N-甲基-D-天门冬氨酸(NMDA)诱导幼鼠痫样发作的特征与评价

目的探讨N-甲基-D-天门冬氨酸(NMDA)诱导幼鼠痫样发作的特征,并评价它与人类婴儿痉挛症的异同。方法实验一:24只乳鼠随机分为对照组和实验组,注射不同剂量NMDA,观察行为变化及最佳NMDA剂量。实验二:30只18天乳鼠随机分为对照组和实验组,于不同时间点注射NMDA(45mg/kg),观察发作高峰期并记录头皮脑电图。实验三:6只乳鼠分别于生后18~30天腹腔注射NMDA(45mg/kg),观察慢性点燃模型建立情况。实验四:4只成鼠及4只乳鼠分别腹腔注射NMDA,观察NMDA引起的癫痫发作是否具有年龄依赖性。结果不同剂量的NMDA均可诱导乳鼠出现特异的屈曲样痉挛发作,发作期脑电图出现节律紊乱,表现为高幅慢波,夹有棘波。18天的幼鼠需要的最佳NMDA剂量为45mg/kg,该量处理后20~40分钟为发作高峰。乳鼠连续腹腔注射NMDA至生后27天开始无特异的屈曲样痉挛发作。成鼠腹腔注射NMDA后不出现特异的屈曲样痉挛发作。结论Wistar乳鼠经腹腔注射NMDA,其行为学表现与人类婴儿痉挛症的临床发作极为相似,提示可以作为一种建立婴儿痉挛症动物模型的方法。     

彩超水囊引导下A型肉毒毒素注射治疗面肌痉挛的临床疗效

目的:探讨彩超水囊引导下肉毒毒素注射治疗面肌痉挛的疗效。方法:面肌痉挛患者96例,随机分为A、B组各48例,A组给予口服药物6个月,B组给予彩超水囊引导下局部注射A型肉毒毒素(BTX-A)。治疗前后分别采用Cohen、Acbert痉挛强度分级评估疗效,观察2组疗效、持续时间、显效率和治疗前后肌痉挛强度及变化情况。结果:A组治疗后肌痉挛强度变化无统计学差异,B组治疗后肌痉挛强度变化有显著性差异(P<0.01),且显效率高于A组(P<0.01)。结论:彩超水囊引导下BTX-A注射治疗能显著降低面肌痉挛的肌张力,且安全、简单易行。     

护理干预在前列腺术后膀胱痉挛预防及治疗中的应用观察

目的探讨护理干预在前列腺术后膀胱痉挛的预防及治疗中的应用。方法研究对象为自04年以来在我院行前列腺手术的168住患者，运用统计学的方法探索护理干预在前列腺术后膀胱痉挛的预防及治疗中的作用．结果护理干预明显降低前列腺手术术后膀胱痉挛的发生率，并且对于术后并发膀胱痉挛的患者，护理干预具备辅助性治疗作用．结论加强前列腺术后的护理干预对前列腺术后膀胱痉挛的发生具有预防和辅助治疗作用．     

Addressing spasticity-related pain in children with spastic cerebral palsy.

Children with spastic cerebral palsy (CP) often suffer pain as a result of their spasms. Some studies have suggested that the pain experienced by these children may be poorly controlled or respond poorly to treatment. Limited research is available that addresses the treatment of pain due to spasms in children. Therefore, clinicians do not have empirical evidence to guide their decisions. Many current treatment options have not been tested for their effect on pain. Previous research has been guided more by the ability of these treatments to increase functional abilities. Pain also is an important indicator of quality of life; however, this has been overlooked in research.     

Lower extremity manifestations of spasticity in chronic spinal cord injury

The prevalence of various manifestations of spasticity from questionnaire responses and from clinical examination of chronic spinal cord injured patients is reported. Extensor spasms, flexor withdrawal spasms, and clonus were reported by most subjects. Those with incomplete lesions reported more interference with activities, more pain, and less functional usefulness, than did those with complete lesions. Extensor spasms were reported to interfere more with transfers, whereas flexor withdrawal spasms were reported to be more frequent at night and to interfere more with sleep. Increased muscle tone was observed more often in extensor than in flexor muscles. Those with incomplete lesions had more hypertonus and more limited passive joint movements than did those with complete lesions. Flexor withdrawal reactions and extensor spasms were also more pronounced in those with incomplete lesions, particularly those with Frankel grade C lesions.     

Long-term effects of combined botulinum toxin treatment and rehabilitation on upper limb muscle spasms: a case report

[Purpose] We report our experience with a patient with a central spinal cord injury who showed improved finger and upper limb functions after long-term treatment with a combination of rehabilitation and botulinum toxin type A. [Participants and Methods] The patient had spasms and pain that gradually became more profound and was given botulinum toxin type A at 1 year 3 months after sustaining a spinal cord injury. We administered 14 botulinum toxin type A injections periodically for 7 years 4 months after the injury. We administered the injections at an average interval of 5.6 months. Splints that allowed extension and improved finger muscle tone and contracture were made for the patient. [Results] The patient experienced gradual alleviation of the spasms in the proximal upper limb muscles and improved range of motion after receiving five doses of botulinum toxin type A. The spasms and range of motion in the fingers gradually improved around 4 years after the injury through splint therapy and a combination of botulinum toxin type A administration and rehabilitation. [Conclusion] The combination of botulinum toxin type A, splint, and rehabilitation therapies can lead to positive improvements in finger spasticity and range of motion and is recommended for hypertonia cases with severe contractures.Key words: Carry-over effect, Concomitant use of splint, Restoration of hand function     

冠状动脉介入治疗后痉挛的原因分析及护理对策

回顾分析了2003年1月-2005年1月行冠状动脉支架植入术后4例发生冠状动脉痉挛的原因,认为可能与血管的狭窄、术中造影剂或机械刺激、精神紧张等因素有关。针对冠状动脉支架植入术后发生冠状动脉痉挛的时间和规律,认真做好术前评估,尤其是高危患健康教育和心理护理,术后严格床头交接班,了解介入治疗血管及未治疗血管狭窄的情况．并对患发作冠状动脉痉挛时的心电图变化进行分析,加强围手术期的病情观察。     

推拿与抗痉挛技术改善卒中患者肌痉挛的疗效

目的观察穴位推拿结合抗痉挛技术对脑卒中后四肢肌痉挛的改善情况。方法选择2009年9月—2010年9月在上海市闵行区中医医院就诊的脑卒中后四肢肌痉挛的患者40例,随机分成实验组和对照组各20例,实验组以穴位推拿结合抗痉挛技术治疗,对照组单纯以抗痉挛术治疗。治疗前后应用肌张力评分量表(Modified Ashworth Scale,MAS)和运动功能评定量表中上肢运动功能测试部分(the up-per extremities motor function test of Fugl-Meyer movement assessment ment,U-FMA)进行患者肌痉挛和运动功能评定。结果两组患者治疗后MAS和U-FMA评分与治疗前比较均有明显改善,差异有统计学意义(P<0.05),但实验组明显优于对照组,两组比较差异有统计学意义(P<0.05)。结论采用抗痉挛技术治疗能改善脑卒中患者的四肢肌痉挛和运动功能,而穴位推拿结合抗痉挛技术能更有效地促进脑卒中患者上肢肌力和运动功能的恢复,有助于减少脑卒中致残率,提高患者的生活质量。     

Hypertension after brainstem stroke

Paroxysmal hypertension associated with diaphoresis and facial flushing occurs after brain injury and after spinal cord lesion above the level of sympathetic outflow. This excessive sympathetic activity is due to the failure of inhibitory impulses from supraspinal vasomotor centers to reach the spinal sympathetic outflow. A case of brainstem stroke, with weakness in all four extremities, is presented. The patient experienced paroxysms of hypertension with bladder spasms, which subsided after treatment of the spasms resulting from bladder infection. Serum levels of dopamine, norepinephrine, and epinephrine were elevated during the episode and were normal after subsidence of the paroxysms.     

替扎尼定与非甾体抗炎药联合治疗急性痉挛性疼痛的临床研究

目的:替扎尼定是具有解痉作用的α2肾上腺能受体激动剂,并具有一定的胃肠道保护作用,适用于单一治疗或与非甾体消炎药(NSAIDs)联合治疗急性痉挛性疼痛。通过替扎尼定和非甾体类抗炎药物的联合应用,临床观察和评估联合用药能否增强疗效和增加安全性。方法:急性痉挛性疼痛70例,随机分为两组,一组服用替扎尼定2mg,bid 双氯芬酸50mg,bid,一组服用双氯芬酸50mg,bid 安慰剂2mg,bid。观察药物疗效和不良反应。结果:联用组的总有效率为70%,胃肠道不良反应发生率为12%,中枢神经系统不良反应发生率为18%;单用组的总有效率为56%,胃肠道不良反应发生率为32%,中枢神经系统不良反应发生率为10%。结论:替扎尼定和非甾体类药物联用具有更好的疗效以及更高的药物耐受性。     

Comparative double-blind study of the effectiveness and tolerance of baclofen, tetrazepam and tizanidine in spastic movement disorders of the lower extremities

In a double-blind comparative study, the therapeutic efficacy and safety of three centrally effective antispasmodics (Tetrazepam, Baclofen and Tizanidine) in patients suffering from multiple sclerosis with spastic motor disturbances of the lower extremities was to be examined. 47 patients of either sex at the age of 23 until 63 were allocated to one of the three therapies by means of minimization. The duration of treatment was limited to 35 days at a maximum. The dosage was optimized corresponding to the clinical symptoms. The antispasmodic efficacy and safety of the above-mentioned substances was investigated with well-established parameters and methods. The typical laboratory parameters were determined at the beginning and at the end of the study. -With reference to cloni, spasms and the muscular tonus, no systematic differences were found between the treatment groups. A previously existing clonus could not be altered decisively by the administration of the three antispasmodics, whereas the muscular tonus could comparably be decreased with all therapeutic measures. Statistically significant differences between the treatment groups were not observed. The patients of all three groups recorded a subjective sensation of relief with reference to the symptoms of spasms by the medication. As to the residual urinary volume, no relevant differences and alterations were determinated in the course of the treatment as well. With reference to undesired side effects quantitative and qualitative differences could be established, in which Tetrazepam showed the most favourable benefit/risk ratio.     

Cyclobenzaprine hydrochloride effect on skeletal muscle spasm in the lumbar region and neck: two double-blind controlled clinical and laboratory studies

A new drug, Cyclobenzaprine hydrochloride (Flexeril), was compared with diazepam (Valium) and placebo in double-blind trials for efficacy in treating spasms and pain in the neck and low back. Complex recording methods involving clinical evaluations (graded), patient self-ratings, goniometry, motion analysis by computer, electromyography of controlled motions and detailed statistical analysis were used. Clinical improvement over two weeks was statistically significant in all treatment groups with a statistically significant preference for Cyclobenzaprine hydrochloride. The most striking improvements recorded were in the electromyographic findings, which showed statistically significant changes for the Cyclobenzaprine group. Clinical muscle spasms are not accompanied by increased myoelectric activity; the reverse is true. With improvement, myoelectric activity in back muscles is augmented during prescribed stressful movements as measured by electromyography and computer analysis combined with complex electrogoniometry.     

Antispastic effect of penile vibration in men with spinal cord lesion

OBJECTIVE: To evaluate the possible antispastic effect of penile vibratory stimulation (PVS) in men with spinal cord lesion (SCL). DESIGN: Unblinded, before-after trial. SETTING: Ambulatory care. PARTICIPANTS: Nine men with SCLs from C2 to T8 were randomly allocated into 2 groups. INTERVENTION: Twenty-four hours of electromyographic recordings from the quadriceps and tibialis anterior muscles were taken, followed by PVS or no treatment and another 24 hours of electromyographic recordings. The presence of electromyographic activity of an amplitude 4 times the baseline, with a duration of more than 5 seconds, was taken to signify a spasm. The number of spasms per hour was calculated before and after PVS and no treatment. Spasticity was evaluated by the Modified Ashworth Scale (MAS). MAIN OUTCOME MEASURE: Reduction in spasticity and spasms. RESULTS: The electromyographic data showed a significant reduction in the frequency of leg spasms up to 3 hours (P<.05). Significantly decreased spasticity, as evaluated by MAS, was found immediately after vibration (P<.01). CONCLUSIONS: PVS may be useful as an antispastic therapy.     

Spasticité et baclofène intrathécal

Direct intrathecal injection of baclofen was first proposed in 1984 by Penn for treatment of severe, chronic and diffuse spasticity of medullary origin. This technique was introduced to France by Lazorthes, since which time many publications have demonstrated the effectiveness and reliability of this method of treatment. Initially only recommended for muscular hypertonia and spasms of spinal origin, its scope has spread to cover cerebral injuries, based on the existence of intractable multifocal spasticity, which is resistant to classic therapies. Selection of patients requires a rigorous, multidisciplinary approach and positive results in the pre-implantation tests. At the stage of chronic administration, beyond the monitoring procedures, technological advances allow doses to be modified in accordance with the clinical results and the expected benefits to the individual. With regard to the results observed for hypertonia, painful spasms, autonomy and quality of life, complications with variable frequency are those that most often able to be reversed. The current pumps are guaranteed to be reliable and have a long life span. The limitations of this type of therapy are linked to organisational constraints and ambulatory monitoring. This treatment falls within the scope of our discipline and is accessible to all physical medicine and rehabilitation teams.     

首选多药联合治疗新诊断的婴儿痉挛患儿动态脑电图及血清神经元特异性烯醇化酶水平的变化

目的 观察首选多药联合治疗新诊断婴儿痉挛患儿动态脑电图(EEG)及血清神经元特异性烯醇化酶(NSE)的变化情况,探讨其疗效及预后的影响因素.方法 对2007年9月至2010年11月我院新诊断的108例婴儿痉挛患儿采用首选多药联合治疗,观察动态脑电图及血清NSE水平改变情况.结果 (1)90例完全控制患儿完全控制1周内复查动态脑电图结果显示:正常动态EEG 56例(62.2％),高峰失律消失、散发尖慢波32例(35.6％),仍存在高峰失律2例(2.2％),总有效率97.8％.(2)收集入院时、痉挛发作完全控制后48 h内及痉挛发作控制后1个月均行血清NSE检测的35例患儿的资料,结果表明痉挛发作完全控制后48 h内血清NSE含量(17.7±5.5)μg/L较人院时(21.2±6.8)μg/L明显降低(t =6.54,P＜0.05);痉挛控制后1个月血清NSE含量(9.0±3.1) μg/L较入院时进一步降低(t =9.29,P＜0.01).结论 多药联合治疗婴儿痉挛患儿脑电图改善较明显,发作控制后血清NSE含量降低.     

Effect of penile vibratory stimulation on spasticity in men with spinal cord injury

OBJECTIVE: Penile vibratory stimulation is the first treatment option for anejaculation in men with spinal cord injury. It has been postulated that it also has an antispasticity effect. The purpose of this study was to determine the effect of penile vibratory stimulation on spasticity in patients with spinal cord injury. DESIGN: Ten male patients with spinal cord injury were included in the study. They were examined at the baseline and 3, 6, 24, and 48 hrs later. After their baseline examination, they performed penile vibratory stimulation. The outcome variables were spasticity (Ashworth scale), spasm frequency, spasm severity, painful spasms, plantar stimulation response, deep tendon reflexes, clonus, and effect on function. RESULTS: Ashworth grade showed a statistically significant decrease at hour 3 and hour 6 examinations (P = 0.001 and P = 0.03, respectively, with Tukey test). The patients showed a tendency toward having less frequent and less severe spasms throughout the study; however, it did not reach to a significant level. Similarly, clonus showed a nonsignificant decrease during follow-up examinations. The other variables did not change considerably. CONCLUSIONS: Penile vibratory stimulation may contribute to the relief of the spasticity in men with spinal cord injury. In treating spasticity, all the factors that increase or decrease the tone should be considered.     

Dysesthesia perceived as painful spasticity: A report of 3 cases

Lesions of the central nervous system often involve the pyramidal tracts and the sensory pathways to produce spasticity, paresthesias, and dysesthesia. Three patients with intractable spasticity were treated with intrathecal baclofen. Two had an implanted Medtronic SynchroMed pump for long-term delivery of the muscle relaxant. The third patient had undergone a screening trial in which the baclofen was delivered into the intrathecal space through a lumbar catheter. All had excellent relief of spasms on clinical examination, but they reported painful spasms particularly at night. Two of the patients were successfully treated for dysesthesia.     

Tetanus: a review.

Tetanus is caused by the organism Clostridium tetani, which produces tetanospasmin, a neurotoxin responsible for the clinical manifestations of muscle rigidity and reflex spasms. The majority of cases follow an anaerobic wound infection associated with trauma. Incubation period is usually 3 days to 3 weeks. 75% of patients present with trismus. Reflex spasms are seen in 70% of patients and characterize the severity of the disease. Treatment involves removal of the offending organism, neutralization of free neurotoxin, controlling rigidity and reflex spasm, and minimizing complications. Diazepam may be used alone in mild cases. Severe cases require the addition of nondepolarizing neuromuscular blocking agents and mechanical ventilation. Respiratory complications occur early and require aggressive airway management. A serious, late complication is the syndrome of sympathetic nervous system overactivity that is treated with alpha and beta blockade. High mortality rates seen in the United States may be due to delays in diagnosis and lack of familiarity with treatment. The disease is preventable with adequate immunization.     

The management of pain in spasticity

Pain is a common feature of spasticity and muscle spasms and the reasons for this are discussed in this article. However, the causes of this spasticity have to be determined and for successful management, knowing the underlying mechanisms, which produce spasticity, is necessary. In addition to knowing the range of available treatments, one has to know their particular contribution to the overall management of the patient. The assessment and management of the spastic patient is multi-disciplinary and painful spasticity changes over time. This therefore requires repeated assessments and the direction of the treatment may also change. Pain may be a dominant feature, but is rarely the sole symptom. This article looks at a strategy for the overall management of the patient with the focus on managing pain.