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Hendriati, Hendriati. "EFEKTIFITAS TOXIN BOTULLINUM UNTUK MANAJEMEN BLEFAROSPASME ESSENSIAL DAN SPASME HEMIFASIAL." Majalah Kedokteran Andalas 34, no. 2 (May 2, 2015): 202. http://dx.doi.org/10.22338/mka.v34.i2.p202-210.2010.
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AbstrakUntuk mengukur efektifikas toxin Botullinum pada kasus-kasus okuloplastik (blefarospasme essensial dan spasme hemifasial.Laporan kasus 16 pasien yang terdiri dari 14 kasus spasme hemifasial dan 2 kasus blefarospasme essensial. Digunakan 6 vial toxin Botullinum. Vial pertama digunakan untuk pasien spasme hemifasial dan 1 pasien blefasrospasme di minggu berikutnya. vial kedua dan ketiga masing-masing digunakan untuk 2 pasien spasme hemifasial. Vial keempat digunakan untuk pasien blefarospasme yang menggunakan vial pertama (setelah 6 bulan), dan 1 pasien spasme hemifasial yang menggunakan vial kedua ( setelah 4 bulan) dan 1 pasien spasme hemifasial baru. Setelah 1 minggu, toxin Botullinum vial keempat digunakan untuk 6 pasien spasme hemifasial dan 1 pasien blefarospasme essensial yang menggunakan vial pertama 8 hari berikutnya (setelah 7 bulan).Terdapat 16 pasien pada studi ini ; 14 spasme hemifasial dan 2 blefarospasme essensial. Pada 5 pasien dilakukan injeksi ulangan dengan jangka waktu yang berbeda. Tidak ditemukan efek samping pada pasien-pasien ini.Toxin Botulinum efektif untuk manajemen spasme hemifasial dan blefarospasme essensial tetapi efeknya temporer. Pada studi ini, jangka waktu injeksi ulangan bervariasi sekitar 4 – 7 bulan pada 5 pasien.Kata Kunci : Toxin Botulinum toxin, spasme hemifasial, blefarospasmeAbstractTo asses Botulinum Toxin efficacy in oculoplastic cases (blepharospasm and hemifacial spasm).A case report on 16 patients consisted of 14 hemifacial spasms and 2 essential blepharospasm. Six vials of botulinum toxin were used. First vial was used for two patients of hemifacial spasm and one blepharospasm patient one week later. Second and third vials were used each for two patients of hemifacial spasms. Fourth vial was used for one blepharospasm patient from first vial user (after six month), one hemifacial spasm from second vial user (after four months) and one new hemifacial spasm. After one week, Botulinum toxin from fourth vial was used for one new patient of hemifacial spasm. Fifth and sixth vial was used for sixLAPORAN KASUS203hemifacial spasms and eight days later for one blepharospasm from first vial user (after seven months).There were 16 patients in this serial study; 14 hemifacial spasms and 2 blepharospasms. Five patients had reinjections with different duration. There is no side effect in those patients.Botulinum toxin is effective in treatment of hemifacial spasm and blepharospasm, but the effects are temporary. In this study, reinjections durations about four to seven months in five patients.Key word : Botulinum toxin, hemifacial spasm, blepharospasm
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Raghuram, Hanumanthan, Rittik Deb, Diptarup Nandi, and Rohini Balakrishnan. "Silent katydid females are at higher risk of bat predation than acoustically signalling katydid males." Proceedings of the Royal Society B: Biological Sciences 282, no. 1798 (January 7, 2015): 20142319. http://dx.doi.org/10.1098/rspb.2014.2319.
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Males that produce conspicuous mate attraction signals are often at high risk of predation from eavesdropping predators. Females of such species typically search for signalling males and their higher motility may also place them at risk. The relative predation risk faced by males and females in the context of mate-finding using long-distance signals has rarely been investigated. In this study, we show, using a combination of diet analysis and behavioural experiments, that katydid females, who do not produce acoustic signals, are at higher risk of predation from a major bat predator, Megaderma spasma , than calling males. Female katydids were represented in much higher numbers than males in the culled remains beneath roosts of M. spasma . Playback experiments using katydid calls revealed that male calls were approached in only about one-third of the trials overall, whereas tethered, flying katydids were always approached and attacked. Our results question the idea that necessary costs of mate-finding, including risk of predation, are higher in signalling males than in searching females.
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Karadjian, Gregory, Alexandre Hassanin, Benjamin Saintpierre, Guy-Crispin Gembu Tungaluna, Frederic Ariey, Francisco J. Ayala, Irene Landau, and Linda Duval. "Highly rearranged mitochondrial genome in Nycteria parasites (Haemosporidia) from bats." Proceedings of the National Academy of Sciences 113, no. 35 (August 15, 2016): 9834–39. http://dx.doi.org/10.1073/pnas.1610643113.
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Haemosporidia parasites have mostly and abundantly been described using mitochondrial genes, and in particular cytochrome b (cytb). Failure to amplify the mitochondrial cytb gene of Nycteria parasites isolated from Nycteridae bats has been recently reported. Bats are hosts to a diverse and profuse array of Haemosporidia parasites that remain largely unstudied. There is a need to obtain more molecular data from chiropteran parasites. Such data would help to better understand the evolutionary history of Haemosporidia, which notably include the Plasmodium parasites, malaria’s agents. We use next-generation sequencing to obtain the complete mitochondrial genome of Nycteria parasites from African Nycteris grandis (Nycteridae) and Rhinolophus alcyone (Rhinolophidae) and Asian Megaderma spasma (Megadermatidae). We report four complete mitochondrial genomes, including two rearranged mitochondrial genomes within Haemosporidia. Our results open outlooks into potentially undiscovered Haemosporidian diversity.
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Manfrini, Olivia, Gabriele Bazzocchi, Alessandra Luati, Alberigo Borghi, Paola Monari, and Raffaele Bugiardini. "Coronary spasm reflects inputs from adjacent esophageal system." American Journal of Physiology-Heart and Circulatory Physiology 290, no. 5 (May 2006): H2085—H2091. http://dx.doi.org/10.1152/ajpheart.00925.2005.
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Mechanisms underlying coronary spasm are still poorly understood. The aim of the study was to assess the hypothesis that fluctuations in the development of coronary spasm might reflect inputs from the adjacent esophageal system. We enrolled patients admitted to the coronary care unit for episodes of nocturnal angina. Seven patients with variant angina and five with coronary artery disease (CAD) had concurrent ECG and esophageal manometric monitoring. ECG monitoring documented 28 episodes of ST elevation in variant angina patients and 16 episodes of ST depression in CAD patients. Manometric analysis showed that esophageal spasms resulted remarkably more frequently in variant angina patients (143 total spasms; individual range 9–31) than in CAD patients (20 total spasms; individual range 0–9; P < 0.01). Time series analysis was used to assess fluctuations in the occurrence of abnormal esophageal waves and its relationship with spontaneous episodes of ST shift. Episodes of esophageal spasm in CAD were sporadic (<1 in 30 min) and not related to ECG-recorded ischemia. In the variant angina group, esophageal spasms were time related to ischemia (>1 into 5 min before ECG-recorded ischemia) ( P < 0.05). A bidirectional analysis of causal effects showed that the influence processes between esophageal and coronary spasms were mutual and reciprocal (transfer function model, P < 0.05) in variant angina. We concluded that in variant angina patients, episodes of esophageal spasms and myocardial ischemia influenced each other. Mechanisms that cause esophageal spasm can feed back to produce coronary spasm. Coronary spasm may feed forward to produce additional episodes of esophageal spasm.
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Wang, Xiaobin, and Rolf Müller. "Pinna-rim skin folds narrow the sonar beam in the lesser false vampire bat (Megaderma spasma)." Journal of the Acoustical Society of America 126, no. 6 (December 2009): 3311–18. http://dx.doi.org/10.1121/1.3257210.
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Salih Alimudin, Nuning Nurcahyani, Elizabeth Devi Krismuniarti, Elly L. Rustiati, and Eka Sulpin Ariyanti. "Studi Keragaman Kelelawar Berdasarkan Perangkap Jaring Kabut di Pusat Latihan Gajah Taman Nasional Way Kambas." Journal of Tropical Upland Resources (J. Trop. Upland Res.) 2, no. 1 (June 14, 2020): 113–20. http://dx.doi.org/10.23960/jtur.vol2no1.2020.86.
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Kelelawar, satu-satunya mamalia terbang, dapat terlihat di Taman Nasional Way Kambas (TNWK), termasuk Pusat Latihan Gajah (PLG). Keberadaan kelelawar dipengaruhi oleh struktur fisik habitat, iklim mikro, ketersediaan air dan sumber makanan, serta interaksi dengan satwa liar lainnya. Di Indonesia terdapat 9 dari 18 kelompok kelelawar dunia, yaitu Pteripodidae, Megadermatidae, Nycteridae, Vespertilionidae, Rhinolopidae, Hipposideridae, Emballonuridae, Rhinopomatidae, Molosidae. Penelitian ini dilakukan dengan menerapkan teknik jaring kabut untuk mempelajari keragaman kelelawar. penangkapan langsung menggunakan mist net dilakukan di 3 titik lokasi, area masjid PLG (lokasi 1), area Rumah Sakit Gajah (lokasi 2), dan area kandang gajah (lokasi 3). Tiga kali ulangan dilakukan selama penangkapan di setiap lokasi. Jumlah kelelawar yang ditangkap (N = 29) terdiri dari 7 spesies, 4 di antaranya adalah kelelawar pemakan buah (Cynopterus minutus, Cynopterus brachyotis, Cynopterus sphinx), Cynopterus titthaecheilus) dan 3 pemakan serangga (Megaderma spasma, Pipistrellus javanicus, dan Scotophilus kuhlili) . Perangkap jaring kabut cocok untuk dilakukan di PLG, TNWK dan keanekaragaman kelelawar representatif diperoleh.
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Malavika Gopi, Akshaya Suresh, Anandu H, Roshni P R, Mamatha M R, and Vinayan K P. "West syndrome - epileptic encephalopathy at early infancy." International Journal of Research in Pharmaceutical Sciences 11, no. 4 (December 25, 2020): 7492–94. http://dx.doi.org/10.26452/ijrps.v11i4.3951.
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West syndrome (WS), synonymously infantile spasm or epileptic spasm, is a rare type of epileptic encephalopathy occurring at early infancy that exists with variable life expectancy. It is the most common form of epileptic encephalopathy. WS presents with spasms marked by extensor or mixed movements with distinct electroencephalogram (EEG) pattern of hypsarrhythmia, flexor and psychomotor arrest. Children with west syndrome always depict abnormal EEG, but sometimes the abnormality is seen only during sleep. The incidence of infantile spasms is found closer to 1 in 2,000 children, that typically begins between 2-12 months of age and peaks between 4-8 months of age. It is observed in otherwise healthy infants and also among infants with abnormal cognitive development. If this spasm happens in older subjects, they are preferably called "epileptic spasms" rather than infantile spasms. The goal for treatment of infantile spasms is to have complete control of spasms. Hormonal therapy with ACTH or vigabatrin is the mainstay of treatment. In spite of the development of new antiepileptic drugs (AEDs), about 35-40% of cases are drug-resistant. Children affected with the west syndrome can be cured, but a successful therapy often depends on the timely diagnosis. This case report is one evidence highlighting the treatment strategy for the west syndrome, and this could be useful for any further study regarding this topic.
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Malavika Gopi, Akshaya Suresh, Anandu H, Roshni P R, Mamatha M R, and Vinayan K P. "West syndrome - epileptic encephalopathy at early infancy." International Journal of Research in Pharmaceutical Sciences 11, no. 4 (December 25, 2020): 7492–94. http://dx.doi.org/10.26452/ijrps.v11i4.3951.
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West syndrome (WS), synonymously infantile spasm or epileptic spasm, is a rare type of epileptic encephalopathy occurring at early infancy that exists with variable life expectancy. It is the most common form of epileptic encephalopathy. WS presents with spasms marked by extensor or mixed movements with distinct electroencephalogram (EEG) pattern of hypsarrhythmia, flexor and psychomotor arrest. Children with west syndrome always depict abnormal EEG, but sometimes the abnormality is seen only during sleep. The incidence of infantile spasms is found closer to 1 in 2,000 children, that typically begins between 2-12 months of age and peaks between 4-8 months of age. It is observed in otherwise healthy infants and also among infants with abnormal cognitive development. If this spasm happens in older subjects, they are preferably called "epileptic spasms" rather than infantile spasms. The goal for treatment of infantile spasms is to have complete control of spasms. Hormonal therapy with ACTH or vigabatrin is the mainstay of treatment. In spite of the development of new antiepileptic drugs (AEDs), about 35-40% of cases are drug-resistant. Children affected with the west syndrome can be cured, but a successful therapy often depends on the timely diagnosis. This case report is one evidence highlighting the treatment strategy for the west syndrome, and this could be useful for any further study regarding this topic.
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Sharma, Suvasini, Shaiphali Goel, Dipti Kapoor, Divyani Garg, Isha Panda, Aman Elwadhi, Bijoy Patra, Sharmila B. Mukherjee, and Harish Pemde. "Evaluation of the Modified Atkins Diet for the Treatment of Epileptic Spasms Refractory to Hormonal Therapy: A Randomized Controlled Trial." Journal of Child Neurology 36, no. 8 (April 9, 2021): 686–91. http://dx.doi.org/10.1177/08830738211004747.
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Objectives: We aimed to evaluate the efficacy of the modified Atkins diet in children with epileptic spasms who had failed hormonal therapy. Methods: Children aged 9 months to 3 years having daily epileptic spasms despite a trial of ACTH or oral prednisolone and 1 additional anticonvulsant medication were enrolled. Children were randomly assigned to receive the modified Atkins diet either immediately or after a delay of 4 weeks. The ongoing anticonvulsant medications were continued unchanged. The primary outcome variable was the proportion of children who achieved spasm freedom as per parental reports at 4 weeks. Secondary outcomes included time to spasm cessation, proportion of children with electroclinical remission, the proportion of children with >50% reduction of spasms at 4 weeks, and adverse effects of the diet. ( ClinicalTrials.gov Identifier: NCT03807141). Results: A total of 91 children were enrolled in the study; 46 in the diet group and 45 in the control group. At the end of 4 weeks, 11 children in the diet group were spasm free compared with none in the control group ( P ≤ .001). The median time to achieve spasm cessation was 10 days (interquartile range 9-20). Nine of these had resolution of hypsarrhythmia on electroencephalography (EEG). Thirty (65.2%) in the diet group had >50% reduction in spasms, compared with none in the control group ( P < .001). The most common side effect was constipation, noted in 34.8% of the children. Conclusions: The modified Atkins diet was found to be effective and well tolerated in children with epileptic spasms refractory to hormonal therapy.
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Yamashita, K., S. Okamoto, K. Hosotani, S. Nakatsu, M. Hojo, K. Miyamoto, and R. Matsumoto. "Interventional Neuroradiology in Hemifacial Spasm." Interventional Neuroradiology 3, no. 2_suppl (November 1997): 32–36. http://dx.doi.org/10.1177/15910199970030s204.
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There have never been functional studies in the diagnosis of hemifacial spasm caused by neurovascular compression. We used neurointerventional techniques to conduct a functional investigation of the artery responsible for hemifacial spasm in seven patients. A microcatheter was inserted into the various arteries of the posterior circulation under systemic heparinization, and its effect on the spasm was evaluated clinically and electromyographically. In six patients who underwent microvascular decompression surgery, the vessels compressing the root exit zone of the facial nerve were surgically determined, and compared with the result of the procedure. The catheter was inserted into twelve arteries. The spasms were stopped immediately and completely by the insertion of the catheter into seven arteries. Six of them were surgically proven to compress the root exit zone of the facial nerve. The spasm was changed in frequency or in type by the insertion into two arteries. These arteries were also compressing the root exit zone. One artery was located at a more peripheral part of it and the other was running over another artery compressing the root exit zone. The spasms were not affected at all by the insertion into three arteries. These arteries were not observed in the operative field and had no contact with the nerve. Superselective ‘angiograms showedpositional qnd configurational changes of the arteries. There was no arterial spasm and tight catheterization leading to stasis of contrast material within the arteries. There were no complications related to the procedures. Functional relationship between the artery and the spasms was established in all the patients, and one patient refused surgery because the frequency of the spasm was reduced by the procedure. The result of this study may suggest that a functional investigation of hemifacial spasm is feasible and seems useful for selecting good candidates for microvascular decompression surgery.
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Harini, Chellamani, Sonal Sharda, Ann Marie Bergin, Annapurna Poduri, Christopher J. Yuskaitis, Jurriaan M. Peters, Kshitiz Rakesh, Kush Kapur, Phillip L. Pearl, and Sanjay P. Prabhu. "Detailed Magnetic Resonance Imaging (MRI) Analysis in Infantile Spasms." Journal of Child Neurology 33, no. 6 (March 26, 2018): 405–12. http://dx.doi.org/10.1177/0883073818760424.
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Purpose: To evaluate initial magnetic resonance imaging (MRI) abnormalities in infantile spasms, correlate them to clinical characteristics, and describe repeat imaging findings. Methods: A retrospective review of infantile spasm patients was conducted, classifying abnormal MRI into developmental, acquired, and nonspecific subgroups. Results: MRIs were abnormal in 52 of 71 infantile spasm patients (23 developmental, 23 acquired, and 6 nonspecific) with no correlation to the clinical infantile spasm characteristics. Both developmental and acquired subgroups exhibited cortical gray and/or white matter abnormalities. Additional abnormalities of deep gray structures, brain stem, callosum, and volume loss occurred in the structural acquired subgroup. Repeat MRI showed better definition of the extent of existing malformations. Conclusion: In structural infantile spasms, developmental/acquired subgroups showed differences in pattern of MRI abnormalities but did not correlate with clinical characteristics.
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Gulati, Amitabh. "The Use of Lumbar Sympathetic Blockade at L4 for Management of Malignancy-Related Bladder Spasms." Pain Physician 3;14, no. 3;5 (May 14, 2011): 305–10. http://dx.doi.org/10.36076/ppj.2011/14/305.
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Background: Cancer-related bladder spasms may be a rare but severe symptom of bladder or metastatic cancer or its related treatments. Various treatments described in the literature include systemic medications, intravesical or epidural medications, or even sacral neurolectomies. Objective: We present 3 patients who have suffered from bladder spasm either from invasion of the bladder wall by tumor (2 patients) or from intravesical chemotherapeutic treatment. Design: Case Report. Setting: Cancer pain management hospital. Methods: For each patient, we describe the use of lumbar sympathetic block to successfully treat the bladder spasms. Sympathetic blockade was performed at the left anterolateral border of lumbar vertebra L4. We used 10 mL of local anesthetic (0.25% bupivacaine) delivered in 2 mL aliquots, each given after negative aspiration for heme. Each procedure was performed with fluoroscopic guidance (both AP and lateral views) with the use of iodine contrast (Omnipaque-180) to confirm the location of the medication and its resulting spread. Results: All 3 patients had a reduction in the frequency and intensity of spasms, with 2 out of 3 patients not having a recurrence of the spasms for up to 2 months post procedure and follow up. Limitations: Case Report. Conclusion: Lumbar sympathetic blockade could be a useful treatment for recurrent bladder spasm in the oncologic population. Based on these findings, we feel that the branches of the sympathetic nerve set at L4 may be a good target for neurolytic procedures, such as radiofrequency ablation, for long term treatment of bladder spasms. Further research is necessary to determine the efficacy of this technique for the treatment of bladder spasms in the oncologic population. Key words: Bladder spasm, cancer pain, splanchnic nerve, lumbar sympathetic block
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Kusuminda, Tharaka, Amani Mannakkara, Rajika Gamage, Bruce D. Patterson, and Wipula B. Yapa. "Roosting ecology of insectivorous bats in a tropical agricultural landscape." Mammalia 86, no. 2 (November 29, 2021): 134–43. http://dx.doi.org/10.1515/mammalia-2021-0056.
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Abstract Bats spend more than half of their life in roosts, where key life events transpire. Therefore the availability and selection of roosts are important to bats everywhere, and may limit their ability to exploit every habitat, including agricultural landscapes such as paddy fields, orchards and tea plantations. This study aimed to investigate the day roosts used by insectivorous bat species in tea plantations of Sri Lanka. We surveyed 18 tea plantations where we recorded a total of 44 roosts involving five families and nine species of bats (Hipposideros galeritus, Hipposideros lankadiva, Hipposideros speoris, Rhinolophus beddomei, Rhinolophus rouxii, Megaderma spasma, Pipistrellus ceylonicus, Pipistrellus coromandra and Miniopterus cf. fuliginosus). Most (26) of the recorded roosts were geomorphic, (11) were anthropogenic, and (7) were in vegetation. H. lankadiva and M. cf. fuliginosus are the only species known to roost exclusively in geomorphic roosts; all others were opportunistic. Although protecting bat roosts is crucial for their conservation, it is challenging in view of existing tea management practices. Therefore, natural roosts should be maintained and protected. The introduction of artificial roosts might increase the number of bats able to forage over tea plantations and maximize their consumption of agricultural pests, thereby increasing tea production.
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Donnelly, Melissa, Thomas E. Martin, Olivia Cropper, Ellena Yusti, Arthur Arfian, Rachael Smethurst, Catherine Fox, et al. "New species records from Buton Island, South East Sulawesi, including regional range extensions." Barbastella 14, no. 1 (2021): 14–32. http://dx.doi.org/10.14709/barbj.14.1.2021.03.
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Peninsular Malaysia is currently thought to host the highest biodiversity of Old World bats of any region, with 110 species recorded. However, the availability of literature to facilitate a similarly thorough species ‘checklist’ is not as readily available for other parts of Southeast Asia, including Sulawesi, Indonesia. Here we highlight 13 new species records from the long-term bat monitoring programme on Buton Island, South East Sulawesi, expanding on Patterson et al.’s (2017) previous inventory for this study area. One species (Hipposideros galeritus) is a new record for Sulawesi, and seven species (Cynopterus c.f. minutus, Rousettus celebensis, Megaderma spasma, Hipposideros c.f. ater, Myotis c.f. horsfieldii, Myotis c.f. moluccarum, and Myotis c.f.muricola) are new records for Buton Island. The remaining five species (Thoopterus nigrescens, Dobsonia exoleta, Acerodon celebensis,Mosia nigrescens, and Mops sarasinorum) have been previously reported from Buton but were missing from the prior site inventory. We also correct a probable mistaken species identification in the previous inventory (Cynopterus cf. titthaecheilus, now identified as Thoopterus nigrescens). This brings the total of confirmed species detected on Buton to 35, equating to 46.7% of all Sulawesi’s known bat diversity in c. 3% of its land area. We highlight Buton as a key area for conserving the region’s bat species.
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HASTRITER, MICHAEL W. "A review of Ascodipterinae (Diptera: Streblidae) of the Oriental and Australasian regions with a description of three new species of Ascodipteron Adensamer and a key to the subfamily." Zootaxa 1636, no. 1 (November 12, 2007): 1–32. http://dx.doi.org/10.11646/zootaxa.1636.1.1.
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The Ascodipterinae of the Oriental and Australasian regions are reviewed. Three new species, each known only from dealate females, are described: 1) Ascodipteron egeri sp. nov. from Malaysia, ex. Megaderma spasma (Linnaeus) attached in urogenital area; 2) Ascodipteron longiascus sp. nov. from southern China, ex. Hipposideros armiger (Hodgson), attachment site unknown; and 3) Ascodipteron wenzeli sp. nov.from Vietnam and Malaysia, ex. Rhinolophus spp. attached in urogenital area. A neotype and lectotype are designated for Ascodipteron phyllorhinae Adensamer and Ascodipteron speiserianum Muir, respectively. A neotype is designated for Ascodipteron archboldi Maa and a lectotype for Ascodipteron emballonurae Banks; the former an objective synonym of A. phyllorhinae and the latter a junior synonym of A. phyllorhinae. A neotype is also designated for Ascodipteron australiansi Muir which is regarded as a junior synonym of A. speiserianum. Ascodipteron lophotes Monticelli, A. megastigmatos Jobling, A. siamense Speiser and A. tabulatum Speiser are considered nomina dubia. The genus Paraascodipteron is tentatively referred to the subfamilyBrachytarsininae. The distribution of Maabella stomalata Hastriter and Bush is extended from China and Vietnam to Borneo, Java, Malaysia, Myanmar, Papua New Guinea, Philippine Islands, and West Papua on numerous species of Hipposideros and Rhinolophus. A key to the recognized species of Ascodipterinae is provided. There are fifteen valid species of Ascodipteron.
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Cirnigliaro, Frank Arthur, Nicole Gauthier, and Moira Rush. "Management of refractory pain in Stiff-Person syndrome." BMJ Case Reports 14, no. 1 (January 2021): e237814. http://dx.doi.org/10.1136/bcr-2020-237814.
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Stiff-Person syndrome (SPS) is a rare autoimmune neurological disorder characterised by episodic painful muscle rigidity and violent spasms. A significant trigger for the painful spasms experienced by patients is pain itself, making optimal pain management and avoidance a necessity. While first-line and second-line therapies for spasm prevention and termination are known, there is a paucity of evidence to guide pain management. We report the case of a 26-year-old woman with SPS referred for excruciating muscle cramping and rigidity with pain lasting beyond the episodes themselves. We report the novel use of ketamine and intravenous magnesium sulfate which may provide analgesia, spasm avoidance and early termination of exacerbations in SPS.
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Srinivas, Sujithra. "Infantile spasm: A review on the severity of epileptic encephalopathy." IP Indian Journal of Neurosciences 8, no. 1 (March 15, 2022): 16–20. http://dx.doi.org/10.18231/j.ijn.2022.004.
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Infantile spasm (IS) comprises of both an age dependent epileptic seizure and distinctive seizure Onset in infants. In the recent past the key observation in classification and standardization of infantile spasm has culminated many recommendations in distinguishing and recognizing the seizure type and the epileptic syndrome or the West syndrome. The Infantile spasm is an early onset epileptic encephalopathy which presents unique electrographic and clinical features, these features are found in children in the middle of the first year of their birth .However the pathophysiology and the heterogeneity of the infantile spasm remains partially or incompletely understood. In the neurobiological basis there are multiple aetiologies converge to form similar clinical interpretations. The description of the electroencephalographic features of the spasm and its hypsarrthythmia plays a pivot role in early diagnosis. The treatment options for infantile spasm are very limited and it is also called a “catastrophic” due to the poor developmental, cognitive and epileptic progress. In the recent past more detailed information about the electrographic and clinical features of the spasms and hypsarrhythmia in EEG has emerged. The advances in the neuro imaging techniques have revealed about the aetiology and the pathophysiology of infantile spasm to yield a prognosis in patients with infantile spasms. The pathophysiology of infantile spasm needs to be better clarified for any kind of novel treatments and a wide range of preclinical animal studies are essential for advancing the knowledge. Here, in this review paper we focus on the preclinical models of Infantile spasm, with information’s regarding the existing models and research findings, elaborate on some novel models and discuss on new data that can help in advancing the understanding of the cellular mechanisms underlying the specific EEG changes such as ictal electrodecrement and interictal hypsarrhythmia presented in Infantile spasm IS.
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Hayek, Salim M. "Occipital Neurostimulation-Induced Muscle Spasms: Implications for Lead Placement." September 2009 5;12, no. 5;9 (September 14, 2009): 867–76. http://dx.doi.org/10.36076/ppj.2009/12/867.
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Background: For many headache types, occipital peripheral nerve stimulation (ONS) provides significant relief of chronic, frequent, and severe headaches. Though rarely reported, ONS may cause painful muscle spasms that make stimulator use impractical. The classic description of the technique advocates placement of the leads transversely at the level of the arch of C1 or at C1-2. At that level, the greater occipital nerve (GON) infrequently pierces the superficial fascia of the neck muscles to become superficial. However, important anatomic variability exists. Objective: To report placement of leads higher at the nuchal line rather than the classically recommended C1 level to avoid ONS-induced muscle spasm. Methods: Four interventional pain physicians independently revised ONS leads due to painful muscle stimulation. Five case reports of surgical ONS lead revision for management of ONS-induced muscle spasms are described and discussed. Results: Placement of peripheral neurostimulator leads at or above the nuchal line in these 5 cases provided good paresthesiae without causing neck muscle spasm. Conclusion: Lead placement at the level of C1 or C1-2 may cause some patients to have intolerable neck/occipital spasm during neurostimulation. This is the first known published report of technical variation in the location of lead placement, at the nuchal line in a transverse fashion, for ONS. Placing ONS leads at the level of the occipital protuberance appears to eliminate ONS-induced muscle spasm while allowing good paresthesia coverage. Limitations: Stimulation parameters vary, thus posting parameters may be misleading as muscle spasms occurred despite multiple reprogramming attempts and were a function of lead position, not program settings. Key words: Occipital nerve stimulator, peripheral neurostimulation, muscle spasm, complication, interventional pain management, cephalgia, headache, migraine, occipital neuralgia, greater occipital nerve
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Aryal, Roshan, Sushan Homagian, Suraj Shrestha, Bikram Prasad Gajurel, Ragesh Karn, Reema Rajbhandari, Niraj Gautam, Ashish Shrestha, Sumit Shahi, and Rajeev Ojha. "Painful tonic spasms in a patient with neuromyelitis optica spectrum disorder: A case report." SAGE Open Medical Case Reports 11 (January 2023): 2050313X2311679. http://dx.doi.org/10.1177/2050313x231167937.
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Painful tonic spasms initially described in association with multiple sclerosis are actually more common in patients with neuromyelitis optica spectrum disorder. Characterized by fierce pain and tonic posture of limbs, painful tonic spasms are common in patients during the recovery phase after the first episode of myelitis. A 68-year-old man presented with painful tonic spasm after 2 months of diagnosis of neuromyelitis optica spectrum disorder. Eventual use of eslicarbazepine resulted in significant control of spasms. Early recognition of painful tonic spasms and appropriate therapeutic medications can significantly decrease the impact it can have on the quality of life among neuromyelitis optica spectrum disorder patients.
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Armstrong, Dallas, and Rana R. Said. "Outcomes of High-Dose Steroid Therapy for Infantile Spasms in Children With Trisomy 21." Journal of Child Neurology 34, no. 11 (May 22, 2019): 646–52. http://dx.doi.org/10.1177/0883073819850650.
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Objective: We performed a retrospective chart review of patients with trisomy 21 and infantile spasms in our university-based pediatric epilepsy center between 2002 and 2016 in order to describe the clinical characteristics of children with these diagnoses as well as to evaluate their response to first-line treatments. Methods: Patients with infantile spasms were identified via the neurophysiology database. Charts were reviewed with attention to infantile spasms diagnosis, presence of trisomy 21, age of reported clinical onset, treatment lag, treatments used, response to treatment, imaging findings, electroencephalography (EEG) data, and developmental outcomes. Results: Of the 310 patients with infantile spasms, 24 also had trisomy 21. Three patients did not meet inclusion criteria. Ten of the 21 patients received nonstandard therapies first line; 2 of the 10 (20%) achieved spasm control, and 4 of the 8 who failed therapy (50%) progressed to Lennox-Gastaut syndrome. Eleven of the 21 patients received standard therapies as first-line treatments (10 with prednisolone according to the protocol in the United Kingdom Infantile Spasms Study [UKISS] and 1 with adrenocorticotrophic hormone [ACTH]). Nine of the 10 patients (90%) who received prednisolone achieved spasm resolution, 6 (60%) of these without relapse. The final patient (10%) failed prednisolone as well as ACTH. One patient received ACTH first line with success. Conclusion: This is the only series to follow children with trisomy 21 and infantile spasms in which a significant proportion received UKISS-protocol prednisolone. It adds to current knowledge about safety, tolerability, and effectiveness of prednisolone in this group.
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Adhikari, Sudhir, and Deepa Gautam. "Outcome of West Syndrome: A Critical Review." Journal of Pediatric Epilepsy 09, no. 01 (March 2020): 001–6. http://dx.doi.org/10.1055/s-0040-1708809.
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AbstractWest syndrome is a genetically heterogeneous electro-clinical syndrome starting in early infancy. Short-term goal of therapy is spasm control and with standard hormonal or vigabatrin treatment, spasms can be controlled in 60 to 80% of patients in 2 weeks to 3 months period. Hormonal treatment with oral steroid is an alternative therapy to injectable adrenocorticotropin hormone, especially in low resource areas. Vigabatrin is preferred in tuberous sclerosis patients. Long-term aim of treatment is sustained remission of seizures and better neurodevelopmental outcome. About 50 to 70% of children are spasm free for prolonged duration, but epilepsy with multiple seizure types including Lennox–Gastaut syndrome is evident in 20 to 40% of children in long-term follow-up. Though hypsarrhythmia is helpful for the diagnosis, prognostic role of the resolution of electroencephalographic abnormalities is still uncertain. Seizures can be controlled in 40 to 60% of the patients, but only 12 to 40% children have normal neurodevelopmental outcome and a third of children are left with severe disabilities. Children with unknown etiology and normal development at spasm onset have better clinical outcome. Young age at onset, nonstandard therapy have less favorable outcome. Surgery is helpful for spasm control in patients with structural lesions and refractory spasms even in the absence of structural lesions.
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Lee, Yoon Ji, and Yong-Suk Kim. "Is there any specificity in gender, triggering factors and HRV according to the left and right lesions of hemifacial spasm? : A retrospective chart review." Journal of Korean Medicine 44, no. 1 (March 1, 2023): 16–27. http://dx.doi.org/10.13048/jkm.23002.
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Objectives: This study is designed to investigate the difference of gender, triggering factors and Heart rate variability(HRV) between left and right hemifacial spasm patients.Methods: Among hemifacial spasm patients who visited the Acupuncture and Moxibustion medicine clinic of Kyung Hee University Korean Medicine Hospital from January 1, 2017, to April 18, 2022, we reviewed the clinical records of subjects with right hemifacial spasm(n=55) and left hemifacial spasm(n=76). We investigated the difference of gender, triggering factors and HRV between left and right hemifacial spasm patients groups by student’s t-test, chi-square test and fisher's exact test using SPSS for windows(version 28.0.0.0.).Results: There was no difference in gender, triggering factors and HRV between left and right hemifacial spasm groups.Conclusion: According to this study, there were few specificity of lesions of left and right in hemifacial spasms.
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Conte, Antonella, Marika Falla, Maria Concetta Diana, Matteo Bologna, Antonio Suppa, Andrea Fabbrini, Carlo Colosimo, Alfredo Berardelli, and Giovanni Fabbrini. "Spread of Muscle Spasms in Hemifacial Spasm." Movement Disorders Clinical Practice 2, no. 1 (November 4, 2014): 53–55. http://dx.doi.org/10.1002/mdc3.12106.
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Nahar Sumi, Most Samsun, Razia Sultana, Sufia Khatun, Mohammad Shah Jahan Chowdhury, Mohammad Enayet Hussain, Rajib Nayan Chowdhury, and Narayan Saha. "Clinical and Electroencephalographic Pattern and Short-Term Outcome to Treatment in Infantile Spasm: A Randomized Controlled Trial." Journal of National Institute of Neurosciences Bangladesh 8, no. 2 (January 15, 2023): 130–35. http://dx.doi.org/10.3329/jninb.v8i2.63747.
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Background: Infantile spasms (epileptic spasm) is an epileptic encephalopathy with unique clinical and electrographic features, which affects children mostly in the middle of the first year of life.
Objective: The aim of this study was to evaluate the clinical and electroencephalographic profile and short-term outcome in infantile spasm.
Methodology: This was a randomized controlled trial study done in Department of Pediatric Neurology, National Institute of Neuroscience & Hospital, Dhaka, Bangladesh. The patient of infantile spasm aged 2 months to 2 years were enrolled in the study from June 2017 to May 2018. With parent’s written informed consent, they were randomized into two groups, 25 in each. One group got ACTH only and another group got both ACTH and vigabatrin. Detailed history including seizure pattern was taken. EEG was done before and after2 -3 weeks of starting treatment. They were followed up at 8, 15, 43 days.
Results: The mean age of onset of seizure (mean ±SD) was 7.24±4.13 (2 to 19) month on hormonal therapy and 6.84±5.89 (2 to 22) month on combination therapy. Most patient had history of perinatal birth asphyxia, developmental delay, seizure pattern was flexor spasm and EEG pattern were predominantly classical hypsarrhythmia in both groups. After treatment cessation of spasms occurred between 14 to 42 days in 72.0% in combination therapy and 44% in hormonal therapy (P value=0.045). EEG became normal in 60.0% and 32.0% patients in combination and hormonal therapy respectively (P value =0.047).
Conclusion: In conclusion combination therapy of ACTH hormone plus vigabatrin has better than ACTH therapy alone in cessation of clinical spasms and electroencephalographic remission.
Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):130-135
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Subedi, Kiran, Rydam Basnet, Bikash Bhandari, Sonsy Gongal, and Ashik Rajak. "West syndrome - Diagnostic dilemma in a month old infant without typical electroencephalographic features: A case report." Journal of Kathmandu Medical College 8, no. 2 (June 30, 2019): 116–17. http://dx.doi.org/10.3126/jkmc.v8i2.28175.
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Infantile spasm constitutes 2% of childhood epilepsies but 25% of epilepsy with onset in the first year of life. The rate of infantile spasm is estimated to be 2.5-6.0 cases per 10,000 live births. Its prevalence rate is 1.5-2.0 cases per 10,000 children aged 10 years or younger. Ninety percent of infantile spasms begin in infants younger than 12 months with a peak onset at age 4-6 months.
We report a case of 45 days old male child who had onset of flexor spasms since one month of age which is an unusual age of onset of West syndrome. The symptoms were initially thought as a simple startle response by the mother. This is a rare case because of its age of onset and lack of typical electroencephalographic features. Although the electroencephalography showed abnormal pattern suggesting seizure disorder, the frequently encountered pattern of hypsarrhythmia seen in children with infantile spasm was not seen in this case. It was difficult to assess developmental regression in a month old child who in subsequent visits had some degree of developmental delay. Hence fulfilling two of the three criterias for the diagnosis.
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Wang, Ling, Shannon Yarosz, Hosain Aghamoosa, Zachary Grinspan, and Anup D. Patel. "Validating an Algorithm to Identify Patients With Infantile Spasms Using Medical Claims." Journal of Child Neurology 33, no. 10 (June 4, 2018): 639–41. http://dx.doi.org/10.1177/0883073818774960.
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An infantile spasm is a brief seizure type that is characteristic of West syndrome. Many infants present with infantile spasms between 3-12 months of age. Early diagnosis and proper treatment of patients with infantile spasms can lead to improved clinical outcomes. However, proper identification of these patients using claims data with validation has not been performed. The authors developed and tested several algorithms using claims data. Claims data consisted of using International Classification of Disease (ICD), Current Procedural Terminology (CPT), and prescription codes. Access to the claims database was from an accountable care organization. The algorithm using the specific ICD code for infantile spasms only performed the best with high sensitivity and specificity. This algorithm can be used to perform additional research in claims data for patients with infantile spasms.
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Panda, Akhila Kumar, Godhavarma Gopinath, and Shaily Singh. "Parry-Romberg syndrome with hemimasticatory spasm in pregnancy; A dystonia mimic." Journal of Neurosciences in Rural Practice 5, no. 02 (April 2014): 184–86. http://dx.doi.org/10.4103/0976-3147.131675.
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ABSTRACTParry-Romberg syndrome (PRS) with hemimasticatory spasm (HMS) is quite an uncommon overlapping phenomenon which very often mimics jaw closing dystonia. A previously healthy 35-year-old female, during her 5 th month of pregnancy started developing intermittent unilateral painful spasms of jaw while conversation, clinching of teeth, or eating, which led to frequent tongue bites. The spasms were worsened during pregnancy. She used to do certain manoeuvre like sensory tricks in form of touching involved side of the face to relieve the symptoms. Apart from this, she developed progressive hemifacial and hemitongue atrophy. Other medical and neurological examinations were normal. Laboratory investigations as well as neuroimaging were noncontributory. The spasm responded to carbamazepine but hemifacial atrophy persists. To our best knowledge, onset and worsening of this syndrome in pregnancy has not been described earlier which might be correlated either with some hormonal imbalance or some unknown mechanisms.
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Rank, M. M., K. C. Murray, M. J. Stephens, J. D'Amico, M. A. Gorassini, and D. J. Bennett. "Adrenergic Receptors Modulate Motoneuron Excitability, Sensory Synaptic Transmission and Muscle Spasms After Chronic Spinal Cord Injury." Journal of Neurophysiology 105, no. 1 (January 2011): 410–22. http://dx.doi.org/10.1152/jn.00775.2010.
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The brain stem provides most of the noradrenaline (NA) present in the spinal cord, which functions to both increase spinal motoneuron excitability and inhibit sensory afferent transmission to motoneurons (excitatory postsynaptic potentials; EPSPs). NA increases motoneuron excitability by facilitating calcium-mediated persistent inward currents (Ca PICs) that are crucial for sustained motoneuron firing. Spinal cord transection eliminates most NA and accordingly causes an immediate loss of PICs and emergence of exaggerated EPSPs. However, with time PICs recover, and thus the exaggerated EPSPs can then readily trigger these PICs, which in turn produce muscle spasms. Here we examined the contribution of adrenergic receptors to spasms in chronic spinal rats. Selective activation of the α1A adrenergic receptor with the agonists methoxamine or A61603 facilitated Ca PIC and spasm activity, recorded both in vivo and in vitro. In contrast, the α2 receptor agonists clonidine and UK14303 did not facilitate Ca PICs, but did decrease the EPSPs that trigger spasms. Moreover, in the absence of agonists, spasms recorded in vivo were inhibited by the α1 receptor antagonists WB4010, prazosin, and REC15/2739, and increased by the α2 receptor antagonist RX821001, suggesting that both adrenergic receptors were endogenously active. In contrast, spasm activity recorded in the isolated in vitro cord was inhibited only by the α1 antagonists that block constitutive receptor activity (activity in the absence of NA; inverse agonists, WB4010 and prazosin) and not by the neutral antagonist REC15/2739, which only blocks conventional NA-mediated receptor activity. RX821001 had no effect in vitro even though it is an α2 receptor inverse agonist. Our results suggest that after chronic spinal cord injury Ca PICs and spasms are facilitated, in part, by constitutive activity in α1 adrenergic receptors. Additionally, peripherally derived NA (or similar ligand) activates both α1 and α2 adrenergic receptors, controlling PICs and EPSPs, respectively.
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Osburn, Leisha L., Aage R. Møller, Jay R. Bhatt, and Aaron A. Cohen-Gadol. "Hemilingual Spasm." Neurosurgery 67, no. 1 (July 1, 2010): 192–96. http://dx.doi.org/10.1227/01.neu.0000370596.78384.2b.
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Abstract OBJECTIVE We report on vascular compression syndrome of the 12th cranial nerve (hypoglossal), an occurrence not previously reported, and demonstrate, through corresponding objective electrophysiological evidence, that microvascular decompression of the hypoglossal nerve root can cure hemilingual spasm. CLINICAL PRESENTATION A 52-year-old man had lower face muscle twitching and tongue spasms, which worsened with talking, chewing, or emotional stress. Carbamazepine offered only temporary relief, and relief from injections of botulinum toxin was insignificant. He was referred for surgical treatment. High-resolution magnetic resonance imaging of his posterior fossa contents revealed no obvious evidence of any compressive vessel along the facial nerve, but a compressive vessel along the hypoglossal nerve was apparent. INTERVENTION The presence of preoperative tongue spasms encouraged interoperative monitoring of tongue motor responses. The facial nerve exit zone was explored, but microsurgical inspection of the seventh/eighth cranial nerve complex did not reveal any compressive vessel. However, at the anterolateral aspect of the medulla oblongata, the hypoglossal nerve was clearly compressed and distorted laterally by a large tortuous vertebral artery. When the artery was mobilized away from the nerve, the abnormal late electromyographic response to transcranial electrical stimulation disappeared; immediately after shredded Teflon was interpositioned between the artery and the nerve, the abnormal spontaneous tongue fasciculation also disappeared. The patient has remained spasm free 6 months after surgery. CONCLUSION Hemilingual spasm may be caused by vascular contact/compression along cranial nerve XII at the lower brainstem and belong to the same family of cranial nerve hyperactivity disorders as hemifacial spasm.
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Kartawan, Gabrielle Alexander, and Tiffany Alexander Kartawan. "Ventricular tachycardia and acute myocardial infarction induced by coronary artery spasm in patient without coronary artery disease." International Journal of Advances in Medicine 9, no. 8 (July 25, 2022): 879. http://dx.doi.org/10.18203/2349-3933.ijam20221846.
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Coronary artery spasm, marked by coronary vasoconstriction, is one of the etiologies of myocardial ischemia, often presenting as vasospastic angina. Vasospastic angina is diagnosed when angina which predominantly occurs at rest, is accompanied by ST-segment changes in ECG, or in the setting of borderline ECG changes, a positive provocation test through coronary angiography is required. Although coronary artery spasms could manifest in wide clinical settings, the occurrence of ventricular arrhythmias and acute myocardial infarction solely caused by spasms without evidence of prior coronary artery disease is rare. This case report is about a 46-year-old man who presented with ventricular tachycardia and acute myocardial infarction that later was found to be secondary to coronary vasospasm observed directly through coronary angiography. We aim to emphasize the importance of coronary artery spasms as the etiology of malignant ventricular arrhythmias and acute myocardial infarction manifestation. Optimization in treatment and prevention shall reduce future life-threatening complications of coronary artery spasms.
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Koyuncu, Halil, Safak Sahir Karamehmetoglu, Fatmanur Otmar Ozcan, Kubra Saygisever-Faikoglu, Gokhan Faikoglu, Yurdaer Ozcan, and Tugce Uskur. "Comparison of the Efficiency and Safety of Oral Phenyramidol and Phenyramidol+Diclofenac Treatment in Muscle Spasms with Spinal Pain – Open-Label Study." Journal of Drug Delivery and Therapeutics 12, no. 4-S (August 15, 2022): 83–86. http://dx.doi.org/10.22270/jddt.v12i4-s.5512.
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Muscle relaxants (MR) and nonsteroidal anti-inflammatory drugs (NSAID) are frequently used in the treatment of spasms and are effective combined or alone in muscle spasms. In this study, 30 patients aged 32-82 years, male and female, with moderate to severe acute spinal pain-muscle spasms due to trauma, sprain, or injury history were evaluated. Group 1 received phenyramidol 400 mg orally 3 times a day for 7 days. In the second group, phenyramidol (400 mg) three times a day + diclofenac (75 mg) once a day was given orally for 7 days. Patients were evaluated on the 0th and 7th days in terms of muscle spasm level, pain intensity, and side effects. Side effects were noted for clinical safety. Evaluation was performed at the start of treatment and after treatment. Compared with the adverse drug reactions that occurred during the study, Group 1 treated with phenyramidol alone showed a statistically significantly better safety profile than Group 2 treated with the combination of phenyramidol and diclofenac (p<0.001). As a result, it was observed that oral phenyramidol treatment alone and oral phenyramidol+diclofenac combination treatment did not have any difference in terms of efficacy, but when compared in terms of side effects, the use of phenyramidol alone showed a higher safety profile.
Keywords: phenyramidol, diclofenac, muscle spasm, spinal pain
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Trinh, Van N., and Joseph E. Villaluz. "A Case Series on the Utility of Dexmedetomidine for the Immediate Treatment of Postoperative Muscle Spasm." Journal of Anesthesiology and Pain Therapy 4, no. 1 (April 11, 2023): 17–21. http://dx.doi.org/10.29245/2768-5365/2023/1.1139.
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Postoperative muscle spasm is a common complaint in the post-anesthesia care unit. Management of postoperative muscle spasm remains a major challenge as first-line anti-spasmodic agents are not without risk. Due to the adverse effects of sedation and risk for respiratory depression and pulmonary aspiration, conventional anti-spasmodic agents may not be an ideal choice for patients who are recovering from anesthesia. In this case series, we present three patients who underwent nonemergent surgeries with subsequent postoperative cervical muscle spasm that went unresolved with conventional PACU pain medications. Below, we demonstrate the potential utility of dexmedetomidine for management of postoperative muscle spasm. This is most notable when oral anti-spasmodic formulations are contraindicated in sedated patients and intravenous skeletal muscle relaxants are inaccessible in the PACU. After receiving incremental boluses of dexmedetomidine, the patients demonstrated immediate improvement in their cervical range of motion and their cervical muscle spasms were markedly reduced. Dexmedetomidine’s unique qualities, such as its quick onset, intravenous route of administration, and minimal effect on respiratory physiology, make it an ideal choice for management of postoperative muscle spasm.
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Haines, Stuart T., and Daniel T. Casto. "Treatment of Infantile Spasms." Annals of Pharmacotherapy 28, no. 6 (June 1994): 779–91. http://dx.doi.org/10.1177/106002809402800616.
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OBJECTIVE: To summarize and evaluate the literature regarding the clinical features, epidemiology, etiology, pathophysiology, and treatment of infantile spasms. DATA SOURCES: A literature search of articles from January 1966 to July 1993 using MEDLINE, EM-Base, and Current Concepts/Life Sciences, as well as bibliographies of relevant articles. STUDY SELECTION: All identified original and review publications regarding the clinical features, epidemiology, etiology, pathophysiology, and treatment of infantile spasms were reviewed. Emphasis was placed on original studies published since 1975. DATA EXTRACTION: Data from published research were extracted and evaluated according to study design, sample size, dosing regimen, outcome measures, and treatment efficacy and safety. DATA SYNTHESIS: Infantile spasms constitute a rare epileptic syndrome with a poor long-term prognosis for normal intellectual development. The spasms are characterized by a brief symmetric contraction of the muscles of the neck, trunk, and/or extremities, often occurring in a series of 2 to more than 100 spasms during a single episode. The disorder is age-specific, with the peak onset of symptoms occurring between 2 and 8 months of age. Spasms of no identifiable cause in infants with normal development prior to the onset of infantile spasms are classified as cryptogenic or idiopathic, whereas those with an identifiable cause are classified as symptomatic. Long-term prognosis is best in cryptogenic cases, with 30–70 percent attaining normal intellect compared with 5–19 percent in symptomatic cases. The etiology and pathophysiology are not well understood. Recent theory postulates that infantile spasms may be caused by an excess of corticotropin-releasing hormone activity during infancy. The suspected association between the whole-cell pertussis vaccine and infantile spasms is coincidental. Few well-designed, prospective, controlled clinical trials for the treatment of infantile spasms have been conducted. CONCLUSIONS: Standard anticonvulsants such as phenytoin, the barbiturates, carbamazepine, and the succinimides have been ineffective. Of the anticonvulsants, only the benzodiazepines, valproic acid, and vigabatrin have shown efficacy in reducing spasm frequency and severity. Hormonal therapy with adrenocorticotropic hormone (ACTH) and/or prednisone has been the most frequently studied treatment modality and appears to be the most effective. Hormonal therapy achieves complete spasm control in 50?75 percent of infants within four weeks of initiation. Opinions differ regarding the relative efficacy between ACTH and prednisone, the need for early initiation of hormonal treatment, and the benefits of high dosages of ACTH (>40 units/d). No treatment has been shown conclusively to improve the long-term intellectual development of these infants. Neurosurgery may be the treatment of choice in select cases when a localized central nervous system abnormality can be demonstrated. Well-designed, blind, prospective clinical trials are needed to answer definitively many lingering questions regarding the treatment of infantile spasms.
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Ghossein, J., and D. Pohl. "P.052 Benign spasms of infancy - a mimicker of infantile epileptic disorders." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 46, s1 (June 2019): S28. http://dx.doi.org/10.1017/cjn.2019.152.
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Background: Benign spasms of infancy (BSI), previously described as benign non-epileptic infantile spasms or benign myoclonus of early infancy, are non-epileptic movements manifesting during the first year of life and spontaneously resolving in the second year of life. BSI are characterized by spasms typically lasting 1-2 seconds, involving to varying degrees the head, neck, trunk, shoulders and upper extremities. Ictal and interictal EEG recordings are normal. BSI are not associated with developmental retardation and do not require treatment. Distinction between BSI and infantile epileptic disorders, such as epileptic spasms or myoclonic epilepsy of infancy, can be challenging given the clinical similarities. Moreover, interictal EEGs can be normal in all conditions. Epileptic spasms and myoclonic epilepsy require timely treatment to improve neurodevelopmental outcomes. Methods: We describe a 6-month old infant presenting with spasm-like movements. His paroxysms as well as a positive family history for epileptic spasms were in keeping with a likely diagnosis of West syndrome. Results: Surprisingly, ictal video EEG did not reveal epileptiform activity, and suggested a diagnosis of BSI. Conclusions: We emphasize that ictal EEG is the gold standard for classification of infantile paroxysms as either epileptic or non-epileptic, thereby avoiding overtreatment of BSI and facilitating timely targeted treatment of infantile epilepsies.
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Thomas, C. K., and B. H. Ross. "Distinct Patterns of Motor Unit Behavior During Muscle Spasms in Spinal Cord Injured Subjects." Journal of Neurophysiology 77, no. 5 (May 1, 1997): 2847–50. http://dx.doi.org/10.1152/jn.1997.77.5.2847.
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Thomas, C. K. and B. H. Ross. Distinct patterns of motor unit behavior during muscle spasms in spinal cord injured subjects. J. Neurophysiol. 77: 2847–2850, 1997. Surface electromyograms (EMG) and force were recorded during repeated involuntary spasms of paralyzed triceps surae muscles of four men with chronic cervical spinal cord injury. The firing rates of 78 medial gastrocnemius (MG) motor units also were recorded intramuscularly with tungsten microelectrodes. Spasms typically involved a relatively rapid rise, then a more gradual fall in triceps surae EMG and torque. Motor unit firing rates either increased and then decreased with the spasm intensity (54%) or were relatively constant (26%), firing mainly at 2–10 Hz. The remaining units (20%) produced trains that included one or several doublets. Mean peak spasm firing rates were 18 ± 9 Hz (mean ± SD) for rate modulated units and 11 ± 10 Hz for units with little or no rate modulation. Some motor units fired at rates comparable with those recorded previously during maximum voluntary contractions performed by intact subjects. Others fired at rates below the minimum usually seen when normal units are first recruited (<6 Hz). Doublets (interspike interval <10 ms) often repeated every 123–333 ms, or were interspersed in trains firing at low steady rates (<11 Hz). This study shows that rate coding for many motor units appears to be similar whether descending motor input is intact or whether it has been reduced severely by spinal cord injury. In contrast, rate modulation in other units appears to depend mainly on voluntary motor commands.
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Murakami, Hiroatsu, Tadashi Kawaguchi, Masafumi Fukuda, Yasushi Ito, Hitoshi Hasegawa, and Ryuichi Tanaka. "Monitoring of the lateral spread response in the endovascular treatment of a hemifacial spasm caused by an unruptured vertebral artery aneurysm." Journal of Neurosurgery 101, no. 5 (November 2004): 861–63. http://dx.doi.org/10.3171/jns.2004.101.5.0861.
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✓ The lateral spread response (LSR) is used in the electrophysiological diagnosis of a hemifacial spasm or for monitoring during microvascular decompression. The authors used LSRs for intraoperative monitoring during endovascular surgery in a rare case of vertebral artery (VA) aneurysm that caused intractable hemifacial spasm. A 49-year-old woman presented with a right hemifacial spasm that had persisted for 9 months. No other clinical symptom was observed. Vertebral artery angiography revealed a saccular aneurysm of the right VA. Magnetic resonance (MR) imaging demonstrated that the aneurysm was compressing the root exit zone of the right facial nerve. Endovascular treatment of the VA aneurysm was performed while monitoring the patient's LSRs. During occlusion of the VA at sites distal and proximal to the aneurysm, the LSRs temporarily disappeared and then reappeared with a higher amplitude than those measured preceding their disappearance. The hemifacial spasm alleviated gradually and disappeared completely 6 months after treatment. The LSRs changed in parallel with the improvement in the patient's hemifacial spasms and eventually disappeared. No recurrence of symptoms has been noticed as of 18 months postoperatively. This is the first report of the use of LSR monitoring during endovascular surgery for an intracranial aneurysm that causes hemifacial spasm. Intraoperative and postoperative changes in the LSRs provided useful information regarding the pathophysiology of hemifacial spasm.
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Webb, PM, and A. Datta. "P.077 Response to the ketogenic diet in refractory epileptic spasms at BC Children’s Hospital." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 49, s1 (June 2022): S28. http://dx.doi.org/10.1017/cjn.2022.174.
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Background: Epileptic spasms (ES) are a devastating seizure type with poor neurodevelopmental outcome; 1/3 are resistant to treatment with first line therapies. Recently attention has been drawn to the ketogenic diet (KD) as a potentially effective therapy, though data regarding optimal time of initiation, and its sustained effectiveness, are lacking. Methods: Retrospective chart review of all patients with ES treated with KD at BC Children’s Hospital between 2002 and 2020 (n=28) with comparison of spasm response based on age of initiation of KD in two groups: < 12 months (n=11) and ≥ 12 months (n=17). Results: Comparing the <12 months and ≥ 12 months groups showed: unknown etiology in 9% vs 25%; spasm freedom for 3 months on KD in 18% vs 41%; median time to spasm freedom was 2 vs 6 weeks; relapse after a period of spasm freedom occurred in 66% vs 70%. Conclusions: Although more effective in children ≥ 12 months of age in the first 3 months, spasm freedom in either group was not sustained with KD. KD is recommended as early therapy for refractory ES, but this study suggests clinicians be aware the KD has limited efficacy in long-term control of ES and must be used with other therapies.
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Webb, PM, and A. Datta. "P.107 Response to the Ketogenic Diet in refractory epileptic spasms at BC Children’s Hospital." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 48, s3 (November 2021): S49—S50. http://dx.doi.org/10.1017/cjn.2021.384.
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Background: Epileptic spasms (ES) are a devastating seizure type with poor neurodevelopmental outcome; 1/3 are resistant to treatment with first line therapies. Recently attention has been drawn to the ketogenic diet (KD) as a potentially effective therapy, though data regarding optimal time of initiation, and its sustained effectiveness, are lacking. Methods: Retrospective chart review of all patients with ES treated with KD at BC Children’s Hospital between 2002 and 2020 (n=28) with comparison of spasm response based on age of initiation of KD in two groups: < 12 months (n=11) and ≥ 12 months (n=17). Results: Comparing the <12 months and ≥ 12 months groups showed: unknown etiology in 9% vs 25%; spasm freedom for 3 months on KD in 18% vs 41%; median time to spasm freedom was 2 vs 6 weeks; relapse after a period of spasm freedom occurred in 66% vs 70%. Conclusions: Although more effective in children ≥ 12 months of age in the first 3 months, spasm freedom in either group was not sustained with KD. KD is recommended as early therapy for refractory ES, but this study suggests clinicians be aware the KD has limited efficacy in long-term control of ES and must be used with other therapies.
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Nemoto, Daiki, Kenichi Utano, Noriyuki Isohata, Shungo Endo, Kensuke Kumamoto, Taka-aki Koshimizu, Alan Lefor, and Kazutomo Togashi. "Topical lidocaine inhibits spasm during colonoscopy: a double-blind, randomized controlled trial (with video)." Endoscopy International Open 05, no. 06 (May 30, 2017): E402—E407. http://dx.doi.org/10.1055/s-0043-105489.
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Abstract Background and study aims Topical peppermint oil prevents intestinal spasm, but can cause rebound spasm. Lidocaine hydrochloride, a local anesthetic, may work as an antispasmodic by blocking Na + channels. The aim of this study was to investigate the effect of topical lidocaine on the inhibition of colonic spasm during colonoscopy, compared with peppermint oil. Patients and methods A randomized, controlled double-blind trial was conducted in an academic endoscopy unit. Patients requiring endoscopic resection were randomly allocated to colonoscopy with topical administration of lidocaine (n = 30) or peppermint oil (n = 30). Similar vials containing different solutions were randomly numbered. Allocation was made based on the vial number. The solution used and the vial number were not revealed during the study. Two endoscopists performed all procedures using midazolam, without anticholinergic agents. When a pre-selected lesion was identified, the solution in the assigned vial was dispersed and the bowel observed for 5 minutes. The primary endpoint was the duration of spasm inhibition, and a secondary endpoint was the occurrence of rebound spasm stronger than before dispersion. Results There were no significant differences in patient demographics. Spasm was inhibited in almost all patients in both groups, with a similar median duration (lidocaine 227 sec vs. peppermint 212.5 sec, P = 0.508). In contrast, rebound spasm occurred less frequently in the lidocaine group (lidocaine 7 % vs. peppermint 47 %, P = 0.001). There were no adverse events or symptoms associated with administration of the solutions. Conclusions The inhibitory effect of lidocaine is not superior to peppermint oil. However, lidocaine significantly decreases the frequency of rebound spasms.
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Lin, Shihao, Yaqing Li, Ana M. Lucas-Osma, Krishnapriya Hari, Marilee J. Stephens, Rahul Singla, C. J. Heckman, et al. "Locomotor-related V3 interneurons initiate and coordinate muscles spasms after spinal cord injury." Journal of Neurophysiology 121, no. 4 (April 1, 2019): 1352–67. http://dx.doi.org/10.1152/jn.00776.2018.
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Spinal cord injury leads to a devastating loss of motor function and yet is accompanied by a paradoxical emergence of muscle spasms, which often involve complex muscle activation patterns across multiple joints, reciprocal muscle timing, and rhythmic clonus. We investigated the hypothesis that spasms are a manifestation of partially recovered function in spinal central pattern-generating (CPG) circuits that normally coordinate complex postural and locomotor functions. We focused on the commissural propriospinal V3 neurons that coordinate interlimb movements during locomotion and examined mice with a chronic spinal transection. When the V3 neurons were optogenetically activated with a light pulse, a complex coordinated pattern of motoneuron activity was evoked with reciprocal, crossed, and intersegmental activity. In these same mice, brief sensory stimulation evoked spasms with a complex pattern of activity very similar to that evoked by light, and the timing of these spasms was readily reset by activation of V3 neurons. Given that V3 neurons receive abundant sensory input, these results suggest that sensory activation of V3 neurons is alone sufficient to generate spasms. Indeed, when we silenced V3 neurons optogenetically, sensory evoked spasms were inhibited. Also, inhibiting general CPG activity by blocking N-methyl-d-aspartate (NMDA) receptors inhibited V3 evoked activity and associated spasms, whereas NMDA application did the opposite. Furthermore, overwhelming the V3 neurons with repeated optogenetic stimulation inhibited subsequent sensory evoked spasms, both in vivo and in vitro. Taken together, these results demonstrate that spasms are generated in part by sensory activation of V3 neurons and associated CPG circuits. NEW & NOTEWORTHY We investigated whether locomotor-related excitatory interneurons (V3) play a role in coordinating muscle spasm activity after spinal cord injury (SCI). Unexpectedly, we found that these neurons not only coordinate reciprocal motor activity but are critical for initiating spasms, as well. More generally, these results suggest that V3 neurons are important in initiating and coordinating motor output after SCI and thus provide a promising target for restoring residual motor function.
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Pavone, Piero, Agata Polizzi, Simona Domenica Marino, Giovanni Corsello, Raffaele Falsaperla, Silvia Marino, and Martino Ruggieri. "West syndrome: a comprehensive review." Neurological Sciences 41, no. 12 (August 22, 2020): 3547–62. http://dx.doi.org/10.1007/s10072-020-04600-5.
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Abstract Since its first clinical description (on his son) by William James West (1793–1848) in 1841, and the definition of the classical triad of (1) infantile spasms; (2) hypsarrhythmia, and (3) developmental arrest or regression as “West syndrome”, new and relevant advances have been recorded in this uncommon disorder. New approaches include terminology of clinical spasms (e.g., infantile (IS) vs. epileptic spasms (ES)), variety of clinical and electroencephalographic (EEG) features (e.g., typical ictal phenomena without EEG abnormalities), burden of developmental delay, spectrum of associated genetic abnormalities, pathogenesis, treatment options, and related outcome and prognosis. Aside the classical manifestations, IS or ES may present with atypical electroclinical phenotypes (e.g., subtle spasms; modified hypsarrhythmia) and may have their onset outside infancy. An increasing number of genes, proteins, and signaling pathways play crucial roles in the pathogenesis. This condition is currently regarded as a spectrum of disorders: the so-called infantile spasm syndrome (ISs), in association with other causal factors, including structural, infectious, metabolic, syndromic, and immunologic events, all acting on a genetic predisposing background. Hormonal therapy and ketogenic diet are widely used also in combination with (classical and recent) pharmacological drugs. Biologically targeted and gene therapies are increasingly studied. The present narrative review searched in seven electronic databases (primary MeSH terms/keywords included West syndrome, infantile spasms and infantile spasms syndrome and were coupled to 25 secondary clinical, EEG, therapeutic, outcomes, and associated conditions terms) including MEDLINE, Embase, Cochrane Central, Web of Sciences, Pubmed, Scopus, and OMIM to highlight the past knowledge and more recent advances.
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Kraft, Stephen P., and Anthony E. Lang. "Botulinum Toxin Injections in the Treatment of Blepharospasm, Hemifacial Spasm, and Eyelid Fasciculations." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 15, no. 3 (August 1988): 276–80. http://dx.doi.org/10.1017/s0317167100027748.
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ABSTRACT:Seventy-six patients with blepharospasm (mean age 56.9 years) received 248 injection treatments with botulinum A exotoxin (mean 3.1 treatments per patient): 87.0% of treatments led to total relief of spasms for a mean interval of 14.1 weeks. The average duration of response remained fairly constant over the first six injection series, although patients with the most severe spasms had shorter intervals than patients with less severe symptoms. Twenty patients with hemifacial spasm (mean age 56.9 years) received 44 treatments (mean 1.9 treatments per patient): In 93.1% of cases there was total relief of periocular and perioral spasms, with a mean interval of 17.4 weeks. The average duration of response for the third series of treatments was much shorter than the mean durations for the first two treatments. Side effects were always transient and included ptosis (23.3%), dry eyes (18.1%), tearing (5.5%), and strabismus (1.4%). No patient had a systemic reaction to the drug. Chronic benign eyelid fasciculations were also successfully treated in 3 patients with single treatments.
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Arai, Riku, Hiroto Kano, Shinya Suzuki, Hiroaki Semba, Takuto Arita, Naoharu Yagi, Takayuki Otsuka, et al. "Myocardial bridging is an independent predictor of positive spasm provocation testing by intracoronary ergonovine injections: a retrospective observational study." Heart and Vessels 35, no. 4 (September 27, 2019): 474–86. http://dx.doi.org/10.1007/s00380-019-01518-7.
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Abstract The relationship between myocardial bridging (MB) and coronary spasms during spasm provocation testing (SPT) remains unclear. We aimed to investigate whether MB was correlated with the SPT by ergonovine (ER) injections in a retrospective observational study. Of the 3340 patients who underwent a first coronary angiography, 166 underwent SPT using ER injections and were divided into 2 groups: MB(+) (n = 23), and MB(−) (n = 143). MB was defined as an angiographic reduction in the diameter of the coronary artery during systole. The patients who had severe organic stenosis in the left anterior descending coronary artery were excluded. The MB(+) group more frequently had diabetes mellitus and chronic kidney disease, and a thicker interventricular septum thickness. The rate of SPT-positivity was higher in the MB(+) group than MB(−) group (56.5% vs. 22.4%, P = 0.001). A multivariate regression analysis showed that the presence of MB was independently associated with SPT-positivity (odds ratio 5.587, 95% confidence interval 2.061–15.149, P = 0.001). In conclusion, coronary spasms during provocation tests with ER independently correlated with the MB. MB may predict coronary spasms.
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Jin, Yi, and Yuan Zhao. "Post-stroke upper limb spasticity incidence for different cerebral infarction site." Open Medicine 13, no. 1 (June 1, 2018): 227–31. http://dx.doi.org/10.1515/med-2018-0035.
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AbstractObjectiveThe purpose of this study was to evaluate the incidence rate of post-stroke upper limb spasticity and its correlation with cerebral infarction site.MethodsA total of 498 inpatient and outpatient cases are included in the present study. The post-stroke upper limb spasticity rate of different cerebral infarction site was calculated.ResultsA total of 498 patients with cerebral infarction are enrolled in this study. Of these patients, 91 have dropped out and 407 have completed the study. Of the completed cases, 172 are in the spasm group and 235 are in the non-spasm group. The total incidence of upper limb spasticity is 34.5%. The incidences of upper extremity spasms are 12.5%, 20%, 22.5%, 35%, 40%, and 42.5% in 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months, respectively. The incidence of upper extremity spasms increases with time. The incidences of upper limb spasticity are 12.1%, 63.3%, 58.5%, 9.4% and 8.3% when cerebral infarction occurs in the cortical and subcortical mixed areas, basal ganglia and internal capsule, cerebralcortex, brainstem and cerebellum respectively. The incidence of upper limb spasticity varies in different infarction sites (P < 0.05).ConclusionThe post-stroke upper limb spasticity rates were different according to the different cerebral infarction site. Patients with the ganglia and internal capsule infarctions had the highest risk of developing post-stroke upper limb spasticity.
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Sjonnesen, KM, J. Appendino, J. Buchhalter, A. Ho, J. Jacobs-Levan, and M. Scantlebury. "P.068 Quality improvement in Infantile Spasms through standardization: a tertiary-care centre retrospective chart review implementation study." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 50, s2 (June 2023): S77. http://dx.doi.org/10.1017/cjn.2023.171.
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Background: Infantile Spasms (IS) is a rare epilepsy syndrome with characteristic features, and a strong consensus regarding treatment strategies. Clinical care pathways provide standardized and evidence-based patient care, support care quality and improve patient outcomes. Standardized electronic notes may support data collection and quality. After the concurrent implementation of an IS pathway and standardized electronic note at the Alberta Children’s Hospital in 2015, improvements in patient outcomes and quality of care were anticipated. Methods: A single-centre, retrospective chart review of patients diagnosed with Infantile spasms in Alberta, Canada from 2011-2019 was completed. Patient characteristics and outcomes were analyzed by pre-pathway and post-pathway implementation status. Results: Rates of 3-month spasm remission, and of remission without relapse did not significantly differ between pre- and post-pathway cohorts. Rates of 2-week spasm remission were not obtainable from a significant proportion of pre-pathway patient records when compared to the post-pathway group, indicating patient record quality improved following the electronic note implementation. A significant proportion of patients received Prednisolone as their first treatment for IS post-pathway implementation compared to pre-pathway (p<0.001). Conclusions: A single-centre experience with concurrent implementation of an IS pathway and standardized electronic note demonstrated no significant changes in patient outcomes. Potential improvements for patient care are identified.
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Lipnicki, BSc, RMT, Michelle. "Massage Therapy for Dystonia: a Case Report." International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice 13, no. 2 (March 4, 2020): 33–44. http://dx.doi.org/10.3822/ijtmb.v13i2.436.
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Background: Dystonia is a neurological disorder, characterized by involuntary muscle spasms and tremors, resulting in abnormal movements and posture. Symptoms include pain, spasms, tremors, and dyskinesia—a difficulty in performing voluntary muscular movements. Conventional treatments include medication, botulism injections, and surgical intervention. Many dystonia patients seek complementary and alternative medicine (CAM) therapies, such as massage, but these treatments are not well documented. This clinical case study documents massage treatment for dystonia for a specific individual.
Purpose: To examine the effects of massage therapy on pain, spasms, and dyskinesia in activities of daily living (ADL), in a patient diagnosed with dystonia as an adult, following trauma.
Methods: A student massage therapist administered 5 massage treatments over a six-week period to a 51-year-old female patient diagnosed with dystonia. The patient presented with symptoms of pain, spasms, tremors, and dyskinesia in ADL. Techniques applied included Swedish massage and hydrotherapy to decrease pain and spasms, and myofascial release and stretching, to decrease dyskinesia. Treatments aimed to increase overall relaxation. Remedial exercise was given to practice smoother movement patterns. Pre- and postnumeric rating scales (NRS) for pain were evaluated each session. Frequency of night pain and spasms, the Modified Bradykinesia Rating Scale (MBRS), the Timed Up and Go (TUG) test, the Functional Rating Index (FRI) and the Modified Gait Efficacy Scale (MGES) were measured at the start and end of the study.
Results: Posttreatment pain intensity generally remained the same or decreased. Positive outcomes were exhibited in the frequency of night pain and spasms, TUG, MBRS, and FRI test scores. The MGES score was negatively affected.
Conclusion: The results suggest massage therapy may temporarily decrease pain intensity, pain and spasm frequency, and dyskinesia in ADL, associated with dystonia.
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Keshavan, Shivan, Guruprasad Peruri, Renu Suthar, Suresh Kumar Angurana, Lokesh Saini, and Jitendra Sahu. "A Neonate with Exaggerated Startle and Tonic Spasms." Journal of Pediatric Neurology 17, no. 04 (June 30, 2018): 146–48. http://dx.doi.org/10.1055/s-0038-1661413.
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AbstractHyperekplexia is a rare, potentially treatable inherited disorder of glycinergic neurotransmission, which is characterized by neonatal onset exaggerated startle response to somatosensory, auditory stimuli, and episodic tonic spasm. Prolonged tonic spasms can be life-threatening and associated with apnea and bradycardia. Awareness about this condition avoids misdiagnosis such as tonic seizures and epilepsy. We describe a term newborn with episodic tonic stiffness mistaken for seizures. Classical exaggerated startle reaction, positive head retraction response to glabellar tap, and characteristic video electroencephalogram confirmed the diagnosis.
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Barajas, Ramon F., John Chi, Lanjun Guo, and Nicholas Barbaro. "MICROVASCULAR DECOMPRESSION IN HEMIFACIAL SPASM RESULTING FROM A CEREBELLOPONTINE ANGLE LIPOMA." Neurosurgery 63, no. 4 (October 1, 2008): E815—E816. http://dx.doi.org/10.1227/01.neu.0000325734.30302.97.
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ABSTRACT OBJECTIVE Hemifacial spasm caused by a cerebellopontine angle lipoma is extremely rare. We describe a patient with left-sided hemifacial spasm caused by vascular compression of the facial and vestibulocochlear cranial nerves by the anteroinferior cerebellar artery embedded within a cerebellopontine angle lipoma. CLINICAL PRESENTATION A 77-year-old man presented with a 10-year history of left-sided facial spasms that progressively worsened over time and significantly interfered with his ability to read, drive, and interact in social situations. Neurological examination showed obvious left hemifacial spasm, including orbicularis oculi and levator labii muscles. Magnetic resonance imaging revealed characteristic abnormal signal within the cerebellopontine angle cistern that was consistent with lipoma abutting the anteroinferior cerebellar artery. INTERVENTION Surgical exploration with standard retrosigmoid craniectomy and subarachnoid dissection of the cerebellopontine angle was performed. The offending anteroinferior cerebellar artery branch was dissected away from the VIIth and VIIIth cranial nerves. Teflon felt was interposed between the artery and nerves after the artery was dissected off the surface of the lipoma. Electrophysiological monitoring showed resolution of the abnormal hemifacial spasm response during the procedure. No attempt was made to resect the lipoma, given the risk to injury of the brainstem and perforating blood vessels. Postoperatively, the patient's symptoms were completely resolved. CONCLUSION This case demonstrates that relief of the vascular compression, when present, of the VIIth cranial nerve is sufficient for resolution of hemifacial spasm symptoms, even when associated with nearby, benign lesions.
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Hu, Amanda, Murray Morrison, and Christopher R. Honey. "Hemi-laryngopharyngeal Spasm (HeLPS): Defining a New Clinical Entity." Annals of Otology, Rhinology & Laryngology 129, no. 9 (April 21, 2020): 849–55. http://dx.doi.org/10.1177/0003489420916207.
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Objective: Hemi-laryngopharyngeal spasm (HeLPS) has recently been described in the neurosurgical literature as a cause of intermittent laryngopharyngeal spasm and cough due to vascular compression of the vagus nerve at the cerebellopontine angle. We present the diagnostic criteria for this syndrome. Methods: A retrospective chart review of six patients with HeLPS and three patients misdiagnosed with this condition are presented. All patients were diagnosed and treated at a tertiary care academic centre from July 2013 to July 2017. Results: Patients with HeLPS had five defining characteristics: 1) All patients had symptoms of episodic laryngopharyngeal spasm and coughing. Patients were asymptomatic between episodes and were refractory to speech therapy and reflux management. 2) Laryngoscopy showed hyperactive twitching of the ipsilateral vocal fold in two of the six patients. No other inter-episodic abnormalities were seen. 3) Botulinum toxin A injections into the thyroarytenoid muscle on the affected ipsilateral side reduced laryngopharyngeal spasms. Botulinum toxin injection in the contralateral thyroarytenoid muscle did not improve laryngopharyngeal spasm. 4) Magnetic resonance imaging revealed ipsilateral neurovascular compression of the vagus nerve rootlets by the posterior inferior cerebellar artery. 5) Microvascular decompression (MVD) surgery of the ipsilateral vagus nerve resolved all symptoms (follow-up 2-4 years). Conclusion: The diagnostic criteria for hemi-laryngopharyngeal spasm (HeLPS) are proposed. Otolaryngology recognition of this new clinical entity may lead to a surgical cure and avoid the unnecessary therapies associated with misdiagnosis. Level of Evidence: 4
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Teragawa, Hiroki, Chikage Oshita, Yuko Uchimura, Ryota Akazawa, and Yuichi Orita. "Coronary Microvascular Vasodilatory Function: Related Clinical Features and Differences According to the Different Coronary Arteries and Types of Coronary Spasm." Journal of Clinical Medicine 11, no. 1 (December 27, 2021): 130. http://dx.doi.org/10.3390/jcm11010130.
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Background: In the clinical setting; the microvascular vasodilatory function test (MVFT) with a pressure wire has been used in ischaemia patients with non-obstructive coronary arteries (INOCA), including vasospastic angina (VSA) and microvascular angina (MVA). The exact factors that affect the microvascular vasodilatory function (MVF) in such patients are still unknown. We aimed to identify the factors, including clinical parameters and lesion characteristics, affecting the MVF in such patients. Methods: A total of 53 patients who underwent coronary angiography, spasm provocation tests (SPTs) and MVFTs were enrolled. In the MVFT, the coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were measured. Of the 53 patients, MVFT data in the left anterior descending coronary artery (LAD) were obtained from 49 patients, and the clinical parameters were checked in all of them. Based on the results of the SPT, coronary spasms were divided into focal spasm, diffuse spasm, and microvascular spasm (MVS). To assess the lesion characteristics influencing MVF, MVFT data were compared according to the types of coronary spasm and coronary vessels in 73 vessels of the 53 patients. Results: In 49 patients who underwent the MVFT in the LAD, the IMR was higher in active smokers (n = 7) than in former smokers (n = 15) and never smokers (n = 27, p < 0.01). In the 73 coronary arteries in this study, the type of coronary spasm did not correlate with the CFR or IMR, whereas a higher IMR were more frequently observed in cases of focal spasm than in cases of diffuse spasm (p = 0.03). In addition, the IMR was higher in the right coronary artery (RCA) than in the LAD (p = 0.02). Conclusion: These results indicate that the smoking status affected the MVF in patients with INOCA, suggesting the possibility of improvement in the MVF by smoking cessation in such patients. In addition, in the assessment of MVF, it may be important to take into account which coronary artery or types of coronary spasm are being evaluated.