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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">We define spasticity as a motor-type disorder&#44; in which there is an increase in muscle tone with exaggerated stretch reflexes&#44; both directly proportional to the velocity&#44; which results from an abnormal processing in the spine of afferent pathways&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Knowledge of the prevalence of spasticity helps us to assess the overall social dimension of the problem&#44; as it affects both the patient and their family&#46; Here in Spain&#44; there is an approximate prevalence of 300&#44;000&#8211;400&#44;000 people affected by spasticity&#44; representing therefore a significant medical problem with high incidence &#40;10 per 1000 population&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Spasticity has multiple causes and its prevalence is closely linked to that of the corresponding diseases&#46; It affects both adults and children and occurs in a large number of neurological disorders such as cerebral palsy&#44; multiple sclerosis&#44; cerebrovascular accidents&#44; etc&#46; Spasticity is the abnormality most often associated with cerebral palsy&#44; with almost 70&#37; affected&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a> This damage is typical of the upper motor neuron or first motor neuron&#44; and both the brain stem and the spinal cord may be affected &#40;encephalopathy&#44; demyelinating diseases&#44; traumatic brain injuries&#44; trauma&#44; tumours&#44; etc&#46;&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical signs of spasticity have classically been divided into two groups<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a>&#58; positive clinical signs&#44; which include increased muscle tone&#44; reflex hyperactivity and extensor plantar responses&#59; and the negative clinical signs&#44; referring to the functions that the patient loses due to spasticity&#44; i&#46;e&#46; loss of agility&#44; loss of selective motor control and poor coordination&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The treatments range from the field of rehabilitation to drug therapy and surgical interventions&#44; both destructive and conservative&#46; Neurosurgical treatments began at the beginning of the 20th century after the classic Sherrington studies&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The main complications that appear in the literature derived from surgical treatment are&#58; infection &#40;10&#37;&#41;&#59; externalisation of the device&#59; rupture of the catheter and displacement of the device &#40;10&#37;&#41;&#59; CSF leak &#40;15&#37;&#41;&#59; and tolerance to baclofen &#40;5&#37;&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">We performed a retrospective descriptive study of 17 patients with spasticity secondary to various diseases&#44; diagnosed and treated surgically by implanting an intrathecal baclofen infusion device in our neurosurgery department in the period 2005&#8211;2018&#44; with a minimum follow-up of one year for each patient&#46; Due to the small sample size&#44; we analysed the results descriptively&#46; In addition to the basic epidemiological data&#44; we analysed the different causes of spasticity&#44; the treatment applied and its complications&#44; surgical outcomes and progress&#46; Clinical follow-up was possible in all but one of the patients&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The quantitative assessment of spasticity and spasms is important for assessing the effects of treatment&#44; as well as the patient&#39;s degree of disability&#46; We have clinical assessment methods available&#44; such as the Ashworth Scale &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; and the modified Ashworth Scale based on muscle tone&#46; These scales&#44; the most used nowadays&#44; are simple&#44; quick to perform and do not require instruments&#46; We can also assess another clinical parameter&#44; the frequency of muscle spasms&#44; using the Spasm Frequency Scale<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> and the Penn Scale &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The inclusion criteria in our study were as follows&#58; patients with severe spasticity &#40;Ashworth greater than 3&#41; in &#8805;2 limbs with at least 2 muscle groups affected in the lower limbs&#44; in whom conservative treatments had failed&#44; with positive response to the baclofen test and a sufficiently high body mass&#46; Clear objectives were set by the multidisciplinary team&#58; to improve patient independence&#59; to facilitate the work of caregivers&#59; to improve the quality of life of patients and family members&#59; to promote hygiene&#59; to reduce pain&#59; and to prevent complications&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The criteria used for exclusion were&#58; recent infection&#59; hypersensitivity to baclofen&#59; insufficient body mass&#59; and negative response to the baclofen test&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In patients who met the inclusion criteria&#44; we performed an efficacy test involving different doses of intrathecal baclofen being administered on consecutive days &#40;initial 25<span class="elsevierStyleHsp" style=""></span>mcg&#44; 50<span class="elsevierStyleHsp" style=""></span>mcg&#44; 75<span class="elsevierStyleHsp" style=""></span>mcg up to a maximum of 100<span class="elsevierStyleHsp" style=""></span>mcg&#41;&#46; If the patient responded&#44; i&#46;e&#46; improved their score on the Ashworth Scale&#44; at any of the above doses&#44; they were considered as candidates for this treatment&#46; If the patient obtained no response even at the maximum dose of 100<span class="elsevierStyleHsp" style=""></span>mcg&#44; they would not benefit from implantation of a baclofen pump&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Patients with a positive baclofen test had a continuous infusion pump implanted&#46; The technique used in our centre is as follows&#58; an intrathecal catheter is inserted at the lumbar level &#40;the level depends on whether or not there are symptoms in the upper limbs&#41; and tunnelled to the abdomen&#44; usually on the left flank&#44; where the pump is implanted&#46; The pump is then programmed as follows&#58; if the duration of effect of the test dose is greater than 12<span class="elsevierStyleHsp" style=""></span>h&#44; that will be the initial dose&#59; if the duration of effect of the test dose is less than 12<span class="elsevierStyleHsp" style=""></span>h&#44; the initial daily dose will be twice the test dose&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The system is recharged and programmed externally by means of a telemetry system&#44; so the dose adjustment is made once the device is implanted&#46; Follow-up is then carried out at scheduled consultations supervised by a specialised nurse and the neurosurgeon&#46; In our centre&#44; we carry out a check-up at 24<span class="elsevierStyleHsp" style=""></span>h and subsequent days until we achieve good control of the spasticity without side effects&#46; Once the dose has been established&#44; the patient is given an appointment for 3&#8211;6 months to recharge the pump and assess their clinical response using the Ashworth and Penn scales&#46; Depending on the type of patient&#44; additional follow-up by rehabilitators&#44; neurologists&#44; paediatricians and&#47;or physiotherapists is recommended&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">It is important to be aware that the dose should not be increased in the first 24<span class="elsevierStyleHsp" style=""></span>h&#46; The increase in dose per day should not exceed 10&#37; to 30&#37; of the previous dose in patients with spinal spasticity&#44; and from 5&#37; to 15&#37; in patients with cerebral spasticity&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">At Hospital Cl&#237;nico&#44; Santiago de Compostela&#44; a total of 17 patients had surgery for implantation of a baclofen pump&#46; In our sample there was a clear predominance of females &#40;15 females to two males&#41;&#46; Mean age at implantation of the pump was 45 &#40;11&#8211;79&#41;&#46; The causes of spasticity of the patients in our series were&#58; multiple sclerosis in five patients &#40;29&#46;4&#37;&#41;&#59; cerebral palsy in six patients &#40;35&#46;4&#37;&#41;&#59; secondary to subarachnoid haemorrhage in two patients &#40;11&#46;7&#37;&#41;&#59; post-traumatic in two patients &#40;11&#46;7&#37;&#41;&#59; tumour in one patient &#40;5&#46;9&#37;&#41;&#59; and unknown in one patient &#40;5&#46;9&#37;&#41;&#46; Multiple sclerosis is the leading cause over the age of 35&#46; Congenital diseases are the most common causes in children and young people&#44; and the main cause of spasticity in males&#46; In our sample&#44; the spasticity in the two male patients was post-traumatic in one and congenital in the other&#46; The incidence of road traffic and other accidents was similar in males and females&#44; being more predominant in young people&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">After passing the phase for inclusion in the treatment&#44; the patients&#8217; doses were determined by analysing the symptoms before and after implantation of the device&#46; Of the 17 patients&#44; 6 &#40;35&#46;4&#37;&#41; remained on the starting dose&#46; However&#44; seven patients &#40;41&#46;1&#37;&#41; needed to have the initial dose increased&#44; although the increase was only significant in patient number 13&#44; as the expected improvement was not obtained&#46; Four patients &#40;23&#46;5&#37;&#41; were able to gradually decrease the dosage thanks to their great improvement &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The mean improvement on the Ashworth Scale at six months was two points &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; in 15 of the patients &#40;88&#46;2&#37;&#41;&#44; with patient 13 being the only one to only improve by one point&#46; For muscle spasms assessed with the Penn Scale at six months&#44; improvements of one point were achieved in cases where therapeutic dose was maintained and there were no problems such as fever or infection&#44; which reduce the effects of baclofen&#46; In six of the patients&#44; the Penn Scale score improved from four to three points&#44; and in ten of the patients&#44; from three to two points&#46; Of our 17 patients&#44; only one had a poor outcome&#44; despite the therapeutic efforts&#46; One of the cases could not be assessed as they were lost to follow-up&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The complications in our sample were minimal&#44; mostly being related to the device&#46; In three patients &#40;17&#37;&#41; it was necessary to re-operate&#59; in two because of dysfunction of the infusion system&#44; one due to disconnection of the catheter and the other rotation of the pump&#59; and in the third&#44; the system had to be removed and repositioned at six months due to a cerebrospinal fluid leak&#46; We can therefore conclude that the treatment has minimal complications&#44; with the vast majority being related to the surgical intervention itself&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">The neurophysiological bases of spasticity have been widely debated&#46; The classic stretch reflex includes the stretch receptor in the muscle spindle and its afferent fibre &#40;Ia&#41; in the dorsal root&#44; which directly or indirectly excites the &#945; motor neuron in the spinal cord&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> The chronic loss of suprasegmental impulses leads to overactivity of the &#945; motor neuron&#46; This phenomenon&#44; added to an abnormal processing of the spinal afferents&#44; leads to the monosynaptic arch being hyperactive&#46; The last step of this process is the increase in acetylcholine release in the neuromuscular junction and&#44; finally&#44; muscle contraction&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">We think of spasticity as a chronic process in which changes take place over time&#44; i&#46;e&#46; we are talking about a dynamic disease in which the properties of the soft tissues alternate until in the end&#44; muscle fibrosis is produced&#46; At this point&#44; musculoskeletal changes occur&#44; usually accompanied by pain&#46; These changes can be divided into various phases&#46; The first is the spastic phase&#44; then the vicious circle phase&#44; in which there is a muscle imbalance due to the predominance of spasticity in certain muscle groups&#59; typical being predominance of the plantar flexors and varus deformity-forming muscles of the foot&#44; the adductors and hip flexors&#44; and the elbow&#44; wrist and finger flexors in the upper limbs&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> The muscle retraction phase is characterised by the persistence of this vicious circle&#44; with unequal growth between agonist and antagonist muscle groups leading to the structuring of this circle due to the lack of accommodation of the sarcomere&#44; which is unable to achieve normal muscle growth&#46; Muscle retraction is understood to be the opposing resistance by the muscle to movement when it is not in contraction&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6&#44;10</span></a> The next phase is osteoarticular deformities&#44; the aim being to prevent this phase with conservative treatment or using the baclofen pump&#59; the collaboration of orthopaedic surgeons would be needed to perform far more invasive interventions&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In the treatment of spasticity&#44; baclofen is considered the pharmacological treatment of choice&#46; It is an analogue of &#947;-aminobutyric acid and acts centrally&#44; inhibiting stretch reflexes and decreasing muscle tone&#46; It is therefore capable of managing severe spasticity of cerebral or spinal origin causing functional disability&#46; Alternatively&#44; diazepam&#44; tizanidine or dantrolene sodium may be used as second choice&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> Botulinum toxin is widely used in patients with spasticity&#46; Its mechanism of action is to block the release of acetylcholine&#44; with an effect that can last 4&#8211;6 months in the treated region&#46; The disadvantages are that it can cause local pain&#44; muscle atrophy&#44; allergic reactions and immunoresistance&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Rehabilitation treatment is fundamental in the approach to spasticity&#44; both focal and generalised&#44; from the beginning&#44; throughout all the evolutionary stages&#46; Physiotherapy should be started early to prevent the onset of spasticity or reduce its intensity&#46; The treatments used include the following&#58; postural therapy&#44; kinesiotherapy&#44; cryotherapy&#44; electrostimulation&#44; biofeedback&#44; hydrotherapy and strengthening of the antagonists&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> Splints and the orthoses can also be used&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">We know that spasticity often acts as a substitute for muscle strength deficit&#44; allowing the preservation of certain functionality&#46; However&#44; it is not uncommon for it to become painful and reduce motor function&#44; resulting in a functional worsening&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">When spasticity does not improve after rehabilitation treatment&#44; neuromuscular blocks and oral drugs&#44; surgical treatment is indicated&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6&#44;14&#44;15</span></a> In our centre&#44; these patients are initially treated with rehabilitation treatment&#44; neuromuscular blocks and oral drugs and are followed up by neurologists and&#47;or paediatricians&#44; who refer patients to our neurosurgery department if they do not respond adequately to conservative treatment&#44; to be assessed for surgical intervention&#46; These patients are given the baclofen test or efficacy test&#46; In this article&#44; we have focused on intrathecal baclofen infusion devices&#44; a non-ablative or reversible procedure which acts on the central nervous system&#46; The intrathecal infusion of baclofen is the main neuromodulation technique&#46; It is able to act at the medullary level without causing central damage&#46; Patients who may benefit from this type of treatment are those with have severe chronic spasticity &#40;spinal or cerebral&#41; with poor response to oral antispastic agents or those who suffer unacceptable side effects with effective oral doses&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Creamer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> show better results in patients with spasticity secondary to stroke treated with intrathecal baclofen&#44; with a reduction in Ashworth score of 99&#37; compared to those treated with conventional oral drugs&#44; who had a reduction of 43&#37;&#46; Sammaraiee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a> show good long-term results in patients with multiple sclerosis treated with intrathecal baclofen&#44; with reduced pain&#44; stiffness and spasms measured with the Penn Scale and spasticity measured with the Ashworth Scale&#44; with statistically significant results&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In our series&#44; we obtained improvements of two points in the Ashworth Scale and one point in the Penn Scale&#46; The need for dose modification will depend largely on intercurrent processes such as infections&#44; other diseases or medications that affect the efficacy of baclofen&#44; as well as the progression of some diseases which course with outbreaks&#44; such as multiple sclerosis&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">From our point of view&#44; this system has a large number of advantages over conventional treatment&#58; measurable efficacy before implantation&#59; minimally invasive technique&#59; it can be complemented by other therapies &#40;rehabilitation&#44; orthopaedic surgery&#44; etc&#46;&#41;&#59; as it is given by intrathecal infusion&#44; the dose required is much lower than with pharmacological treatment&#44; so there are also fewer side effects&#46; Disadvantages include the need to recharge the pump after a certain time or for repeat surgery due to breakdown of the device&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">We are aware of the small number of patients in our sample&#44; so we consider this work to be a starting point&#44; which should be continued in the future in order to obtain statistically significant results&#46; However&#44; despite the small number of patients treated&#44; the good results obtained in our study show us that a greater number of patients could benefit from this type of therapy&#44; improving the quality of life of both the patient and the caregiver&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The implantation of the baclofen pump is one of the surgical techniques of choice in our department&#46; However&#44; it is used in very few centres&#44; with Santiago de Compostela and La Coru&#241;a being the only ones specialised in this treatment in the region of Galicia&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">We would recommend greater collaboration from other services&#44; as we believe there is a large number of patients who would benefit from this therapy&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0155" class="elsevierStylePara elsevierViewall">We believe that the treatment of spasticity should be personalised&#46; It is important that the objectives are agreed with the patient and the caregiver&#44; while making sure that expectations are always realistic&#46; The purpose is to improve function&#44; promote hygiene&#44; reduce pain&#44; prevent complications and&#44; as a consequence&#44; improve quality of life&#46; Among all the surgical techniques used for the treatment of spasticity&#44; the implantation of intrathecal baclofen infusion devices has proved to be a simple&#44; reversible technique with corroborated results and very few drawbacks&#46; One of these drawbacks is the need for refills every three to six months depending on the dose received&#44; but this allows us to modulate the doses according to the needs of the patient&#46; This treatment improves patient autonomy&#44; and the majority of patients and their caregivers are satisfied with the implant&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest regarding the publication of this article&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Spasticity represents a medical problem whose incidence is increasing during the last years due to pathologies such as cerebral palsy&#44; stroke&#44; multiple sclerosis&#44; trauma or encephalopathy&#44; affecting both adults and children&#46; The treatments include rehabilitation&#44; pharmacotherapy and surgery&#44; among which we highlight intrathecal baclofen infusion devices&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Intrathecal baclofen devices implanted patients in Clinical Hospital of Santiago de Compostela from 2005 to 2018 were selected for retrospective analysis using assessment of spasticity scales&#44; such as Ashworth Scale&#46; Complications are described&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Surgery was performed in 17 patients for baclofen pump implant&#44; achieving an improvement of 2 points on the Ashworth Scale in 88&#46;2&#37; of the patients and of 1 point on the Penn Scale in 94&#37;&#46; Complications were seen in 3 patients&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intrathecal baclofen is a simple technique with good results for improving the quality of life of patients with spasticity&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
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            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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          2 => array:2 [
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La espasticidad representa un problema m&#233;dico cuya incidencia est&#225; aumentando debido a enfermedades como par&#225;lisis cerebral&#44; ictus&#44; esclerosis m&#250;ltiple&#44; traumatismos o encefalopat&#237;as&#44; afectando tanto a adultos como a ni&#241;os&#46; Los tratamientos incluyen rehabilitaci&#243;n&#44; farmacoterapia y cirug&#237;a&#44; entre las cuales destacamos las bombas de baclofeno intratecal&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Seleccionamos a los pacientes portadores de bomba de baclofeno intratecal implantada en el Hospital Cl&#237;nico de Santiago de Compostela entre 2005-2018 y analizamos retrospectivamente los resultados mediante escalas de valoraci&#243;n de espasticidad&#44; como la de Ashworth&#44; as&#237; como las complicaciones observadas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se implantaron bombas de baclofeno a 17 pacientes&#44; obteniendo una mejor&#237;a de 2 puntos en la escala de Ashworth en el 88&#44;2&#37; y de 1 punto en la escala de Penn en el 94&#37;&#46; Se observaron complicaciones en 3 pacientes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con baclofeno intratecal es una t&#233;cnica sencilla con resultados muy positivos para mejorar la calidad de vida de pacientes con espasticidad&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Santin-Amo JM&#44; Flores-Justa A&#44; Rom&#225;n-Pena P&#44; Raposo-Furelos M&#44; Frieiro-Dantas C&#44; Serramito Garc&#237;a R&#44; et al&#46; Baclofeno intratecal para el tratamiento de la espasticidad&#58; revisi&#243;n de los casos presentes tratados en nuestro servicio&#46; Neurocirugia&#46; 2019&#59;30&#58;288&#8211;293&#46;</p>"
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                  \t\t\t\t">Normal tone&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Moderate hypertonia&#58; examiner&#39;s force passive movement&nbsp;\t\t\t\t\t\t\n
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Review article
Intrathecal baclofen as a treatment for spasticity: Review of the cases treated in our hospital
Baclofeno intratecal para el tratamiento de la espasticidad: revisión de los casos presentes tratados en nuestro servicio
José María Santin-Amo
Corresponding author
cochemelide@hotmail.com

Corresponding author.
, Ana Flores-Justa, Paula Román-Pena, Martín Raposo-Furelos, Carla Frieiro-Dantas, Ramón Serramito García, Juan Manuel Villa, Miguel Gelabert-González
Servicio de Neurocirugía, Hospital Clínico Universitario de Santiago de Compostela, Departamento de Cirugía, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">We define spasticity as a motor-type disorder&#44; in which there is an increase in muscle tone with exaggerated stretch reflexes&#44; both directly proportional to the velocity&#44; which results from an abnormal processing in the spine of afferent pathways&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Knowledge of the prevalence of spasticity helps us to assess the overall social dimension of the problem&#44; as it affects both the patient and their family&#46; Here in Spain&#44; there is an approximate prevalence of 300&#44;000&#8211;400&#44;000 people affected by spasticity&#44; representing therefore a significant medical problem with high incidence &#40;10 per 1000 population&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Spasticity has multiple causes and its prevalence is closely linked to that of the corresponding diseases&#46; It affects both adults and children and occurs in a large number of neurological disorders such as cerebral palsy&#44; multiple sclerosis&#44; cerebrovascular accidents&#44; etc&#46; Spasticity is the abnormality most often associated with cerebral palsy&#44; with almost 70&#37; affected&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a> This damage is typical of the upper motor neuron or first motor neuron&#44; and both the brain stem and the spinal cord may be affected &#40;encephalopathy&#44; demyelinating diseases&#44; traumatic brain injuries&#44; trauma&#44; tumours&#44; etc&#46;&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical signs of spasticity have classically been divided into two groups<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a>&#58; positive clinical signs&#44; which include increased muscle tone&#44; reflex hyperactivity and extensor plantar responses&#59; and the negative clinical signs&#44; referring to the functions that the patient loses due to spasticity&#44; i&#46;e&#46; loss of agility&#44; loss of selective motor control and poor coordination&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The treatments range from the field of rehabilitation to drug therapy and surgical interventions&#44; both destructive and conservative&#46; Neurosurgical treatments began at the beginning of the 20th century after the classic Sherrington studies&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The main complications that appear in the literature derived from surgical treatment are&#58; infection &#40;10&#37;&#41;&#59; externalisation of the device&#59; rupture of the catheter and displacement of the device &#40;10&#37;&#41;&#59; CSF leak &#40;15&#37;&#41;&#59; and tolerance to baclofen &#40;5&#37;&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">We performed a retrospective descriptive study of 17 patients with spasticity secondary to various diseases&#44; diagnosed and treated surgically by implanting an intrathecal baclofen infusion device in our neurosurgery department in the period 2005&#8211;2018&#44; with a minimum follow-up of one year for each patient&#46; Due to the small sample size&#44; we analysed the results descriptively&#46; In addition to the basic epidemiological data&#44; we analysed the different causes of spasticity&#44; the treatment applied and its complications&#44; surgical outcomes and progress&#46; Clinical follow-up was possible in all but one of the patients&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The quantitative assessment of spasticity and spasms is important for assessing the effects of treatment&#44; as well as the patient&#39;s degree of disability&#46; We have clinical assessment methods available&#44; such as the Ashworth Scale &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; and the modified Ashworth Scale based on muscle tone&#46; These scales&#44; the most used nowadays&#44; are simple&#44; quick to perform and do not require instruments&#46; We can also assess another clinical parameter&#44; the frequency of muscle spasms&#44; using the Spasm Frequency Scale<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> and the Penn Scale &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The inclusion criteria in our study were as follows&#58; patients with severe spasticity &#40;Ashworth greater than 3&#41; in &#8805;2 limbs with at least 2 muscle groups affected in the lower limbs&#44; in whom conservative treatments had failed&#44; with positive response to the baclofen test and a sufficiently high body mass&#46; Clear objectives were set by the multidisciplinary team&#58; to improve patient independence&#59; to facilitate the work of caregivers&#59; to improve the quality of life of patients and family members&#59; to promote hygiene&#59; to reduce pain&#59; and to prevent complications&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The criteria used for exclusion were&#58; recent infection&#59; hypersensitivity to baclofen&#59; insufficient body mass&#59; and negative response to the baclofen test&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In patients who met the inclusion criteria&#44; we performed an efficacy test involving different doses of intrathecal baclofen being administered on consecutive days &#40;initial 25<span class="elsevierStyleHsp" style=""></span>mcg&#44; 50<span class="elsevierStyleHsp" style=""></span>mcg&#44; 75<span class="elsevierStyleHsp" style=""></span>mcg up to a maximum of 100<span class="elsevierStyleHsp" style=""></span>mcg&#41;&#46; If the patient responded&#44; i&#46;e&#46; improved their score on the Ashworth Scale&#44; at any of the above doses&#44; they were considered as candidates for this treatment&#46; If the patient obtained no response even at the maximum dose of 100<span class="elsevierStyleHsp" style=""></span>mcg&#44; they would not benefit from implantation of a baclofen pump&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Patients with a positive baclofen test had a continuous infusion pump implanted&#46; The technique used in our centre is as follows&#58; an intrathecal catheter is inserted at the lumbar level &#40;the level depends on whether or not there are symptoms in the upper limbs&#41; and tunnelled to the abdomen&#44; usually on the left flank&#44; where the pump is implanted&#46; The pump is then programmed as follows&#58; if the duration of effect of the test dose is greater than 12<span class="elsevierStyleHsp" style=""></span>h&#44; that will be the initial dose&#59; if the duration of effect of the test dose is less than 12<span class="elsevierStyleHsp" style=""></span>h&#44; the initial daily dose will be twice the test dose&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The system is recharged and programmed externally by means of a telemetry system&#44; so the dose adjustment is made once the device is implanted&#46; Follow-up is then carried out at scheduled consultations supervised by a specialised nurse and the neurosurgeon&#46; In our centre&#44; we carry out a check-up at 24<span class="elsevierStyleHsp" style=""></span>h and subsequent days until we achieve good control of the spasticity without side effects&#46; Once the dose has been established&#44; the patient is given an appointment for 3&#8211;6 months to recharge the pump and assess their clinical response using the Ashworth and Penn scales&#46; Depending on the type of patient&#44; additional follow-up by rehabilitators&#44; neurologists&#44; paediatricians and&#47;or physiotherapists is recommended&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">It is important to be aware that the dose should not be increased in the first 24<span class="elsevierStyleHsp" style=""></span>h&#46; The increase in dose per day should not exceed 10&#37; to 30&#37; of the previous dose in patients with spinal spasticity&#44; and from 5&#37; to 15&#37; in patients with cerebral spasticity&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">At Hospital Cl&#237;nico&#44; Santiago de Compostela&#44; a total of 17 patients had surgery for implantation of a baclofen pump&#46; In our sample there was a clear predominance of females &#40;15 females to two males&#41;&#46; Mean age at implantation of the pump was 45 &#40;11&#8211;79&#41;&#46; The causes of spasticity of the patients in our series were&#58; multiple sclerosis in five patients &#40;29&#46;4&#37;&#41;&#59; cerebral palsy in six patients &#40;35&#46;4&#37;&#41;&#59; secondary to subarachnoid haemorrhage in two patients &#40;11&#46;7&#37;&#41;&#59; post-traumatic in two patients &#40;11&#46;7&#37;&#41;&#59; tumour in one patient &#40;5&#46;9&#37;&#41;&#59; and unknown in one patient &#40;5&#46;9&#37;&#41;&#46; Multiple sclerosis is the leading cause over the age of 35&#46; Congenital diseases are the most common causes in children and young people&#44; and the main cause of spasticity in males&#46; In our sample&#44; the spasticity in the two male patients was post-traumatic in one and congenital in the other&#46; The incidence of road traffic and other accidents was similar in males and females&#44; being more predominant in young people&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">After passing the phase for inclusion in the treatment&#44; the patients&#8217; doses were determined by analysing the symptoms before and after implantation of the device&#46; Of the 17 patients&#44; 6 &#40;35&#46;4&#37;&#41; remained on the starting dose&#46; However&#44; seven patients &#40;41&#46;1&#37;&#41; needed to have the initial dose increased&#44; although the increase was only significant in patient number 13&#44; as the expected improvement was not obtained&#46; Four patients &#40;23&#46;5&#37;&#41; were able to gradually decrease the dosage thanks to their great improvement &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The mean improvement on the Ashworth Scale at six months was two points &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; in 15 of the patients &#40;88&#46;2&#37;&#41;&#44; with patient 13 being the only one to only improve by one point&#46; For muscle spasms assessed with the Penn Scale at six months&#44; improvements of one point were achieved in cases where therapeutic dose was maintained and there were no problems such as fever or infection&#44; which reduce the effects of baclofen&#46; In six of the patients&#44; the Penn Scale score improved from four to three points&#44; and in ten of the patients&#44; from three to two points&#46; Of our 17 patients&#44; only one had a poor outcome&#44; despite the therapeutic efforts&#46; One of the cases could not be assessed as they were lost to follow-up&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The complications in our sample were minimal&#44; mostly being related to the device&#46; In three patients &#40;17&#37;&#41; it was necessary to re-operate&#59; in two because of dysfunction of the infusion system&#44; one due to disconnection of the catheter and the other rotation of the pump&#59; and in the third&#44; the system had to be removed and repositioned at six months due to a cerebrospinal fluid leak&#46; We can therefore conclude that the treatment has minimal complications&#44; with the vast majority being related to the surgical intervention itself&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">The neurophysiological bases of spasticity have been widely debated&#46; The classic stretch reflex includes the stretch receptor in the muscle spindle and its afferent fibre &#40;Ia&#41; in the dorsal root&#44; which directly or indirectly excites the &#945; motor neuron in the spinal cord&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> The chronic loss of suprasegmental impulses leads to overactivity of the &#945; motor neuron&#46; This phenomenon&#44; added to an abnormal processing of the spinal afferents&#44; leads to the monosynaptic arch being hyperactive&#46; The last step of this process is the increase in acetylcholine release in the neuromuscular junction and&#44; finally&#44; muscle contraction&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">We think of spasticity as a chronic process in which changes take place over time&#44; i&#46;e&#46; we are talking about a dynamic disease in which the properties of the soft tissues alternate until in the end&#44; muscle fibrosis is produced&#46; At this point&#44; musculoskeletal changes occur&#44; usually accompanied by pain&#46; These changes can be divided into various phases&#46; The first is the spastic phase&#44; then the vicious circle phase&#44; in which there is a muscle imbalance due to the predominance of spasticity in certain muscle groups&#59; typical being predominance of the plantar flexors and varus deformity-forming muscles of the foot&#44; the adductors and hip flexors&#44; and the elbow&#44; wrist and finger flexors in the upper limbs&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> The muscle retraction phase is characterised by the persistence of this vicious circle&#44; with unequal growth between agonist and antagonist muscle groups leading to the structuring of this circle due to the lack of accommodation of the sarcomere&#44; which is unable to achieve normal muscle growth&#46; Muscle retraction is understood to be the opposing resistance by the muscle to movement when it is not in contraction&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6&#44;10</span></a> The next phase is osteoarticular deformities&#44; the aim being to prevent this phase with conservative treatment or using the baclofen pump&#59; the collaboration of orthopaedic surgeons would be needed to perform far more invasive interventions&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In the treatment of spasticity&#44; baclofen is considered the pharmacological treatment of choice&#46; It is an analogue of &#947;-aminobutyric acid and acts centrally&#44; inhibiting stretch reflexes and decreasing muscle tone&#46; It is therefore capable of managing severe spasticity of cerebral or spinal origin causing functional disability&#46; Alternatively&#44; diazepam&#44; tizanidine or dantrolene sodium may be used as second choice&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> Botulinum toxin is widely used in patients with spasticity&#46; Its mechanism of action is to block the release of acetylcholine&#44; with an effect that can last 4&#8211;6 months in the treated region&#46; The disadvantages are that it can cause local pain&#44; muscle atrophy&#44; allergic reactions and immunoresistance&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Rehabilitation treatment is fundamental in the approach to spasticity&#44; both focal and generalised&#44; from the beginning&#44; throughout all the evolutionary stages&#46; Physiotherapy should be started early to prevent the onset of spasticity or reduce its intensity&#46; The treatments used include the following&#58; postural therapy&#44; kinesiotherapy&#44; cryotherapy&#44; electrostimulation&#44; biofeedback&#44; hydrotherapy and strengthening of the antagonists&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> Splints and the orthoses can also be used&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">We know that spasticity often acts as a substitute for muscle strength deficit&#44; allowing the preservation of certain functionality&#46; However&#44; it is not uncommon for it to become painful and reduce motor function&#44; resulting in a functional worsening&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">When spasticity does not improve after rehabilitation treatment&#44; neuromuscular blocks and oral drugs&#44; surgical treatment is indicated&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6&#44;14&#44;15</span></a> In our centre&#44; these patients are initially treated with rehabilitation treatment&#44; neuromuscular blocks and oral drugs and are followed up by neurologists and&#47;or paediatricians&#44; who refer patients to our neurosurgery department if they do not respond adequately to conservative treatment&#44; to be assessed for surgical intervention&#46; These patients are given the baclofen test or efficacy test&#46; In this article&#44; we have focused on intrathecal baclofen infusion devices&#44; a non-ablative or reversible procedure which acts on the central nervous system&#46; The intrathecal infusion of baclofen is the main neuromodulation technique&#46; It is able to act at the medullary level without causing central damage&#46; Patients who may benefit from this type of treatment are those with have severe chronic spasticity &#40;spinal or cerebral&#41; with poor response to oral antispastic agents or those who suffer unacceptable side effects with effective oral doses&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Creamer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> show better results in patients with spasticity secondary to stroke treated with intrathecal baclofen&#44; with a reduction in Ashworth score of 99&#37; compared to those treated with conventional oral drugs&#44; who had a reduction of 43&#37;&#46; Sammaraiee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a> show good long-term results in patients with multiple sclerosis treated with intrathecal baclofen&#44; with reduced pain&#44; stiffness and spasms measured with the Penn Scale and spasticity measured with the Ashworth Scale&#44; with statistically significant results&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In our series&#44; we obtained improvements of two points in the Ashworth Scale and one point in the Penn Scale&#46; The need for dose modification will depend largely on intercurrent processes such as infections&#44; other diseases or medications that affect the efficacy of baclofen&#44; as well as the progression of some diseases which course with outbreaks&#44; such as multiple sclerosis&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">From our point of view&#44; this system has a large number of advantages over conventional treatment&#58; measurable efficacy before implantation&#59; minimally invasive technique&#59; it can be complemented by other therapies &#40;rehabilitation&#44; orthopaedic surgery&#44; etc&#46;&#41;&#59; as it is given by intrathecal infusion&#44; the dose required is much lower than with pharmacological treatment&#44; so there are also fewer side effects&#46; Disadvantages include the need to recharge the pump after a certain time or for repeat surgery due to breakdown of the device&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">We are aware of the small number of patients in our sample&#44; so we consider this work to be a starting point&#44; which should be continued in the future in order to obtain statistically significant results&#46; However&#44; despite the small number of patients treated&#44; the good results obtained in our study show us that a greater number of patients could benefit from this type of therapy&#44; improving the quality of life of both the patient and the caregiver&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The implantation of the baclofen pump is one of the surgical techniques of choice in our department&#46; However&#44; it is used in very few centres&#44; with Santiago de Compostela and La Coru&#241;a being the only ones specialised in this treatment in the region of Galicia&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">We would recommend greater collaboration from other services&#44; as we believe there is a large number of patients who would benefit from this therapy&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0155" class="elsevierStylePara elsevierViewall">We believe that the treatment of spasticity should be personalised&#46; It is important that the objectives are agreed with the patient and the caregiver&#44; while making sure that expectations are always realistic&#46; The purpose is to improve function&#44; promote hygiene&#44; reduce pain&#44; prevent complications and&#44; as a consequence&#44; improve quality of life&#46; Among all the surgical techniques used for the treatment of spasticity&#44; the implantation of intrathecal baclofen infusion devices has proved to be a simple&#44; reversible technique with corroborated results and very few drawbacks&#46; One of these drawbacks is the need for refills every three to six months depending on the dose received&#44; but this allows us to modulate the doses according to the needs of the patient&#46; This treatment improves patient autonomy&#44; and the majority of patients and their caregivers are satisfied with the implant&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest regarding the publication of this article&#46;</p></span></span>"
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            1 => "Baclofeno"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Spasticity represents a medical problem whose incidence is increasing during the last years due to pathologies such as cerebral palsy&#44; stroke&#44; multiple sclerosis&#44; trauma or encephalopathy&#44; affecting both adults and children&#46; The treatments include rehabilitation&#44; pharmacotherapy and surgery&#44; among which we highlight intrathecal baclofen infusion devices&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Intrathecal baclofen devices implanted patients in Clinical Hospital of Santiago de Compostela from 2005 to 2018 were selected for retrospective analysis using assessment of spasticity scales&#44; such as Ashworth Scale&#46; Complications are described&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Surgery was performed in 17 patients for baclofen pump implant&#44; achieving an improvement of 2 points on the Ashworth Scale in 88&#46;2&#37; of the patients and of 1 point on the Penn Scale in 94&#37;&#46; Complications were seen in 3 patients&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intrathecal baclofen is a simple technique with good results for improving the quality of life of patients with spasticity&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
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            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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          2 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La espasticidad representa un problema m&#233;dico cuya incidencia est&#225; aumentando debido a enfermedades como par&#225;lisis cerebral&#44; ictus&#44; esclerosis m&#250;ltiple&#44; traumatismos o encefalopat&#237;as&#44; afectando tanto a adultos como a ni&#241;os&#46; Los tratamientos incluyen rehabilitaci&#243;n&#44; farmacoterapia y cirug&#237;a&#44; entre las cuales destacamos las bombas de baclofeno intratecal&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Seleccionamos a los pacientes portadores de bomba de baclofeno intratecal implantada en el Hospital Cl&#237;nico de Santiago de Compostela entre 2005-2018 y analizamos retrospectivamente los resultados mediante escalas de valoraci&#243;n de espasticidad&#44; como la de Ashworth&#44; as&#237; como las complicaciones observadas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se implantaron bombas de baclofeno a 17 pacientes&#44; obteniendo una mejor&#237;a de 2 puntos en la escala de Ashworth en el 88&#44;2&#37; y de 1 punto en la escala de Penn en el 94&#37;&#46; Se observaron complicaciones en 3 pacientes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con baclofeno intratecal es una t&#233;cnica sencilla con resultados muy positivos para mejorar la calidad de vida de pacientes con espasticidad&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Santin-Amo JM&#44; Flores-Justa A&#44; Rom&#225;n-Pena P&#44; Raposo-Furelos M&#44; Frieiro-Dantas C&#44; Serramito Garc&#237;a R&#44; et al&#46; Baclofeno intratecal para el tratamiento de la espasticidad&#58; revisi&#243;n de los casos presentes tratados en nuestro servicio&#46; Neurocirugia&#46; 2019&#59;30&#58;288&#8211;293&#46;</p>"
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                  \t\t\t\t">Normal tone&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Moderate hypertonia&#58; examiner&#39;s force passive movement&nbsp;\t\t\t\t\t\t\n
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ISSN: 25298496
Original language: English
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