RESUMEN
A case of spinal myoclonus that complicated spasticity management is presented. A 37-year-old man with a C6 American Spinal Injury Association class B spinal cord injury was referred for treatment of spasticity. He had failed previous treatments with baclofen and dantrolene but was partly relieved by diazepam, although with unacceptable side effects. Further evaluation, including simultaneous electroencephalogram, videotaping, and electromyography of the quadriceps, anterior tibialis, posterior tibialis, and medial hamstring suggested myoclonic jerks of spinal origin that initiated episodes of unsustained clonus. During the worst episodes, myoclonic jerks came once every 16 to 22 seconds and persisted for 4 to 5 hours. Each episode of clonus lasted approximately 4 to 6 seconds. Treatment with valproic acid greatly diminished the frequency of myoclonic jerks with minimal side effects. Functionally, the patient was much less fatigued and better able to maintain his full time employment.
Asunto(s)
Espasticidad Muscular/etiología , Mioclonía/etiología , Traumatismos de la Médula Espinal/complicaciones , Actividades Cotidianas , Adulto , Anticonvulsivantes/uso terapéutico , Quimioterapia Combinada , Electroencefalografía , Electromiografía , Humanos , Masculino , Relajantes Musculares Centrales/uso terapéutico , Espasticidad Muscular/tratamiento farmacológico , Mioclonía/tratamiento farmacológico , Factores de Tiempo , Ácido Valproico/uso terapéuticoRESUMEN
A controlled clinical trial of the anti-epileptic efficacy and toxic side effects of diphenylsilanediol was conducted on 24 client-owned epileptic dogs. Data obtained from an abbreviated procedural treatment program indicated that diphenylsilanediol compared favorably with primidone as an anti-epileptic compound, but had limiting toxic side effects to the liver, pancreas, and possibly to other tissues. There was a mean reduction of 60.7% in seizure frequency in 15 epileptic dogs treated with diphenylsilanediol when compared with their pretreatment frequency. There was a mean reduction of 55.6% in seizure frequency in 9 spileptic control dogs treated with primidone. Samples of blood obtained from the dogs in the program on the 4th, 8th, 12th, 24th, and 36th weeks of treatment were examined for complete blood cell count, blood urea nitrogen, liver function, and pancreatic function. Toxic side effects were not seen among the primidone-treated control dogs, with the exception of occasional dose-related drowsiness. Among the diphenylsilanediol-treated dogs, 3 developed liver disease, 2 developed definite pancreatic changes, and 2 showed evidence of bone marrow suppression. Four dogs died during treatment with diphenylsilanediol, whereas no deaths occurred during the same interval of primidone therapy.