Mertens P, Parise M, Garcia-Larrea L, Benneton C, Millet M F, Sindou M
Department of Neurosurgery, Hopital Neurologique, Lyon, France.
Acta Neurochir Suppl. 1995;64:17-25. doi: 10.1007/978-3-7091-9419-5_5.
Seventeen patients with severe disabling spinal spasticity were selected and treated by chronic intrathecal baclofen infusion using an implanted programmable pump. Nine patients were tetraparetic, seven were paraplegic and one paraparetic. Patients were regularly followed for 5 to 69 months (mean 37.5 months). The clinical efficacy of baclofen was estimated by means of evaluation of: hypertonia, spasms, pain and functional disability. All patients experienced significant amelioration of quality of life secondary to reduction of hypertonia, spasms and pain related to contractures. Neurogenic pain improved in 3 cases and remained unchanged in 3 others. In patients whose motor functions were partially preserved, various degrees of motor improvement were detected. Electrophysiological recordings of Polysynaptic flexion reflexes (FR) were obtained to control conditions, and under intrathecal baclofen, in order to quantify the spinal excitability responsible for spontaneous or induced spasms. Flexion reflex threshold was increased and amplitude proved to be very significantly reduced by chronic baclofen infusion in all our patients. Twelve patients with neurogenic bladder dysfunction were also evaluated by a clinically oriented questionnaire and by quantitative urodynamic recordings, before and after pump implantation. In patients with normal micturition, this was not changed by intrathecal baclofen. In patients with spastic bladder, intrathecal baclofen produced a decrease of detrusor hypertonia and hyperactivity in 50% of cases, with reduction of leakage and increase in functional bladder capacity.
选择17例严重致残性脊髓痉挛患者，使用植入式可编程泵进行慢性鞘内注射巴氯芬治疗。9例为四肢瘫患者，7例为截瘫患者，1例为截瘫伴单瘫患者。对患者进行定期随访5至69个月（平均37.5个月）。通过评估以下方面来估计巴氯芬的临床疗效：张力亢进、痉挛、疼痛和功能障碍。所有患者因张力亢进、痉挛及与挛缩相关的疼痛减轻，生活质量均有显著改善。3例患者神经源性疼痛改善，3例无变化。在运动功能部分保留的患者中，检测到不同程度的运动功能改善。为控制病情并在鞘内注射巴氯芬的情况下，获取多突触屈曲反射（FR）的电生理记录，以量化导致自发或诱发痉挛的脊髓兴奋性。在我们所有患者中，慢性注射巴氯芬使屈曲反射阈值升高，幅度显著降低。还在泵植入前后，通过临床定向问卷和定量尿动力学记录对12例神经源性膀胱功能障碍患者进行评估。在排尿正常的患者中，鞘内注射巴氯芬对此无影响。在痉挛性膀胱患者中，鞘内注射巴氯芬在50%的病例中使逼尿肌张力亢进和活动亢进减轻，漏尿减少，功能性膀胱容量增加。
