McClelland Shearwood, Bethoux Francois A, Boulis Nicholas M, Sutliff Matthew H, Stough Darlene K, Schwetz Kathleen M, Gogol Danuta M, Harrison Michelle, Pioro Erik P
Department of Neurosurgery, University of Minnesota Medical School, Mayo Mail Code 96, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
Muscle Nerve. 2008 Mar;37(3):396-8. doi: 10.1002/mus.20900.
Clinical signs and symptoms of spasticity include hypertonia, involuntary movements (spasms, clonus), decreased range of motion, contractures, and often spasm-related pain. When spasticity is refractory to medical management, patients may be referred for intrathecal baclofen (ITB) pump placement. We reviewed a cohort of amyotrophic lateral sclerosis (ALS) patients with intractable spasticity requiring ITB to further define the impact of ITB on pain relief in this patient population. From 2003 to 2005, eight patients (mean age 43.8 years; 5 men, 3 women) with ALS received ITB for pain associated with intractable spasticity at our institution. Mean disease duration preoperatively was 47.4 months, mean follow-up was 9.8 months, and pain was evaluated using a 0-10 scoring system. All patients experienced spasticity relief in response to a preoperative bolus test injection of ITB (25-50 microg) via lumbar puncture. Following ITB pump placement, the average reduction of pain was 54% (P = 0.0082). Six patients (75%) experienced pain score reduction, three of whom had complete pain relief. Postoperative pain reduction was predicted by the degree of pain reduction following preoperative ITB test injection. These results support ITB as a treatment modality for pain associated with spasticity in ALS.
痉挛的临床体征和症状包括张力亢进、不自主运动（痉挛、阵挛）、活动范围减小、挛缩，以及常与痉挛相关的疼痛。当痉挛对药物治疗无效时，患者可能会被转诊接受鞘内注射巴氯芬（ITB）泵植入。我们回顾了一组患有顽固性痉挛且需要ITB治疗的肌萎缩侧索硬化症（ALS）患者，以进一步明确ITB对该患者群体疼痛缓解的影响。2003年至2005年期间，8例ALS患者（平均年龄43.8岁；5名男性，3名女性）在我们机构接受了ITB治疗，以缓解与顽固性痉挛相关的疼痛。术前平均病程为47.4个月，平均随访时间为9.8个月，采用0至10分评分系统评估疼痛。所有患者在术前通过腰椎穿刺进行ITB（25 - 50微克）推注试验注射后，痉挛均得到缓解。ITB泵植入后，疼痛平均减轻了54%（P = 0.0082）。6例患者（75%）疼痛评分降低，其中3例疼痛完全缓解。术前ITB试验注射后的疼痛减轻程度可预测术后疼痛减轻情况。这些结果支持ITB作为治疗ALS中与痉挛相关疼痛的一种治疗方式。
