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The Journal of International Medical... Mar 2020Post-stroke spasticity seriously affects patients' quality of life. Spasticity is considered to involve both neural and non-neural factors. Current clinical scales, such... (Review)
Review
Post-stroke spasticity seriously affects patients' quality of life. Spasticity is considered to involve both neural and non-neural factors. Current clinical scales, such as the Modified Ashworth Scale and the Modified Tardieu Scale, lack reliability and reproducibility. These scales are also unable to identify the neural and non-neural contributions to spasticity. Surface electromyography and biomechanical and myotonometry measurement methods for post-stroke spasticity are discussed in this report. Surface electromyography can provide neural information, while myotonometry can estimate muscular properties. Both the neural and non-neural contributions can be estimated by biomechanical measurement. These laboratory methods can quantitatively assess spasticity. They can provide more valuable information for further study on treatment and rehabilitation than clinical scales.
Topics: Electromyography; Humans; Muscle Spasticity; Quality of Life; Reproducibility of Results; Stroke
PubMed: 31801402
DOI: 10.1177/0300060519888425 -
Postgraduate Medical Journal Sep 2001Hyperekplexia (startle disease) is a rare non-epileptic disorder characterised by an exaggerated persistent startle reaction to unexpected auditory, somatosensory and... (Review)
Review
Hyperekplexia (startle disease) is a rare non-epileptic disorder characterised by an exaggerated persistent startle reaction to unexpected auditory, somatosensory and visual stimuli, generalised muscular rigidity, and nocturnal myoclonus. The genetic basis is a mutation usually of the arginine residue 271 leading to neuronal hyperexcitability by impairing glycinergic inhibition. Hyperekplexia is usually familial, most often autosomal dominant with complete penetrance and variable expression. It can present in fetal life as abnormal intrauterine movements, or later at any time from the neonatal period to adulthood. Early manifestations include abnormal responses to unexpected auditory, visual, and somatosensory stimuli such as sustained tonic spasm, exaggerated startle response, and fetal posture with clenched fists and anxious stare. The tonic spasms may mimic generalised tonic seizures, leading to apnoea and death. Consistent generalised flexor spasm in response to tapping of the nasal bridge (without habituation) is the clinical hallmark of hyperekplexia. Electroencephalography may show fast spikes initially during the tonic spasms, followed by slowing of background activity with eventual flattening corresponding to the phase of apnoea bradycardia and cyanosis. Electromyography shows a characteristic almost permanent muscular activity with periods of electrical quietness. Nerve conduction velocity is normal. No specific computed tomography findings have been reported yet. Clonazepam, a gamma aminobutyric acid (GABA) receptor agonist, is the treatment of choice for hypertonia and apnoeic episodes. It, however, may not influence the degree of stiffness significantly. A simple manoeuvre like forced flexion of the head and legs towards the trunk is known to be life saving when prolonged stiffness impedes respiration.
Topics: Diagnosis, Differential; Humans; Infant, Newborn; Muscle Rigidity; Reflex, Abnormal; Reflex, Startle
PubMed: 11524514
DOI: 10.1136/pmj.77.911.570 -
International Journal of Molecular... Jul 2023Quinoa ( Willd.) is a dicotyledonous cereal that is rich in nutrients. This important crop has been shown to have significant tolerance to abiotic stresses such as...
Quinoa ( Willd.) is a dicotyledonous cereal that is rich in nutrients. This important crop has been shown to have significant tolerance to abiotic stresses such as salinization and drought. Understanding the underlying mechanism of stress response in quinoa would be a significant advantage for breeding crops with stress tolerance. Here, we treated the low-altitude quinoa cultivar CM499 with either NaCl (200 mM), NaCO/NaHCO (100 mM, pH 9.0) or PEG6000 (10%) to induce salinity, alkalinity and hypertonia, respectively, and analyzed the subsequent expression of genes and small RNAs via high-throughput sequencing. A list of known/novel genes were identified in quinoa, and the ones responding to different stresses were selected. The known/novel quinoa miRNAs were also identified, and the target genes of the stress response ones were predicted. Both the differently expressed genes and the targets of differently expressed miRNAs were found to be enriched for reactive oxygen species homeostasis, hormone signaling, cell wall synthesis, transcription factors and some other factors. Furthermore, we detected changes in reactive oxygen species accumulation, hormone (auxin and ethylene) responses and hemicellulose synthesis in quinoa seedlings treated with stresses, indicating their important roles in the response to saline, alkaline or hyperosmotic stresses in quinoa. Thus, our work provides useful information for understanding the mechanism of abiotic stress responses in quinoa, which would provide clues for improving breeding for quinoa and other crops.
Topics: Chenopodium quinoa; Reactive Oxygen Species; Salinity; Transcriptome; Plant Breeding; Crops, Agricultural; Sequence Analysis, RNA; Hormones; Muscle Hypertonia
PubMed: 37511549
DOI: 10.3390/ijms241411789 -
Current Neurology and Neuroscience... Aug 2019The purpose of this review is to familiarize the reader with assessments and measurement of spasticity in people with multiple sclerosis (MS). Spasticity affects 60-84%... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to familiarize the reader with assessments and measurement of spasticity in people with multiple sclerosis (MS). Spasticity affects 60-84% of people with MS, worsening as disability worsens and impacting activity, participation, and quality of life. Spasticity manifests in many ways, including spasms, resistance to passive stretch, pain, and perception of tightness, and can affect muscles throughout the body, making assessment and quantification of spasticity challenging but important. Assessment tools include those quantified by clinicians, instrumentation, and patients.
RECENT FINDINGS
Most tools for measuring spasticity are based on clinician scoring, were developed many years ago, and have undergone minimal recent advances. More recent developments are patient-reported outcome measures for spasticity, including the Numeric Rating Scale for Spasticity (NRS-S) and the disease-specific Multiple Sclerosis Spasticity Scale-88 (MSSS), and, most recently, imaging through elastography. MS-related spasticity is common and often disabling. There are various spasticity measurement tools available, each with advantages and limitations. Newer tools are likely to be developed as our understanding of spasticity in MS grows.
Topics: Elasticity Imaging Techniques; Humans; Multiple Sclerosis; Muscle Spasticity; Severity of Illness Index
PubMed: 31471769
DOI: 10.1007/s11910-019-0991-2 -
Neurology India Sep 2002
Review
Topics: Humans; Muscle Relaxants, Central; Muscle Spasticity
PubMed: 12391445
DOI: No ID Found -
Annals of Physical and Rehabilitation... Jul 2019Spasticity following lesions of the central nervous system such as stroke is a major cause of impairment and disability, especially when it affects the upper limb, and... (Review)
Review
BACKGROUND
Spasticity following lesions of the central nervous system such as stroke is a major cause of impairment and disability, especially when it affects the upper limb, and can be focally relieved by intramuscular injections of botulinum toxin (BT). Functional improvements of the affected upper limb after a BT focal treatment remain controversial.
OBJECTIVE
We aimed to assess the functional effects of BT treatment on upper-limb spasticity in the literature, identify flaws and deficiencies in proving these effects and propose leads for future trials.
METHODS
We searched the MEDLINE and Cochrane databases for trials, reviews and meta-analyses assessing the effect of BT injection in upper-limb spasticity. This was a non-systematic narrative review, and the selection of articles was based on the authors' expertise. The review focused on stroke-related spasticity and disability.
RESULTS
Patients' therapeutic targets involved use of the disability assessment scale (DAS) or goal attainment scale (GAS). Impairments and passive function goals prevailed for active function and participation and were more frequently achieved for the former than the latter. Meta-analyses showed no to mild effect sizes for improvement in upper-limb function but failed to show higher and/or better use of the paretic upper limb in activities of daily living after BT injection.
CONCLUSION
BT injections for impairment and passive function are related to improved kinematic parameters; however, the relation between relief of spasticity and improved upper-limb activity has not been established. Possible explanations for the lack of functional effect in studies are first, disability is mainly due to muscle weakness rather than spasticity, so patients with the best underlying motricity may benefit the most from BT injections; second, assessment methods may not be adapted to screen eligible patients; third, most studies' endpoints were at 4 to 12 weeks after a single injection, but repeated treatment sessions might be needed to observe functional outcome on the upper limbs; and finally, the association of rehabilitation programs or non-pharmacological treatments may enhance the functional effects of BT injections.
Topics: Arm; Botulinum Toxins, Type A; Clinical Trials as Topic; Hand Strength; Humans; Muscle Spasticity; Neuromuscular Agents; Patient Care Planning; Recovery of Function; Treatment Outcome
PubMed: 29960017
DOI: 10.1016/j.rehab.2018.05.1320 -
Drug Design, Development and Therapy 2016Poststroke spasticity affects up to one-half of stroke patients and has debilitating effects, contributing to diminished activities of daily living, quality of life,... (Review)
Review
Poststroke spasticity affects up to one-half of stroke patients and has debilitating effects, contributing to diminished activities of daily living, quality of life, pain, and functional impairments. Botulinum toxin (BoNT) is proven to be safe and effective in the treatment of focal poststroke spasticity. The aim of this review is to highlight BoNT and its potential in the treatment of upper and lower limb poststroke spasticity. We review evidence for the efficacy of BoNT type A and B formulations and address considerations of optimal injection technique, patient and caregiver satisfaction, and potential adverse effects of BoNT.
Topics: Animals; Botulinum Toxins; Humans; Muscle Spasticity; Stroke
PubMed: 27022247
DOI: 10.2147/DDDT.S80804 -
Neurology India 2022Spastic cerebral palsy (CP) is the commonest physiological type according to literature which comes mainly from the developed countries where prematurity is a common...
INTRODUCTION
Spastic cerebral palsy (CP) is the commonest physiological type according to literature which comes mainly from the developed countries where prematurity is a common cause for cerebral palsy. In developing countries like India, the leading causes of cerebral palsy are birth asphyxia, infections, and hyperbilirubinemia and, hence, the physiological type of CP is likely to be different. However, the data from our country is scant.
METHODS
103 consecutive treatment-naive CP patients attending pediatric neurology clinic were evaluated in detail using an objective tool, hypertonia assessment tool (HAT) over a period of 6months. Based on the predominant tone, the cases were classified as spastic, dyskinetic, ataxic/hypotonic, and mixed. The type of cerebral palsy was correlated with perinatal details and neuroimaging findings.
RESULTS
Out of 103 children, the most common physiological type of CP seen was of dyskinetic type [54 (52.4%)], followed by spastic CP in 30 (29.1%) and mixed (dyskinetic+spastic) CP in 19 (18.4%) children. The most common cause for dyskinetic CP was perinatal asphyxia 33 (61%); for spastic CP was prematurity 17 (56.7%) and; for mixed CP, the main cause was perinatal asphyxia 12 (63.2%). The main neuroimaging finding in predominant dyskinetic CP was basal ganglia/thalamus involvement followed by pericentral and perirolandic gliosis, whereas in spastic CP, it was periventricular leucomalacia. In mixed CP, there was multicystic encephalomalacia.
CONCLUSIONS
Dyskinetic CP either as predominant type or along with spasticity is the most common physiological type of CP in India and is due to birth-asphyxia, hyperbilirubinemia, hypoglycemia, and infections.
Topics: Asphyxia; Cerebral Palsy; Child; Female; Humans; Hyperbilirubinemia; Muscle Spasticity; Neuroimaging; Pregnancy
PubMed: 35864637
DOI: 10.4103/0028-3886.349640 -
Complementary Therapies in Medicine Sep 2022The main purpose of review articles is to increase insight into the best possible practice for increasing the health condition of future subjects. This requires the... (Review)
Review
The main purpose of review articles is to increase insight into the best possible practice for increasing the health condition of future subjects. This requires the collection of as many relevant data as possible from earlier case studies, but such data should be mutually independent. If the data from the reviewed single- or multi-case studies are not entirely mutually independent, the conclusions of the review study may easily - though not necessarily - become biased. This is shown on the basis of a 2020 systematic review about the effects of deep dry needling on spasticity and related physical disabilities. We analyzed this study by checking undisclosed possible overlaps regarding the subjects dealt with in the various case studies that were reviewed. This analysis raised also some questions about the accuracy of the number of subjects that had been treated, which is an aspects of which errors can commonly not be disclosed by the readers. The objective of our Letter is to show that insufficient attention by authors, editor and reviewers for an unambiguous presentation of the data regarding the subjects dealt with can make it impossible for readers to draw correct conclusions regarding the optimization of possible treatments.
Topics: Dry Needling; Humans; Muscle Spasticity
PubMed: 35398482
DOI: 10.1016/j.ctim.2022.102828 -
Annals of Physical and Rehabilitation... Nov 2019This paper revisits the taxonomy of the neurophysiological consequences of a persistent impairment of motor command execution in the classic environment of sensorimotor... (Review)
Review
This paper revisits the taxonomy of the neurophysiological consequences of a persistent impairment of motor command execution in the classic environment of sensorimotor restriction and muscle hypo-mobilization in short position. Around each joint, the syndrome involves 2 disorders, muscular and neurologic. The muscular disorder is promoted by muscle hypo-mobilization in short position in the context of paresis, in the hours and days after paresis onset: this genetically mediated, evolving myopathy, is called spastic myopathy. The clinician may suspect it by feeling extensibility loss in a resting muscle, although long after the actual onset of the disease. The neurologic disorder, promoted by sensorimotor restriction in the context of paresis and by the muscle disorder itself, comprises 4 main components, mostly affecting antagonists to desired movements: the first is spastic dystonia, an unwanted, involuntary muscle activation at rest, in the absence of stretch or voluntary effort; spastic dystonia superimposes on spastic myopathy to cause visible, gradually increasing body deformities; the second is spastic cocontraction, an unwanted, involuntary antagonist muscle activation during voluntary effort directed to the agonist, aggravated by antagonist stretch; it is primarily due to misdirection of the supraspinal descending drive and contributes to reducing movement amplitude; and the third is spasticity, one form of hyperreflexia, defined by an enhancement of the velocity-dependent responses to phasic stretch, detected and measured at rest (another form of hyperreflexia is "nociceptive spasms", following flexor reflex afferent stimulation, particularly after spinal cord lesions). The 3 main forms of overactivity, spastic dystonia, spastic cocontraction and spasticity, share the same motor neuron hyperexcitability as a contributing factor, all being predominant in the muscles that are more affected by spastic myopathy. The fourth component of the neurologic disorder affects the agonist: it is stretch-sensitive paresis, which is a decreased access of the central command to the agonist, aggravated by antagonist stretch. Improved understanding of the pathophysiology of deforming spastic paresis should help clinicians select meaningful assessments and refined treatments, including the utmost need to preserve muscle tissue integrity as soon as paresis sets in.
Topics: Humans; Motor Neurons; Muscle Contraction; Muscle Spasticity; Muscle, Skeletal; Paresis
PubMed: 30500361
DOI: 10.1016/j.rehab.2018.10.004