Broseta J, Morales F, García-March G, Sánchez-Ledesma M J, Anaya J, Gonzalez-Darder J, Barberá J
Department of Neurosurgery, Hospital Virgen de la Vega, Salamanca, Spain.
Acta Neurochir Suppl (Wien). 1989;46:39-45. doi: 10.1007/978-3-7091-9029-6_9.
On the basis of previous experimental and clinical studies patients with severe spasticity due to spinal cord damage from multiple sclerosis in 8 cases and postraumatic paraplegia in 6 and resistent to all conservative treatments were selected for a trial with morphine and baclofen administered intrathecally through a catheter placed in the spinal subarachnoid space rostral to the affected segments and attached to a subcutaneous reservoir. Whereas morphine single injection did not show any benefit, baclofen bolus injection 30 to 60 micrograms, revealed a marked decrease of spasticity and associated symptoms in 8 cases. After checking the clinical effect during 3 weeks and changes in electroneurophysiological studies and bladder manometry the catheter was attached to a subcutaneous programmable pump able to be refilled percutaneously and administered baclofen continuously or more often following a multistep complex programme in total doses of 90 to 150 micrograms per day. After a mean follow-up of 5 months all cases showed an absence of spasms and pain, a notable improvement for bettering of sphincter functions and a marked muscle relaxation that improves motor capacity, leading to increased ambulation or mobility. Neither complications nor side-effects were observed.
基于先前的实验和临床研究，选取了8例因多发性硬化症导致脊髓损伤而出现严重痉挛的患者、6例创伤后截瘫且对所有保守治疗均无效的患者，通过置于受影响节段上方脊髓蛛网膜下腔的导管鞘内注射吗啡和巴氯芬，并连接皮下储液器进行试验。单次注射吗啡未显示出任何益处，而30至60微克的巴氯芬推注在8例患者中显示出痉挛及相关症状明显减轻。在检查3周内的临床效果以及神经电生理研究和膀胱测压的变化后，将导管连接到一个可经皮重新填充的皮下可编程泵上，并按照多步骤复杂程序持续或更频繁地给予巴氯芬，每日总剂量为90至150微克。平均随访5个月后，所有病例均未出现痉挛和疼痛，括约肌功能明显改善，肌肉显著松弛，运动能力提高，步行或活动能力增强。未观察到并发症或副作用。
