Jarrett L, Nandi P, Thompson A J
National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK.
J Neurol Neurosurg Psychiatry. 2002 Dec;73(6):705-9. doi: 10.1136/jnnp.73.6.705.
Established treatment options for managing severe lower limb spasticity and associated pain are of limited value in people with advanced multiple sclerosis (MS). This has resulted in a resurgence of the use of lumbar intrathecal phenol injection (IP). The aim of this study was to investigate the authors' experience with IP.
This observational study collected cross sectional data from patients with progressive MS who received IP for severe lower limb spasticity. Data from 25 patients were collected prospectively before and after treatment. In 15 cases the data related to the first treatment and in 10 to serial injections. Outcome measures collected included the Ashworth scale, a spasm frequency scale, a pain rating score, and the percentage achievement of practical goals.
After injection, all patients demonstrated reduced lower limb tone bilaterally. After the initial injection there was significant improvement on the targeted as compared with the non-targeted side (Wilcoxon rank p=0.003), while no difference in the degree of improvement between the targeted and non-targeted side was seen after serial injections (Wilcoxon rank p=0.731). Twenty four patients were easier to position and 21 had a reduction in their spasm frequency and intensity. Eleven patients with pain reported benefit. Carers found washing and dressing easier in 16 patients and improved safety when using the hoist in 10. Six patients had recurrence of skin breakdown and five patients reported transient adverse changes in their bowel function.
IP can reduce lower limb tone bilaterally after both initial and serial injections. This is most noticeable on the targeted side after initial injection. IP can reduce spasms and pain, leading to improvements in care and overall comfort. IP is an effective treatment option in the management of severe spasticity. Documented selection criteria are essential.
对于晚期多发性硬化症（MS）患者，现有的用于治疗严重下肢痉挛及相关疼痛的方法价值有限。这导致腰椎鞘内酚注射（IP）的使用再度兴起。本研究旨在调查作者使用IP的经验。
这项观察性研究收集了因严重下肢痉挛接受IP治疗的进展型MS患者的横断面数据。前瞻性收集了25例患者治疗前后的数据。其中15例数据与首次治疗有关，10例与连续注射有关。收集的结果指标包括Ashworth量表、痉挛频率量表、疼痛评分以及实际目标达成百分比。
注射后，所有患者双侧下肢肌张力均降低。首次注射后，与非靶向侧相比，靶向侧有显著改善（Wilcoxon秩和检验p = 0.003），而连续注射后靶向侧与非靶向侧改善程度无差异（Wilcoxon秩和检验p = 0.731）。24例患者更易于摆放体位，21例患者的痉挛频率和强度降低。11例疼痛患者报告症状改善。护理人员发现16例患者的洗漱和穿衣变得更容易，10例患者使用升降机时安全性提高。6例患者出现皮肤破损复发，5例患者报告肠道功能有短暂不良变化。
IP在首次注射和连续注射后均可双侧降低下肢肌张力。首次注射后在靶向侧最为明显。IP可减轻痉挛和疼痛，从而改善护理和整体舒适度。IP是治疗严重痉挛的有效选择。记录选择标准至关重要。
