Treating patients with severe spasticity with intrathecal baclofen: The role of GABA<sub>B</sub> receptors

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  • 痙縮治療におけるバクロフェン持続髄注（ITB）療法の臨床―GABA<sub>B</sub>受容体からの考察―

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<p>Intrathecal baclofen (ITB) therapy is effective for the treatment of patients with subacute or chronic severe spasticity due to, for example, stroke, cerebral palsy, and severe traumatic brain- and spinal cord injury. The anti-spasticity effect of baclofen has been attributed to its binding to GABAB receptors at the dorsal column of the spinal cord. GABAB receptors are members of the G protein-coupled receptor family; tolerance must be considered during ITB therapy. One of the activation mechanisms is their desensitization in the presence of G protein-coupled receptor kinase (GRK) subtypes (GRK4 and GRK5); their degradation in cells (their downregulation) with prolonged administration of baclofen is another. Therefore, the prolonged administration of ITB and/or overstimulation of receptors should be avoided. The prescribed dose should be as low as possible if spasticity does not become worse. Interestingly, ITB therapy is effective not only in patients with spasticity, but also in patients with paroxysmal sympathetic hyperactivity due to severe traumatic brain injuries. We reviewed the effectiveness and problems with ITB therapy in 57 patients (59 pumps implanted). </p>

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