Intrathecal baclofen for long-term treatment of spasticity: a multi-centre study (original) (raw)
Related papers
Chronic intrathecal baclofen administration for control of severe spasticity
Journal of Neurosurgery, 1990
✓ Baclofen, the most effective drug for treating spasticity, is a specific agonist of gamma-aminobutyric acid-B receptors, and is very abundant in the superficial layers of the spinal cord. Given orally, baclofen does not easily penetrate the blood-brain barrier, and is distributed equally to the brain and spinal cord. Direct intrathecal administration was given in order to change the distribution of the drug by preferentially perfusing the spinal cord. Eighteen patients presenting a severe spastic syndrome were treated with chronic intrathecal infusion of baclofen in the lumbar cerebrospinal fluid. After clinical preselection, 38 patients were implanted with a lumbar access port allowing long-term trials in order to determine the efficacy of baclofen therapy and the effective 12-hour dose. The 18 patients selected for chronic administration were implanted with a programmable pump. The pathology in these cases was: multiple sclerosis (6 cases), posttrauma spastic syndrome (eight cas...
Continuous intrathecal baclofen delivery in severely disabling spasticity
2018
Background/Aim. Spasticity is the consequence of several clinical conditions including cerebral palsy, brain injury, spinal cord injury, multiple sclerosis, aneurysm bleeding, and some other neurological disorders. The aim of this study was to determine the efficacy of intrathecal baclofen (ITB) treatment in medically intractable severely disabling spastic-ity and present the challenges encountered during pump im-plantation surgery on these patients. Methods. The patients who underwent intrathecal baclofen pump implantation surgery between the years 2012 and 2015 with minimum follow-up of six months were recruited from the clinic archives. Twenty two patients with severe spasticity who had Modified Asworth Spasticity Scale (MASS) score of 3 or 4 were enrolled in our series. Eight of twenty-two patients were at pediatric age and they all were non-ambulant before surgery. Results. All of the patients underwent program-mable intrathecal baclofen pump implantation surgery. Catheters were placed via percutaneous technique into to the subarachnoid space in 18 patients while, we had to perform partial hemi-laminectomy in order to place the cathe-ters in 4 patients. All the patients improved significantly and 5 began using upper extremities and 3 adults became am-bulant following physical therapy. Mean of the MASS scores improved from 3.59 to 1.32 (p < 0.001). Conclusion. The ITB therapy obviously increased quality of life and functional outcome in patients with disabling spasticity. As a result , physical treatment was more useful for these patients. Although some spinal abnormalities due to spasticity may necessitate partial hemilaminectomy to implant the pump, patients with intractable spasticity should be given the chance of intrathecal baclofen treatment at the earliest period of their lifetime disability.
Intrathecal Delivery of Baclofen As Functional Treatment of Severe Spasticity
2016
In some patients severe spasticity of cerebral or spinal origin cannot be treated successfully with conventional oral medication or physical modalities. Intrathecal baclofen therapy with implanted pump has represented effective treatment from mid-80’s. Baclofen (Lioresal) is a muscle relaxant and a potent GABA agonist that acts via GABAb receptors at the posterior columns of spinal cord level, to inhibit the release of excitatory neurotransmitters by inhibiting calcium ions influx into presynaptic terminals. This direct binding on spinal cord receptors leads to higher efficiency compared to peroral therapy in which baclofen does not pass the brain-blood barrier. The article overviews indications and contraindications for intrathecal baclofen therapy, selection and preparation of patients for surgery, the surgical procedure of pump implantation, long term follow-up with pump refill procedure and possible complications of intratecal baclofen therapy. The experiences of the Center for ...
Intraspinal baclofen in the treatment of severe spasticity and spasms
Acta Neurochirurgica, 1991
Ten patients with severe spasticity were evaluated according to a standardized protocol in order to be treated by intraspinal baclofen. Entry criteria in the protocol were the following: 1) Stable central nervous system lesion, 2) Severe spasticity and/or fiexo-extensor spasms not controllable by oral treatment, 3) Normal CSF circulation and 4) Informed consent. All patients received a test dose of twenty-five micrograms of baclofen injected intrathecally. At intervals of at least one day, doses were increased in 10-25 microgram steps until total abolition of spontaneous spasms was achieved in complete spinal cord lesions. In patients with residual motor function, doses were titrated until the optimal dose was found that reduced spasms and enabled performance of maximum daily life activities according to the patient's neurological level.
Electroencephalography and clinical neurophysiology, 1997
The aim of this study was to evaluate the clinical usefulness of lower limb flexion reflexes (FR) in the assessment of spinal excitability responsible for spontaneous or induced spasms. FR were recorded on the short head of biceps femoris, after electrical stimulation of the ipsilateral sural nerve at the ankle, in 17 spastic patients selected for chronic intrathecal administration of baclofen. The results obtained before and after treatment were compared with clinical scores commonly used to assess spasticity (Ashworth and spasm scores). Before intrathecal baclofen 15/17 patients (88%) had pathologically enhanced flexor reflexes in the lower limbs, which were associated to clinical spasms. Reflex enhancement was accompanied in 47% of cases by abnormal decrease of reflex threshold. No significant correlation appeared between the magnitude or threshold of FR in control conditions and either the hypertonia (Ashworth scale) or the number of clinical spasms per unit of time. Intrathecal...
The Journal of Spinal Cord Medicine, 2013
Objective: To review the available evidence on the effectiveness of intrathecal baclofen in the treatment of spasticity in individuals with spinal cord injuries (SCIs) at least 6 months post-injury or diagnosis. Data sources: A literature search of multiple databases (Pub Med, CINAHL, EMBASE) was conducted to identify articles published in the English language. Study selection: Studies were included for review if: (1) more than 50% of the sample size had suffered a traumatic or non-traumatic SCI; (2) there were more than three subjects; (3) subjects received continuous intrathecal baclofen via an implantable pump aimed at improving spasticity; and (4) all subjects were ≥6 months post-SCI, at the time of the intervention. Data extraction: Data extracted from the studies included patient and treatment characteristics, study design, method of assessment, and outcomes of the intervention. Data synthesis: Methodological quality was assessed using the PEDro for randomized-controlled trials (RCTs) and the Downs and Black (D&B) tool for non-RCTs. A level of evidence was assigned to each intervention using a modified Sackett scale. Conclusion: The literature search resulted in 677 articles. No RCTs and eight non-RCTs (D&B scores 13-24) met criteria for inclusion, providing a pooled sample size of 162 individuals. There was substantial level 4 evidence that intrathecal baclofen is effective in reducing spasticity. Mean Ashworth scores reduced from 3.1-4.5 at baseline to 1.0-2.0 (P < 0.005) at follow-up (range 2-41 months). Average dosing increased from 57-187 μg/ day at baseline to 218.7-535.9 μg/day at follow-up. Several complications from the use of intrathecal baclofen or pump and catheter malfunction were reported.
Outcomes of intratechal baclofen (itb) therapy in spacticity
Turkish Neurosurgery, 2010
AIm: Spasticity is associated with various neurological conditions. Intrathecal baclofen (ITB) is one of the popular treatments for severe spasticity. In this paper we present our experience in treating 30 patients with both spinal and supraspinal spasticity with chronic infusion of Baclofen to evaluate the long term efficacy of this treatment on spasticity, disability and pain, and to evaluate the side effects of intrathecal Baclofen. mAterIAl and methOds: The medical records of 30 patients who underwent baclofen pump placement from 2000 to 2010 under Department of Neurosurgery at the University of Akdeniz at Antalya/Turkey, were reviewed. All study subjects had diffuse chronic, severe, and generalized spasticity (Ashworth score ≥ 3), and had shown inadequate response to various oral antispastic drugs including baclofen. All patients were evaluated by means of the Ashworth score, spasm frequency, Barthel index, Rankin scales and VAS. results: Spasticity and spasm frequency and pain scores were clinically and statistically decreased in all patients. COnClusIOn: ITB therapy increases the quality of lifestyle and functional independence by reducing not only cerebral but also spinal related spasticity in appropriately selected cases.
Pain Physician, 2011
Background: Intrathecal baclofen has been an effective therapy in the management of spasticity. As interventional pain physicians are rapidly becoming the experts in intrathecal drug delivery, they are now frequently asked to trial and implant intrathecal baclofen therapy. While some physicians might be very comfortable with the process of trialing and implanting, others will have next to no experience until the first consult appears on their desks. While uncomplicated lower extremity spasticity can usually be trialed with a single-shot bolus injection, more complicated cases of upper and lower extremities or hemiparetic spasticity need a more delicate approach. This is the first case series in the literature reporting a trial using an indwelling temporary catheter and inpatient admission. Moreover, while the technical aspects of intrathecal therapy trialing and implantation might be familiar for the interventional physician, we review the indications and goals of therapy, about whi...