Overview of botulinum toxin as a treatment for spasticity in stroke patients

Spasticity after the occurrence of stroke induces limb deformity, functional disability and/or pain in patients, which limits their activities of daily living and deteriorates their quality of life. Botulinum toxin (BTX) has recently been reported as an efficacious therapeutic agent for the treatment of spasticity. Systematic review and meta-analysis studies have demonstrated that BTX therapy after stroke reduces spasticity and increases physical activity capacity and performance levels. Moreover, BTX can be used as an adjuvant in physiotherapy. Several studies have confirmed that the combination of BTX therapy and physiotherapy improves motor recovery. However, to date, only a few such combination studies have been conducted and their findings are considered preliminary and controversial. Therefore, future studies are required to determine the appropriate combination of treatment methods that will aid motor recovery.

Loss of neuronal integrity: a cause of hypometabolism in patients with traumatic brain injury without MRI abnormality in the chronic stage

PURPOSE

Traumatic brain injury (TBI) causes brain dysfunction in many patients. However, some patients have severe brain dysfunction but display no abnormalities on magnetic resonance imaging (MRI). There have been some reports of hypometabolism even in such patients. The purpose of this study was to investigate the relationship between metabolic abnormality and loss of neuronal integrity in TBI patients with some symptoms but without MRI abnormalities.

METHODS

The study population comprised ten patients with TBI and ten normal volunteers. All of the patients were examined at least 1 year after the injury. ( 15)O-labelled gas PET and [(11)C]flumazenil (FMZ) positron emission tomography (PET) were carried out. The cerebral metabolic rate of oxygen (CMRO(2)) and binding potential (BP) images of FMZ were calculated. Axial T2WI, T2*WI and FLAIR images were obtained. Coronal images were added in some cases.

RESULTS

All of the patients had normal MRI findings, and all showed areas with abnormally low CMRO(2). Low uptake on BP images was observed in six patients (60%). No lesions that showed low uptake on BP images were without low CMRO(2). On the other hand, there were 14 lesions with low CMRO(2) but without BP abnormalities.

CONCLUSION

These results indicate that there are metabolic abnormalities in TBI patients with some symptoms after brain injury but without abnormalities on MRI. Some of the hypometabolic lesions showed low BP, indicating a loss of neuronal integrity. Thus, FMZ PET may have potential to distinguish hypometabolism caused by neuronal loss from that caused by other factors.

[Bispectral index based comparison of propofol dose requirement combined with various types of analgesic methods for total intravenous anesthesia]

We hypothesized that propofol dose requirement for total intravenous anesthesia is varied with the analgesic methods during anesthesia if the depth of anesthesia is maintained at the same level with bispectral index. Adult gynecological patients without any complications were randomly allocated to four groups; propofol with 1) continuous epidural block-oxygen-nitrous oxide (n = 18), 2) continuous epidural block-oxygen-air (n = 21), 3) fentanyl (total 5 micrograms.kg-1)-oxygen-nitrous oxide (n = 18) and 4) fentanyl (total 5 micrograms.kg-1)-oxygen-air (n = 21) group. Propofol 1.5 mg.kg-1 and vecuronium 0.15 mg.kg-1 were administered intravenously for endotracheal intubation. Propofol was titrated to maintain bispectral index between 40 and 60. Total dose of propofol except the dose for induction was compared among the groups with one-way ANOVA and Scheffé's F test and P < 0.05 was considered as significant. Results were expressed as means +/- SDs. The age, body weight, height and hemodynamic changes during anesthesia among the groups were not significantly different. Total required dose of propofol for continuous epidural block-oxygen-nitrous oxide, continuous epidural block-oxygen-air, fantanyl-oxygen-nitrous oxide and fentanyl-oxygen-air group were 4.78 +/- 0.87 mg.kg-1.h-1, 6.10 +/- 0.93 mg.kg-1.h-1, 5.79 +/- 0.75 mg.kg-1.h-1 and 6.58 +/- 1.19 mg.kg-1.h-1, respectively. Nitrous oxide was able to reduce the dose of propofol significantly either with epidural anesthesia or fentanyl used for analgesia.