鞘内注射巴氯芬-肉毒杆菌毒素联合疗法在治疗脑瘫所致痉挛症中的疗效

Riccardo Marvulli, Giuseppa Lagioia, Giancarlo Ianieri, Lucrezia Dell'Olio, Alessandra Zonno, Mariagrazia Riccardi, Rosa Bianca Sinisi, Laura Belinda Rizzo, Giacomo Farì, Marisa Megna, Maurizio Ranieri
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引用次数: 0

摘要

背景:脑性瘫痪(CP)是一组永久性但并非一成不变的运动和/或姿势和运动功能障碍,是由于发育中/未成熟的大脑受到非进行性干扰、病变或异常所致。其中一种临床表现是肌肉痉挛,这对患者的功能和生活质量造成了极大的影响。痉挛的治疗是多学科的,包括药物和物理干预;鞘内注射巴氯芬对严重痉挛和口服药物反应不佳的患者有积极作用,而局部注射 A 型肉毒杆菌毒素(BTXA)可改善肌张力、运动和疼痛:本研究旨在评估鞘内巴氯芬输注(ITB)-肉毒杆菌毒素联合疗法在治疗痉挛性四肢瘫中的疗效。所有患者均接受了鞘内注射巴氯芬治疗;下肢未出现痉挛症状,而上肢出现明显痉挛。所有患者在注射前(T0)、注射后 30 天(T1)、注射后 60 天(T2)和治疗后 90 天(T3)分别接受了肌肉测量、阿什沃斯量表、数字评定量表和视觉模拟量表评估:所有数据均显示,研究期间痉挛、疼痛、生活质量和自理能力均有所改善,P < 0.05。无副作用出现:本研究证明了鞘内注射巴氯芬和肉毒杆菌毒素联合治疗在治疗 CP 患者痉挛、疼痛、生活质量和自理能力方面的有效性和安全性。
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Intrathecal Baclofen Infusion-Botulinum Toxin Combined Treatment Efficacy in the Management of Spasticity due to Cerebral Palsy.

Background: Cerebral Palsy (CP) is a group of permanent, but not unchanging, disorders of movement and/or posture and motor function, which are due to a non-progressive interference, lesion, or abnormality of the developing/immature brain. One clinical presentation is muscle spasticity, which leads to a significant impact on the individual's functionality and quality of life. Spasticity treatment is multidisciplinary and includes pharmacological and physical intervention; intrathecal baclofen shows a positive effect in severe spasticity and suboptimal response to oral drugs, while local injection of Botulinum toxin type A (BTXA) improves muscle tone, motion and pain.

Objective: The aim of this study was to evaluate the efficacy of the combined intrathecal baclofen infusion (ITB) - botulinum toxin treatment in the management of spasticity in CP.

Methods: 8 patients with spastic tetraparesis were enrolled. All patients were treated with intrathecal Baclofen; in lower limbs, no spastic symptoms appeared, while marked spasticity was noted in upper limbs. We injected the right and left Biceps Brachial (BB) and Flexor Digitorum Superficialis (FDS) muscles with botulinum toxin type A. All patients underwent Myometric measurement, Ashworth Scale, Numerical Rating Scale, and Visual Analogic Scale evaluation before infiltration (T0), 30 days after injection (T1), 60 days after injection (T2), and 90 days after treatment (T3).

Results: All data demonstrated an improvement in spasticity, pain, quality of life, and self-care during the study, with p < 0.05. No side effects appeared.

Conclusion: This study demonstrated the efficacy and safety of intrathecal baclofen infusion and botulinum toxin combined treatment in the management of spasticity, pain, quality of life, and selfcare in CP patients.

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