Discussions (D)
Terence R. Anthoney in Neuroanatomy and the Neurologic Exam, 2017
♦ 1. Described methods of testing muscle tone include observation, palpation, moving parts of the body passively in a controlled manner, shaking and/or dropping parts of the body, eliciting reflexes, seeing how quickly a patient can stop a movement, and measuring ranges of motion at joints. Are some or all of these methods equivalent—i.e., do they measure the same thing?♦ 2. Is the amount of resistance encountered in making passive movements of relaxed parts of the body invariably a direct measure of muscle tone, or can other “conditions” mimic hypertonia or hypotonia?♦ 3. Related to Methodologic Conflict 1, does hypotonia include such findings as pendulous myotatic reflexes, diminished myotatic reflexes, increased ranges of motion, and inability to check rebound movements, or are these findings in addition to hypotonia? Similarly, does hypertonia include such findings as certain abnormal postures, lack of associated movements, and increased myotatic reflexes, or are these findings in addition to hypertonia?
Musculoskeletal and Soft-Tissue Emergencies
Anthony FT Brown, Michael D Cadogan in Emergency Medicine, 2020
Tetanus itself is rare, but worldwide it is an important cause of death in parts of Asia, Africa and South America. The incubation time from injury to first symptoms ranges from 3 to 21 days (usually about 10 days).The most common symptoms are jaw stiffness (trismus), dysphagia, neck stiffness and abdominal and back pain. Hypertonia is found on examination.Localized or generalized painful spasms follow within 24–72 h, becoming more severe and prolonged from minimal stimuli.Death may occur from laryngospasm, respiratory failure or autonomic dysfunction.There is no rapid diagnostic test to prove the diagnosis, therefore admit a suspected case immediately to the intensive care unit (ICU).
Pain in neurological disease
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
Generally speaking, drugs of the benzodiazepine group have been viewed with caution in long-term pain management because of the increasingly recognized problems of tolerance and dependence. However, although under most circumstances they are not analgesic, they are anxiolytic and, to varying degrees, antispastic. This last property may be valuable in the treatment of pain associated with muscular hypertonia. Spasticity may be relieved by both benzodiazepines and baclofen. Dantrolene, which acts peripherally on striated muscle, is of dubious value as a sole antispastic agent but may act synergistically with baclofen.14 Baclofen has an antinociceptive action distinct from its antispastic effect, but the clinical effect in most pain associated with neurologic disease is probably marginal when it is given systemically (see below under Spinal drug administration).
An expansion of phenotype: novel homozygous variant in the MED17 identified in patients with progressive microcephaly and global developmental delay
Published in Journal of Neurogenetics, 2022
Rafiullah Rafiullah, Alia M. Albalawi, Sultan R. Alaradi, Majed Alluqmani, Muhammad Mushtaq, Abdul Wali, Sulman Basit
Perinatal history of both affected individuals was unremarkable. Head circumference in both affected individuals was more than 2 SD below the mean. Patient IV:3 was diagnosed at the age of 4 months with severe ID and progressive microcephaly. The onset of seizures was noted at the age of 2 years. The EEG showed multifactorial spikes and poly spikes during sleep. Magnetic resonance imaging (MRI) findings at the age of 6months revealed mild atrophy of vermis, cerebellar, and cerebral as well as mild delay in myelination, small thalami, and thin brainstem (Figure 1(B)). Both patients never acquire speech and were unable to walk at the age of 3 and 5 years. Moreover, both patients experience severe eye tracking problems. Muscle tone was found high (hypertonia). Patients failed to move their upper or lower limbs and were completely bedridden.
The impact of early spasticity on the intensive functional rehabilitation phase and community reintegration following traumatic spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2020
Andréane Richard-Denis, Bich-Han Nguyen, Jean-Marc Mac-Thiong
Spasticity occurs during recovery from spinal shock, which corresponds to the depression of the spinal reflexes below the level of injury.4,5 Spasticity is defined by Lance as “a motor disorder characterised by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper excitability of the stretch reflex”.6 Spasticity is not only restricted to muscular hypertonia, but is rather part of a complex spectrum of signs and symptoms, defined as the upper motoneurone syndrome (comprising spasms, clonus and Babinski sign).3 The onset of muscle hypertonia, spasms and clonus is presumably due to a neuronal hyper sensibility and axonal sprouting.7 Spasticity may lead to pain, mobility disorders, limit functional status as well as quality of life.8–10 Accordingly, spasticity was reported as a top concern for patients in the chronic phase following TSCI.11,12 As spasticity generally develops after the first month following a SCI (thus during the intensive functional rehabilitation phase),7 the impact of spasticity on various outcomes (complication, functional recovery) has been reported during the chronic phase following TSCI. However, some individuals will develop signs and/or symptoms of spasticity earlier in the rehabilitation process, during the acute care phase. However, the impact of the development of spasticity during this period on the subsequent rehabilitation phase remains unknown.
The Impact of Intrathecal Baclofen Therapy on Health-related Quality of Life for Children with Marked Hypertonia
Published in Developmental Neurorehabilitation, 2020
Kirsty Stewart, Lisa Copeland, Jennifer Lewis
The effective management of spasticity and dystonia in pediatric neurological conditions such as cerebral palsy (CP), genetic conditions and acquired brain injury (ABI), is challenging. The presence of severe spasticity and dystonia commonly results in associated pain, difficulties with daily cares, poor sleep hygiene, difficulties with feeding and positioning and reduced quality of life.1,2 In the treatment of severe hypertonia, a multimodal treatment approach is frequently taken including physical therapies, prescription of complex equipment, positioning, oral medications, orthopedic surgery, and Botulinum toxin injections.3,4 For children whose hypertonia cannot be adequately managed, intrathecal baclofen therapy (ITB) may be considered as a treatment option.