F-2-04-03
INTRATH ECAL BACLOFEN FOR TREATMENT OF SPINAL SPASTICITY
Selcuk Kucukoglu*, Betul Turan*, Koncuy Sivrioglu*, Muammer Doygun**, Ender Korfali**
Uludag University School of Medicine, *PM&R and **Neurosurgery Departments, Bursa, Turkey
Spasticity is a significant problem that limits the daily activities of many spinal cord injured patients. Two male, traumatic C5 incomplete tetraplegic patients suffering from Ashworth grade 4 spasticity are presented in this report.
Owing to the intractable spasticity unresponsive to oral trial, intrathecal baclofen (ITB) infusion system was implanted under general anesthesia. Continuous baclofen infusion of 150 μg/day in case 1 and 125 μg/day in case 2 resulted in grade 2 spasticity. While ITB application has been continuing for 29 months and 19 months in case 1 and 2 respectively, significant improvement has been achieved in their functional status including transfer and ambulation as well as decrease in sleep disturbance and dysesthetic pain. As a result of the profound decrease in muscle tonus during follow-up, ITB dosages were reduced to 60 μg/day and after spasticity remained at the desired level.
Our experience with these two spinal cord injured patients have shown that ITB administration is a clinically effective method for the management of intractable spinal spasticity and the observation that spasticity has not worsened in spite of the dose reduction requires further investigation.
F-2-04-04
SELECTIVE INTRATHECAL NERVE BLOCK FOR SPASTIC TETRAPLEGIA
Eiji lwatsubo, K. Kajio & T. Ueta (LWC Spinal Injuries Center, Iizuka, Japan)
Abstract: (purpose) Selective intrathecal phenol block of lumbar nerve is an established procedure in pain clinic to control intractable cancer pain. To eliminate severe leg spasm of tetraplegia same procedure was introduced in past 6 years. (method) For 26 spastic tetraplegics, 0.3ml of 10% phenoi-glycerine was instilled into the subarachnoid space at Th 12/L1 or LI/L2, bilaterally on each side over 15 min. interval. (result) This procedure obtained selective lumbar nerve block from L1 to L4, controlling spasm of Ms. ileopsoas, quadriceps femoris, abductor and adductor. Though the pasta recurred in 3 to 12 months and 50 procedures for 26 tetraplegics were required, rehabilitation training and ADL were improved in most cases without any influence to bladder, bowel or sexual function. (conclusion) Selective intrathecal phenol block is valuable to improve QOL of spastic tetraplegia without any side effect.
