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Continuously infused intrathecal baclofen over 12 months for spastic hypertonia in adolescents and adults with cerebral palsy.

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.

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  • Authors+Show Affiliations

    ,

    Department of Physical Medicine & Rehabilitation, University of Alabama School of Medicine, Birmingham, AL 35233-7330, USA. meythaler@sun.rehabm.uab.edu

    , , ,

    Source

    MeSH

    Adolescent
    Adult
    Analysis of Variance
    Baclofen
    Cerebral Palsy
    Female
    Humans
    Infusion Pumps
    Injections, Spinal
    Male
    Muscle Hypertonia
    Muscle Relaxants, Central
    Statistics, Nonparametric
    Treatment Outcome

    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 -