The Effect of Baclofen on the Gait of Hemiplegic Children Assessed by Means of Polarised Light Goniometry

1980 ◽  
Vol 25 (4) ◽  
pp. S29-S35 ◽  
Author(s):  
Adrian M. B. Minford ◽  
J. Keith Brown ◽  
Robert A. Minns ◽  
P. Frazer ◽  
L. Hollway ◽  
...  
Keyword(s):  
Side Effects ◽  
Clinical Improvement ◽  
Knee Flexion ◽  
Nocturnal Enuresis ◽  
Gait Cycle ◽  
Child Behaviour ◽  
Functional Improvement ◽  
Slight Improvement ◽  
Concentration Difficulty ◽  
Polarised Light

Gait was assessed by polarised light goniometry in 15 hemiplegic children aged 4−15 years. After initial clinical and goniometric assessment, baclofen 5−10 mg/day was started and increased over 4−6 weeks to a dose of 1−1.5 mg/kg/day. Assessment was repeated one week later. A statistically significant decrease in hip and knee flexion at the ‘toe-off’ phase of the gait cycle was found in both legs. Of the nine children who showed most change in goniometric assessment, five showed an obvious clinical improvement, two a slight improvement, one no change and one child's gait deteriorated. Of six children with minimal or no change goniometrically, four showed no change clinically, one minimal clinical improvement and one a deterioration clinically. Side effects included transient sedation (seven children), concentration difficulty (one child), behaviour disturbance (1 child) and nocturnal enuresis (three children). We concluded that although baclofen causes functional improvement in some hemiplegic children, its use should be carefully supervised in view of possible side effects and possible deterioration in gait.

Clinical Management of Clozapine Patients in Relation to Efficacy and Side-Effects

1992 ◽  
Vol 160 (S17) ◽  
pp. 54-59 ◽  
Author(s):  
D. Naber ◽  
R. Holzbach ◽  
C. Perro ◽  
H. Hippius
Keyword(s):  
Side Effects ◽  
Clinical Management ◽  
Side Effect ◽  
Marked Improvement ◽  
Hospital Readmissions ◽  
Patient Treatment ◽  
Slight Improvement ◽  
Major Side Effect ◽  
Clozapine Treatment ◽  
Clozapine Withdrawal

Medical charts of 480 schizophrenic in-patients (581 treatments) were analysed to evaluate the efficacy and side-effects of clozapine. Clozapine treatment lasted for mean 49 (s.d. 38) days. Of the sample, 11.0% showed worsening or no change, 31.5% slight improvement, 53.0% marked improvement and 4.5% almost total reduction of symptoms. At least one major side-effect occurred in 68.0% of patients. A combination of clozapine with classical neuroleptics, antidepressants, benzodiazepines or lithium is tolerated by most patients, but increases the incidence of some side-effects. Clozapine treatment had to be discontinued because of severe side-effects in 8.6% of patients. In 81 schizophrenic out-patients, clozapine significantly reduced the days of in-patient treatment and number of hospital readmissions. Two patients developed leucopenia but had no complications after clozapine withdrawal. This study indicates a satisfactory benefit/risk ratio and compliance in most of the patients.

Oxybutynin Efficacy in the Treatment of Primary Enuresis

PEDIATRICS ◽  
1988 ◽  
Vol 82 (1) ◽  
pp. 104-106
Author(s):  
John S. Lovering ◽  
Susan E. Tallett ◽  
James B. J. McKendry
Keyword(s):  
Urinary Tract ◽  
Side Effects ◽  
Treatment Period ◽  
Nocturnal Enuresis ◽  
Drug Regimen ◽  
Double Blind Study ◽  
Double Blind ◽  
History Of ◽  
Clinic Population ◽  
Or History

The effectiveness of oxybutynin in the treatment of primary enuresis was evaluated in a double-blind study. A total of 30 children (25 boys, five girls), at least 6 years of age, with primary enuresis and no daytime incontinence or history of other urinary tract problems were selected at random from an enuresis clinic population. The study was explained to the families and they were told how to keep records of nocturnal bed-wetting episodes and side effects. The patients were treated with a 10 mg of oxybutynin at suppertime for 28 days. Before or after the treatment period, all children received an identical placebo for 4 weeks. Two-sided paired t tests were used to compare frequency of nocturnal enuresis. Frequency during the drug regimen did not differ significantly from that during the placebo study. There were no differences in findings between boys and girls or between children who had previously taken imipramine and those who had not. The study showed no evidence that oxybutynin is effective in treating primary enuresis.

scholarly journals T231. QUALITY OF LIFE IN ANTIPSYCHOTIC-NAïVE YOUTH: EXPLORING THE INTERPLAY WITH METABOLIC SIDE-EFFECTS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S321-S321
Author(s):  
Araba Chintoh ◽  
Mahavir Agarwal ◽  
Nicole Mackenzie ◽  
Gary Remington ◽  
Margaret Hahn
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Waist Circumference ◽  
Clinical Improvement ◽  
Clinical Presentation ◽  
Well Being ◽  
Small Sample ◽  
Metabolic Side Effects ◽  
Metabolic Indices

Abstract Background This observational, exploratory pilot study aims to understand changes in clinical presentation and quality of life (QoL) in antipsychotic-naïve youth. Outcomes for these first-episode psychosis patients will be explored in the context metabolic changes during their first three months of treatment. Methods Participants (n = 10) aged 14–29 years were followed throughout their first three months of treatment with an antipsychotic medication (of physician’s/patient’s choice). Participants were evaluated on metabolic indices including weight, waist circumference, and BMI, as well as QoL [Pediatric Quality of Life Index (PedsQL) and PedsQL General Well-Being Scale] and clinical presentation [Clinical Global Impression (CGI) scale]. Descriptive statistics and nonparametric tests were conducted to compare significant changes across these variables. Results Significant changes in metabolic indices were observed over the first three months of treatment, as measured in weight gain (p = 0.02), increased waist circumference (p = 0.02) and increased BMI (p = 0.01). Physicians rated clinical improvement in participants, CGI score (p = 0.03). However, patient-rated QoL remained unchanged within all subcategories, including psychosocial (p = 0.52) and general well-being (p = 0.35). Discussion It appears that antipsychotic-related metabolic side effects may not impede upon early clinical improvement or impact QoL. In addition, there does not appear to be a relationship between clinical presentation and QoL as our small sample show QoL remains neutral or positive. Taken together, these findings suggest that clinical presentation and metabolic side effects may not be influential in early psychosis. From a clinical perspective, these early pilot data add to the literature highlighting the significant, early, antipsychotic-induced metabolic side effects in youth, and also encouraging clinicians to attend to the interplay between treatment and related QoL. This study is limited by its small sample size and naturalistic treatment allocation. These participants will be followed longitudinally to monitor development of adverse metabolic outcomes as well as changes in QoL in later stages of treatment/illness. The field must to understand how treatment and management of metabolic side effects can be augmented to promote clinical improvement and QoL, given the prevalence of adolescent patients who eventually wish to discontinue antipsychotic drugs because of metabolic side effects.

scholarly journals Hyperbaric Oxygen for Radiation Necrosis of the Brain

2019 ◽  
Vol 47 (1) ◽  
pp. 92-99
Author(s):  
Jayson Co ◽  
Marcus Vinicius De Moraes ◽  
Rita Katznelson ◽  
A. Wayne Evans ◽  
David Shultz ◽  
...  
Keyword(s):  
Side Effects ◽  
Clinical Improvement ◽  
Median Time ◽  
Hyperbaric Oxygen ◽  
Demographic Data ◽  
Symptom Improvement ◽  
Presenting Symptoms ◽  
Transient Improvement ◽  
Brain Radiation

Abstract:Introduction:Hyperbaric oxygen therapy (HBOT) shows promising results in treating radionecrosis (RN) but there is limited evidence for its use in brain RN. The purpose of this study is to report the outcomes of using HBOT for symptomatic brain RN at a single institution.Methods:This was a retrospective review of patients with symptomatic brain RN between 2008 and 2018 and was treated with HBOT. Demographic data, steroid use, clinical response, radiologic response and toxicities were collected. The index time for analysis was the first day of HBOT. The primary endpoint was clinical improvement of a presenting symptom, including steroid dose reduction.Results:Thirteen patients who received HBOT for symptomatic RN were included. The median time from last brain radiation therapy to presenting symptoms of brain RN was 6 months. Twelve patients (92%) had clinical improvement with median time to symptom improvement of 33 days (range 1–109 days). One patient had transient improvement after HBOT but had recurrent symptomatic RN at 12 months. Of the eight patients with evaluable follow-up MRI, four patients had radiological improvement while four had stable necrosis appearance. Two patients had subsequent deterioration in MRI appearances, one each in the background of initial radiologic improvement and stability. Median survival was 15 months with median follow-up of 10 months. Seven patients reported side effects attributable to HBOT (54%), four of which were otologic in origin.Conclusions:HBOT is a safe and effective treatment for brain RN. HBOT showed clinical and radiologic improvement or stability in most patients. Prospective studies to further evaluate the effectiveness and side effects of HBOT are needed.

scholarly journals Genetic Algorithms Based Approach for Designing Spring Brake Orthosis – Part I: Spring Parameters

2012 ◽  
Vol 9 (3) ◽  
pp. 303-316 ◽  
Author(s):  
M. S. Huq ◽  
M. O. Tokhi
Keyword(s):  
First Principles ◽  
Knee Flexion ◽  
Gait Cycle ◽  
Sagittal Plane ◽  
Swing Phase ◽  
Full Extension ◽  
Torsion Spring ◽  
Constant Torque ◽  
Spring Type ◽  
Hip Flexion

Spring brake orthosis (SBO) concentrates purely on the knee to generate the swing phase of the paraplegic gait with the required hip flexion occurring passively as a consequence of the ipsilateral knee flexion, generated by releasing the torsion spring mounted at the knee joint. Electrical stimulation then drives the knee back to full extension, as well as restores the spring potential energy. In this paper, genetic algorithm (GA) and its variant multi-objective GA (MOGA) is used to perform the search operation for the ‘best’ spring parameters for the SBO spring mounted on an average sized subject simulated in the sagittal plane. Conventional torsion spring is tested against constant torque type spring in terms of swing duration as, based on first principles, it is hypothesized that constant torque spring would be able to produce slower SBO swing phase as might be preferred in assisted paraplegic gait. In line with the hypothesis, it is found that it is not possible to delay the occurrence of the flexion peak of the SBO swing phase further than its occurrence in the natural gait. The use of conventional torsion spring causes the swing knee flexion peak to appear rather faster than that of the natural gait, resulting in a potentially faster swing phase and hence gait cycle. The constant torque type spring on the other hand is able to stretch duration of the swing phase to some extent, rendering it the preferable spring type in SBO.

Injectable Neuromuscular Blockade in the Treatment of Spasticity and Movement Disorders

2003 ◽  
Vol 18 (1_suppl) ◽  
pp. S50-S66 ◽  
Author(s):  
Ann H. Tilton
Keyword(s):  
Botulinum Toxin ◽  
Side Effects ◽  
Neuromuscular Blockade ◽  
Negative Symptoms ◽  
Motor Nerve ◽  
Significant Risk ◽  
Functional Improvement ◽  
Onset Of Action ◽  
Treatment Benefit ◽  
Duration Of Action

Neuromuscular blockade via injection of alcohol, phenol, or botulinum toxin reduces the tone of overactive muscles in order to restore the appropriate balance between agonists and antagonists. Such a restoration allows improved stretch and increased resting length and can reduce the likelihood of contracture. Alcohol or phenol, injected onto the motor nerve, denatures proteins and promotes axonal degeneration. The onset of action is within hours, whereas the duration of action is variable, ranging from 2 weeks to 6 months and beyond. The advantages of alcohol or phenol chemodenervation lie in their low cost and lack of antigenicity. The disadvantages include the technical difficulty of the injections and significant risk for pain as a result of treatment. Botulinum toxins, purified forms of Clostridium botulinum exotoxins, are injected directly into muscle, where they cleave one or more vesicle fusion proteins, thus blocking release of acetylcholine at the neuromuscular junction. Three commercial products—two of serotype A and one of B—are available. Each differs in its unit potency, side effects, and duration of action. On average, botulinum toxin has a clinical onset of action approximately 12 to 72 hours after injection, with a peak effect at 1 to 3 weeks. Effects then plateau for 1 to 2 months, with patients often requiring reinjection approximately every 3 months. Side effects may include local discomfort at the site of the injection and excessive weakness of the injected or nearby muscles, although more distant effects may occur. Antibody formation is a significant clinical concern and eventually obviates treatment benefit in approximately 5% of patients. Switching serotypes may be effective, at least temporarily. Consensus dosing guidelines have been developed and are presented within. Numerous studies have suggested that botulinum toxin has a role in the care of children with spasticity or dystonia related to cerebral palsy, and may improve equinus, gait, upper extremity use, comfort, and care. Evidence of functional improvement remains equivocal in the severely impaired child; however, there is evidence for improvement in less impaired children. The optimal candidate for injectable neuromuscular blockade is one who has a limited number of muscles that need treatment, who does not have fixed contracture, and who retains selective motor control. The ultimate goal of treatment for the hypertonic child is to maximize function, comfort, and independence. Hypertonia is only one aspect of the upper motoneuron syndrome, which includes both positive and negative symptoms. The treatment program, in which chemodenervation is only one tool, requires a multidisciplinary evaluation and individualized plan to address the whole patient. (J Child Neurol 2003:18:S50—S66).

Single-Dose Treatment of Trichomonal Vaginitis: A Comparison of Tinidazole and Metronidazole

1973 ◽  
Vol 1 (2) ◽  
pp. 438-441
Author(s):  
R Anjaneyulu ◽  
S A Gupte ◽  
D B Desai
Keyword(s):  
Single Dose ◽  
Side Effects ◽  
Clinical Response ◽  
Clinical Improvement ◽  
Statistical Evaluation ◽  
Comparative Trial ◽  
Dose Treatment ◽  
Satisfactory Clinical Response ◽  
Single Dose Treatment ◽  
Better Than

A randomized, comparative trial was carried out in 100 patients with trichomonal vaginitis to compare the efficacy and toleration of a single 2 g dose of tinidazole and metronidazole. Tinidazole produced parasitological cure in 94% of patients (47/50) and a satisfactory clinical response in 96% of patients (48/50); for metronidazole the figures were 64% (32/50) and 72% (36/50) respectively. Side-effects were reported by 52% of patients (26/50) on tinidazole and 82% of patients (41/50) on metronidazole. Severity of side-effects and their frequency per patient were significantly less (p<0.05 to 0.01) with tinidazole than with metronidazole. Statistical evaluation of the results showed that tinidazole was significantly better than metronidazole with respect to parasitological cure (p<0.01) and clinical improvement (p<0.01) and also with regard to the incidence and intensity of side effects (p<0.01).

scholarly journals The effectiveness of Fractional CO2 laser and long-pulsed ND- YAG laser in managing striae

2021 ◽  
Author(s):  
Hendawy AF ◽  
Aly DG ◽  
Shokeir HA ◽  
Samy NA
Keyword(s):  
Side Effects ◽  
Clinical Improvement ◽  
Co2 Laser ◽  
Nd:Yag Laser ◽  
The Other ◽  
Yag Laser ◽  
Fractional Co2 Laser ◽  
Pregnant Females ◽  
Significant Difference ◽  
Significant Clinical Improvement

Abstract Background: Striae Distansae (SD) are a disfiguring dermal condition, characterized by linear bands of atrophic skin, occurring at sites of dermal damage caused by stretching. They affect adolescents and more than 70% of pregnant females due to stretching of the skin. Aims: To evaluate and to compare the efficacy of 1, 064 nm Long Pulsed Nd: YAG laser and Fractional CO2 laser in the management of SD. Patients/Methods: Thirty female patients with bilateral symmetrical SD were treated with Fractional CO2 laser on one side and long-pulsed Nd: YAG laser on the other side. All patients received 3 sessions at 3 weeks interval. Global Aesthetic improvement scale (GAIS) and was used to evaluate improvement 3 months post treatment. Four mm punch biopsies were taken from each side before treatment and 3 months after the last session to measure epidermal and collagen thickness. Findings: More significant clinical improvement was noted with the Nd:YAG laser than Fractional CO2 laser. Both GAIS and satisfaction score were significantly higher in the Nd:YAG laser treated side epidermal and collagen thickness were evidently increased in the Nd: YAG laser treated lesions than those treated by Fractional CO2 laser with no significant difference. Conclusions: Long pulsed Nd-YAG laser is clinically more effective than the Fractional CO2 laser in treating SD without serious side effects, although there was no significant difference between them histopathologically.

Recurrent patellar dislocations in adolescents result in decreased knee flexion during the entire gait cycle

2020 ◽  
Vol 28 (7) ◽  
pp. 2053-2066 ◽  
Author(s):  
Carlo Camathias ◽  
Elias Ammann ◽  
Rahel L. Meier ◽  
Erich Rutz ◽  
Patrick Vavken ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Gait Cycle

On Transfemoral Prosthetic Knee Design for Natural Human Knee Motion

2020 ◽  
Vol 13 (1) ◽  
pp. 49-59
Author(s):  
Wen-Tzong Lee ◽  
Kevin Russell ◽  
Raj S. Sodhi
Keyword(s):  
Design Process ◽  
Knee Flexion ◽  
Gait Cycle ◽  
Design Method ◽  
Human Gait ◽  
Motion Generation ◽  
Knee Motion ◽  
Human Knee ◽  
Prosthetic Knee ◽  
Position Data

Background: A transfemoral prosthetic knee is an artificial knee used by above-the-knee amputees. There are two major categories of transfemoral prosthetic knee designs: pin joint-based and polycentric designs. While pin joint-based knee designs only allow pure rotation of the knee, polycentric knee designs allow a combination of rotational and translational knee motion which is exhibited in natural knee motion. Objective: This work presents both the recently-patented design process and the resulting design of a polycentric transfemoral prosthetic knee that approximates natural spatial human knee motion during flexion and extension. Methods: The design process includes tibial motion acquisition, Revolute-Revolute-Spherical-Spherical linkage (or RRSS) motion generation, RRSS linkage axode generation and circle fitting. The polycentric transfemoral prosthetic knee design produced from this process includes a gear joint with a specific spatial orientation to approximate natural spatial human knee motion. Results: Using the design process, a polycentric transfemoral prosthetic knee was designed to replicate a group of five tibial positions over 37.5° of knee flexion (the amount of knee flexion in a standard human gait cycle) with a minimal structural error. Conclusion: The circular gear-based knee design accurately replicated natural spatial knee motion over the tibial position data given for a standard human gait cycle. The knee design method must be implemented over a broader sampling of tibial position data to determine if a circular gear-based knee design is consistently accurate.

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