Zachariah S B, Borges E F, Varghese R, Cruz A R, Ross G S
Neurology Service (127), Veterans Affairs Medical Center, Bay Pines, FL 33504.
Am J Med Sci. 1994 Jul;308(1):38-40. doi: 10.1097/00000441-199407000-00009.
Divalproex sodium (DVS; Depakote) is a commonly used antiepileptic agent that increases the levels of gamma aminobutyric acid. Spasticity from different causes may be due to a deficiency of inhibitory transmitters like gamma aminobutyric acid or an excess of excitatory neurotransmitters. Spasticity also may be accompanied by pain. The authors administered DVS orally for pain and spasticity in three patients with a history of spinal cord injury and one patient with a history of head injury. Three patients had marked improvement in spasticity and pain. One patient, who had some symptomatic improvement in spasticity, could not tolerate DVS because of gastric irritation. In contrast to the side effects of sedation and increased motor weakness associated with antispasticity drugs commonly used, no such side effects were detected with DVS. It is suggested that a possible enhancement by DVS of gamma aminobutyric acid-ergic postsynaptic inhibition of motor reflex arc in the spinal cord may represent a new nonsedating, management approach for spasticity as a result of traumatic spinal cord and head injuries.
丙戊酸钠（DVS；德巴金）是一种常用的抗癫痫药物，可提高γ-氨基丁酸水平。不同原因引起的痉挛可能是由于γ-氨基丁酸等抑制性递质缺乏或兴奋性神经递质过多所致。痉挛还可能伴有疼痛。作者对3例有脊髓损伤病史的患者和1例有头部损伤病史的患者口服丙戊酸钠治疗疼痛和痉挛。3例患者的痉挛和疼痛有明显改善。1例痉挛有一定症状改善的患者因胃部刺激无法耐受丙戊酸钠。与常用抗痉挛药物相关的镇静和运动无力增加等副作用不同，丙戊酸钠未检测到此类副作用。提示丙戊酸钠可能增强脊髓运动反射弧中γ-氨基丁酸能突触后抑制，这可能代表一种治疗创伤性脊髓和头部损伤所致痉挛的新的非镇静管理方法。
