Journal articles on the topic 'Anti-spastic Medications'

<strong><em>Abstract&mdash;</em></strong><em>Spasticity following spinal cord injury (SCI) is a common symptom which negatively affects quality of life. Despite its prevalence, spasticity as a syndrome in the SCI population is not always managed effectively because it has various presentations. Different drugs are used to manage spasticity. A prospective interventional study in 20 acute spinal cord injury patients has been done to find out the effect of various anti-spastic medications like Baclofen, Diazepam, Tizanidine, Gabapentine, on spasticity and results were measured clinically on Modified Ashworth scale (MAS), Penn Spasm Frequency scale (PSFS) and Hmax/Mmax ratio. Baclofen in dose range of 15-37.5 mg/day showed highly significant reduction in mean Hmax/Mmax ratio and significant reduction in mean PSFS. Although mean MAS also showed reduction, but this was non-significant.</em>

Abstract Introduction: Spasticity is a pervasive and debilitating condition. Anti-spastic medications like Baclofen and Diazepam are most commonly used for spasticity management. Objectives: The study aimed to evaluate and compare the efficacy of Baclofen with that of Diazepam in the management of spasticity following acquired spinal cord injuries. Methods: In this randomised open-label study involving 60 patients, 30 patients received 5 mg of oral Baclofen thrice daily and 30 patients received 5 mg of oral Diazepam thrice daily for the management of spasticity. The extent of spasticity was measured by Modified Ashworth Scale (MAS). The efficacy of these drugs was measured with the mean improvement in the above parameters on days 7, 14, 28, 56 and 90 from the start of pharmacotherapy. Results: Baseline muscle spasticity scores were comparable. At the endpoint, mean improvement in tone of right and left hip flexors (1.43 vs. 0.87), hip adductors (1.30 vs. 0.87), knee flexors (0.80 vs. 0.37), ankle plantar flexors (0.80 vs. 0.37) and ankle dorsiflexors (1.23 vs. 0.93) were significantly higher in Baclofen group (p&lt;0.05), while the tone of right and left hip abductors, hip and knee extensors showed no significant difference among the groups. Conclusion: Baclofen was found to be superior to Diazepam in terms of efficacy, especially for flexor spasticity of lower limbs in acquired spinal cord injuries.

IntroductionSpasticity is one of the primary pathologies associated with cerebral palsy (CP), yet no definitive evidence exists to guide the appropriate level of spasticity management for an individual. Spasticity management strategies often differ by center. On one end of this strategy spectrum is a highly-interventional approach, characterized by treatments such as a selective dorsal rhizotomy (SDR), intrathecal baclofen pump (ITB), and anti-spasticity injections and medications. On the other end of the spectrum is a less interventional approach, involving minimal use of these treatments, and no SDR.Methods and analysisA retrospectively-matched, multi-center study protocol is described that comprehensively compares the long-term outcomes of a highly-interventional versus a minimally-interventional spasticity management strategy. We will analyze two groups of adults with spastic bilateral CP (≥21 years). In one group are individuals who underwent an SDR between the ages of 4 and 10 years, along with ongoing spasticity management during childhood and adolescence. In the other group are individuals who received minimal spasticity management and did not undergo an SDR. Individuals with prolonged use of an intrathecal baclofen (ITB) pump will be excluded. The two groups will be matched for spasticity and other important clinical characteristics at baseline. This study design improves on many of the limitations found in the existing outcome literature.Ethics and disseminationThis study received necessary approval from the University of Minnesota and Western Institutional Review Boards. Results will be disseminated via peer-reviewed publications and conference presentations.Trial registration numberNCT03789786.

Objectives: In this retrospective study, we investigated how spasticity developed in patients diagnosed with a prolonged DOC over an almost two-year observation period (21 months), and how it related to the patients’ age, gender, time since injury, etiology, level of consciousness, and anti-spastic medications. Methods: In total, 19 patients with a severe brain injury and prolonged DOC admitted to a long-term care facility were included in this study (14 male, age: 45.8 ± 15.3 years, 10 traumatic brain injury, 1.01 ± 0.99 years after brain injury, 11 minimally conscious state vs. 8 vegetative state). Each patient was assessed at admission and then quarterly, totaling eight assessments over 21 months. Spasticity was measured with the Modified Ashworth Scale (MAS) for both upper and lower limbs. The Western Neuro Sensory Stimulation Profile (WNSSP) was administered to assess the level of consciousness. Any other medical and demographic information of interest was obtained through medical records. Linear mixed models were used to assess each variable’s impact on the change of spasticity over time. Results: Significant differences were observed in the evolution of spasticity in patients based on their etiology for the upper limbs [F (7, 107.29) = 2.226; p = 0.038], and on their level of consciousness for the lower limbs [F (7, 107.07) = 3.196; p = 0.004]. Conclusion: Our preliminary results suggest that spasticity evolves differently according to the type of brain lesion and the level of consciousness. Spasticity in DOCs might therefore be mediated by different mechanisms and might have to be treated differently among patients. Future longitudinal studies should be performed prospectively in a bigger cohort and with data collection beginning earlier after brain injury to confirm our results and better understand the evolution of spasticity in this population.

Nagarmotha (Cyperus rotundus) is found throughout India. Its genus name Cyperus is derived from Cypeiros, an ancient Greek name and rotundus from a Latin word for round and refers to the tuber. It is locally known as “Mutha”. The plant is a widely used traditional medicinal herb in India, China, Japan, Korea, Combodia, Nigeria, and Bangladesh. The plant produces rhizomes, tubers, basal bulbs and fibrous roots below ground and rosettes of leaves, scapes and umbels above ground. The rhizomes of nut grass is widely utilized in ancient medication round the world to treat various diseases like constipation, dysentery, abdominal distention, animal tissue stomach ache, chest pains, irregular catamenia, painful catamenia, skin diseases, staphylococcal infection infections, leprosy, sprains and bruises, and fever, analgesic, sedative, medication, anti malarial drug, abdomen disorders, and diarrhoea . Cyperus rotundus has the properties of antimicrobial activity, anti-lesion activity, analgesic activity, anti inflammatory activity, anti diarrhoeal activity, antipyretic activity, medication activity, anti-emetic activity, tranquilizing activity, anti urolithatic activity, antispatic activity, hypolipidaemic activity, wound healing activity, medication activity, inhibitor activity, metastatic tumor activity, antifungal activity, antidiabetic drug activity, anti-obesity activity, antiallergic activity, anti-blood platelet impact, opposing rheumy activity, anti malarial drug activity, gastroprotective activity, hepatoprotective activity, cytoprotective impact, hypotensive activity, ovicidal and larvicidal activity . The petroleum ether extract and essential oil of Cyperus rotundus possessed analgesic activity. Phenols and alkaloids are the active constituents of C. rotundus. Cyperus rotundus preparations (powder in fine suspension, aqueous and alcoholic extracts) exhibited a lipolytic action and mobilized fat from the adipose tissues and thus helping to reduce the obesity. Methanolic extract of the fresh aerial part of the Cyperus rotundus was fractionated by column chromatography method using petroleum ether, chloroform, ethyl acetate and methanol. The ethyl acetate fraction showed potent antibacterial activity compared to control and standard commercial antibiotic tetracycline. It is a widely used plant in traditional medicine around the world for treatment of various diseases. It is deemed with infinite medicinal properties authenticated by the scientific committee. The rhizomes of Cyperus rotundus are used as traditional folk medicine for the treatment of stomach and bowel disorders and inflammatory diseases in Asian countries. The use of the plant as an analgesic, anti-arthritic, antibacterial, anti-cancer, anticandida, anti-convulsant, anti-diabetic, anti-emetic, anti-histaminic, anti-inflammatory, anti-malarial, anti-obesity, anti-pyretic, anti-spastic, gastroprotective, hypotensive, sedative, and tranquilizing agent has been documented by various scientists. Ethnobotanical use of Cyperus rotundus showed that the rhizomes were used to treat aging, apoptosis, atherosclerosis, cancer, cystitis, epilepsy, genotoxicity, hirutism, nociception and prostatitis disorders. The tuber part of Cyperus rotundus is also used for the treatment of dysmenorrheal and menstrual irregularities from ancient times. The rhizome of Cyperus rotundus are α-cyperolone, β-cyperone, ρ-cymol, calcium, camphene, copaene, cyperene, cyperenone, cyperol, cyperolone, caryophyllene, cyperotundone, d-copadiene, d-epoxyguaiene, isocyperol, isokobusone, kobusone, limonene, linoleic-acid, linolenic-acid, mustakone, myristic acid, oleanolic acid, oleic acid, β-pinene, patchoulenone, rotundene, rotundenol, rotundone, α-rotunol, β-rotunol, β-selinene, selinatriene, sitosterol, stearic acid, sugeonol, and sugetriol. Phytochemical constituents of Cyperus rotundus revealed the presence of alkaloids, flavonoids, glycosides, phenols, tannins, steroids, starch and many novel sesquiterpenoids. Sesquiterpene hydrocarbons such as cypera-2,4 (15)-diene, isorotundene, norrotundene and the oxygenated compound cyperadione were isolated and identified.

Abstract Metamizole (dipyrone) is a popular analgetic, non-opioid drug, commonly used in human and veterinary medicine. In some cases, this agent is still incorrectly classified as a non-steroidal anti-inflammatory drug (NSAID). Metamizole is a pro-drug, which spontaneously breaks down after oral administration to structurally related pyrazolone compounds. Apart from its analgesic effect, the medication is an antipyretic and spasmolytic agent. The mechanism responsible for the analgesic effect is a complex one, and most probably rests on the inhibition of a central cyclooxygenase-3 and activation of the opioidergic system and cannabinoid system. Metamizole can block both PG-dependent and PG-independent pathways of fever induced by LPS, which suggests that this drug has a profile of antipyretic action distinctly different from that of NSAIDs. The mechanism responsible for the spasmolytic effect of metamizole is associated with the inhibited release of intracellular Ca2+ as a result of the reduced synthesis of inositol phosphate. Metamizole is predominantly applied in the therapy of pain of different etiology, of spastic conditions, especially affecting the digestive tract, and of fever refractory to other treatments. Co-administration of morphine and metamizole produces superadditive, antinociceptive effects. Metamizole is a relatively safe pharmaceutical preparation although it is not completely free from undesirable effects. Among these side-effects, the most serious one that raises most controversy is the myelotoxic effect. It seems that in the past the risk of metamizole- induced agranulocytosis was exaggerated. Despite the evidence showing no risk of teratogenic and embryotoxic effects, the drug must not be administered to pregnant women, although it is allowed to be given to pregnant and lactating animals. This paper seeks to describe the characteristics of metamizole in the light of current knowledge.

Background: Infantile-Onset Ascending Hereditary Spastic Paralysis (IAHSP) is a rare, progressive neurodegenerative disorder caused by mutations in the ALS2 gene. It typically presents during infancy with delayed developmental motor milestones, hypertonia, and lower limb spasticity, progressing to involve the upper limbs and resulting in severe motor impairment. Cognitive function is usually preserved, and MRI ndings are often normal, making genetic testing essential for diagnosis. Case Presentation: We report the case of a 4½-year-old girl presenting with delayed motor development and progressive spasticity, initially affecting lower limbs and later extending to the upper limbs. Diagnostic workup, including MRI and nerve conduction studies, was unremarkable. Whole-exome sequencing revealed a homozygous nonsense variant in the ALS2 gene, conrming the diagnosis of IAHSP. Symptomatic treatment, including physiotherapy, syndopa (levodopa + carbidopa) and anti-spasticity medications, was initiated with limited success. Conclusion: IAHSP is a rare genetic disorder with a poor motor prognosis. Early diagnosis through genetic testing is crucial for management, and multidisciplinary care plays a vital role in improving the quality of life, although signicant motor improvement remains unlikely.

Background: The prevalence of spasticity in multiple sclerosis (MS) patients is nearly 90%. Most patients do not respond to current anti-spastic medications. Objective: To evaluate the efficacy and safety of Government Pharmaceutical Organization cannabis extract (GPOCE) in the treatment of spasticity in MS patients in Thailand. Materials and Methods: This prospective pilot study in patients diagnosed with MS whose spasticity was not relieved under current spasticity treatments, was performed between November 2019 and June 2020. The GPOCE formulation of THC:CBD 1:1 was administered to all patients. The treatment outcomes were determined at 12 weeks and compared with their baseline. Results: Seven patients participated in the present study. Among these, two patients withdrew after receiving only a small dose of GPOCE. Finally, five patients were included in the final analysis. The primary outcome was a reduction in the Modified Ashworth Score (MAS), which decreased among participants from a baseline of 15 (IQR 12 to 19) to 6 (IQR 1 to 12) (p=0.043). The key secondary outcome was a clinically relevant response (CRR), which was defined as a reduction of the spasticity Numeric Rating Scale (NRS) of more than thirty percent compared to baseline. Four patients (80%) achieved CRR. Moreover, the overall spasticity NRS decreased from a median of 6 (IQR5 to 7) to 2 (IQR2 to 3). A reduction of other NRS parameters, including fatigue, pain, tremor, sleep, spasm, anxiety, and depression, was also observed after treatment. Moreover, GPOCE was generally well tolerated. Conclusion: GPOCE is useful in treating spasticity in patients with MS. The safety profile is acceptable under the supervision of a health care provider. Keywords: Multiple sclerosis (MS), Cannabis extract, Spasticity

Abstract Background Tuberculous meningitis (TBM) accounts for about 1% of all tuberculosis cases and about 5% of extrapulmonary tuberculosis cases. However, it poses major importance because approximately half of those affected die or become severely disabled. Herein, the successful treatment of an 11-month-old boy with progressive limb weakness, fever, developmental retardation, and loss of consciousness due to tuberculosis, was reported. Case presentation An 11-month-old (Iranian Turk) boy was referred to Loghman Hakim hospital for progressive limb weakness and loss of previously attained developmental milestones for the past 2 months. He also had persistent fever and loss of consciousness for about 14 to 21 days. Before being referred to our center, the patient had been diagnosed with hydrocephalus at another center due to possible acute bacterial meningitis based on a CT scan and MRI imaging. On physical examination, anterior fontanel bulging and neck stiffness were observed on the admission. His body temperature and heart rate were 38.1 C and 86 beats per minute (bpm), respectively. He had left 6 cranial nerve palsy and spastic quadriparesis with a power of grade 3/5. Other systemic examinations were normal. Endoscopic third ventriculostomy (ETV) (and leptomeningeal biopsy) revealed diffuse thickening of the floor and lateral walls of the 3rd ventricle and also a cobblestone appearance in the form of multiple white patchy lesions was detected on the floor of the 3rd ventricle. CSF analysis and polymerase chain reaction confirmed the TB meningitis. During hospitalization, a temporary EVD (external ventricular drain) was initially inserted. Eventually, defervescence was denoted 5–6 days after initiation of anti-TB medications, and a permanent ventriculoperitoneal shunt was inserted due to hydrocephalus. Gradually his truncal and limb tone and motor function improved, as did his emotional responses to his parents and ability to eat. The patient can walk without help in the 15th month following the operation and resolved hydrocephalus demonstrated on follow-up imaging. Conclusion Over half of treated TB meningitis patients die or suffer severe neurological sequelae, mainly due to late diagnosis. Hence, early diagnosis and prompt initiation of TB treatment offer the best chance of a good neurological outcome.

Introduction: Spasticity is common sequelae of stroke, and often these patients receive anti-spastic drugs such as baclofen or tizanidine. Stroke patients have multiple co-morbidities such as hypertension, diabetes, and seizure. Tizanidine is an α2 and imidazole receptor agonist at a spinal and supraspinal level resulting in reduced central sympathetic outflow and causing hypotension rarely, especially in those receiving beta-blockers or angiotensin-converting enzyme inhibitors. Case presentation: We report a 56-year-old hypertensive male presenting with altered sensorium who had recurrent intracerebral hemorrhage with left spastic hemiplegia and focal seizures. He was on amlodipine, atenolol, telmisartan and oxcarbazepine. After 3 doses of tizanidine 2mg, his blood pressure dropped from 140/90 to 80/40 mmHg and pulse from 82 bpm to 44 bpm. His blood counts, serum chemistry, procalcitonin, and Trop I were normal. ECG revealed sinus bradycardia. Discussion: After 8 hours of withdrawing tizanidine, his blood pressure became 110/70 mmHg, and on the next day, it became 140/82 mmHg. His attendants were taught physiotherapy to minimize spasticity. Conclusion: This patient highlights the need for close monitoring of patients receiving tizanidine co-medication with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. These drugs have a synergistic effect on reducing the renin-angiotensin-aldosterone system, thereby hypotension and bradycardia.

Asthma is known by various terms as ḍīq al nafs, ribw, boḩr and dama in Unani system of medicine. It is a chronic inflammatory paroxysmal disease characterized by spastic contraction of smooth muscles in bronchioles, which can cause extreme difficulty in breathing. According to the Global Asthma Report 2018, about 6% of children and 2% of adults in India are known to be living with asthma. Herein we describe a case of bronchial asthma which was successfully treated with Unani medicines. The patient was a 21 year old male, suffering from asthma for 19 years but without any co-morbidity. He was prescribed bronchodilator, anti-inflammatory and anti-spasmodic Unani drugs such as tukhm khaṭmī (Althaea officinalis Linn. seed), tukhm khubbāzī (Malva sylvestris Linn. seed), aşl-us-sūs muqashshar (Glycyrrhiza glabra Linn., peeled root), parsiāoshān (Adiantum capillus-veneris Linn.) etc. in crude form as decoction. He was symptom free and medication free after 2 months of treatment till he last reported in April 2019. The results are attributed to the herbal drugs which not only provide symptom relief but also correct the airway hyper-responsiveness and correct the histopathological changes induced by asthma.

Nagarmotha (Cyperus rotundus) is found throughout India. Its genus name Cyperusis derived from Cypeiros, an ancient Greek name and rotundus from a Latin word for round and refers to the tuber. It is locally known as “Mutha”. The plant is a widely used traditional medicinal herb in India, China, Japan, Korea, Combodia, Nigeria, and Bangladesh.The plant produces rhizomes, tubers, basal bulbs and fibrous roots below ground and rosettes of leaves, scapes and umbels above ground. The rhizomes of nut grass is widely utilized in ancient medication round the world to treat various diseases like constipation, dysentery, abdominal distention, animal tissue stomach ache, chest pains, irregular catamenia, painful catamenia, skin diseases, staphylococcal infection infections, leprosy, sprains and br uises, and fever, analgesic, sedative, medication, anti malarial drug, abdomen disorders, and diarrhoea . C. rotundus has the properties of antimicrobial activity, anti-lesion activity, analgesic activity, anti inflammatory activity, anti diarrhoeal activity, antipyretic activity, medication activity, anti-emetic activity, tranquilizing activity, anti urolithatic activity, antispatic activity, hypolipidaemic activity, wound healing activity, medication activity, inhibitor activity, metastatic tumor activity, antifungal activity, antidiabetic drug activity, anti-obesity activity, anti-allergic activity, anti-blood platelet impact, opposing rheumy activity, anti malarial drug activity, gastroprotective activity, hepatoprotective activity, cytoprotective impact, hypotensive activity, ovicidal and larvicidal activity .The petroleum ether extract and essential oil of C. rotundus possessed analgesic activity. Phenols and alkaloids are the active constituents of C. rotundus. C. rotundus preparations (powder in fine suspension, aqueous and alcoholic extracts) exhibited a lipolytic action and mobilized fat from the adipose tissues and thus helping to reduce the obesity. Methanolic extract of the fresh aerial part of the Cyperus rotundus was fractionated by column chromatography method using petroleum ether, chloroform, ethyl acetate and methanol. The ethyl acetate fraction showed potent antibacterial activity compared to control and standard commercial antibiotic tetracycline. It is a widely used plant in traditional medicine around the world for treatment of various diseases. It is deemed with infinite medicinal properties authenticated by the scientific committee. The rhizomes of C. rotundus are used as traditional folk medicine for the treatment of stomach and bowel disorders and inflammatory diseases in Asian countries. The use of the plant as an analgesic, anti-arthritic, antibacterial, anti-cancer, anti-candida, anti-convulsant, anti-diabetic, anti-emetic, anti-histaminic, anti-inflammatory, anti-malarial, anti-obesity, anti-pyretic, anti-spastic, gastroprotective, hypotensive, sedative, and tranquilizing agent has been documented by varios scientists. Ethnobotanical use of C. rotundus showed that the rhizomes were used to treat aging, apoptosis, atherosclerosis, cancer, cystitis, epilepsy, genotoxicity, hirutism, nociception and prostatitis disorders. The tuber part of C. rotundus is also used for the treatment of dysmenorrheal and menstrual irregularities from ancient times. The rhizome of C. rotundus are α-cyperolone, β-cyperone, ρ-cymol, calcium, camphene, copaene, cyperene, cyperenone, cyperol, cyperolone, caryophyllene, cyperotundone, d-copadiene, d-epoxyguaiene, isocyperol, isokobusone, kobusone, limonene, linoleic-acid, linolenic-acid, mustakone, myristic acid, oleanolic acid, oleic acid, β-pinene, patchoulenone, rotundene, rotundenol, rotundone, α-rotunol, β-rotunol, β-selinene, selinatriene, sitosterol, stearic acid, sugeonol, and sugetriol. Phytochemical constituents of C. rotundus revealed the presence of alkaloids, flavonoids, glycosides, phenols, tannins, steroids, starch and many novel ses-quiterpenoids. Sesquiterpene hydrocarbons such as cypera-2, 4(15)-diene, isorotundene, norrotundene and the oxygenated compound cyperadione were isolated and identified.

Abstract Burn injuries in patients with significant pre-existing medical conditions provide unique challenges in both medical management and surgical planning. Spasticity, if left untreated, can be one of the most disabling consequences of a neurologic injury. Treatment is largely dependent on pharmacologic management with anti-spasmodic agents such as baclofen. Baclofen’s effectiveness when taken orally is often limited by its systemic side effects, which mostly affect the central nervous system (CNS). Intrathecal baclofen (ITB) can circumvent these intolerable adverse effects while achieving symptom relief via a more targeted therapeutic route. However, abrupt cessation of chronic baclofen use can precipitate an acute life-threatening withdrawal syndrome. We present a case of a 47-year-old female who sustained 54% total body surface area (TBSA) full-thickness flame burns to the circumferential bilateral lower extremities, left arm, left anterior and posterior trunk, flank, and perineum. She had a pre-morbid C5 spinal cord injury resulting in spastic paraplegia for which she had an ITB pump implanted into her left abdominal wall for symptom management. This pump was directly beneath her operative burn wounds. We discuss the complex issues that were encountered throughout her care related to medication reservoir supply, life-threatening risk of baclofen withdrawal, pain-specialist availability, medical-legal barriers, and the multi-staged surgical plan for coverage, balancing proper wound debridement with risk of device exposure and infection. To our knowledge, this is the only case report detailing the cohort of obstacles that may be associated with these devices, specifically with burn patients.