Le traitement par voie intrathécale des troubles neuropérinéaux
Tóm tắt
La clonidine injectée par voie intrathécale a été testée chez des patients blessés médullaires intolérants ou résistants au traitement parasympathicolytique. Si l’effet précoce de la clonidine sur les paramètres urodynamiques était satisfaisant, les effets secondaires cardiovasculaires et la survenue d’une tolérance précoce en ont limité l’utilisation en infusion chronique. Le baclofène intrathécal a, quant a` lui, un effet sur le réflexe mictionnel sur le plan théorique, mais peu d’effets en pratique clinique sur l’hyperactivité vésicale de patients souffrant d’une spasticité d’origine spinale. Il peut provoquer par ailleurs une modification de la qualité des érections et une incapacité à l’obtention d’éjaculations par stimulation vibratoire pénienne. L’évaluation de nouvelles cibles pharmacologiques médullaires telles que les récepteurs sérotoninergiques ou dopaminergiques pourraient avoir un intérêt à l’avenir.
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