RELIEF OF SPASTICITY IN SCI MEN AND WOMEN USING RECTAL PROBE ELECTROSTIMULATION

Although there are numerous approaches to the treatment of spasticity, many patients are still unable to find a satisfactory method of manag ing their spasms with acceptable side effects. In the course of our fe rtility studies using rectal probe electrostimulation (RPES) in SCI me n to produce ejaculation, we observed that a majority of the men exper ienced significant relief of their spasticity for many hours. This rep ort describes a prospective, single-blinded study of this phenomenon i n six SCI men and three SCI women who underwent RPES a total of 71 tim es. The mean age of the subjects was 28.2 years (21-41), the mean time from injury was 6.0 years (0.5-15); there were three paraplegic and s ix quadriplegic persons: four were Frankel class A and five were class B. Although all subjects had moderate to severe spasticity, only four took antispasm medications; one had undergone surgery for implantatio n of an epidural stimulator. The effectiveness of RPES on spasticity w as evaluated by each subject for frequency of spasms and interference of daily activities and by independent, blinded assessors for tone, fr equency of spasms and DTRs; four patients underwent quantitative video tape analysis of the pendulum test and two underwent somatosensory evo ked potentials (SSEPs) to evaluate electrical activity in the central nervous system. Treatment Variables included varying probe sizes and n umber of stimulations. All subjects experienced good to excellent decr ease in tone, frequency of spasms and interference with ADL from 3 to 24 hours depending on treatment variables used. Mean duration of relie f was 8.2 hours. Only one man ejaculated consistently with stimulation and there was no difference in spasticity relief between men and wome n and between the anejaculatory and ejaculatory males. There was no re lation between subject age, age of injury, level or completeness of in jury and relief of spasticity. All subjects felt RPES was more effecti ve than medications, stretching or other modalities in relieving spasm s, including the one subject with the epidural stimulator. No untoward effects were reported.