Bensmail D, Quera Salva M A, Roche N, Benyahia S, Bohic M, Denys P, Bussel B, Lofaso F
Physical Medicine and Rehabilitation Department, AP-HP, Hôpital Raymond Poincaré, Université Versailles-Saint-Quentin, Garches, France.
Neurology. 2006 Oct 24;67(8):1432-6. doi: 10.1212/01.wnl.0000239827.38036.23.
To prospectively evaluate the effect of pump-infused intrathecal baclofen infusion (ITB) in therapeutic doses on sleep quality and on daytime and nighttime respiratory function in patients with severe spasticity.
We prospectively evaluated 20 consecutive patients (mean +/- SD age 45 +/- 13 years). We assessed spasticity and obtained polysomnography, pulmonary function tests, and resting energy expenditure measurements 1 week before and at least 8 days after pump implantation. Patients stopped oral baclofen upon pump implantation but continued other medications unchanged. We report descriptive statistics as means +/- SD.
Most of the patients had multiple sclerosis (n = 9) or spinal cord injury (n = 8); there was one case each of cerebral palsy, hereditary spastic paraplegia, and Friedreich ataxia. Before and after ITB initiation, mean Ashworth scores were 2.75 +/- 0.85 and 1.15 +/- 0.36, and mean spasm scores were 3.75 +/- 0.55 and 1.00 +/- 0.56. ITB improved total sleep time (p = 0.05) and sleep efficiency (p = 0.01) and reduced periodic leg movements (p = 0.02). ITB did not modify sleep-related respiratory events, lung function tests, CO2 rebreathing response, or resting energy expenditure.
Compared with oral baclofen, intrathecal baclofen infusion did not affect respiratory function and improved sleep continuity. Intrathecal baclofen infusion in therapeutic doses may act at the spinal level rather than at the supraspinal level.
前瞻性评估治疗剂量的泵注鞘内巴氯芬输注（ITB）对严重痉挛患者睡眠质量以及白天和夜间呼吸功能的影响。
我们前瞻性评估了连续20例患者（平均±标准差年龄45±13岁）。在泵植入前1周和植入后至少8天，我们评估了痉挛情况，并进行了多导睡眠图、肺功能测试和静息能量消耗测量。患者在泵植入后停用口服巴氯芬，但其他药物维持不变。我们以均值±标准差报告描述性统计数据。
大多数患者患有多发性硬化症（n = 9）或脊髓损伤（n = 8）；各有1例脑性瘫痪、遗传性痉挛性截瘫和弗里德赖希共济失调。在开始ITB治疗前后，平均Ashworth评分分别为2.75±0.85和1.15±0.36，平均痉挛评分为3.75±0.55和1.00±0.56。ITB改善了总睡眠时间（p = 0.05）和睡眠效率（p = 0.01），并减少了周期性腿部运动（p = 0.02）。ITB未改变与睡眠相关的呼吸事件、肺功能测试、二氧化碳再呼吸反应或静息能量消耗。
与口服巴氯芬相比，鞘内巴氯芬输注不影响呼吸功能，且改善了睡眠连续性。治疗剂量的鞘内巴氯芬输注可能作用于脊髓水平而非脊髓上水平。
