Becker W J, Harris C J, Long M L, Ablett D P, Klein G M, DeForge D A
University of Calgary, Alberta, Canada.
Can J Neurol Sci. 1995 Aug;22(3):208-17. doi: 10.1017/s031716710003986x.
Severe spasticity unresponsive to oral drugs may respond satisfactorily to baclofen delivered intrathecally.
Intrathecal baclofen (IB) therapy delivered by means of implanted infusion pumps was used for nine patients with severe spasticity. Six patients had multiple sclerosis, two cervical spinal cord injury, and one head injury. All were non-ambulatory.
Patients showed improvement in many areas, including ability to transfer, seating, pain control, personal care, and liability to skin breakdown. Before IB therapy, only three of the nine patients were able to live at home in the community and six were institutionalized. At the end of our follow-up period, only one patient remained institutionalized, three lived in group homes and five lived at home in the community. In the year preceding pump implantation, the nine patients spent a total of 755 days in acute care hospitals. In the year following onset of IB therapy, they spent only 259 days in hospital.
IB therapy can improve patient quality of life and can be cost-effective in carefully selected patients with severe spasticity and disability. The drug delivery catheter is that part of the therapeutic system most vulnerable to failure. Because of the varied expertise required to manage these patients effectively, and the potential for a variety of complications, it is essential that an IB program is supported by a well-organized multi-disciplinary medical team.
对口服药物无反应的严重痉挛可能对鞘内注射巴氯芬反应良好。
通过植入式输注泵进行鞘内巴氯芬（IB）治疗，用于9例严重痉挛患者。6例患有多发性硬化症，2例患有颈髓损伤，1例患有头部损伤。所有患者均无法行走。
患者在多个方面有所改善，包括转移能力、坐位、疼痛控制、个人护理以及皮肤破损易感性。在进行IB治疗前，9例患者中只有3例能够在社区居家生活，6例被安置在机构中。在我们的随访期结束时，只有1例患者仍住在机构中，3例住在集体之家，5例在社区居家生活。在植入泵前的一年中，这9例患者在急症医院共住院755天。在开始IB治疗后的一年中，他们仅住院259天。
IB治疗可改善患者生活质量，对于精心挑选的严重痉挛和残疾患者可能具有成本效益。给药导管是治疗系统中最易出现故障的部分。由于有效管理这些患者需要多种专业知识，且存在各种并发症的可能性，因此IB治疗项目必须有组织良好的多学科医疗团队支持。
