Natale M, Mirone G, Rotondo M, Moraci A
Department of Neurosurgery, Second University of Naples SUN, Naples, Italy.
Clin Neurol Neurosurg. 2012 May;114(4):321-5. doi: 10.1016/j.clineuro.2011.10.046. Epub 2011 Nov 21.
Intrathecal baclofen therapy (ITB) is a well-known treatment for spasticity. Despite this fact, several topics have to be still discussed: new indications and screening tools, appropriate surgical timing and complicance avoidance.
A total of 112 consecutive patients all with a severe, progressive and refractory to medical therapy spasticity from different causes were treated using ITB, after a bolus test. Every patient was assessed by means of Modified Ashworth Scale (MAS), Penn spasm frequency scale (SFS) and Visual Analog Scale for pain. Since available, a Gait analysis was also performed.
There were 63 males (56%) and 49 females (44%). Seventy-four (66%) had a quadriparesis, 34 (30.4%) had a paraparesis and 4 (3.6%) were hemiplegic. Among these patients 77 (68.7%) were non ambulatory, while 35 (31.3%) were ambulatory. These patients suffered from spasticity due to many different diseases. Mean follow-up was 55 months. The mean Modified Ashworth score decreased from 4.5±0.5 preoperatively to 1.2±0.4 on chronic intrathecal baclofen. Daily baclofen dose varied between 23 and 500 mcg. Drug-induced complications and catheter related problems occurred, respectively in 7 (6.3%) and 10 patients (8.9%).
Although ITB is a well known and good treatment option in the management of severe spasticity, because of the different goals and subgroups of patients treated, a variety of techniques are needed to evaluate the benefits of this therapy. New indications, effects of ITB on central nervous system and cognitive functions needs yet to be fully clarified.
鞘内注射巴氯芬疗法（ITB）是一种治疗痉挛的知名方法。尽管如此，仍有几个问题有待讨论：新的适应症和筛查工具、合适的手术时机以及避免并发症。
共有112例连续患者，均因不同原因导致严重、进行性且药物治疗无效的痉挛，在进行推注试验后接受ITB治疗。每位患者均通过改良Ashworth量表（MAS）、宾夕法尼亚痉挛频率量表（SFS）和视觉模拟疼痛量表进行评估。如有条件，还进行了步态分析。
男性63例（56%），女性49例（44%）。74例（66%）为四肢瘫，34例（30.4%）为截瘫，4例（3.6%）为偏瘫。这些患者中，77例（68.7%）不能行走，35例（31.3%）能够行走。这些患者因多种不同疾病而出现痉挛。平均随访时间为55个月。改良Ashworth评分的平均值从术前的4.5±0.5降至鞘内长期注射巴氯芬后的1.2±0.4。每日巴氯芬剂量在23至500微克之间。药物引起的并发症和与导管相关的问题分别发生在7例（6.3%）和10例患者（8.9%）中。
尽管ITB是治疗严重痉挛的一种知名且良好的选择，但由于治疗的患者目标和亚组不同，需要多种技术来评估这种疗法的益处。ITB的新适应症、对中枢神经系统和认知功能的影响仍有待充分阐明。
