SummaryThe effects of intrathecal baeZofen infusion were studied in 9 spinal cord injury patients whose spasticity had been refractory to oral medications. In a two stage, placebo controlled trial, baeZofen was administered into the lumbar intrathecal space and subsequent eZinical and neurophysiologic changes were assessed.In stage 1, 9 patients underwent a 5 day percutaneous infusion of baeZofen and placebo via an external pump. Ashworth and reflex scores were assessed at time of enrollment, after infusion of that amount of baeZofen which provided optimal spasticity control and after intrathecal infusion of placebo. The mean Ashworth grade decreased from 3·78 ± 1·34 to 1·16 ± 0·48 (p < 0·001) while mean reflex score decreased from 3·57 ± 1·05 to 0·64 ± 0·87 (p < 0·001). These values differed significantly from those associated with placebo therapy (Ashworth grade-2·54 ± 1·04, P < 0·001; reflex score-2·56 ± 1·04, P < 0·01). Objective improvements in functional abilities and independence were noted in 8 patients, while somatosensory and brainstem auditory evoked potentials were unchanged in all patients. Urodynamic evaluation revealed increased bladder capacity in 3 patients, while in 4 no change was observed.In Stage 2, permanent programmable infusion pumps were implanted in 7 patients who demonstrated a good response during Stage 1. In this group, mean Ashworth score decreased from 3·79 ± 0·69 to 2 ± 0·96 (p < 0·001) and mean reflex score decreased from 3·85 ± 0·62 to 2·18 ± 0·43 (p < 0·001). BaeZofen dosage increased from 182 ± 135 to 528 ± 266 mcg/day over the 3-22 month follow-up period. Most of the dosage increase occurred within the initial 12 months following infusion pump implantation and tended to plateau thereafter.Minor complications such as catheter dislodgement/kinking and nausea occurred infrequently while no device related infections were observed. There was no eZinical evidence of any significant baeZofen neurotoxicity either in Stage 1 or 2. The only ambulatory patient developed marked lower extremity weakness during Stage 1 intrathecal baeZofen infusio� and was temporarily unable to walk.We coneZude that continuous administration of intrathecal baeZofen is an effective and safe modality for spasticity control in patients who are refractory to oral medications.
Following spinal instrumentation for scoliosis, a patient developed intractable axial dystonia refractory to conservative medical management. We describe the successful treatment of this dystonia with a continuous infusion of intrathecal baclofen and the subsequent long-term management.
The alternative complement cascade is predominantly activated during extracorporeal circulation. Anti-factor D monoclonal antibody 166-32 is effective in inhibiting the activation of complement, neutrophils, and platelets. Inhibition of the alternative complement pathway by targeting factor D could be useful in reducing systemic inflammation in patients undergoing cardiopulmonary bypass.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.