Ebook: Local-spinal Therapy of Spasticity

Historical photograph of spinal anaesthesia In 1884 the American neurologist J. L. eases. His discovery, however, marks the Corning, by blocking the neural con­ onset of the era of regional anaesthesia. It took almost one hundred years until his duction to the hind extremities of a dog by injecting cocaine-solution into the lumbar original idea of "local medication of the vertebral interspace, was the first to per­ cord" was again reconsidered due to two form spinal (or epidural?) anaesthesia [1]. reasons: At that time, he was unaware of the local I. The discovery of different drug receptors anaesthetic properties of cocaine (dis­ in the spinal cord made it possible, by in­ covered in the same year by C. Koller, who trathecal injection (or epidural appli­ cation, if the drug penetrates the dura), applied cocaine to the eye of one of his pa­ tients [3]) and did not intend to introduce to alter nociceptive or motor transmis­ an anaesthetic procedure. Corning's pri­ sion within the spinal cord. mary aim was the application of drugs in 2. Implantable devices for long-term appli­ proximity of the central nervous system, i. e. cation of drugs to specific sites of the spinal cord, in order to treat or even heal body, including the spinal spaces, were developed during the 1970's.

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The book presents a new method in the management of spasticity based on the use of modern implantable infusion systems and on local-spinal administration of antispastic agents. With regard to efficacy, this therapy is superior to all other current antispastic regimens. In the book, basic experimental studies on spinal pharmacology of the drugs used are presented, and other therapeutic regimens for spasticity (systemic medication, surgical therapy and neural stimulation) are reviewed. The technological equipment and its application for different indications of regional therapy is explained in detail. Since the subject of local-spinal therapy of spasticity has so far not been treated in a comprehensive, compact form, the purpose of this volume is to inform the reader about this new and highly effective method. In the future this therapy is likely to play an important role in the rehabilitation of severely handicapped patients after central nervous lesion. Possible long-term results are also presented for the first time.