Theophylline

Exacerbation of spasticity Within 36 hours of administering theophylline {dose not statedl for chronic obstructive pulmonary disease, a patient with an ischaemic cerebrovascular accident lost selective finger and wrist motion and had notable exacerbation of spasticity of his hemiplegic limbs. The patient complained of increased shoulder pain and muscle spasm although no shoulder trauma or subluxation was identified. Despite aggress i \ C therapy consisting of heat, passive and active assistive range of motion, and compressive modalilies, full finger and wrist extension was no longer possible and shoulder rotation was decreased. Thirty-six hours after Aleopbylline was discontinued, because of lack of therapeutic benefit, the patient regained selective movement of his fingers and wrist as well as the elbow and shoulder. Forty-eight hours after theophylline was ~Iopped. the range of motion was again normal. To confirm a cause-etTect relationship between theophylline and increased spasticity, the drug was readministered at a dosage of 300mg every 8 hours. Thirty­six hours later, the upper extremity tone had increased, the range of motion was limited and selective finger and wrist motion were lost to' the same degree as before. Theophylline was discontinued once again and all symptoms resolved. Two mechanisms of actions have been proposed. Theophylline is known to have a d irec! vaSGcon strictor effect on the cerebral circulation and the heightened spasticity may have been secondary to a funhcr cerebral ischaemic state. Alternatively, theophylline through IOhibition of phosphodiesterase has been shown to increase cyclic AMP, producing an increase in calcium influx and subsequent release of acetylcholine at the neuromuscular junction. An increase in the neurotransmitter may account for the increased spasticity. Clark, J.E. and Devenp<)rt. 1.K.: Journal of Ihe American Med".1 "'''''''i.lion 2S0: 485 (22·29 lui 19&3)

0157-7271/83/0826·000710$01.00/0 © ADIS Press Reactions 26 Aug 1983 7