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Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury.
Medicine (Baltimore). 2017 Aug; 96(34):e7472.M

Abstract

Intrathecal baclofen (ITB) has been known to reduce spasticity which did not respond to oral medications and botulinum toxin treatment. However, few results have been reported comparing the effects of ITB therapy in patients with cerebral palsy (CP) and acquired brain injury. This study aimed to investigate beneficial and adverse effects of ITB bolus injection and pump therapy in patients with CP and to compare outcomes to patients with acquired brain injury such as traumatic brain injury and hypoxic brain injury. ITB test trials were performed in 37 patients (19 CP and 18 acquired brain injury). Based on ambulatory function, CP patients were divided into 2 groups: 11 patients with nonambulatory CP and 8 patients with ambulatory CP. Change of spasticity was evaluated using the Modified Ashworth Scale. Additional positive or negative effects were also evaluated after ITB bolus injection. In patients who received ITB pump implantation, outcomes of spasticity, subjective satisfaction and adverse events were evaluated until 12 months post-treatment. After ITB bolus injection, 32 patients (86.5%) (CP 84.2% versus acquired brain injury 88.9%) showed a positive response of reducing spasticity. However, 8 patients with CP had negative adverse effects. Particularly, 3 ambulatory CP patients showed standing impairment and 1 ambulatory CP patient showed impaired gait pattern such as foot drop because of excessive reduction of lower extremity muscle tone. Ambulatory CP patients received ITB pump implantation less than patients with acquired brain injury after ITB test trials (P = .003 by a chi-squared test). After the pump implantation, spasticity was significantly reduced within 1 month and the effect maintained for 12 months. Seventeen patients or their caregivers (73.9%) were very satisfied, whereas 5 patients (21.7%) suffered from adverse events showed no subjective satisfaction. In conclusion, ITB therapy was effective in reducing spasticity in patients with CP and acquired brain injury. Before ITB pump implantation, it seems necessary to perform the ITB bolus injection to verify beneficial effects and adverse effects especially in ambulatory CP.

Authors+Show Affiliations

aDepartment and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine bDepartment of Medicine, The Graduate School of Yonsei University cRehabilitation Institute of Neuromuscular Disease dDepartment of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine eBrain Korea 21 PLUS Project for Medical Science, Yonsei University fYonsei Stem Cell Research Center, Avison Biomedical Research Center, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28834868

Citation

Yoon, Young Kwon, et al. "Outcomes of Intrathecal Baclofen Therapy in Patients With Cerebral Palsy and Acquired Brain Injury." Medicine, vol. 96, no. 34, 2017, pp. e7472.
Yoon YK, Lee KC, Cho HE, et al. Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury. Medicine (Baltimore). 2017;96(34):e7472.
Yoon, Y. K., Lee, K. C., Cho, H. E., Chae, M., Chang, J. W., Chang, W. S., & Cho, S. R. (2017). Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury. Medicine, 96(34), e7472. https://doi.org/10.1097/MD.0000000000007472
Yoon YK, et al. Outcomes of Intrathecal Baclofen Therapy in Patients With Cerebral Palsy and Acquired Brain Injury. Medicine (Baltimore). 2017;96(34):e7472. PubMed PMID: 28834868.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury. AU - Yoon,Young Kwon, AU - Lee,Kil Chan, AU - Cho,Han Eol, AU - Chae,Minji, AU - Chang,Jin Woo, AU - Chang,Won Seok, AU - Cho,Sung-Rae, PY - 2017/8/24/entrez PY - 2017/8/24/pubmed PY - 2017/9/12/medline SP - e7472 EP - e7472 JF - Medicine JO - Medicine (Baltimore) VL - 96 IS - 34 N2 - Intrathecal baclofen (ITB) has been known to reduce spasticity which did not respond to oral medications and botulinum toxin treatment. However, few results have been reported comparing the effects of ITB therapy in patients with cerebral palsy (CP) and acquired brain injury. This study aimed to investigate beneficial and adverse effects of ITB bolus injection and pump therapy in patients with CP and to compare outcomes to patients with acquired brain injury such as traumatic brain injury and hypoxic brain injury. ITB test trials were performed in 37 patients (19 CP and 18 acquired brain injury). Based on ambulatory function, CP patients were divided into 2 groups: 11 patients with nonambulatory CP and 8 patients with ambulatory CP. Change of spasticity was evaluated using the Modified Ashworth Scale. Additional positive or negative effects were also evaluated after ITB bolus injection. In patients who received ITB pump implantation, outcomes of spasticity, subjective satisfaction and adverse events were evaluated until 12 months post-treatment. After ITB bolus injection, 32 patients (86.5%) (CP 84.2% versus acquired brain injury 88.9%) showed a positive response of reducing spasticity. However, 8 patients with CP had negative adverse effects. Particularly, 3 ambulatory CP patients showed standing impairment and 1 ambulatory CP patient showed impaired gait pattern such as foot drop because of excessive reduction of lower extremity muscle tone. Ambulatory CP patients received ITB pump implantation less than patients with acquired brain injury after ITB test trials (P = .003 by a chi-squared test). After the pump implantation, spasticity was significantly reduced within 1 month and the effect maintained for 12 months. Seventeen patients or their caregivers (73.9%) were very satisfied, whereas 5 patients (21.7%) suffered from adverse events showed no subjective satisfaction. In conclusion, ITB therapy was effective in reducing spasticity in patients with CP and acquired brain injury. Before ITB pump implantation, it seems necessary to perform the ITB bolus injection to verify beneficial effects and adverse effects especially in ambulatory CP. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/28834868/Outcomes_of_intrathecal_baclofen_therapy_in_patients_with_cerebral_palsy_and_acquired_brain_injury_ L2 - http://dx.doi.org/10.1097/MD.0000000000007472 DB - PRIME DP - Unbound Medicine ER -