Spasticity management

Fu J, Gutierrez C, Bmera E, Guo Y, Palla S. Use of ii ectable spasticity management agents in a cancer center. Support Care Cancer 2013 21(5) 1227-32. 

Intrathecal Management of severe spasticity of spinal cord origin in patients who are unresponsive to oral baclofen therapy or experience intolerable CNS side effects at effective doses. Intended for use by the intrathecal route in single bolus test doses (via spinal catheter or lumbar puncture) and, for chronic use, only in implantable pumps approved by the FDA specifically for the administration of baclofen into the intrathecal space. 

Muscle spasticity For the acute and intermittent management of increased muscle tone associated with spasticity. 

Wagstaff Al, Bryson HM Tizanidine a review of its pharmacology, clinical efficacy and tolerability in the management of spasticity associated with cerebral and spinal disorders. Drugs 1997 53(3) 435-452. 

Ronan S, Gold JT Nonoperative management of spasticity in children. Childs Nerv Syst 2007 23 943 [PMID 17646995] Verrotti A et al Pharmacotherapy of spasticity in children with cerebral palsy. Pediatr Neurol 2006 34 1. [PMID 16376270] Ward AB Spasticity treatment with botulinum toxins. J Neural Transm 2008 115 607. [PMID 18389166]... 

Chou R, Peterson K, Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions a systematic review. J Pain Symptom Manage. 2004 28 140-175. 

Gallichio JE. Pharmacologic management of spasticity following stroke. Phys Ther. 2004 84 973-981. 

Sampson FC, Hayward A Evans G, et al. Functional benefits and cost/benefit analysis of continuous intrathecal baclofen infusion for the management of severe spasticity. J Neurosurg. 2002 96 1052-1057. 

Satkunam LE. Rehabilitation medicine 3. Management of adult spasticity. CMAJ. 2003 169 1173-1179. 

Wasiak J, Hoare B, Wallen M. Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy. Cochrane Database Syst Rev. 2004 CD003469. 

Botulinum toxin is the treatment of choice for focal dystonias such as torticollis and writer s cramp and for hemifacial spasm, and may complement the management of spasticity. 

Glenn MB. Nerve blocks. In Glenn M, Whyte J, editors. The Practical Management of Spasticity in Children and Adults. Philadelphia Lea Febiger, 1990 227-58. 

Khalili AA, Betts HB. Peripheral nerve block with phenol in the management of spasticity. Indications and complications. JAMA 1967 200(13) 1155-7. 

Khalili AA, Benton JG. A physiologic approach to the evaluation and the management of spasticity with procaine and phenol nerve block including a review of the physiology of the stretch reflex. Clin Orthop Relat Res 1966 47 97-104. 

Yadav SL, Singh U, Dureja GP, Singh KK, Chaturvedi S. Phenol block in the management of spastic cerebral paky. Indian J Pediatr 1994 61(3) 249-55. 

Cannabinoids are no more effective than codeine in controlling pain and have depressant effects on the central nervous system that limit their use. Their widespread introduction into clinical practice for pain management is therefore undesirable. In acute postoperative pain they should not be used. Before cannabinoids can be considered for treating spasticity and neuropathic pain, further valid randomised controlled studies are needed. 

As a consequence of his dualistic view of diseases being either spastic or paralytic in nature, Hoffmann managed with a very limited number of drugs, a blessing for his patients no doubt, compared to the involved prescriptions of his colleagues. His medicines were either what he called tonica, which supposedly increased the tension in the fibers, or spasmolytic preparations to counteract the effects of excessive tension. To this should of course be added the indispensable bloodletting. 

In addition to its use in managing an acute attack of malignant hyperthermia see above), dantrolene has been used in the treatment of spasticity and hyperreflexia. Dantrolene causes a generalized weakness thus, its use should be restricted to nonambulatory patients with severe spasticity. Hepatotoxicity has been reported with continued use, requiring hver function tests. 

Other uses Thiopental is commonly used for the induction of anesthesia, and certain benzodiazepines (eg, diazepam, midazolam) are used as components of anesthesia protocols. Special uses include the management of seizure disorders (eg, clonazepam, phenobarbital) and muscle spasticity (diazepam). Longer-acting dmgs (eg, chlordiazepoxide, diazepam) are used in the management of withdrawal states in persons physiologically dependent on ethanol and other sedative-hypnotics. 

Zaleplon and zolpidem are related hypnotics which, though structurally different from benzodiazepines, appear to have a similar mechanism of action. However, neither drug is effective in the management of seizures nor in muscle spasticity states. Compared with benzodiazepines, zaleplon and zolpidem are less likely to alter sleep patterns. Remember—buspirone is not a hypnotic The answer is (E). 

Methixene hydrochloride besides possessing antimuscarinic properties also exhibit antihistaminic, local anaesthetic and antispasmodic actions. It is invariably employed in the management of pylorospasm, biliary dyskinesia, spastic colon, gastritis and also in duodenal ulcer. 

It is employed in the symptomatie eontrol and management of Parkinson s disease. It has also been used in the treatment of acute spastic disorders of the skeletal muscles caused hy trauma, tension, and vertebral disk dislocation. It is also used alleviate the extrapyramidal syndrome induced by drugs, e.g., reserpine and phenothiazine derivatives. 

Eperisone hydrochloride is a centrally acting muscle relaxant useful in the management of various spastic conditions including cerviced spondylosis and cerebral palsy. It is structuredly related to tolperisone. 

Baclofen is approved for the treatment of reversible spasticity and its associated pain in a variety of nemo-logical conditions of both spinal cord and cerebral origin, such as multiple sclerosis, amyotrophic lateral sclerosis, and spinal cord injmies. It can be administered orally or intrathecally. Intrathecal baclofen is used to manage chronic intractable spasticity in patients who are unresponsive, or who have intolerable side effects, to a minimum 6 week course of oral therapy. There must be a positive response to a test dose of intrathecal baclofen prior to implantation of a continuous infusion pump. The safety and efficacy of baclofen have not been established in the pediatric population. 

Comparative studies Oral baclofen has been compared retrospectively with tizanidine as adjuvant therapy to botulinum toxin type A in the management of spasticity in children [77 ]. In 30 children with gastrocnemius spasticity, of whom 17 were treated with adjuvant oral baclofen and 13 received tizanidine, the mean Gross Motor Functional Measurement scores (77 versus 68) and caregiver questionnaire scores (70 versus 67) were higher with tizanidine than baclofen. The authors suggested that the combination of botulinum toxin type A with tizanidine is more effective and causes fewer adverse reactions than the combination of botulinum toxin type A and oral... 

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