Albright A L
Department of Neurosurgery, Children's Hospital of Pittsburgh, PA 15213, USA.
J Child Neurol. 1996 Nov;11 Suppl 1:S29-35. doi: 10.1177/0883073896011001S05.
Intrathecal baclofen reduces spasticity in individuals with cerebral palsy. Intrathecal doses are far lower than oral doses and the effects are considerably greater, and the side effects are fewer. Response to intrathecal baclofen must be confirmed by a screening trial before implantation of a pump for chronic infusion. Intrathecal baclofen reduces spasticity in the upper and lower extremities and is often associated with improved gait and upper extremity function. Quality of life improves for patients and caregivers. The Medtronic pump has been exceedingly reliable and typically functions for 4 or 5 years. The currently available intrathecal catheter is associated with far fewer complications than the initial catheter. Baclofen overdoses are unusual and are usually caused by pump programming errors rather than pump malfunction. Preliminary studies suggest that continuous intrathecal baclofen infusion reduces generalized dystonia in cerebral palsy. Screening to determine response of dystonia to intrathecal baclofen is by continuous infusion. The doses required to reduce dystonia are higher than those for cerebral spasticity. Additional investigations are underway to quantify the effects of continuous intrathecal baclofen infusion on communication, disability, and dystonia.
鞘内注射巴氯芬可减轻脑瘫患者的痉挛。鞘内注射剂量远低于口服剂量，效果却显著得多，且副作用更少。在植入用于长期输注的泵之前，必须通过筛选试验来确认对鞘内注射巴氯芬的反应。鞘内注射巴氯芬可减轻上肢和下肢的痉挛，且常伴有步态和上肢功能的改善。患者和护理人员的生活质量得到提高。美敦力泵极其可靠，通常可运行4至5年。目前可用的鞘内导管比最初的导管并发症少得多。巴氯芬过量情况罕见，通常是由泵的编程错误而非泵故障引起的。初步研究表明，持续鞘内注射巴氯芬可减轻脑瘫患者的全身性肌张力障碍。通过持续输注来筛选以确定肌张力障碍对鞘内注射巴氯芬的反应。减轻肌张力障碍所需的剂量高于治疗脑性痉挛的剂量。正在进行进一步研究以量化持续鞘内注射巴氯芬对沟通、残疾和肌张力障碍的影响。
