The contribution to spasticity qualification in neurological rehabilitation of patients with upper motor neuron syndrome.
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The behaviour of submandibular, cervical, thoracic and abdominal respiratory muscles was examined in the pentobarbitone-urethane-anaesthetized rabbit during progressive asphyxia induced by rebreathing. During asphyxic hyperpnoea the external intercostal, interchondral and scalene inspiratory activities augmented until succeeded by the apnoeic period, in which all were inhibited with the diaphragm. Likewise, the genioglossus, sternohyoid and thyrohyoid muscles exhibited inspiratory augmentation during asphyxic hyperpnoea until the onset of apnoeic inhibition. However, late in the apnoea these muscles, together with the sternothyroid, sternomastoid and digastric muscles, generated an augmenting tonic discharge associated with an intense abdominal constriction, and with the extension of the limbs characteristic of opisthotonus. This intense tonic activity, which was never expressed by the diaphragm and thoracic inspiratory muscles, was immediately interrupted or terminated by the subsequent inspiratory efforts of gasping respiration, during which the abdominal muscles were inhibited but all the submandibular, cervical and thoracic inspiratory muscles greatly participated. The mylohyoid muscles presented augmenting expiratory activity during asphyxic hyperpnoea which declined during the apnoea. These muscles, however, did not exhibit the intense tonic discharge expressed by the expiratory abdominal and inspiratory submandibular and cervical muscles in late apnoea and were not active in gasping.
The triad of rigidity, fever, and elevation of serum creatine phosphokinase (CPK) levels, labeled 'neuroleptic malignant syndrome' (NMS), is a dangerous complication of neuroleptic drug treatment. Amantadine was introduced for the pharmacological management of NMS because of its beneficial effects in Parkinson's disease which were attributed to direct or indirect dopaminomimetic properties of amantadine. While the dopaminomimetic effects of amantadine are weak under experimental conditions, recent studies have confirmed that amantadine is an antagonist at the N-methyl-D-aspartate (NMDA) type of glutamate receptor. Two lines of evidence suggest that amantadine or other NMDA receptor antagonists could be effective drugs for the reversal of NMS symptoms. First, glutamate antagonists restore the balance between glutamatergic and dopaminergic systems when dopaminergic transmission has been antagonized by neuroleptic drugs. Second, by virtue of their effects against rigor and spasticity, NMDA antagonists may reduce increased muscle tone and prevent rhabdomyolysis. In conclusion, NMS may be considered an iatrogenic excitatory aminoacid syndrome which is amenable to NMDA receptor antagonist therapy.
We report the case of a 28-year-old man with decreased visual acuity after closed head trauma sustained in a motor vehicle accident 16 weeks earlier. Several structures thought to be associated with the control of accommodation were injured. The patient had a persistent accommodative spasm causing up to 7.0 diopters of pseudomyopia. We present the patient's progress through the clinic, including manifest and cycloplegic refractions and results of a trial with atropine drops, and successful transition to bilateral pseudophakia 2 years and 9 months after the accident.
Cerebral palsy (CP) is a common cause of movement disorders in children. The upper motor neuron syndrome of CP leads to several types of muscle overactivity, including spasticity. Reduction of muscle overactivity may be an important treatment goal, to improve comfort, care, and active function and to prevent future musculoskeletal complications. After a comprehensive team evaluation, a treatment plan is generated. Treatments may include physical and occupational therapy, oral medications, botulinum toxin and/or phenol injections, intrathecal baclofen, selective dorsal rhizotomy, and orthopedic surgery. Successful and early prevention of contracture may reduce the need for later corrective surgery.
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The role of intramuscular botulinum toxin A in the treatment of 26 children with cerebral palsy was evaluated. The indication for injection was the presence of a dynamic contracture of lower-limb muscles interfering with positioning or walking. Spastic target muscles were identified by clinical examination and, in ambulant children, by gait analysis. Between 50 and 320 units of botulinum toxin were injected into each muscle group to a total dose of 100 to 400 units per child. The effects of injection were monitored by repeated clinical examination and gait analysis. There were no clinically detectable systemic side-effects, and all but one patient had a reduction in tone, which occurred within three days and persisted for two to four months. There were significant improvements in ambulatory status and in sagittal-plane kinematics. In some cases these gains persisted after the tone-reducing effects of the toxin had worn off.
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Selective dorsal rhizotomy (SDR) is an evidence-based treatment for cerebral palsy (CP) spasticity. During their lifetime, patients with CP spasticity may require orthopedic surgery for muscles and joints to correct physical deformities and provide a better quality of life. In this review, the authors discuss the timing of such orthopedic surgery, its necessity, and whether it is influenced by the performance of SDR. A review of findings from the authors' 19 years of experience yields the following conclusions: 1) that SDR reduces orthopedic surgery requirements when compared with historical controls; 2) that SDR performed in patients at a young age (2-4 years) can reduce future orthopedic surgery requirements; 3) that independent walkers and diplegic patients will have the smallest amount of orthopedic surgery post-SDR; and 4) that patients who need assistance walking and those with quadriplegia will have the greatest amount, although the frequency of orthopedic surgery for quadriplegic patients is not as high as popularly believed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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