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Continuously infused intrathecal baclofen for spastic/dystonic hemiplegia: a preliminary report.

Abstract

The objective of this study was to determine whether the continuous intrathecal delivery of baclofen will control spastic hypertonia associated with long-standing hemiplegia from acquired brain injury. Six hemiparetic patients (average age, 50 (range, 42-66) yr) with more than 6 mo of disabling lower limb spastic hypertonia on one side caused by either a unilateral traumatic brain injury or a stroke were recruited in a consecutive manner. The setting was a tertiary care outpatient and inpatient rehabilitation center directly attached to a university hospital. Patients were screened via a randomized, double-blind, placebo-controlled, crossover design to receive either an intrathecally administered bolus injection of normal saline or 50 microg of baclofen. Data for Ashworth rigidity scores, spasm scores, and deep tendon reflex scores were collected on the affected upper limb and lower limb side. Those who dropped an average of two points on their affected lower limb side Ashworth scores were then offered computer-controlled pump implantation for continuous intrathecal administration of baclofen. Differences over time were assessed via descriptive statistics and Wilcoxon's signed-rank test. After 3 mo of treatment, the average lower limb Ashworth score on the affected side decreased from 3.7 +/- 1.0 to 1.9 +/- 0.6 standard deviation (SD) (P < 0.0001), the reflex score from 1.8 +/- 1.3 to 0.5 +/- 0.8 SD (P = 0.0208), and the spasm score from 1.3 +/- 1.2 to 0.8 +/- 1.3 SD (P > 0.05). The average upper limb Ashworth score on the affected side decreased from 3.4 +/- 0.9 to 2.1 +/- 0.9 SD (P = 0.0002), the reflex score from 2.3 +/- 0.5 to 1.7 +/- 0.5 SD (P > 0.050, and the spasm score from 0.8 +/- 1.3 to 0 +/- 0 SD (P > 0.05). The average intrathecally administered dose of baclofen that was required to attain these effects was 205.3 microg, which was continuously infused for 24 h. Continuous intrathecal infusion of baclofen is capable of maintaining a reduction in the dystonia on the hemiparetic side without significantly affecting motor strength on the normal side.

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  • Authors+Show Affiliations

    ,

    Department of Physical Medicine and Rehabilitation, University of Alabama School of Medicine, Birmingham 35233-7330, USA.

    ,

    Source

    MeSH

    Adult
    Aged
    Baclofen
    Brain Injuries
    Cerebrovascular Disorders
    Double-Blind Method
    Dystonia
    Female
    Hemiplegia
    Humans
    Infusion Pumps, Implantable
    Infusions, Parenteral
    Injections, Spinal
    Male
    Middle Aged
    Muscle Relaxants, Central
    Muscle Spasticity
    Severity of Illness Index

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    10340423

    Citation

    Meythaler, J M., et al. "Continuously Infused Intrathecal Baclofen for Spastic/dystonic Hemiplegia: a Preliminary Report." American Journal of Physical Medicine & Rehabilitation, vol. 78, no. 3, 1999, pp. 247-54.
    Meythaler JM, Guin-Renfroe S, Hadley MN. Continuously infused intrathecal baclofen for spastic/dystonic hemiplegia: a preliminary report. Am J Phys Med Rehabil. 1999;78(3):247-54.
    Meythaler, J. M., Guin-Renfroe, S., & Hadley, M. N. (1999). Continuously infused intrathecal baclofen for spastic/dystonic hemiplegia: a preliminary report. American Journal of Physical Medicine & Rehabilitation, 78(3), pp. 247-54.
    Meythaler JM, Guin-Renfroe S, Hadley MN. Continuously Infused Intrathecal Baclofen for Spastic/dystonic Hemiplegia: a Preliminary Report. Am J Phys Med Rehabil. 1999;78(3):247-54. PubMed PMID: 10340423.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Continuously infused intrathecal baclofen for spastic/dystonic hemiplegia: a preliminary report. AU - Meythaler,J M, AU - Guin-Renfroe,S, AU - Hadley,M N, PY - 1999/5/26/pubmed PY - 1999/5/26/medline PY - 1999/5/26/entrez SP - 247 EP - 54 JF - American journal of physical medicine & rehabilitation JO - Am J Phys Med Rehabil VL - 78 IS - 3 N2 - The objective of this study was to determine whether the continuous intrathecal delivery of baclofen will control spastic hypertonia associated with long-standing hemiplegia from acquired brain injury. Six hemiparetic patients (average age, 50 (range, 42-66) yr) with more than 6 mo of disabling lower limb spastic hypertonia on one side caused by either a unilateral traumatic brain injury or a stroke were recruited in a consecutive manner. The setting was a tertiary care outpatient and inpatient rehabilitation center directly attached to a university hospital. Patients were screened via a randomized, double-blind, placebo-controlled, crossover design to receive either an intrathecally administered bolus injection of normal saline or 50 microg of baclofen. Data for Ashworth rigidity scores, spasm scores, and deep tendon reflex scores were collected on the affected upper limb and lower limb side. Those who dropped an average of two points on their affected lower limb side Ashworth scores were then offered computer-controlled pump implantation for continuous intrathecal administration of baclofen. Differences over time were assessed via descriptive statistics and Wilcoxon's signed-rank test. After 3 mo of treatment, the average lower limb Ashworth score on the affected side decreased from 3.7 +/- 1.0 to 1.9 +/- 0.6 standard deviation (SD) (P < 0.0001), the reflex score from 1.8 +/- 1.3 to 0.5 +/- 0.8 SD (P = 0.0208), and the spasm score from 1.3 +/- 1.2 to 0.8 +/- 1.3 SD (P > 0.05). The average upper limb Ashworth score on the affected side decreased from 3.4 +/- 0.9 to 2.1 +/- 0.9 SD (P = 0.0002), the reflex score from 2.3 +/- 0.5 to 1.7 +/- 0.5 SD (P > 0.050, and the spasm score from 0.8 +/- 1.3 to 0 +/- 0 SD (P > 0.05). The average intrathecally administered dose of baclofen that was required to attain these effects was 205.3 microg, which was continuously infused for 24 h. Continuous intrathecal infusion of baclofen is capable of maintaining a reduction in the dystonia on the hemiparetic side without significantly affecting motor strength on the normal side. SN - 0894-9115 UR - https://www.unboundmedicine.com/medline/citation/10340423/Continuously_infused_intrathecal_baclofen_for_spastic/dystonic_hemiplegia:_a_preliminary_report_ L2 - http://Insights.ovid.com/pubmed?pmid=10340423 DB - PRIME DP - Unbound Medicine ER -