Electroconvulsive therapy (ECT) of psychiatric disorders occasionally is complicated by trauma to the patient; the seizures induced may cause dislocations or fractures. Inasmuch as the muscular component of the convulsion is not essential for benefit from the procedure, neuromuscular blocking agents and thiopental are employed. Succinylcholine or mivacurium is used most often because of the brevity of relaxation.
CONTROL OF MUSCLE SPASMS Agents that act in the CNS to block spasms are considered in Chapter 20. Two peripherally-acting agents are used, botulinum toxin (see Chapter 6) and dantrolene. Botulinum toxin A (BOTOX), by blocking ACh release, produces flaccid paralysis of skeletal muscle and diminished activity of parasympathetic and sympathetic cholinergic synapses. Inhibition lasts from several weeks to 3-4 months, and restoration of function requires nerve sprouting. Uses of BOTOX in dermatology and ophthalmology are described in Chapters 62 and 63.
In addition to its use in managing an acute attack of malignant hyperthermia (see above), dantrolene has been used in the treatment of spasticity and hyperreflexia. Dantrolene causes a generalized weakness; thus, its use should be restricted to nonambulatory patients with severe spasticity. Hepatotoxicity has been reported with continued use, requiring liver function tests.
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