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Implanted pump systems for treatment of spasticity.
J Zierski1, H Müller, D Dralle
1Department of Neurosurgery, Justus-Liebig-University, Giessen, Federal Republic of Germany.
Acta Neurochirurgica. Supplementum
|January 1, 1988
Summary
Continuous intrathecal baclofen administration via a pump system effectively manages severe spasticity in patients unresponsive to oral medications. This treatment significantly reduces spasticity and improves quality of life without central side effects.
Area of Science:
- Neurology
- Neurosurgery
- Rehabilitation Medicine
Background:
- Severe spasticity significantly impairs rehabilitation in approximately one-third of patients with spinal trauma, multiple sclerosis, and brain injuries.
- Traditional treatments for intractable spasticity include invasive surgical or destructive procedures.
- Oral antispastic medications are often inadequate for managing severe spasticity.
Purpose of the Study:
- To evaluate the efficacy and safety of continuous intrathecal baclofen administration using a totally implantable pump system for uncontrollable spasticity.
- To assess the impact of this treatment on spasticity scores, electromyography, and quality of life.
Main Methods:
- A study involving 30 patients with incapacitating spasticity resistant to oral baclofen treatment.
- Indications included spinal cord injury, multiple sclerosis, cerebral palsy, and brain injury.
- Clinical assessment utilized spasticity scores, integrated electromyography (IEMG), and motography.
Main Results:
- All patients achieved effective spasticity control with intrathecal baclofen.
- Mean IEMG reduction was 55%, and Ashworth's score decreased from 3 to 0.
- Significant improvements in quality of life were observed without impairment of voluntary motor function or central side effects.
Conclusions:
- Continuous intrathecal baclofen delivery via an implantable pump is a highly effective treatment for severe, refractory spasticity.
- The mechanism involves direct spinal GABAergic action, bypassing systemic side effects.
- Minor, correctable complications were associated with the pump system.