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Orally delivered baclofen to control spastic hypertonia in acquired brain injury.

Abstract

To determine if oral/systemic delivery of baclofen can effectively decrease spastic hypertonia due to acquired brain injury (traumatic brain injury, stroke, anoxia, or encephalopathy). Tertiary care outpatient rehabilitation center directly attached to a university hospital. Patients were a convenience sample recruited consecutively who had been referred for treatment of their spastic hypertonia to our spasticity clinic over a 5-year period. The spastic hypertonia was due to an acquired brain injury by either traumatic brain injury (TBI), stroke, or anoxic brain injury. All patients were more than 6 months postinjury or illness. Retrospective review of patients before and after initiation of treatment with oral baclofen, per standardized clinical data sheets. Thirty-five patients (22 TBI patients) were started on oral baclofen and were reevaluated between 1 to 3 months after initiation of treatment. Data for motor tone (Ashworth scores), spasm scores (Penn spasm frequency score), and deep tendon reflex scores were collected on the affected upper extremity (UE) and lower extremity (LE) side(s). Normal extremities were not assessed. Differences over time were assessed via descriptive statistics and Wilcoxon signed-rank. After 1 to 3 months of treatment when subjects had reached their maximal tolerated dosage, the average LE Ashworth score in the affected lower extremities (LEs) decreased from 3.5 to 3.2 (P =.0003), the reflex score decreased from 2.5 to 2.2 (P =.0274), and there was no statistical difference in the spasm score (P >.05). When the 22 TBI patients are analyzed separately, the average LE Ashworth score decreased from 3.5 to 3.2 (P =.0044) and the reflex score decreased from 2.7 to 2.0 (P =.0003). There was no statistically significant change in UE tone, spasm frequency, or reflexes after 1 to 3 months of treatment (P >.05). The average dosage at follow-up was 57 mg/day of baclofen (range 15-120 mg/day). There was a 17% incidence of somnolence that limited the maximum daily dosage of the medication. The oral delivery of baclofen is capable of reducing LE spastic hypertonia resulting from acquired brain injury. The lack of effect upon the upper extremities may be due to receptor specificity issues. GABA-B receptors may be less involved in the modulation of UE spastic hypertonia.

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  • Authors+Show Affiliations

    ,

    Department of Physical Medicine and Rehabilitation, School of Medicine, University of Alabama at Birmingham, Spain Rehabilitation Center R157, 619 6th Avenue S., Birmingham, AL 35249, USA.

    , , ,

    Source

    MeSH

    Administration, Oral
    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Baclofen
    Brain Injuries
    Child
    Disorders of Excessive Somnolence
    Extremities
    Female
    Humans
    Male
    Middle Aged
    Muscle Hypertonia
    Muscle Relaxants, Central
    Sampling Studies
    Stroke
    Treatment Outcome

    Pub Type(s)

    Clinical Trial
    Journal Article
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    15247821

    Citation

    Meythaler, Jay M., et al. "Orally Delivered Baclofen to Control Spastic Hypertonia in Acquired Brain Injury." The Journal of Head Trauma Rehabilitation, vol. 19, no. 2, 2004, pp. 101-8.
    Meythaler JM, Clayton W, Davis LK, et al. Orally delivered baclofen to control spastic hypertonia in acquired brain injury. J Head Trauma Rehabil. 2004;19(2):101-8.
    Meythaler, J. M., Clayton, W., Davis, L. K., Guin-Renfroe, S., & Brunner, R. C. (2004). Orally delivered baclofen to control spastic hypertonia in acquired brain injury. The Journal of Head Trauma Rehabilitation, 19(2), pp. 101-8.
    Meythaler JM, et al. Orally Delivered Baclofen to Control Spastic Hypertonia in Acquired Brain Injury. J Head Trauma Rehabil. 2004;19(2):101-8. PubMed PMID: 15247821.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Orally delivered baclofen to control spastic hypertonia in acquired brain injury. AU - Meythaler,Jay M, AU - Clayton,Warren, AU - Davis,Linda K, AU - Guin-Renfroe,Sharon, AU - Brunner,Robert C, PY - 2004/7/13/pubmed PY - 2004/9/8/medline PY - 2004/7/13/entrez SP - 101 EP - 8 JF - The Journal of head trauma rehabilitation JO - J Head Trauma Rehabil VL - 19 IS - 2 N2 - To determine if oral/systemic delivery of baclofen can effectively decrease spastic hypertonia due to acquired brain injury (traumatic brain injury, stroke, anoxia, or encephalopathy). Tertiary care outpatient rehabilitation center directly attached to a university hospital. Patients were a convenience sample recruited consecutively who had been referred for treatment of their spastic hypertonia to our spasticity clinic over a 5-year period. The spastic hypertonia was due to an acquired brain injury by either traumatic brain injury (TBI), stroke, or anoxic brain injury. All patients were more than 6 months postinjury or illness. Retrospective review of patients before and after initiation of treatment with oral baclofen, per standardized clinical data sheets. Thirty-five patients (22 TBI patients) were started on oral baclofen and were reevaluated between 1 to 3 months after initiation of treatment. Data for motor tone (Ashworth scores), spasm scores (Penn spasm frequency score), and deep tendon reflex scores were collected on the affected upper extremity (UE) and lower extremity (LE) side(s). Normal extremities were not assessed. Differences over time were assessed via descriptive statistics and Wilcoxon signed-rank. After 1 to 3 months of treatment when subjects had reached their maximal tolerated dosage, the average LE Ashworth score in the affected lower extremities (LEs) decreased from 3.5 to 3.2 (P =.0003), the reflex score decreased from 2.5 to 2.2 (P =.0274), and there was no statistical difference in the spasm score (P >.05). When the 22 TBI patients are analyzed separately, the average LE Ashworth score decreased from 3.5 to 3.2 (P =.0044) and the reflex score decreased from 2.7 to 2.0 (P =.0003). There was no statistically significant change in UE tone, spasm frequency, or reflexes after 1 to 3 months of treatment (P >.05). The average dosage at follow-up was 57 mg/day of baclofen (range 15-120 mg/day). There was a 17% incidence of somnolence that limited the maximum daily dosage of the medication. The oral delivery of baclofen is capable of reducing LE spastic hypertonia resulting from acquired brain injury. The lack of effect upon the upper extremities may be due to receptor specificity issues. GABA-B receptors may be less involved in the modulation of UE spastic hypertonia. SN - 0885-9701 UR - https://www.unboundmedicine.com/medline/citation/15247821/Orally_delivered_baclofen_to_control_spastic_hypertonia_in_acquired_brain_injury_ L2 - http://Insights.ovid.com/pubmed?pmid=15247821 DB - PRIME DP - Unbound Medicine ER -