(1970)
Diazepam in spasticity. Lancet 1, 1161-1162.
(1973)
Baclofen for spasticity. Drug Ther. Bull. 11, 63-64.
(1974)
Dantrolene sodium for treatment of spasticity. Med. Lett. Drugs Ther. 16,
61-62.
(1974) A
comparative trial of dimethothiazine in spastic conditions. Practitioner 213,
101-105.
(1977)
Oestrogens, calcium transport, and coronary spasm. Lancet 1, 229-230.
(1983) Drugs
to relieve spasticity. Drug Ther. Bull. 21, 1-3.
(1984)
Mantakassa: an epidemic of spastic paraparesis associated with chronic cyanide
intoxication in a cassava staple area of
(1984)
Mantakassa: an epidemic of spastic paraparesis associated with chronic cyanide
intoxication in a cassava staple area of
(1989)
Spasticity. Lancet 2, 1488-1490.
(1991)
Consensus conference. Clinical use of botulinum toxin. National Institutes of
Health.
(1994)
Intrathecal baclofen for spasticity. Med. Lett. Drugs Ther. 36, 21-22.
(1994) A
double-blind, placebo-controlled trial of tizanidine in the treatment of
spasticity caused by multiple sclerosis. United Kingdom Tizanidine Trial Group.
Neurology 44, S70-S78.
Abstract: Tizanidine was evaluated in a prospective, double-blind, randomized,
placebo-controlled trial in 187 patients with MS. Taken orally for 9 weeks and
preceded by a titration phase for a period of 3 weeks starting at 2 mg daily,
tizanidine produced a significant reduction in spastic muscle tone compared
with placebo treatment. Within the effective dose range of 24 to 36 mg given
daily in three doses, tizanidine achieved a 20% mean reduction in muscle tone.
Approximately 75% of patients, with all degrees of spasticity, reported
subjective improvement without an increase in muscle weakness, but there was no
improvement in activities of daily living depending on movement. Tizanidine
achieved its maximum effect on spasticity within 1 week of the start of
treatment; the benefit was maintained for at least 1 week after discontinuation
of therapy. A variety of adverse events was recorded by patients taking
tizanidine, but these were minor and reversible, and rarely limited treatment.
Tizanidine is a well- tolerated and effective drug for symptomatic treatment of
spasticity
(1997)
Marijuana as medicine: how strong is the science? Consum. Rep. 62, 62-63.
(1997)
Tizanidine for spasticity. Med. Lett. Drugs Ther. 39, 62-63.
(1998)
Spasticity: current and future management. Royal
Abstract: Tizanidine hydrochloride (Zanaflex), an alpha 2-adrenoreceptor
agonist, is the first new antispasticity agent to become available in the
Aarli J.A.
(1992) [Treatment with botulinum toxin--a new and effective therapy]. Tidsskr.
Nor Laegeforen. 112, 2624.
Abbott R.
(1996) Sensory rhizotomy for the treatment of childhood spasticity. J. Child
Neurol. 11 Suppl 1, S36-S42.
Abstract: Sensory rhizotomy in the treatment of spasticity has been evolving
over the past century since its first use in 1888. This paper reviews its
historical evolution, current physiologic basis, range in current surgical
technique, and the outcome, along with complications seen over the past decade
since its repopularization
Abdel-Salam
A., Eyres K.S., and Cleary J. (1992) A new paradiscal injection technique for
the relief of back spasm after chemonucleolysis. Br. J. Rheumatol. 31, 491-493.
Abstract: Back spasm, or spasm of the back muscles, is the commonest adverse
reaction encountered after chemonucleolysis. In order to overcome this
troublesome complication, the authors present a new 'paradiscal injection
technique'. After the injection of chymopapain into the affected disc, the
needle is withdrawn to just outside the annulus. Bupivacaine is injected into
the paradiscal 'space' which acts upon the paravertebral muscles. Eighty
consecutive patients have been treated by chemonucleolysis with paradiscal
injection for pain relief. All patients were discharged the same day or the
following day and no immediate complications occurred. When reviewed 3 weeks
later, only three (3.8%) patients complained of back pain (which was different
in character to that present before the injection or was exacerbated by the
injection). Pain persisted in the same patients until 6 months after the
injection but was negligible. None of the remaining patients had developed back
pain as a result of chymopapain. The authors suggest that the addition of
paradiscal injection of bupivicaine after cymopapain injection can reduce the
incidence of spasm of the back muscles. This technique is a major contribution
to increasing the efficacy of chemonucleolysis for the treatment of herniated
lumbar disc
Abel N.A.
and Smith R.A. (1994) Intrathecal baclofen for treatment of intractable spinal
spasticity. Arch. Phys. Med. Rehabil. 75, 54-58.
Abstract: This study assessed the safety and efficacy of intrathecal baclofen
in the treatment of intractable spasticity caused by spinal cord injury or
multiple sclerosis. Twenty-three patients with severe chronic spasticity
underwent bolus test dosing with 50, 75, or 100 micrograms of intrathecal
baclofen administered by lumbar puncture. All patients were either refractory
to oral baclofen at a dose of 120 mg/d or side effects were unacceptable at a
lower dose. There was a significant decrease in tone and spasticity in all 23
patients. Nineteen patients underwent implantation of a programmable pump and
intrathecal catheter designed to deliver baclofen directly to the spinal cord.
Rigidity (tone) was decreased from a mean prebolus Ashworth score of 3.8 to a
mean postbolus Ashworth score of 1.5 and spasms from a mean prebolus score of
3.5 to a mean postbolus score of 1.2 for a minimum of 4 hours. Patients have
been observed for a mean of 16 months (range 2 to 34 months). Ashworth scores
have remained reduced to an acceptable level (< or = 2 with periodic
adjustment in dosage in all but three patients. There has been one pump malfunction
and four catheter malfunctions; few serious medication and postoperative
complications have occurred. There was one death caused by underlying disease,
one patient voluntarily withdrew, and three patients developed tolerance to the
extent that optimal control of spasticity tone could not be maintained.
Although intrathecal baclofen is safe and effective in the majority of
patients, three patients required > 1,000 micrograms/d with increasingly
higher doses over time and exhibited a poor response
Abramson
A.S. (1967) Modern concepts of management of the patient with spinal cord
injury. Arch. Phys. Med. Rehabil. 48, 113-121.
Acland R.H.
(1993) Intrathecal baclofen for the management of severe spasticity. N. Z. Med.
J. 106, 129-130.
Adachi H.,
Riku S., Fujishiro K., and Kuru S. (1998) [A case of Satoyoshi syndrome with
symptoms resembling neuroleptic malignant syndrome]. Rinsho Shinkeigaku 38,
637-640.
Abstract: Satoyoshi syndrome is a rare neurological disorder of unknown
etiology characterized by progressive muscle spasms, alopecia, diarrhea and
skeletal abnormalities. We here describe a 25-year-old man who developed
symptoms similar to neuroleptic malignant syndrome (NMS). He began to have the
clinical characteristics of Satoyoshi syndrome at the age of 12 years. He was
admitted to hospitals many times with painful muscle spasms and pyrexia in the
early stage of the disease. He received steroid pulse therapy and oral
prednisone at the age of 19, the extent and frequency of the spells being
reduced thereafter. He was admitted to our hospital due to recurrence of his
usual muscle spasms. He was treated with midazolam intravenously to relieve
severe muscle ache, pain in the left shoulder, and insomnia. About 90 minutes
later, he became comatose, with the following manifestations: hyperthermia, low
blood pressure, tachycardia, profuse perspiration, acute respiratory failure,
and ensuing cardiac arrest. He developed rhabdomyolysis, acute renal failure,
hepatic damage, and diffuse intravascular coagulation. Serum creatine kinase
level was elevated to 306,910 IU. He died of multiple organ failure 13 days
after admission. His symptoms resembled NMS and malignant hyperthermia (MH).
None of patients with Satoyoshi syndrome accompanied by NMS or MH have been
reported. It remains to be clarified whether midazolam administration induces
NMS in Satoyoshi syndrome. Nevertheless, careful attention should be paid when
one administers midazolam to patients with this syndrome
Adamcho
N.I., Bondar' V.P., and Rusavskii I.V. (1978) [Prevention and treatment of the
complications of peridurography]. Vopr. Neirokhir. 43-47.
Abstract: In lumbar peridurography conducted in 117 patients with discogenic
radiculitis complications occurred both in the stage of peridural anesthesia
and after introduction of the radiocontrast medium. During anesthesia the dura
mater was punctured in 4 patients, in another 2 patients dicaine penetrated
into the subarachnoid space and caused spinal anesthesia with a high upper
level. Peridural anesthesia with paralysis of the respiratory musculature
developed in 1 patient. After the injection of the radiocontrast medium, spasm
in the lower extremities and trunk of the type of spinal epilepsy developed in
4 patients. The clinical picture, prevention, and treatment of these
complications are discussed
Advokat C.,
Mosser H., and Hutchinson K. (1997) Morphine and dextrorphan lose
antinociceptive activity but exhibit an antispastic action in chronic spinal
rats. Physiol Behav. 62, 799-804.
Abstract: Within 3-4 weeks after spinal transection, morphine-induced
antinociception, assessed with the tail flick reflex in rats, is profoundly
reduced. The cause of this decrement is unknown. The present studies were
conducted to determine whether this phenomenon reflects a general loss in
opiate activity or a selective decline in opiate antinociception. This was
accomplished by assessing the effect of morphine on two different responses,
the tail flick reflex and the hindlimb spasticity that develops in chronic
spinal rats. Because excitatory amino acid antagonists are also antinociceptive
in acute spinal rats, the effect of one such drug, dextrorphan, on these two
behaviors was also evaluated in chronic spinal animals. The antinociceptive and
antispastic effect of subcutaneous (6 mg/kg) and intrathecal (5 micrograms)
morphine injections were assessed in intact and chronic (21-28 days) spinal
rats, whereas the effect of subcutaneous (25 and 40 mg/kg) and intrathecal (350
micrograms) dextrorphan was assessed in acute (1 day) and chronic spinal rats.
The antinociceptive effect of both drugs was significantly reduced in chronic
spinal animals, relative to saline controls. However, each drug treatment
produced a significant antispastic effect in the same animals, indicating a
selective decline in opiate action. This outcome also suggests that excitatory
amino acid antagonists may be useful as adjunct antispastic agents
Abstract: OBJECTIVE: Baclofen is known for the alleviation of signs and
symptoms of spasticity. Reports from our previous study have suggested that it
may be at least as effective as clonidine in the management of physical
symptoms of opiate withdrawal syndromes and superior to clonidine in the
management of mental symptoms. We now report on a randomized double- blind
comparison of baclofen vs. clonidine in view of side-effects profile. METHODS:
A total of 62 opiates addicts were randomly assigned to treatment with baclofen
or clonidine during a 14-day, double-blind clinical trial. All patients met the
DSM IV criteria for opioid dependence. Maximum daily doses were 40 mg for
baclofen and 0.8 mg for clonidine. This trial medication was given three times
per day in divided doses. The severity of side-effects was measured in days 0,
1, 2, 3, 4, 7 and 14. RESULTS: There was no significant difference between two
treat7ments in terms of retention in treatment (dropout) and overall
side-effect. Nevertheless, significantly more problems relating to hypotension
were encountered with subjects on clonidine. CONCLUSION: We conclude that, the
low incidence of hypotension with baclofen suggests that the drug may be
suitable for outpatient ambulatory treatment of withdrawal from opiates
Aicardi J.
and Chevrie J.J. (1975) [Neurologic manifestations following pertussis
vaccination]. Arch. Fr. Pediatr. 32, 309-317.
Abstract: Twenty cases of acute neurological complications occuring within 7
days of pertussis immunization are reported. Convulsions were present in every
case and status epilepticus was observed in five infants. In only 4 cases were
neurological or epileptic sequelae lacking. The clustering of neurological
complications in the 24 hours following immunization is not consistent with the
hypothesis of a mere temporal coincidence. However, the mechanism and incidence
of post-immunization encephalopathies remains obscure and epidemiological
studies are in order
Aisen M.L.,
Dietz M.A., Rossi P., Cedarbaum J.M., and Kutt H. (1992) Clinical and
pharmacokinetic aspects of high dose oral baclofen therapy. J. Am. Paraplegia
Soc. 15, 211-216.
Abstract: Baclofen is a centrally acting muscle relaxant used for treatment of
spasticity. Some patients, to experience adequate symptomatic relief, require
dosages of baclofen that significantly exceed the conventional 80 mg daily
maximum advocated by the 1992 Physicians' Desk Reference. In this pilot study
of baclofen kinetics and dynamics in eleven patients, the safety and efficacy
of high dose baclofen was confirmed. The data suggest that the pharmacokinetics
of high dose baclofen may vary from those described previously. Time-to-peak
plasma levels and plasma half-lives were noted to be substantially longer than
prior reports indicate. Baclofen blood levels were observed to rise gradually
over time in some patients on a stable dosing regimen, probably a result of
impaired renal clearance. These findings may indicate that a change in pattern
of prescription is warranted and that a reliable and practical measurement of
systemic baclofen levels has a useful role in clinical practice, particularly
for the patient with neurogenic bladder and potential renal insufficiency
Aisen M.L.,
Dietz M., McDowell F., and Kutt H. (1994) Baclofen toxicity in a patient with
subclinical renal insufficiency. Arch. Phys. Med. Rehabil. 75, 109-111.
Abstract: Baclofen, a centrally acting gamma-aminobutyric acid agonist is a
commonly used pharmacotherapy for spasticity of spinal origin. It is primarily
excreted by glomerular filtration with a clearance proportional to creatinine
clearance. We describe a 39-year-old quadriplegic women who, over a 16-week
period, developed clinical signs of baclofen toxicity confirmed by
progressively rising serum baclofen levels while on a conventional stable
dosing regimen. During this period blood urea nitrogen and creatinine
concentrations were normal and stable (9mg/dL and 0.8mg/dL, respectively).
However, creatinine clearance values were consistently low (55 to 60m/min),
suggesting renal insufficiency as the underlying cause. After a decrease in
baclofen dosage, evidence of baclofen toxicity resolved. Clinicians should be
alert to signs of evolving baclofen toxicity even in patients on an apparently
stable regimen. Baclofen dosage adjustments based on systemic baclofen level
may play a role in optimizing the clinical management of spasticity
Akinfieva
T.A. and Gerasimova I.L. (1984) [Comparative toxicity of various barium compounds].
Gig. Tr. Prof. Zabol. 45-46.
Akiyama T.,
Maeda K., and Yamada W. (1971) [Electromyographic studies on muscle tone of the
lower extremities in spastic paralysis]. Iryo. 25, 74-90.
Akman M.N.,
Loubser P.G., Donovan W.H., O'Neill M.E., and Rossi C.D. (1993) Intrathecal
baclofen: does tolerance occur? Paraplegia 31, 516-520.
Abstract: Concern over the development of tolerance in patients on continuous
intrathecal baclofen therapy has arisen as this new form of treatment for
spasticity has gained wider use. We have studied time-dose relationships in 18
spinal cord injured patients who have undergone intrathecal baclofen infusion
pump implantation since February 1988 in our facility. Our data show that there
was a significant increase in baclofen dosage needed to control spasticity
during the first 12 months post implantation. After 12 months, however, no
significant changes in dosage requirement was detected. In addition, there was
no significant difference between completely and incompletely spinal cord
injured patients with regard to both the initial dose and the tolerance trend
Akman M.N.,
Loubser P.G., Fife C.E., and Donovan W.H. (1994) Hyperbaric oxygen therapy:
implications for spinal cord injury patients with intrathecal baclofen infusion
pumps. Case report. Paraplegia 32, 281-284.
Abstract: A patient with a cervical spinal cord injury receiving intrathecal
baclofen for spasticity control underwent a 7 week course of hyperbaric oxygen
therapy to induce healing of an ischial decubitus ulcer. After completion of
this treatment and during a routine baclofen infusion pump refill, the actual
pump reservoir volume exceeded computer measurements obtained with telemetry.
Examination of the physiology of hyperbaric oxygen therapy in relation to
infusion pump function revealed that the intraspinal pressures attained during
hyperbaric oxygen therapy produced retrograde leakage of cerebrospinal fluid
into the infusion pump reservoir
Al Essa
M.A., Bakheet S.M., Patay Z.J., Nounou R.M., and Ozand P.T. (1999) Cerebral
fluorine-18 labeled 2-fluoro-2-deoxyglucose positron emission tomography (FDG
PET), MRI, and clinical observations in a patient with infantile G(M1)
gangliosidosis. Brain Dev. 21, 559-562.
Abstract: The clinical, biochemical, pathological and neuroradiological
findings of a 2-year-old Saudi boy with infantile G(M1) gangliosidosis are
reported. The patient had a progressive neurologic deterioration, manifesting
with developmental regression, sensorimotor and psychointellectual dysfunction
and generalized spasticity that started at 4 months of age. Cherry-red macula,
facial dysmorphia, hepatomegaly, exaggerated startle response to sounds,
skeletal dysplasia, and vacuolated foamy lymphocytes that contain finely
fibrillar material in addition to lamellar membranes and electron-dense rounded
bodies were seen. MRI of the brain demonstrated mild diffuse brain atrophy and
features of delayed dysmyelination and demyelination. Brain FDG PET scan
revealed a mild decrease in the basal ganglia uptake, and moderate to severe
decrease in thalamic and visual cortex uptake, and an area of increased glucose
uptake in the left frontal lobe, probably representing an active seizure focus.
The functional changes indicated by FDG PET scan and the structural
abnormalities shown on MRI were found to be complementary in the imaging
evaluation of infantile G(M1) gangliosidosis
Al Khodairy
A.T., Gobelet C., and Rossier A.B. (1998) Has botulinum toxin type A a place in
the treatment of spasticity in spinal cord injury patients? Spinal Cord. 36,
854-858.
Abstract: OBJECTIVE: To present and discuss treatment of severe spasms related
to spinal cord injury with botulinum toxin type A. DESIGN: A 2-year follow- up
study of an incomplete T12 paraplegic patient, who was reluctant to undergo intrathecal
baclofen therapy, presenting severe painful spasms in his lower limbs treated
with intramuscular injections of botulinum toxin type A. SETTING: Department of
Physical Medicine and Rehabilitation, Hopital de Gravelone, Sion, Switzerland.
SUBJECT: Single patient case report. MAIN OUTCOME MEASURE: Spasticity, spasms
and pain measured with the modified Ashworth scale, spasm frequency score and
visual analogue scale. RESULTS: Treatment of spasticity with selective
intramuscular injections of botulinum toxin type A resulted in subjective and
objective improvement. CONCLUSION: Botulinum toxin type A has its place in the
treatment of spasticity in spinal cord injury patients. This treatment is
expensive and its effect is reversible. It can complement intrathecal baclofen
in treating upper limb spasticity in tetraplegic patients. Tolerance does occur
to the toxin. Although high doses of the product are well tolerated, the
quantity should be tailored to the patient's need. The minimal amount necessary
to reach clinical effects should be adhered to and booster doses at short
period intervals should be avoided
Al Khodairy
A.T., Vuagnat H., and Uebelhart D. (1999) Symptoms of recurrent intrathecal
baclofen withdrawal resulting from drug delivery failure: a case report. Am. J.
Phys. Med. Rehabil. 78, 272-277.
Abstract: A 24-yr-old, completely (T8) paraplegic male patient presenting with
severe spasticity had a drug administration device implanted in April 1991 for
continuous intrathecal administration of baclofen. After a period of remarkable
improvement in both the spasticity level and his quality of life, the patient
experienced several short-lasting episodes of increased spasticity, with severe
spasms. Among the possible causes of these deleterious episodes were microcrystalluria,
obstipation, a decubitus ulcer, a foreign body in the buttocks, drug tolerance
to baclofen, electromagnetic interference, and erroneous filling and programing
of the pump. The catheter was the most common source of intrathecal baclofen withdrawal
symptoms and had to be changed four times in 5 yr. Intrathecal baclofen
administered through an implantable drug administration device is a highly
effective but complex and expensive procedure that requires careful patient
selection and close monitoring by highly qualified and well-trained health
professional. Withdrawal symptoms may be related to noncompliance on the part
of the patient, erroneous filling or programing of the pump, depletion of the
battery, random component failure, concomitant illness, drug tolerance, or
advancement of the disease itself. When failure of the device is suspected,
substitution with oral baclofen is recommended until a full work-up is
performed to determine the defect
Albany K.
(1997) Physical and occupational therapy considerations in adult patients
receiving botulinum toxin injections for spasticity. Muscle Nerve Suppl 6,
S221-S231.
Abstract: Physical and occupational therapists play important roles in the
evaluation and management of patients receiving botulinum toxin injections for
spasticity. Baseline evaluation includes areas beyond the muscles being
injected, since local spasticity reduction may lead to more widespread
functional changes. Because the evaluation itself influences tone, a consistent
order of muscle evaluation is recommended. The range of preinjection
assessments includes evaluation of tone, mobility, strength, balance,
endurance, assistive devices, and others. After injection, therapeutic
interventions have multiple aims, including strengthening and facilitation,
increasing range of motion, retraining of ambulation and gait, improving the
fit and tolerance of orthoses, and improved functioning in ADLs
Albright
A.L., Cervi A., and Singletary J. (1991) Intrathecal baclofen for spasticity in
cerebral palsy. JAMA 265, 1418-1422.
Abstract: Seventeen patients with congenital spastic cerebral palsy and six
patients with other forms of spasticity were injected intrathecally with doses
of placebo or baclofen, 25 micrograms, 50 micrograms, or 100 micrograms, in a
randomized, double-blind manner. Muscle tone in the upper and lower extremities
was assessed by Ashworth scores both before the injections and every 2 hours
afterward for 8 hours. Function of the upper extremities was evaluated before
the injections and 4 hours afterward. Muscle tone in the lower extremities was
significantly decreased within 2 hours after baclofen injection and remained
lower than baseline 8 hours afterward. Upper extremity tone and function were
not significantly affected by these single doses. Confusion and drowsiness
occurred in two of the youngest children in the study after the 50-micrograms
dose, but cleared within 2 hours. Our findings indicate that intrathecal
baclofen reduces spasticity in children with cerebral palsy, as it does in
adults with spasticity of spinal origin
Albright
A.L. (1992) Neurosurgical treatment of spasticity: selective posterior
rhizotomy and intrathecal baclofen. Stereotact. Funct. Neurosurg. 58, 3-13.
Abstract: The pathophysiology of spasticity and the history of posterior
rhizotomies are reviewed. The rationale for selective posterior rhizotomies is
that electrical stimulation identifies afferent posterior rootlets that
terminate on relatively uninhibited alpha motoneurons; if these uninhibited
rootlets are divided, spasticity can be alleviated without loss of other
posterior root functions. Indications, technique, and results of selective
posterior rhizotomies are presented. The use of continuous intrathecal baclofen
(CITB) is summarized. CITB at doses of approximately 300 micrograms/day
consistently reduces lower extremity spasticity and diminishes or alleviates
muscle spasms in adults with spasticity of spinal origin. Single doses of
intrathecal baclofen significantly decrease lower extremity muscle tone in
children with cerebral palsy, and the effects can be maintained in these
patients by CITB infusions which diminish muscle tone not only in the lower
extremities, but in the upper extremities as well. CITB is best accomplished
via an externally programmable pump that allows titration of the daily dose to
attain the desired reduction in spasticity. Factors influencing the decision
for rhizotomy or CITB are presented
Albright
A.L., Barron W.B., Fasick M.P., Polinko P., and Janosky J. (1993) Continuous
intrathecal baclofen infusion for spasticity of cerebral origin. JAMA 270,
2475-2477.
Abstract: OBJECTIVE--To determine if continuous intrathecal baclofen infusion
(CIBI) would provide continuous relief of spasticity in patients with
spasticity of cerebral origin, especially children with cerebral palsy.
DESIGN--Prospective, unblinded trial, before and after CIBI. SETTING--
Children's
Albright
A.L., Barry M.J., and Hoffmann P. (1995) Intrathecal L-baclofen for cerebral
spasticity: case report. Neurology 45, 2110-2111.
Albright
A.L., Barry M.J., Fasick M.P., and Janosky J. (1995) Effects of continuous
intrathecal baclofen infusion and selective posterior rhizotomy on upper
extremity spasticity. Pediatr. Neurosurg. 23, 82-85.
Abstract: This study was performed to compare the effects of continuous
intrathecal baclofen infusion (CIBI) and selective posterior rhizotomy (SPR) on
upper extremity (UE) spasticity and range of motion in children with cerebral
palsy. Spasticity was assessed with the Ashworth scale of muscle tone and range
of motion was evaluated. Thirty-eight patients who had been treated with CIBI
for at least 6 months were paired, according to pretreatment UE muscle tone and
functional status, with 38 patients who had undergone SPR. The CIBI dosage had
been titrated to reduce over lower extremity spasticity and improve lower
extremity function, rather than to improve UE tone. The pretreatment muscle
tone in the two groups was virtually identical. The UE tone of children treated
with CIBI decreased from 2.07 prior to treatment to 1.66 after 1 year (p <
0.01). The tone of children treated with SPR decreased from 2.03 to 1.70 after
1 year (p = 0.005). In that group, the likelihood of a clinically significant
reduction in muscle tone (one point or greater) was greater in children with a
higher pretreatment UE muscle tone. There was no correlation between the
percentage of posterior lumbar roots divided in SPR and the subsequent
reduction in UE tone. There were no significant changes in the range of motion
in any UE joint, at either 6 or 12 months, after either CIBI or SPR. We conclude
that both CIBI and SPR significantly reduce UE spasticity, in addition to the
previously documented reduction in lower extremity spasticity
Albright
A.L. (1996) Intrathecal baclofen in cerebral palsy movement disorders. J. Child
Neurol. 11 Suppl 1, S29-S35.
Abstract: Intrathecal baclofen reduces spasticity in individuals with cerebral
palsy. Intrathecal doses are far lower than oral doses and the effects are
considerably greater, and the side effects are fewer. Response to intrathecal
baclofen must be confirmed by a screening trial before implantation of a pump
for chronic infusion. Intrathecal baclofen reduces spasticity in the upper and
lower extremities and is often associated with improved gait and upper
extremity function. Quality of life improves for patients and caregivers. The
Medtronic pump has been exceedingly reliable and typically functions for 4 or 5
years. The currently available intrathecal catheter is associated with far
fewer complications than the initial catheter. Baclofen overdoses are unusual
and are usually caused by pump programming errors rather than pump malfunction.
Preliminary studies suggest that continuous intrathecal baclofen infusion
reduces generalized dystonia in cerebral palsy. Screening to determine response
of dystonia to intrathecal baclofen is by continuous infusion. The doses
required to reduce dystonia are higher than those for cerebral spasticity.
Additional investigations are underway to quantify the effects of continuous
intrathecal baclofen infusion on communication, disability, and dystonia
Albright
A.L. (1996) Baclofen in the treatment of cerebral palsy. J. Child Neurol. 11,
77-83.
Abstract: Baclofen, a gamma-aminobutyric acid agonist, acts at the spinal cord level
to impede the release of excitatory neurotransmitters that cause spasticity.
Oral baclofen improves cerebral spasticity mildly, but its activity is limited
because of its poor lipid solubility. Cerebrospinal fluid baclofen levels after
intrathecal administration are many times higher than those achieved after oral
administration. Continuous intrathecal baclofen infusion has been used to treat
cerebral spasticity in two patient groups: in older ambulatory children with
inadequate underlying leg strength, and in patients with severe spasticity in
both the upper and lower extremities. Responsiveness to intrathecal baclofen is
confirmed by test injections before insertion of a programmable subcutaneous
pump. Continuous intrathecal baclofen infusion dosages vary from 27 to 800
micrograms/day. Continuous intrathecal baclofen infusion reduces spasticity in
the upper and lower extremities, and improves upper extremity function and
activities of daily living but has no effect on athetosis in the dosages used to
treat spasticity. Complications related to the intrathecal catheter occur in
approximately 20% of patients, and infection requiring pump removal occurs in
approximately 5%. Preliminary studies indicate that continuous intrathecal
baclofen infusion alleviates some forms of generalized dystonia associated with
cerebral palsy
Albright
A.L. and Shultz B.L. (1999) Plasma baclofen levels in children receiving
continuous intrathecal baclofen infusion. J. Child Neurol. 14, 408-409.
Abstract: To determine the plasma baclofen concentrations of children
undergoing continuous intrathecal baclofen infusion for treatment of cerebral
spasticity, we assayed plasma samples from six children, 8 to 18 years of age,
who were receiving intrathecal baclofen at constant rates of 77 to 400
micrograms/day. Plasma levels were at or below the limit of quantification (10
ng/mL) in all patients
Alexopoulos
K.A. (1973) The importance of breech delivery in the pathogenesis of brain
damage. End results of a long-term follow-up. Clin. Pediatr. (Phila)
12, 248-249.
Angelucci L., Lorentz G., Maccari S., Patacchioli F.R.,
Scaccianoce S., and Taglialatela G. (1990) [Pharmacologic profile of protirelin
tartrate]. Ann. Ital. Med.
Int. 5, 232-244.
Abstract: Pharmacological interest in the tripeptide thyrotropin-releasing
hormone (TRH) is due to the multiple effects it produces. In fact, apart from
taking part in regulating the activity of the hypothalamo- pituitary-thyroid
axis, TRH produces various neuropharmacological effects which indicate a biological
role that is probably more important than that of a releasing hormone. Trials
performed in animals have shown, for example, the dose-dependent capacity of
TRH to induce analgesia, probably by interacting with the opioid peptide
system. Motor activity is affected by TRH. In fact this tripeptide elicits an
increase in spontaneous motor and explorative activities by interacting with
the dopaminergic neurotransmitter system at the nucleus accumbens level. The
neuropharmacological activities of TRH include an interesting arousal effect
and an analeptic action on generalized depression of the CNS whether this
depression is of natural origin, such as hibernation, or induced
pharmacologically (barbiturates, ethanol) or of a traumatic origin (coma). This
analeptic action is attributable to stimulation of cholinergic neurons in the
septo- hippocampal area and to the presence of terminals containing TRH in the
lateral septum and TRH receptors concentrated especially in the medial septum
and diagonal band of Broca. It has also been suggested that TRH localized in
the pineal gland has a part in activating the neuronal mechanisms of arousal.
Associated with the arousal effect and especially evident in variously
originated shock conditions are the activating effects of TRH on vegetative
functions (body temperature, circulation, the gastrointestinal tract). These
stimulatory activities on the CNS were the rationale for therapeutic use of TRH
in the initial treatment of coma due to brain trauma and for the treatment of endogenous
depression. A most interesting property of TRH is that of counteracting the
neurological deficit due to experimental lesion of the spinal cord particularly
with regard to spasticity and ataxia. Electrophysiological trials have shown
that TRH depolarizes the motoneurons in frog spinal cord thereby increasing the
monosynaptic reflex. Furthermore, TRH has recently been shown to have a trophic
effect on cultures of rat fetus spinal cord. On this basis TRH has been used
successfully for the treatment of amyotropic lateral sclerosis (Charcot's
syndrome) and spinocerebellar degeneration. Further support for this
therapeutic strategy is given by the demonstration that deafferentiation of rat
spinal cord produces an increased density of TRH spinal receptors. Recent
studies have also given encouraging results on the possible therapeutic use of
TRH for the treatment of Alzheimer's disease.(ABSTRACT TRUNCATED AT 400 WORDS)
Anzai E.,
Shiozawa Z., Shindo K., Tsunoda S., Koizumi K., and Uchiyama G. (1990)
[123I-iodoamphetamine single photon emission computed tomography in three
patients with amyotrophic lateral sclerosis]. Kaku Igaku 27, 863-867.
Abstract: We examined the 123I-iodoamphetamine SPECT for 3 patients with ALS,
who were clinically diagnosed. Patient 1 was a 31-years-old man, who had
bilateral muscle weakness of his upper extremities, and spasticity in lower
extremities. Patient 2 was a 51-years-old woman, who had marked weakness of her
upper extremities and bulbar sign. Patient 3 was a 68- years-old man, who had
severe degree of marked weakness of his upper extremities and mild bulbar
signs. Cerebral cognitive function were all normal in three patients. Computed
tomographic and magnetic resonance imagings showed moderate degree of cortical
atrophy in patient 1, but no abnormalities in patients 2 and 3. In 123I-IMP
SPECT, however, hypoperfusion were recognized on the bilateral fronto-parietal
border zone areas in these three patients with ALS. It was suggested that
patients with ALS showed varying degrees of impaired perfusion in the
fronto-parietal border zone areas in spite of normal cognitive functions
Arita J.,
Hamano S.,
Abstract: Satoyoshi syndrome is a very rare disease of unknown etiology,
characterized by intermittent painful muscle spasms, alopecia, multiple
epiphyseal changes, diarrhea and endocrine disorders. We administered
intravenous gammaglobulin to a 7-year-old girl with Satoyoshi syndrome.
Frequency of muscle spasms and the titers of antinuclear antibody and anti-DNA
antibody decreased. This is the first report of gammaglobulin therapy of
Satoyoshi syndrome. We suggest that this illness could be related to an
autoimmune mechanism
Arjona V.E.
(1974) Sterotactic hypothalamotomy in erethic children. Acta Neurochir. (Wien.
) Suppl 21, 185-191.
Armstrong
R.W. (1992) Intrathecal baclofen and spasticity: what do we know and what do we
need to know? Dev. Med. Child Neurol. 34, 739-745.
Armstrong
R.W., Steinbok P., Cochrane D.D.,
Abstract: Management of severe spasticity in children is often a difficult
problem. Orally administered medications generally offer limited benefits. This
study examines the value of intrathecally administered baclofen in the
treatment of 19 children with severe spasticity of cerebral origin: eight of whom
sustained brain injury associated with trauma, near drowning, or cardiac
arrest; 10 with cerebral palsy (spastic quadriplegia); and one child with
Leigh's disease. At the time of entry into the study, patients ranged from 4 to
19 years of age, and all were completely dependent on caretakers for activities
of daily living. Children who responded positively to a trial dose of
intrathecal baclofen underwent insertion of a drug delivery system for
continuous infusion. This was followed by a double-blind trial of baclofen or
placebo and follow-up review at 3 and 6 months, and yearly thereafter. Seven
children did not undergo pump implantation because of excess sedation or poor
response. The 12 remaining children have been followed for a period of 1 to 5
years. Favorable responses were present in all 12 children as determined by the
Ashworth Scale, with the greatest benefit being reduction of lower limb tone.
Except in the case of one child who had reduction in lower limb tone that
resulted in difficulty with transfers, the caretakers all reported significant
benefits from intrathecal baclofen, with improvement in muscle tone, behavior,
sitting, and general ease of care being most commonly noted. Central side
effects were seen in some children who received continuous intrathecal baclofen
infusion and included hypotension (two patients), bradycardia (two), apnea or
respiratory depression (two), and sedation (one). During a total of 568 months
of pump operation there were 10 mechanical complications, including two related
to pump or side port failure and eight related to catheter kinks, extrusions,
or dislodgment. Pump pocket effusion occurred in five children and a
cerebrospinal fluid fistula was seen in one child. Local infection occurred in
three children and meningitis in two children. The results demonstrate the
potential value of continuous intrathecal baclofen infusion for treatment of
severe spasticity of cerebral origin. However, this treatment can result in
significant complications and more experience is required before the long-term
benefits can be determined
Ashby P.,
Burke D., Rao S., and Jones R.F. (1972) Assessment of cyclobenzaprine in the
treatment of spasticity. J. Neurol. Neurosurg. Psychiatry 35, 599-605.
Ashby P. and
White D.G. (1973) "Presynaptic" inhibition in spasticity and the
effect of beta(4- chlorophenyl)GABA. J. Neurol. Sci. 20, 329-338.
Ast D. and
Cunha B.A. (1990) Chronic encephalitis caused by leukoencephalopathy. Heart
Lung 19, 678-684.
Abstract: As mentioned previously, both MS and PML are demyelinating conditions
of the CNS and pose diagnostic difficulties in their differentiation because of
similarities in their clinical findings. However, certain features unique to
each of these diseases are helpful in clinical diagnosis. MS, unlike PML, is a
disease of unknown cause. Polygenetic influences in combination with exposure
to an environmental agent and immune-mediated factors may be operative in the
pathogenesis of MS. Age of onset peaks in the third to fourth decades with a
predominance in women, as contrasted with PML, which peaks in the fifth to
sixth decades in most non-AIDS-associated cases with a slight predominance in
men. MS is more prevalent in areas farther from the equator: North America,
Europe,
Aubry M.L.,
Cowell P., Davey M.J., and Shevde S. (1970) Aspects of the pharmacology of a
new anthelmintic: pyrantel. Br. J. Pharmacol. 38, 332-344.
Ault B.,
Gruenthal M., Armstrong D.R., Nadler J.V., and Wang C.M. (1986) Baclofen
suppresses bursting activity induced in hippocampal slices by differing
convulsant treatments. Eur. J. Pharmacol. 126, 289-292.
Abstract: Epileptiform activity was induced in area CA3 of hippocampal slices
by superfusion of medium containing 50 microM bicuculline and 3.5 mM K, 50
microM bicuculline and 5 mM K, 50 nM kainic acid and 3.5 mM K, or 7 mM K. Burst
potentials were recorded at rates between 5 and 44/min, depending on the
convulsant treatment. Baclofen reduced the frequency of burst firing in all
slices tested in a dose-dependent manner, with little change in the morphology
of individual bursts. Thus baclofen primarily affected the initiation of
epileptiform discharges. IC50 values varied between 27 and 500 nM and were
positively correlated with the rate of bursting. These experiments indicate
that baclofen, at concentrations present in the CSF of patients treated for
spasticity, has an anticonvulsant-like effect in the hippocampal formation and
suggest that its mode of action is to reduce the excitability of pyramidal
cells
Abstract: The usefulness of botulinum toxin A treatment when planning hand
surgery in eight children with spastic hemiplegia was evaluated. The hand
function of the children was assessed before and after treatment using a test
battery consisting of quantitative and qualitative functional assessment. The
results of preoperative botulinum treatment supported surgical intervention in
four children and serial botulinum treatment in three children. In one child,
the preoperative botulinum treatment provided no additional information. We
conclude that preoperative botulinum A treatment in most children with spastic
hemiplegia, for whom hand surgery is being considered, identifies the patients
who would not benefit from the planned surgery or for whom the functional
benefit would probably not outweigh the burden of surgical procedure and
postoperative rehabilitation
Avakian
G.N., Chukanova E.I., and Nikonov A.A. (2000) [The administration of midocalm
in the treatment of vertebrogenic algesic syndromes]. Zh. Nevrol. Psikhiatr. Im
S. S. Korsakova 100, 26-31.
Awad I.A.
and Barnett G.H. (1990) Neurological deterioration in a patient with a spinal
arteriovenous malformation following lumbar puncture. Case report. J.
Neurosurg. 72, 650-653.
Abstract: The mechanism of nonhemorrhagic neurological deterioration from
spinal arteriovenous malformation (AVM) and the role of acute surgical
intervention in this setting are not well understood. The case is described of
a 65-year-old man who presented with a 2-year history of mild gait spasticity
and vague sensory complaints affecting both lower extremities. Following a
diagnostic lumbar puncture, these symptoms progressed painlessly over a 4-day
period to total motor paraplegia, urinary retention, and hypesthesia in all
modalities with a midthoracic sensory level. Magnetic resonance imaging showed
a probable spinal AVM but no evidence of hemorrhage or cord compression. Spinal
angiography confirmed the diagnosis of spinal AVM fed by radicular branches of
left T-7 and T-8 segmental intercostal arteries. Drainage was via long dorsal
veins caudally. Emergency laminectomy with intradural exploration was
performed. There was no evidence of prior hemorrhage or focal mass effect, although
the cerebrospinal fluid pressure was elevated. The dural component of the
spinal AVM was excised, and its communications with the spinal cord were
disconnected intradurally. Neurological function started improving within 6
hours of the patient awakening from anesthesia. He had achieved antigravity
strength in every muscle group of the lower extremities by the time of
discharge to a rehabilitation center 10 days after surgery. Three months
postoperatively, he was ambulating with a walker and was continent of urine and
stool. Possible pathophysiological mechanisms are discussed in light of the
favorable response to timely surgical intervention
Azouvi P.,
Roby-Brami A., Biraben A., Thiebaut J.B., Thurel C., and Bussel B. (1993)
Effect of intrathecal baclofen on the monosynaptic reflex in humans: evidence
for a postsynaptic action. J. Neurol. Neurosurg. Psychiatry 56, 515-519.
Abstract: Intrathecal baclofen is a very powerful antispastic agent. Its
mechanism of action on the monosynaptic H-reflex in spinal patients was
investigated. It could inhibit rapidly and profoundly monosynaptic reflexes in
lower limbs, but did not modify Ia vibratory inhibition of the soleus H-reflex.
To assess more precisely its effect on Ia afferents, an experimental paradigm
using Ia heteronymous facilitation of the soleus H-reflex was used. Intrathecal
baclofen did not modify the amount of monosynaptic facilitation of the soleus
H-reflex brought about by stimulation of the femoral nerve. This demonstrates
that the main part of the inhibitory effect of baclofen on the H-reflex in
spinal patients is not due to a presynaptic effect, suggesting a postsynaptic
site of action
Azouvi P.,
Mane M., Thiebaut J.B., Denys P., Remy-Neris O., and Bussel B. (1996)
Intrathecal baclofen administration for control of severe spinal spasticity:
functional improvement and long-term follow-up. Arch. Phys. Med. Rehabil. 77,
35-39.
Abstract: OBJECTIVES: To assess long-term efficacy and functional benefits of
intrathecal baclofen for severe spinal spasticity. DESIGN: A prospective
before-after trial. SETTING: A neurological rehabilitation department of a
university hospital. Pump implantation was realized in neurosurgery; follow-up
was carried out mostly on an outpatient basis. PATIENTS: Eighteen patients with
severe and disabling spinal spasticity received intrathecal baclofen by an
implantable pump; average follow-up was 37.4 months (range, 9 to 72). MAIN
OUTCOME MEASURES: Spasticity (Ashworth and spasms frequency scores); disability
(Functional Independence Measure [FIM]). RESULTS: A significant decrease in
tone and spasms was observed in all patients. Tolerance appeared during the
first 6 to 9 months. Later on, efficacy remained stable, except in cases of
mechanical problems of the pump or catheter. Functional assessment found a
highly significant (p < .001) increase of FIM score (particularly for
bathing, dressing lower body, transfers, and in some cases, locomotion). This
was particularly marked in patients with thoracic spinal cord lesion. In cases
of severe upper limb dysfunction, FIM was only improved for wheelchair
displacements, due to a better sitting position, but nursing became easier and
life comfort was enhanced. Severe side effects (overdose) were observed in two
cases. CONCLUSION: Efficacy remained stable after 6 to 9 months. Marked
improvement of functional independence was observed in paraplegic patients.
Improvement was less spectacular in patients with severe upper limb
dysfunction, but nevertheless appreciable in terms of life comfort and use of
attendants
Azzam F.J.
(1987) A simple and effective method for stopping post-anesthetic clonus.
Anesthesiology 66, 98.
Backman C.,
Nystrom A., Backman C., and Bjerle P. (1993) Arterial spasticity and cold
intolerance in relation to time after digital replantation. J. Hand Surg. [
Abstract: Cold induced arterial vasospasm was studied in ten patients with
single digit replantation, by measuring finger systolic pressure at different
finger temperatures. Each patient was examined three times; within 2 weeks of
surgery, after 1 year and after 3 years. The replantations were performed using
long arterial and venous grafts. Cold-related vasospasm is established during
the first year after trauma, and thereafter seems to be persistent. It is concluded
that the subjective cold tolerance, which affects all patients after digital
amputation regardless of whether replantation is performed or not, is partly
due to vasospasm. It is less pronounced in patients without pathological
vasospasm in the replanted digit. Cold intolerance is likely to decrease during
the first 2 years after replantation, but not to disappear completely
Backon J.
(1989) Inhibiting noradrenergic overactivity by inhibition of thromboxane and
concomitant activation of opiate receptors via dietary means. Med. Hypotheses
29, 65-74.
Abstract: A yin-yang hypothesis is presented linking noradrenergic activity,
thromboxane, melatonin, left hemisphere functioning, and cyclic AMP on the one
hand, and dopamine, beta-endorphin, calcium, right hemisphere functioning, and
cyclic GMP on the other. It is further suggested that there is a yoking of NA,
TXA2, serotonin and melatonin in the left hemisphere, and a similar yoking of
DA, BE, calcium and cGMP in the right. Evidence is presented to support the
hypothesis that each element (NA, TXA2, etc.) on one side can modulate or
balance a corresponding element (DA, BE, etc.) on the other. It is suggested
that thromboxane is the key element in noradrenergic overactivity and that not
taking this into consideration has confounded much prior research. This theory
takes into account information processing models as well as pharmacological
data and neurochemical theory on coupling of adenylate cyclase to its hormone
receptors. Inhibiting noradrenergic overactivity can be obtained by inhibiting
thromboxane and concomitantly activating opiate receptors. This protocol may
have clinical utility in treating a wide range of disorders such as: anxiety,
depression, schizophrenia, sleeplessness, withdrawal states, enuresis, Gilles
de la Tourette syndrome, Parkinsonism, Alzheimers, dementia, anorexia, infant
ruminations, essential tremor, spasticity of spinal cord injury, diarrhoea,
ulcerative colitis, extrapyramidal symptoms, akathisia, neuroleptic malignant
syndrome, attention deficit disorder, hyperhidrosis, and possibly AIDS
Baikushev S.
(1967) [Effect of prostigmine on voluntary and tonic contraction in patients
with spastic paralysis. Electromyographic studies]. Folia Med. (Plovdiv. ) 9,
89-98.
Bajd T.,
Munih M., and Kralj A. (1999) Problems associated with FES-standing in
paraplegia. Technol. Health Care 7, 301-308.
Abstract: Prolonged immobilization, such as occurs after the spinal cord injury
(SCI), results in several physiological problems. It has been demonstrated that
the standing posture can ameliorate many of these problems. Standing exercise
can be efficiently performed by the help of functional electrical stimulation (
Bakay B.,
Nissinen E., Sweetman L.,
Abstract: The patient, H.Chr.B., was among the first reported with
hyperuricemia and central nervous system symptoms. He has been found to have a
variant of hypoxanthine guanine phosphoribosyl transferase (HPRT; E.C.2.4.2.8)
distinct from the enzyme present in patients with the Lesch-Nyhan syndrome. The
patient had chroeoathetosis, spasticity, dysarthric speech, and hyperuricemia.
However, his intelligence was normal and he had no evidence of self-mutilation.
There was no activity of HPRT in the lysates of erythrocytes and cultured
fibroblasts when analyzed in the usual manner. Using a newly developed method
for the study of purine metabolism in intact cultured cells, this patient was
found to metabolize some 9% of 8-14C-hypoxanthine, and 90% of the isotope
utilized was converted to adenine and guanine nucleotides. In contrast, cells
from patients with the Lesch-Nyhan syndrome were virtually completely unable to
convert hypoxanthine to nucleotides. The patient's fibroblasts were even more
efficient in the metabolism of 8- 14C-guanine, which was utilized to the extent
of 27%, over 80% of which was converted to guanine and adenine nucleotides. The
growth of the cultured fibroblasts of this patient was intermediate in media
containing hypoxanthine aminopterin thymidine (HAT), whereas the growth of
Lesch-Nyhan cells was inhibited and normal cells grew normally. Similarly in
8-azaguanine, 6-thioguanine, and 8-azahypoxanthine, the growth of the patient's
cells was intermediate between normal and Lesch- Nyhan cells. These
observations provide further evidence for genetic heterogeneity among patients
with disorders in purine metabolism involving the HPRT gene. They document that
this famous patient did not have the Lesch-Nyhan syndrome
Baker D.,
Pryce G., Croxford J.L., Brown P., Pertwee R.G., Huffman J.W., and Layward L.
(2000) Cannabinoids control spasticity and tremor in a multiple sclerosis
model. Nature 404, 84-87.
Abstract: Chronic relapsing experimental allergic encephalomyelitis (CREAE) is
an autoimmune model of multiple sclerosis. Although both these diseases are
typified by relapsing-remitting paralytic episodes, after CREAE induction by
sensitization to myelin antigens Biozzi ABH mice also develop spasticity and
tremor. These symptoms also occur during multiple sclerosis and are difficult
to control. This has prompted some patients to find alternative medicines, and
to perceive benefit from cannabis use. Although this benefit has been backed up
by small clinical studies, mainly with non-quantifiable outcomes, the value of
cannabis use in multiple sclerosis remains anecdotal. Here we show that
cannabinoid (CB) receptor agonism using R(+)-WIN 55,212, delta9-
tetrahydrocannabinol, methanandamide and JWH-133 (ref. 8) quantitatively
ameliorated both tremor and spasticity in diseased mice. The exacerbation of
these signs after antagonism of the CB1 and CB2 receptors, notably the CB1
receptor, using SR141716A and SR144528 (ref. 8) indicate that the endogenous
cannabinoid system may be tonically active in the control of tremor and spasticity.
This provides a rationale for patients' indications of the therapeutic
potential of cannabis in the control of the symptoms of multiple sclerosis, and
provides a means of evaluating more selective cannabinoids in the future
Baker D.,
Pryce G., Croxford J.L., Brown P., Pertwee R.G., Makriyannis A., Khanolkar A.,
Layward L., Fezza F., Bisogno T., and Di M., V (2001) Endocannabinoids control
spasticity in a multiple sclerosis model. FASEB J. 15, 300-302.
Abstract: Spasticity is a complicating sign in multiple sclerosis that also
develops in a model of chronic relapsing experimental autoimmune
encephalomyelitis (CREAE) in mice. In areas associated with nerve damage,
increased levels of the endocannabinoids, anandamide (arachidonoylethanolamide,
AEA) and 2-arachidonoyl glycerol (2-AG), and of the AEA congener,
palmitoylethanolamide (PEA), were detected here, whereas comparable levels of
these compounds were found in normal and non-spastic CREAE mice. While
exogenously administered endocannabinoids and PEA ameliorate spasticity,
selective inhibitors of endocannabinoid re-uptake and hydrolysis-probably
through the enhancement of endogenous levels of AEA, and, possibly,
2-arachidonoyl glycerol-significantly ameliorated spasticity to an extent
comparable with that observed previously with potent cannabinoid receptor
agonists. These studies provide definitive evidence for the tonic control of
spasticity by the endocannabinoid system and open new horizons to therapy of
multiple sclerosis, and other neuromuscular diseases, based on agents
modulating endocannabinoid levels and action, which exhibit little psychotropic
activity
Bakheit
A.M., Ward C.D., and McLellan D.L. (1997) Generalised botulism-like syndrome
after intramuscular injections of botulinum toxin type A: a report of two
cases. J. Neurol. Neurosurg. Psychiatry 62, 198.
Bakheit
A.M., Thilmann A.F., Ward A.B., Poewe W., Wissel J., Muller J., Benecke R.,
Collin C., Muller F., Ward C.D., and Neumann C. (2000) A randomized,
double-blind, placebo-controlled, dose-ranging study to compare the efficacy
and safety of three doses of botulinum toxin type A (Dysport) with placebo in
upper limb spasticity after stroke. Stroke 31, 2402-2406.
Abstract: BACKGROUND AND PURPOSE: We sought to define an effective and safe
dose of botulinum toxin type A (Dysport) for the treatment of upper limb muscle
spasticity due to stroke. METHODS: This was a prospective, randomized,
double-blind, placebo-controlled, dose-ranging study. Patients received either
a placebo or 1 of 3 doses of Dysport (500, 1000, 1500 U) into 5 muscles of the
affected arm. Efficacy was assessed periodically by the Modified Ashworth Scale
and a battery of functional outcome measures. RESULTS: Eighty-three patients
were recruited, and 82 completed the study. The 4 study groups were comparable
at baseline with respect to their demographic characteristics and severity of
spasticity. All doses of Dysport studied showed a significant reduction from baseline
of muscle tone compared with placebo. However, the effect on functional
disability was not statistically significant and was best at a dose of 1000 U.
There were no statistically significant differences between the groups in the
incidence of adverse events. CONCLUSIONS: The present study suggests that
treatment with Dysport reduces muscle tone in patients with poststroke upper
limb spasticity. Treatment was effective at doses of Dysport of 500, 1000, and
1500 U. The optimal dose for treatment of patients with residual voluntary
movements in the upper limb appears to be 1000 U. Dysport is safe in the doses
used in this study
Bakheit
A.M., Severa S., Cosgrove A., Morton R., Rousso S.H., Doderlein L., and Lin
J.P. (2001) Safety profile and efficacy of botulinum toxin A (Dysport) in
children with muscle spasticity. Dev. Med. Child Neurol. 43, 234-238.
Abstract: Botulinum toxin A (BTX-A) is widely used in the management of muscle
spasticity in children. However, at present the dose of BTX-A for a given patient
is selected empirically. The aim of this study is to provide dosage guidelines
that are based on risk/benefit assessment. This was a multicentre retrospective
study of the safety profile and efficacy of BTX-A in children with chronic
muscle spasticity. Data in 758 patients who received a total of 1594 treatments
were analysed (mean age 7.2 years; 429 males, 329 females). Spastic cerebral
palsy (CP) was the most common diagnosis (94% of the study sample). Of all
treatments 7% resulted in adverse events; incidence was related to the total
dose rather than the dose calculated on the basis of body weight. The highest
incidence of adverse events was observed in patients who received >1000 IU
of BTX-A per treatment session. The odds of an adverse event was 5.1 times
greater for this group of patients than for those who had 250 IU or less
(p<0.001). A good overall response to treatment was reported in 82% and
treatment goals were fully or partially achieved in 3% and 94% of participants
respectively. More patients in the highest dose group reported functional
deterioration. Interestingly, multilevel treatments resulted in a better
response than single-level treatments (odds ratio 1.7, 95% CI 1.3 to
2.2,p=0.001)
Balentine
J.D. and Gutsche B.B. (1966) Central nervous system lesions in rats exposed to
oxygen at high pressure. Am. J. Pathol. 48, 107-127.
Barolat G.,
Myklebust J.B., and Wenninger W. (1988) Effects of spinal cord stimulation on
spasticity and spasms secondary to myelopathy. Appl. Neurophysiol. 51, 29-44.
Abstract: 16 subjects with severe spasms secondary to traumatic and
nontraumatic myelopathy underwent epidural spinal cord stimulation. 4 patients
had a complete motor and sensory spinal cord lesion. 6 of the subjects with an
incomplete spinal cord lesion were ambulatory. All patients had previously
undergone extensive trials with medications and physical therapy. All 14
subjects in whom a satisfactory placement of the electrode could be obtained
had a reduction in the severity of the spasms. In 6 patients, the spasms were
almost abolished. Extremity, trunkal and abdominal spasms were affected. Clonus
in the upper extremities was consistently reduced. Marked improvement in
bladder and bowel function was observed in each of 2 subjects. In over 1-year
follow-up, 5 subjects show persistence of the results, with less stimulation
required to maintain the therapeutic effects. No neurological deterioration
occurred following the procedure or after long-term spinal stimulation. 1
patient showed after several months of continuous stimulation increased
voluntary motor control present only when spinal cord stimulation was
activated. Complications included 1 system infection, 1 electrode migration, 1
wire breakage and skin breakdown at a connector site, development of high
impedance in 1 electrode and 1 skin breakdown over the lead
Barolat G.
(1988) Surgical management of spasticity and spasms in spinal cord injury: an
overview. J. Am. Paraplegia Soc. 11, 9-13.
Abstract: Spasms and spasticity constitute a significant problem in spinal cord
injured individuals. Surgical intervention may be indicated when spasms and
spasticity cannot be satisfactorily controlled by medications and physical
therapy. Surgical procedures carried out on the nervous system include
neurotomy, rhizotomy, myelotomy, cordectomy and spinal cord stimulation. The
various procedures and their indications will be discussed
Barolat G.
(1993) Experience with 509 plate electrodes implanted epidurally from C1 to L1.
Stereotact. Funct. Neurosurg. 61, 60-79.
Abstract: This article summarizes the experience gained with implantation of
509 plate electrodes performed by a single neurosurgeon. 350 patients were
subjected to implantation of plate electrodes in the dorsal epidural space. 227
patients were implanted for chronic pain management (reflex sympathetic
dystrophy, failed back syndrome/arachnoiditis, pain following spinal cord
injury, nerve injury pain and other miscellaneous pain conditions), 105
patients for motor disorders (spasms/spasticity following spinal cord or head
injury, cerebral palsy, multiple sclerosis, spasmodic torticollis and other
miscellaneous conditions) and 18 patients for both. A total of 509 electrodes
were implanted in the dorsal epidural space. The electrodes types were: 442
Medtronic Resume, 39 Medtronic Resume-TL and 25 Neuromed Lamitrode. 378
electrodes were implanted for chronic pain management, 106 for motor disorders
and 25 in patients presenting with both pain and motor disorders. 192
electrodes were implanted in the cervical area and 317 in the thoracic area.
3.7% of the implanted electrodes became infected and had to be surgically
removed. Electrode migration occurred in 1.1% of the patients and electrode
breakage in 4 patients. 288 (70%) of the implanted electrodes are still being
used. Technical factors relevant to the surgical implantation of plate
electrodes at various levels in the spine are presented and discussed
Barolat G.,
Singh-Sahni K., Staas W.E., Jr., Shatin D., Ketcik B., and Allen K. (1995)
Epidural spinal cord stimulation in the management of spasms in spinal cord
injury: a prospective study. Stereotact. Funct. Neurosurg. 64, 153-164.
Abstract: Forty-eight spinal cord injury victims were implanted with an
epidural spinal cord stimulation system to treat spasms that had not
satisfactorily responded to medical therapy. All the patients were at least 6
months after the injury. The protocol included assessment by independent
examiners preoperatively and at 3, 6, 12 and 24 months after the implant. Pre-
and postoperative data collection included the frequency and severity of the
spasms. Combining the frequency and intensity scores into a 'severity' score
provided a more accurate clinical picture. No patient observed neurological
deterioration following the surgical procedure or the neurostimulation
treatment. A statistically significant reduction in the severity of the spasms
was observed in the follow-up evaluations, with results that progressively
increased in time. It is appears that spinal cord stimulation is an effective
and safe alternative in the management of spasms in spinal cord injury victims.
Its exact role in relation to intrathecal baclofen infusion and ablative
procedures remains to be defined
Barros Filho T.E., Greve J.M., Oliveira R.P., Chiovatto J., and Carnei