Albright A L
Department of Neurosurgery, University of Pittsburgh School of Medicine, PA 15213, USA.
J Child Neurol. 1996 Mar;11(2):77-83. doi: 10.1177/088307389601100202.
Baclofen, a gamma-aminobutyric acid agonist, acts at the spinal cord level to impede the release of excitatory neurotransmitters that cause spasticity. Oral baclofen improves cerebral spasticity mildly, but its activity is limited because of its poor lipid solubility. Cerebrospinal fluid baclofen levels after intrathecal administration are many times higher than those achieved after oral administration. Continuous intrathecal baclofen infusion has been used to treat cerebral spasticity in two patient groups: in older ambulatory children with inadequate underlying leg strength, and in patients with severe spasticity in both the upper and lower extremities. Responsiveness to intrathecal baclofen is confirmed by test injections before insertion of a programmable subcutaneous pump. Continuous intrathecal baclofen infusion dosages vary from 27 to 800 micrograms/day. Continuous intrathecal baclofen infusion reduces spasticity in the upper and lower extremities, and improves upper extremity function and activities of daily living but has no effect on athetosis in the dosages used to treat spasticity. Complications related to the intrathecal catheter occur in approximately 20% of patients, and infection requiring pump removal occurs in approximately 5%. Preliminary studies indicate that continuous intrathecal baclofen infusion alleviates some forms of generalized dystonia associated with cerebral palsy.
巴氯芬是一种γ-氨基丁酸激动剂，作用于脊髓水平，阻碍引起痉挛的兴奋性神经递质的释放。口服巴氯芬对脑性痉挛有轻度改善作用，但其活性有限，因为其脂溶性较差。鞘内给药后脑脊液中巴氯芬水平比口服给药后高许多倍。持续鞘内输注巴氯芬已用于治疗两组患者的脑性痉挛：一组是腿部力量不足的大龄能行走儿童，另一组是上下肢均有严重痉挛的患者。在植入可编程皮下泵之前，通过试验注射来确认对鞘内巴氯芬的反应性。持续鞘内输注巴氯芬的剂量为每天27至800微克。持续鞘内输注巴氯芬可减轻上下肢的痉挛，改善上肢功能和日常生活活动能力，但在用于治疗痉挛的剂量下对手足徐动症无效。与鞘内导管相关的并发症约发生在20%的患者中，需要移除泵的感染约发生在5%的患者中。初步研究表明，持续鞘内输注巴氯芬可缓解某些形式的与脑瘫相关的全身性肌张力障碍。
