T.A. BIKMULLIN, M.S. LEVIN, E.R. BARIEV, F.N. KHAKIMOVA

Republican Clinical Hospital of the MH of RT, 138 Orenburgskiy Trakt, Kazan, Russian Federation, 420064

 Bikmullin T.A. ― Cand. Med. Sc., Head of the Department of Neurosurgery №1, tel. +7-917-269-71-20, e-mail: bikmullin_timur@bk.ru

Levin M.S. ― doctor of the Department of Neurosurgery №1, tel. (843) 231-21-83, e-mail: nho_rkb@mail.ru

Bariev E.R. ― doctor of the Department of Neurosurgery №1, tel. +7-917-221-20-54, e-mail: barieved@mail.ru

Khakimova F.N. ― doctor of the Department of Neurosurgery №1, tel. +7-950-311-44-50, e-mail: f.foreign@yandex.ru

A clinical analysis was conducted of the surgical treatment outcomes in patients with spastic syndrome of various etiologies by baclofen pump implantation. A significant reduction in the severity of spastic syndrome in all operated patients was found, which was manifested in a significant tone decrease according to Ashworth scale and improvement of the locomotor status according to Arens scale. The frequency of complications during catamnesis from 1 to 4 years was 5.9%. The features of patients with previously implanted baclofen pumps are revealed. The main ways to eliminate the difficulties in the subsequent treatment of this category of patients were outlined.

Key words: spastic syndrome, baclofen pump, complications.

REFERENCES

1. Klyushnikov S.A., Illarioshkin S.N., Ivanova-Smolenskaya I.A. Spastic syndrome in neurology. The possibilities of tolperisone (midokalma®) in the therapy of spastic manifestations of neurovascular syndromes. Mezhdunarodnyy nevrologicheskiy zhurnal, 2011, no. 5 (43) (in Russ.).
2. Walter J.S.,•Sacks J.,•Othman R.,•Anfinsen L. Characteristics of persons with spinal cord injury as documented by use of an interactive data system. The journal of spinal cord medicine, 2000, Jan, pp. 126-129.
3. http://vestnik.mednet.ru/content/view/234/30/lang,ru/
4. http://www.neuro-med.ru/spastika.htm
5. Burchiel K.J., et al. Prospective, Multicenter Study of Spinal Cord Stimulation for Relief of Chronic Back and Extremity Pain. Spine, 1996, vol. 21 (23), pp. 2786-2794.
6. Adams M.M., Hicks A.L. Spasticity after spinal cord injury. Spinal. Cord, 2005, Oct, 43 (10), pp. 577-86.
7. Bonica J.J. The Surgical Management of Pain. Philadelphia: Lea and Febiger, 2003. 2020 p.
8. Burchiel K.J., Bums A.S. Summary statement: pain, spasticity, and bladder and sexual function after spinal cord injury. Spine, 2001, vol. 15; 26 (24 Suppl), p. 161.
9. Abbott R., Forem S.L. & Johann M. Selective posteri or hizotomy for the treatment of spasticity. Child’s Nerv. Syst, 1989, vol. 5, pp. 337-46.
10. Daverat P., Petit H., Kemoun G., Dartigues J.F., Barat M. The long term out come in 149 patients with spinal cord injury.WParaplegia, 1995, vol. 33 (l1), pp. 665-8.
11. Maynard F.M., Karunas R.S., Waring W.P. 3rd. Epidemiology of spasticity following traumatic spinal cord injury.Arch. Phys. Med. Rehabil, 1990, vol. 71 (8), pp. 566-9.
12. Damulin I.V., Parfenov V.A., Skoromets A.A., Yakhno N.N. Narusheniya krovoobrashcheniya v golovnom i spinnom mozge [Circulatory disorders in the brain and spinal cord. In: Diseases of the nervous system. A guide for doctors]. Bolezni nervnoy sistemy. Rukovodstvo dlya vrachey. Moscow: Meditsina, 2005. Vol. 1. Pp. 232-303.
13. Livshits A., Rappaport Z.H., Livshits V., Gepstein R. Surgical treatment of pain ful spasticity after spinal cord injury. Spinal Cord, 2002, vol. 40 (4), pp. 161-6.
14. Fizicheskaya reabilitatsiya invalidov s porazheniem oporno-dvigatel’noy sistemy [Physical rehabilitation of disabled people with defeat of the locomotor system]. Chast’ II. Fizicheskaya reabilitatsiya detey, stradayushchikh detskim tserebral’nym paralichom. Glava 4. Kliniko-funktsional’naya kharakteristika detskogo tserebral’nogo paralich, pod red. S.P. Evseevai, S.F. Kurdybaylo. Moscow, 2010. Pp. 199-200.
15. Radensky P.W., Archer J.W., Dournaux S.F., O’Brien C.F. The Estimated Cost of Managing Focal Spasticity: A Physician Practice Patterns Survey. Neurorehabil Neural Repair, 2001, 15 (1), pp. 57-68.
16. Postma T.J., Oenema D., Terpstra S., et al. Cost analysis of the treatment of severe spinals pasticity with a continuous intra the cal baclofen infusion system. Pharmaco economics, 1999 Apr, 15 (4), pp. 395-404.
17. Sindou M., Mifsud J.J., Boisson D. & Goutelle A. Selective posterior hizotomy in the dorsal root entry zone for treatment of hyper spasticity and pain in the hemiplegic upper limb. Neurosurgery, 1986, vol. 18, pp. 587-95.
18. Walter J.S., Sacks J., Othman R., et al.; Hines VASCI Service Physicians. Characteristics of persons with spinal cord injury as documented by use of an interactive data system. J. Spinal. Cord. Med, 2000, Winter, 23 (4), pp. 257-62.
19. Sommerfeld D.K., Eek E.U., Svensson A.K. et al. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke, 2004, vol. 35, pp. 134-139.
20. Skalsky A.J., Fournier C.M. Intra the cal baclofen bolus do sing and catheter tip placement in pediatric tone management. Phys. Med. Rehabil. Clin. N. Am, 2015 Feb, 26 (1), pp. 89-93. doi:10.1016/j.pmr.2014.09.011.
21. Tanju U Car, Saim Kazan, Umut Turgut, Nehir Karaman Samancı. Outcomes of Intra the cal Baclofen (Itb) Therapy in Spacticity. Turkish Neurosurgery, 2011, vol. 21, no. 1, pp. 59-65.
22. Natale M., Mirone G., Rotondo M., Moraci A. Intra the cal baclofen therapy for severe spasticity: analysis on a series of 112 consecutive patients and future prospective. Clin. Neurol. Neurosurg, 2012, May, 114 (4), pp. 321-5. doi:10.1016/j.clineuro.2011.10.046.Epub2011Nov21.
23. Zahavi A., Geertzen J.H., Middel B., et al. Long term effect (more than five years) of intra the cal baclofen on impairment, disability, and quality of life in patients with severe spasticity of spinal origin. J. Neurol. Neurosurg. Psychiatry, 2004, Nov, 75 (11), pp. 1553-7.
24. De Lissovoy G., Matza L.S., Green H., et al. Cost-effectiveness of intra the cal baclofen therapy for the treatment of severe spasticity associated with cerebral palsy. J. Child. Neurol, 2007 Jan, 22 (1), pp. 49-59.
25. Albright A.L1., Turner M., Pattisapu J.V. Best-practice surgical techniques for intra the cal baclofen therapy. J. Neurosurg, 2006 Apr, 104 (4 Suppl), pp. 233-9.