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
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.
