INTRATHECAL BACLOFEN FOR SEVERE SPASTICITY
INTRATHECAL BACLOFEN FOR SEVERE SPASTICITY
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DOI：
10.1111/j.1749-6632.1988.tb31822.x
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发表时间：
1988-06-01
影响因子：
5.2
通讯作者：
PENN, RD
中科院分区：
文献类型：
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作者：
PENN, RD
在过去的三年里，我们采取了一种新的方法来控制痉挛。这是基于临床观察，口服巴氯芬可减轻脊髓完全解剖横断患者的痉挛。这意味着巴氯芬可以通过单独作用于脊髓回路而具有其临床效果。获得良好治疗反应的困难在于口服巴氯芬均匀分布于脑和脊髓，因此全身药物浓度的增加导致嗜睡和精神混乱沿着痉挛的控制。解决的办法是通过优先灌注脊髓来改变药物的分布。为了实现这一点，将植入的药物泵连接到导管，并将巴氯芬缓慢注射到腰椎脑脊液（CSF）中。这种药物输送方式的改变结果是戏剧性的。那些痉挛状态非常严重的病人，他们的肌肉张力已经降低到正常水平，痉挛也减少了，所以他们不再引起症状。巴氯芬的日剂量可以减少一百倍，不会发生中枢副作用。在本文中，我将首先介绍我们对16例长期鞘内注射巴氯芬患者的临床研究结果，然后讨论该技术似乎如此有效的原因，以及可以为药物泵的其他神经学应用提供哪些经验教训。
Over the past three years, we have taken a new approach to the control of spasticity. It is based on the clinical observation that oral baclofen reduces spasticity in patients with complete anatomical transection of the spinal cord. This means that baclofen can have its clinical effect by acting solely upon spinal circuitry. The difficulty in achieving a good therapeutic response is that oral baclofen is distributed equally to the brain and spinal cord, so that increases in systemic drug concentration result in drowsiness and mental confusion along with control of spasticity. The solution is to change the distribution of drug by preferentially perfusing the spinal cord. To accomplish this, an implanted drug pump is connected to a catheter and baclofen is slowly injected into the lumbar cerebrospinal fluid (CSF). The results of this modification in drug delivery are dramatic.’Patients whose spasticity had been so severe that surgical procedures to cut nerve roots had been considered have had their muscle tone reduced to normal and spasms reduced so they no longer cause symptoms. The daily dose of baclofen can be reduced one hundredfold and central side effects do not occur. In this paper I will first present the results of our clinical studies on sixteen patients on chronic intrathecal baclofen and then discuss the reasons why the technique seems to work so well, and what lessons can be drawn for other neurological applications of drug pumps.