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Therkildsen ER, Kaster P, Nielsen JB. A scoping review on muscle cramps and spasms in upper motor neuron disorder-two sides of the same coin? Front Neurol 2024; 15:1360521. [PMID: 38497037 PMCID: PMC10940373 DOI: 10.3389/fneur.2024.1360521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Background Muscle cramps are typically regarded as benign muscle overactivity in healthy individuals, whereas spasms are linked to spasticity resulting from central motor lesions. However, their striking similarities made us hypothesize that cramping is an under-recognized and potentially misidentified aspect of spasticity. Methods A systematic search on spasms and cramps in patients with Upper Motor Neuron Disorder (spinal cord injury, cerebral palsy, traumatic brain injury, and stroke) was carried out in Embase/Medline, aiming to describe the definitions, characteristics, and measures of spasms and cramps that are used in the scientific literature. Results The search identified 4,202 studies, of which 253 were reviewed: 217 studies documented only muscle spasms, 7 studies reported only cramps, and 29 encompassed both. Most studies (n = 216) lacked explicit definitions for either term. One-half omitted any description and when present, the clinical resemblance was significant. Various methods quantified cramp/spasm frequency, with self-reports being the most common approach. Conclusion Muscle cramps and spasms probably represent related symptoms with a shared pathophysiological component. When considering future treatment strategies, it is important to recognize that part of the patient's spasms may be attributed to cramps.
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Affiliation(s)
| | | | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
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Sexual Health in the Neurogenic Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Manthou M, Abdulla DSY, Pavlov SP, Jansen R, Bendella H, Nohroudi K, Stein G, Meyer C, Ozsoy O, Ozsoy U, Behram Kandemir Y, Sarikcioglu L, Semler O, Schoenau E, Dunlop S, Angelov DN. Whole body vibration (WBV) following spinal cord injury (SCI) in rats: Timing of intervention. Restor Neurol Neurosci 2017; 35:185-216. [DOI: 10.3233/rnn-160691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Marilena Manthou
- Department of Histology and Embryology, Aristotle University Thessaloniki, Greece
| | | | | | - Ramona Jansen
- Department of Anatomy I, University of Cologne, Germany
| | - Habib Bendella
- Department of Neurosurgery, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | | | - Gregor Stein
- Department of Orthopedics and Trauma Surgery, University of Cologne, Germany
| | - Carolin Meyer
- Department of Orthopedics and Trauma Surgery, University of Cologne, Germany
| | - Ozlem Ozsoy
- Department of Physiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Umut Ozsoy
- Department of Anatomy, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Levent Sarikcioglu
- Department of Anatomy, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | | | - Sarah Dunlop
- Experimental and Regenerative Neuroscience, School of Animal Biology, The University of Western Australia, WA, Australia
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Courtois F, Alexander M, McLain AB(J. Women's Sexual Health and Reproductive Function After SCI. Top Spinal Cord Inj Rehabil 2017; 23:20-30. [PMID: 29339874 PMCID: PMC5340506 DOI: 10.1310/sci2301-20] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sexual function and to a lesser extent reproduction are often disrupted in women with spinal cord injuries (SCI), who must be educated to better understand their sexual and reproductive health. Women with SCI are sexually active; they can use psychogenic or reflexogenic stimulation to obtain sexual pleasure and orgasm. Treatment should consider a holistic approach using autonomic standards to describe remaining sexual function and to assess both genital function and psychosocial factors. Assessment of genital function should include thoracolumbar dermatomes, vulvar sensitivity (touch, pressure, vibration), and sacral reflexes. Self-exploration should include not only clitoral stimulation, but also stimulation of the vagina (G spot), cervix, and nipples conveyed by different innervation sources. Treatments may consider PDE5 inhibitors and flibanserin on an individual basis, and secondary consequences of SCI should address concerns with spasticity, pain, incontinence, and side effects of medications. Psychosocial issues must be addressed as possible contributors to sexual dysfunctions (eg, lower self-esteem, past sexual history, depression, dating habits). Pregnancy is possible for women with SCI; younger age at the time of injury and at the time of pregnancy being significant predictors of successful pregnancy, along with marital status, motor score, mobility, and occupational scores. Pregnancy may decrease the level of functioning (eg, self-care, ambulation, upper-extremity tasks), may involve complications (eg, decubitus ulcers, weight gain, urological complications), and must be monitored for postural hypotension and autonomic dysreflexia. Taking into consideration the physical and psychosocial determinants of sexuality and childbearing allows women with SCI to achieve positive sexual and reproductive health.
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Affiliation(s)
- Frédérique Courtois
- Departement of Sexology, Université du Québec à Montréal, Montreal, Canada
- Institut de réadaptation Gingras Lindsay de Montréal, Montreal, Canada
| | - Marcalee Alexander
- Department of Rehabilitative Medicine, Birmingham VA Medical Center, Birmingham, Alabama
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham
- Department of Physical Medicine and Rehabilitation, Harvard School of Medicine, Boston, Massachusetts
| | - Amie B. (Jackson) McLain
- Department of Physical Medicine and Rehabilitation, University of Alabama School of Medicine, Birmingham, Alabama
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Trofimenko V, Hotaling JM. Fertility treatment in spinal cord injury and other neurologic disease. Transl Androl Urol 2016; 5:102-16. [PMID: 26904416 PMCID: PMC4739989 DOI: 10.3978/j.issn.2223-4683.2015.12.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Infertility in individuals with neurologic disorders is complex in etiology and manifestation. Its management therefore often requires a multimodal approach. This review addresses the implications of spinal cord injury (SCI) and other neurologic disease on fertility, including the high prevalence of sexual dysfunction, ejaculation disorders and compromised semen parameters. Available treatment approaches discussed include assisted ejaculation techniques and assisted reproductive technology including surgical sperm retrieval and intracytoplasmic sperm injection (ICSI).
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Affiliation(s)
- Vera Trofimenko
- 1 Division of Urology, University of Utah, Salt Lake City, Utah, USA ; 2 Center for Reconstructive Urology and Men's Health, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - James M Hotaling
- 1 Division of Urology, University of Utah, Salt Lake City, Utah, USA ; 2 Center for Reconstructive Urology and Men's Health, Division of Urology, University of Utah, Salt Lake City, Utah, USA
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Courtois F, Charvier K. Sexual dysfunction in patients with spinal cord lesions. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:225-45. [PMID: 26003247 DOI: 10.1016/b978-0-444-63247-0.00013-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Many aspects of sexuality can be disrupted following a spinal cord lesion (SCL). It can alter an individual's self-esteem and body image, interfere with positioning and mobility, introduce unexpected problems with incontinence and spasticity, decrease pleasure, and delay orgasm. Sexual concerns in men can involve erectile function, essential for intercourse, ejaculation function, necessary for fertility, and the ability to reach orgasm. In women they can involve concerns with vaginal lubrication, genital congestion, and vaginal infections, which can all go unnoticed, and orgasm, which may be lost. All of these concerns must be addressed during rehabilitation as individuals with SCL continue to live an active sexual life, and consider sexuality among their top priority for quality of life. This chapter describes the impact of SCL on various phases of men's and women's sexual responses and on various aspects of sexuality. Treatments are described in terms of what is currently available and what is specific to the SCL population. New approaches in particular for women are described, along with tips from sexual counseling which consider an overall approach, taking into account the primary, secondary, and tertiary consequences of the SCL on the individual's sexuality. Throughout the chapter, attempts are made to integrate neurophysiologic knowledge, findings from the literature on SCL, and clinical experience in sexual rehabilitation.
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Affiliation(s)
- Frédérique Courtois
- Department of Sexology, Université du Québec à Montréal, Montreal, Quebec, Canada.
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Lew-Starowicz M, Gianotten WL. Sexual dysfunction in patients with multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:357-70. [DOI: 10.1016/b978-0-444-63247-0.00020-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Wirth F, Schempf G, Stein G, Wellmann K, Manthou M, Scholl C, Sidorenko M, Semler O, Eisel L, Harrach R, Angelova S, Jaminet P, Ankerne J, Ashrafi M, Ozsoy O, Ozsoy U, Schubert H, Abdulla D, Dunlop SA, Angelov DN, Irintchev A, Schönau E. Whole-Body Vibration Improves Functional Recovery in Spinal Cord Injured Rats. J Neurotrauma 2013; 30:453-68. [DOI: 10.1089/neu.2012.2653] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Felicitas Wirth
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Greta Schempf
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Gregor Stein
- Department of Orthopedics and Trauma Surgery, University of Cologne, Köln, Germany
| | | | - Marilena Manthou
- Department of Histology and Embryology, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Carolin Scholl
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Malina Sidorenko
- Department of Anatomy, Medical Faculty, University of Sofia, Sofia, Bulgaria
| | - Oliver Semler
- Department of Children's Hospital, University of Cologne, Köln, Germany
| | - Leonie Eisel
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Rachida Harrach
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Srebrina Angelova
- Jean-Uhrmacher Institute for ENT-Research, University of Cologne, Köln, Germany
| | - Patrick Jaminet
- Department of Hand, Plastic, and Reconstructive Surgery with Burn Unit, BG- Trauma Centre, University of Tuebingen, Tuebingen, Germany
| | - Janina Ankerne
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Mahak Ashrafi
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Ozlem Ozsoy
- Department of Physiology, Akdeniz University, Antalya, Turkey
| | - Umut Ozsoy
- Department of Physiology Anatomy, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Diana Abdulla
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Sarah A. Dunlop
- Experimental and Regenerative Neuroscience, School of Animal Biology, The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Andrey Irintchev
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Eckhard Schönau
- Department of Children's Hospital, University of Cologne, Köln, Germany
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Courtois F, Rodrigue X, Côté I, Boulet M, Vézina JG, Charvier K, Dahan V. Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat? Spinal Cord 2012; 50:869-77. [PMID: 22869221 DOI: 10.1038/sc.2012.83] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Review the literature on the acute or prophylactic treatment of autonomic dysreflexia in the context of sexual activities. SETTING International. METHODS Medline search using AD and spinal cord injury and all years of publication. RESULTS Thirty-seven papers on the specific treatment of AD showed that nifedipine, prazosin, captopril and clonidine are candidates in the context of sexual activities. Prazosin, however, has an initial hypotensive effect requiring to begin treatment 12 h before intercourse, which makes it less ideal for spontaneous sexual activities. Captopril has an initial hypotensive effect and was only studied in acute AD. Its usefulness in prophylaxis remains to be demonstrated. Clonidine has successfully been used clinically for decades, but never studied in randomized control trials. Nifedipine remains the most widely studied and significant treatment of AD whether in acute or prophylactic conditions. Recent concerns suggest increased cardiovascular risks with sublingual nifedipine in non-SCI populations, but negative long-term effects have not been reported in the SCI population. CONCLUSION Sexual function is a priority for men with SCI. As sexual activities, in particular ejaculation, can be a source of AD, adequate treatments and prophylaxis must be considered in the context of sexual activities. Experts must meet and conclude on the thresholds, parameters and treatments that should be considered in the long-term management of AD in the context of sexual function in men with SCI.
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Affiliation(s)
- F Courtois
- Outpatient Clinic, Institut de Réadaptation en Déficience Physique de Québec, Quebec, Quebec, Canada.
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Everaert K, de Waard WIQ, Van Hoof T, Kiekens C, Mulliez T, D'herde C. Neuroanatomy and neurophysiology related to sexual dysfunction in male neurogenic patients with lesions to the spinal cord or peripheral nerves. Spinal Cord 2010; 48:182-91. [PMID: 20048757 DOI: 10.1038/sc.2009.172] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
STUDY DESIGN Review article. OBJECTIVES The neuroanatomy and physiology of psychogenic erection, cholinergic versus adrenergic innervation of emission and the predictability of outcome of vibration and electroejaculation require a review and synthesis. SETTING University Hospital Belgium. METHODS We reviewed the literature with PubMed 1973-2008. RESULTS Erection, emission and ejaculation are separate phenomena and have different innervations. It is important to realize, which are the afferents and efferents and where the motor neuron of the end organ is located. When interpreting a specific lesion it is important to understand if postsynaptic fibres are intact or not. Afferents of erection, emission and ejaculation are the pudendal nerve and descending pathways from the brain. Erection is cholinergic and NO-mediated. Emission starts cholinergically (as a secretion) and ends sympathetically (as a contraction). Ejaculation is mainly adrenergic and somatic. For vibratory-evoked ejaculation, the reflex arch must be complete; for electroejaculation, the postsynaptic neurons (paravertebral ganglia) must be intact. CONCLUSION Afferents of erection, emission and ejaculation are the pudendal nerve and descending pathways from the brain. Erection is cholinergic and NO-mediated. Emission starts cholinergically (as a secretion) and ends sympathetically (as a contraction). Ejaculation is mainly adrenergic and somatic. In neurogenic disease, a good knowledge of neuroanatomy and physiology makes understanding of sexual dysfunction possible and predictable. The minimal requirement for the success of penile vibration is a preserved reflex arch and the minimal requirement for the success of electroejaculation is the existence of intact post-ganglionic fibres.
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Affiliation(s)
- K Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium.
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Abstract
INTRODUCTION Delineation of the underlying neurophysiological mechanisms of ejaculatory behavior is crucial for the treatment of male sexual dysfunction, including premature ejaculation. Recent studies provide compelling evidence that a population of lumbar spinothalamic (LSt) cells may play a role in the regulation of the ejaculatory response. Subsequent to ejaculation, LSt cells exhibit markers of activation that are not only highly correlated with ejaculatory behavior, but are also absent following the expression of other components of sexual behavior, such as mounts or intromissions. Similarly, targeted chemical lesion of LSt cells using substance P-saporin abolishes ejaculatory behavior explicitly. Early evidence suggests that pharmacological manipulation of LSt cells may offer additional evidence of crucial LSt cell involvement in the generation of ejaculation. AIM This review is intended to summarize what has currently been revealed regarding the role of LSt cells in the regulation and generation of ejaculatory behavior, and also to discuss the direction of future behavioral investigations. METHODS Information presented in this discussion was derived from analysis of numerous recent articles detailing the delineation of anatomical and physiological correlates of sexual behavior, as well as numerous literature searches using the National Library of Medicine PubMed Services. RESULTS A great deal of the work that has led to the implication of LSt cells in ejaculatory behavior is reviewed in the present article, including clinical data, as well as anatomical, physiological, and behavioral examinations. The rationale for ongoing pharmacological studies is also discussed. CONCLUSION LSt cells appear to play a vital role in the generation and regulation of ejaculatory behavior. Additional elucidation of this "ejaculation generator" could prove invaluable for the future treatment of male sexual dysfunction. Studies are currently in progress to further reveal the precise function of these cells and mechanisms of action through which they operate.
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Affiliation(s)
- Brandt Young
- Department of Physiology/Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
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Soler JM, Previnaire JG, Plante P, Denys P, Chartier‐Kastler E. Midodrine Improves Orgasm in Spinal Cord‐Injured Men: The Effects of Autonomic Stimulation. J Sex Med 2008; 5:2935-41. [DOI: 10.1111/j.1743-6109.2008.00844.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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