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Intrathecal Administration of Baclofen for Treatment of Spasticity: Neurobiological Principles and First Clinical Results

  • U. H. Wiese
  • W. Grüninger
  • J. Bockhorn
  • N. Wünsche
Conference paper
Part of the Advances in Neurosurgery book series (NEURO, volume 16)

Abstract

The term “spasticity,” as defined by LANCE (7) as “a motor disorder characterized by a velocity dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks,” includes a clinical phenomenon which is produced by spinal and supraspinal lesions in the central nervous system: The transection of the brain stem at midbrain level, a condition that SHERRINGTON (16) called “decerebrate rigidity,” and the condition after spinal cord trauma are combined with clinical and electrophysiological findings identical to the above-mentioned definition. Nevertheless, it certainly cannot be excluded that different mechanisms of neuronal interactions are involved in the formation of spasticity. Although the imbalance between the different descending systems, including the reticulospinal and vestibulospinal tracts, could play a major role in the spasticity triggered by supraspinal lesions, the “sprouting” theory is gaining more and more importance in the light of growing knowledge of the plasticity of the adult central nervous system. McCOUCH et al. (9) and LIU and CHAMBERS (8) found in monkeys and cats a sprouting of segmental afferent terminals below a spinal cord transection area. It appeared that sprouts and terminals of dorsal root fiber axons in part take over vacated synaptic sites originally occupied by terminations of descending, now degenerated, fibers.

Keywords

Adult Central Nervous System Pump Implantation Vestibulospinal Tract Decerebration Rigidity Tonic Stretch 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Burke D, Andrews CJ, Knowles L (1971) The action of a GABA derivate in human spasticity. J Neurol Sci 14: 199–208PubMedCrossRefGoogle Scholar
  2. 2.
    Davidoff RA (1980) Effects of baclofen on synaptic activity in the spinal cord. In: Feldman RG, Young RR, Koella WP (eds) Spasticity: Disordered motor control. Yearbook Medical Publishers, Chicago, Illinois, pp 421–432Google Scholar
  3. 3.
    Davidoff RA, Hackman (193) Drugs, chemicals and toxins: Their effects on the spinal cord. In: Davidoff RA (ed) Handbook of the spinal cord, vol 1. Marcel Dekker, New Yo’rk Basel, pp 409–476Google Scholar
  4. 4.
    Fox S, Krnejevic K, Morris ME, Puil E, Werman R (1978) Action of baclofen on mammalian synaptic transmission. Neuroscience 3: 495–515PubMedCrossRefGoogle Scholar
  5. 5.
    Jones RF, Burke D, Marosszeky JE, Gillies JD (1970) A new agent for the control of spasticity. J Neurol Neurosurg Psychiatry 33: 464–468PubMedCrossRefGoogle Scholar
  6. 6.
    Kudo Y, Kurachi M, Fukuda H (1976) Action of baclofen on the isolated spinal cord of the frog. Jpn J Pharmacol 26: 99PCrossRefGoogle Scholar
  7. 7.
    Lance JW (1980) Symposium synopsis. In: Feldman RG, Young RR, Koella WP (eds) Spasticity: Disordered motor control. Year Book Medical Publishers, Chicago, IllinoisGoogle Scholar
  8. 8.
    Liu CN, Chambers WW (1958) Intraspinal sprouting of dorsal root axons. Arch Neurol Psychiat 79: 46–61Google Scholar
  9. 9.
    McCouch GP, Austin GM, Liu CN, Liu CY (1958) Sprouting as a cause of spasticity. J Neurophysiol 21: 205–216PubMedGoogle Scholar
  10. 10.
    Müller H, Zierski J (1986) Empfehlungen zur Langzeitanwendung von intrathecalem Baclofen bei spinaler und cerebraler Spastizität.Google Scholar
  11. 11.
    Pederson E, Arlien-Soborg P, Mai J (1974) The mode of action of the GABA derivate baclofen in human spasticity. Acta Neurol Scand 50: 665–680CrossRefGoogle Scholar
  12. 12.
    Penn RD (1986) Vortrag, Symposium local-spinal Therapie der Spastik, GießenGoogle Scholar
  13. 13.
    Pierau FK, Matheson GK, Wurster RD (1975) Presynaptic action of beta (-4-chlorophenyl)-GABA. Exp Neurol 48: 343–351PubMedCrossRefGoogle Scholar
  14. 14.
    Potasher SJ (1979) Effects on amino acid release and metabolism in slices of guinea pig cerebral cortex. J Neurochem 32: 103–109CrossRefGoogle Scholar
  15. 15.
    Puil E (1983) Action and interaction of S-glutamate in the spinal cord. In: Davidoff A (ed) Handbook of the spinal cord, vol 1. Marcel Dekker, New York Basel, pp 105–169Google Scholar
  16. 16.
    Sherrington CS (1898) Decerebrate rigidity and reflex coordination of movements. J Physiol (Lond) 22: 319–332Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • U. H. Wiese
    • 1
  • W. Grüninger
    • 1
  • J. Bockhorn
    • 1
  • N. Wünsche
    • 1
  1. 1.RückenmarkverletzteNeurochirurgische Klinik und Rehabilitations-KlinikBayreuthGermany

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