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Neurologic Side Effects
Published in Ayse Serap Karadag, Berna Aksoy, Lawrence Charles Parish, Retinoids in Dermatology, 2019
Stiff-person syndrome (SPS) is a rare disorder of unknown etiology. SPS is characterized by muscle rigidity and intermittent spasms involving the axial and limb muscles. Clinical diagnostic features of SPS are axial and proximal extremity muscle stiffness, painful muscle cramps, lumbar hyperlordosis, and continuous firing of normal motor unit potentials that can be suppressed by diazepam on electromyography. In 60%–70% of patients, antibodies against glutamic acid decarboxylase (GAD) are present. Due to the presence of GAD antibodies and other autoantibodies such as anti-amphiphysin antibodies, SPS has been associated with autoimmune and paraneoplastic disorders (38).
Case 41: Fever and confusion
Published in Barry Wright, Subodh Dave, Nisha Dogra, 100 Cases in Psychiatry, 2017
Barry Wright, Subodh Dave, Nisha Dogra
He was found to have tachycardia (120 beats per minute) and raised blood pressure (160/104 mm Hg). Core body temperature was 39°C. Central nervous system (CNS) examination revealed extrapyramidal muscle rigidity assumed to be secondary to antipsychotic medication, with a generalized tremor that was attributed to agitation and anxiety. Further systemic examination did not reveal any other abnormality.
Agitation and Psychosis
Published in Marc E. Agronin, Alzheimer's Disease and Other Dementias, 2014
Valproic acid, which is dispensed as divalproex sodium, comes in a variety of preparations, including enterically coated and extended-release tablets, sprinkles, and syrup. The extended-release form is dosed once daily and at a dose 20% higher when converting from an immediate-release preparation. Five to six days after each dose increase, a trough blood level should be drawn at least 12 hours after the last dose and before the next dose; the aim should be for levels in the range of 40–90 milligrams per milliliter. Valproic acid levels should be checked every four months once an individual is stable. The most common side effects include gastrointestinal intolerance, sedation, and ataxia. Hepatotoxicity, thrombocytopenia, and pancreatitis are less common but important side effects. For this reason, the clinician should be sure to obtain baseline liver function tests, an amylase level, and a complete blood count and then to monitor these levels every 4–6 months while the patient continues on treatment with valproic acid. A rare but possible side effect may involve muscle rigidity and abnormal movements.
A synthesis and appraisal of clinical practice guidelines, consensus statements and Cochrane systematic reviews for the management of focal spasticity in adults and children
Published in Disability and Rehabilitation, 2022
Gavin Williams, Barby J. Singer, Stephen Ashford, Brian Hoare, Tandy Hastings-Ison, Klemens Fheodoroff, Steffen Berwick, Edwina Sutherland, Bridget Hill
Search terms included guideline/or practice guideline/or clinical pathway/consensus, AND muscle spasticity/or muscle hypertonia/or muscle rigidity/or muscle tonus/spasm/or dystonia/or paraparesis, spastic/or hypertonicity/or dystonia. Titles and abstracts of retrieved articles were independently evaluated by two reviewers with full text retrieved where data were not sufficient to determine eligibility. CPG and consensus statements were assessed for methodological rigor and transparency of development using the Appraisal of Guidelines, Research and Evaluation (AGREE II) [16] instrument by four authors. The AGREE collaboration is an international team of guideline developers and researchers. The AGREE II statement is a 23-item appraisal tool that evaluates guideline development, reporting and evaluation. It states what is required for clinical implementation of a guideline. The AGREE II instrument was not applied to the Cochrane systematic reviews. Data were independently extracted by two reviewers including study characteristics, principles of management, outcome measures and adjunctive treatment. A third reviewer was used to resolve any disagreement.
A review of the effects of baclofen and of THC:CBD oromucosal spray on spasticity-related walking impairment in multiple sclerosis
Published in Expert Review of Neurotherapeutics, 2018
Multiple sclerosis (MS) is a complex disease with a highly heterogeneous and unpredictable clinical course [1]. The North American Research Committee on MS (NARCOMS) Registry has identified 11 key symptom domains that are commonly affected in MS: mobility, hand function, tremor/coordination, vision, pain, fatigue, bowel/bladder function, sensory, spasticity, cognition, and depression. An analysis of symptom prevalence over time in registry participants found that the majority of individuals with MS perceived at least some degree of impairment in most domains during the first year of their disease and that the severity of impairment increased in all domains with longer disease duration. With regard to mobility, the self-reported prevalence of gait disability (any degree) by NARCOMS registrants was 50% at disease onset and increased to 78% after 10 years of disease. The proportion of registrants who reported occasional use of a cane or worse degree of disability increased from 15% to 42% during this time frame [2]. At least moderate spasticity was present in 15% of registrants at the time of disease onset and increased to 32% by year 10 [2]. In a relevant proportion of patients, MS spasticity-associated muscle rigidity can contribute to neurodegenerative mobility impairment [3]. In a cross-sectional survey of NARCOMS registrants evaluating the impact of spasticity on daily activities, 40% of respondents with MS spasticity (n = 8220) reported that it moderately or greatly interfered with walking [4].
Medical Art Therapy Research Moves Forward: A Review of Clay Manipulation With Parkinson’s Disease
Published in Art Therapy, 2018
Deborah L. Elkis-Abuhoff, Morgan Gaydos
This report summarizes the authors’ three previous studies (Elkis-Abuhoff et al., 2008, 2013; Goldblatt, Elkis-Abuhoff, Gaydos, & Napoli, 2010) that explored the role of art therapy for patients diagnosed with Parkinson’s disease (PD) as a foundation for the current phase of our research. PD is a neurodegenerative disease that targets motor and cognitive functions causing disordered movement. The disease affects physical movement and accelerates dopamine cell depletion. Some common symptoms include muscle rigidity, postural abnormality and instability, clumsiness, tremors, difficulty walking, freezing, fatigue, and slowing of emotional responses and voluntary movement. PD affects the nerve cells located in the substantia nigra region of the central brain by decreasing dopamine production; this results in the slowing down or miscommunication of signals from the main neurotransmitter to various muscles within the body (Elbaz, Carcaillon, Kab, & Moisan, 2016).