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Journal of Neurosurgical Sciences 2000 Giugno;44(2):69-76

lingua: Inglese

Shoulder-hand syndrome in neurosurgical patients treated with barbiturates. A long term evaluation

De Santis A. 1, Ceccarelli G. 1, Cesana B. M. 2, Bello L. 1, Spagnoli D. 1, Villani R. M. 1

1 Institute of Neurosurgery, University of Milan;
2 Epidemiology Unit, Ospedale Maggiore , IRCCS, Milan, Italy


Objectives. To ­assess ­the inci­dence of shoulder-hand syndrome (­SHS) in neu­ro­sur­gi­cal ­patients (­head inju­ries, intra­cra­ni­al rup­tured aneu­rysms ­and intra­cra­ni­al menin­gio­mas), treat­ed ­with bar­bit­u­rates. ­SHS is a chron­ic con­di­tion char­ac­ter­ized by ­intense ten­der­ness ­and func­tion­al impair­ment affect­ing ­one ­hand, ­the shoul­der or ­both. Barbiturates ­have ­been iden­ti­fied as ­cause of ­SHS, ­although ­there is con­tro­ver­sial evi­dence on ­the inci­dence of ­this dis­or­der in ­patients start­ed on ­long-­term Phenobarbital (PB) ther­a­py.
Methods. One hundred and twenty-six neu­ro­sur­gi­cal ­patients, treat­ed ­with bar­bit­u­rates, ­and a con­trol ­group of 108 ­patients, treat­ed ­with car­ba­maz­e­pine or phen­y­toin, ­were ­enrolled. Both ­groups ­were fol­lowed up ­for at ­least 24 to 36 ­months.
Results. Thirty-five PB-treat­ed ­patients (27.6%) expe­ri­enced ­SHS. In ­these ­patients ­SHS devel­oped dur­ing ­the ­first 7 ­months of ther­a­py ­and ­regressed ­after PB dis­con­tin­u­a­tion or, in 2 cas­es, ­after dos­age reduc­tion. None of ­the ­patients in ­the con­trol ­group devel­oped ­SHS.
Conclusions. The occur­rence of ­SHS in ­the ­study ­group ­was ­much ­more com­mon ­than ­that report­ed pre­vi­ous­ly. This high­er inci­dence ­should ­depend ­upon ­the coex­is­tence of sep­ar­ate ­risk fac­tors ­such as ­age ­over 50 ­years, sur­gery ­and intra­cra­ni­al pathol­o­gy. Early diag­no­sis ­and rap­id with­drawl of treat­ment ­are impor­tant ­for symp­to­mat­ic ­relief ­and ­full func­tion­al recov­ery.

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