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Thread: Progressive spasticity and tone 12 months post injury

  1. #1

    Progressive spasticity and tone 12 months post injury

    I am currently experiencing increasing tone and spasticity unrelated to bladder or bowel issues 18 months after my injury. I've tried a number of anti-spasmodic regimens to no avail. I do not have syrinx formation. As anyone else down with such an issue that is appearing somewhat hopeless?

  2. #2
    Spasticity, in which abnormal stretch reflexes intensify muscle resistance to passive movements, often develops after spinal cord injury and worsens over time. Several factors may contribute to spasticity. Changes in the strength of connections between neurons or in the neurons themselves may alter the threshold of the stretch reflex. Spinal cord injury also may release one type of interneurons from control by a class of neurotransmitters that includes serotonin and norepinephrine. This change in the balance of neurotransmitters may increase these neurons' excitability and enhance stretch reflexes. Some of the antispasticity drugs mimic serotonin and can partially restore reflexes, a finding that supports this neurotransmitter theory. Another possible cause of spasticity is that the reactions of pressure receptors in the skin may become stronger, causing muscle spasms that may grow stronger with time. Interneurons activated by NMDA receptors also may contribute to spasticity. NMDA receptors probably help adjust the strength of connections in the brain during learning. Researchers have found that a class of drugs that blocks NMDA receptors can restore stretch reflexes to almost normal strength.

    Based on all this, any external stimuli such as UTI, full bowel or bladder, pressure ulcer, ingrown toenail, tight clothing, pain, fever,fatigue, and some common medications including non tricycli antidepressants such as fluoxetine or Trazadone may increase spasticity.

    There is "good" spasticity which should not be causing problems. If the spasticity worsens and causes problems, it should be looked in to.
    After the above causes are ruled out, the management of spasticity begins. It takes quite a while to find just the right medication,etc..

    Communicate your concerns with your spinal cord doctor.Don't give up!

    CWO

  3. #3
    Senior Member McDuff's Avatar
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    Icesax, I had the same problem. Mine hit at about 11 months post. My fix was to get a baclofen pump. Here is a thread I started:
    thread

    Do a search on baclofen pump, you will see a lot of info posted. This may or may not apply to you but worth reading up on. As Nurse said, take it one step at a time.

    McD

    "Rather be ridin' than rollin'"

  4. #4
    spasms are good. are they throwing u out of your chair? if not they are good.
    get a standing frame and embrace your spasms, lol. it much better to have them than not to. and it means something is getting trough your damaged cord, thats good as well.
    dont let some "sci SPECIALIST" put u on some rediculous medication.

  5. #5
    Senior Member Belle's Avatar
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    What regimens have you tried?

    My husband also had increasing spasticity for the first year or so. It seems to have leveled off. For him it is tolerable - and it keeps his legs from being atrophied. He found that using an FES bike helped too.

    *************
    AB wife of T8 complete para

  6. #6
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    Here's a topic I know something about. Unfortunately, for me, the news isn't good.

    I'm a c3-c4 incomplete quad almost 5 years out. I only have use of my left arm, grip in left hand, and use of left thumb. I operate my power chair, remote controls, and computer. I also feed myself and brush my teeth with an electric toothbrush. I rely on others for everything else. I jealously guard my capabilities, but tone is eroding my ability to function. I go to work about 1 day a week.

    I've made several posts to these message boards with disappointing response. I don't think I've been ignored; it's just a tough problem.

    My tone issues started immediately, and by 6 months out I was taking 130 mg a day of Baclofen - found out later this is too much. Tone kept getting worse. I tried Dantrium and Botox injections - no luck. Tried Zanaflex with marginal results. At the 2 year point I began exploring a Baclofen pump. Also did an MRI to rule out Syrinx. Pump trial showed some promise so had pump implanted. Tone kept getting worse despite 80 mg Baclofen and 32 mg Zanaflex orally each day in addition to 650 micro liters (ml) Baclofen from pump. Did test to show pump catheter was into spinal cord. Used to be able to walk a hundred yards or so with platform walker. Tone got so bad, I could no longer make my legs move. Learned, due to gravity, pump works better on legs than on upper body. Suffered a serious drug overdose/interaction - in hospital with complete memory lose, hallucinations, and severe paranoia; too much Baclofen and Zanaflex.

    I'm now on 800 ml Baclofen pump and 8 mg oral Zanaflex daily. Tone is still awful. At times the "attacks" are so bad I can't do those items I mentioned earlier, but legs are a tiny bit better since last Baclofen pump increase. I find staying warm and reducing tension keeps tone down some. Also found biofeedback helps to reduce tone when it gets really bad - I tell myself to relax. Over the past month my tone has stabilized; still bad and upper body joints (fingers, hands, wrists, elbows, shoulders) still ache and are stiff, but most of the time I at least can function.

    Doctors (SCI specialist, rehab (fills the pump), and PCP) are stumped. Next (probably last) test will be GAD anti-bodies blood work to see if I'm prone to Stiff Man's Syndrome - very rare, no cure, but at least may know why I keep getting stiffer.

    Sorry my news isn't better. If my docs make a break through, I'll post it here. Please do the same.

    I still hold out hope for 2005.

    Bob

  7. #7
    Bob,
    I have heard of stiff man syndrome but don't think I have every seen someone with it. Let us know your results and more about the syndrome if your results come back positive.

    A wish and prayer for everyone to have a better year in 2005!

    CWO

  8. #8
    i can relate. my spasticity also became progressively worse over time and as i started to exercise more, my spasticity increased. i tried baclofen at a reasonable dosage to no avail. all it did was make me nauseous and tired. i am hesitant to take drugs because they dont really agree with me and i dont want to completely get rid of my spasms. i find that standing and exercise in general, especially movement of my back and legs, relaxes my spasticity. its strange that exercise at one point seemed to increase my spasticity and now it does the exact opposite, but it has been the only thing that has helped.

  9. #9
    what is your injury icesax? (complete/incomplete and level.)

  10. #10
    Dr. Young posted information about Stiff Man's Syndrome two years ago. The reference is:Stiff Man Syndrome CRF

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