spasm

Clostridium botulinum and botulism, the disease it causes, have been known to man for centuries 1. Botulism is a severe neuroparalytic disease caused by the action of botulinum neurotoxins (BoNTs) produced by anaerobic spore-forming C. botulinum and some of its close relatives 2. The BoNTs are regarded as the most potent toxins known to mankind 3. If left untreated, a severe case of botulism leads to death of the patient due to paralysis of respiratory muscles. Although the disease has been known to man since ancient time, Muller in 1870 coined the name 'botulism' for the newly described disease 4. Following the advent of

Purpose A randomized study was performed to assess whether new technologies offer advantages over the conventional technique on the clinical and functional outcome of patients with full-thickness rectal prolapse and fecal incontinence, submitted to Altemeier's procedure with levatorplasty. Methods Between January 1999 and December 2003, 58 patients (55 females; mean age, 70.9 ± 11.3 years) with full-thickness rectal prolapse were evaluated with continence score, colonoscopy, anorectal manometry, anal electromyography, and sacral reflex latency; 40 of them were selected and randomly assigned to two groups: 20 patients (Group 1; 19 females, 73.4 ± 10.4 years) were submitted to a conventional operation with monopolar electrocautery and handsewn anastomosis, and 20 (Group 2; 18 females, 71.5 ± 12.2 years) using harmonic scalpel and circular stapler. Patients were followed up with clinical examination, anorectal manometry, and anal electromyography, with mean follow-up 29.3 ± 8.5 and 27.5 ± 9.2 months in Groups 1 and 2, respectively. Results Operative time, blood loss, and hospital stay were significantly reduced in Group 2 (P < 0.001), whereas no differences were found in pain score, time to return to normal activity, morbidity, and mortality. Complications were two (10 percent) stenosis in Group 1. Fecal continence score significantly improved in both groups (P < 0.01), whereas anorectal manometry and neurophysiologic data were not significantly modified by the operation. Recurrence rates were 15 and 10 percent in Groups 1 and 2, respectively (P= not significant). Conclusions The clinical and functional long-term results of perineal rectosigmoidectomy with levatorplasty are not influenced by surgical instruments and type of coloanal anastomosis. The clinical relevance of the short-term results in high-risk patients should be specifically investigated.

Although consensus has not yet been reached on clinically meaningful, feasible and effective outcome measures relevant to the treatment of spasticity and patient reported outcomes, development and inclusion of such a multidimensional test battery is required for understandable interpretations of future studies.

The authors' purposes are to 1) discuss the physiologic effects of cold on the body, 2) review the literature on cryotherapy, 3) examine the benefits and the limitations of the use of cold, and 4) stimulate interest in further clinical and laboratory research. The results of this literature investigation suggest that cold can be beneficial in the treatment of patients with a wide variety of neurologic and musculoskeletal conditions, although uniform guidelines have not yet been established. Cryotherapy is the local or systemic application of cold for therapeutic purposes. The use of cold in medicine is prehistoric; it is predated perhaps only by its sister therapy, heat. Throughout the ages, controversy has existed about the relative therapeutic value of heat versus cold. Hippoc rates recommended the application of cold to recent injuries, whereas Galen used only warm water and oil in his treatment regimen. 1 The therapeutic value of heat versus cold is still a controversial issue. Interest in cryother apy has increased in recent years; however, clinical decisions to use cold therapy continue to be based on the subjective feeling by the patient, the impression of the observer, and the subsequent course of the pathology rather than on pertinent research data.

G. Paul Moore influenced the study of spasmodic dysphonia (SD) with his 1960 publication that examined the neurological, medical, and vocal fold behavior in a group of patients with adductor spasmodic dysphonia (ADSD). This review of advances in the diagnosis and treatment of SD follows a time line of research that can be traced in part to the early work of Moore et al. This article reviews the research in ADSD over the past 50 plus years. The capstone events that brought SD to its present day level of management by laryngologists and speech-language pathologists are highlighted. A look to the future to understand more of the disorder is offered for this debilitating disorder.

The authors' purposes are to 1) discuss the physiologic effects of cold on the body, 2) review the literature on cryotherapy, 3) examine the benefits and the limitations of the use of cold, and 4) stimulate interest in further clinical and laboratory research. The results of this literature investigation suggest that cold can be beneficial in the treatment of patients with a wide variety of neurologic and musculoskeletal conditions, although uniform guidelines have not yet been established. Cryotherapy is the local or systemic application of cold for therapeutic purposes. The use of cold in medicine is prehistoric; it is predated perhaps only by its sister therapy, heat. Throughout the ages, controversy has existed about the relative therapeutic value of heat versus cold. Hippoc rates recommended the application of cold to recent injuries, whereas Galen used only warm water and oil in his treatment regimen. 1 The therapeutic value of heat versus cold is still a controversial issue. Interest in cryother apy has increased in recent years; however, clinical decisions to use cold therapy continue to be based on the subjective feeling by the patient, the impression of the observer, and the subsequent course of the pathology rather than on pertinent research data.

Although consensus has not yet been reached on clinically meaningful, feasible and effective outcome measures relevant to the treatment of spasticity and patient reported outcomes, development and inclusion of such a multidimensional test battery is required for understandable interpretations of future studies.

The effectiveness of topical peppermint oil added to barium sulphate suspension in relieving colonic muscle spasm during double contrast barium enema examination was assessed in a double blind study. 141 patients were randomized either to a control group (71 patients) examined with standard barium suspension or to the treatment group which received peppermint oil mixed with the barium preparation. No residual spasm was evident in a significant proportion of patients in the treated group (60%) compared with the control group (35%) (p<0.001). The patients' acceptability of the procedure was good and there were no adverse effects on the overall quality of the examination. In conclusion, the addition of peppermint oil to the barium suspension seems to reduce the incidence of colonic spasm during the examination. The technique is simple, safe, cheap and it may lessen the need for intravenous administration of spasmolytic agents.

We report a case of worsening respiratory distress associated with opisthotonus secondary to tracheomalacia, a rather unique pathophysiological phenomenon. A 2-month-old male baby was referred to our hospital for respiratory distress syndrome with a noticeable opisthotonus. Examination and investigation confirmed the presence of an aberrant innominate artery compressing the trachea. The infant underwent aortopexy and made a dramatic post-operative recovery. Of special note, the opisthotonus vanished soon after the operation. Opisthotonus is not always related to neurological impairment and may be a warning sign of mediastinal overcrowding in patients with respiratory distress syndrome secondary to vascular compression.

To determine whether personality factors play causal, concomitant, or consequential roles in common voice disorders, a vocally normal control group and four groups with voice disorders-functional dysphonia (FD), vocal nodules (VN), spasmodic dysphonia (SD), and unilateral vocal fold paralysis (UVFP)-were compared on measures of personality and psychological adjustment. Superfactor group comparisons revealed that the majority of FD and VN subjects were classified as introverts and extraverts, respectively. Comparisons involving the SD, UVFP, and control subjects did not identify consistent personality differences. The disability hypothesis, which suggests that personality features and emotional maladjustment are solely a negative consequence of vocal disability, was not supported. Personality variables and their behavioral consequences may therefore contribute to FD and VN. Results are presented within the context of a dispositional theory offered by Roy and Bless (2000a).

Objectives/Hypothesis: Distinguishing muscle tension dysphonia (MTD) from adductor spasmodic dysphonia (ADSD) can be difficult. Unlike MTD, ADSD is described as "task-dependent," implying that dysphonia severity varies depending upon the demands of the vocal task, with connected speech thought to be more symptomatic than sustained vowels. This study used an acoustic index of dysphonia severity (i.e., the Cepstral Spectral Index of Dysphonia [CSID]) to: 1) assess the value of "task dependency" to distinguish ADSD from MTD, and to 2) examine associations between the CSID and listener ratings.

R1 and R2 blink reflex responses to single and paired stimuli were investigated in 23 control subjects, 21 patients with blepharospasm (BSP), 20 patients with torticollis spasmodica (TS), and 23 with hemifacial spasm (HFS). For paired stimuli, we compared measurements of area and peak responses at two and three times R2 threshold. R1 and R2 indices were calculated as the average of the recovery values at 0 . 5 , 0.3-, and 0.21-s interstimulus intervals to test individual patients. Peak amplitude measurements at three times R2 threshold were optimal. The R2 index was abnormal in 67% of BSP patients, 37% of TS patients, and 50% of HFS patients on the affected side and 20% on the unaffected side. A normal R2 index in one third of patients with BSP may indicate that different pathophysiological mechanisms are involved in this type of focal dystonia. 0 1996 John Wiley & Sons, Inc.

Objectives/Hypothesis: Adductor spasmodic dysphonia (ADSD) can mimic the voice characteristics of muscle tension dysphonia (MTD) contributing to diagnostic confusion and inappropriate management. Elevated spectral noise has been reported in MTD, which may aid in differential diagnosis. The longterm average spectrum (LTAS) can be compared to a Gaussian bell curve using spectral moments analysis. Four moments describe features of the LTAS: spectral mean (moment 1), standard deviation (moment 2), skewness (moment 3), and kurtosis (moment 4). This investigation evaluated spectral moments analysis of the LTAS as an objective test to distinguish ADSD from MTD.

Twenty eight patients with severe, intractable spasticity have been treated by chronic intrathecal administration of baclofen. An implantable programmable drug-administration-device (DAD) was used with a permanent intrathecal catheter. Infusion of 50 to 800 ug//day of baclofen completely abolished spasticity. Follow-up was up to two years. Therapeutic effect was documented by clinical assessment of tone, spasms and reflexes and by electrophysiological recordings of monoand polysynaptic reflex activity. Complications and untoward side-effects of the procedure were few. This procedure is recommended for spasticity of spinal origin refractory to physiotherapy and oral medication. It is a preferable alternative to ablative surgical intervention.

✓ Intractable lower extremity spasms after spinal cord injury is a significant source of morbidity. A case of refractory spasticity in paraplegia was successfully converted to flaccid paraplegia by intrathecal injection of phenol and glycerin in metrizamide. This chemical rhizolysis is simple and effective, and the presence of metrizamide allows both fluoroscopic guidance for accurate intrathecal phenol placement and good miscibility with cerebrospinal fluid. A brief comparative review of alternative therapeutic modalities is presented.

, . Spasmodic dysphonia (SD) is a voice disorder of uncertain etiology characterized by uncontrolled, intermittent and speech induced spasms of intrinsic muscles of the larynx resulting in strangled, strained and breathy voice commonly seen in women. Botulinum injection into the thyroarytenoid muscle is the standard treatment in controlling the disorder. Surgical intervention is by unilateral sectioning of recurrent laryngeal nerve and partial thyroarytenoid resection. Speech therapy is ineffective in spasmodic dysphonia, especially in moderate and severe cases. The aim of the present study was to determine the effect of Botulinum toxin type A injections for adductor type of SD on duration of benefit, perceived voice related quality of life. MATERIALS AND METHODS: 29 patients treated with Botulinum Toxin A injected into thyroarytenoid muscles on both sides. Pre and Post treatment Subjective assessment by Voice-Related Quality of Life (V-RQOL) scoring during the follow up for 18 months. RESULTS: There was improvement after injection in quality of life as indicated by the Voice-Related Quality of Life (V-RQOL). The average cycle of remission dysphonia was six months on average. CONCLUSIONS: Botulinum is effective in giving a 50 to 100% VRQOL to the patients with SD. Per cutaneous route of injection showed statistically significant results than intra oral route. Results suggested significant effects on participants' perceived quality of life and acoustic variables, over time, for all participants..

We report on two patients with reflex periodic spasms (PS) triggered by eating. Both patients also had significant cognitive and motor deficits. In both patients, reflex eating PS started during meal and occurred repeatedly at intervals of about 5-30 s, and the whole episode lasted about 10-15 min with 15-20 consecutive PS. Clinically, each PS was characterized by the trunk and head flexion, eyeball elevation, abduction of the upper limbs, and loss of consciousness. Ictal EEG recordings of PS revealed high-voltage sharp slow waves followed by a brief 1-2 s voltage attenuation. Simultaneous EMG recording of right and left deltoid muscles revealed an abrupt increase of tone lasting 0.5-1.5 s. In two patients, the origins of reflex PS were perirolandic suprasylvian and temporolimbic, respectively, because the first patient had focal epilepsy associated with cortical malformation including bilateral opercular dysplasia and the second one had cryptogenic temporal lobe epilepsy.

This article reviews lateralizing semiological signs during epileptic seizures with respect to prediction of the side of the epileptogenic zone and, therefore, presurgical diagnostic value. The lateralizing significance of semiological signs and symptoms can frequently be concluded from knowledge of the cortical representation. Visual, auditory, painful, and autonomic auras, as well as ictal motor manifestations, e.g., version, clonic and tonic activity, unilateral epileptic spasms, dystonic posturing and unilateral automatisms, automatisms with preserved responsiveness, ictal spitting and vomiting, emotional facial asymmetry, unilateral eye blinking, ictal nystagmus, and akinesia, have been shown to have lateralizing value. Furthermore, ictal language manifestations and postictal features, such as ToddÕs palsy, postictal aphasia, postictal nosewiping, postictal memory dysfunction, as well as peri-ictal water drinking, peri-ictal headache, and ipsilateral tongue biting, are reviewed. Knowledge and recognition of semiological lateralizing signs during seizures is an important component of the presurgical evaluation of epilepsy surgery candidates and adds further information to video/EEG monitoring, neuroimaging, functional mapping, and neuropsychological evaluation.

We report a 7-year-old boy with very severe tetanus treated with continuous infusion of magnesium sulphate for the control of spasms and severe autonomic dysfunction which was refractory to deep sedation and mechanical ventilation. The infusion was not associated with any adverse effects and he made an uneventful recovery. We recommend the use of intravenous magnesium sulphate infusion as an inexpensive and highly effective modality in severe tetanus.

A family in the northeast of England with Anderson-Fabry's disease is presented. Alpha-galactosidase activity in plasma and white cells was significantly reduced in three adult male members of the family. One of them had an abnormal chromosome karyotype pattern with an extra Y chromosome (47,XYY) and he was clinically less severely affected than his brothers. Coincidentally five other members ofthe family suffered from a form of familial spastic paraplegia. Since the original description of the disorder by Anderson (1898) and Fabry (1898) the concept of this condition has gradually evolved from a purely dermatological curiosity to a generalized systemic disorder, shown by Scriba (1950) to be the result of an abnormality of lipid metabolism. Sweeley and Klionsky (1963) and Jensen (1966) established the disease specifically as a disorder of glycolipid metabolism and Brady et al (1967) identified it as an inborn error of metabolism caused by the absence of ceramide trihexosidase, an enzyme later shown to be a specific a-galactosidase (Kint, 1970). Deficiency of this enzyme leads to intracellular accumulation throughout the body of ceramide trihexoside, and blood vessels are particularly affected; cardiovascular and renal disease are usually the terminal event in the fourth and fifth decades of life. Wallace (1973) has recently reviewed this disease comprehensively. He emphasized that early diagnosis was necessary to allow timely genetic advice. The purpose of this study is to describe an unusual, previously unreported, family with Anderson-Fabry's disease in the northeast of England in which one member had a 47,XYY chromosome complement. Methods All members of the family with Anderson-Fabry's disease were clinically examined and had full ophthalmological assessment. Skin lesions were studied histo

Although much work is yet to be done in this area, nine general conclusions can be derived: 1. Local site-of-injection side effects from botulinum toxin injections are rare, assuming proper technique is used. 2. The two most common medication-related side effects from botulinum toxin orofacial injections are alterations in salivary consistency and inadvertent weakness of the swallowing, speech, and facial muscles. These complications are injection site-specific (eg, more common with lateral pterygoid injections and palatal and tongue muscle injections) and dose-dependent problems. These problems are bothersome but are not contraindications for the therapy if it is needed. 3. The data presented in this article are mostly case series-based and open trial-based information that is promising, but randomized, blinded, controlled trials are needed to establish the true efficacy of this method for the orofacial motor and pain disorders. 4. The novice should begin with injection of muscles ...

With great interest, I read the paper by Rathore et al. (1). In this study, the investigators exclusively used Cook Medical (Bloomington, Indiana) hydrophilic-coated sheaths. They found significantly higher rate of abscess formation and infection in patients randomized to hydrophilic-coated Cook sheaths. This reaction has been described in the literature by many investigators (2-6) and has been exclusively related to the use of coated Cook sheaths but not other coated sheaths. Many centers with similar experience changed their practice by using other coated sheaths eliminating this adverse event. Rathore et al. (1) downplayed this reaction and did not mention that this adverse event has exclusively been reported in association with hydrophilic-coated Cook sheaths. They should have mentioned this painful and costly adverse reaction in their abstract result and conclusion and advised against using hydrophilic-coated Cook sheaths. Making a general statement in their discussion that all coated sheaths may have this problem is misleading and incorrect. Terumo M Coat hydrophilic sheaths (Terumo Interventional Systems, Somerset, New Jersey) may be substituted for coated Cook sheaths as such an adverse event has not been reported with Terumo sheaths. Furthermore, Rathore et al. (1) downplayed the fact that they did not routinely use antispasm medications in their study limiting their results and conclusion. I cannot recall any centers in the U.S. that do not routinely use antispasm medications. It is not clear why the authors avoided routine use of antispasm medications in their patients. Routine use of antispasm medications could have markedly reduced their patient discomfort and the risk of radial artery occlusion.

Background: Voluntary nystagmus has been recognized as a pendular, rapid, conjugate, primarily horizontal, benign eye movement initiated and maintained by voluntary effort. Case: A 10-year-old Japanese girl presented with voluntary nystagmus associated with accommodation spasms. Her chief complaints, intermittent blurred vision, headache, and soreness of the eyes, were thought to be related to the voluntary nystagmus and accommodation spasms. Findings: The waveform of the nystagmus appeared pendular, the frequency was 13-15 Hz, and the amplitude was 3-5 degrees. Scanning laser ophthalmoscopic video images clearly demonstrated vertical and torsional components in addition to the horizontal eye movements. Her refraction was unstable, varying between Ϫ 0.5 diopters (D) and Ϫ 5.5 D, and the recording of the accommodometer increased to Ϫ 12.0 D when nystagmus was initiated. Conclusions: This may be a unique form of voluntary nystagmus that consists of horizontal, vertical, and rotational components associated with accommodation spasms. Observation of this patient continues, without any further treatment or examination.

Purified botulinum A exotoxin was used in the treatment of forty seven patients with benign essential blepharospasm, 11 patients with hemifacial spasm and 2 patients with age-related entropion. The treatment was effective in all three groups for an average of 3-4 months when symptoms recurred and repeated chemodenervation with toxin was needed. The commonest complication was transient ptosis with an overall frequency of 7.8%. This incidence increased to 11.1% with toxin doses higher than 25 units per orbicularis. The treatment was well accepted by the patients, who were subsequently able to return to pre-blepharospasm lifestyles.

Local injections of botulinum neurotoxin are now considered an efficacious treatment for neurological and non-neurological conditions. One of the most recent achievements in the field is the observation that botulinum neurotoxin provides benefit in diseases of the gastrointestinal tract. Botulinum neurotoxin inhibits contraction of gastrointestinal smooth muscles and sphincters; it has also been shown that the neurotoxin blocks cholinergic nerve endings in the autonomic nervous system, but it does not block nonadrenergic responses mediated by nitric oxide. This aspect has further promoted the interest to use botulinum neurotoxin as a treatment for overactive smooth muscles, such as the anal sphincters to treat anal fissure and outlettype constipation, or the lower esophageal sphincter to treat esophageal achalasia. Knowledge of the anatomical and

Differentiating adductor spasmodic dysphonia (ADSD) from muscle tension dysphonia (MTD) can be difficult. This investigation examined the precision of response to unilateral lidocaine block of the recurrent laryngeal nerve (RLN block) as a potential diagnostic test to discriminate ADSD from MTD. Patients with ADSD (n = 23) and MTD (n = 20) were audio-recorded before and during RLN block. The patients completed self-ratings of dysphonia severity, vocal effort, and laryngeal tightness, and blinded listeners completed auditory-perceptual ratings of overall severity, breathiness, and strain of voice samples before and during the block. Repeated-measures analysis of variance, with &quot;group&quot; (ADSD/MTD) as the between-subjects variable and &quot;time&quot; (before block/during block) as the within-subjects variable, confirmed significant &quot;time&quot; effects, but no significant &quot;group-by-time&quot; interaction effects, indicating that both disorder groups responded favorab...

Many manual therapists assess and treat spinal stiffness of people with low back pain. The objectives of this study were to investigate: (i) whether spinal stiffness changes after treatment; (ii) the relationship between pre-treatment spinal stiffness and change in stiffness with treatment; (iii) the relationship between spinal stiffness, pain, disability and global perceived effect of treatment; (iv) whether spinal stiffness predicts outcome of treatment or response to treatment in chronic low back pain patients. One hundred and ninety-one subjects with chronic low back pain were randomly allocated to groups that received either spinal manipulative therapy, motor control exercise, or a general exercise program. Spinal stiffness was assessed before and after intervention. All three groups showed a significant decrease in stiffness following treatment ( p<0.001). No difference between groups was observed. There was a significant negative correlation between pre-treatment stiffness and change in stiffness (r¼À0.61; p<0.001). There was a significant but weak correlation (r¼0.18; p¼0.02) between change in stiffness and change in global perceived effect of treatment, and a significant but weak correlation between change in stiffness and change in function for subjects in the spinal manipulative therapy group (r¼À0.28; p¼0.02). No significant association was observed between initial stiffness score and any of the final outcome measures following treatment. Initial stiffness did not predict response to any treatment. In conclusion, spinal stiffness decreases over the course of an episode of treatment, more so in those with the stiffest spines, but the decrease is not dependent on treatment and is not generally related to outcome.

✓ Tethering of the spinal cord in the lumbar and sacral regions of children with congenital anomalies is a well-recognized problem; however, tethering in the cervical region has rarely been reported. A search of the literature revealed no reports of symptomatic postoperative cervical spinal cord tethering. The authors present five cases of delayed postoperative cervical spinal cord tethering and discuss the benefit of detethering in these patients. All five patients were young (16 to 42 years of age) at presentation. All had done well after an initial surgical procedure but returned between 1 and 31 years postoperatively with symptoms including severe headache, upper-extremity pain, and progressive neurological deficits. In each case, magnetic resonance imaging indicated dorsal tethering of the cord in the cervical region. Surgical exploration with microscopic sharp detethering of the cervical cord was performed on each patient with favorable results. To avoid retethering, wide Tuto...

Chorea-acanthocytosis is a rare autosomal recessive disorder linked to chromosome 9q211 and characterized by progressive neurodegeneration and abnormal red-cell morphology.2, 3 The clinical signs begin in the third or fourth decade with a hyperkinetic syndrome ...

Background: Cyclobenzaprine hydrochloride is a muscle relaxant that is effective in improving muscle spasm, reducing local pain and tenderness, and increasing range of motion in acute, painful musculoskeletal conditions. Sedation is the most common adverse event associated with its use at the usual dosage of 10 mg TID. Studies in healthy adults suggest that a lower dose may produce less sedation. Because cyclobenzaprine~ duration of action is 4 to 6 hours, reducing the dosing frequency to 10 mg BID would create a potentially painful untreated interval between doses. The alternative is administration of a lower dose (eg, 5 or 2.5 mg) TID. Objective: These studies were designed to assess the efficacy and tolerability of cyclobenzaprine 2.5, 5, and 10 mg TID compared with placebo in patients with acute musculoskeletal spasm. Methods: In 2 randomized, double-blind, placebo-controlled, parallel-group trials conducted at primary care centers in the United States, adult patients with acute painful muscle spasm of the lumbar or cervical region were randomly assigned to receive treatment with 2.5, 5, or 10 mg cyclobenzaprine TID or placebo for 7 days (study 1: cyclobenzaprine 5 or 10 mg TID or placebo; study 2: cyclobenzaprine 2.5 or 5 mg TID or placebo). The primary efficacy measures were patient-rated clinical global impression of change, medication helpfulness, and relief from starting backache. Neither study included a nonsteroidal anti-inflammatory drug (NSAID) as an active control. Although physicians frequently prescribe an analgesic or NSAID in addition to cyclobenzaprine, these studies were not designed to assess whether adding cyclobenzaprine provides a benefit over that of an analgesic.

A young female patient suffering from Satoyoshi syndrome had the first characteristic signs and symptoms of hair loss and progressive spontaneous intermittent painful spasms of limb muscles at age 6.5 years. Thereafter, she developed chronic diarrhea, amenorrhea, and skeletal deformities. In the orofacial region, she suffered from painful spasms of the masseter (jaw closing) muscles, progressive tooth loss, and degeneration of the mandibular condyles. Treatment with steroids and provision of complete dentures improved the signs and symptoms. Early diagnosis and timely provision of multidisciplinary care can minimize complications in these patients and improve their orofacial functions and quality of life.

In the study, we evaluated 61 multiple sclerosis patients hospitalized at our hospital in the period from October 1, 2013 to February 15, 2014. The aim of the study was to investigate pain syndromes associated with the underlying disease. Pain in the month preceding assessment was reported by 90% of patients. Most patients suffered from low back pain (52%) and musculoskeletal pain (39%), followed by neck pain (31%), painful tonic spasm (26%), neuropathic extremity pain (23%) and pain due to spasticity (21%). Other types of pain were present in less than 20% of patients. A total of 67% of patients were taking analgesics; the most frequently used were nonsteroidal antiinflammatory drugs, while drugs against neuropathic pain were taken by a smaller number of patients. The high incidence of pain syndromes pointed to the importance of regular physical therapy procedures.

Botulinum toxin has become the initial treatment of choice for the management of essential blepharospasm, hemifacial spasm and other craniocervical dystonias. Numerous studies have confirmed a 90% to 95% response rate. Although a number of common side effects have been reported, the occurrence and incidence of rare local complications remains poorly understood. More importantly, the acute and chronic distant effects of botulinum toxin have not been clearly elucidated. A better understanding of such effects is essential if clinicians are to appropriately advise patients on the use of this therapeutic modality. This article is based on the Duke University experience in the management of over 500 patients with craniocervical spasm disorders, combined with a review of the published literature. These disorders include essential blepharospasm, oromandibular dystonia, hemifacial spasm, and torticollis. The incidence of side effects following more than 6000 treatments with botulinum toxin i...

To evaluate distant effects of botulinum toxin, single fibre electromyography on the extensor digitorum communis muscle and six tests of cardiovascular reflexes were performed in five patients injected with BoTox (Oculinum'^' 20-130 units) for

Background: The fruit of Rosa moschata has traditionally been used for the treatment of abdominal spasm and diarrhoea. Therefore, the aim of this study was to investigate mechanism(s) responsible for its medicinal use in gut spasm and diarrhea. Methods: Hydro-methanolic extract of Rosa moschata (Rm.Cr) was studied in isolated rabbit's jejunal preparations for possible antispasmodic activity. Based upon in vitro relaxant activity in isolated gut preparations, in vivo antidiarrheal activity was carried out in mice to confirm its antidiarrheal effect. Acute toxicity study was performed to determine safe dose range before in vivo experiments. Results: In isolated rabbits' jejunal preparations, Rm.Cr inhibited the spontaneous and high K +-induced contractions with respective EC 50 values of 0.66 (0.44-0.97; n = 5) and 2.28 mg/mL (1.43-3.62; n = 5), like that of verapamil. This suggests the presence of calcium channel blocking (CCB) activity as a possible mode of action. The Ca ++ channel blocking activity was further confirmed when pre-treatment of isolated jejunums with Rm.Cr (1-5 mg/mL) caused a rightward shift in the Ca ++ concentration-response curves (CRCs), similar to verapamil. Rm.Cr was safe up to 2000 mg/kg for in vivo acute toxicity. Rm.Cr provided 55% and 80% protection from diarrhoea in respective doses of 100 mg/kg and 1000 mg/kg. These data indicates that the crude extract of Rosa moschata possesses Ca ++ antagonist-like constituent(s), which explains its inhibitory effect on gut motility; a mechanism that underlies its antidiarrheal and antispasmodic activities. Conclusion: The study shows that the crude extract of fruits of Rosa moschata possesses antispasmodic effects mediated possibly through voltage gated Ca++ channel blockade, which provides sound pharmacological base to its medicinal use in gut spasms and diarrhoea, though additional mechanism(s) cannot be ruled out.

Aims/Background-Ocular neuromyotonia is characterised by spontaneous spasm of extraocular muscles and has been described in only 14 patients. Three further cases, two with unique features, are described, and the underlying mechanism reviewed in the light of recent experimental evidence implicating extracellular potassium concentration in causing spontaneous firing in normal and demyelinated axons. Methods-Two patients had third nerve neuromyotonia, one due to compression by an internal carotid artery aneurysm, which has not been reported previously, while the other followed irradiation of a pituitary tumour, a common association in the published reports. Selective activation occurred in both, where neuromyotonic activity was triggered by prolonged voluntary activation of specific extraocular muscles with or without spread of activity to other third nerve muscles. The other patient had fourth nerve involvement, where spasms of the superior oblique muscle were induced only by alcohol, a phenomenon which has not been described.

Cardamom (Elettaria cardamomum) is traditionally used in various gastrointestinal, cardiovascular and neuronal disorders. To rationalize cardamom use in constipation, colic, diarrhea, hypertension and as diuretic. Cardamom crude extract (Ec.Cr) was studied using in vitro and in vivo techniques. Ec.Cr caused atropine-sensitive stimulatory effect in isolated guinea-pig ileum at 3-10mg/ml. In rabbit jejunum preparations, Ec.Cr relaxed spontaneous and K+ (80 mM)-induced contractions as well as shifted Ca++ curves to right, like verapamil. Ec.Cr (3-100mg/kg) induced fall in the arterial blood pressure (BP) of anaesthetized rats, partially blocked in atropinized animals. In endothelium-intact rat aorta, Ec.Cr relaxed phenylephrine (1 microM)-induced contractions, partially antagonized by atropine and also inhibited K+ (80 mM) contractions. In guinea-pig atria, Ec.Cr exhibited a cardio-depressant effect. Ec.Cr (1-10mg/kg) produced diuresis in rats, accompanied by a saluretic effect. It enh...