Baclofen in the Therapeutic of Sequele of Traumatic Brain Injury: Spasticity

Abstract

Traumatic brain injury (TBI) is an alteration in brain function, caused by an external force, which may be a hit on the skull, rapid acceleration or deceleration, penetration of an object, or shock waves from an explosion. Traumatic brain injury is a major cause of morbidity and mortality worldwide, with a high prevalence rate in pediatric patients, in which treatment options are still limited, not available at present neuroprotective drugs. Although the therapeutic management of these patients is varied and dependent on the severity of the injury, general techniques of drug types are handled, as well as physical and surgical. Baclofen is a muscle relaxant used to treat spasticity and improve mobility in patients with spinal cord injuries, relieving pain and muscle stiffness. Pharmacological support with baclofen is contradictory, because disruption of its oral administration may cause increased muscle tone syndrome and muscle spasm, prolonged seizures, hyperthermia, dysesthesia, hallucinations, or even multisystem organ failure. Combined treatments must consider the pathophysiology of broader alterations than only excitation/inhibition context, allowing the patient's reintegration with the greatest functionality.

Treatment with Botulinum Toxin for Refractory Fever Caused by Severe Spasticity: A Case Series

“…The treatment of fever in general should be specific for the etiology whenever possible and not just targeted toward the symptom [ 1 ]. Similar to reports by other authors, all patients received treatment with antipyretics, muscle relaxants and physical methods without an adequate control [ 16 ].…”

“…Fever resolved in no more than 48 h without any recurrence. Application of BoNTA is an accepted treatment for spasticity [ 2 , 15 , 16 ], and to our knowledge, BoNTA has not been reported for the treatment of fever in patients with spasticity.…”

Management of Spasticity After Traumatic Brain Injury in Children

“…No specific recommendation as to the timing of an intrathecal Baclofen implant after TBI has been made. Toxic doses of Baclofen causes loss of consciousness and respiratory suppression, while rapid withdrawal from Baclofen can lead to seizures, hallucinations and hyperthermia with eventual multi organ failure due to rhabdomyolysis (53). Patients and their families should be cautioned that cessation of Baclofen can lead to serious complications, so they should never run out of the medicine.…”

“…There are also on-going studies looking at new drugs, these include Cannabinoid receptor agonists, Serotonin receptor agonists, Glycine agonists and Kynurenic acid, which is a derivative of Tryptophane (53).…”

“…Oral Baclofen (43,44) Performs better at reducing lower limb spasticity than upper limb (47) Intrathecal Baclofen Animal studies shows great benefit if early use (1st week), compared to at week 4 (39) Intrathecal Baclofen Early use safe, safe in children (48)(49)(50)(51) Dantrolene Poor evidence, high risk (40,45) Benzodiazepines High dose needed, good adjunct (45) Clonidine May dampen neural recovery (46) Clonidine Good adjunct treatment, low side effect profile (40) Gabapentin Good adjunct (40) Cannabinoids, SSRI's, Glycine agonists, Kynurenic acid All experimental (53) In a Cochrane review (54) All above has no strong evidence for or against in TBI Botox Very good clinical studies and effect (54,55) None of the lesioning techniques have been well studied in clinical TBI-related spasticity studies…”