil these functions to some extent under normal circumstances. However, in the context of multiple sclerosis (MS), it is still questionable whether cannabinoids are superior to existing, conventional medicationsfor the treatment of spasticity and pain. In the case of spasticity, there are too few controlled clinical trials to draw any reliable conclusion at this stage. In the case of pain, most of the available trials suggest that cannabinoids are not superior to existing treatments; however, few trials have examined chronic pain syndromes that are relevant to MS. Whether or not cannabinoids do have therapeutic potential in the treatment of MS, a further issue will be whether synthetic cannabinoids should be used in preference to cannabis itself. Smoking cannabis is associated with significant risks of lung cancer and other respiratory dysfunction. Furthermore, delta9-THC, as a broad-spectrum cannabinoid receptor agonist, will activate both CB1 and CB2 receptors. Synthetic cannabinoids, which target specific cannabinoid receptor subtypes in specific parts of the CNS, are likely to be of more therapeutic use than delta9-THC itself. If rapid absorption is necessary, such synthetic drugs could be delivered via aerosol formulations.
Analgesics, Non-Narcotic↗
Properties and use of botulinum toxin and other microbial neurotoxins in medicine.
Crystalline botulinum toxin type A was licensed in December 1989 by the Food and Drug Administration for treatment of certain spasmodic muscle disorders following 10 or more years of experimental treatment on human volunteers. Botulinum toxin exerts its action on a muscle indirectly by blocking the release of the neurotransmitter acetylcholine at the nerve ending, resulting in reduced muscle activity or paralysis. The injection of only nanogram quantities (1 ng = 30 mouse 50% lethal doses [U]) of the toxin into a spastic muscle is required to bring about the desired muscle control. The type A toxin produced in anaerobic culture and purified in crystalline form has a specific toxicity in mice of 3 x 10(7) U/mg. The crystalline toxin is a high-molecular-weight protein of 900,000 Mr and is composed of two molecules of neurotoxin (ca. 150,000 Mr) noncovalently bound to nontoxic proteins that play an important role in the stability of the toxic unit and its effective toxicity. Because the toxin is administered by injection directly into neuromuscular tissue, the methods of culturing and purification are vital. Its chemical, physical, and biological properties as applied to its use in medicine are described. Dilution and drying of the toxin for dispensing causes some detoxification, and the mouse assay is the only means of evaluation for human treatment. Other microbial neurotoxins may have uses in medicine; these include serotypes of botulinum toxins and tetanus toxin. Certain neurotoxins produced by dinoflagellates, including saxitoxin and tetrodotoxin, cause muscle paralysis through their effect on the action potential at the voltage-gated sodium channel. Saxitoxin used with anaesthetics lengthens the effect of the anaesthetic and may enhance the effectiveness of other medical drugs. Combining toxins with drugs could increase their effectiveness in treatment of human disease.
Bacterial Toxins↗
Established hip dislocations in children with cerebral palsy.
Hip dislocation in children with cerebral palsy is caused by a combination of factors, including spastic muscle imbalance, persistent fetal femoral geometry, acetabular dysplasia, and flexion-adduction contracture. The incidence of dislocation correlates with the severity of the spasticity, and the prevalence is close to 50% in neurologically immature, spastic quadriplegic children. Successful hip reductions improve muscular balance, provide satisfactory reduction of the femoral head, and establish good pelvic coverage. In 31 occurrences of established hip dislocation in 24 patients, the most successful operations used a combined procedure consisting of soft-tissue release, open reduction, femoral varus derotation and shortening osteotomy, and pelvic osteotomy.
Cerebral Palsy↗
[Treatment of spasticity with botulinum toxin and muscle afferent block].
Spasticity is partly caused by disinhibition of spinal stretch reflex activity and blocking of the group Ia afferents may improve its clinical symptoms. Since muscle afferent block has been successfully used for treating dystonia, this method may become useful for treating spasticity as well. We injected diluted lidocaine (0.5%, 50 ml/session) and ethanol (5 ml) into thigh adductors (for leg crossing), medial hamstrings (for medial rotation of the leg), quadriceps femoris (for hyperextension of the knee), tibialis posterior and triceps surae muscles (pes equinovarus deformity), biceps brachii and forearm flexors (for flexion deformities of the upper extremity) in 12 patients with spasticity. Although the duration of action was short (< 1 day) at first, it was gradually prolonged to several weeks by repeating the injection every 3-4 days. The final outcome was comparable to that obtained by botulinum toxin injection in the same group of patients. This method may prove its promise as a means of treating spasticity.
Adult↗
[When and how to prescribe muscle relaxants in spasticity ?].
Explore the source record for details and available documents.
Baclofen↗
Review article: botulinum toxin in the therapy of gastrointestinal motility disorders.
Since 1980, botulinum toxin has been employed for the treatment of various voluntary muscle spastic disorders in the fields of neurology and ophthalmology. More recently, botulinum toxin has been proved to be effective in the therapy of dyskinetic smooth muscle disorders of the gastrointestinal tract. Achalasia and anal fissure are the gastrointestinal disorders in which botulinum toxin therapy has been most extensively investigated. Botulinum toxin is the best treatment option for achalasia in patients whose condition makes them unfit for pneumatic dilation or surgery. In anal fissure, botulinum toxin is highly effective and may become the treatment of choice. In the future, botulinum toxin application in the gastrointestinal tract will be extended to many other gastrointestinal disorders, such as non-achalasic motor disorders of the oesophagus, dysfunction of Oddi's sphincter, achalasia of the internal anal sphincter and others. This article describes the mechanism of action, rationale of employment, indications and side-effects of botulinum toxin application in smooth muscle disorders of the gastrointestinal tract, and compares the results of different techniques of botulinum toxin therapeutic application.
Anti-Dyskinesia Agents↗
The individuality of chest wall motion in tetraplegia.
We have studied the motion of the chest wall in eight supine tetraplegic subjects using optical contour mapping. Measurements were obtained during quiet breathing, exaggerated breathing, during the course of a deep inspiration and during static inspiratory efforts. The pattern of motion showed a high degree of individual variability which did not appear to be related to the age of the patient, the duration of injury or the presence of intercostal muscle spasticity. By contrast, it did appear to be related to the presence of bony rib cage stiffness, and possibly the action of the neck accessory muscles. The pattern of rib cage motion in tetraplegia is more complex than conventionally thought.
Abdominal Muscles↗
Absence of tonic electromyographic activity during sleep in normal and spastic nonmimetic skeletal muscles in man.
An electromyographic study of nonmimetic skeletal muscles was carried out in 8 normal adults and 4 patients with spastic hemiparesis during all stages of sleep for a total of 21 nights. All normal subjects showed absence of tonic electromyographic activity in all nonmimetic skeletal muscles in all stages of sleep. Also, during quiet, relaxed wakefulness, tonic muscle discharges disappeared in the normal subjects. Three patients with upper motor neuron spasticity demonstrated results during sleep similar to those obtained in the normal subjects. In the fourth patient, tonic muscle discharges persisted into stage 2 non-REM sleep, disappeared within 30 to 240 seconds following the onset of stage 2 sleep, and were absent during stages 3 and 4 sleep and REM sleep.
Adult↗
Treatment of pain and neuromuscular tension; a report on intravenous use of tetracaine in 365 cases.
Three hundred and sixty-five patients were given tetracaine intravenously for various types of pain and neuromuscular tension. In the treatment of pain, myositis, muscle spasm, and visceral spasm most patients were relieved. Best results were obtained in syndromes in which pain was associated with muscle spasm, such as in pain in the lower part of the back and scalenus anticus syndromes. The effects of tetracaine intravenously are those of analgesia, vasodilatation, and relaxation of spastic muscle. Sixty-five of the patients were treated for neuromuscular tension, and there was good relaxation and increased comfort. Alcoholics were relieved of some of the tension symptoms and may have been helped to resist the desire to drink. Of 14 patients with premenstrual tension, 13 had complete relief. Eight patients with mixed anxiety and tension states also responded well. Toxic and allergic reactions were negligible, and other side effects were infrequent and of no consequence.
Anesthetics↗
Relative decreases in knee extension torque with increased knee extension velocities in stroke patients with hemiparesis.
I examined the isokinetic knee extension torque (KET) produced by the paretic and nonparetic lower limbs of 27 stroke patients, with hemiparesis, at knee extension velocities (KEVs) of 30 degrees, 60 degrees, 120 degrees, and 180 degrees/sec. The purpose of this study was to determine whether the relative decreases in KET at velocities greater than 30 degrees/sec were different on the two sides. To further investigate this relative decrease, the relationship between the torque at 30 degrees/sec and those at higher speeds also was examined on each side. Relative decreases in KET differed between speeds, but not between sides. Torques at speeds greater than 30 degrees/sec were correlated significantly with the torque at 30 degrees/sec. These findings suggest that patients with hemiparesis and minimal muscle spasticity may have difficulty moving forcefully at higher speeds because they are weak. Therapeutic interventions, therefore, might be most beneficial when they are directed toward helping patients with hemiparesis activate their weak muscles.
Aged↗
The ligamento-muscular stabilizing system of the spine.
STUDY DESIGN: Electrical and mechanical stimulation of the lumbar supraspinous ligament of three patients with L4-L5 spinal deficits and of the feline model, respectively, was applied while recording electromyography on the multifidus muscles. OBJECTIVES: To determine if mechanoreceptors in the human spine can reflexively recruit muscle force to stabilize the lumbar spine, and to demonstrate, in the feline model, that such ligamento-muscular synergy is elicited by mechanical deformation of the lumbar supraspinous ligament (and possibly of other spinal ligaments), the facet joint capsule, and the disc. SUMMARY OF BACKGROUND DATA: The literature repeatedly confirms that ligaments have only a minor mechanical role in maintaining spine stability, and that muscular co-contraction of anterior and posterior muscles is the major stabilizing mechanism of the spine. The literature also points out that various sensory receptors are present in spinal ligaments, and that the ligaments are innervated by spinal and autonomic nerves. Data that describe how ligaments and muscles interact to provide stability to the spine were not found. METHODS: The supraspinous ligament at L2-L3 and L3-L4 was electrically stimulated in three patients undergoing surgery to correct deficits at L4-L5. Electromyography was performed from the multifidus muscles at L2-L3 and L3-L4, bilaterally. In 12 cats, the supraspinous ligaments from L1-L2 to L6-L7 were mechanically deformed, sequentially, while electromyography was performed from the multifidus muscles of the six levels. Loading of the ligament was applied before and after each of the two vertebrae were externally fixed to prevent motion. RESULTS: Electromyograms were recorded from the multifidus muscles, bilaterally, in the two of the three patients, demonstrating a direct relationship to receptors in the supraspinous ligament. Electromyograms were recorded from the feline multifidus muscle with mechanical loading of the supraspinal ligament at each of the L1-L2 to L6-L7 motion segments. In the free-spine condition the largest electromyographic discharge was present in the level of ligament deformation, and lower electromyographic discharge was recorded in two rostral and caudal segments. After immobilizing any two vertebrae, loading of the ligament resulted in electromyographic discharge in the muscles of the same level and at least one level above and/or below. CONCLUSIONS: Deformation or stress in the supraspinous ligament, and possibly in other spinal ligaments, recruits multifidus muscle force to stiffen one to three lumbar motion segments and prevent instability. Strong muscular activity is seen when loads that can cause permanent damage to the ligament are applied, indicating that spastic muscle activity and possibly pain can be caused by ligament overloading.
Animals↗
Effects of botulinum toxin A injection and exercise on the growth of juvenile rat gastrocnemius muscle.
Botulinum toxin A (Btx) injections and supervised exercise are often used concurrently to treat calf muscle spasticity in children. This study has analyzed the early effects of Btx-induced paralysis and increased activity by voluntary wheel running on cell growth-related processes in juvenile rat gastrocnemius muscle. Btx injection at 29 days of age prevented the normal increases in wet mass (50%) and fiber cross-sectional area (34%) seen by 36 days of age in control rats. Btx-injected vs. contralateral muscles had 22% fewer myonuclei per fiber length but greater than twofold the number of MyoD-positive nuclei at 36 days of age. The accretion of 5-bromo-2'-deoxyuridine-labeled newly produced myonuclei did not differ between limbs. Voluntary exercise during the 7 days increased the mass (18%) and fiber size (23%) of Btx-injected and contralateral muscles but did not affect any other variable. Thus Btx injection and exercise had early effects on muscle and fiber size without consistently associated changes in myonuclear production or number. This suggests the presence of noncontractile activity-dependent, growth-promoting cytoplasmic events in juvenile muscle.
Animals↗
Some manoeuvres for releasing the hypertonus of spastic and shortened muscles.
We describe some physiotherapeutic techniques and manoeuvres releasing the increased tone of spastic and shortened muscles. The techniques can be generally characterised and summed up into three groups as follows: I. First types of manoeuvres consists in setting up the extremity or segment into the position usually opposed or antagonistic to the limited direction. This position is held for several tens of seconds. After this, partial of the originally limited range of motion could be observed. A modification of this approach is effective for persistent extensor spasticity of the lower extremities. Extremity is taken up into the internal rotation and flexion of the hip joint, into the maximal flexion of knee joint and into dorsiflexion of ankle joint, and this position is held at least for 30 seconds. After this, the extensor spasticity is usually diminished and also the voluntary movements and gait pattern improved. II. Short active jerk (not exceeding 1/2 sec) in the free direction, alternatively against mild resistance, followed by 3-4 second release and slow stretch into the restricted range. It is essentially important that the initial jerk is as brisk as possible but performed with no special effort. In case the resistance is applied, it should be only slight. Then the therapist must grasp a "melting" of the hypertonus and cautiously guide the segment into the slow and gentle stretch. III. Pressure stimulation of the particular active zones. The application of these manoeuvres and its combinations are demonstrated in case reports.
Adult↗
Use of a hand-held dynamometer and a Kin-Com dynamometer for evaluating spastic hypertonia in children: a reliability study.
BACKGROUND AND PURPOSE: Studies in subjects with spastic hypertonia indicate that the higher resistance to stretch in the spastic muscles is not only due to hyperactive stretch reflexes but also to changes in the muscle-tendon unit (nonreflex components). The aim of this study was to compare the test-retest reliability of two methods: hand-held dynamometry and isokinetic dynamometry for the evaluation of nonreflex and reflex-mediated resistive force in the plantar flexors of young children with spastic cerebral palsy (CP). SUBJECTS: Ten children 2 to 7 years of age with a diagnosis of spastic CP (either diplegia [n = 7] or hemiplegia [n = 3]) participated in the study. METHODS: The resistive force recorded at 0 degrees of dorsiflexion during passive ankle dorsiflexions executed at low and high velocities was evaluated twice at a 1-month interval with a Penny and Giles myometer (a hand-held dynamometer) and a Kin-Com dynamometer. The electromyographic activity of the soleus and tibialis anterior muscles was recorded during Kin-Com testing to detect unwanted activity during low-velocity tests and to identify trials with a reflex response during high-velocity tests. RESULTS: High intraclass correlation coefficients (ICCs) for the resistive force values recorded at the test and retest were computed for both the myometer (ICCs = .79 and .90) and the Kin-Com (ICCs = .84 and .84) at low and high velocities, respectively. Coefficients of variation for force values measured at a 1-month interval at low and high velocities were 13.9% and 13.2% with the myometer and 11.8% and 12.8% with the Kin-Com. CONCLUSION AND DISCUSSION: The results suggest that the myometer can provide a measure of spastic hypertonia with a reproducibility and a variation in the measures that compare to those of a computer-controlled dynamometer. From a clinical point of view, the myometer is simpler and cheaper to use given the lower cost and the little time required for testing and data analysis. Care must be taken to select a velocity that is low enough not to evoke a stretch reflex (to isolate nonreflex components) and another that is high enough to elicit a reflex response, so that it becomes possible to differentiate the reflex and non-reflex components involved in spasticity. Such a distinction is important for the choice of treatment procedures.
Ankle Joint↗
Relationship of muscle strength for knee extension to walking capacity in patients with spastic hemiparesis.
Muscle strength for knee extension, both isokinetic and isometric, and walking capacity, maximum velocity and walking rate, were examined in 11 post-stroke hemiparetic patients. The degree of spasticity of the affected lower extremity was not related to the isokinetic and isometric torques, or to the walking capacity. Although both the isokinetic and isometric torques decreased on the affected side compared to the non-affected side, the rate of decrease was remarkable in isokinetic torque at fast velocities. The walking capacity was well correlated with isokinetic torque of the affected side at fast velocities but not isometric torques. These results suggest that reduction of muscle strength at rapid movements is an essential feature of spastic paresis and is primary cause of motor disabilities such as impaired locomotor function.
Adult↗