Spastic Conditions Research Articles

Levator Labii Superioris Alaeque Nasi Targeted Botulinum Toxin Injection for Treatment of Perinasal Facial Discomfort and Snarling.

Botulinum toxin has been increasingly studied and used for varying conditions, most notably, cosmetics. However, it has been shown that botulinum toxin demonstrates a high efficacy in treating spasticity disorders throughout the body, including the face. Facial spasms vary in pathophysiology, region, and severity. Some can be so severe that they can cause discomfort and emotional distress due to the involuntary facial expressions caused by the spasms. Most spasticity conditions are often treated with adjuvant therapy of oral muscle relaxants and analgesics depending on severity. However, these treatments impose risks of varying adverse effects from sedation, hypotension, and if chronic use, more severe effects such as central nervous system complications or QT prolongation. In addition, if spasms are localized, the muscle relaxant's mechanism is not targeted, leading to unnecessary systemic use. That being said, a more targeted and manageable treatment such as botulinum toxin presents itself as a potential option for patient's physical condition and everyday life quality. Our case presents a 62-year-old male, with a chronic history of localized, idiopathic spasms and discomfort within the Levator Labii Superioris Aqulae Nasi region. The patient had no history of previous neurological disorders, and imaging was unremarkable. The patient had been treated over the past 13 years with varying oral therapeutics including Cymbalta, Ibuprofen, and cyclobenzaprine with limited improvement, but presented to the clinic seeking a different treatment plan, as the adverse effects from the muscle relaxants were impeding his everyday activities. The patient was also experiencing significant pain and emotional stress due to the spasms. The risk and benefits of treatment options were discussed and the patient decided to move forward with botulinum injections. After the first injection, the patient reported his pain had significantly improved and was relieved to be off of chronic pain medications. Our case demonstrates, what increasing literature further also supports: botulinum toxin is becoming a potential effective treatment for a breadth of spasticity disorders with a more targeted mechanism, and more manageable treatment plan, while simultaneously improving the patient's quality of life.

Embracing the Versatility of Botulinum Neurotoxins in Conventional and New Therapeutic Applications.

Botulinum neurotoxins (BoNTs) have been used for almost half a century in the treatment of excessive muscle contractility. BoNTs are routinely used to treat movement disorders such as cervical dystonia, spastic conditions, blepharospasm, and hyperhidrosis, as well as for cosmetic purposes. In addition to the conventional indications, the use of BoNTs to reduce pain has gained increased recognition, giving rise to an increasing number of indications in disorders associated with chronic pain. Furthermore, BoNT-derived formulations are benefiting a much wider range of patients suffering from overactive bladder, erectile dysfunction, arthropathy, neuropathic pain, and cancer. BoNTs are categorised into seven toxinotypes, two of which are in clinical use, and each toxinotype is divided into multiple subtypes. With the development of bioinformatic tools, new BoNT-like toxins have been identified in non-Clostridial organisms. In addition to the expanding indications of existing formulations, the rich variety of toxinotypes or subtypes in the wild-type BoNTs associated with new BoNT-like toxins expand the BoNT superfamily, forming the basis on which to develop new BoNT-based therapeutics as well as research tools. An overview of the diversity of the BoNT family along with their conventional therapeutic uses is presented in this review followed by the engineering and formulation opportunities opening avenues in therapy.

Nerve transfers in the forearm: potential use in spastic conditions.

Deformities of the spastic upper limb result frequently from the association of spasticity, muscle contracture and muscle imbalance between strong spastic muscles and weak non-spastic muscles. This studywas designed to evaluate the feasibility of combining selective neurectomy of the usual spastic and strong muscles together with transfer of their motor nerves to the usual weak muscles, to improve wrist and fingers motion while decreasing spasticity. Twenty upper limbs from fresh frozen human cadavers were dissected. All motor branches of the radial and median nerve for the forearm muscles were identified. We attempted all possible end-to-end nerve transfers between the usually strong "donor" motor branches, namely FCR and PT, and the usually weak "recipient" motor branches (ERCL, ECRB, PIN, AIN). The PT hadtwo nerve branches in 80%, thus allowing selective neurectomy. The proximal PT branch couldbe anastomosed end-to-end in 45% (AIN) to 85% (ECRL) of cases with the potential recipient branches.The distal PT branch could be anastomosed end to end to all potential recipient nerves. TheFCRhad a single branch in all cases. End-to-end anastomosis was possible in 90% for the ECRL and in 100% for all other recipient branches, but sacrificed all FCR innervation, ruling out hyperselectiveneurectomy. Selective neurectomies can be associated with distal nerve transfers at the forearm level in selected cases. The motor nerve to the PT is the best donor for nerve transfer combined with selective neurectomy, transferred to the ECRL, ECRB, PIN or AIN.

MRI RESEARCH OF THE CAUSES OF PAIN SYNDROMES IN THE BACK AND OSTEOCHONDROSIS OF THE SPINE

The aim of the study was to search for organic changes in the tissues of the spine that are the cause of pain syndromes in the back and spine. With the help of MRI, the state of the muscular corset of the spine was diagnosed and the violations found were compared with the localization of pain syndromes in the back and the localization of dystrophic manifestations in the vertebrae and intervertebral discs. In 70 patients who underwent MRI examinations of areas with pain syndromes in the back, it was shown that osteochondrosis of the spine is preceded by spastic conditions of the intervertebral muscles, leading to disruption of trophism of the vertebrae and intervertebral discs, as well as to the development of pain syndromes.

NERVOUS FACTORS OF ARTERIAL HYPERTENSION PROSPECTS FOR PREVENTION AND REHABILITATION

The article provides a theoretical analysis of the causes of arterial hypertension, describes a three-month observation of the initial stage of the development of hypertension and experiments on non-drug normalization of blood pressure on a group of volunteers. It has been shown that arterial hypertension is associated with spastic conditions of the intervertebral muscles in the lower thoracic spine, which lead to compression of the sympathetic nerves that control the transport of water through the kidneys and disturb the balance of fluid circulation through the circulatory system. The possibility of prevention of arterial hypertension and non-drug rehabilitation of patients with this disease has been shown.

MRI RESEARCH OF THE CAUSES OF DYSTROPHIC PROCESSES IN THE SPINE


 
 
 
 The aim of the study was to search for organic changes in the tissues of the spine, which are the cause of pain syndromes in the back and spine.
 Method. MRI was used to diagnose the condition of the muscular corset of the spine and conditions of the identified disorders with the localization of pain syndromes in the back and the localization of dystrophic manifestations in the vertebrae and intervertebral discs.
 Results. In 70 patients who underwent MRI of areas with pain syndromes in the back, it was shown that dystrophic manifestations in the spine are preceded by spastic conditions of the intervertebral muscles, leading to disruption of trophism (nutrition and regeneration) of the vertebrae and intervertebral discs, as well as the spine, the development of pain syndromes.
 The localization of spastic conditions of the intervertebral muscles coincides with the areas in which people experience pain, caused, according to most neurologists, by osteochondrosis of the spine. Osteochondrosis of the spine as a dystrophic process is a consequence of the spastic conditions of the muscles that cause disturbances in the trophism of the vertebrae and intervertebral discs.
 Conclusions: Spinal osteochondrosis is not a disease, but an irreversible dystrophic process in the vertebrae and intervertebral discs. The reasons for the development of dystrophic processes and back pain are spastic conditions in the intervertebral muscles.
 
 
 

PATHOPHYSIOLOGICAL COMPONENTS OF ARTERIAL HYPERTENSION. PROSPECTS FOR PREVENTION AND REHABILITATION

The article provides a theoretical analysis of the causes of arterial hypertension, describes a 3-month observation of the initial stage of the development of hypertension and experiments on non-drug normalization of blood pressure on a group of volunteers. We show that arterial hypertension is associated with spastic conditions of the intervertebral muscles in the lower thoracic spine, which leads to compression of sympathetic nerves that control the transport of water through the kidneys, which in turn upsets the balance of fluid circulation through the circulatory system.Theoretical analysis and experimental data made it possible to formulate a hypothesis about the dominant role of disorders in the activity of the sympathetic part of the nervous system in the development of primary and persistent arterial hypertension. The possibility of prevention of arterial hypertension and non-drug rehabilitation of patients with this disease has been shown.

Obturator nerve block

One of the forgotten techniques of regional anesthesia is blockade of the obturator nerve, which was performed using anatomical landmarks and neurostimulation. In recent years, ultrasonic navigation methods have gained wide popularity when using regional blockades. The purpose of the review is to present the current understanding of the use of obturator nerve block in clinical practice. The review presents the anatomical features of the obturator nerve passage, surgical and therapeutic indications for the use of its blockade. The technique for performing obturator blockade using ultrasound navigation is described in detail. Blockade of the obturator nerve using ultrasound navigation can reduce the likelihood of surgical complications during transurethral resection of a tumor located on the lateral wall of the bladder, improve analgesia after hip and knee surgery, and effectively relieve spastic conditions of the adductor muscles of the hip.

NERVOUS COMPONENT OF ARTERIAL HYPERTENSION. PROSPECTS FOR PREVENTION AND REHABILITATION

The article provides a theoretical analysis of the causes of arterial hypertension, describes a 3-month observation of the initial stage of the development of hypertension and experiments on non-drug normalization of blood pressure on a group of volunteers. It was shown that arterial hypertension is associated with spastic conditions of the intervertebral muscles in the lower thoracic spine, which lead to compression of sympathetic nerves that control the transport of water through the kidneys and disturb the balance of fluid circulation through the circulatory system.
 Theoretical analysis and experimental data made it possible to formulate a hypothesis about the dominant role of disorders in the activity of the sympathetic part of the nervous system in the development of primary and persistent arterial hypertension. The possibility of prevention of arterial hypertension and non-drug rehabilitation of patients with this disease has been shown

ПАТОФИЗИОЛОГИЧЕСКИЕ КОМПОНЕНТЫ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ. ПЕРСПЕКТИВЫ ПРОФИЛАКТИКИ И РЕАБИЛИТАЦИИ

The article provides a theoretical analysis of the causes of arterial hypertension, describes a 3month observation of the initial stage of the development of hypertension and experiments on non-drug normalization of blood pressure on a group of volunteers. We show that arterial hypertension is associated with spastic conditions of the intervertebral muscles in the lower thoracic spine, which leads to compression of sympathetic nerves that control the transport of water through the kidneys, which in turn upsets the balance of fluid circulation through the circulatory system. Theoretical analysis and experimental data made it possible to formulate a hypothesis about the dominant role of disorders in the activity of the sympathetic part of the nervous system in the development of primary and persistent arterial hypertension. The possibility of prevention of arterial hypertension and non-drug rehabilitation of patients with this disease has been shown.

Botulinum toxin therapy in the SARS-CoV-2 pandemic: patient perceptions from a German cohort

The SARS-CoV-2 virus pandemic has provoked drastic countermeasures including shutdowns of public services. We wanted to describe the effects of a 6 week shutdown of a large German botulinum toxin (BT) outpatient clinics on patients and their well-being. 45 patients (age 61.9 ± 9.8 years, 29 females, 16 males) receiving BT therapy (319.3 ± 201.9MU-equivalent, treatment duration 8.3 ± 5.5 years) were surveyed with a standardised questionnaire. The shutdown delayed BT therapy by 6.6 ± 2.3 weeks. 93% of the patients noticed increased muscle cramps and 82% increased pain reducing their quality of life by 40.2 ± 19.5%. For 23 patients with cervical dystonia this reduction was 41.1 ± 18.3%, for 3 patients with blepharospasm 33.3 ± 15.3%, for 9 patients with spasticity 37.8 ± 15.6%, for 4 patients with pain conditions 37.4 ± 35.7% and for 3 patients with hemifacial spasm 27.5 ± 17.1%. After the shutdown 66% of patients perceived BT therapy as more important than before, 32% perceived it as unchanged. For all patients long-term availability of BT therapy was very important or important. 98% of the patients perceived the shutdown as inadequate and felt their patient rights not respected. The shutdown confirmed the considerable burden of disease caused by dystonia, spasticity, hemifacial spasm and various pain conditions and the importance of BT therapy to treat them. Any shutdown severely affects these patients and needs to be avoided.

Perioperative Sedation and Sympatholysis Due to Tizanidine

Tizanidine is a short acting central muscle relaxant. It has agonist activity at noradrenergic alpha 2 receptors and inhibits the excitatory (presynaptic) motor neurons at both the spinal and supraspinal levels. Its action is through central alpha 2 receptors agonism. Tizanidine is a Food and Drug Administration (FDA) approved drug for reducing muscle tone in spastic conditions like spastic quadriparesis, multiple sclerosis, spinal cord injury and so on. Working knowledge of this kind of drugs are rarely used in the clinical practice which is useful for the anaesthesiologists to manage cases in the perioperative period. Here Authors reported the perioperative effects of Tizanidine in a patient with clitoral mass excision under general anaesthesia. All preoperative investigations were found with in normal limits. Patient was on tizanidine preoperatively for spastic quadriparesis. Intraoperatively, there were no significant fluctuations of Blood Pressure (BP) and Heart Rate (HR) even laryngoscopic response blunted. Postoperatively patient was calm and drowsy. This perioperative sympatholysis and sedation was due to tizanidine.

Role of botulinum neurotoxin-A in cerebral revascularization graft vasospasm prevention: current state of knowledge.

Graft stenosis and occlusion remain formidable complications in cerebral revascularization procedures, which can lead to significant morbidity and mortality. Graft vasospasm can result in early postoperative graft stenosis and occlusion and is believed to be at least partially mediated through adrenergic pathways. Despite various published treatment protocols, there is no single effective spasmolytic agent. Multiple factors, including anatomical and physiological variability in revascularization conduits, patient age, and comorbidities, have been associated with graft vasospasm pathogenesis and response to spasmolytics. The ideal spasmolytic agent thus likely needs to target multiple pathways to exert a generalizable therapeutic effect. Botulinum toxin (BTX)-A is a powerful neurotoxin widely used in clinical practice for the treatment of a variety of spastic conditions. Although its commonly described paradigm of cholinergic neural transmission blockade has been widely accepted, evidence for other mechanisms of action including inhibition of adrenergic transmission have been described in animal studies. Recently, the first pilot study demonstrating clinical use of BTX-A for cerebral revascularization graft spasm prevention has been reported. In this review, the mechanistic basis and potential future clinical role of BTX-A in graft vasospasm prevention is discussed.

Medical cannabis in the treatment of cancer pain and spastic conditions and options of drug delivery in clinical practice.

The use of cannabis for medical purposes has been recently legalised in many countries including the Czech Republic. As a result, there is increased interest on the part of physicians and patients in many aspects of its application. This mini review briefly covers the main active substances of the cannabis plant and mechanisms of action. It focuses on two conditions, cancer pain and spasticity in multiple sclerosis, where its effects are well-documented. A comprehensive overview of a few cannabis-based products and the basic pharmacokinetics of marijuana's constituents follows. The review concludes with an outline for preparing cannabis (dried inflorescence) containing drug dosage forms that can be produced in a hospital pharmacy.

The Benefits of Botulinum Neurotoxin Treatment in a Multitude of Medical Conditions

Botulinum neurotoxins (BoNTs) are responsible for botulism in humans and vertebrates, being one of the six most catastrophic potential bioterrorism agents. This are ~150 kDa proteins, assembled as a ~50 kDa light chain (LC) and a ~100 kDa heavy chain (HC). The LC acts like a zinc metalloproteinase that cleaves three proteins in neurons, members of the SNARE (Soluble N-ethylmaleimide sensitive fusion attachment protein receptors) family: VAMP (vesicle-associated membrane protein) / synaptobrevin, SNAP-25 (synaptosomal-associated protein 25) and syntaxin. After cleavage of any of this proteins, neurotransmission is blocked and flaccid paralysis of the muscle is installed. This extraordinary restricted tropism for the cholinergic presynaptic membrane makes this drug unique regarding its toxicity, pharmacological and therapeutic use. Taking into consideration the potential of this substance, this paper aims to summarize the most relevant data regarding the mechanism of actions and its main clinical applications, in order to improve medical practice. Therefore, we presented the mechanism of action in order to understand its usage in different pathologies, such as dystonias, spasticity, nephrologic and urologic conditions, cosmetic use, depression, gastroenterologic and proctologic diseases, dermatologic conditions, pathologies specific to plastic surgery and also the role of BoNT therapy in pain management. It is well documented in the literature that important discoveries have been made through recent experimental and clinical studies. Even so, there is still much to learn about the therapeutic action of this drug in terms of molecular and pathophysiological mechanisms, in order to benefit of the whole healing potential of this amazing toxin.

Movement therapy without moving - First results on isometric movement training for post-stroke rehabilitation of arm function.

This study explores the use of isometric movement training for arm rehabilitation after stroke. The aim of this approach is to enhance movement skill even when the person training is not moving. This is accomplished by deceptively displaying virtual motions, exploiting known cross-modal sensory interactions between vision and proprioception. This approach can be advantageous in situations where actual movement is prohibitive due to weakness, spasticity, instability, or unsafe conditions. We present early insights on usability of and tolerance to this training approach and quantitative results that can power future clinical trials.

A New Input Device for Spastics Based on Strain Gauge.

This article presents a new sensor for use by people with spastic disorders and similar conditions and enables them to steer and control medical devices such as electric powered wheelchairs. As spastic patients often suffer from cramping of their extremities, which can then no longer be controlled, using a standard joystick while operating a powered wheelchair can lead to dangerous situations. To prevent this, we designed a sensor based on strain gauges, which is shaped like a flat disc that can be operated using any body part. By shifting weight along the x- and y-axis, the disc tilts in all directions thereby generating proportionate output signals. The disc can also be pressed downward (z-axis), for example, to open a wheelchair’s menu. Thanks to the sensor’s flat disc-like construction and the option of mounting it into a control panel, users are not in danger of becoming stuck on the disc during spastic episodes. In the event of a spasm, body parts simply slide over the disc reducing risk of unintended actions. The sensor is adaptive and adjustable enabling it to fit a user’s range of strength and motion at any time. It was developed to ensure users can operate sensitive systems safely.

Pharmacological characteristics of metamizole.

Metamizole (dipyrone) is a popular analgetic, non-opioid drug, commonly used in human and veterinary medicine. In some cases, this agent is still incorrectly classified as a non-steroidal anti-inflammatory drug (NSAID). Metamizole is a pro-drug, which spontaneously breaks down after oral administration to structurally related pyrazolone compounds. Apart from its analgesic effect, the medication is an antipyretic and spasmolytic agent. The mechanism responsible for the analgesic effect is a complex one, and most probably rests on the inhibition of a central cyclooxygenase-3 and activation of the opioidergic system and cannabinoid system. Metamizole can block both PG-dependent and PG-independent pathways of fever induced by LPS, which suggests that this drug has a profile of antipyretic action distinctly different from that of NSAIDs. The mechanism responsible for the spasmolytic effect of metamizole is associated with the inhibited release of intracellular Ca2+ as a result of the reduced synthesis of inositol phosphate. Metamizole is predominantly applied in the therapy of pain of different etiology, of spastic conditions, especially affecting the digestive tract, and of fever refractory to other treatments. Co-administration of morphine and metamizole produces superadditive, antinociceptive effects. Metamizole is a relatively safe pharmaceutical preparation although it is not completely free from undesirable effects. Among these side-effects, the most serious one that raises most controversy is the myelotoxic effect. It seems that in the past the risk of metamizole-induced agranulocytosis was exaggerated. Despite the evidence showing no risk of teratogenic and embryotoxic effects, the drug must not be administered to pregnant women, although it is allowed to be given to pregnant and lactating animals. This paper seeks to describe the characteristics of metamizole in the light of current knowledge.

Case Scenario: Self-extraction of Intrathecal Pump Medication with a Concomitant Intrathecal Granulomatous Mass

Case Scenario: Self-extraction of Intrathecal Pump Medication with a Concomitant Intrathecal Granulomatous Mass

Application of Botulinum toxin in orthodontics

Botulinum toxin type A (BTX-A), a potent neurotoxin that reversibly blocks presynaptic acetylcholine release, has been applied successfully to treat facial spastic conditions such as blepharospasm, strabismus and cervical dystonia. Since the first reported application in dentistry in 1994, BTX-A has been used with great success to used in the orofacial region to help treat masticatory and facial muscle spasm, severe bruxism, facial tics, and hypertrophy of the masticatory muscles. The clinician may be aware of the many courses becoming available and aimed at dentists to start using it in the cosmetic context. This article intends to provide a basic understanding of the many functional uses of the drug in the orofacial region that may be relevant to everyday practice, especially in orthodontic field.