Meythaler J M, Guin-Renfroe S, Grabb P, Hadley M N
Department of Physical Medicine and Rehabilitation, University of Alabama School of Medicine, Birmingham 35233-7330, USA.
Arch Phys Med Rehabil. 1999 Jan;80(1):13-9. doi: 10.1016/s0003-9993(99)90301-5.
To determine if the long-term use of continuously infused intrathecal baclofen (ITB) over a 1-year period will control spastic-dystonic hypertonia in patients with traumatic brain injury (TBI).
Tertiary care outpatient and inpatient rehabilitation center directly attached to a university hospital.
Persons with TBI and intractable spasticity and dystonia for more than 6 months' duration recruited in a consecutive manner.
TBI patients were admitted to the study after screening via a bolus injection of either intrathecal normal saline or 50 microg of baclofen. Data for Ashworth rigidity scores, spasm scores, and deep tendon reflex scores were collected for both the upper extremities (UE) and lower extremities (LE). Patients whose LE Ashworth scores decreased an average of 2 points were then offered implantation of a computer-controlled pump for continuous ITB. Changes over time were assessed statistically via Friedman's analysis for ordinal data and ANOVA for linear data. Differences between set points in time were also assessed via Wilcoxon signed rank.
Seventeen patients (average age 29+/-11 yrs) with spasticity and/or dystonia treated over 1 year via a computer-controllable intrathecal delivery system for the delivery of ITB.
After 1 year of continuous ITB treatment the average LE Ashworth score decreased from 3.5+/-1.3 (SD) to 1.7+/-0.9 (p < .0001), spasm score from 1.8+/-1.3 to 0.2+/-0.5 (p< .0001), and reflex score from 2.5+/-1.1 to 0.1+/-0.3 (p < .0001). The average UE Ashworth score decreased from 2.9+/-1.5 to 1.6+/-1.0 (p < .0001), spasm score from 1.2+/-1.5 to 0.2+/-0.6 (p < 0.0001), and reflex score from 2.2+/-0.5 to 1.0+/-0.8 (p < .0001). The average ITB dose required to attain these effects at 1 year was 302 microg continuously infused per day.
Continuous intrathecal infusion of baclofen is capable of maintaining a reduction in spasticity and dystonia in both the upper and lower extremities of TBI patients.
确定在1年时间内持续鞘内注射巴氯芬（ITB）能否控制创伤性脑损伤（TBI）患者的痉挛性肌张力障碍性高张力。
一所大学医院直属的三级医疗门诊和住院康复中心。
连续招募的TBI且伴有顽固性痉挛和肌张力障碍超过6个月的患者。
TBI患者在通过鞘内注射生理盐水或50微克巴氯芬进行推注筛查后纳入研究。收集上肢（UE）和下肢（LE）的Ashworth强直评分、痉挛评分和深部腱反射评分数据。然后，将LE Ashworth评分平均降低2分的患者植入计算机控制泵以持续输注ITB。通过Friedman分析对有序数据和ANOVA对线性数据进行时间变化的统计学评估。时间设定点之间的差异也通过Wilcoxon符号秩进行评估。
17例（平均年龄29±11岁）伴有痉挛和/或肌张力障碍的患者在1年时间内通过计算机可控鞘内给药系统接受ITB治疗。
连续ITB治疗1年后，LE平均Ashworth评分从3.5±1.3（标准差）降至1.7±0.9（p <.0001），痉挛评分从1.8±1.3降至0.2±0.5（p<.0001），反射评分从2.5±1.1降至0.1±0.3（p <.0001）。UE平均Ashworth评分从2.9±1.5降至1.6±1.0（p <.0001），痉挛评分从1.2±1.5降至0.2±0.6（p <0.0001），反射评分从2.2±0.5降至1.0±0.8（p <.0001）。1年时达到这些效果所需的平均ITB剂量为每天持续输注302微克。
持续鞘内输注巴氯芬能够使TBI患者上下肢的痉挛和肌张力障碍持续降低。
