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Comparison of clinical and neurophysiologic responses to intrathecal baclofen bolus administration in moderate-to-severe spasticity after acquired brain injury.

Abstract

OBJECTIVES

To compare clinical and neurophysiologic responses to intrathecal baclofen (ITB) bolus injection in subjects with spasticity after acquired brain injury.

DESIGN

Prospective case series.

SETTING

Tertiary care rehabilitation center.

PARTICIPANTS

Thirty consecutive ITB pump candidates with dysfunctional spasticity caused by traumatic brain injury, hypoxic encephalopathy, or stroke.

INTERVENTION

A single 50-microg ITB bolus.

MAIN OUTCOME MEASURES

Lower-extremity Ashworth Scale score at 2, 4, and 6 hours after ITB bolus; soleus Hoffmann reflex (H-reflex)/M-wave amplitude (H/M) ratio and abductor hallucis F-wave persistence and F/M ratio at 5 hours. Nonparametric repeated-measures analysis of variance and paired t test were used for statistical analyses.

RESULTS

The Ashworth score on the more involved side significantly decreased from 2.4+/-0.7 at baseline to 1.5+/-0.6 and 1.4+/-0.6 at 4- and 6-hour evaluations, respectively (P<.001). H/M ratio significantly decreased bilaterally (more involved side, 62%+/-28% to 14%+/-19%; less involved side, 59%+/-26% to 11%+/-20%; P<.001). F-wave persistence significantly decreased on the more involved side (86%+/-17% to 75%+/-13%, P<.05) with no change in F/M ratio. There was no significant correlation among these outcome measures before or after the ITB bolus injection.

CONCLUSIONS

H/M ratio is more sensitive than the Ashworth score or F-wave persistence in detecting a physiologic response to ITB bolus. H-reflex is useful for verification of ITB bolus administration, as an adjunct to clinical evaluation, particularly among patients with moderate spasticity at rest or with small changes in Ashworth score. However, potential application of the marked sensitivity of the H-reflex to other clinically challenging situations, such as early detection of possible ITB system malfunction, awaits further investigation.

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  • Authors+Show Affiliations

    ,

    Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS 39216, USA. dstokic@mmrcrehab.org

    ,

    Source

    MeSH

    Adolescent
    Adult
    Analysis of Variance
    Baclofen
    Brain Injuries
    Dose-Response Relationship, Drug
    Electromyography
    Female
    Follow-Up Studies
    H-Reflex
    Humans
    Injections, Spinal
    Injury Severity Score
    Male
    Middle Aged
    Muscle Relaxants, Central
    Muscle Spasticity
    Probability
    Prospective Studies
    Rehabilitation Centers
    Risk Assessment
    Severity of Illness Index
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

    Language

    eng

    PubMed ID

    16181946

    Citation

    Stokic, Dobrivoje S., et al. "Comparison of Clinical and Neurophysiologic Responses to Intrathecal Baclofen Bolus Administration in Moderate-to-severe Spasticity After Acquired Brain Injury." Archives of Physical Medicine and Rehabilitation, vol. 86, no. 9, 2005, pp. 1801-6.
    Stokic DS, Yablon SA, Hayes A. Comparison of clinical and neurophysiologic responses to intrathecal baclofen bolus administration in moderate-to-severe spasticity after acquired brain injury. Arch Phys Med Rehabil. 2005;86(9):1801-6.
    Stokic, D. S., Yablon, S. A., & Hayes, A. (2005). Comparison of clinical and neurophysiologic responses to intrathecal baclofen bolus administration in moderate-to-severe spasticity after acquired brain injury. Archives of Physical Medicine and Rehabilitation, 86(9), pp. 1801-6.
    Stokic DS, Yablon SA, Hayes A. Comparison of Clinical and Neurophysiologic Responses to Intrathecal Baclofen Bolus Administration in Moderate-to-severe Spasticity After Acquired Brain Injury. Arch Phys Med Rehabil. 2005;86(9):1801-6. PubMed PMID: 16181946.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Comparison of clinical and neurophysiologic responses to intrathecal baclofen bolus administration in moderate-to-severe spasticity after acquired brain injury. AU - Stokic,Dobrivoje S, AU - Yablon,Stuart A, AU - Hayes,Antonio, PY - 2005/03/15/accepted PY - 2005/9/27/pubmed PY - 2005/10/20/medline PY - 2005/9/27/entrez SP - 1801 EP - 6 JF - Archives of physical medicine and rehabilitation JO - Arch Phys Med Rehabil VL - 86 IS - 9 N2 - OBJECTIVES: To compare clinical and neurophysiologic responses to intrathecal baclofen (ITB) bolus injection in subjects with spasticity after acquired brain injury. DESIGN: Prospective case series. SETTING: Tertiary care rehabilitation center. PARTICIPANTS: Thirty consecutive ITB pump candidates with dysfunctional spasticity caused by traumatic brain injury, hypoxic encephalopathy, or stroke. INTERVENTION: A single 50-microg ITB bolus. MAIN OUTCOME MEASURES: Lower-extremity Ashworth Scale score at 2, 4, and 6 hours after ITB bolus; soleus Hoffmann reflex (H-reflex)/M-wave amplitude (H/M) ratio and abductor hallucis F-wave persistence and F/M ratio at 5 hours. Nonparametric repeated-measures analysis of variance and paired t test were used for statistical analyses. RESULTS: The Ashworth score on the more involved side significantly decreased from 2.4+/-0.7 at baseline to 1.5+/-0.6 and 1.4+/-0.6 at 4- and 6-hour evaluations, respectively (P<.001). H/M ratio significantly decreased bilaterally (more involved side, 62%+/-28% to 14%+/-19%; less involved side, 59%+/-26% to 11%+/-20%; P<.001). F-wave persistence significantly decreased on the more involved side (86%+/-17% to 75%+/-13%, P<.05) with no change in F/M ratio. There was no significant correlation among these outcome measures before or after the ITB bolus injection. CONCLUSIONS: H/M ratio is more sensitive than the Ashworth score or F-wave persistence in detecting a physiologic response to ITB bolus. H-reflex is useful for verification of ITB bolus administration, as an adjunct to clinical evaluation, particularly among patients with moderate spasticity at rest or with small changes in Ashworth score. However, potential application of the marked sensitivity of the H-reflex to other clinically challenging situations, such as early detection of possible ITB system malfunction, awaits further investigation. SN - 0003-9993 UR - https://www.unboundmedicine.com/medline/citation/16181946/Comparison_of_clinical_and_neurophysiologic_responses_to_intrathecal_baclofen_bolus_administration_in_moderate_to_severe_spasticity_after_acquired_brain_injury_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-9993(05)00333-3 DB - PRIME DP - Unbound Medicine ER -