Interventional treatment of spasticity

Question 1

Mechanism of action of Chemical neurolytic agents

Answer 1

iInduces demyelination and axonal destruction via protein denaturation and axonal necrosis

Question 2

Onset, peak and duration of Botox

Answer 2

Onset three days. Peak effect three weeks. Duration three months.

Question 3

Cervical : lumbar ratio for drug concentration of intrathecal baclofen

Answer 3

1 : 3

Question 4

Pros and cons of phenol compared to Botox

Answer 4

Phenol is cheaper with a longer effect (>6months), but is more technically difficult to perform

Question 5

Mechanism of action of botulinum toxin

Answer 5

block the presynaptic release of acetylcholine by binding to SNARE complex preventing exocytosis of acetylcholine containing vesicles

Question 6

Total units limit injected for Botox

Answer 6

400 units total

Question 7

What are the four botulinum toxin types that are FDA approved

Answer 7

Type A: botox, xeomin, dysport

Type B: Myobloc

Question 8

About how many units per muscles Botox injected

Answer 8

25 to 200 units per muscle

Question 9

What are the 2 main orthopedic surgical treatments for spasticity

Answer 9

Tendon lengthening and tendon transfer procedures

Question 10

What surgical procedure is commonly used to treat equionvarus deformity of the foot

Answer 10

Split anterior tibial tendon transfer (SPLATTT)

Question 11

What are some examples of chemical neurolytic agents

Answer 11

Phenol and ethyl alcohol

Question 12

What kind of disease is Botox contraindicated with

Answer 12

Neuromuscular disease such as ALS, myasthenia gravis, Lambert Eaton

Question 13

What is the ratio of baclofen concentration at the spinal cord for intrathecal compared to oral baclofen

Answer 13

100 : 1

Question 14

What is the most common side effect of phenol injection

Answer 14

Pain, dysesthesia and bleeding

Question 15

How long does the dysesthesia after phenol injection last?

Answer 15

Weeks to months

Question 16

How do you treat baclofen overdose

Answer 16

physostigmine which is an anticholinesterase

Question 17

What is the main thing you look for in differentiating baclofen overdose versus withdrawal

Answer 17

Withdrawal has no weakness. Overdose has severe weakness

Question 18

What medication is Botox contraindicated with

Answer 18

Aminoglycoside or spectinomycin antibiotics

Question 19

How do you dose the Pump infusion after the trial

Answer 19

Usually double the clinically effective trial dose and use this amount as the initial 24 hour infusion dose

Question 20

What is the functional life of a baclofen pump

Answer 20

Five years

Question 21

What is the usual starting dose been doing a trial of intrathecal baclofen

Answer 21

50 µg

Question 22

What bones is the tibialis anterior tendon attached to during the SPLATTT procedure?

Answer 22

Cuboid and 3rd cuneiform