Agarwal Saurabh, Patel Tejas, Shah Nehal, Patel Bhoomika M
Institute of Pharmacy, Nirma University, S.G. Highway, Ahmedabad, 382481, India.
Sparsh Paediatric Rehabilitation Clinic, Navrangpura, Ahmedabad, 380009, India.
Biomed Pharmacother. 2017 Mar;87:628-635. doi: 10.1016/j.biopha.2017.01.005. Epub 2017 Jan 10.
Spasticity from the upper motor neuron syndrome can result from a variety of conditions affecting the cortex or spinal cord. Some of the more common conditions associated with spasticity include spinal cord injury, cerebral palsy, and post-stroke syndrome. In this study we compared the efficacy and safety of baclofen vs tolperisone in spasticity. One hundred fifty patients with cerebral palsy or post stroke or spinal cord injury associated spasticity were enrolled in present study. Group I comprised of Seventy-five patients receiving baclofen and group II comprised of 75 patients receiving tolperisone. For efficacy measurement 4 evaluation methods were used, 1) Modified Ashworth Scale for muscle tone, 2) Medical research council scale for muscle strength and 3) Barthel Index for functional outcome 4) Coefficient of efficacy. In efficacy evaluation, both groups showed significant improvement in muscle tone, muscle strength and functional outcome at week 6 (Group I, 1.55±0.053, 2.79+0.032, 59.31±1.32; Group II, 1.57±0.053, 3.04±0.032, 73±1.32 respectively). In between the group analysis, there was no significant difference in muscle tone improvement in both the groups after 6 weeks (Group I, 1.055±0.053 vs Group II, 1.57±0.053, p>0.05). Group II showed non-significant but greater improvement in muscle strength (Week 6; Group I, 2.79±0.032 vs Group II, 3.04±0.032, p>0.07). Improvement in functional outcomes was greater in group II as compared to group I (Group I, 59.31±1.32 vs Group II, 73±1.32, p<0.05). Overall efficacy coefficient was greater for group II (3.6) as compared to group I (2.3). Baclofen showed more side effects compared to tolperisone in, asthenia being the most frequent. Tolperisone offers greater improvement in activities of daily living compared to baclofen. Tolperisone is more tolerable drug as compared to baclofen.
上运动神经元综合征导致的痉挛可能由多种影响皮层或脊髓的病症引起。一些与痉挛相关的较为常见的病症包括脊髓损伤、脑瘫和中风后综合征。在本研究中，我们比较了巴氯芬与托哌酮治疗痉挛的疗效和安全性。150例患有脑瘫、中风后或脊髓损伤相关痉挛的患者被纳入本研究。第一组由75例接受巴氯芬治疗的患者组成，第二组由75例接受托哌酮治疗的患者组成。为了测量疗效，使用了4种评估方法：1）改良Ashworth肌张力量表；2）医学研究委员会肌力量表；3）Barthel功能结局指数；4）疗效系数。在疗效评估中，两组在第6周时肌张力、肌力和功能结局均有显著改善（第一组分别为1.55±0.053、2.79+0.032、59.31±1.32；第二组分别为1.57±0.053、3.04±0.032、73±1.32）。在组间分析中，6周后两组肌张力改善无显著差异（第一组1.055±0.053 vs第二组1.57±0.053，p>0.05）。第二组肌力改善虽不显著但更大（第6周；第一组2.79±0.032 vs第二组3.04±0.032，p>0.07）。与第一组相比，第二组功能结局改善更大（第一组59.31±1.32 vs第二组73±1.32，p<0.05）。第二组的总体疗效系数（3.6）高于第一组（2.3）。与托哌酮相比，巴氯芬的副作用更多，最常见的是乏力。与巴氯芬相比，托哌酮在改善日常生活活动方面效果更好。与巴氯芬相比，托哌酮是更易耐受的药物。
