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[鞘内注射巴氯芬与肉毒杆菌毒素治疗小儿脑性瘫痪]

[Intrathecal baclofen and Botulinum toxin in infantile cerebral palsy].

作者信息

Téllez de Meneses M, Barbero P, Alvarez-Garijo J A, Mulas F

机构信息

Hospital Universitario La Fe, 46009 Valencia, Espana.

出版信息

Rev Neurol. 2005 Jan 15;40 Suppl 1:S69-73.

Abstract

INTRODUCTION

Infantile cerebral palsy is considered to be a motor disorder affecting both posture and movement. It is the manifestation of a cerebral lesion that took place during the maturing process of the brain. Spastic cerebral palsy is the most frequent variety. The spasticity presented by these patients strongly influences their functioning and gives rise to several complications that affect their quality of life.

AIMS AND DEVELOPMENT

The main aim of this study is to determine a set of suitable and effective therapeutic steps that can be used to improve patients' spasticity and to prevent the complications that stem from them, such as contractures, deformities, surgery, etc. Multiple treatments were used, including physiotherapy, rehabilitation and oral pharmacotherapy, with few satisfactory results. At present there are two very promising therapeutic alternatives for patients with infantile cerebral palsy: Botulinum toxin, which we already have a great deal of experience with, and intrathecal treatment with baclofen. We report on a series of 10 patients aged between 8 and 15 years who had had an intrathecal baclofen infusion pump implanted. To date (maximum follow-up: 12 months), their clinical course has been satisfactory in most cases, with no severe complications related to the surgical technique, except in one individual who presented a fistula that resolved spontaneously.

CONCLUSIONS

Intrathecal baclofen seems to be a very useful alternative in the treatment of spasticity to improve the quality of life of these patients and those around them.

摘要

引言

小儿脑瘫被认为是一种影响姿势和运动的运动障碍。它是大脑成熟过程中发生的脑损伤的表现。痉挛型脑瘫是最常见的类型。这些患者出现的痉挛强烈影响其功能,并引发多种影响其生活质量的并发症。

目的与进展

本研究的主要目的是确定一套合适且有效的治疗措施,可用于改善患者的痉挛状况,并预防由痉挛引发的并发症,如挛缩、畸形、手术等。采用了多种治疗方法,包括物理治疗、康复治疗和口服药物治疗,但效果不尽人意。目前,对于小儿脑瘫患者有两种非常有前景的治疗选择:我们已经积累了大量经验的肉毒杆菌毒素,以及鞘内注射巴氯芬治疗。我们报告了一系列10例年龄在8至15岁之间且已植入鞘内巴氯芬输注泵的患者。迄今为止(最长随访时间:12个月),大多数病例的临床过程令人满意,除了1例出现自发愈合的瘘管的个体外,未发生与手术技术相关的严重并发症。

结论

鞘内注射巴氯芬似乎是治疗痉挛的一种非常有用的选择,可改善这些患者及其周围人群的生活质量。

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