肌肉痉挛的机制分析.ppt

* 纹状趾(Hitchhiker’s Great Toe) 踇长伸肌 膝关节僵硬 臀大肌 股直肌 股外侧肌 股内侧肌 股中间肌 腘绳肌 腓肠肌 髂腰肌 (无力) 屈曲膝 腘绳肌内侧头 腘绳肌外侧头 股四头肌 腓肠肌 股内收畸形(剪刀步态) 长收肌 大收肌 股薄肌 髂腰肌(weak) 耻骨肌 (weak) 肌痉挛病例#1 患者女性,44岁,右利手,非裔美国人 患有狼疮性肾炎,因动脉炎致左侧偏瘫. 左侧肱二头肌痉挛, 但该肌肉存在用于血液透析的动静脉瘘. 肌痉挛病例 #2 患者白人女性,47岁,左利手,家族性痉挛性截瘫 肌痉挛改善4年后诉症状恶化. 肌痉挛病例 #3 患者男性,15岁,右利手,非裔美国人,横贯性脊髓炎所致截瘫 巴氯芬泵植入2月后, 诉肌痉挛加重并伴全身瘙痒 肌痉挛病例 #4 患者男,40岁,美国白人,右利手,痉挛性大脑性两侧瘫(Little病) 植入巴氯芬泵3月后, 肌痉挛无改善. * This slide illustrates the concept of the origins of spasticity as a disorder affecting the afferent and efferent arcs of the monosynaptic reflex loop. Some of the neuronal elements included in this pathway are the Group Ia and II afferents in the muscle spindle, as well as the Group Ib afferents in the Golgi tendon organs. * This diagram is a representation of the spinal cord circuitry basic to the understanding of spastic hypertonia. * Clonazepam is a benzodiazepine approved for the management of seizures It causes less sedation than diazepam and has a slightly lower risk for dependence. Most commonly used for the treatment of nighttime spasms, clonazepam’s usual dosage is .5 to 1 mg at bedtime. Patients experiencing significant daytime residual sedation may decrease the dose to 0.25 mg at night. Otherwise, the side effect profile resembles that of diazepam. * Clonazepam is a benzodiazepine approved for the management of seizures It causes less sedation than diazepam and has a slightly lower risk for dependence. Most commonly used for the treatment of nighttime spasms, clonazepam’s usual dosage is .5 to 1 mg at bedtime. Patients experiencing significant daytime residual sedation may decrease the dose to 0.25 mg at night. Otherwise, the side effect profile resembles that of diazepam. * Other agents, such as those listed above, have provided benefits to patients suffering from spasticity or muscle spasms, although their usage is generally investigational and sometimes controversial. * * * +/- indicated whether or not treatment was administered: