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array:23 [ "pii" => "S1130147390711852" "issn" => "11301473" "doi" => "10.1016/S1130-1473(90)71185-2" "estado" => "S300" "fechaPublicacion" => "1990-01-01" "aid" => "71185" "copyright" => "Sociedad Española de Neurocirugía" "copyrightAnyo" => "1990" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Neurocirugia. 1990;1:269-77" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2553 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 946 "PDF" => 1596 ] ] "itemSiguiente" => array:18 [ "pii" => "S1130147390711864" "issn" => "11301473" "doi" => "10.1016/S1130-1473(90)71186-4" "estado" => "S300" "fechaPublicacion" => "1990-01-01" "aid" => "71186" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Neurocirugia. 1990;1:279-82" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 6796 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 2094 "PDF" => 4690 ] ] "es" => array:9 [ "idiomaDefecto" => true "titulo" => "Patogenia de la hidrocefalia en el mielomeningocele" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "279" "paginaFinal" => "282" ] ] "contieneResumen" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. 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"apellidos" => "Baguena" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Monforte" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147390711840?idApp=UINPBA00004B" "url" => "/11301473/0000000100000005/v1_201305151000/S1130147390711840/v1_201305151000/es/main.assets" ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Infusión intratecal de baclofeno en el tratamiento de la espasticidad severa" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "269" "paginaFinal" => "277" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "G. García-March, M.<span class="elsevierStyleSup">a</span>J. Sánchez-Ledesma, J. Anaya, J.M. Gonçalves, J. Broseta" "autores" => array:5 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "García-March" ] 1 => array:2 [ "nombre" => "M.<span class="elsevierStyleSup">a</span>J." "apellidos" => "Sánchez-Ledesma" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Anaya" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Gonçalves" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Broseta" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio y Cátedra de Neurocirugía, Complejo Hospitalario y Universidad de Salamanca. Salamanca" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Descriptores" "identificador" => "xpalclavsec156559" "palabras" => array:7 [ 0 => "Espasticidad" 1 => "Dolor" 2 => "Disfunción vesical neurogénica" 3 => "Espasmos" 4 => "Distonía" 5 => "Baclofeno" 6 => "Bombas programables" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec156560" "palabras" => array:7 [ 0 => "Spasticity" 1 => "Pain" 2 => "Neurogenic bladder dysfunction" 3 => "Spasms" 4 => "Dystonia" 5 => "Baclofen" 6 => "Programmable pumps" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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 60<span class="elsevierStyleHsp" style=""></span>μg 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 225<span class="elsevierStyleHsp" style=""></span>μg. 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.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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 60<span class="elsevierStyleHsp" style=""></span>μg 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 225<span class="elsevierStyleHsp" style=""></span>μg 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.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">García-March, G.; Sánchez-Ledesma, M.<span class="elsevierStyleSup">a</span> J.; Anaya, J.; Gonçalves, J. M.; Broseta, J.: Infusión intratecal de baclofeno en el tratamiento de la espasticidad severa. Neurocirugía 1990; 1: 269–277.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High frequency cervical spinal cord stimulation in spasticity and motor disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Broseta" 1 => "G. García-march" 2 => "M.J. Sánchez-Ledesma" 3 => "J. Barberá" 4 => "J. 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