Abstract
In patients with a spinal lesion, spasticity and the occurrence of strong flexor or extensor spasms may be responsible for significant disability. In such cases, the effects of treatments administered per os are frequently insufficient. Surgical procedures may be effective but must be reserved for very exceptional cases. Recently, Penn and Kroin (1984, 1985; Penn et al. 1989) have shown that intrathecal administration of baclofen is an effective treatment for severe spasticity. An electrophysiological study was performed in order to determine the mechanisms of action of intrathecal baclofen on spinal function: on presynaptic la or flexor reflex afferent (FRA) terminals or directly on alpha motoneurons. Clinical examination was focused on determining whether a lessening of spasticity could induce an improvement in voluntary movements.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Ashby P, White DG (1973) “Presynaptic” inhibition in spasticity and the effect of β (4-chlorophenyl) GABA. J Neurol Sci 20:329–338
Azouvi P, Roby-Brami A, Biraben A, Thiebaut JB, Thurel C, Bussel B (1993) Effect of intrathecal baclofen on the monosynaptic reflex in man. Evidence for a post-synaptic action. J Neurol Neurosurg Psychiatry (in press)
Castaigne P, Held JP, Pierrot-Deseilligny E, Bussel B, Macquart-Moulin J (1973) Etude de l’effet du lioresal dans la spasticité. Rev Neurol 128:245–250
Delwaide PJ (1973) Human monosynaptic reflexes and presynaptic inhibition. An interpretation of spastic hypereflexia. In: Desmedt JE (ed) New developments in electromyography and clinical neurophysiology, vol 3. Karger, Basel, pp 508–522
Delwaide PJ (1985) Electrophysiological analysis of the mode of action of muscle relaxants in spasticity. Ann Neurol 17:90–95
Edwards FR, Harrison PJ, Jack JJ, Kullmann B (1989) Reduction by baclofen of monosynaptic EPSPs in lumbosacral motoneurones of the anaesthetized cat. J Physiol (Lond) 416:539–556
Hultborn H, Meunier S, Morin C, Pierrot-Deseilligny E (1987) Assessing changes in presynaptic inhibition of la fibers: a study in man and the cat. J Physiol (Lond) 389:729–756
Jimenez I, Rudomin P, Enriquez M (1991) Differential effects of (-) baclofen on la and descending monosynaptic EPSPs. Exp Brain Res 85:103–113
Macdonnel RAL, Talalla A, Swash M, Grundy D (1989) Intrathecal baclofen and the H reflex. J Neurol Neurosurg Psychiatry 52:1110–1112
Mazières L, Morin C, Pierrot-Deseilligny E (1984) Effet de l’amplitude du réflexe test sur le niveau de facilitation ou d’inhibition des réponses monosynaptiques. J Physiol (Paris) 79:59A
Meinck HM (1980) Facilitation and inhibition of the human H-reflex as a function of the amplitude of the control reflex. EEG Clin Neurophysiol 48:203–211
Meunier S, Pierrot-Deseilligny E (1989) Gating of the afferent volley of the monosynaptic stretch reflex during movement in man. J Physiol (Lond) 419:753–763
Müller H, Zierski J, Dralle D, Hoffmann O, Michaelis G (1988) Intrathecal baclofen in spasticity. In: Müller H, Zierski J, Penn RD (eds) Local spinal therapy of spasticity. Springer, Berlin Heidelberg New York, pp 155–214
Ochs G, Struppler A, Meyerson BA, Linderoth B, Gybels J, Gardner BP, Teddy P, Jamous A, Weinmann P (1989) Intrathecal baclofen for long-term treatment of spasticity: a multicentre study. J Neurol Neurosurg Psychiatry 52:933–939
Penn RD, Kroin JS (1984) Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1:1078
Penn RD, Kroin JS (1985) Continuous intrathecal baclofen for severe spasticity. Lancet 2:125–127
Penn RD, Savoy SM, Corcos D, Latsh M, Gottlieb G, Parke B, Kroin JS (1989) Intrathecal baclofen for severe spinal spasticity. N Engl J Med 320:1517–1521
Pierau FK, Zimmermann P (1973) Action of a GABA derivative on post-synaptic potentials and membrane properties of cat’s spinal motoneurones. Brain Res 54:376–380
Roby-Brami A, Bussel B (1987) Long-latency spinal reflex in man after FRA stimulation. Brain 110:707–725
Young RR, Delwaide PJ (1981) Drug therapy: spasticity. N Engl J Med 304:28–33, 96–99
Zieglgansberger W, Howe JR, Sutor B (1988) The neuropharmacology of baclofen. In: Müller H, Zierski J, Penn RD (eds) Local spinal therapy of spasticity. Springer, Berlin Heidelberg New York, pp 7–50
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1993 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Bussel, B., Azouvi, P., Roby-Brami, A. (1993). Effect of Intrathecal Baclofen on Monosynaptic Reflex in Man. In: Thilmann, A.F., Burke, D.J., Rymer, W.Z. (eds) Spasticity. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-78367-8_38
Download citation
DOI: https://doi.org/10.1007/978-3-642-78367-8_38
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-78369-2
Online ISBN: 978-3-642-78367-8
eBook Packages: Springer Book Archive