新抗痙攣藥Baclofen之臨床試用經驗

Clinical Experience of a New Antispasticity Drug-Baclofen

連倚南(I-Nan Lien) ； 李素菁(Su-Ching Lee)

《中華民國復健醫學會雜誌》 17期 (1989/12) Pp. 38-44

https://doi.org/10.6315/JRMA.198912.0010

摘要

本文乃研究Baclofen對45例肢體有明顯痙攣現家的病例（包括25例腦病變，20例脊髓病變）的治療報告。本研究之平均用藥日數為44天，大多數病例之每日最高劑量為40~60mg。其治療有效者佔全部病例的80%，包括著效者58%，稍有效者22%著效者在腦病變患者有52%，在脊髓病變患者有65%，稍有效者在腦病變患者有28%。在脊髓病變患者有15，二類病例之全部有效率均為80%。本研究中出現的明顯副作用包括頭暈、全身無力、嗜睡及低血壓，共有7例。佔總人數的16%。在使用Baclofen的治療過程中，所有病例的血液、生化及尿液檢查均來顯示明顯的變化。雖然BacIofen對中樞神經系統的所有作用機轉尚未完全澄清，但是在治療痙攣，尤其是程度較厲害的痙攣，它是一安全且有效的選擇。

並列摘要

Baclofen,a derivative of gamma-aminobutyric acid, was introduced in 1966 as a possible treatment for spasticity due to cortico-spinal tract lesions. The previous reports suggested that it may be more effective than other spasmolytic agents, currently available. This report presents our experience with baclofen in the management of spasticity in 45 hospitalized patients of department of rehabilitation in NTUH. Among them, 25 cases were cerebral lesion (3 head injured, 22 cerebral vascular diceased),20 cases were spinal cord lesion (11 quadriplegic,9 paraplegic). 36 cases were males and 9 cases were females. The age distribution was from 13 years old to 74 years old, with the mean age of 46 years.
The duration of treatment ranged from 5 days to 130 days, wth the avarage of 44 days. Among them, 27cases(60%)were treated over 4 weeks The most common dose was 60mg per day.
The total effective rate was 80% in which 58% was markedly effective and 22% was slightly effective. The markedly effectively rate in cerebral lesion group was 52% while that in spinal cord lesion group was 65%。The overall effective rate in either group was 80%.
The evident side effects were seen in 7 cases, in elude dizzinese (3cases), general weakness (2cases), sleepiness (2cases) and hypotension(lcase) The occurring rate was 16%.。
There was no definite abnormalities in urinalysis, hemogram and blood chemistry examinations directly related to the use of baclofen in this study.
The precise mechanism of effects of baclofen is still not well known, currently it is thought that activation of GABAB receptors by baclofen restricts calcium in-flux into pre-synaptic terminals and that it is this restriction that reduces evoked transmitter release In turn, the reduction of excitatory transmitter release by afferent fibers is responsible for the diminished reflex acxity.
While the precise mechanism is still not sure, baclofen appears to be a safe and effective drug in the management of spasticity, especially strong spasticity and spasticity related to spinal cord lesion, as compared with diazepam. For it is better tolerated even at large dose, without side effects of general weakness and sleepiness.

並列關鍵字

antispasticity drug