Tags

Type your tag names separated by a space and hit enter

Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury.
Paraplegia 1991; 29(1):48-64P

Abstract

The effects of intrathecal baclofen infusion were studied in 9 spinal cord injury patients whose spasticity had been refractory to oral medications. In a two stage, placebo controlled trial, baclofen was administered into the lumbar intrathecal space and subsequent clinical and neurophysiologic changes were assessed. In stage 1, 9 patients underwent a 5 day percutaneous infusion of baclofen and placebo via an external pump. Ashworth and reflex scores were assessed at time of enrollment, after infusion of that amount of baclofen which provided optimal spasticity control and after intrathecal infusion of placebo. The mean Ashworth grade decreased from 3.78 +/- 1.34 to 1.16 +/- 0.48 (p less than 0.001) while mean reflex score decreased from 3.57 +/- 1.05 to 0.64 +/- 0.87 (p less than 0.001). These values differed significantly from those associated with placebo therapy (Ashworth grade--2.54 +/- 1.04, p less than 0.001; reflex score--2.56 +/- 1.04, p less than 0.01). Objective improvements in functional abilities and independence were noted in 8 patients, while somatosensory and brainstem auditory evoked potentials were unchanged in all patients. Urodynamic evaluation revealed increased bladder capacity in 3 patients, while in 4 no change was observed. In Stage 2, permanent programmable infusion pumps were implanted in 7 patients who demonstrated a good response during Stage 1. In this group, mean Ashworth score decreased from 3.79 +/- 0.69 to 2 +/- 0.96 (p less than 0.001) and mean reflex score decreased from 3.85 +/- 0.62 to 2.18 +/- 0.43 (p less than 0.001). Baclofen dosage increased from 182 +/- 135 to 528 +/- 266 mcg/day over the 3-22 month follow-up period. Most of the dosage increase occurred within the initial 12 months following infusion pump implantation and tended to plateau thereafter. Minor complications such as catheter dislodgement/kinking and nausea occurred infrequently while no device related infections were observed. There was no clinical evidence of any significant baclofen neurotoxicity either in Stage 1 or 2. The only ambulatory patient developed marked lower extremity weakness during Stage 1 intrathecal baclofen infusion and was temporarily unable to walk. We conclude that continuous administration of intrathecal baclofen is an effective and safe modality for spasticity control in patients who are refractory to oral medications.

Authors+Show Affiliations

Institute for Rehabilitation and Research, Baylor College of Medicine, Houston, Texas 77030.

Pub Type(s)

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

Language

eng

PubMed ID

2023770

Citation

Loubser, P G., et al. "Continuous Infusion of Intrathecal Baclofen: Long-term Effects On Spasticity in Spinal Cord Injury." Paraplegia, vol. 29, no. 1, 1991, pp. 48-64.
Loubser PG, Narayan RK, Sandin KJ, et al. Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury. Paraplegia. 1991;29(1):48-64.
Loubser, P. G., Narayan, R. K., Sandin, K. J., Donovan, W. H., & Russell, K. D. (1991). Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury. Paraplegia, 29(1), pp. 48-64.
Loubser PG, et al. Continuous Infusion of Intrathecal Baclofen: Long-term Effects On Spasticity in Spinal Cord Injury. Paraplegia. 1991;29(1):48-64. PubMed PMID: 2023770.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury. AU - Loubser,P G, AU - Narayan,R K, AU - Sandin,K J, AU - Donovan,W H, AU - Russell,K D, PY - 1991/1/1/pubmed PY - 1991/1/1/medline PY - 1991/1/1/entrez SP - 48 EP - 64 JF - Paraplegia JO - Paraplegia VL - 29 IS - 1 N2 - The effects of intrathecal baclofen infusion were studied in 9 spinal cord injury patients whose spasticity had been refractory to oral medications. In a two stage, placebo controlled trial, baclofen was administered into the lumbar intrathecal space and subsequent clinical and neurophysiologic changes were assessed. In stage 1, 9 patients underwent a 5 day percutaneous infusion of baclofen and placebo via an external pump. Ashworth and reflex scores were assessed at time of enrollment, after infusion of that amount of baclofen which provided optimal spasticity control and after intrathecal infusion of placebo. The mean Ashworth grade decreased from 3.78 +/- 1.34 to 1.16 +/- 0.48 (p less than 0.001) while mean reflex score decreased from 3.57 +/- 1.05 to 0.64 +/- 0.87 (p less than 0.001). These values differed significantly from those associated with placebo therapy (Ashworth grade--2.54 +/- 1.04, p less than 0.001; reflex score--2.56 +/- 1.04, p less than 0.01). Objective improvements in functional abilities and independence were noted in 8 patients, while somatosensory and brainstem auditory evoked potentials were unchanged in all patients. Urodynamic evaluation revealed increased bladder capacity in 3 patients, while in 4 no change was observed. In Stage 2, permanent programmable infusion pumps were implanted in 7 patients who demonstrated a good response during Stage 1. In this group, mean Ashworth score decreased from 3.79 +/- 0.69 to 2 +/- 0.96 (p less than 0.001) and mean reflex score decreased from 3.85 +/- 0.62 to 2.18 +/- 0.43 (p less than 0.001). Baclofen dosage increased from 182 +/- 135 to 528 +/- 266 mcg/day over the 3-22 month follow-up period. Most of the dosage increase occurred within the initial 12 months following infusion pump implantation and tended to plateau thereafter. Minor complications such as catheter dislodgement/kinking and nausea occurred infrequently while no device related infections were observed. There was no clinical evidence of any significant baclofen neurotoxicity either in Stage 1 or 2. The only ambulatory patient developed marked lower extremity weakness during Stage 1 intrathecal baclofen infusion and was temporarily unable to walk. We conclude that continuous administration of intrathecal baclofen is an effective and safe modality for spasticity control in patients who are refractory to oral medications. SN - 0031-1758 UR - https://www.unboundmedicine.com/medline/citation/2023770/Continuous_infusion_of_intrathecal_baclofen:_long_term_effects_on_spasticity_in_spinal_cord_injury_ L2 - http://dx.doi.org/10.1038/sc.1991.7 DB - PRIME DP - Unbound Medicine ER -