1/7. cyproheptadine for intrathecal baclofen withdrawal.OBJECTIVE: To evaluate the efficacy of cyproheptadine in the management of acute intrathecal baclofen (ITB) withdrawal. DESIGN: Descriptive case series. SETTING: University hospital with a comprehensive in- and outpatient rehabilitation center. PARTICIPANTS: Four patients (3 with spinal cord injury, 1 with cerebral palsy) with implanted ITB infusion pumps for treatment of severe spasticity, who had ITB withdrawal syndrome because of interruption of ITB infusion. INTERVENTIONS: patients were treated with 4 to 8mg of cyproheptadine by mouth every 6 to 8 hours, 5 to 10mg of diazepam by mouth every 6 to 12 hours, 10 to 20mg of baclofen by mouth every 6 hours, and ITB boluses in some cases. MAIN OUTCOME MEASURES: Clinical signs and symptoms of ITB withdrawal of varying severity were assessed by vital signs (temperature, heart rate), physical examination (reflexes, tone, clonus), and patient report of symptoms (itching, nausea, headache, malaise). RESULTS: The patients in our series improved significantly when the serotonin antagonist cyproheptadine was added to their regimens. fever dropped at least 1.5 degrees C, and heart rate dropped from rates of 120 to 140 to less than 100bpm. Reflexes, tone, and myoclonus also decreased. patients reported dramatic reduction in itching after cyproheptadine. These changes were associated temporally with cyproheptadine dosing. DISCUSSION: Acute ITB withdrawal syndrome occurs frequently in cases of malfunctioning intrathecal infusion pumps or catheters. The syndrome commonly presents with pruritus and increased muscle tone. It can progress rapidly to high fever, altered mental status, seizures, profound muscle rigidity, rhabdomyolysis, brain injury, and death. Current therapy with oral baclofen and benzodiazepines is useful but has variable success, particularly in severe cases. We note that ITB withdrawal is similar to serotonergic syndromes, such as in overdoses of selective serotonin reuptake inhibitors or the popular drug of abuse 3,4-methylenedioxymethamphetamine (Ecstasy). We postulate that ITB withdrawal may be a form of serotonergic syndrome that occurs from loss of gamma-aminobutyric acid B receptor-mediated presynaptic inhibition of serotonin. CONCLUSION: cyproheptadine may be a useful adjunct to baclofen and benzodiazepines in the management of acute ITB withdrawal syndrome.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
2/7. The effects of noncontingent access to food on the rate of object mouthing across three settings.Object mouthing is associated with several potential deleterious side effects. In the current investigation, we modified the use of noncontingent access to competing items (food) and evaluated the effects of the treatment on object mouthing across three settings. Results demonstrated reductions in mouthing associated with the modified treatment.- - - - - - - - - - ranking = 2.3333333333333keywords = mouth (Clic here for more details about this article) |
3/7. dental care for the neglected mouth of an adolescent with cerebral palsy: a case report.A case report is presented of the preventive and clinical care of an adolescent with a neglected mouth, complicated by the medical history of cerebral palsy. CLINICAL RELEVANCE: knowledge of the treatment which ideally may be offered to patients with cerebral palsy may help such patients retain and maintain their dentition.- - - - - - - - - - ranking = 1.6666666666667keywords = mouth (Clic here for more details about this article) |
4/7. The effect of mouth closure on drooling and speech.The efficacy of a feeding program to decrease drooling and increase vocalizations by promoting mouth closure was explored in two boys with cerebral palsy through the use of oral facilitation techniques. A single-subject ABA design was repeated across subjects. Baseline 1 consisted of 5 (Subject 1) and 10 (Subject 2) half-hour sessions during which the subjects were fed applesauce and apple juice without treatment. A 1-hr play session followed, during which saliva was collected on an absorbent bib and weighted. Bilabial vocalizations produced by the subjects were recorded and counted. A 12-session intervention phase followed, which was identical to the baseline phase except that treatment was implemented. Treatment consisted of techniques to reduce tactile hypersensitivity before feeding and the application of jaw control during feeding. Baseline 2 consisted of 7 sessions identical to baseline 1. The results suggest that this intervention decreases drooling but does not increase bilabial vocalizations. Longer treatment and follow-up may be needed in future efficacy studies.- - - - - - - - - - ranking = 1.6666666666667keywords = mouth (Clic here for more details about this article) |
5/7. Severe Dysphagia after botulinum toxin B injection to the lower limbs and lumbar paraspinal muscles.We report a case of severe dysphagia in a 29-yr-old woman with cerebral palsy after she was injected with botulinum toxin B to her lower limbs and lumbar paraspinal muscles. Four days after the treatment, she developed difficulty swallowing, more severe for solid foods than for liquids, accompanied by dry mouth, blurred vision, and voice hoarseness. Fifteen days after the injection, with worsening of her dysphagia, she was hospitalized. A laryngoscopic evaluation revealed bilateral vocal cord paresis, and a modified barium swallow test demonstrated delayed oral initiation, upper airway penetration, and no reflexive cough. In the following days, she improved spontaneously and was discharged 12 days later when she re-acquired the ability to swallow solid foods. Her symptoms resolved completely only 75 days after the injection. Although dysphagia is a common side effect of botulinum injection in the neck, to our knowledge, this is the first reported case of severe dysphagia after injection in a distant anatomic site.- - - - - - - - - - ranking = 0.33333333333333keywords = mouth (Clic here for more details about this article) |
6/7. Decreasing drooling through techniques to facilitate mouth closure.A single case ABA experimental design is presented in which techniques to facilitate mouth closure were hypothesized to decrease drooling. The subject was an 11-year-old male with mental retardation and cerebral palsy. Baseline 1 consisted of 10 half-hour sessions of play, followed by 1-hour periods during which the amount of saliva collected on an absorbent bib was measured and recorded. The subsequent treatment phase of 4 weeks was identical to the baseline except that a half-hour period of intervention was substituted for the half-hour of play. Intervention involved providing jaw control with intermittent tapping and jiggling, stroking the upper gum, and giving juice with jaw control. Baseline 2 consisted of 10 sessions identical to baseline 1. Results indicate that the amount of saliva leaving the mouth was a function of the presence or absence of intervention.- - - - - - - - - - ranking = 2keywords = mouth (Clic here for more details about this article) |
7/7. A minimally obtrusive, secure mask for prevention of access to the mouth.Several childhood neurological conditions can lead to problems with unintended access to the mouth. Earlier workers have demonstrated benefits in the use of a helmet restricting mouth access, within a behavioural modification programme. Conventionally, such headgear is very obtrusive. This paper presents a simple technique using conventional plaster-based moulding, which has been successfully used in making secure, minimally obtrusive masks. masks produced for two children have been readily accepted and have been successful. Any such headgear should be used only within a managed behavioural modification programme.- - - - - - - - - - ranking = 2keywords = mouth (Clic here for more details about this article) |