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Continuously infused intrathecal baclofen over 12 months for spastic hypertonia in adolescents and adults with cerebral palsy.
Arch Phys Med Rehabil 2001; 82(2):155-61AP

Abstract

OBJECTIVE

To determine if the continuous intrathecal delivery of baclofen will control spastic hypertonia caused by long-standing cerebral palsy (CP).

DESIGN

Case series.

SETTING

Tertiary care outpatient and inpatient rehabilitation center directly attached to a university hospital.

PATIENTS

Thirteen CP patients (average age, 25yr; range, 13--43yr) with intractable spastic hypertonia and quadriparesis (one of whom had predominate diplegia) who had not responded to oral medications including baclofen.

INTERVENTION

Patients were screened via a bolus injection of baclofen intrathecally. Those who dropped an average of 2 points on their lower extremity (LE) Ashworth scores were offered computer-controlled pump implantation for 12 months of continuous delivery of intrathecal baclofen (ITB).

MAIN OUTCOME MEASURES

Ashworth rigidity scores, spasm scores, and deep tendon reflex scores were collected for both the upper extremities (UEs) and LEs. Differences over time were assessed via descriptive statistics and Wilcoxon's signed-rank test.

RESULTS

After 1 year of continuous ITB treatment, the average LE Ashworth score +/- standard deviation decreased from 3.4 +/- 1.2 to 1.5 +/- 0.7 (p <.0001), spasm score from 1.4 +/- 1.6 to 0.6 +/- 1.2 (p =.1024), and reflex score from 2.5 +/- 1.2 to 0.7 +/- 1.1 (p <.0001). The average UE Ashworth score decreased from 3.0 +/- 1.2 to 1.7 +/- 1.0 (p <.0001), spasm score from 1.2 +/- 1.6 to 0.2 +/- 0.6 (p =.0135), and reflex score from 2.3 +/- 0.7 to 0.5 +/- 0.9 (p <.0001). The average ITB dose required to attain these effects at 1 year was 263 +/- 91microg continuously infused per day.

CONCLUSION

Continuously infused ITB can reduce spastic hypertonia in the UEs and LEs associated with long-standing CP. This reduction in tone will allow more freedom of movement and the potential for improved function.

Authors+Show Affiliations

Department of Physical Medicine & Rehabilitation, University of Alabama School of Medicine, Birmingham, AL 35233-7330, USA. meythaler@sun.rehabm.uab.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11239304

Citation

Meythaler, J M., et al. "Continuously Infused Intrathecal Baclofen Over 12 Months for Spastic Hypertonia in Adolescents and Adults With Cerebral Palsy." Archives of Physical Medicine and Rehabilitation, vol. 82, no. 2, 2001, pp. 155-61.
Meythaler JM, Guin-Renfroe S, Law C, et al. Continuously infused intrathecal baclofen over 12 months for spastic hypertonia in adolescents and adults with cerebral palsy. Arch Phys Med Rehabil. 2001;82(2):155-61.
Meythaler, J. M., Guin-Renfroe, S., Law, C., Grabb, P., & Hadley, M. N. (2001). Continuously infused intrathecal baclofen over 12 months for spastic hypertonia in adolescents and adults with cerebral palsy. Archives of Physical Medicine and Rehabilitation, 82(2), pp. 155-61.
Meythaler JM, et al. Continuously Infused Intrathecal Baclofen Over 12 Months for Spastic Hypertonia in Adolescents and Adults With Cerebral Palsy. Arch Phys Med Rehabil. 2001;82(2):155-61. PubMed PMID: 11239304.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Continuously infused intrathecal baclofen over 12 months for spastic hypertonia in adolescents and adults with cerebral palsy. AU - Meythaler,J M, AU - Guin-Renfroe,S, AU - Law,C, AU - Grabb,P, AU - Hadley,M N, PY - 2001/3/10/pubmed PY - 2001/4/17/medline PY - 2001/3/10/entrez SP - 155 EP - 61 JF - Archives of physical medicine and rehabilitation JO - Arch Phys Med Rehabil VL - 82 IS - 2 N2 - OBJECTIVE: To determine if the continuous intrathecal delivery of baclofen will control spastic hypertonia caused by long-standing cerebral palsy (CP). DESIGN: Case series. SETTING: Tertiary care outpatient and inpatient rehabilitation center directly attached to a university hospital. PATIENTS: Thirteen CP patients (average age, 25yr; range, 13--43yr) with intractable spastic hypertonia and quadriparesis (one of whom had predominate diplegia) who had not responded to oral medications including baclofen. INTERVENTION: Patients were screened via a bolus injection of baclofen intrathecally. Those who dropped an average of 2 points on their lower extremity (LE) Ashworth scores were offered computer-controlled pump implantation for 12 months of continuous delivery of intrathecal baclofen (ITB). MAIN OUTCOME MEASURES: Ashworth rigidity scores, spasm scores, and deep tendon reflex scores were collected for both the upper extremities (UEs) and LEs. Differences over time were assessed via descriptive statistics and Wilcoxon's signed-rank test. RESULTS: After 1 year of continuous ITB treatment, the average LE Ashworth score +/- standard deviation decreased from 3.4 +/- 1.2 to 1.5 +/- 0.7 (p <.0001), spasm score from 1.4 +/- 1.6 to 0.6 +/- 1.2 (p =.1024), and reflex score from 2.5 +/- 1.2 to 0.7 +/- 1.1 (p <.0001). The average UE Ashworth score decreased from 3.0 +/- 1.2 to 1.7 +/- 1.0 (p <.0001), spasm score from 1.2 +/- 1.6 to 0.2 +/- 0.6 (p =.0135), and reflex score from 2.3 +/- 0.7 to 0.5 +/- 0.9 (p <.0001). The average ITB dose required to attain these effects at 1 year was 263 +/- 91microg continuously infused per day. CONCLUSION: Continuously infused ITB can reduce spastic hypertonia in the UEs and LEs associated with long-standing CP. This reduction in tone will allow more freedom of movement and the potential for improved function. SN - 0003-9993 UR - https://www.unboundmedicine.com/medline/citation/11239304/Continuously_infused_intrathecal_baclofen_over_12_months_for_spastic_hypertonia_in_adolescents_and_adults_with_cerebral_palsy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-9993(01)43752-X DB - PRIME DP - Unbound Medicine ER -