Long‐term Intrathecal Baclofen: Outcomes After More than 10 Years of Treatment

Mathur, Sunjay; Chu, Samuel Kai Wah; McCormick, Zachary L; Chien, George C. Chang; Marciniak, Christina

doi:10.1016/j.pmrj.2013.12.005

Cited by 65 publications

(64 citation statements)

References 33 publications

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“…There were no reported infective complications, early pump revisions or explantations. The most common side effects were baclofen-related: 3 (60.0%) out of the fi ve patients had transient hypotension immediately after ITB implantation, while patient 2 had excessive somnolence during a routine ITB refi ll ( [18][19][20][21][22][23] Despite intensive inpatient rehabilitation and follow-up after ITB pump implantation, the reduction in limb spasticity was not accompanied by a corresponding signifi cant increase in independent locomotor abilities or self-care. The only patient in this series who experienced reduced functional disability had central paraplegia sparing his upper limbs, intact cognition and motivation, which could have positively impacted rehabilitation gains.…”

Section: Discussionmentioning

confidence: 99%

Treatment of severe, disabling spasticity with continuous intrathecal baclofen therapy following acquired brain injury: the experience of a tertiary institution in Singapore

Wang

Law

King

et al. 2016

smedj

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INTRODUCTIONIntrathecal baclofen (ITB) therapy is a proven, effective treatment for disabling cortical spasticity. We describe the fi rst local series of fi ve patients with acquired brain injury (ABI) who received ITB and were followed up for 63.8 months.METHODS A retrospective review of medical and rehabilitation records of patients who received ITB therapy was carried out. Data studied included baseline demographic and injury variables, implantation data, spasticity and function, ITB dosage over time and complications.RESULTS From 2006 to 2010, a total of fi ve patients received ITB therapy via implanted pumps about 39.4 months after ABI. Four out of fi ve patients experienced signifi cant reductions in their lower limb spasticity scores and improvements in global function and dependency. One patient had minor adverse events associated with baclofen-related sedation. The mean ITB dose at one year was 182.7 ± 65.6 mcg/day. CONCLUSION Our preliminary study showed encouraging long-term outcomes and safety for ITB therapy after ABI-related intractable spasticity. Individual ITB responses over time were variable, with gender differences. The outcomes experienced by our centre were comparable to those in the general ABI population, supporting the effi cacy of ITB therapy for chronic disabling spasticity.

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Section: Discussionmentioning

confidence: 99%

Treatment of severe, disabling spasticity with continuous intrathecal baclofen therapy following acquired brain injury: the experience of a tertiary institution in Singapore

Wang

Law

King

et al. 2016

smedj

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“…The long-term efficacy and benefits of the ITB treatment on spasticity, pain, and spasm frequency has been investigated in several studies [36, 37]. To our knowledge, this is the first open study investigating the effectiveness of ITB treatment in patients with inherited ataxia.…”

Section: Discussionmentioning

confidence: 99%

Inherited Ataxia and Intrathecal Baclofen for the Treatment of Spasticity and Painful Spasms

Berntsson

Gauffin

Melberg

et al. 2019

Stereotact Funct Neurosurg

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Background: Intrathecal baclofen (ITB) treatment is considered a powerful tool in the management of severe spasticity in neurological conditions such as multiple sclerosis, cerebral palsy, and traumatic spinal cord and brain injury. Objectives: The objective of this study was to assess the effectiveness of the ITB in patients with inherited ataxia suffering from severe painful spasms and/or spasticity. Method: A total of 5 patients with spinocerebellar ataxia 3 or 7 or Friedreich’s ataxia were included in this observational multicenter study. The patients were interviewed and completed outcome measures assessing pain (The Brief Pain Inventory), fatigue (Fatigue Severity Scale), and life satisfaction (LiSAT-9) before and 1 year after the treatment. Spasticity (Modified Ashworth Scale) and spasm frequency (SPFS) were measured objectively for each patient. Results: The mean treatment time was 1.9 years. Evaluation of established standard forms revealed symptomatic relief from spasticity, spasms, pain, and fatigue in addition to improved body posture, sleep, and life satisfaction after ITB treatment. Conclusions: We report the potential beneficial effects of ITB treatment in patients with inherited ataxia who also suffer from spasticity/spasms. ITB treatment indication in neurological disorders allows for extension to the treatment of spasticity/ spasms in patients with hereditary ataxia.

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“…Baclofen, the clinically approved GABA-B agonist, has potent stereospecific suppressive effects upon motor tone [253] and is widely used clinically to regulate motor tone in the case of spasticity [254][255][256]; but it has also been implicated in having suppressive effects upon nociceptive processing after intrathecal delivery in preclinical models of facilitated processing [217] and hyperpathia in mono and polyneuropathies and spinal injury [220][221][257][258][259] and in humans [260,261].…”

Section: Spinal Gaba-b Agonistsmentioning

confidence: 99%

Current and Future Issues in the development of spinal agents for the management of pain

Yaksh¹,

Fisher²,

Hockman³

et al. 2016

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Targeting analgesic drugs for spinal delivery reflects the fact that while the conscious experience of pain is mediated supraspinally, input initiated by high intensity stimuli, tissue injury and/or nerve injury is encoded at the level of the spinal dorsal horn and this output informs the brain as to the peripheral environment. This encoding process is subject to strong upregulation resulting in hyperesthetic states and downregulation reducing the ongoing processing of nociceptive stimuli reversing the hyperesthesia and pain processing. The present review addresses the biology of spinal nociceptive processing as relevant to the effects of intrathecally-delivered drugs in altering pain processing following acute stimulation, tissue inflammation/injury and nerve injury. The review covers i) the major classes of spinal agents currently employed as intrathecal analgesics (opioid agonists, alpha 2 agonists; sodium channel blockers; calcium channel blockers; NMDA blockers; GABA A/B agonists; COX inhibitors; ii) ongoing developments in the pharmacology of spinal therapeutics focusing on less studied agents/targets (cholinesterase inhibition; Adenosine agonists; iii) novel intrathecal targeting methodologies including gene-based approaches (viral vectors, plasmids, interfering RNAs); antisense, and toxins (botulinum toxins; resniferatoxin, substance P Saporin); and iv) issues relevant to intrathecal drug delivery (neuraxial drug distribution), infusate delivery profile, drug dosing, formulation and principals involved in the preclinical evaluation of intrathecal drug safety.Keywords: Adenovirus transfection, dorsal horn, neurotoxins, pain pathways, spinal drug delivery, spinal analgesics, toxicity. RATIONALETargeting analgesic drugs for direct spinal delivery reflects the fact that while the conscious experience of pain is mediated supraspinally, input initiated by high intensity stimuli, tissue injury and/or nerve injury is encoded at the level of the spinal dorsal horn. Thus, high intensity (e.g., nociceptive) stimulation activates populations of small primary afferents, generating an intensity-dependent increase in activity of second order dorsal horn projection neurons. This excitation is transmitted through spinofugal projection pathways to higher centers, such as the somatosensory thalamus -somatosensory cortex, and to the medial thalamus -limbic cortices that are respectively believed to underlie the sensory-discriminative and affectivemotivational components of the pain experience [1-3]. The dorsal horn encoding process reflects a remarkable plasticity wherein the input-output function of the spinal dorsal horn is subject to pronounced regulation by local neuronal and nonneuronal circuits as well as supraspinal (bulbospinal) input. Thus, following tissue or nerve injury there is an enhanced neuronal response to moderate or low intensity stimuli, e.g., *Address correspondence to this author at the University of California, San Diego, Anesthesia Research Lab 0818, 9500 Gilman Dr. LaJolla, CA 92093, USA; ...

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Long‐term Intrathecal Baclofen: Outcomes After More than 10 Years of Treatment

Cited by 65 publications

References 33 publications

Treatment of severe, disabling spasticity with continuous intrathecal baclofen therapy following acquired brain injury: the experience of a tertiary institution in Singapore

Treatment of severe, disabling spasticity with continuous intrathecal baclofen therapy following acquired brain injury: the experience of a tertiary institution in Singapore

Inherited Ataxia and Intrathecal Baclofen for the Treatment of Spasticity and Painful Spasms

Current and Future Issues in the development of spinal agents for the management of pain

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