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Continuous intrathecal baclofen in spinal cord spasticity. A prospective study
J M Meythaler1, W D Steers, S M Tuel
1Department of Physical Medicine and Rehabilitation, University of Virginia Health Sciences Center, Charlottesville.
American Journal of Physical Medicine & Rehabilitation
|December 1, 1992
Summary
Continuous intrathecal baclofen infusion effectively reduces spasticity and improves motor control in patients with spinal spasticity. However, escalating doses are needed due to tolerance, and complications require careful management and rehabilitation.
Area of Science:
- Neurology
- Neurosurgery
- Pharmacology
Background:
- Spinal spasticity significantly impacts quality of life and motor function.
- Oral medications are often insufficient for managing severe spasticity.
- Intrathecal baclofen infusion offers a targeted treatment approach.
Purpose of the Study:
- To evaluate the efficacy and safety of continuous intrathecal baclofen infusion for spinal spasticity.
- To assess changes in muscle tone, reflexes, and spasm scores over one year.
- To monitor baclofen dosage requirements and identify potential complications.
Main Methods:
- A prospective study involving ten consecutive patients with spinal spasticity.
- Continuous intrathecal baclofen infusion via a programmable pump.
- Assessment of muscle tone (Ashworth scale), reflexes, and spasm scores at baseline, 3 months, and 1 year.
- Monitoring of baclofen dosage and adverse events.
Main Results:
- Significant reductions in muscle tone (2.32 points), reflexes (2.22 points), and spasm scores (1.65 points) after one year (P < 0.0001).
- Average baclofen dose increased from 92.22 to 290.95 mcg (P < 0.0001) between 1 month and 1 year.
- Dosage more than doubled between 3 months and 1 year (P < 0.0022), indicating tolerance.
- Complications included atelectasis, hypotension, erectile dysfunction, pseudo-meningoceles, and catheter issues.
Conclusions:
- Continuous intrathecal baclofen infusion is effective for managing refractory spinal spasticity.
- Tolerance to intrathecal baclofen necessitates dose escalation to maintain efficacy.
- The procedure requires intensive rehabilitation and close monitoring due to potential complications and costs.