Neurophysiological evidence for muscle tone reduction by intrathecal baclofen at the brainstem level

Kumru, H. and Stetkarova, I. and Schindler, C. and Vidal, J. and Kofler, M.. (2011) Neurophysiological evidence for muscle tone reduction by intrathecal baclofen at the brainstem level. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, Vol. 122, H. 6. pp. 1229-1237.

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Official URL: http://edoc.unibas.ch/dok/A6002282

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OBJECTIVE: Intrathecal baclofen (ITB) is an efficient treatment modality for severe spasticity that is considered to act at the spinal level. Its influence on phasic spasticity is usually determined clinically by testing muscle reflexes, and on tonic spasticity by using scores such as the Modified Ashworth Scale (MAS). Neurophysiological techniques, e.g., soleus H reflex, may provide additional information regarding ITB efficacy. There is, however, only scarce information available on time-response relationships of clinical and neurophysiological measures of spasticity obtained at different levels along the neuroaxis. METHODS: Fourteen patients with severe spastic paraparesis underwent serial evaluation of MAS in upper and lower limbs and serial testing of H reflex in soleus and flexor carpi radialis muscles, T wave in quadriceps and biceps brachii muscles, and blink reflex (BR) with and without prepulse, at baseline, and 15, 30, 60, 90, 120, and 180min following ITB bolus application. RESULTS: ITB bolus application caused significant suppression of soleus H reflex after 15min and of quadriceps T wave after 30min, while MAS dropped significantly after 60min together with significant suppression of BR R2 area without and with prepulse stimulation. H reflex in flexor carpi radialis and T wave in biceps brachii were not significantly suppressed by ITB. The time course of early changes in soleus H(max)/M(max) ratio and quadriceps T wave indicates a suppression of hyperreflexia at the spinal level, while a later reduction of MAS synchronously with suppression of BR with and without prepulse concurs with a brainstem effect of ITB. CONCLUSION: Temporal concurrence between suppression of brainstem reflexes and desired suppression of lower limb muscle hypertonia after ITB bolus application suggests that both may be at least partially mediated from a common CNS region of activity. SIGNIFICANCE: Our data concur with a significant brainstem action of ITB
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Infectious Disease Modelling > Epidemiology and Transmission Dynamics (Smith)
03 Faculty of Medicine > Departement Public Health > Sozial- und Präventivmedizin
UniBasel Contributors:Schindler, Christian
Item Type:Article, refereed
Article Subtype:Research Article
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:08 Nov 2012 16:23
Deposited On:08 Nov 2012 16:16

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