Baclofen Pump Intervention for Spasticity Affecting Pulmonary Function

Abstract

Introduction: Muscle spasticity may adversely affect pulmonary function after spinal cord injury (SCI). However, there is limited information regarding the treatment of spasticity as a determinant of pulmonary function. This study presents the case of a man with C4 tetraplegia who had severe spasticity and difficulty weaning from ventilatory support.Methods: Case presentation.Results: Severe spasticity likely contributed to respiratory compromise in this patient. Successful and rapid weaning from the ventilator occurred within 3 weeks of baclofen pump placement.Conclusions: Randomized clinical trials among SCI patients with significant spasticity are needed to determine whether intervention with a baclofen pump facilitates earlier ventilatory weaning.J Spinal Cord Med. 2005;28:343-347

Respiratory Motor Control Disrupted by Spinal Cord Injury: Mechanisms, Evaluation, and Restoration

“…It has been shown that most human SCI lesions are to some degree incomplete [6, 70, 71] which is also true for respiratory motor control [85]. Further, the unintended and unwanted muscle activity or spasticity experienced by many people with spinal cord injuries can also impair respiratory function [9, 69, 86]. Thus, the evaluation of motor control of respiration is as yet not well developed [69].…”

Effect of Spinal Cord Injury on the Respiratory System: Basic Research and Current Clinical Treatment Options

“…Some studies indicated that muscle spasticity may also affect respiration after SCI (135,136). For example, in a recent case study, baclofen was administered to a C4-level patient who was unable to wean from the ventilator (136).…”

Respiratory Function Under Intrathecal Baclofen Therapy in Patients With Spastic Tetraplegia

“…The efficacy of ITB therapy for severe spasticity is well known . Patients with acute CSCI often require mechanical ventilation . It has been reported that patients with spastic diplegic CP have reduced FVC and FEV1.0 , and it is well understood that these patients are at high risk for aspiration pneumonia .…”

“…However, these patients sometimes experience subjective respiratory improvement after ITB initiation. Some were reported that the ITB therapy improved sleep apnea in a patient with CP and that it facilitated earlier ventilatory weaning in a patient with SCI . However, it was also reported that ITB therapy did not modify lung function tests in patients with various types of spasticity .…”