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Case Series: Intrathecal Baclofen Therapy in Stiff-Person Syndrome.
Neuromodulation. 2018 Oct; 21(7):655-659.N

Abstract

OBJECTIVES

Stiff-person syndrome (SPS) is associated with axial rigidity superimposed on sustained muscle spasms. These symptoms commonly interfere with the performance of activities of daily living including ambulation. This retrospective case series evaluates the outcomes of screening tests and chronic infusion of intrathecal baclofen (ITB) in patients diagnosed with SPS treated in our spasticity clinic.

MATERIALS AND METHODS

Patients were identified from an institutional review board-approved clinical registry of ITB therapy. Data from clinical encounters were extracted from the registry and from the patients' electronic medical record. All patients with medically refractory spasticity related to SPS screened with an ITB injection were included. In addition to pertinent demographic and clinical information, data from validated outcome measures routinely used in the clinic were collected: pain Numeric Rating Scale, Spasm Frequency Scale, lower extremity Modified Ashworth Scale (MAS), and Timed 25 Foot Walk. Outcomes data for chronic ITB infusion were assessed at early (<6 months) and late follow-up (6-12 months) visits after surgery.

RESULTS

Nine patients were included, and seven received chronic ITB infusion. MAS scores were improved at early and late follow-up, and five patients experienced a reduction in pain scores. Walking performance remained stable in previously ambulatory patients. Four patients experienced complications related to ITB implantation, which resolved with medical or surgical treatment.

CONCLUSION

Consistent with other case series, our results suggest that ITB is an effective therapy for medically intractable spasticity due to SPS, and symptom reduction can be achieved without compromising ambulation.

Authors+Show Affiliations

Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA.Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA.Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA.Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA.Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA.Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29532593

Citation

Abbatemarco, Justin Ralph, et al. "Case Series: Intrathecal Baclofen Therapy in Stiff-Person Syndrome." Neuromodulation : Journal of the International Neuromodulation Society, vol. 21, no. 7, 2018, pp. 655-659.
Abbatemarco JR, Willis MA, Wilson RG, et al. Case Series: Intrathecal Baclofen Therapy in Stiff-Person Syndrome. Neuromodulation. 2018;21(7):655-659.
Abbatemarco, J. R., Willis, M. A., Wilson, R. G., Nagel, S. J., Machado, A. G., & Bethoux, F. A. (2018). Case Series: Intrathecal Baclofen Therapy in Stiff-Person Syndrome. Neuromodulation : Journal of the International Neuromodulation Society, 21(7), 655-659. https://doi.org/10.1111/ner.12765
Abbatemarco JR, et al. Case Series: Intrathecal Baclofen Therapy in Stiff-Person Syndrome. Neuromodulation. 2018;21(7):655-659. PubMed PMID: 29532593.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case Series: Intrathecal Baclofen Therapy in Stiff-Person Syndrome. AU - Abbatemarco,Justin Ralph, AU - Willis,Mary Alissa, AU - Wilson,Robert G, AU - Nagel,Sean J, AU - Machado,Andre G, AU - Bethoux,Francois A, Y1 - 2018/03/13/ PY - 2017/10/05/received PY - 2017/12/12/revised PY - 2018/01/31/accepted PY - 2018/3/14/pubmed PY - 2018/11/20/medline PY - 2018/3/14/entrez KW - Stiff-person syndrome KW - intrathecal baclofen KW - pain KW - rehabilitation KW - spasticity SP - 655 EP - 659 JF - Neuromodulation : journal of the International Neuromodulation Society JO - Neuromodulation VL - 21 IS - 7 N2 - OBJECTIVES: Stiff-person syndrome (SPS) is associated with axial rigidity superimposed on sustained muscle spasms. These symptoms commonly interfere with the performance of activities of daily living including ambulation. This retrospective case series evaluates the outcomes of screening tests and chronic infusion of intrathecal baclofen (ITB) in patients diagnosed with SPS treated in our spasticity clinic. MATERIALS AND METHODS: Patients were identified from an institutional review board-approved clinical registry of ITB therapy. Data from clinical encounters were extracted from the registry and from the patients' electronic medical record. All patients with medically refractory spasticity related to SPS screened with an ITB injection were included. In addition to pertinent demographic and clinical information, data from validated outcome measures routinely used in the clinic were collected: pain Numeric Rating Scale, Spasm Frequency Scale, lower extremity Modified Ashworth Scale (MAS), and Timed 25 Foot Walk. Outcomes data for chronic ITB infusion were assessed at early (<6 months) and late follow-up (6-12 months) visits after surgery. RESULTS: Nine patients were included, and seven received chronic ITB infusion. MAS scores were improved at early and late follow-up, and five patients experienced a reduction in pain scores. Walking performance remained stable in previously ambulatory patients. Four patients experienced complications related to ITB implantation, which resolved with medical or surgical treatment. CONCLUSION: Consistent with other case series, our results suggest that ITB is an effective therapy for medically intractable spasticity due to SPS, and symptom reduction can be achieved without compromising ambulation. SN - 1525-1403 UR - https://www.unboundmedicine.com/medline/citation/29532593/Case_Series:_Intrathecal_Baclofen_Therapy_in_Stiff_Person_Syndrome_ L2 - https://doi.org/10.1111/ner.12765 DB - PRIME DP - Unbound Medicine ER -