Department of Neurology and Neurorehabilitation, Instituto Guttmann, Badalona, Spain.
Clin Neurophysiol. 2011 Jun;122(6):1229-37. doi: 10.1016/j.clinph.2010.09.010. Epub 2010 Oct 2.
Intrathecal baclofen (ITB) is an efficient treatment modality for severe spasticity that is considered to act at the spinal level. Its influence on phasic spasticity is usually determined clinically by testing muscle reflexes, and on tonic spasticity by using scores such as the Modified Ashworth Scale (MAS). Neurophysiological techniques, e.g., soleus H reflex, may provide additional information regarding ITB efficacy. There is, however, only scarce information available on time-response relationships of clinical and neurophysiological measures of spasticity obtained at different levels along the neuroaxis.
Fourteen patients with severe spastic paraparesis underwent serial evaluation of MAS in upper and lower limbs and serial testing of H reflex in soleus and flexor carpi radialis muscles, T wave in quadriceps and biceps brachii muscles, and blink reflex (BR) with and without prepulse, at baseline, and 15, 30, 60, 90, 120, and 180 min following ITB bolus application.
ITB bolus application caused significant suppression of soleus H reflex after 15 min and of quadriceps T wave after 30 min, while MAS dropped significantly after 60 min together with significant suppression of BR R2 area without and with prepulse stimulation. H reflex in flexor carpi radialis and T wave in biceps brachii were not significantly suppressed by ITB. The time course of early changes in soleus H(max)/M(max) ratio and quadriceps T wave indicates a suppression of hyperreflexia at the spinal level, while a later reduction of MAS synchronously with suppression of BR with and without prepulse concurs with a brainstem effect of ITB.
Temporal concurrence between suppression of brainstem reflexes and desired suppression of lower limb muscle hypertonia after ITB bolus application suggests that both may be at least partially mediated from a common CNS region of activity.
Our data concur with a significant brainstem action of ITB.
鞘内注射巴氯芬（ITB）是一种治疗严重痉挛的有效方法，被认为作用于脊髓水平。其对阵挛性痉挛的影响通常通过测试肌肉反射在临床上确定，对强直性痉挛通过使用改良 Ashworth 量表（MAS）等评分确定。神经生理学技术，如比目鱼肌 H 反射，可能提供有关 ITB 疗效的其他信息。然而，关于沿神经轴不同水平获得的痉挛的临床和神经生理学测量的时间-反应关系的信息非常有限。
14 例严重痉挛性截瘫患者接受了上肢和下肢 MAS 的连续评估，以及比目鱼肌和桡侧腕屈肌 H 反射的连续测试、股四头肌和肱二头肌 T 波、眨眼反射（BR），包括有无预脉冲，在基线以及 ITB 推注后 15、30、60、90、120 和 180 分钟时进行。
ITB 推注后 15 分钟比目鱼肌 H 反射明显抑制，30 分钟后股四头肌 T 波明显抑制，60 分钟时 MAS 明显下降，BR 无预脉冲和预脉冲刺激的 R2 区明显抑制。桡侧腕屈肌 H 反射和肱二头肌 T 波未被 ITB 明显抑制。比目鱼肌 H(max)/M(max)比值和股四头肌 T 波早期变化的时间过程表明，脊髓水平的反射亢进被抑制，而 MAS 的后期下降与 BR 有无预脉冲刺激的抑制同时发生，这与 ITB 的脑干效应一致。
ITB 推注后，脑干反射的抑制与下肢肌肉张力过高的期望抑制同时发生，这表明两者至少部分由一个共同的中枢神经系统活动区域介导。
我们的数据与 ITB 的显著脑干作用一致。
