Action of dantrolene sodium on single motor units of cat muscle in vivo

Pharmacologic Treatment Tools: Systemic Medications and Toxins, Opportunities, and Pitfalls

Treatment of pathologic muscle overactivity associated with upper motor neuron syndrome can be multifaceted. One of the initial decisions to be made when formulating an overarching treatment plan is selecting a combination of strategies that is most applicable. Strategies may include physical interventions, such as stretching or splinting modalities, or surgery, whereas pharmacotherapeutic strategies encompass oral/systemic medications as well as agents, such as toxins and alcohols, used for focal chemodenervation. This article reviews the oral/systemic therapies as well as toxins that are used focally. Although medication can also be administered via intrathecal pumps, this treatment approach is discussed elsewhere.

The effects of fatigue on the torque-frequency curve of the human paralysed soleus muscle

An advanced understanding of the torque-generating properties of the chronically paralysed soleus muscle may be instrumental in developing improved methods to activate human paralysed muscle. We established the shape of the torque-frequency curve before and after fatigue of the human paralysed soleus muscle. After fatigue, the normalized torque-frequency curve was shifted to the right, suggesting a higher frequency was required to generate the same relative torque. Low frequency fatigue (LFF) consisting of reduced torques at low frequencies and normal torques at higher frequencies was demonstrated. Conversely, the acutely paralysed soleus muscle was found to be fatigue-resistant and showed no shift in the torque-frequency curve. The muscle activation history (potentiation), LFF, and changing contractile speeds may affect the torque-frequency curve after fatigue. These factors may also play an important role in the development of optimal methods to activate paralysed muscle to attenuate fatigue.

Effects of electrically induced fatigue on the twitch and tetanus of paralyzed soleus muscle in humans

We analyzed the twitch and summated torque (tetanus) during repetitive activation and recovery of the human soleus muscle in individuals with spinal cord injury. Thirteen individuals with complete paralysis (9 chronic, 4 acute) had the tibial nerve activated every 1,500 ms with a 20-Hz train (7 stimuli) for 300 ms and a single pulse at 1,100 ms. The stimulation protocol lasted 3 min and included 120 twitches and 120 tetani. Minimal changes were found for the acute group. The chronic group showed a significant reduction in the torque and a significant slowing of the contractile speeds of both the twitch and tetanus. The decrease in the peak twitch torque was significantly greater than the decrease in the peak tetanus torque early during the fatigue protocol for the chronic group. The twitch time to peak and half relaxation time were prolonged during fatigue, which was associated with improved fusion of the tetanus torque. At the end of the fatigue protocol, the decrease in the peak twitch torque was not significantly different from the decrease in the peak tetanus torque. After 5 min of rest, the contractile speeds recovered causing the tetanus to become unfused, but the tetanus torque became less depressed than the twitch torque. The differential responses for the twitch and the tetanus suggest an interplay between optimal fusion created from contractile speed slowing and excitation contraction coupling compromise. These issues make the optimal design of functional electrical stimulation systems a formidable task.

In vivo 31P NMR assessed effects of dantrolene on mechanics and energy metabolism in tetanic stimulated rat gastrocnemius

Dantrolene does not affect fatigue from submaximal effort and MVC while it decreases twitch tension. We hypothesize that dantrolene could modify the relation between energy metabolism and fatigue by inhibiting calcium release from the sarcoplasmic reticulum. The effects of dantrolene (10 mg) on mechanical and metabolic parameters of gastrocnemius muscle were examined by 31P NMR during an in vivo fatigue test. The fatigue test constituted of three successive 20 min periods of increased stimulation rhythms and followed by a 20 min recovery period. 31P NMR was used to determine phosphocreatine (PCr), ATP and intracellular pH changes, while tension was recorded. We showed that dantrolene increased mechanical fatigue while PCr levels were similar to those from control animals. Acidosis was most prominent in dantrolene treated rats. These results suggest that dantrolene firstly affects calcium cycling with additive effects to fatigue and, secondly, modifies the activation of oxidative metabolism and the energy cost of the generated tension.

Dantrolene sodium and fatigue of long duration

A long-lasting impairment of muscular force generation follows fatiguing exercise (fatigue of long duration), the physiological basis of which is not well understood. To investigate the role of reduced calcium release in long-lasting fatigue, we examined the effects of dantrolene sodium, which selectively decreases calcium release from the sarcoplasmic reticulum. The drug impaired muscle function in a pattern identical to that of long-lasting fatigue. The results are consistent with either independent effects of dantrolene and exercise at the same site in the excitation-contraction coupling chain, or independent actions at separate serial sites.

Trends in the pathophysiology and pharmacotherapy of spasticity

Spasticity develops after supraspinal or spinal lesions of descending motor systems, with obligate involvement of the corticospinal tract. Spasticity is characterized by an increase in muscle tone, which, in contrast to many other types of enhanced muscle tone, shows a marked velocity-dependent increase when the muscle is passively stretched. The pathophysiological mechanisms underlying this spastic muscle tone remain obscure. Three major causes are currently considered possible: (1) changes in the excitability of spinal interneurones; (2) receptor hypersensitivity; (3) formation of new synapses by sprouting. The latter mechanism could account for the long time course over which spastic muscle tone develops in hemiplegic or paraplegic patients, but there is no experimental evidence for this hypothesis. The electromyographic (EMG) gait analysis of patients with spasticity has thrown doubt on the common belief that the velocity-dependent increase in spastic muscle tone is evoked by stretch reflex activity and has led to the idea that spastic muscle tone resides in the muscle fibres themselves. While such a mechanism may contribute to the slowness of active movements in spastic patients, recent experiments on patients with spastic arm paresis have confirmed the classical view that the spastic muscle tone is related to the EMG activity evoked in the passively stretched muscle. This pathological EMG activity is seen during the entire range of the dynamic phase of the stretch, during which a normal muscle exhibits only an early, phasic burst at the highest stretch velocities employed. For the pharmacological treatment of spasticity, substances with different central or peripheral actions are available. Their assumed receptor actions are described, together with their main indications and side-effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Antispasticity drugs: mechanisms of action

Several different drugs are now used, or are potentially useful, to treat patients with spasticity. Although these compounds vary in their actions on spinal neurons and reflex arcs, it is possible to formulate reasonable hypotheses regarding their modes of action. The benzodiazepines bind to specific benzodiazepine receptors linked to classic gamma-aminobutyric acid (GABA) receptors located on the terminals of primary afferent fibers. This binding results in an increased affinity of the GABA receptor for the amino acid, an augmented flux of chloride ions across the terminal membrane, and an increase in the amount of presynaptic inhibition. Baclofen activates GABAB receptors putatively located on the same terminals. Activation of these receptors retards the influx of calcium ions into the terminals, thereby reducing the evoked release of excitatory amino acids and possibly other transmitters. Progabide and its metabolites act on both classic and GABAB receptors. Glycine works on specific inhibitory receptors located on spinal interneurons and motoneurons. The phenothiazines act on the brainstem to alter the function of fusimotor fibers. Phenytoin and carbamazepine reduce the afferent output of muscle spindles. Dantrolene diminishes the activation of the contractile process in muscle fibers by reducing the release of calcium ions from the sarcoplasmic reticulum. This review summarizes the data supporting these concepts.

The action of dantrolene sodium on individual fast and slow motor units of the rat anaesthetized with urethane

Rats, anaesthetized with urethane, were injected intravenously with dantrolene sodium in a vehicle of 5% mannitol taken to pH 10 with NaOH. The muscle relaxant action of dantrolene sodium was measured from the contractions of individual motor units of the extensor digitorum longus (EDL), soleus (SOL) and segmental tail (ST) muscles. Data were also collected from their parent whole muscle preparations. The depressant action of dantrolene sodium on the percentage-normalized amplitude of contraction of the individual motor units was greater than its effect on the whole muscle twitch amplitude, in all three muscles. The twitch amplitude of fast contracting motor units was significantly more reduced (P less than 0.001) by dantrolene sodium than was that of slow contracting motor units. Dantrolene sodium reduced the contraction time of all motor units. The effect of the drug on half-relaxation time varied within and between groups of motor units studied. The drug was confirmed to have a greater depressant action on the twitch contraction than on the fused tetanus of whole muscle. This was true also for single motor units. With tetanic stimulation the effect of dantrolene sodium was also dependent upon the motor unit type, fast or slow. A maximum depression of contractile tension occurred at a stimulation frequency of 64 Hz for fast EDL motor units whereas the maximum depression for ST slow units, the slowest units tested, was at a stimulation frequency of 14 Hz.

After-effects of repetitive stimulation at low frequency on fast-contracting motor units of cat muscle

Twitch and tetanic contractions of single motor units of the cat peroneus tertius muscle were examined after application of a test allowing their identification as either fast fatigable (f.f.) or fast fatigue-resistant (f.r.) or fast intermediate (f.i.) or slow units as established by Burke, Levine, Tsairis & Zajac (1973). The test was found to leave two kinds of after-effects in f.f., f.r. and f.i. units whereas it did not affect slow units. The first after-effect was an early and brief potentiation of twitch tension occurring in all f.r. and f.i. units and in most f.f. units. The second after-effect, termed 'delayed fatigue', was a prolonged depression of tension output, that developed slowly following the early potentiation in all f.f. and f.i. units and more than half of the f.r. units. One hour after the test, unfused tetanic contractions elicited by 20-40/sec stimulation were deeply depressed in motor units that had been left without stimulation since the end of the test. Recovery took place in 3-5 hr. Motor units affected by delayed fatigue could nevertheless be made to develop nearly normal tension by gradual build-up upon prolonged stimulation at 30-40/sec. Maximal tetanic contractions elicited by 200/sec stimulation were much less depressed during delayed fatigue than unfused tetanic contractions. These observations suggest that contractile mechanism were not impaired by delayed fatigue. Since absence of change in muscle action potential indicated that excitation of muscle fibres was not affected either, delayed fatigue might be due to a temporary failure of excitation-contraction coupling.