鞘内注射巴氯芬对患有多发性硬化症相关痉挛患者步行能力影响的评估。

Evaluation of the impact of intrathecal baclofen on the walking ability of people with Multiple Sclerosis related spasticity.

作者信息

Sammaraiee Y, Stevenson V L, Keenan E, Buchanan K, Lee H, Padilla H, Farrell R A

机构信息

National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK.

National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK; University College London, Queen Square, Institute of Neurology, London, UK.

出版信息

Mult Scler Relat Disord. 2020 Nov;46:102503. doi: 10.1016/j.msard.2020.102503. Epub 2020 Sep 20.

DOI:10.1016/j.msard.2020.102503

PMID:33032053

Abstract

BACKGROUND

Spasticity is a frequent and disabling symptom in people with Multiple Sclerosis (MS). Intrathecal baclofen (ITB) is an effective but infrequently used treatment in ambulant people.

OBJECTIVE

To evaluate the impact of ITB on ambulation in people with moderate to severe MS related spasticity.

METHODS

Data was collected prospectively regarding spasticity and ambulation at baseline, after ITB trial via lumbar puncture, 3 months and annually thereafter.

RESULTS

30 subjects; Mean age 47.9 (26-64), 67% female, mean EDSS 6.5 [6.5-7.5]. Reduction in mean Ashworth score (pre 1.44: post 0.98, p<0.001) and Penn spasm score (pre 3: post 1; p<0.001) was shown. 20 people (67%) proceeded with implantation; lower limb MRC power was predictive of proceeding to pump (OR 2.98; 95% CI 1.01 - 8.7; p <0.05). In those proceeding to implantation there was no difference in 10mTW at 1 year (ANOVA (F(3,24) = 2.6, p=0.13). Currently, 15 (75%) remain ambulatory (mean 3.75 years, range 1-9). After implant, 17 (85%) discontinued all oral anti-spasticity treatments conferring other benefits.

CONCLUSION

Ambulation in people with MS can be preserved for several years whilst effectively treating spasticity with ITB with careful patient selection; ITB should not be considered a last resort.

摘要

背景

痉挛是多发性硬化症（MS）患者常见且致残的症状。鞘内注射巴氯芬（ITB）是一种有效的治疗方法，但在能行走的患者中使用较少。

目的

评估ITB对中度至重度MS相关痉挛患者行走能力的影响。

方法

前瞻性收集患者基线时、经腰椎穿刺进行ITB试验后、3个月时以及此后每年的痉挛和行走能力数据。

结果

30名受试者；平均年龄47.9岁（26 - 64岁），67%为女性，平均扩展残疾状态量表（EDSS）评分为6.5 [6.5 - 7.5]。平均Ashworth评分降低（术前1.44：术后0.98，p<0.001），Penn痉挛评分降低（术前3：术后1；p<0.001）。20人（67%）进行了植入；下肢医学研究委员会（MRC）肌力是继续使用泵的预测因素（比值比2.98；95%置信区间1.01 - 8.7；p <0.05）。在进行植入的患者中，1年后10米步行试验（10mTW）无差异（方差分析（F(3,24) = 2.6，p = 0.13）。目前，15人（75%）仍能行走（平均3.75年，范围1 - 9年）。植入后，17人（85%）停止了所有具有其他益处的口服抗痉挛治疗。