Department of Neurology, Hochzirl Hospital, Zirl, Austria.
Research Unit for Neurorehabilitation, South Tyrol, Bolzano, Italy.
Brain Behav. 2018 Nov;8(11):e01124. doi: 10.1002/brb3.1124. Epub 2018 Sep 28.
Intrathecal baclofen (ITB) is a commonly used treatment in severe spasticity. The main objective of this study was to assess the impact of ITB on reduction or withdrawal of oral drugs in patients with paroxysmal sympathetic hyperactivity (PSH) after severe traumatic brain injury.
We retrospectively evaluated 20 patients with PSH due to severe traumatic brain injury who were treated with ITB in a primary care and referral center of neurology. Rates of and time until complete withdrawal or possible reduction in oral baclofen and oral propranolol after ITB treatment were calculated. Moreover, vegetative parameters (heart rate and blood pressure) as well as hypertonic attacks were assessed.
The median time of complete oral baclofen disposal was 5 ± 3.7 (CI 95% [2.9-7.1], range 0-14) days after ITB pump implantation in 20 of 20 patients, and the median time of complete oral propranolol disposal was 24 ± 62.97 (CI 95% [-7.87-55.87], range 5-191) in 15 of 20 patients. With ITB treatment, PSH improved promptly in all patients with alleviation of heart rate and blood pressure as well as reduction in attacks with motor phenomena. ITB treatment was safe and without complications.
ITB might facilitate cutting back or dispensing with other conventional oral drugs, such as oral baclofen and oral propranolol. Our study provides further evidence that ITB treatment should be considered in patients with otherwise medically refractory PSH in severe traumatic brain injury. Further prospective multicenter studies are needed to confirm the findings of this study.
鞘内注射巴氯芬(ITB)是治疗严重痉挛的常用方法。本研究的主要目的是评估 ITB 对严重创伤性脑损伤后发生阵发性交感神经过度兴奋(PSH)的患者减少或停用口服药物的影响。
我们回顾性评估了 20 例因严重创伤性脑损伤导致 PSH 的患者,他们在初级保健和神经学转诊中心接受 ITB 治疗。计算了 ITB 治疗后完全停用或可能减少口服巴氯芬和口服普萘洛尔的比率和时间。此外,评估了植物神经参数(心率和血压)和高渗性发作。
20 例患者中有 20 例在 ITB 泵植入后 5±3.7(95%CI [2.9-7.1],范围 0-14)天完全停用口服巴氯芬,15 例患者中有 15 例在 24±62.97(95%CI [-7.87-55.87],范围 5-191)天完全停用口服普萘洛尔。所有患者在接受 ITB 治疗后 PSH 迅速改善,心率和血压均得到缓解,运动现象引起的发作减少。ITB 治疗安全,无并发症。
ITB 可能有助于减少或停止其他常规口服药物,如口服巴氯芬和口服普萘洛尔。我们的研究进一步证明,在严重创伤性脑损伤中,对于其他药物治疗无效的 PSH 患者,应考虑 ITB 治疗。需要进一步的前瞻性多中心研究来证实本研究的结果。