Search PubMed⌕ Search

Biomedical subjects

M P Sheehy

Publications and source records attributed to M P Sheehy.

17 recordsLinked to original sources
PubMed2003

[Problems of treating writer's cramp with botulinum toxin injections: results from 10 years of experience].

We studied the efficacy of botulinum toxin (BTX-A) injections in 167 patients, from a large cohort of 259 patients, presenting with writer's cramp (WC) and followed up to 10 years. The selection of the muscle was based on a careful physical examination, using up to 6 manoeuvres whilst attempting to write in order to bring out the original dystonic posture. The injection technique had to be precise, under EMG guidance, with a hollow recording needle to detect muscle or finger fascicle. The results showed a good efficacy and tolerance of this treatment in the long term with recovery of normal writing in 46 per cent, partial benefit in 10 per cent, failure in 21 per cent, and loss to follow-up after the first injection in 23 per cent. Among the responders, 27 per cent carried on the treatment every 9 months on average, with a duration of benefit of 6 months with follow-up between 3 and 9 years. Mirror dystonia had no prognostic value. Secondary dystonia, tremulous WC, long duration WC and progressive WC were associated with poor outcome.

Adult↗
PubMed1990

Writer's cramp.

Writer's cramp has been recognized for over a century, and originally was construed as a physical motor disorder. However, an unfortunate use of the descriptive term 'professional neuroses' to describe this and other similar task-specific conditions, coupled subsequently with fashions in psychiatry, led to the mistaken belief that writer's cramp was due to psychic rather than motor pathology. Evidence has accumulated in recent years showing that writer's cramp is a real focal motor disorder, with a close relation to dystonia. This article summarizes what is known about the aetiology, clinical features, pathophysiology and treatment of writer's cramp and analogous occupational cramps, with the aim of drawing the attention of neuroscientists to this common, bizarre and poorly understood condition.

Female↗
PubMed1988

Writer's cramp.

Explore the source record for details and available documents.

Adult↗
PubMed1987

Examination of motor function in lesions of the spinal cord by stimulation of the motor cortex.

Electrical stimulation of the motor cortex was performed in 3 patients with cervical cord trauma and in 3 with cervical myelopathy caused by cervical spondylosis. Abnormal conduction in central motor tracts was demonstrated in 5 of the 6 patients; yet in 4 of these, cortical somatosensory evoked potentials from the same limb were of normal latency. In the remaining patient who had normal motor latencies, the somatosensory evoked potentials were delayed on one side. Electrophysiological examination of the motor pathways by cortical stimulation may therefore be of considerable value in the assessment and management of patients with traumatic and compressive disease of the spinal cord.

Adult↗
PubMed1987

Anticholinergic-induced chorea in the treatment of focal dystonia.

The occurrence of chorea, induced by trihexyphenidyl (benzhexol hydrochloride) during the treatment of five adult patients who had focal or segmental dystonia, is described. The dose at which chorea appeared ranged from 15 to 60 mg/day (mean 31.7 mg/day). All but one patient had developed common adverse effects of this drug (dry mouth, blurred vision, and confusion) at lower doses (mean 21.8 mg per day). There was an inverse relationship between the age of the patient and the dose of trihexyphenidyl at which chorea developed.

Adult↗
PubMed1987

The interpretation of electromyographic responses to electrical stimulation of the motor cortex in diseases of the upper motor neurone.

The complexities of interpreting results of electrical stimulation of the motor cortex in pathological states are discussed and illustrated by reference to results from a variety of patients with diseases affecting the upper motor neurone (multiple sclerosis, cervical spondylosis and myelopathy, motor neurone disease, hemiparesis due to cerebral infarction, and hereditary spastic paraplegia). The abnormalities of the electromyographic (EMG) responses after anodal cortical stimulation consisted of delay in the latency to onset, dispersion or reduction in response size or even absence of EMG responses. These changes were not confined to any specific condition or pathology. Previous work has suggested that the sequence of events that follow anodal cortical stimulation involves repetitive excitatory inputs to spinal motoneurones and transmission across at least one central synapse. Accordingly, delayed latencies may not exclusively indicate slowing of motor conduction, while the absence of any response may not indicate complete failure of conduction in corticomotoneurone pathways.

Adult↗
PubMed1985

Lisuride in dystonia.

Lisuride hydrogen maleate, 0.4 to 5 (mean, 3) mg/d, was given orally to 42 subjects with various types of dystonia. In seven of the eight patients who improved (one with segmental dystonia, one with myoclonic dystonia, two with spasmodic torticollis, two with cranial dystonia, and two with tardive dystonia), the response was confirmed by double-blind placebo substitution. No patients with a suspected structural brain lesion improved. There was no consistent pattern of response among those patients with different forms of idiopathic (primary) dystonia. Lisuride improved some patients, but had no effect on other, apparently identical, patients.

Administration, Oral↗
PubMed1983

Acute anticholinergic action in focal dystonia.

We have investigated the effects of the intravenous administration of three anticholinergic drugs (atropine, benztropine, and chlorpheniramine) with variable antihistaminic properties in comparison with saline in adult-onset focal dystonias. In many patients, the severity of the involuntary movements varied from one observation to the next. Patients with spasmodic torticollis, writer's cramp, and segmental dystonia showed little change with any of the active drugs. The occasional individual who improved by more than 20% did so at the expense of drug-induced drowsiness. We conclude that cholinergic mechanisms are not of general importance in the pathogenesis of these conditions. However, the beneficial response to benztropine and chlorpheniramine in two of 20 patients emphasizes the continuing need for a trial-and -error approach in the therapy of these focal dystonias.

Acute Disease↗
PubMed1982

Anticholinergics in adult-onset focal dystonia.

Anticholinergics are one of the most common treatments used in adult-onset focal dystonias although their general efficacy has not been proven. We have investigated the effects of intravenous administration of atropine, benztropine and chlorpheniramine, in comparison to normal saline, in 20 patients with adult-onset focal dystonias (spasmodic torticollis (9), cranial dystonia (6), writer's cramp (5), and have retrospectively reviewed the notes of 78 patients (spasmodic torticollis (38), cranial dystonia (25), writer's cramp (15), who had received chronic oral anticholinergic therapy in varying doses at some time in the past. Patients with spasmodic torticollis and writer's cramp showed no consistent change with any of the intravenous drugs, while the few with cranial dystonia who improved usually did so at the expense of drug-induced sedation. The natural variability of these disorders was evident in the response to normal saline, which caused changes in the scores for severity of the involuntary movements of 20% or more in some patients. Only 8 of the patients who had received chronic oral therapy obtained more than mild benefit, and in 3 of them this improvement was transient. We conclude that cholinergic mechanism are not of general or prime importance in the pathogenesis of adult-onset focal dystonias. However, each new patient warrants a trial of chronic oral anticholinergic therapy in view of the occasional useful responses obtained with these drugs.

Administration, Oral↗
PubMed1982

Writers' cramp-a focal dystonia.

We have examined 29 subjects with writers' cramp (and 4 with typists' and one with pianists' cramp) and have noted two major groupings, simple and dystonic. We have observed spread from one to the other. We have seen repeatedly, in patients with isolated simple writers' cramp certain subtle physical signs which are found also in other basal ganglia diseases. We have noted also the frequent association of other features of segmental and generalized dystonia in patients with dystonic writers' cramp. We have demonstrated that patients with isolated writers' cramp have no higher an incidence of psychiatric disturbance, as judged by formal Present State Examination, than the normal population. We conclude that isolated writers' cramp is a physical illness rather than a psychological disturbance, and that it is a focal dystonia.

Adult↗
PubMed1980

Lisuride in the treatment of Parkinsonism.

Lisuride 1.2-4.8 mg daily was given to 10 patients with severe Parkinsonism for up to 9 months. All had been taking bromocriptine and eight had been taking levodopa combined with carbidopa. Total replacement of bromocriptine by lisuride was achieved in every case, but partial or total levodopa replacement was possible only in five patients. Lisuride 1 mg has approximately the same antiparkinsonian activity as bromocriptine 15 mg or levodopa 250-500 mg combined with carbidopa, but the duration of action of each dose is short, and gastro-intestinal and neuropsychiatric side effects are common. However, lisuride i.v. may be of considerable value in the emergency treatment of severe Parkinsonism.

Administration, Oral↗