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Intrathecal baclofen for multiple sclerosis related spasticity: A twenty year experience.
Mult Scler Relat Disord 2019; 27:95-100MS

Abstract

OBJECTIVE

Evaluate long-term efficacy and safety of ITB in treating MS-related spasticity over ∼ 20 years of service provision in a single centre.

METHODS

A single centre prospective observational cohort study was performed. Eligible subjects underwent ITB trial by bolus dose via lumbar puncture and responders proceeded to pump implantation. Demographics, spasticity scores (Ashworth), spasm score (Penn), stiffness, pain and discomfort (Visual Analogue Scale), mobility (10 M walk), spasticity treatment, and ITB doses were analysed longitudinally.

RESULTS

106 people were included with 568 patient years of data. Ashworth, Penn and VAS/NRS mean scores improved post-trial compared with baseline (p < 0.001). Sustained efficacy was reported on Ashworth, Penn and VAS scores over time. After 1 year, 73 (69%) discontinued all oral antispasticity medications. Complication rates were low at 0.05 complications per pump year and mostly mechanical (usually catheter) related. In 8 ambulatory subjects, 7 (87%) continued to walk one year after pump insertion, 5 (62%) were still walking at time of analysis (mean follow up 3.4 years).

CONCLUSIONS

ITB is an effective and safe long term treatment for refractory MS related spasticity. Efficacy was sustained over time and the majority of subjects subsequently discontinued systemic medications. In a small cohort, ability to walk was preserved, indicating ITB should be considered earlier in this cohort.

Authors+Show Affiliations

Neurorehabilitation (NHNN), Neuroinflammation (IoN, UCL), Queen Square, London WC1N 3BG, United Kingdom.Neurorehabilitation (NHNN), Neuroinflammation (IoN, UCL), Queen Square, London WC1N 3BG, United Kingdom.Neurorehabilitation (NHNN), Neuroinflammation (IoN, UCL), Queen Square, London WC1N 3BG, United Kingdom.Neurorehabilitation (NHNN), Neuroinflammation (IoN, UCL), Queen Square, London WC1N 3BG, United Kingdom.Neurorehabilitation (NHNN), Neuroinflammation (IoN, UCL), Queen Square, London WC1N 3BG, United Kingdom.Neurorehabilitation (NHNN), Neuroinflammation (IoN, UCL), Queen Square, London WC1N 3BG, United Kingdom. Electronic address: rachel.farrell@ucl.ac.uk.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

30366276

Citation

Sammaraiee, Yezen, et al. "Intrathecal Baclofen for Multiple Sclerosis Related Spasticity: a Twenty Year Experience." Multiple Sclerosis and Related Disorders, vol. 27, 2019, pp. 95-100.
Sammaraiee Y, Yardley M, Keenan L, et al. Intrathecal baclofen for multiple sclerosis related spasticity: A twenty year experience. Mult Scler Relat Disord. 2019;27:95-100.
Sammaraiee, Y., Yardley, M., Keenan, L., Buchanan, K., Stevenson, V., & Farrell, R. (2019). Intrathecal baclofen for multiple sclerosis related spasticity: A twenty year experience. Multiple Sclerosis and Related Disorders, 27, pp. 95-100. doi:10.1016/j.msard.2018.10.009.
Sammaraiee Y, et al. Intrathecal Baclofen for Multiple Sclerosis Related Spasticity: a Twenty Year Experience. Mult Scler Relat Disord. 2019;27:95-100. PubMed PMID: 30366276.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrathecal baclofen for multiple sclerosis related spasticity: A twenty year experience. AU - Sammaraiee,Yezen, AU - Yardley,Martin, AU - Keenan,Liz, AU - Buchanan,Katrina, AU - Stevenson,Val, AU - Farrell,Rachel, Y1 - 2018/10/15/ PY - 2018/07/13/received PY - 2018/09/04/revised PY - 2018/10/13/accepted PY - 2018/10/27/pubmed PY - 2019/4/18/medline PY - 2018/10/27/entrez KW - Intrathecal baclofen KW - Multiple sclerosis KW - Quality of life KW - Rehabilitation KW - Spasticity KW - Symptomatic treatment SP - 95 EP - 100 JF - Multiple sclerosis and related disorders JO - Mult Scler Relat Disord VL - 27 N2 - OBJECTIVE: Evaluate long-term efficacy and safety of ITB in treating MS-related spasticity over ∼ 20 years of service provision in a single centre. METHODS: A single centre prospective observational cohort study was performed. Eligible subjects underwent ITB trial by bolus dose via lumbar puncture and responders proceeded to pump implantation. Demographics, spasticity scores (Ashworth), spasm score (Penn), stiffness, pain and discomfort (Visual Analogue Scale), mobility (10 M walk), spasticity treatment, and ITB doses were analysed longitudinally. RESULTS: 106 people were included with 568 patient years of data. Ashworth, Penn and VAS/NRS mean scores improved post-trial compared with baseline (p < 0.001). Sustained efficacy was reported on Ashworth, Penn and VAS scores over time. After 1 year, 73 (69%) discontinued all oral antispasticity medications. Complication rates were low at 0.05 complications per pump year and mostly mechanical (usually catheter) related. In 8 ambulatory subjects, 7 (87%) continued to walk one year after pump insertion, 5 (62%) were still walking at time of analysis (mean follow up 3.4 years). CONCLUSIONS: ITB is an effective and safe long term treatment for refractory MS related spasticity. Efficacy was sustained over time and the majority of subjects subsequently discontinued systemic medications. In a small cohort, ability to walk was preserved, indicating ITB should be considered earlier in this cohort. SN - 2211-0356 UR - https://www.unboundmedicine.com/medline/citation/30366276/Intrathecal_baclofen_for_multiple_sclerosis_related_spasticity:_A_twenty_year_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2211-0348(18)30371-7 DB - PRIME DP - Unbound Medicine ER -