一种在面对感染的巴氯芬泵时避免巴氯芬戒断的新方法。

A Novel Approach to Avoid Baclofen Withdrawal When Faced With Infected Baclofen Pumps.

机构信息

Department of Neurosurgery, Albany Medical Center, Albany, New York, USA.

Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA.

出版信息

Neuromodulation. 2019 Oct;22(7):834-838. doi: 10.1111/ner.12873. Epub 2018 Oct 16.

DOI:10.1111/ner.12873

PMID:30325089

Abstract

BACKGROUND

Intrathecal (IT) Baclofen is beneficial for spasticity, but if pumps become infected necessitating removal, baclofen withdrawal is difficult to manage and life-threatening. Furthermore there is no consistency between dosing and severity of withdrawal. Case reports detail full baclofen withdrawal at dosages of 260 μg/day.

OBJECTIVE

To demonstrate that in patients on stable IT baclofen for prolonged periods, externalizing a patient's original IT pump is a safe, effective way to wean IT doses.

METHODS

Here, we describe a technique of continuing IT baclofen when urgent pump removal is needed. Specifically, we remove the infected pump. Then using a new or existing lumbar drain based on extent of infection, we reconnect the pump after cleaning with betadine and administer therapy externally during IT weaning.

RESULTS

Hundred forty seven baclofen pumps were implanted or replaced within four years. Infections occurred in seven patients. We utilized this technique in five of seven patients. Mean IT dose at time of explant was 400.5 ± 285.3 μg/day. We titrated the dose by 20-50% per day based on clinical response over a mean of 6.2 ± 1.3 days. The catheter was removed at bedside once weaning was complete. No patients had any signs of withdrawal, excluding minimal spasticity increases while optimizing oral treatment.

CONCLUSION

Here, we show preliminary evidence that an externalized IT pump is an effective means of weaning IT baclofen when infection of the pump occurs. This treatment strategy warrants further investigation, but appears to be a safe and effective.

CONFLICT OF INTEREST

Dr. Pilitsis is a consultant for Medtronic, Boston Scientific, Nevro, Jazz Pharmaceuticals, Neurobridge Therapeutics, and Abbott and receives grant support from Medtronic, Boston Scientific, Abbott, Nevro, Jazz Pharmaceuticals, GE Global Research and NIH 1R01CA166379. She is medical advisor for Centauri and Karuna and has stock equity. Dr. Sukul receives consultant fees from Medtronic. Julia Prusik receives grant support from Jazz Pharmaceuticals.

摘要

背景

鞘内（IT）巴氯芬有益于痉挛，但如果泵感染需要移除，巴氯芬戒断则难以管理且危及生命。此外，剂量与戒断严重程度之间没有一致性。病例报告详细描述了在每天 260μg 的剂量下完全戒断巴氯芬的情况。

目的

证明对于长期接受稳定 IT 巴氯芬治疗的患者，将患者原始的 IT 泵外化是一种安全、有效的戒断 IT 剂量的方法。

方法

在这里，我们描述了一种在急需移除感染泵时继续 IT 巴氯芬治疗的技术。具体来说，我们移除感染的泵。然后，根据感染的严重程度，使用新的或现有的腰椎引流管，在对其进行贝他定清洁后重新连接泵，并在 IT 戒断期间进行外部治疗。

结果

在四年内共植入或更换了 147 个巴氯芬泵。有 7 名患者发生感染。我们在其中 5 名患者中使用了这种技术。在泵取出时，患者的 IT 剂量平均值为 400.5±285.3μg/天。我们根据平均 6.2±1.3 天的临床反应，每天将剂量减少 20-50%。一旦戒断完成，即可在床边取出导管。没有患者出现戒断迹象，除了在优化口服治疗时轻微增加痉挛。

结论

在这里，我们初步证明了当泵感染时，将 IT 泵外化是戒断 IT 巴氯芬的有效方法。这种治疗策略需要进一步研究，但似乎是安全有效的。

利益冲突

Pilitsis 博士是 Medtronic、Boston Scientific、Nevro、Jazz Pharmaceuticals、Neurobridge Therapeutics 和 Abbott 的顾问，并从 Medtronic、Boston Scientific、Abbott、Nevro、Jazz Pharmaceuticals、GE 全球研究和 NIH 1R01CA166379 获得研究资助。她是 Centauri 和 Karuna 的医疗顾问，拥有股票权益。Sukul 博士收取 Medtronic 的咨询费。Julia Prusik 从 Jazz Pharmaceuticals 获得研究资助。