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Intrathecal baclofen administration for control of severe spinal spasticity: functional improvement and long-term follow-up.
Arch Phys Med Rehabil. 1996 Jan; 77(1):35-9.AP

Abstract

OBJECTIVES

To assess long-term efficacy and functional benefits of intrathecal baclofen for severe spinal spasticity.

DESIGN

A prospective before-after trial.

SETTING

A neurological rehabilitation department of a university hospital. Pump implantation was realized in neurosurgery; follow-up was carried out mostly on an outpatient basis.

PATIENTS

Eighteen patients with severe and disabling spinal spasticity received intrathecal baclofen by an implantable pump; average follow-up was 37.4 months (range, 9 to 72).

MAIN OUTCOME MEASURES

Spasticity (Ashworth and spasms frequency scores); disability (Functional Independence Measure [FIM]).

RESULTS

A significant decrease in tone and spasms was observed in all patients. Tolerance appeared during the first 6 to 9 months. Later on, efficacy remained stable, except in cases of mechanical problems of the pump or catheter. Functional assessment found a highly significant (p < .001) increase of FIM score (particularly for bathing, dressing lower body, transfers, and in some cases, locomotion). This was particularly marked in patients with thoracic spinal cord lesion. In cases of severe upper limb dysfunction, FIM was only improved for wheelchair displacements, due to a better sitting position, but nursing became easier and life comfort was enhanced. Severe side effects (overdose) were observed in two cases.

CONCLUSION

Efficacy remained stable after 6 to 9 months. Marked improvement of functional independence was observed in paraplegic patients. Improvement was less spectacular in patients with severe upper limb dysfunction, but nevertheless appreciable in terms of life comfort and use of attendants.

Authors+Show Affiliations

Department of Neurological Rehabilitation, Raymond Poincaré Hospital, Garches, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

8554471

Citation

Azouvi, P, et al. "Intrathecal Baclofen Administration for Control of Severe Spinal Spasticity: Functional Improvement and Long-term Follow-up." Archives of Physical Medicine and Rehabilitation, vol. 77, no. 1, 1996, pp. 35-9.
Azouvi P, Mane M, Thiebaut JB, et al. Intrathecal baclofen administration for control of severe spinal spasticity: functional improvement and long-term follow-up. Arch Phys Med Rehabil. 1996;77(1):35-9.
Azouvi, P., Mane, M., Thiebaut, J. B., Denys, P., Remy-Neris, O., & Bussel, B. (1996). Intrathecal baclofen administration for control of severe spinal spasticity: functional improvement and long-term follow-up. Archives of Physical Medicine and Rehabilitation, 77(1), 35-9.
Azouvi P, et al. Intrathecal Baclofen Administration for Control of Severe Spinal Spasticity: Functional Improvement and Long-term Follow-up. Arch Phys Med Rehabil. 1996;77(1):35-9. PubMed PMID: 8554471.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrathecal baclofen administration for control of severe spinal spasticity: functional improvement and long-term follow-up. AU - Azouvi,P, AU - Mane,M, AU - Thiebaut,J B, AU - Denys,P, AU - Remy-Neris,O, AU - Bussel,B, PY - 1996/1/1/pubmed PY - 1996/1/1/medline PY - 1996/1/1/entrez SP - 35 EP - 9 JF - Archives of physical medicine and rehabilitation JO - Arch Phys Med Rehabil VL - 77 IS - 1 N2 - OBJECTIVES: To assess long-term efficacy and functional benefits of intrathecal baclofen for severe spinal spasticity. DESIGN: A prospective before-after trial. SETTING: A neurological rehabilitation department of a university hospital. Pump implantation was realized in neurosurgery; follow-up was carried out mostly on an outpatient basis. PATIENTS: Eighteen patients with severe and disabling spinal spasticity received intrathecal baclofen by an implantable pump; average follow-up was 37.4 months (range, 9 to 72). MAIN OUTCOME MEASURES: Spasticity (Ashworth and spasms frequency scores); disability (Functional Independence Measure [FIM]). RESULTS: A significant decrease in tone and spasms was observed in all patients. Tolerance appeared during the first 6 to 9 months. Later on, efficacy remained stable, except in cases of mechanical problems of the pump or catheter. Functional assessment found a highly significant (p < .001) increase of FIM score (particularly for bathing, dressing lower body, transfers, and in some cases, locomotion). This was particularly marked in patients with thoracic spinal cord lesion. In cases of severe upper limb dysfunction, FIM was only improved for wheelchair displacements, due to a better sitting position, but nursing became easier and life comfort was enhanced. Severe side effects (overdose) were observed in two cases. CONCLUSION: Efficacy remained stable after 6 to 9 months. Marked improvement of functional independence was observed in paraplegic patients. Improvement was less spectacular in patients with severe upper limb dysfunction, but nevertheless appreciable in terms of life comfort and use of attendants. SN - 0003-9993 UR - https://www.unboundmedicine.com/medline/citation/8554471/Intrathecal_baclofen_administration_for_control_of_severe_spinal_spasticity:_functional_improvement_and_long_term_follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-9993(96)90217-8 DB - PRIME DP - Unbound Medicine ER -