Local-spinal Therapy of Spasticity by H. Müller, J. Zierski, R. D. Penn (auth.), Prof. Hermann

By H. Müller, J. Zierski, R. D. Penn (auth.), Prof. Hermann Müller MD, Priv.-Doz. Jan Zierski MD, Richard D. Penn MD (eds.)

Historical picture of spinal anaesthesia In 1884 the yank neurologist J. L. eases. His discovery, despite the fact that, marks the Corning, through blockading the neural con­ onset of the period of neighborhood anaesthesia. It took virtually 100 years until eventually his duction to the hind extremities of a puppy by way of injecting cocaine-solution into the lumbar unique notion of "local medicine of the vertebral interspace, was once the 1st to in step with­ twine" was once back reconsidered as a result of shape spinal (or epidural?) anaesthesia [1]. purposes: at the moment, he was once ignorant of the neighborhood I. the invention of alternative drug receptors anaesthetic houses of cocaine (dis­ within the spinal wire made it attainable, via in­ coated within the comparable 12 months by means of C. Koller, who trathecal injection (or epidural appli­ cation, if the drug penetrates the dura), utilized cocaine to the attention of 1 of his pa­ tients [3]) and didn't intend to introduce to change nociceptive or motor transmis­ an anaesthetic technique. Corning's pri­ sion in the spinal twine. mary objective used to be the applying of substances in 2. Implantable units for long term appli­ proximity of the valuable frightened process, i. e. cation of substances to precise websites of the spinal wire, which will deal with or maybe heal physique, together with the spinal areas, have been constructed through the 1970's.

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Secondly, the three families of agents discussed produce a potent analgesia by receptors which are clearly distinct. g. ) and there is no evidence of cross tolerance. These considerations of the use of receptor-selective agents suggest several future directions which may be taken. A lternative spinal neurochemical systems: Given the complexity of the spinal substrate, a number of other endogenous receptor systems may be relevant to nociceptive processing. Thus, the intrathecal administration of serotonin [113], cholinergic agonists [100] and neurotensin [112] will produce a significant alteration in the response of the animal to strong stimuli in the absence of any change in motor function and with a selective pharmacology which precludes nonspecific membrane interactions.

From a theoretical point of view, such pharmacological augmentation procedures can only be effective if: 1) the respective system is activated by the "pain stimulus"; 2) the neurotransmitter system which is activated terminates on the appropriate substrate relevant to nociceptive transmission; and 3) if the augmentation paradigm indeed results in a prominent suppression of the mechanism which is responsible for recovering the active material from the synaptic cleft. Spasticity: The recent consideration of the effects of baclofen and particularly morphine on spasticity is important for several reasons.

The iontophoretic application of norepinephrine into spinal motor neurons can produce a significant hyperpolarization and a suppression of interneurons in the vicinity of the motor neuron pool [24, 39, 90]. Excitation after focal administration has been observed. This appears to correlate with the observations that norepinephrine, with an action in the ventral hom, can produce a facilitation of C-fiber evoked 29 ventral root reflexes [8]. The effect on ventral hom activity has not been fully characterized with regard to pharmacology.

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