Kamin F, Rommer P S, Abu-Mugheisib M, Koehler W, Hoffmann F, Winkelmann A, Benecke R, Zettl U K
1] Department of Neurology, University of Rostock, Rostock, Germany [2] Department of Pathology, MVZ Hochstraße, Brandenburg an der Havel, Germany.
1] Department of Neurology, University of Rostock, Rostock, Germany [2] Department of Neurology, Medical University of Vienna, Vienna, Austria.
Spinal Cord. 2015 Feb;53(2):109-13. doi: 10.1038/sc.2014.155. Epub 2014 Sep 16.
Multiple sclerosis (MS) is an autoimmune disease affecting young people and is a major cause of disability. In the course of time, disability progresses and symptoms like spasticity may occur. Spasticity is a major cost factor in MS patients. Various agents are approved for the treatment of spasticity, but each of those agents may have several side effects. Intrathecally administered steroids (triamcinolone-acetonide (TCA)) may be efficient in treating spasticity in patients with lesions in the spinal cord and no response to first-line therapeutics. The aim of this study is to show effects of TCA treatment on clinical parameters in patients with MS.
This multicentre open label study included 54 patients with MS. The clinical outcome parameters were spasticity, disability, maximum walking distance, bladder function and quality of life. All patients received physiotherapy in addition to TCA treatment to obtain optimal effects on clinical parameters.
Spasticity, maximum walking distance as well as disability improved significantly (P ⩽ 0.001) during TCA applications. Bladder function improved in every seventh patient.
We observed the effects of intrathecally administered TCA on different clinical parameters including bladder function. TCA administration is a safe method to treat different symptoms in MS patients. Longitudinal trials with repeated TCA cycles are needed to show long-term effects. Besides TCA treatment, physiotherapy contributes to the improvement of clinical parameters.
多发性硬化症（MS）是一种影响年轻人的自身免疫性疾病，是导致残疾的主要原因。随着时间推移，残疾会逐渐加重，可能会出现痉挛等症状。痉挛是MS患者的一个主要成本因素。多种药物被批准用于治疗痉挛，但每种药物都可能有多种副作用。鞘内注射类固醇（曲安奈德（TCA））可能对脊髓有病变且对一线治疗无反应的患者治疗痉挛有效。本研究的目的是展示TCA治疗对MS患者临床参数的影响。
这项多中心开放标签研究纳入了54例MS患者。临床结局参数包括痉挛、残疾程度、最大步行距离、膀胱功能和生活质量。所有患者在接受TCA治疗的同时还接受了物理治疗，以获得对临床参数的最佳效果。
在应用TCA期间，痉挛、最大步行距离以及残疾程度均有显著改善（P⩽0.001）。每七名患者中有一名患者的膀胱功能得到改善。
我们观察到鞘内注射TCA对包括膀胱功能在内的不同临床参数的影响。TCA给药是治疗MS患者不同症状的一种安全方法。需要进行重复TCA周期的纵向试验来展示长期效果。除了TCA治疗外，物理治疗有助于改善临床参数。
