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Long-term continuously infused intrathecal baclofen for spastic-dystonic hypertonia in traumatic brain injury: 1-year experience.
Arch Phys Med Rehabil. 1999 Jan; 80(1):13-9.AP

Abstract

OBJECTIVE

To determine if the long-term use of continuously infused intrathecal baclofen (ITB) over a 1-year period will control spastic-dystonic hypertonia in patients with traumatic brain injury (TBI).

SETTING

Tertiary care outpatient and inpatient rehabilitation center directly attached to a university hospital.

SUBJECTS

Persons with TBI and intractable spasticity and dystonia for more than 6 months' duration recruited in a consecutive manner.

DESIGN

TBI patients were admitted to the study after screening via a bolus injection of either intrathecal normal saline or 50 microg of baclofen. Data for Ashworth rigidity scores, spasm scores, and deep tendon reflex scores were collected for both the upper extremities (UE) and lower extremities (LE). Patients whose LE Ashworth scores decreased an average of 2 points were then offered implantation of a computer-controlled pump for continuous ITB. Changes over time were assessed statistically via Friedman's analysis for ordinal data and ANOVA for linear data. Differences between set points in time were also assessed via Wilcoxon signed rank.

DATA SET

Seventeen patients (average age 29+/-11 yrs) with spasticity and/or dystonia treated over 1 year via a computer-controllable intrathecal delivery system for the delivery of ITB.

RESULTS

After 1 year of continuous ITB treatment the average LE Ashworth score decreased from 3.5+/-1.3 (SD) to 1.7+/-0.9 (p < .0001), spasm score from 1.8+/-1.3 to 0.2+/-0.5 (p< .0001), and reflex score from 2.5+/-1.1 to 0.1+/-0.3 (p < .0001). The average UE Ashworth score decreased from 2.9+/-1.5 to 1.6+/-1.0 (p < .0001), spasm score from 1.2+/-1.5 to 0.2+/-0.6 (p < 0.0001), and reflex score from 2.2+/-0.5 to 1.0+/-0.8 (p < .0001). The average ITB dose required to attain these effects at 1 year was 302 microg continuously infused per day.

CONCLUSION

Continuous intrathecal infusion of baclofen is capable of maintaining a reduction in spasticity and dystonia in both the upper and lower extremities of TBI patients.

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  • Publisher Full Text

    • Authors+Show Affiliations

    Meythaler JM
    Department of Physical Medicine and Rehabilitation, University of Alabama School of Medicine, Birmingham 35233-7330, USA.
    Guin-Renfroe S
    No affiliation info available
    Grabb P
    No affiliation info available
    Hadley MN
    No affiliation info available

    MeSH

    AdolescentAdultAnalysis of VarianceBaclofenBrain InjuriesChildDose-Response Relationship, DrugDrug Administration ScheduleDrug Therapy, Computer-AssistedDystoniaFemaleGABA AgonistsHumansInjections, SpinalMaleMiddle AgedMuscle SpasticityPhysical Therapy Modalities

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    9915366

    Citation

    Meythaler, J M., et al. "Long-term Continuously Infused Intrathecal Baclofen for Spastic-dystonic Hypertonia in Traumatic Brain Injury: 1-year Experience." Archives of Physical Medicine and Rehabilitation, vol. 80, no. 1, 1999, pp. 13-9.
    Meythaler JM, Guin-Renfroe S, Grabb P, et al. Long-term continuously infused intrathecal baclofen for spastic-dystonic hypertonia in traumatic brain injury: 1-year experience. Arch Phys Med Rehabil. 1999;80(1):13-9.
    Meythaler, J. M., Guin-Renfroe, S., Grabb, P., & Hadley, M. N. (1999). Long-term continuously infused intrathecal baclofen for spastic-dystonic hypertonia in traumatic brain injury: 1-year experience. Archives of Physical Medicine and Rehabilitation, 80(1), 13-9.
    Meythaler JM, et al. Long-term Continuously Infused Intrathecal Baclofen for Spastic-dystonic Hypertonia in Traumatic Brain Injury: 1-year Experience. Arch Phys Med Rehabil. 1999;80(1):13-9. PubMed PMID: 9915366.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Long-term continuously infused intrathecal baclofen for spastic-dystonic hypertonia in traumatic brain injury: 1-year experience. AU - Meythaler,J M, AU - Guin-Renfroe,S, AU - Grabb,P, AU - Hadley,M N, PY - 1999/1/23/pubmed PY - 1999/1/23/medline PY - 1999/1/23/entrez SP - 13 EP - 9 JF - Archives of physical medicine and rehabilitation JO - Arch Phys Med Rehabil VL - 80 IS - 1 N2 - OBJECTIVE: To determine if the long-term use of continuously infused intrathecal baclofen (ITB) over a 1-year period will control spastic-dystonic hypertonia in patients with traumatic brain injury (TBI). SETTING: Tertiary care outpatient and inpatient rehabilitation center directly attached to a university hospital. SUBJECTS: Persons with TBI and intractable spasticity and dystonia for more than 6 months' duration recruited in a consecutive manner. DESIGN: TBI patients were admitted to the study after screening via a bolus injection of either intrathecal normal saline or 50 microg of baclofen. Data for Ashworth rigidity scores, spasm scores, and deep tendon reflex scores were collected for both the upper extremities (UE) and lower extremities (LE). Patients whose LE Ashworth scores decreased an average of 2 points were then offered implantation of a computer-controlled pump for continuous ITB. Changes over time were assessed statistically via Friedman's analysis for ordinal data and ANOVA for linear data. Differences between set points in time were also assessed via Wilcoxon signed rank. DATA SET: Seventeen patients (average age 29+/-11 yrs) with spasticity and/or dystonia treated over 1 year via a computer-controllable intrathecal delivery system for the delivery of ITB. RESULTS: After 1 year of continuous ITB treatment the average LE Ashworth score decreased from 3.5+/-1.3 (SD) to 1.7+/-0.9 (p < .0001), spasm score from 1.8+/-1.3 to 0.2+/-0.5 (p< .0001), and reflex score from 2.5+/-1.1 to 0.1+/-0.3 (p < .0001). The average UE Ashworth score decreased from 2.9+/-1.5 to 1.6+/-1.0 (p < .0001), spasm score from 1.2+/-1.5 to 0.2+/-0.6 (p < 0.0001), and reflex score from 2.2+/-0.5 to 1.0+/-0.8 (p < .0001). The average ITB dose required to attain these effects at 1 year was 302 microg continuously infused per day. CONCLUSION: Continuous intrathecal infusion of baclofen is capable of maintaining a reduction in spasticity and dystonia in both the upper and lower extremities of TBI patients. SN - 0003-9993 UR - https://www.unboundmedicine.com/medline/citation/9915366/Long_term_continuously_infused_intrathecal_baclofen_for_spastic_dystonic_hypertonia_in_traumatic_brain_injury:_1_year_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-9993(99)90301-5 DB - PRIME DP - Unbound Medicine ER -