Boster Aaron, Nicholas Jacqueline, Bartoszek Mary Pat, O'Connell Colleen, Oluigbo Chima
Multiple Sclerosis Center, Department of Neurology (AB, JN, MPB, C. O'Connell), and Department of Neurosurgery (C. Oluigbo), The Ohio State University Medical Center, Columbus.
Neurol Clin Pract. 2014 Apr;4(2):123-130. doi: 10.1212/cpj.0000000000000000.
Spasticity is a debilitating symptom associated with numerous neurologic conditions. While intrathecal baclofen therapy (ITB) is an established treatment for spasticity, complications can lead to loss of efficacy (LOE) and baclofen withdrawal. Untreated withdrawal syndrome can be fatal. Prompt diagnosis and management of LOE is essential. Numerous methods have been described in the literature for diagnosing the cause of LOE. Many of the methods require equipment not readily available in the outpatient setting. Furthermore, there is no established consensus on the sequencing of these diagnostic tests. Herein, we review ITB literature on troubleshooting LOE for applicability to the managing clinician. Using this information and our clinical experience, we propose an algorithm with management recommendations to simplify and expedite the troubleshooting process in the outpatient setting.
痉挛是一种与多种神经系统疾病相关的使人衰弱的症状。虽然鞘内注射巴氯芬疗法（ITB）是治疗痉挛的既定方法，但并发症可能导致疗效丧失（LOE）和巴氯芬戒断。未经治疗的戒断综合征可能是致命的。及时诊断和处理疗效丧失至关重要。文献中描述了许多用于诊断疗效丧失原因的方法。其中许多方法需要门诊环境中不易获得的设备。此外，对于这些诊断测试的顺序尚无既定的共识。在此，我们回顾ITB文献中关于解决疗效丧失问题的内容，以确定其对临床管理人员的适用性。利用这些信息和我们的临床经验，我们提出一种带有管理建议的算法，以简化和加快门诊环境中的故障排除过程。
