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Spinal Cord Ser Cases 2022 May 21;8(1):56. Epub 2022 May 21.

Department of Spinal Cord Injury, Veterans Affairs New Jersey Health Care System, East Orange, NJ, 07018, USA.

Introduction: Oral baclofen is commonly used for spasticity management, especially with neurogenic bladder in spinal cord injury (SCI). A less common side effect of baclofen is transient alterations of consciousness, which can easily be confused for altered mental status secondary to orthostatic hypotension in SCI.

Case Presentation: A 43-year-old man with an acute SCI secondary to an aortic dissection was found to have episodes of confusion after titrating oral baclofen from 5 mg three times per day to 10 mg three times per day at an acute rehabilitation facility. Read More

Neuroreport 2022 Jun 11;33(9):399-407. Epub 2022 May 11.

School of Nursing, Beijing University of Chinese Medicine, Beijing 100029, China.

Background: Increasing data show that structural changes of spastic muscle and hyperexcitability of reticulospinal tract (RST) are involved in the pathogenesis of spasticity after stroke (SAS). Our previous study has indicated that the anti-spastic effect of acupuncture, especially waggle needling (WN, a multiple directional needling method with joint movement), on SAS rats was related to the KCC2-GABAA pathway in cerebral cortex. Furthermore, as a peripheral stimulation to treat upper motor neuron injury-related spasticity, acupuncture's effect on peripheral spastic muscles and inhibitory neurotransmitters in the brainstem, the origin of the RST, should be further clarified. Read More

Cureus 2022 Apr 16;14(4):e24180. Epub 2022 Apr 16.

Neurosurgery, University of Michigan, Ann Arbor, USA.

Intrathecal drug delivery (IDD) has multiple indications, including chronic pain, spasticity, and spinal cord injury. Patients with an IDD device implanted who are undergoing decompressive spinal surgery may be at risk for intrathecal (IT) drug overdose in the perioperative setting. The present report describes a patient with an IDD device who underwent elective spinal surgery that was complicated by prolonged, severe alteration in mental status over several days, requiring discontinuation of his IT medications. Read More

Eur J Neurol 2022 May 19. Epub 2022 May 19.

Global Medical Affairs, Almirall S.A., Barcelona, Spain.

Background And Purpose: Nabiximols is a therapeutic option for patients with multiple sclerosis (MS) spasticity whose symptoms are poorly controlled by conventional oral first-line medications. This study aimed to assess the relationship between changes in spasticity severity (measured on the 0-10 numerical rating scale [NRS]) and the presence of associated symptoms in patients treated with nabiximols; and to investigate the presence of the newly-described 'Spasticity-Plus syndrome'.

Methods: We analyzed real-world data from the Italian Medicines Agency e-Registry for 1138 patients with MS spasticity who began treatment with nabiximols. Read More

Am Health Drug Benefits 2022 Mar;15(1):13-20

Clinical Trials Results Analyst, National Institutes of Health, Bethesda, MD.

Background: Multiple sclerosis (MS) is a progressive autoimmune disorder of the central nervous system characterized by symptoms including reduced mobility, pain, fatigue, and spasticity. MS affects nearly 1 million people in the United States, with significant negative impact on a patient's quality of life, and an average lifetime cost of care in excess of $4 million. The cost-effective management of patients with MS faces several challenges. Read More

Mov Disord Clin Pract 2022 May 30;9(4):501-507. Epub 2022 Mar 30.

Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada.

Background: Progressive supranuclear palsy (PSP)-pallido-nigro-luysian atrophy (PNLA) is a neuropathological entity thought to be a variant of classic PSP. Clinical features and pathologic hallmarks are the same in both conditions; however, age and order of symptom onset, disease duration and prognosis, and distribution and density of pathology differentiate the 2 entities.

Objectives: This study presents a PSP-PNLA case confirmed pathologically with a clinical presentation of hemichorea/ballism, spasticity, progressive hemiparesis, and a frontal behavioral syndrome with relative cognitive sparing early in the disease course. Read More

Contemp Clin Trials Commun 2022 Aug 5;28:100921. Epub 2022 May 5.

Department of Human Movement Science, University of Zululand, KwaDlangezwa, 3886, South Africa.

Background: Spasticity is one of the most common problems after the first stroke. Dry needling (DN) has been presented as a new therapeutic approach used by physiotherapists for the management of post-stroke spasticity. This study aimed to determine whether the addition of exercise therapy to the DN results in better outcomes in wrist flexors spasticity, motor neuron excitability, motor function and range of motion (ROM) in patients with chronic stroke. Read More

Expert Rev Neurother 2022 May 18. Epub 2022 May 18.

Department of Neurosciences, S Camillo Forlanini Hospital of Rome, Italy.

Introduction: Spasticity is a common, debilitating symptom of multiple sclerosis (MS) with several treatment options including the cannabinoid-based treatment, nabiximols. The purpose of this review was to examine the existing clinical practice guidelines that direct the management of multiple-sclerosis-associated spasticity (MSS), to identify areas of similarity and divergence, and suggest where standardization and improvement may be obtained.

Areas Covered: Published literature (PubMed), websites of relevant European medical associations and Health Technology Assessment bodies, were systematically searched to identify guidelines describing the pharmacological management of MSS, focussing on European countries where nabiximols (Sativex® oromucosal spray) is approved. Read More

North Clin Istanb 2022 11;9(2):102-108. Epub 2022 Mar 11.

Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey.

Objective: The Modified Ashworth Scale, the Modified Tardieu Scale, and measuring the passive range of motion is commonly preferred examination tools for spasticity in cerebral palsy (CP). Ultrasonography has become increasingly used to provide relevant insight into spastic muscle morphology and structure recently. It was aimed to reveal associations between the clinical and ultrasonographic parameters of gastrocnemius medialis (GM) and lateralis muscles in this population. Read More

Phys Ther Res 2022 29;25(1):1-11. Epub 2021 Sep 29.

Department of Human Development, Graduate School of Human Development and Environment, Kobe University, Japan.

We review the current views on the control and coordination of movements following the traditions set by Nikolai Bernstein. In particular, we focus on the theory of neural control of effectors - from motor units to individual muscles, to joints, limbs, and to the whole body - with spatial referent coordinates organized into a hierarchy with multiple few-to-many mappings. Further, we discuss synergies ensuring stability of natural human movements within the uncontrolled manifold hypothesis. Read More

BMJ Case Rep 2022 May 17;15(5). Epub 2022 May 17.

Medical Image Department, Neuroradiology Unit, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.

BMC Neurol 2022 May 16;22(1):180. Epub 2022 May 16.

Department of Neuromuscular Disease, The Third Affiliated Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei, 050000, PR China.

Background: Hereditary spastic paraplegia (HSP) is a group of neurodegenerative diseases characterized by lower-limb spastic paraplegia with highly genetic and clinical heterogeneity. However, the clinical sign of spastic paraplegia can also be seen in a variety of hereditary neurologic diseases with bilateral corticospinal tract impairment. The purpose of this study is to identify the disease spectrum of spastic paraplegia, and to broaden the coverage of genetic testing and recognize clinical, laboratorial, electrophysiological and radiological characteristics to increase the positive rate of diagnosis. Read More

Front Neurosci 2022 29;16:863793. Epub 2022 Apr 29.

School of Rehabilitation, Capital Medical University, Beijing, China.

Objective: This study was conducted to investigate the effects of the exogenous overexpression of nerve growth factors NT-3 and IGF-1 on the recovery of nerve function after spinal cord injury (SCI) and identify the potential mechanism involved.

Methods: Sixty-four female SD rats were randomly divided into four groups: an SCI group, an adeno-associated viral (AAV)-RFP and AAV-GFP injection group, an AAV-IGF-1 and AAV-NT-3 injection group, and a Sham group. After grouping, the rats were subjected to a 10-week electrophysiological and behavioral evaluation to comprehensively evaluate the effects of the intervention on motor function, spasticity, mechanical pain, and thermal pain. Read More

Front Neurol 2022 28;13:872927. Epub 2022 Apr 28.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Background And Purpose: A variety of hereditary diseases overlap with neurological phenotypes or even share genes with hereditary spastic paraplegia (HSP). The aim of this study was to determine the clinical features and genetic spectrum of patients with clinically suspected HSPs.

Methods: A total of 52 patients with clinically suspected HSPs were enrolled in this study. Read More

Front Genet 2022 26;13:845967. Epub 2022 Apr 26.

Neurology Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Hypomyelination with brain stem and spinal cord involvement and leg spasticity (HBSL) is a rare form of leukodystrophy presenting with varying clinical and imaging features. We report a case of HBSL to investigate the clinical and radiological characteristics of HBSL resulting from cytoplasmic aspartyl-tRNA synthetase gene (DARS) mutations. We report a patient of HBSL with compound heterozygous mutations in DARS1. Read More

IEEE Trans Neural Syst Rehabil Eng 2022 17;30:1277-1287. Epub 2022 May 17.

Vibratory stimulation may improve post-stroke symptoms such as spasticity; however, current studies are limited by the large, clinic-based apparatus used to apply this stimulation. A wearable device could provide vibratory stimulation in a mobile form, enabling further study of this technique. An initial device, the vibrotactile stimulation (VTS) Glove, was deployed in an eight-week clinical study in which sixteen individuals with stroke used the device for several hours daily. Read More

Sci Rep 2022 May 12;12(1):7818. Epub 2022 May 12.

Gillette Children's Specialty Healthcare, St. Paul, USA.

Orthopedic and neurological impairments (e.g., muscle contractures, spasticity) are often treated in children and young adults with cerebral palsy (CP). Read More

Paediatr Neonatal Pain 2022 Mar 15;4(1):34-43. Epub 2021 Oct 15.

Children's Hospital Westmead Clinical School The University of Sydney Sydney NSW Australia.

Background: Chronic pain is estimated to impact one-in-three children with cerebral palsy (CP). Psychological interventions including behavioral and cognitive strategies play a key role in chronic pain management, but there is a paucity of research exploring their use in children with CP.

Aim: To investigate the acceptability and feasibility of biofeedback assisted relaxation training (BART) for chronic pain management in children with CP using a mixed-methods study design. Read More

Disabil Rehabil 2022 May 11:1-18. Epub 2022 May 11.

Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK.

Purpose: The primary objective of the review was to collate the available evidence on factors associated with joint contractures in adults.

Methods: A systematic literature search was conducted on MEDLINE, CINAHL, AMED, and EMBASE. Studies that involved participants aged ≥18 and assessed joint contracture as a primary or secondary outcome were included. Read More

Neural Regen Res 2022 Nov;17(11):2491-2496

Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.

No definite consensus has currently been reached regarding the safety and efficacy of low- or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity. The latest research indicates that when combined with local injections of botulinum toxin type A, it is more effective on post-stroke muscle spasticity than local injections of botulinum toxin type A alone. We designed a prospective, single-center, non-randomized, controlled clinical trial to investigate the safety and efficacy of different frequencies of repetitive transcranial magnetic stimulation combined with local injections of botulinum toxin type A in treating post-stroke lower limb muscle spasticity to determine an optimal therapeutic regimen. Read More

Neural Regen Res 2022 Nov;17(11):2459-2464

School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education; Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China.

Classic paired associative stimulation can improve synaptic plasticity, as demonstrated by animal experiments and human clinical trials in spinal cord injury patients. Paired associative magnetic stimulation (dual-target peripheral and central magnetic stimulation) has been shown to promote neurologic recovery after stroke. However, it remains unclear whether paired associative magnetic stimulation can promote recovery of lower limb motor dysfunction after spinal cord injury. Read More

Evid Based Complement Alternat Med 2022 27;2022:9656503. Epub 2022 Apr 27.

Department of Medical Surgical-Therapy, Medicine Faculty, Extremadura University, 06006 Badajoz, Spain.

This systematic review aimed to provide an up-to-date analysis of the effects of equine-assisted therapies (EAT) in people with multiple sclerosis (PwMS). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this systematic review. PubMed and Web of Science databases were employed in the search, which ended in February 2022. Read More

Seizure 2022 Apr 18;99:12-15. Epub 2022 Apr 18.

Neurology Unit, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy.

Background: IRF2BPL is an intronless gene that was mapped to 14q24.3 chromosome in 2000 and codes for the interferon regulatory factor 2 binding like protein.

Objective: To analyses the clinical characteristics of the patients reported in the literature and of an additional patient we observed in order to better delineate the phenomenological spectrum of the disease and provide indications to improve clinical recognition and facilitate diagnosis. Read More

Neurol Sci 2022 May 7. Epub 2022 May 7.

UOC Neurology and Stroke Unit, ASST Lecco, Merate, Italy.

The Italian neurologist Vincenzo Neri (1880-1960), a pupil of Joseph Babiński (1857-1932), greatly contributed to refining the semiotics of neurological examination and was a pioneer in medical cinematography. In 1909, Neri proposed a sign to diagnose leg paresis due to a pyramidal tract lesion. According to Neri, if a patient standing with the legs apart and the arms crossed on the chest bends the trunk of the pelvis, when the trunk has almost reached the horizontal line, the leg on the paralyzed side flexes, whereas the unaffected leg remains extended. Read More

J Orthop 2022 May-Jun;31:99-102. Epub 2022 Apr 21.

Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India.

Purpose: Acquired brain injury causing spasticity, pain and loss of function is a major cause of disability and lower quality of life. Sacral 1 (S1) neurectomy claims promising outcomes in spastic hemiparesis. This cadaveric study was conducted to study the surgical anatomy, surgical approach and feasibility of S1 neurectomy and contralateral S1 (cS1) transfer. Read More

Cochrane Database Syst Rev 2022 05 5;5:CD013444. Epub 2022 May 5.

Review Production and Quality Unit, Editorial & Methods Department, Cochrane Central Executive, London, UK.

Background: Spasticity and chronic neuropathic pain are common and serious symptoms in people with multiple sclerosis (MS). These symptoms increase with disease progression and lead to worsening disability, impaired activities of daily living and quality of life. Anti-spasticity medications and analgesics are of limited benefit or poorly tolerated. Read More

J Neurophysiol 2022 May 4. Epub 2022 May 4.

Shirley Ryan Ability Lab, Chicago, IL, United States.

Spasticity is one of the most common symptoms manifested following spinal cord injury (SCI). The aim of the study was to assess spasticity in people with subacute and chronic SCI with different severity injury standardizing the time and assessments of spasticity. We tested 110 individuals with SCI classified by the American Spinal Injury Association Impairment Scale (AIS) as motor complete (AIS A and B; subacute, n=25; chronic, n=33) or motor incomplete (AIS C and D; subacute, n=23; chronic, n=29) at a similar time post-injury (subacute=~1-month post-injury during inpatient rehabilitation and chronic=>1-year post-injury) using a clinical (Modified Ashworth Scale) and kinematic (Pendulum test) outcomes to assess spasticity in the quadriceps femoris muscle. Read More