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At least 127 records · Page 7Linked to original sources
PubMed2004

Botulinum toxin A for treatment of neurogenic detrusor overactivity and incontinence in patients with spinal cord lesions.

OBJECTIVE: To evaluate the efficacy of intravesical botulinum toxin A (BTA) in the treatment of severe neurogenic detrusor overactivity (NDO) with incontinence in patients with spinal cord lesions (SCLs). MATERIAL AND METHODS: Fifteen SCL patients suffering from NDO and incontinence were included in the study. The volume of urine leakage during episodes of incontinence was quantified, and filling cystometry was performed before and after BTA treatment. During BTA treatment, a total of 300 IU of BTA was injected cystoscopically into the detrusor muscle, excluding the trigone region. Antibiotic prophylaxis was given. RESULTS: Thirteen of 15 patients (87%) reported that they were fully continent after treatment and the volume of leakage in the two incontinent patients was significantly reduced. Anticholinergic medication was stopped in all patients after BTA treatment. Cystometry showed a marked reduction in pressures after treatment in all patients, with the maximum detrusor pressure during filling being significantly reduced (p < 0.0005) and the maximum volume at a detrusor pressure of <40 cmH2O being significantly increased (p < 0.0005) in all patients. The maximum bladder capacity was increased, although not significantly. The period during which the patients remained continent following treatment ranged from 4 to 12 months (median 7 months). With the exception of slight haematuria, which resolved spontaneously, no side-effects were observed, and no cases of autonomic hyperreflexia were seen during treatment. CONCLUSION: BTA proved to be a highly effective treatment modality for NDO and incontinence in SCL patients. Treatment was easy to perform and the duration of effect was acceptable. Furthermore, BTA treatment was associated with virtually no side-effects.

Administration, Intravesical↗
PubMed2005

Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome.

Vaginal sEMG biofeedback and pelvic floor physical therapists' manual techniques are being increasingly included in the treatment of vulvar vestibulitis syndrome (VVS). Successful treatment outcomes have generated hypotheses concerning the role of pelvic floor pathology in the etiology of VVS. However, no data on pelvic floor functioning in women with VVS compared to controls are available. Twenty-nine women with VVS were matched to 29 women with no pain with intercourse. Two independent, structured pelvic floor examinations were carried out by physical therapists blind to the diagnostic status of the participants. Results indicated that therapists reached almost perfect agreement in their diagnosis of pelvic floor pathology. A series of significant correlations demonstrated the reliability of assessment results across muscle palpation sites. Women with VVS demonstrated significantly more vaginal hypertonicity, lack of vaginal muscle strength, and restriction of the vaginal opening, compared to women with no pain with intercourse. Anal palpation could not confirm generalized hypertonicity of the pelvic floor. We suggest that pelvic floor pathology in women with VVS is reactive in nature and elicited with palpations that result in VVS-type pain. Treatment interventions need to recognize the critical importance of addressing the conditioned, protective muscle guarding response in women with VVS.

Adult↗
PubMed2005

An unusual case of Dantrolene sodium-induced urinary retention in post-traumatic minimally responsive state.

INTRODUCTION: An unusual case of urinary retention is reported occurring during the inpatient rehabilitation of minimally responsive state (MRS) following severe traumatic brain injury (TBI). CLINICAL PICTURE: Urodynamic evaluation showed detrusor acontractility and subsequent management involved intermittent bladder catheterization and treatment of a single urinary tract infection. TREATMENT: Factors contributing to her bladder paralysis included severe immobility, tetraplegia and treatment of diffuse spasticity with oral Dantrolene sodium 250 mg per day. Constipation, diabetes and spinal cord injury were absent. In addition, she received unilateral partial sciatic neurolysis with 50% alcohol for severe knee flexor spasticity and intra-muscular Botulinum toxin A to both spastic upper limbs. OUTCOME: Bladder acontractility resolved completely when Dantrolene was reduced with subsequent achievement of a catheter-free status and small post-void residual volumes. Repeat urodynamics showed spontaneous detrusor contractions. CONCLUSION: A discussion of possible aetiologic factors for detrusor acontracility following TBI is presented including a brief review of the literature.

Adult↗
PubMed1996

Relationship between muscular tone, movement and periarticular new bone formation in postcoma-unaware (PC-U) patients.

Forty-eight post-traumatic brain-injured patients in postcoma-unawareness (PC-U) state, are included in this study. All recovered consciousness at least 1 month after the accident. The muscular tone and movement of all limbs was examined. At least two X-rays of the big joints were taken. Periarticular new bone formation appeared in 26 patients. This heterotopic ossification occurs in severely injured patients, primarily in proximal joints of the upper and lower extremities. Their aetiology in brain injury is unknown. Risk factors include prolonged coma, tone and movements in the involved extremity, and associated fractures. We found that the appearance of periarticular new bone formation had a close correlation with pathological movement (paresis or plegia), a borderline correlation with hypertonus, and no correlation with hypotonus or with associated fractures.

Arthrography↗
PubMed2004

Insulin and hypertonicity recruit GLUT4 to the plasma membrane of muscle cells by using N-ethylmaleimide-sensitive factor-dependent SNARE mechanisms but different v-SNAREs: role of TI-VAMP.

Insulin and hypertonicity each increase the content of GLUT4 glucose transporters at the surface of muscle cells. Insulin enhances GLUT4 exocytosis without diminishing its endocytosis. The insulin but not the hypertonicity response is reduced by tetanus neurotoxin, which cleaves vesicle-associated membrane protein (VAMP)2 and VAMP3, and is rescued upon introducing tetanus neurotoxin-resistant VAMP2. Here, we show that hypertonicity enhances GLUT4 recycling, compounding its previously shown ability to reduce GLUT4 endocytosis. To examine whether the canonical soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) mechanism is required for the plasma membrane fusion of the tetanus neurotoxin-insensitive GLUT4 vesicles, L6 myoblasts stably expressing myc-tagged GLUT4 (GLUT4myc) were transiently transfected with dominant negative N-ethylmaleimide-sensitive factor (NSF) (DN-NSF) or small-interfering RNA to tetanus neurotoxin-insensitive VAMP (TI-VAMP siRNA). Both strategies markedly reduced the basal level of surface GLUT4myc and the surface gain of GLUT4myc in response to hypertonicity. The insulin effect was abolished by DN-NSF, but only partly reduced by TI-VAMP siRNA. We propose that insulin and hypertonicity recruit GLUT4myc from partly overlapping, but distinct sources defined by VAMP2 and TI-VAMP, respectively.

Animals↗
PubMed1988

Increased masticatory muscle stiffness during limb muscle flaccidity associated with succinylcholine administration.

The resistance of mouth opening to a constant force of 1.7 N was measured in 44 pediatric subjects anesthetized with enflurane and paralyzed with succinylcholine or vecuronium. Measurements were made during a deep level of anesthesia before relaxant administration, immediately after the loss of the adductor pollicis muscle twitch and 45 s later. In 22 patients receiving succinylcholine, there was a significant reduction in mean mouth opening (from 16.9 +/- 2.8 to 12.6 +/- 4.3 to 13.0 +/- 4.3 mm; P less than 0.0005) and an increase in jaw stiffness (from 102.3 +/- 21.9 to 154.5 +/- 77.4 to 150.5 +/- 77.0 Nm/degree; P less than 0.02) immediately after disappearance of the evoked thenar muscle twitch, as well as 45 s later. In six patients receiving succinylcholine, measurements were continued at 1 min intervals; mouth opening reduction and jaw stiffness increase lasted up to 10 min and extended beyond the return of visible twitch. One patient had a reduction of mouth opening from 20 to less than 1 mm; his corresponding jaw stiffness changed from 83.4 to 3335.4 Nm/degree. This patient, considered by us to have masseter spasm, required several attempts at tracheal intubation due to an increased resistance to mouth opening, as did one other patient. Patients receiving vecuronium showed a significant (P less than 0.02) increase of mouth opening 45 s following loss of twitch (from 19.8 +/- 3.6 to 20.9 +/- 4.1 mm; jaw stiffness changed from 87.0 +/- 15.3 to 83.0 +/- 17.2 Nm/degree). Anesthesia and surgery proceeded normally; in most patients, in excess of 1 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Effects of surface spinal cord stimulation on spasticity and quantitative assessment of muscle tone in hemiplegic patients.

Spasticity after a stroke interferes with the normal function of a limb. Electric stimulation has been used in a variety of ways to decrease spasticity. The purposes of this study were (1) to quantify the effectiveness of electric stimulation on decreasing ankle spasticity and (2) to develop a quantitative assessment of muscle tone, which could be replicated in the clinic. Ten patients with hemiparesis resulting from ischemic stroke participated in the study according to the selection criteria. Their mean age was 57 yr, with a mean stroke interval of 12.5 months. Patients received electric stimulation for 45 min through surface electrodes applied to the skin in the 12th thoracic and 1st lumbar areas. All patients received five electric stimulation treatment sessions. The electrical pulses were amplitude modulated frequency beat with a carry frequency of 2500 Hz and a stimulation frequency of 20 Hz. The stimulation intensity was adjusted to each patient to produce a sensory stimulation. The pre- and posttreatment evaluation included surface electromyography activity during passive ankle dorsiflexion, passive ankle dorsiflexion resistance at different angular velocities, as measured by an isokinetic machine and the modified Ashworth scale. Our results indicate that the surface spinal cord stimulation with middle frequency modulated to low frequency for sensory stimulation on the skin of 12th thoracic and first lumbar area is effective in reducing calf muscle spasticity of hemiplegic patients. The isokinetic torque measures for spasticity are a sensitive tool to document the effects of the treatment.

Adult↗
PubMedDate not supplied

Botulinum toxin treatment of lumbrical spasticity: a brief report.

Botulinum toxin A has been used to treat wrist and finger spasticity mainly through injection of the forearm flexor muscles. This case study describes its first reported use in managing spastic lumbricals of the hand. A 19-year-old male had significant flexion deformity and hypertonicity of the left wrist and hand, particularly the second through fifth metacarpophalangeal joints, after traumatic brain injury. By using the 0-4 Ashworth scale, spasticity of the lumbricals across the second to fourth metacarpophalangeal joints was rated 2, with persistent clonus of the finger flexors as confirmed by electromyography to the middle and ring fingers, even after botulinum toxin A injection of the flexor digitorum sublimis and profundus muscles. By using the electromyography-guided technique, botulinum toxin A was injected into the first lumbrical of the index finger (12 units), second and third lumbricals of the middle and ring fingers, respectively (15 units each), and fourth lumbrical of the little finger (10 units). At follow-up, clinical and electromyographic examination revealed a significant reduction in tone and clonus of the injected lumbricals. Ashworth scores of the lumbricals from the index to little finger improved to 1. Botulinum toxin A injection of the lumbricals can be beneficial in managing spasticity of these muscles. It is well tolerated and effective at doses of 10 to 15 units. Lumbrical injection of botulinum toxin A is a useful adjunct in our percutaneous armamentarium for managing the spastic hand.

Adult↗
PubMed2002

Myogenic failure in posterior urethral valve disease: real or imagined?

PURPOSE: It has been suggested that hypocontractility or myogenic failure develops in older boys with a history of 9 posterior urethral valved as the hyperactive, poorly compliant bladders decompensate with age. Also a much higher prevalence of myogenic failure has been reported than we have observed. We determine the prevalence of myogenic failure in boys with a posterior urethral valve and whether myogenic failure was a consequence of earlier detrusor instability or diminished compliance. MATERIALS AND METHODS: We retrospectively reviewed the urodynamic findings of 51 boys after transurethral ablation of a posterior urethral valve. Group 1 (longitudinal group) consisted of 11 boys 12 to 19 years old who had undergone at least 1 serial urodynamic study before and 1 after age 10 years. Group 2 (younger group) included 33 boys whose urodynamic testing was performed before age 10 years. Group 3 (older group) comprised 7 previously treated boys whose initial urodynamic study was done after age 12 years. RESULTS: Overall, myogenic failure was noted in 3 (all group 1) of 51 (5.9%) patients. Each of the 3 boys initially had a hypocompliant bladder, and myogenic failure developed only after institution of anticholinergic therapy and resolved once anticholinergics were discontinued. An additional 34 boys treated with anticholinergics did not have myogenic failure. No tendency towards myogenic failure or marked increase in bladder capacity for age was noted in the older boys. CONCLUSIONS: In our experience myogenic failure is uncommon and more likely secondary to anticholinergic therapy than a preordained consequence of valve disease. We postulate that our proactive, early aggressive use of urodynamic studies and pharmacotherapy to identify and manage the secondary effects of valve disease reduces the incidence of myogenic failure.

Adolescent↗
PubMed2003

Morphology, phenotype and ultrastructure of fibroblastic cells from normal and neuropathic human detrusor: absence of myofibroblast characteristics.

PURPOSE: Fibroblasts are functionally diverse and fibroblastic cells with smooth muscle-like characteristics (myofibroblasts) regulate smooth muscle activity in certain tissues. The presence of myofibroblasts has been reported in the bladder with important implications for normal function and detrusor overactivity. We assessed fibroblastic cell characteristics to discern features suggesting a myofibroblast phenotype in normal or neuropathic human detrusor. MATERIALS AND METHODS: A total of 25 control samples were obtained from cadaveric organ donors or patients with a mean age of 42.3 years investigated for hematuria and compared with samples from 18 patients with a mean age of 37.4 years with neurogenic detrusor overactivity. Morphology, phenotypic expression of various markers and the ultrastructure of each fibroblastic cell visible in multiple sections from each specimen was evaluated by 2 independent assessors. RESULTS: Fibroblastic cells were observed throughout the smooth muscle and connective tissue. They were located peripherally on muscle fascicles and had a polar stellate appearance with processes ramifying in interfascicular planes and muscle. They possessed vimentin-like immunoreactivity and weak c-kit-like immunoreactivity but not desmin or alpha-smooth muscle actin-like immunoreactivity. Ultrastructurally they showed dilated rough endoplasmic reticulum with a moderately electron dense amorphous content and prominent golgi complexes. Nuclei had clumped peripheral heterochromatin. There were extensive flattened processes that lacked basal laminae. There was no specific contact with nerve fibers or smooth muscle. Neuropathic bladder samples did not differ overtly from those of controls. CONCLUSIONS: The detrusor possesses an extensive network of fibroblastic cells and processes. No evidence of myofibroblast differentiation was discerned in normal or neuropathic detrusor, although a minority subpopulation or regional variability in cellular phenotype could not be excluded.

Adult↗
PubMed2003

Inhibition of human detrusor contraction by a urothelium derived factor.

PURPOSE: Stimulating muscarinic receptors in pig bladder urothelium causes the release of a diffusable factor that inhibits contractions of the underlying detrusor muscle. We investigated whether the contractions of human detrusor strips elicited by the muscarinic agonist carbachol, electrical field stimulation, KCl or the neurokinin receptor agonist neurokinin A are affected by the urothelium. MATERIALS AND METHODS: Paired intact and urothelium denuded muscle strips were placed in modified gassed Tyrode's solution at 37C. Cumulative concentration-response curves to carbachol or KCl were constructed. In other tissues the strips were stimulated electrically (1 to 40 Hz) with trains of square wave pulses 20 seconds in duration at 5-minute intervals. RESULTS: Cholinergic contractions evoked by electrical field stimulation at 10 and 30 Hz or by carbachol were significantly inhibited in the presence of an intact urothelium. Contractions elicited by KCl and by 10 microM neurokinin A were not modified by the urothelium. The urothelium mediated inhibition of contractions induced by carbachol was not affected by 300 microM L-NG-nitroarginine, 1 microM ODQ (1H-[1,2,4]oxadiazolo[4,3-alpha]quinoxalin-1-one), 1 microM propranolol or 5 microM indomethacin. CONCLUSIONS: Muscarinic agonists stimulate the release of an inhibitory factor from the human urothelium. The factor is distinct from nitric oxide and it persists in the presence beta-adrenoceptor blockade or cyclooxygenase inhibition.

Aged↗
PubMed2004

A male murine model of partial bladder outlet obstruction reveals changes in detrusor morphology, contractility and Myosin isoform expression.

PURPOSE: Mice with gene deletion or targeted over expression are important for understanding the remodeling that follows partial bladder outlet obstruction (PBOO). This condition predominates in males. We produced PBOO in male mice and now report the physiological, histological and molecular consequences. MATERIALS AND METHODS: Male C57bl/6 mice were surgically obstructed or subjected to sham surgery and unoperated mice served as controls. Four weeks later the bladders were excised and their function was assessed with in vitro whole bladder cystometry. The optimum volume for pressure generation was determined and isometric pressures were measured for field stimulation and depolarization with KCl. Bladder hypertrophy was classified as severe-bladder mass greater than 50 mg or mild-bladder mass less than 50 mg. The percent muscle fraction was determined by histological analyses. The expression of C-terminal (SM1 and SM2) and N-terminal (SM-B and SM-A) isoforms of myosin heavy chain was analyzed by reverse transcriptase-polymerase chain reaction. RESULTS: Severely hypertrophied bladders had larger optimum volume (p >0.001) and generated less pressure in response to field stimulation (p >0.001) and KCl (p >0.01) with a slower rate of pressure generation than controls or sham operated mice. Increased SM1-to-SM2 and SM-A-to-SM-B ratios were noted in severely obstructed bladders relative to controls or sham operated mice (p <0.05). The muscle fraction decreased slightly in the severely hypertrophied group (p not significant). CONCLUSIONS: Our male mouse model of PBOO demonstrates an increase in bladder mass, larger capacity and significantly decreased pressure generation in the in vitro whole bladder model. Obstruction induced increases in the expression of C-terminal (SM1) and N-terminal (SM-A) myosin heavy chain isoforms.

Animals↗
PubMed2003

Effect of botulinum toxin type A on cerebral palsy with upper limb spasticity.

OBJECTIVE: The objective of this study was to investigate the effects of botulinum toxin type A injections in reducing upper limb muscular spasticity and in improving motor function in children with cerebral palsy. DESIGN: Fifteen children with spastic cerebral palsy who were undergoing regular physical and occupational therapy were enrolled. Botulinum toxin type A injections in clinically indicated target muscle groups were administered after the children had received 3 mo of therapy. A follow-up study was carried out at 6 wk and 12 wk, respectively, after the botulinum toxin type A injections. The main outcome measurements included the Modified Ashworth Scale, the upper limb Physician's Rating Scale, the Bruininks-Oseretsky Test of Motor Proficiency, and the self-care domain of the Pediatric Evaluation of Disability Inventory. RESULTS: The reduction of spasticity in the treated muscle groups differed significantly between the control period and both study periods. Improvements on the Physician's Rating Scale score during the study period also differed significantly as compared with improvements during the control period. There was a significant difference in the improvement of fine motor skills, as measured with Bruininks-Oseretsky Test of Motor Proficiency, between the control period and both study periods. Improvements in self-care capability differed significantly between the control period and 12 wk after botulinum toxin type A treatment, but not between the control period and at 6 wk after treatment. Muscle strength of grasp and pinch did not differ significantly between the control and the study period. Distribution of body parts involvement, disease severity, and function in daily living activities had no significant correlation with functional improvement after the treatment. CONCLUSIONS: Our findings support the premise that botulinum toxin type A injections are effective in reducing upper limb spasticity and in improving movement pattern and fine motor function of patients with spastic cerebral palsy. A reduction in caregivers' burden and improved quality of life were demonstrated through the study period.

Adolescent↗
PubMed2005

Manual treatment effects to the upper cervical apophysial joints before, during, and after endotracheal anesthesia: a placebo-controlled comparison.

OBJECTIVES: In this preliminary, placebo-controlled clinical trial, two different manual treatments were compared, spinal manipulation and postisometric relaxation, for dysfunctional motion segments of the upper cervical spinal column. The influence of the muscular portion on the joint-play restriction of a motion segment can be ignored in anesthesia, and the manual evaluation of this joint-play restriction must be focused on nonmuscular structures. By retesting in anesthesia, it is possible to examine whether mobilization and manipulation affect exclusively the muscular structures or also affect the other parts of the motion segment. Conclusions can be drawn about the superiority of one or both treatments and about the structural basis of the restricted joint play and its palpation. DESIGN: A total of 26 inpatients at the surgical or orthopedic department of the University of Rostock were examined manually at four testing times: before and after manual treatment, in anesthesia, and within 24 hrs of completing anesthesia. They were randomized into three groups: postisometric relaxation (mobilization), spinal manipulation (thrust technique), and placebo. RESULTS: A highly significant effect for both treatments was found posttherapeutically (P < 0.01) but not for placebo. In anesthesia, the treatment effect of spinal manipulation was further significant (P < 0.01) when compared with placebo. For postisometric relaxation, however, it was not (P = 0.160). A significant difference between spinal manipulation and postisometric relaxation was not found in anesthesia (P = 0.137). The treatment effect postnarcotically was further significant when compared with placebo only for spinal manipulation (P = 0.011). CONCLUSIONS: Both treatments are superior to placebo. Postisometric relaxation seems to affect mainly the muscular parts of the treated segments and less so the other parts, such as the joint capsule or the segmental affiliated ligaments and fascia. Spinal manipulation seems to influence all other segmental parts more effectively, and the treatment effect persists longer. A joint-play restriction cannot be an exclusively muscular tension phenomenon. Segmental motion dysfunctions show a high variability in their spontaneous course.

Adult↗
PubMedDate not supplied

Crystalline aggregates of protein-glycogen complexes (alias 'virus-like particles') in skeletal muscle: report of a case and review of the literature.

Crystalline arrays of so-called 'virus-like particles' were found in post-mortem samples of skeletal muscle obtained from an 11-month-old female infant. In a large number of skeletal muscle fibres crystalline inclusions were abundant, variously configurated and positively stained with a cytochemical method for polysaccharides. A battery of enzymatic tests, including some with diastase and alpha-amylase, was, however, entirely noncontributory. A muscle biopsy studied 5 months before death had disclosed no crystalline inclusions of any kind. The literature concerning similar cases of 'virus-like particles', crystalline glycogen aggregates or protein-glycogen complexes in muscle is reviewed. Possible reasons underlying the aggregation of protein-glycogen complexes into crystalline arrays are discussed.

Female↗
PubMed1984

Head-position training through biofeedback: prosthetic or cure?

This report investigates the effectiveness of biofeedback in the treatment of poor head-positioning in patients with cerebral palsy. Four patients were given feedback of head-position trainer: two were given 20 sessions, the other two were given 10 sessions followed by 10 sessions of social reinforcement. It was found that biofeedback produced significant changes in head control during therapy but that these did not transfer well to other situations, nor did it result in long-term positive improvement. The use of social reinforcement produced excellent and long-term gains. These results are discussed in terms of stimulus properties and reinforcement conditions. General implications of this study in relation to the generalisation and maintenance of behaviour change are also discussed.

Adolescent↗