| Neurophysiological basis and clinical applications of the H-reflex as an adjunct for evaluating response to intrathecal baclofen for spasticity. | |
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MedLine Citation:
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PMID: 17691382 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Implanted programmable pumps that infuse intrathecal baclofen (ITB) markedly enhance the ability of clinicians to manage severe spasticity in appropriately selected patients. Studies addressing the efficacy of this treatment modality have primarily used clinical outcome measures of impairment, particularly reduction in stiffness as measured by the Ashworth scale. Several recent studies, however, highlight comparalively higher sensitivity of neurophysiologic techniques, especially the H-reflex, as an objective index of spinal cord response to ITB administration. We review the conceptual, physiological, and methodological hases for use of the H-reflex as an adjunct to clinical evaluation among patients receiving ITB infusion, including published reports and selected case studies that address the potential advantages and limitations of such techniques when applied to dose titration and system "troubleshooting" scenarios, We also address the implications of such findings in the context of reported complications such as "tolerance" to ITB administration and catheter "microfracture". The accumulated knowledge suggests that H-reflex is a sensitive method for documenting altered spinal cord responsiveness in the presence of ITB delivery. We therefore recommend using H-reflex as an adjunct to clinical evaluation when judging the overall effectiveness of ITB administration. |
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Authors:
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D S Stokic; S A Yablon |
Publication Detail:
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Type: Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Acta neurochirurgica. Supplement Volume: 97 ISSN: 0065-1419 ISO Abbreviation: Acta Neurochir. Suppl. Publication Date: 2007 |
Date Detail:
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Created Date: 2007-08-13 Completed Date: 2007-09-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100962752 Medline TA: Acta Neurochir Suppl Country: Austria |
Other Details:
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Languages: eng Pagination: 231-41 Citation Subset: IM |
Affiliation:
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Center for Neuroscience and Neurological Recovery, Jackson, MS, USA. dstokic@mmrcrehab.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Baclofen
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therapeutic use* Dose-Response Relationship, Drug Drug Delivery Systems H-Reflex / drug effects* Humans Muscle Relaxants, Central / therapeutic use* Muscle Spasticity / drug therapy*, physiopathology |
| Chemical | |
Reg. No./Substance:
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0/Muscle Relaxants, Central; 1134-47-0/Baclofen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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