AIM:To evaluate the efficacy and safety of baclofen for treatment of refractory gastroesophageal reflux-induced chronic cough (GERC) unresponsive to standard anti-reflux therapy. METHODS:Sixteen patients with refracto...AIM:To evaluate the efficacy and safety of baclofen for treatment of refractory gastroesophageal reflux-induced chronic cough (GERC) unresponsive to standard anti-reflux therapy. METHODS:Sixteen patients with refractory GERC were given an 8-wk course of baclofen 20 mg three times a day as an add-on therapy to omeprazole. Changes in the cough symptom score, cough threshold to capsaicin, reflux symptom score and possible adverse effects were determined after treatment. The variables of multi-channel intraluminal impedance combined with pH monitoring were compared between responders and non-responders to baclofen. RESULTS:Twelve of 16 patients completed treatment. Cough disappeared or improved in 56.3% (9/16)of patients, including 6 patients with acid refluxinduced cough (66.7%) and 3 patients with non-acid reflux-induced cough (33.3%). With baclofen treatment, the cough symptom score began to decrease at week 2, was clearly decreased at week 6 and reached a minimum at week 8. At the end of therapy, the lowest concentration of capsaicin required for induction of ≥ 2 and ≥ 5 coughs increased from 0.98 (1.46) to 1.95 (6.82) μmol/L (Z = -2.281, P = 0.024) and from 1.95 (7.31) to 7.8 (13.65) μmol/L (Z = -2.433, P = 0.014), respectively, and the reflux symptom score decreased from 8.0 ± 1.6 to 6.8 ± 0.8 (t = 2.454, P = 0.023). The number of acid reflux episodes was significantly lower in responders than in non-responders. The main adverse effects were somnolence, dizziness and fatigue. CONCLUSION:Baclofen is a useful, but suboptimal treatment option for refractory GERC.展开更多
<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Cerebral palsy is the m...<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Cerebral palsy is the most common chronic motor disability that begins in childhood with the predominant motor abnormality</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> that</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> is spasticity</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""> <b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The purpose of the present study was to compare the efficacy of oral baclofen and oral tizanidine in reducing spasticity in cerebral palsy patients. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This randomized controlled trial was conducted from January 2010 to December 2011 and it was carried out in the Out Patient Department (OPD) of Pediatrics at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh and Center for Neurodevelopment and Autism in Children (CNAC) of Bangabandhu Sheikh Mujib Medical University (B中央人民政府), Dhaka, Bangladesh. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: A total number of 70 cerebral palsy children were recruited for this study of which 35 patients were in </span><span style="font-family:Verdana;">Tizanidine</span><span style="font-family:Verdana;"> group and 35 patients were in </span><span style="font-family:Verdana;">baclofen</span><span style="font-family:Verdana;"> group. </span><span style="font-family:Verdana;">Furthermore</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 70 cerebral palsy children were taken as control who were treated with </span><span style="font-family:Verdana;">placebo</span><span style="font-family:Verdana;">. Tizanidine had superior efficacy in reducing tone in spastic cerebral palsy over baclofen measured by using </span><span style="font-family:Verdana;">Modified</span><span style="font-family:Verdana;"> Ashworth scale in </span><span style="font-family:Verdana;">different</span> <span style="font-family:Verdana;">time period</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> from AS score-3 to score-2 (p < 0.05). Tizanidine was also superior in joint angle improvement in spastic cerebral palsy measured by </span><span style="font-family:Verdana;">physician</span><span style="font-family:Verdana;"> rating scale from AS score-3 to score-2 (crouch p < 0.0001) and foot contact from AS score-3 to score-2 (p < 0.0001);but no statistically significant improvement in gross motor function. </span><span style="font-family:Verdana;">Adverse</span><span style="font-family:Verdana;"> effect </span><span style="font-family:Verdana;">w</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> more in </span><span style="font-family:Verdana;">baclofen</span><span style="font-family:Verdana;"> group. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: For reducing generalized spasticity with regards to muscle tone, joint angle </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> improvement in gait in cerebral palsy patients, tizanidine has superior efficacy and less adverse effects than baclofen.</span></span></span></span>展开更多
BACKGROUND： Recent researches have demonstrated that baclofen is a commonly central anti-spasm drug. In addition, neural facilitation technique based on nerve development and neurophysiology is widely used for rehabi...BACKGROUND： Recent researches have demonstrated that baclofen is a commonly central anti-spasm drug. In addition, neural facilitation technique based on nerve development and neurophysiology is widely used for rehabilitation training of motor disorder after central nerve injury. However, whether baclofen combining with neural facilitation technique can relieve muscular spasm after spinal cord injury needs further studies. OBJECTIVE： To observe the effect of baclofen combining with neural facilitation technique on decreasing muscular tension in two lower extremities after spinal cord injury. DESIGN： Randomized controlled study. SETTING- Departments of Rehabilitation and Orthopaedics, the Third Affiliated Hospital of Guangzhou Medical College. PARTICIPANTS： A total of 28 patients with spinal cord injury, including 17 males and 11 females, whose age ranged from 31 to 71 years, were selected from Departments of Rehabilitation and Orthopaedics, the Third Affiliated Hospital of Guangzhou Medical College from March 2005 to September 2006. The illness course ranged from 22 to 54 days and the mean course was （38±8） days. All patients were diagnosed as the fLrst onset and the increase of extensor muscular tension in two lower extremities after thoracic vertebra injury by using spine MR or CT examination. Informed consents were obtained from all the patients. METHODS： All 28 patients who had upper motor neuronal paralysis in two lower extremities after spinal cord injury in thoracic vertebra region were randomly divided into treatment group and control group with 14 cases in each group. Patients in both groups received routine therapy, while those in the treatment group were treated with oral baclofen （the beginning dosage： 5 rag/time; three times per day, 5 mg was increased every three days; the maximal dosage was 60 mg/day; 6 weeks in total） （made in Weicai Pharmaceutical Co., Ltd.; tablet; batch number： HC20040029） combining with neural facilitation technique, which accorded to Rood technique （slight joint extrusion, slow and persistent stretch, etc.）, Brunnstrom technique （non-symmetric cervical reflex： head turning to one side promoting contralateral flexuosity in both upper and lower extremities） and Bobath technique （reflective inhibition, such as reducing supine position; increasing lateral recumbent position, rolling in bed and posture transfer; controlling key sites; 6 weeks in total）. MAIN OUTCOME MEASURES： At 6 weeks after treatment, modified Ashworth grading method and Barthel Index were used to detect extensor muscular tension in two lower extremities and activities of daily living （ADL） of patients in both groups. RESULTS： ①Grade of muscular tension in two lower extremities： At 6 weeks after treatment, muscular tension in the treatment group was classified into grade I （n =12）, gradeII （n =2） and grade III（n =0）, which was markedly improved as compared with that in the control group [grade Ⅰ （n =6）, grade Ⅱ （n =4） and grade Ⅲ （n =4）]. In addition, there was significant difference between the two groups （P 〈 0.05）. ②ADL ability： Barthel Index of patients with complete and incomplete spinal cord injury in the treatment group was higher than that in the control group at 6 weeks after treatment, and there was significant difference between them （P 〈 0.05）. CONCLUSION： Baclofen combining with neural facilitation technique can not only remarkably relieve muscular tension of upper motor neuronal paralysis after spinal cord injury, but also obviously accelerate recoveries of motor functional and ADL ability.展开更多
Patients with Hallervorden-Spatz disease may be confronted by invasive procedure, like gastrostomy and thalamotomy for care of the status of extreme dystonia and rigidity. This rare disorder possesses potential periop...Patients with Hallervorden-Spatz disease may be confronted by invasive procedure, like gastrostomy and thalamotomy for care of the status of extreme dystonia and rigidity. This rare disorder possesses potential perioperative risks, such as difficult airway management, aspiration pneumonia, hyperpyrexia, dehydration, acute renal failure, and postoperative pulmonary insufficiency. As patients were usually in the state of uncontrollable dystonia and rigidity, delayed endotracheal extubation had been suggested by several previous case reports. We report the anesthetic management of a 34-year-old Hallervorden-Spatz disease woman scheduled for intrathecal baclofen pump implantation under general anesthesia. Preoperatively she had suffered from severe dystonia, confusion and repeated attacks of respiratory insufficiency and pneumonia requiring mechanical ventilation and critical care. Anesthesia was induced uneventfully and the catheter of the pump reached the CSF via T2 interspace. Intraoperative intrathecal baclofen injection mildly relieved her severe dystonia and rigidity. Hemodynamics and arterial blood gas were improved than preoperative. She was extubated after consciousness was regained. Postanesthetic visit demonstrated a fair outcome. Whether this treatment applies to every case confronted by general anesthesia needs to be elucidated. Nevertheless, we suggest intrathecal baclofen may help postanesthetic pulmonary care by attenuating dystonia and rigidity and can be an adjuvant for anesthesia care in patients with Hallervorden-Spatz disease.展开更多
Objective: Baclofen (β-p-chlorophenyl-GABA) selectively activates the GABAB subtype of γ-aminobutyric acid (GABA) receptors, a group of receptors known to provide inhibitory neurotransmission in the central nervous ...Objective: Baclofen (β-p-chlorophenyl-GABA) selectively activates the GABAB subtype of γ-aminobutyric acid (GABA) receptors, a group of receptors known to provide inhibitory neurotransmission in the central nervous system. Available for over thirty years in oral form for the treatment of skeletal muscle spasticity, its availability now includes continuous intrathecal infusion via an internally implanted pump. While ideal for long-term attenuation of symptoms, this treatment modality can also become disastrous should the pump empty and withdrawal subsequently ensue. Case Report: A 48-year-old male with a past medical history of T8 spinal cord injury from a motor vehicle crash originally presented with altered mental status. Because of resultant paraplegia and spasticity from his injuries, a neurosurgeon implanted an intrathecal baclofen pump three years prior to presentation with symptomatic relief. Further exploration revealed that he had missed his scheduled pump refill appointment and interrogation of his pump confirmed a completely empty reservoir. The patient endured a protracted hospital course that included rhabdomyolysis, acute renal failure, lactic acidosis, respiratory failure, and systemic inflammatory response syndrome. Treatment included benzodiazepines, dantrolene, aggressive hydration, opiates, and refill of his intrathecal baclofen pump. His mentation and ventilatory status improved with recovery from his critical illness and eventual discharge. Conclusions: Treatment of intrathecal baclofen withdrawal should focus on restoration of previous intrathecal baclofen levels by refill of the intrathecal pump. Adjuvant medications such as benzodiazepines, propofol, cyproheptadine, dantrolene, tizanidine, and opiates may prove crucial in helping with muscle spasticity while these levels are reestablished. A high index of suspicion, leading to timely initiation of proper treatment, may serve as the most important factor in successful recovery from this life-threatening syndrome.展开更多
BACKGROUND Severe spasticity may negatively impact functionality and quality of life after spinal cord injury(SCI).Intrathecal baclofen treatment(IBT)is effectively used to manage severe spasticity and reduce comorbid...BACKGROUND Severe spasticity may negatively impact functionality and quality of life after spinal cord injury(SCI).Intrathecal baclofen treatment(IBT)is effectively used to manage severe spasticity and reduce comorbidities.However,long-term IBT may have a negative effect on bone mineral content(BMC),bone mineral density(BMD)and body composition(such as percentage fat mass and lean body mass).We demonstrated the negative effects of long-term IBT use in a single case compared with two non-IBT users.CASE SUMMARY A 46-year old Caucasian male Veteran(case)with a 21 year history of complete tetraplegia(complete C6 SCI)was implanted with IBT for 20 years.The case was matched to two participants with different time since injuries[2(match 1)and 13(match 2)years]without IBT.Knee BMC and BMD at the epiphysis and metaphysis of the distal femur and proximal tibia were evaluated using dual knee and the dual femur modules of GE Lunar iDXA software.Total and leg body composition assessments were also conducted for the three participants.Potential effect of long-term IBT was demonstrated by changes in BMD,consistent with bone demineralization,at the distal femur and proximal tibia and changes in percentage fat mass and lean mass of legs.The case showed 113%lower BMD at the distal femur,and 78.1%lower at the proximal tibia compared to match 1,moreover the case showed 45%lower BMD at the distal femur,and no observed changes at the proximal tibia compared to match 2.The case had 27.1%and 16.5%greater leg%fat mass compared to match 1 and match 2,respectively.Furthermore,the case had 17.4%and 11.8%lower%leg lean mass compared to match 1 and match 2,respectively.CONCLUSION Long-term IBT may impact bone health and body composition parameters in persons with complete SCI.It may be prudent to encourage regular screening of individuals on long-term IBT considering the prevalence of osteoporosis related fractures,cardiovascular diseases,and metabolic disorders in this population.展开更多
Objective To investigate the specific method,efficacy and safety of intrathecal baclofen(ITB)in the treatment of moderate and severe spasticity.Methods The clinical features,response to ITB trial,clinical outcomes and...Objective To investigate the specific method,efficacy and safety of intrathecal baclofen(ITB)in the treatment of moderate and severe spasticity.Methods The clinical features,response to ITB trial,clinical outcomes andtreatment-related complicationsafter baclofen pump implantation surgery were retrospectively analyzed in patients with moderate to severe spasticity who received ITB treatment in Hong Kong University Shenzhen Hospital from August 2022 to August 2023.Results The study included 22 patients with moderate to severe spasticity,of whom 18 patients(81.8%)were effective in ITB trial.For these patients with effective trial,the lowest mean Modified Ashworth Scale(MAS)score of lower extremity muscle groups after ITB bolus injection was decreased significantly compared with the baseline mean value before injection(1.29±0.81 vs 3.31±1.18,t=11.364,P<0.001),and the M/H amplitude ratio of soleus H-reflex at 4 hours after ITB bolus injection was significantly higher than the baseline value(9.61±4.66 s 3.83±2.69,t=7.780,P<0.001).Among the 18 patients with effective ITB trial,10 patients received baclofen pump implantation surgery with the informed consent of the patients or their guardians.Compared with the 8 patients without surgery,the baseline mean MAS score of lower extremity muscle groups of the 10 patients who received surgery was higher(3.71±1.06vs 2.83±1.16,F=5.645,P<0.05),the maximum reduction of mean MAS score of lower extremity muscle groups of the 10 patients who received surgery was greater(2.61±0.99 vs 1.30±0.64,F=20.696,P<0.001).In 10 patients who received baclofen pump implantation surgery,the mean MAS score of lower limb muscle groups was significantly decreased in the first and sixth months after surgery compared with the baseline mean value before surgery(1.64±0.91,1.16±0.89 and 3.71±1.06,F=39.946,P<0.001).Among them,2 patients were followed up to 12 months after surgery,2 patients were followed up to 18 months after surgery,and the mean MAS score of their lower limb muscle groups showed continuous improvement,and 1 patient with cerebral palsy combined with lower urinary tract hyperactive syndrome also showed significant improvement of urgent urinary incontinence after surgery.Up to the last followup,the daily dose of baclofen in 10 patients receiving baclofen pump implantation was(143.60±96.24)μg,and notreatment-related1complications occurred.ConclusionITB3 can effectively relieve spasticity symptoms and other related neurological dysfunction in patients with moderate and severe spasticity,and the efficacy can be maintained for a long time,and treatment-related complications are rare.Preoperative ITB trial is helpful to screen out patients more suitable for baclofen pump implantation.Patients with higher grade of spasticity at baseline and better efficacy of ITB trial are more suitable for baclofen pump implantation.The soleus H reflex can effectively reflect the change of stretch reflex of lower limb muscle groups in patients with spasticity treated by ITB,and can be used to evaluate the treatment effect of ITB.展开更多
Baclofen is a selective gamma-aminobutyric acid (GABA) type B agonist that may have important medicinal uses,such as in analgesics and drug addiction treatment.In addition,evidence is accumulating that suggests GABAer...Baclofen is a selective gamma-aminobutyric acid (GABA) type B agonist that may have important medicinal uses,such as in analgesics and drug addiction treatment.In addition,evidence is accumulating that suggests GABAergic-mediated neurotransmission is altered during aging.This study investigated whether baclofen administration (5 mg kg 1) induces differential effects on cortical electrical activity with age.Electroencephalograms (EEGs) were recorded from young (3-4 months) and aged (15-17 months) rats,and both the absolute and relative powers in five frequency bands (delta:2-4 Hz;theta:4-8 Hz;alpha:8-12 Hz;beta:12-20 Hz;gamma:20-100 Hz) were analyzed.Before administration of baclofen,we found that the EEG relative power in the beta band was higher in the aged than that in the young rats.After administration of baclofen,there was a slower increase in the relative power in the delta band in the aged than that in the young rats.Moreover,there was no significant difference between the two age groups in absolute power in any frequency band.These findings indicate that baclofen treatment appears to differentially modify cortical EEG activity as a function of age.Our data further elucidate the relationship between GABA B receptor-mediated neurotransmission and aging.展开更多
基金Supported by National Natural Science Foundation of China, No. 81170079Shanghai Shenkang Hospital Development Center Project, No. SHDC12012211
文摘AIM:To evaluate the efficacy and safety of baclofen for treatment of refractory gastroesophageal reflux-induced chronic cough (GERC) unresponsive to standard anti-reflux therapy. METHODS:Sixteen patients with refractory GERC were given an 8-wk course of baclofen 20 mg three times a day as an add-on therapy to omeprazole. Changes in the cough symptom score, cough threshold to capsaicin, reflux symptom score and possible adverse effects were determined after treatment. The variables of multi-channel intraluminal impedance combined with pH monitoring were compared between responders and non-responders to baclofen. RESULTS:Twelve of 16 patients completed treatment. Cough disappeared or improved in 56.3% (9/16)of patients, including 6 patients with acid refluxinduced cough (66.7%) and 3 patients with non-acid reflux-induced cough (33.3%). With baclofen treatment, the cough symptom score began to decrease at week 2, was clearly decreased at week 6 and reached a minimum at week 8. At the end of therapy, the lowest concentration of capsaicin required for induction of ≥ 2 and ≥ 5 coughs increased from 0.98 (1.46) to 1.95 (6.82) μmol/L (Z = -2.281, P = 0.024) and from 1.95 (7.31) to 7.8 (13.65) μmol/L (Z = -2.433, P = 0.014), respectively, and the reflux symptom score decreased from 8.0 ± 1.6 to 6.8 ± 0.8 (t = 2.454, P = 0.023). The number of acid reflux episodes was significantly lower in responders than in non-responders. The main adverse effects were somnolence, dizziness and fatigue. CONCLUSION:Baclofen is a useful, but suboptimal treatment option for refractory GERC.
文摘<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Cerebral palsy is the most common chronic motor disability that begins in childhood with the predominant motor abnormality</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> that</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> is spasticity</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""> <b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The purpose of the present study was to compare the efficacy of oral baclofen and oral tizanidine in reducing spasticity in cerebral palsy patients. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This randomized controlled trial was conducted from January 2010 to December 2011 and it was carried out in the Out Patient Department (OPD) of Pediatrics at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh and Center for Neurodevelopment and Autism in Children (CNAC) of Bangabandhu Sheikh Mujib Medical University (B中央人民政府), Dhaka, Bangladesh. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: A total number of 70 cerebral palsy children were recruited for this study of which 35 patients were in </span><span style="font-family:Verdana;">Tizanidine</span><span style="font-family:Verdana;"> group and 35 patients were in </span><span style="font-family:Verdana;">baclofen</span><span style="font-family:Verdana;"> group. </span><span style="font-family:Verdana;">Furthermore</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 70 cerebral palsy children were taken as control who were treated with </span><span style="font-family:Verdana;">placebo</span><span style="font-family:Verdana;">. Tizanidine had superior efficacy in reducing tone in spastic cerebral palsy over baclofen measured by using </span><span style="font-family:Verdana;">Modified</span><span style="font-family:Verdana;"> Ashworth scale in </span><span style="font-family:Verdana;">different</span> <span style="font-family:Verdana;">time period</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> from AS score-3 to score-2 (p < 0.05). Tizanidine was also superior in joint angle improvement in spastic cerebral palsy measured by </span><span style="font-family:Verdana;">physician</span><span style="font-family:Verdana;"> rating scale from AS score-3 to score-2 (crouch p < 0.0001) and foot contact from AS score-3 to score-2 (p < 0.0001);but no statistically significant improvement in gross motor function. </span><span style="font-family:Verdana;">Adverse</span><span style="font-family:Verdana;"> effect </span><span style="font-family:Verdana;">w</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> more in </span><span style="font-family:Verdana;">baclofen</span><span style="font-family:Verdana;"> group. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: For reducing generalized spasticity with regards to muscle tone, joint angle </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> improvement in gait in cerebral palsy patients, tizanidine has superior efficacy and less adverse effects than baclofen.</span></span></span></span>
文摘BACKGROUND： Recent researches have demonstrated that baclofen is a commonly central anti-spasm drug. In addition, neural facilitation technique based on nerve development and neurophysiology is widely used for rehabilitation training of motor disorder after central nerve injury. However, whether baclofen combining with neural facilitation technique can relieve muscular spasm after spinal cord injury needs further studies. OBJECTIVE： To observe the effect of baclofen combining with neural facilitation technique on decreasing muscular tension in two lower extremities after spinal cord injury. DESIGN： Randomized controlled study. SETTING- Departments of Rehabilitation and Orthopaedics, the Third Affiliated Hospital of Guangzhou Medical College. PARTICIPANTS： A total of 28 patients with spinal cord injury, including 17 males and 11 females, whose age ranged from 31 to 71 years, were selected from Departments of Rehabilitation and Orthopaedics, the Third Affiliated Hospital of Guangzhou Medical College from March 2005 to September 2006. The illness course ranged from 22 to 54 days and the mean course was （38±8） days. All patients were diagnosed as the fLrst onset and the increase of extensor muscular tension in two lower extremities after thoracic vertebra injury by using spine MR or CT examination. Informed consents were obtained from all the patients. METHODS： All 28 patients who had upper motor neuronal paralysis in two lower extremities after spinal cord injury in thoracic vertebra region were randomly divided into treatment group and control group with 14 cases in each group. Patients in both groups received routine therapy, while those in the treatment group were treated with oral baclofen （the beginning dosage： 5 rag/time; three times per day, 5 mg was increased every three days; the maximal dosage was 60 mg/day; 6 weeks in total） （made in Weicai Pharmaceutical Co., Ltd.; tablet; batch number： HC20040029） combining with neural facilitation technique, which accorded to Rood technique （slight joint extrusion, slow and persistent stretch, etc.）, Brunnstrom technique （non-symmetric cervical reflex： head turning to one side promoting contralateral flexuosity in both upper and lower extremities） and Bobath technique （reflective inhibition, such as reducing supine position; increasing lateral recumbent position, rolling in bed and posture transfer; controlling key sites; 6 weeks in total）. MAIN OUTCOME MEASURES： At 6 weeks after treatment, modified Ashworth grading method and Barthel Index were used to detect extensor muscular tension in two lower extremities and activities of daily living （ADL） of patients in both groups. RESULTS： ①Grade of muscular tension in two lower extremities： At 6 weeks after treatment, muscular tension in the treatment group was classified into grade I （n =12）, gradeII （n =2） and grade III（n =0）, which was markedly improved as compared with that in the control group [grade Ⅰ （n =6）, grade Ⅱ （n =4） and grade Ⅲ （n =4）]. In addition, there was significant difference between the two groups （P 〈 0.05）. ②ADL ability： Barthel Index of patients with complete and incomplete spinal cord injury in the treatment group was higher than that in the control group at 6 weeks after treatment, and there was significant difference between them （P 〈 0.05）. CONCLUSION： Baclofen combining with neural facilitation technique can not only remarkably relieve muscular tension of upper motor neuronal paralysis after spinal cord injury, but also obviously accelerate recoveries of motor functional and ADL ability.
文摘Patients with Hallervorden-Spatz disease may be confronted by invasive procedure, like gastrostomy and thalamotomy for care of the status of extreme dystonia and rigidity. This rare disorder possesses potential perioperative risks, such as difficult airway management, aspiration pneumonia, hyperpyrexia, dehydration, acute renal failure, and postoperative pulmonary insufficiency. As patients were usually in the state of uncontrollable dystonia and rigidity, delayed endotracheal extubation had been suggested by several previous case reports. We report the anesthetic management of a 34-year-old Hallervorden-Spatz disease woman scheduled for intrathecal baclofen pump implantation under general anesthesia. Preoperatively she had suffered from severe dystonia, confusion and repeated attacks of respiratory insufficiency and pneumonia requiring mechanical ventilation and critical care. Anesthesia was induced uneventfully and the catheter of the pump reached the CSF via T2 interspace. Intraoperative intrathecal baclofen injection mildly relieved her severe dystonia and rigidity. Hemodynamics and arterial blood gas were improved than preoperative. She was extubated after consciousness was regained. Postanesthetic visit demonstrated a fair outcome. Whether this treatment applies to every case confronted by general anesthesia needs to be elucidated. Nevertheless, we suggest intrathecal baclofen may help postanesthetic pulmonary care by attenuating dystonia and rigidity and can be an adjuvant for anesthesia care in patients with Hallervorden-Spatz disease.
文摘Objective: Baclofen (β-p-chlorophenyl-GABA) selectively activates the GABAB subtype of γ-aminobutyric acid (GABA) receptors, a group of receptors known to provide inhibitory neurotransmission in the central nervous system. Available for over thirty years in oral form for the treatment of skeletal muscle spasticity, its availability now includes continuous intrathecal infusion via an internally implanted pump. While ideal for long-term attenuation of symptoms, this treatment modality can also become disastrous should the pump empty and withdrawal subsequently ensue. Case Report: A 48-year-old male with a past medical history of T8 spinal cord injury from a motor vehicle crash originally presented with altered mental status. Because of resultant paraplegia and spasticity from his injuries, a neurosurgeon implanted an intrathecal baclofen pump three years prior to presentation with symptomatic relief. Further exploration revealed that he had missed his scheduled pump refill appointment and interrogation of his pump confirmed a completely empty reservoir. The patient endured a protracted hospital course that included rhabdomyolysis, acute renal failure, lactic acidosis, respiratory failure, and systemic inflammatory response syndrome. Treatment included benzodiazepines, dantrolene, aggressive hydration, opiates, and refill of his intrathecal baclofen pump. His mentation and ventilatory status improved with recovery from his critical illness and eventual discharge. Conclusions: Treatment of intrathecal baclofen withdrawal should focus on restoration of previous intrathecal baclofen levels by refill of the intrathecal pump. Adjuvant medications such as benzodiazepines, propofol, cyproheptadine, dantrolene, tizanidine, and opiates may prove crucial in helping with muscle spasticity while these levels are reestablished. A high index of suspicion, leading to timely initiation of proper treatment, may serve as the most important factor in successful recovery from this life-threatening syndrome.
基金Supported by the DoD-CDRMP,No.W81XWH-14-SCIRP-CTA.
文摘BACKGROUND Severe spasticity may negatively impact functionality and quality of life after spinal cord injury(SCI).Intrathecal baclofen treatment(IBT)is effectively used to manage severe spasticity and reduce comorbidities.However,long-term IBT may have a negative effect on bone mineral content(BMC),bone mineral density(BMD)and body composition(such as percentage fat mass and lean body mass).We demonstrated the negative effects of long-term IBT use in a single case compared with two non-IBT users.CASE SUMMARY A 46-year old Caucasian male Veteran(case)with a 21 year history of complete tetraplegia(complete C6 SCI)was implanted with IBT for 20 years.The case was matched to two participants with different time since injuries[2(match 1)and 13(match 2)years]without IBT.Knee BMC and BMD at the epiphysis and metaphysis of the distal femur and proximal tibia were evaluated using dual knee and the dual femur modules of GE Lunar iDXA software.Total and leg body composition assessments were also conducted for the three participants.Potential effect of long-term IBT was demonstrated by changes in BMD,consistent with bone demineralization,at the distal femur and proximal tibia and changes in percentage fat mass and lean mass of legs.The case showed 113%lower BMD at the distal femur,and 78.1%lower at the proximal tibia compared to match 1,moreover the case showed 45%lower BMD at the distal femur,and no observed changes at the proximal tibia compared to match 2.The case had 27.1%and 16.5%greater leg%fat mass compared to match 1 and match 2,respectively.Furthermore,the case had 17.4%and 11.8%lower%leg lean mass compared to match 1 and match 2,respectively.CONCLUSION Long-term IBT may impact bone health and body composition parameters in persons with complete SCI.It may be prudent to encourage regular screening of individuals on long-term IBT considering the prevalence of osteoporosis related fractures,cardiovascular diseases,and metabolic disorders in this population.
文摘Objective To investigate the specific method,efficacy and safety of intrathecal baclofen(ITB)in the treatment of moderate and severe spasticity.Methods The clinical features,response to ITB trial,clinical outcomes andtreatment-related complicationsafter baclofen pump implantation surgery were retrospectively analyzed in patients with moderate to severe spasticity who received ITB treatment in Hong Kong University Shenzhen Hospital from August 2022 to August 2023.Results The study included 22 patients with moderate to severe spasticity,of whom 18 patients(81.8%)were effective in ITB trial.For these patients with effective trial,the lowest mean Modified Ashworth Scale(MAS)score of lower extremity muscle groups after ITB bolus injection was decreased significantly compared with the baseline mean value before injection(1.29±0.81 vs 3.31±1.18,t=11.364,P<0.001),and the M/H amplitude ratio of soleus H-reflex at 4 hours after ITB bolus injection was significantly higher than the baseline value(9.61±4.66 s 3.83±2.69,t=7.780,P<0.001).Among the 18 patients with effective ITB trial,10 patients received baclofen pump implantation surgery with the informed consent of the patients or their guardians.Compared with the 8 patients without surgery,the baseline mean MAS score of lower extremity muscle groups of the 10 patients who received surgery was higher(3.71±1.06vs 2.83±1.16,F=5.645,P<0.05),the maximum reduction of mean MAS score of lower extremity muscle groups of the 10 patients who received surgery was greater(2.61±0.99 vs 1.30±0.64,F=20.696,P<0.001).In 10 patients who received baclofen pump implantation surgery,the mean MAS score of lower limb muscle groups was significantly decreased in the first and sixth months after surgery compared with the baseline mean value before surgery(1.64±0.91,1.16±0.89 and 3.71±1.06,F=39.946,P<0.001).Among them,2 patients were followed up to 12 months after surgery,2 patients were followed up to 18 months after surgery,and the mean MAS score of their lower limb muscle groups showed continuous improvement,and 1 patient with cerebral palsy combined with lower urinary tract hyperactive syndrome also showed significant improvement of urgent urinary incontinence after surgery.Up to the last followup,the daily dose of baclofen in 10 patients receiving baclofen pump implantation was(143.60±96.24)μg,and notreatment-related1complications occurred.ConclusionITB3 can effectively relieve spasticity symptoms and other related neurological dysfunction in patients with moderate and severe spasticity,and the efficacy can be maintained for a long time,and treatment-related complications are rare.Preoperative ITB trial is helpful to screen out patients more suitable for baclofen pump implantation.Patients with higher grade of spasticity at baseline and better efficacy of ITB trial are more suitable for baclofen pump implantation.The soleus H reflex can effectively reflect the change of stretch reflex of lower limb muscle groups in patients with spasticity treated by ITB,and can be used to evaluate the treatment effect of ITB.
基金supported by grants from the Training Program for Young Backbone Teachers of Yunnan University,the Research Foundation of Yunnan University (Grant No.2008YB007)the Science Foundation of the Education Department of Yunnan (Grant No.09Y0034)+1 种基金the Special Fund of the "211" Third Phase Project of Yunnan University (Grant No.21134018)the National College Student Innovation Experiment Program (Grant No.101067312)
文摘Baclofen is a selective gamma-aminobutyric acid (GABA) type B agonist that may have important medicinal uses,such as in analgesics and drug addiction treatment.In addition,evidence is accumulating that suggests GABAergic-mediated neurotransmission is altered during aging.This study investigated whether baclofen administration (5 mg kg 1) induces differential effects on cortical electrical activity with age.Electroencephalograms (EEGs) were recorded from young (3-4 months) and aged (15-17 months) rats,and both the absolute and relative powers in five frequency bands (delta:2-4 Hz;theta:4-8 Hz;alpha:8-12 Hz;beta:12-20 Hz;gamma:20-100 Hz) were analyzed.Before administration of baclofen,we found that the EEG relative power in the beta band was higher in the aged than that in the young rats.After administration of baclofen,there was a slower increase in the relative power in the delta band in the aged than that in the young rats.Moreover,there was no significant difference between the two age groups in absolute power in any frequency band.These findings indicate that baclofen treatment appears to differentially modify cortical EEG activity as a function of age.Our data further elucidate the relationship between GABA B receptor-mediated neurotransmission and aging.
