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Intrathecal Baclofen Therapy to Reduce Spacticity in Two Patients with Traumatic Central Nervous System Injury

使用椎管內Baclofen注射療法降低脊髓損傷或創傷性腦傷患者的張力

摘要


張力的形成在脊髓損傷或創傷性腦傷的患者十分常見。傳統的口服劑量較大的baclofen療法常常會引發許多副作用,像是腸胃不適以及精神和神經系統的症狀。在這種情況之不,椎管內baclofen注射療法常常扮演另一種有效的選擇。在台灣因爲沒有發表相似的報告應用在脊髓損傷或創傷性腦傷的患者,所以我們發表這篇病歷報告分亨我們的椎管內baclofen注射療法的經驗和兩位患者接受椎管內baclofen注射療法後的成效。在這篇病例報告中第一例病患是一位21歲的男性,診斷是頸椎第三第四節的創傷性脊髓損傷併有頸椎第三第四節的椎間盤突出,導致四肢不完全的癱瘓。第二例病患是一位19歲的勞性,診斷是腦挫傷併有左側額葉顯葉以及頂葉的硬腦膜不出血。這兩位病患分別於受傷後28個月和受傷後29個月接受椎管內baclofen注射療法幫浦的植入,手術前皆有經過詳細的術前評估和成功的椎管內baclofen注射療法的篩檢測試。術前和術後都有使用生活功能獨立程度量度表和修正版艾許沃斯評分來做評估和紀錄。兩位病患接受完椎管內baclofen注射療法後都得到良好的成效。修正版艾許沃斯評分在手術完調整是當劑量之後有明顯的不降。在術後門診追蹤的紀錄,兩位患者的生活功能獨立程度量度表皆有持續明顯的進步。第一位位者在術後追蹤了三個月,而第二位患者在術後追蹤了七個月。兩位病患在後續的醫療追蹤紀錄裡並未發生任何的併發症,藥物過量或藥物戒斷的症狀。椎管內baclofen注射療法在這篇報告中顯示,對於脊髓損傷及創傷性腦傷的患者,證實可以有效的降低患者的張力。

並列摘要


Spasticity is a common sequela in patients with spinal cord injury (SCI) or traumatic brain injury (TBI). Conventional oral baclofen therapy in large doses may induce gastrointestinal discomfort and neuropsychiatric symptoms. Intrathecal baclofen (ITB) is a relatively new modality for treating spasticity of spinal cord origin. Herein, we present our experience with ITB therapy for treatment of SCI- and TBI-related spasticity. Case 1 involves a 21-year-old man with SCI at the C3-C4 region accompanied by a traumatic herniated intervertebral disc, resulting in incomplete tetraplegia. Case 2 involves a 19-year-old man with a localized brain contusion and acute subdural hematoma in the left frontal-temporal-parietal lobe. Both patients underwent ITB implantation after preoperative and ITB screening 28 months and 29 months, respectively to treat severe spasticity. Functional independent measure scores and mean modified Ashworth scores were calculated preoperatively and postoperatively in both patients to evaluate outcome of ITB therapy. Overall, both patients exhibited a good response. Mean modified Ashworth scores decreased soon after ITB implantation and adequate dosage adjustment in both patients. Functional independent scores improved gradually during the follow-up periods. There were no complications, and no overdose or withdrawal symptoms at 3-month postoperative follow-up in case 1 and at 7-month postoperative follow-up in case 2. ITB therapy is effective in reducing spasticity in patients with SCI and in patients with TBI.

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