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Intrathecal baclofen in severe spasticity
Intrathecal baclofen in severe spasticity E.M. Delhaas, J.M. Spit, J.J.M. Kums (Zwolle) With maximum tolerable oral doses baclofen the thera~utical benefits are insu~cient in severe spasticity. Achieved by by-passing the blood-brain-barrier intrathecal baclofen administration yield to a powerful treatment in intractable cases. For continuous baclofen infusion the Medtronic implantable, programmable drug delivery system connected with a spinal catheter was used in 32 intractable cases of spasticity (12 spinal cord lesions, 11 multiple sclerosis, 9 cerebral origin). All the seriously handicapped patients received considerable benefits of their spas-
tic features of the extremities, trunk and bladder. The very low incidence of side-effects during intrathecal administration is related to the baclofen serum levels below 10 m&L. Tolerance is probably the major problem for the future. Treatment with temporary replacement by morphine seems to be possible. CSFleakage as a result of the dura puncture could easily be treated by epidural injection of 20 ml homologue blood. The incidence of catheter related problems (dislocation, kinking, disconnection) can be diminished by new catheter technology.
Cerebrospinai fluid findings in muslin-Barr~‘s
syndrome
A.E.J. de Jager, S. Djojoatmodjo,
J.B.M. Kuks, A.W. Teelken (Groningen)
Samples of CSF and serum were obtained from 54 patients with Guillain-Barre’s syndrome (36 m, 18 f, median age 43 years). Controls were samples from 97 patients with low back pain (56 m, 41 f, median age 42 years) and from 53 multiple sclerosis patients (19 m, 34 f, median age 40 years). The samples were analyzed for protein levels, including IgG. In the GBS patients CSF total protein level was only slightly elevated in the first week of the disease, rose in the second part of the progressive phase of the disease, reached its highest level in the plateau phase (mean 2.36 gr/l) and dropped slowly in the first half of the recovery phase. No correlation was found between protein levels and the duration of the different stadia, nor with the severity of the disease.
Various formulas originated to detect intrathecal IgG synthesis were used in the GBS patients. IgG index and Tou~ellotte’s formula showed intrathecal IgG synthesis; the log-plot was normal. In 6 patients oligoclonal bands were seen on immunoelectrophoresis but each patient had the same bands in the serum. Comparison between the percentage albumin transfer and the IgG quotient showed a proportional increased IgG transfer with increasing barrier breakdown. We conclude that high CSF IgG levels in GBS patients are due to serum leakage through the damaged blood brain barrier and not to intrathecal synthesis. The results of IgG index and Tourtellotte’s formula are regarded as false positives.
The diagnostic value of the presence of anti-neuronal antibodies for paraneoplastic disorders in the CNS J.W.B. Moll, S.C. Henze~-Logmans,
T.A.W. Splinter, M.E.L. van der Burg, Ch.J. Vecht
The diagnostic value of the presence of anti-neuronal antibodies in serum was examined in 21 patients suspected of paraneoplastic disorders of the central nervous system (CNS) (group I) and was compared to three control groups; group II: 25 patients with a neurological disease, without cancer and no signs of paraneoplastic disorder; group III: 27 patients with neurological disease and cancer and no signs of a paraneoplastic disorder; group IV: 94 patients with cancer and without neurlogical disease. In group I, anti-nuclear neuronal antibodies were detected in 8 patients (38%), in titers from 1:lOOOto 1:32.000. A
small cell lung cancer was present in 6 patients, ovarian cancer in 1 patient and in 1 patient no tumor could be detected. The neurological symptoms preceded a diagnosis of cancer in 5 out of 8 patients. Only in control group III, antineuronal antibodies were found in serum of 2 out of 94 patients (2%). These data indicate a moderate sensitivity of 38%, but a high specificity of 98.6% (95% confidence interval 95.5-99.8%) for the presence of anti-nuclear neuronal antibodies if a paraneoplastic CNS disorder is suspected.
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tic features of the extremities, trunk and bladder. The very low incidence of side-effects during intrathecal administration is related to the baclofen serum levels below 10 m&L. Tolerance is probably the major problem for the future. Treatment with temporary replacement by morphine seems to be possible. CSFleakage as a result of the dura puncture could easily be treated by epidural injection of 20 ml homologue blood. The incidence of catheter related problems (dislocation, kinking, disconnection) can be diminished by new catheter technology.
Cerebrospinai fluid findings in muslin-Barr~‘s
syndrome
A.E.J. de Jager, S. Djojoatmodjo,
J.B.M. Kuks, A.W. Teelken (Groningen)
Samples of CSF and serum were obtained from 54 patients with Guillain-Barre’s syndrome (36 m, 18 f, median age 43 years). Controls were samples from 97 patients with low back pain (56 m, 41 f, median age 42 years) and from 53 multiple sclerosis patients (19 m, 34 f, median age 40 years). The samples were analyzed for protein levels, including IgG. In the GBS patients CSF total protein level was only slightly elevated in the first week of the disease, rose in the second part of the progressive phase of the disease, reached its highest level in the plateau phase (mean 2.36 gr/l) and dropped slowly in the first half of the recovery phase. No correlation was found between protein levels and the duration of the different stadia, nor with the severity of the disease.
Various formulas originated to detect intrathecal IgG synthesis were used in the GBS patients. IgG index and Tou~ellotte’s formula showed intrathecal IgG synthesis; the log-plot was normal. In 6 patients oligoclonal bands were seen on immunoelectrophoresis but each patient had the same bands in the serum. Comparison between the percentage albumin transfer and the IgG quotient showed a proportional increased IgG transfer with increasing barrier breakdown. We conclude that high CSF IgG levels in GBS patients are due to serum leakage through the damaged blood brain barrier and not to intrathecal synthesis. The results of IgG index and Tourtellotte’s formula are regarded as false positives.
The diagnostic value of the presence of anti-neuronal antibodies for paraneoplastic disorders in the CNS J.W.B. Moll, S.C. Henze~-Logmans,
T.A.W. Splinter, M.E.L. van der Burg, Ch.J. Vecht
The diagnostic value of the presence of anti-neuronal antibodies in serum was examined in 21 patients suspected of paraneoplastic disorders of the central nervous system (CNS) (group I) and was compared to three control groups; group II: 25 patients with a neurological disease, without cancer and no signs of paraneoplastic disorder; group III: 27 patients with neurological disease and cancer and no signs of a paraneoplastic disorder; group IV: 94 patients with cancer and without neurlogical disease. In group I, anti-nuclear neuronal antibodies were detected in 8 patients (38%), in titers from 1:lOOOto 1:32.000. A
small cell lung cancer was present in 6 patients, ovarian cancer in 1 patient and in 1 patient no tumor could be detected. The neurological symptoms preceded a diagnosis of cancer in 5 out of 8 patients. Only in control group III, antineuronal antibodies were found in serum of 2 out of 94 patients (2%). These data indicate a moderate sensitivity of 38%, but a high specificity of 98.6% (95% confidence interval 95.5-99.8%) for the presence of anti-nuclear neuronal antibodies if a paraneoplastic CNS disorder is suspected.
187