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Neurochirurgie
Vol 49, N° 2-3  - mai 2003
pp. 289-292
Doi : NCHIR-05-2003-49-2-3C2-0028-3770-101019-ART18
LE TRAITEMENT PAR BACLOFÈNE INTRATHÉCAL CHEZ LE TRAUMATISÉ CRÂNIEN GRAVE
Revue de la littérature
 

E. CUNY
[1]  Service de Neurochirurgie, Hôpital Pellegrin, Bordeaux.

Tirés à part : E. Cuny

[2]   Service de Neurochirurgie, Hôpital Pellegrin, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076 Bordeaux.

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Il existe deux types d'hypertonie liés au traumatisme crânien grave. La première, la plus fréquemment traitée, survient à distance du traumatisme crânien, la seconde survient à la phase précoce de l'éveil. Cette dernière est associée à d'autres symptômes et définit le syndrome post-traumatique de dysautonomie. Le baclofène intrathécal traite efficacement la spasticité du traumatisé crânien, en améliorant le score d'Ashworth, de spasmes, et le score réflexe mais diminue aussi le nombre de crises neurovégétatives. L'amélioration fonctionnelle réelle du patient est plus difficile à définir. Pour être efficace le traitement de baclofène intrathécal doit être administré à des doses suffisantes, délivré à l'aide d'un cathéter dont l'extrémité se projette suffisamment haut sur la moelle spinale, de façon continue et suffisamment prolongée pour que le bénéfice fonctionnel puisse être objectivé.

Abstract
Intrathecal baclofen and traumatic brain injury. A review

Severe head injury can induce hypertonia. There are two kinds of hypertonia related to severe injury. The most common one is a spasticity that occurs a long time after the head injury ; the second is hypertonia that occurs during the early stage of the post-trauma recovery. Hypertonia is associated with other symptoms and defines post-trauma dysautonomia. Intrathecal baclofen can alleviate spasticity in severe head injury with improvement of the Ashworth score, spasm score or reflex score. But it also improves the number of paroxymal dysautonomic episodes. Real functional improvement is more difficult to show. To be effective, intrathecal baclofen therapy in brain injured patients needs high doses per day, through a spinal catheter in the mediothoracic region, and delivered at least continuously for a few hours to achieve a functional improvement.

Keywords: intrathecal baclofen , severe head trauma , severe autonomic disorders , independence






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