Kontinuirana intratekalna primena baklofena kod teškog onesposobljavajućeg spasticiteta
Sažetak
Uvod/Cilj. Spasticitet je posledica nekoliko kliničkih stanja kao što su cerebralna paraliza, povrede mozga, povrede kičmene moždine, multipla skleroza, ruptura neurizme sa krvarenjem, kao i neki drugi neurološki poremećaji. Cilj ove studije bio je da se utvrdi efikasnost primene intratekalnog baklofena (ITB) u lečenju upornog teškog onesposobljavajućeg spasticiteta, kao i izazovi sa kojima se susrećemo tokom hirurške ugradnje pumpe kod ovih bolesnika. Metode. Iz kliničkih protokola u periodu 2012–2015. godina izdvojili smo bolesnike kojima je ugrađena baklofenska pumpa intratekalno uz minimlno praćenje od šest meseci. Dvadeset dva bolesnika sa teškim spasticitetom koji su imali modifikovani Asworth skor spasticiteta (MASS) između 3 i 4 bili su uključena u studiju. Osam od 22 bolesnika bila su u dečjem uzrastu i svi su bili nepokretni pre hirurškog zahvata. Rezultati. Svi bolesnici bili su podvrgnuti hirurškoj implantaicji programabilne intratekalne baklofenske pumpe. Kateteri su postavljeni perkutano u subarahnoidni prostor kod 18 bolesnika, dok smo parcijalnu hemilaminektomiju primenili za ugradnju katetera kod četiri bolesnika. Kod svih bolesnika javilo se značajno poboljšanje, 5 bolesnika počelo je da koristi gornje ekstremitete, a tri odrasla bolesnika postala su ambulantna tokom fizikalne terapije. Srednji MASS skorovi poboljšali su se od 3.59 do 1.32 (p < 0.001). Zaključak. ITB terapija je očigledno popravila kvalitet života i funkcionalnu sposobnost bolesnika sa onesposobljavajućim spasticitetom. Zahvaljujući tome fizikalna terapija bila je mnogo korisnija kod ovih bolesnika. Iako neke abnormalnosti zbog spasticiteta mogu zahtevati parcijalnu hemilaminektomiju da bi se ugradila pumpa, bolesnicima sa upornim spasticitetom treba pružiti šansu za primenu ITB lečenja u najranijem periodu njihove doživotne onesposobljenosti.
Reference
Brashear A, Lambeth K. Spasticity. Curr Treat Options Neurol 2009; 11(3): 153–61.
Lance JW. What is spasticity? Lancet 1990; 335(8689): 606.
Anderson WS, Jallo GI. Intrathecal Baclofen Therapy and the Treatment of Spasticity. Neurosurgery Quarterly 2007; 17(3): 185–192.
Penn RD, Kroin JS. Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1984; 1(8385): 1078.
Pin TW, McCartney L, Lewis J, Waugh M. Use of intrathecal ba-clofen therapy in ambulant children and adolescents with spas-ticity and dystonia of cerebral origin: A systematic review. Dev Med Child Neurol 2011; 53(10): 885–95.
Plassat R, Perrouin VB, Menei P, Menegalli D, Mathé JF, Richard I. Treatment of spasticity with intrathecal Baclofen admin-istra¬tion: Long-term follow-up, review of 40 patients. Spinal Cord 2004; 42(12): 686–93.
Guillaume D, Van Havenbergh A, Vloeberghs M, Vidal J, Roeste G. A clinical study of intrathecal baclofen using a programma-ble pump for intractable spasticity. Arch Phys Med Rehabil 2005; 86(11): 2165–71.
Coffey JR, Cahill D, Steers W, Park TS, Ordia J, Meythaler J, et al. Intrathecal baclofen for intractable spasticity of spinal origin: Results of a long-term multicenter study. J. Neurosurg 1993; 78(2): 226–32.
Baker KW, Tann B, Mutlu A, Gaebler-Spira D. Improvements in children with cerebral palsy following intrathecal baclofen: Use of the Rehabilitation Institute of Chicago Care and Com-fort Caregiver Questionnaire (RIC CareQ). J Child Neurol 2014; 29(3): 312–7.
Borowski A, Pruszczynski B, Miller F, Synder M. Quality of life in cerebral palsy children treated with intrathecal baclofen pump implantation in parents' opinion. Chir Narzadow Ruchu Ortop Pol 2010; 75(5): 318–22. (Polish)
Stempien L, Tsai T. Intrathecal baclofen pump use for spastici-ty: A clinical survey. Am J Phys Med Rehabil 2000; 79(6): 536–41.
Dario A, Scamoni C, Bono G, Ghezzi A, Zaffaroni M. Functional improvement in patients with severe spinal spasticity treated with chronic intrathecal baclofen infusion. Funct Neurol 2001; 16(4): 311–5.
Hansen CR, Gooch JL, Such-Neibar T. Prolonged, severe in-trathe¬cal baclofen withdrawal syndrome: A case report. Arch Phys Med Rehabil 2007; 88(11): 1468–71.
Shirley KW, Kothare S, Piatt JH, Adirim TA. Intrathecal baclo-fen overdose and withdrawal. Pediatr Emerg Care 2006; 22(4): 258–61.
Watve SV, Sivan M, Raza WA, Jamil FF. Management of acute overdose or withdrawal state in intrathecal baclofen therapy. Spinal Cord 2012; 50(2): 107–11.
Phillips MM, Miljkovic N, Ramos-Lamboy M, Moossy JJ, Horton J, Buhari AM, et al. Clinical Experience With Continuous In-trathecal Baclofen Trials Prior to Pump Implantation. PM R 2015; 7(10): 1052–8.
Gooch JL, Oberg WA, Grams B, Ward LA, Walker ML. Care pro¬vider assessment of intrathecal baclofen in children. Dev Med Child Neurol 2004; 46(8): 548–52.
Gray N, Morton RE, Brimlow K, Keetley R, Vloeberghs M. Goals and outcomes for non ambulant children receiving continuous infusion of intrathecal baclofen. Eur J Paediatr Neurol 2012; 16(5): 443–8.
McCoy AA, Fox MA, Schaubel DE, Ayyangar RN. Weight gain in children with hypertonia of cerebral origin receiving in-trathecal baclofen therapy. Arch Phys Med Rehabil 2006; 87(11): 1503–8.
Krach LE. Intrathecal baclofen use in adults with cerebral pal-sy. Dev Med Child Neurol 2009; 51(Suppl 4): 106–12.
Ginsburg GM, Lauder AJ. Progression of scoliosis in patients with spastic quadriplegia after the insertion of an intrathecal baclofen pump. Spine (Phila Pa 1976) 2007; 32(24): 2745–50.
Gerszten PC, Albright AL, Johnstone GF. Intrathecal baclofen infu¬sion and subsequent orthopedic surgery in patients with spastic cerebral palsy. J Neurosurg 1998; 88(6): 1009–13.
Gooch JL, McFadden M, Oberg W. Orthopedic surgery in chil-dren with intrathecal baclofen pumps. J Pediatr Rehabil Med 2013; 6(4): 233–8.
Nance P, Schryvers O, Schmidt B, Dubo H, Loveridge B, Fewer D. In¬trathecal baclofen therapy for adults with spinal spasticity: Therapeutic efficacy and effect on hospital admissions. Can J Neurol Sci 1995; 22(1): 22–9.