Intrathecal Baclofen in Tetanus

Müller, H.; Zierski, J.; Börner, U.; Hempelmann, G.

doi:10.1111/j.1749-6632.1988.tb31823.x

Cited by 14 publications

(18 citation statements)

References 21 publications

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“…Many patients suffering from spontaneous spasms at night were able to sleep undisturbed and had considerably less problems in dressing and personal hygiene. In cases with spastic bladder disturbance voiding was facilitated (cf ref 25). Patients able to walk, that is, having minor degrees of paresis or using their spastic increase of extensor tone to maintain upright posture (patients nos.…”

Section: Resultsmentioning

confidence: 99%

“…22 Several other studies have subsequently been published.2324 Intrathecal baclofen seems to be effective also in tetanus. 25 We present the results of a multi-centre study conducted at four independent hospitals in four European countries following identical investigational protocols and using the same, programmable DAD for intrathecal application of baclofen as treatment of spasticity.…”

mentioning

confidence: 99%

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Intrathecal baclofen for long-term treatment of spasticity: a multi-centre study.

Ochs

Strüppler

Meyerson

et al. 1989

Journal of Neurology, Neurosurgery & Psychiatry

168

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SUMMARY Twenty eight patients with severe, intractable spasticity have been treated by chronic intrathecal administration of baclofen. An implantable programmable drug-administration-device (DAD) was used with a permanent intrathecal catheter. Infusion of 50 to 800 ug//day of baclofen completely abolished spasticity. Follow-up was up to two years. Therapeutic effect was documented by clinical assessment of tone, spasms and reflexes and by electrophysiological recordings of monoand polysynaptic reflex activity. Complications and untoward side-effects of the procedure were few. This procedure is recommended for spasticity of spinal origin refractory to physiotherapy and oral medication. It is a preferable alternative to ablative surgical intervention.After an upper motoneuron lesion in man, a spastic syndrome often develops with a delay of weeks or months. This is characterised by hyperactive monoand polysynaptic reflexes and a velocity dependent increase in muscle tone. Depending on the site of the lesion, the features of the motor disorder can vary considerably. In spinal cord transection the powerful inhibitory action of the vestibulo-spinal pathway (projecting from the lateral vestibular nucleus) on the tonic innervation offlexors is eliminated, leading to an increase in flexor muscle tone of the legs. Lesions of the reticulo-spinal pathways cause loss of inhibition of the flexion reflex, resulting in spontaneous and sometimes painful flexor spasms. On the other hand, extensor spasms can also occur. All these patients suffer frequently from severe disability having their legs in a fixed, usually flexed, position causing nursing problems and severe handicap in daily life.Flexor spasticity is often resistant to drugs in tolerable doses. Microsurgical procedures like selective peripheral neurotomy, posterior rhizotomy' and longitudinal myelotomy have been used. These interventions are designed to interrupt the spinal reflex arc or to reduce the afferent input to the dorsal horn.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Intrathecal baclofen for long-term treatment of spasticity: a multi-centre study.

Ochs

Strüppler

Meyerson

et al. 1989

Journal of Neurology, Neurosurgery & Psychiatry

168

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“…Agonists of the metabotropic GABA B receptor such as baclofen have been evaluated for their utility in targeting a number of peripheral disorders thought to involve aberrant reflexes and sensations including pain, overactive bladder, hiccups, tetanus/spasticity, and headache [3-10]. GABA B receptor agonists have also been evaluated for their effects on airways hyperresponsiveness, GERD and cough [11-20].…”

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confidence: 99%

Antitussive effects of the peripherally restricted GABAB receptor agonist lesogaberan in guinea pigs: Comparison to baclofen and other GABAB receptor-selective agonists

Canning

Mori²,

Lehmann

2012

Cough

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BackgroundGastroesophageal reflux disease (GERD) is a common cause of chronic cough. Both acid and nonacid reflux is thought to play a role in the initiation of coughing and cough hypersensitivity. The GABAB receptor agonist lesogaberan was developed as a peripherally restricted anti-reflux therapy that reduces the frequency of transient lower esophageal sphincter relaxations (TLESR; the major cause of reflux) in animals and in patients with GERD. GABAB receptor agonists have also been shown to possess antitussive effects in patients and in animals independent of their effects on TLESR, suggesting that lesogaberan may be a promising treatment for chronic cough.MethodsWe have assessed the direct antitussive effects of lesogaberan (AZD3355). The effects of other GABAB receptor agonists were also determined. Coughing was evoked in awake guinea pigs using aerosol challenges with citric acid.ResultsLesogaberan dose-dependently inhibited citric acid evoked coughing in guinea pigs. Comparable effects of the GABAB receptor agonists baclofen and 3-aminopropylphosphinic acid (3-APPiA) on cough were also observed. Baclofen produced obvious signs of sedation and respiratory depression. By contrast, both lesogaberan and 3-APPiA (both inactivated centrally by GABA transporters) were devoid of sedative effects and did not alter respiratory rate.ConclusionsTogether, the data suggest that lesogaberan and related GABAB receptor agonists may hold promise as safe and effective antitussive agents largely devoid of CNS side effects.

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“…The risk of secondary infection of an indwelling intrathecal catheter and of meningitis is increased when an indwelling intrathecal catheter is present in the subarachnoid space, so CSF analysis was performed for all patients initially, at weekly intervals, whenever fever occurred, and when the catheter was removed [11,16,18,19]. In our patients, the duration of perfusion ranged from 8 to 30 days ( , days).…”

Section: Discussionmentioning

confidence: 99%

“…Because it does not cross the blood-brain barrier, and because high intrathecal concentrations must be achieved in tetanus patients, baclofen needs to be administered directly in the subarachnoid space. However, it does not interfere with the autonomic dysfunction observed in more severe forms of disease [9][10][11].…”

mentioning

confidence: 99%

Intrathecal Baclofen for the Treatment of Tetanus

et al. 2004

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Tetanus remains a serious problem in public health, particularly in developing countries, despite efficient prevention programs. A retrospective study was conducted at an infectious diseases intensive care unit during 1998-2003 involving patients admitted with grade III tetanus. The aim of the study was to evaluate the efficacy and safety of intrathecal baclofen for the treatment of tetanus. Lumbar puncture was performed, and a subarachnoid catheter was inserted for drug administration. An intrathecal bolus of baclofen was followed by a continuous infusion of 20 microg/h, until a maximum daily dose of 2 mg was provided. Twenty-two patients were treated overall. Control of the symptoms was achieved in all patients but one. Seven patients had colonization of the catheter, and 1 patient developed meningitis. All patients except one recovered. In our study, this means of treatment was efficacious and well tolerated.

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Intrathecal Baclofen in Tetanus

Cited by 14 publications

References 21 publications

Intrathecal baclofen for long-term treatment of spasticity: a multi-centre study.

Intrathecal baclofen for long-term treatment of spasticity: a multi-centre study.

Antitussive effects of the peripherally restricted GABAB receptor agonist lesogaberan in guinea pigs: Comparison to baclofen and other GABAB receptor-selective agonists

Intrathecal Baclofen for the Treatment of Tetanus

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