The Underutilization of Intrathecal Baclofen in Poststroke Spasticity
The Underutilization of Intrathecal Baclofen in Poststroke Spasticity
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DOI：
10.1310/tsr1803-195
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发表时间：
2011-05-01
影响因子：
2.2
通讯作者：
McGuire, John R.
中科院分区：
文献类型：
--
作者：
Dvorak, Eric M.;Ketchum, Nicholas C.;McGuire, John R.
中风是美国成年人残疾的主要原因之一，据报道有640万人患有中风。痉挛是中风后出现的上运动神经元综合征的临床特征之一。中风后痉挛的患病率从17%到42.6%不等，平均三分之二的痉挛患者有上肢和下肢受累。口服药物和肉毒杆菌神经毒素注射是目前治疗问题性痉挛的方法。然而，这些治疗通常受到副作用或剂量上限的限制。鞘内巴氯芬（ITB）是一种经过验证的方法，用于管理致残性痉挛从多种病因。研究表明，中风后痉挛患者的流动性、日常生活活动和生活质量得到改善。尽管ITB有好处，但只有不到1%的患有严重致残性痉挛的中风患者正在接受ITB治疗。这篇文章将回顾严重卒中后痉挛的患病率和ITB的使用率，并将讨论其在卒中幸存者中有限使用的原因。
Stroke is one of the leading causes of adult disability in the United States, with a reported prevalence of 6.4 million people. Spasticity is one of the clinical features of the upper motor neuron syndrome seen after a stroke. The prevalence of spasticity after a stroke ranges from 17% to 42.6%, and an average of two-thirds of people with spasticity have upper and lower extremity involvement. Oral medications and botulinum neurotoxin injections are current treatments for problematic spasticity. However, these treatments are often limited by side effects or dose ceilings. Intrathecal baclofen (ITB) is a proven method for the management of disabling spasticity from multiple etiologies. Studies have demonstrated improved mobility, activities of daily living, and quality of life in spastic poststroke patients. Despite the benefits of ITB, fewer than 1% of stroke patients with severe disabling spasticity are being treated with ITB. This article will review the prevalence of severe poststroke spasticity and the rate of ITB use and will discuss reasons for its limited use in stroke survivors.