[Intrathecal baclofen therapy: a 30-year experience]. / Intratekal'naya baklofenovaya terapiya: 30 let primeneniya.

BACKGROUND: The first pump for intrathecal administration of baclofen was implanted in 1984. Over thirty years, intrathecal prolonged infusion of muscle relaxants has occupied a worthy niche among all methods for correction of non-focal drug-resistant disabling muscle spasticity. However, this method has not become routine despite high awareness of specialists in Russia and abroad, as well as undeniable advantages for restoring the daily activity, improving the walking pattern and providing care and quality of life in people with limited mobility. This is due to scrupulous analysis of adverse events and accurate attitude towards its use.The purpose of this review was to systematize data on indications, selection criteria, pump implantation technique, subsequent patient management and treatment outcomes over a 30-year history. METHOD: A review of national and foreign literature was performed. RESULTS AND CONCLUSION: Prolonged intrathecal baclofen therapy is perspective for long-term treatment of severe spasticity interfering with quality of life and self-care if oral muscle relaxants are contraindicated or ineffective. This procedure is effective for impaired articulation, chewing and spastic pain syndrome. One can reduce the incidence of side effects via correct dosage of the drug, and tolerance to therapy can be reduced by timely elimination of problems with catheter.

Application of 2D Gait Analysis for the Assessment of Gait Disturbance in Patients with Spastic Tetraparesis.

The aim of the study was to explore the use of 2D gait analysis for assessing gait abnormalities in patients with spastic tetraparesis associated with spinal cord injury and other lesions of the cervical spinal cord. Materials and Methods: The study included 12 patients with tetraparesis of various etiologies. Gait assessment was performed by video analysis using reflective markers (1.5 cm) and a special walking platform. The spatial coordinates of the markers were determined by capturing the reflected light with infrared LEDs located around the lenses of video cameras. Results: Using 2D gait analysis, numerical indicators of gait disturbance in spastic tetraparesis were obtained. We found a prolongation of the stand phase with a shortening of the swing phase (from 81.9 [76.1; 89.2] to 85.3 [74.4; 90.2]%; p=0.97) and the period of the double step (from 0.50 [0.45; 0.96] to 0.40 [0.34; 0.66]; p=0.4) in comparison with the target (normal) values (60% - for the stand phase; 1.41 - for the double-step period). The movements in the hip, knee, and ankle joints are described using numerical values.We then compared the data obtained from the left and right sides of the patient's body: there were no statistically significant differences between the two sets of data. We also compared the gait characteristics before and after treatment (in 4 patients). Statistically significant differences in values were obtained for the stand and swing phases (p=0.035), the range of motion in the hip joint (p=0.01), and gait velocity (p=0.046). Kendall's analysis revealed no significant correlation between the data obtained by video gait analysis and the gait changes by the Modified Ashworth Scale (р>0.05). Conclusion: 2D gait analysis is a promising method for quantifying gait disturbance in patients with spastic tetraparesis. It allows one to identify characteristic gait patterns, in particular, an increase in the stand phase with a shortening of the swing phase and the double step period, as well as a decrease in the range of motion in the hip joints with an increase in the knee and ankle ones.

Intrathecal Baclofen Therapy in Russia: National Register, the Effect of One-Year Usage.

Patients with severe muscular spasticity still represent the most complex and resistant to therapy group of neuro-rehabilitation patients. In a few years, in Russia, intrathecal baclofen therapy has appeared to be the most effective method for such spasticity. For the first time the authors developed and implemented in clinical practice "Prospective register to treat spastic states using intrathecal baclofen therapy in Russian Federation" aimed at therapy classification of spastic patients: to reveal management characteristics, assess treatment outcomes and frequency of occurrence of adverse events that will finally help specify the need for the method employment in real clinical practice. The article presents the findings of a one-year usage of Register, which enabled to make a preliminary evaluation of intrathecal baclofen therapy in Russia.

[Combined use of local anesthetic with clonidine in cases of tooth extraction].

The technique of local anesthesia by lidocain in combination with clonidine (clofelinum) as vasoconstrictor in the dose of 1 microg/kg was compared with local anesthesia by novocain in combination with adrenaline (1:200 000) or by lidocain without vasoconstrictor or by articain in combination with adrenaline (0.012 mg/ml). Lidocain use led to expressed tachycardia and considerable increase of cardiac oufput in moderate hypertension reactions. Adrenaline addition in anesthetic solution increases general peripheral resistance and all parameters of arterial pressure with simultaneous rise of heart contractions. Adrenaline substitution as local vasoconstrictor for clofelinum decreases sympathetic tension during operation, prevents hypertensive reactions as the result of general peripheral resistance decrease, stabilizes heart rhythm and basic indices of central hemodynamics, that testifies to its (technique) adequacy.