Τομέας Χειρουργικής
Library of the School of Health Sciences

2012-07-06

2012

Μαργέτης Κωνσταντίνος

Καθηγητής Δ. Σακάς (επιβλέπων), Αν. Καθ. Ε. Μποβιάτσης, Αν. Καθ. Γ. Στράντζαλης

Ανοικτή προοπτική μελέτη της δράσης της ενδορραχιαίως χορηγούμενης μπακλοφένης στη λειτουργία του νευρικού συστήματος σε ασθενείς με σπαστικότητα

Greek

The intrathecal baclofen (ITB) therapy is an established method for the
treatment of spasticity. Due to its relatively recent introduction into
clinical practice, there is a paucity of studies in regard to the effects of
ITB on the function of the Central Nervous System. Baclofen is the only
selective GABA-B agonist in clinical use. Therefore, studying the effects of
baclofen is also an instrument for the clinical study of the function of GABA-B
receptors. The objective of this thesis is to study the CNS effects of ITB in
fields where available data are limited.
We studied the effect of ITB therapy on the main neurotransmitter
systems of the CNS. CSF levels of the main metabolites of serotonin, dopamine,
and noradrenaline (5-HIAA, HVA, and MHPG respectively) were quantified by means
of high performance liquid chromatography prior to and following the ITB
therapy. ITB treatment resulted in a significant reduction of CSF 5-HIAA levels
and a nearly significant reduction of HVA levels. In contrast, MHPG levels and
the HVA: 5-HIAA ratio remained unchanged.
We then showed that ITB resulted in the amelioration of psychiatric
distress symptoms and in particular, ITB offered an improvement at the SCL-90R
subscales of general severity index, positive symptoms total, anxiety,
depression and obsession-compulsion.
We evaluated the ITB effects on the disorders of consciousness and we
showed that long term ITB therapy was associated with a significant improvement
in 2 of the six patients with concurrent spasticity and disorder of
consciousness.
We then showed that ITB improved the hypertonia due to hereditary
spastic paraplegia, traumatic brain injury, spinal cord injury, stroke and
dystonic type of cerabral palsy.
Finally we evaluated the complications of ITB treatment and we
presented the prevention and management methods we have developed in our
department.
In summary, ITB is a relatively safe method that can improve the
hypertonia, the psychiatric distress symptoms and possibly the disorders of
consciousness in spasticity patients. These data along with the effects of ITB
on the CNS neurotransmitters pave the way for further research on the role of
both ITB and GABA-B agonists in new indications.

baclofen, intrathecal injection, GABA-B receptors, neurotransmitter agents, spasticity

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https://pergamos.lib.uoa.gr/uoa/dl/object/1305712