stiffness and spasm （2）肌肉僵硬和痉挛（2）课件

Muscle stiffness and spasm in MS Miranda Olding RGN MSCN November 2012 The nervous system Made of nerve cells(neurons) and glial cells(meaning glue) Neuron. Information passes as an electrical current down the axon, And then electrically, or chemically, as a neuro-tranmitter, in between Neurons. Neurones http:/www.bbc.co.uk/schools/gcsebitesize/science/aqa/nervesandh ormones/thenervoussystemrev2.shtml /research/_neuron/index.html Neurotransmitters can be either excitatory (stimulating),or inhibitory, (calming); the amount of excitatory or inhibitory input the cell receives dictates whether the cell fires or the impulse is suppressed. Biology of muscle spasm inhibitory signals stop them firing. The firing is Action Potential an electrical transfer of energy. Spasticity occurs as a result of an imbalance between the excitatory and inhibitory signals from the brain and/or spinal cord. The nerve pathway connecting the brain and spinal cord is made of upper motor neurones. The pathway between the spinal cord and muscles is made of lower motor neurones. In MS, spasticity ( muscle spasm how are you sitting, moving ask your GP to adjust your prescription. See your MS nurse or neurologist again if this doesnt work you can go higher with supervision youd need a blood test before its not licensed for MS. This means your GP could prescribe it if they want to, but may have to get private 44(4):287-91. The effects of mind-body training on stress reduction, positive affect, and plasma catecholamines.Jung YH, Kang DH, Jang JH, Park HY, Byun MS, Kwon SJ, Jang GE, Lee US, An SC, Kwon JS. Neurosci Lett. 2010 Jul 26;479(2):138-42. Epub 2010 May 28. Clinical Cognitive Neuroscience Center, Neuroscience Institute, SNU-MRC, Seoul, Republic of Korea Yoga Asana sessions increase brain GABA levels: a pilot study.Streeter CC, Jensen JE, Perlmutter RM, Cabral HJ, Tian H, Terhune DB, Ciraulo DA, Renshaw PF. J Altern Complement Med. 2007 May;13(4):419-26. Division of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA. Injectable therapies Anaesthetic / Diagnostic Nerve Blocks Procaine Lignocaine Neurolytic Nerve Blocks Ethanol Phenol Botulinum Toxin Intrathecal Baclofen Intrathecal Phenol Injections Advantages Not permanent Evidence to support efficacy in reducing spasticity and improving function Effects are localized - not systemic Disadvantages Not permanent - may need to repeat injections Ethanol and Phenol: require greater skill to inject, increased risk of paresthesias, dysesthesias Botulinum toxin: more expensive than other injections, may develop antibodies Only of use in single muscle spasticity Not appropriate if contracture already present Botulinum toxin therapy Naturally occurring substance produced by bacterium clostridium botulinum Powerful neurotoxin (type A) Blocks release of acetylcholine at neuromuscular junction Results in muscle weakness - effect in 4-7 days - peak 4-6 weeks - lasts 3-4 months Botulinum toxin Side effects Excessive localised muscle weakness Flu like symptoms Fatigue without objective weakness Dry mouth Follow up Must be multi disciplinary Education Physiotherapy e.g stretching regime Splinting / casting Review goals 4-6 weeks post injection Medical review 3-4 months Cannabinoids Research is mixed, most recent trial, clinical measures of muscle stiffness did not change In a 2009 systematic review of RCT trials on people with MS taking cannabis extracts (THC 359:1221-1231. Exciting possibilities APS therapy Based on the function of the cell Electrically simulates Action Potential Dr. Lia Van der Plaat in Hull recently having very positive results with people with MS with pain but marked improvements in muscle spasm and fatigue also occurred. Clinical research project about to start in Hull MS Therapy Centre in Bedford investing in machines to pilot therapy clinically APS therapy logistics Personal machines cost around 1,200 To be effective, need 3 x treatments of hour a week, ongoing. In Hull, clinic delivered a 6 week course Then helped people to access funding via the personal health budget scheme We intended to duplicate this model but PHBs not working in our area currently, so will try to help people to access charitable grants. www.apstherapy.co.nz has good information. Headquarters is Do everything to stay