痙性麻痺に対するバクロフェン髄注療法

Intrathecal Baclofen Therapy for Spastic Paralysis

Point

・バクロフェン髄注療法は，重度の痙性麻痺で内服加療の効果が不十分な場合や内服の副作用が強い場合に適応となる．

・全身麻酔下に，投与量の調節が可能な電池内臓のポンプを腹部に留置し，充塡されたバクロフェンを持続投与する．

・約3カ月に1度程度の間隔で薬液の補充を行い，また，6〜7年に1度ポンプ交換手術が必要となる．

　Intrathecal baclofen therapy（ITB）is a recognized treatment for spastic paralysis. Direct injection of baclofen into the intrathecal space through a catheter from a battery-loaded pump implanted in the abdomen allows effective administration of the drug at much lower doses than oral administration. ITB therapy is indicated for patients with severe spastic paraparesis that do not respond sufficiently to first-line medical therapy or in whom the side effects complicate treatment. A pump implantation is considered in cases where spasticity is improved after intrathecal infection of a small amount of baclofen. Postoperative complications include CSF leakage, infection and device malfunction. Postoperatively, the patient requires baclofen refills every 2-3 months and pump replacement surgery every 6-7 years. Currently, ITB therapy is not widespread in Japan, although further popularization is expected.