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Vol. 1. Issue 5.
Pages 269-277 (January 1990)
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Vol. 1. Issue 5.
Pages 269-277 (January 1990)
Infusión intratecal de baclofeno en el tratamiento de la espasticidad severa
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G. García-March, M.aJ. Sánchez-Ledesma, J. Anaya, J.M. Gonçalves, J. Broseta
Servicio y Cátedra de Neurocirugía, Complejo Hospitalario y Universidad de Salamanca. Salamanca
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Resumen

Sobre la base de estudios clínicos y experimentales previos se seleccionaron 22 pacientes con espasticidad severa resistente a la terapéutica farmacológica convencional, cuya naturaleza obedecía a una afectación medular en 17 casos, 7 por esclerosis múltiple, 8 por paraplegia postraumática y 2 por otras causas, y a una lesión encefálica difusa en 5 casos. En este grupo se valoró el efecto de la infusión intratecal de morfina y baclofeno a través de un catéter colocado en el espacio subaracnoideo conectado a un reservorio subcutáneo. Mientras la inyección de morfina no mostró ningún beneficio, la administración de baclofeno en bolos de 12,5 a 60μg originó en 17 casos una marcada mejoría de la espasticidad y los síntomas asociados. En estos casos, tras un período de prueba de tres semanas y después de comprobar el efecto positivo del baclofeno sobre la espasticidad mediante la clínica, los estudios electroneurofisiológicos y la manometría vesical, se procedió a sustituir el reservorio por una bomba de infusión programable que permitía la administración crónica de baclofeno de forma continua, en bolos o combinando ambos modos de infusión, llegando a unas dosis diarias totales de baclofeno entre 25 y 225μg. Después de un período de seguimiento medio de 13,5 meses, todos los casos muestran una ausencia de espasmos dolorosos, una notable mejoría en el control esfinteriano y una marcada relajación que les permite una mayor capacidad motora. En ningún caso han aparecido complicaciones o efectos secundarios.

Descriptores:
Espasticidad
Dolor
Disfunción vesical neurogénica
Espasmos
Distonía
Baclofeno
Bombas programables
Summary

Based on previous experimental and clinical studies, 22 patients with severe spasicity, in 17 due to spinal cord damage, resulting from multiple sclerosis in 7 cases and postraumatic paraplejia in 8 and other situations in 2, and in 5 due to traumatic central spasticity, that were resistent to all conservative attempts, were selected to a trial with morphine and baclofen intratecally administered through a catheter placed in the spinal subaracnoidal space, attached to a subcutaneous reservoir. Whereas morphine single bolus did not show any benefit, baclofen bolus of 12.5 to 60μg revealed a marked decrease of spasticity and associated symptoms in 17 cases. In them, after checking the clinical effect during a period of 3 weeks and the changes in electroneurophysiological studies and bladder manometry, the catheter was attached to a subcutaneous programmable pump able to be refilled percutaneously that administered baclofen continuously or more often following a multistep complex program in total doses of 25 to 225μg per day. After a mean follow-up of 13.5 months all cases showed an absence of spasms and pain, a notable bettering of sphincterian functions and a marked relaxation that improves motor ability, though not motor potency, leading to increase deambulation or movility capacities. Neither complications nor side-effects were observed.

Key words:
Spasticity
Pain
Neurogenic bladder dysfunction
Spasms
Dystonia
Baclofen
Programmable pumps

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