Dysautonomia syndrome in the acute recovery phase after traumatic brain injury: relief with intrathecal Baclofen therapy

Abstract

In the initial phase of severe head injury, dysautonomic abnormalities are frequent. Within the framework of a prospective study, evaluating the efficacy of continuous intrathecal Baclofen therapy (CIBT) on hypertonia during the initial recovery phase of severe head injury, the authors report on the preliminary results of this treatment on paroxysmal dysautonomia about four patients. Continuous intrathecal Baclofen infusion was first delivered, for a test period, continuously for 6 days. If a relapse of dysautonomia occurred at the end of the test period, an implantation of a continuous intrathecal infusion pump delivering Baclofen was performed. Results were assessed with four continuous variables; duration (days), dose of Baclofen per day (microg/d), number of dysautonomic paroxysmal episodes per day, and initial recovery evaluated by a scale of the first initial stages of head injury coma recovery. For three patients: (1) the number of dysautonomic paroxysmal episodes per day and the doses of Baclofen during the follow-up period were correlated (p = 0.02, p < 0.001, p = 0.008, respectively, distribution-free test of Spearman), (2) during the test period and the relapse after the test period, the number of paroxysmal episodes and the Baclofen dose are correlated to p < 0.05, p = 0.03, p = 0.04, respectively (distribution-free test of Spearman). The second statistical test was used to prove that Baclofen doses and number of paroxysmal dysautonomic episodes are correlated independently of the duration of follow-up. The fourth patient improved with CIBT without any recurrence at the end of the treatment test period. For the four patients, recovery score increased during the overall follow-up. In the authors' experience CIBT is very efficient to control paroxysmal dysautonomia during the initial recovery phase in severe head injury, and seems to facilitate recovery.

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

“…(6)(7)(8)(9)(10)(11)(12)(13)(14) Other benefi ts of ITB therapy include reduction of central pain, improvement in cerebral dysautonomia and improvements in disorders of consciousness. (15,16) Despite the established therapeutic value of ITB therapy, there is a paucity of local literature. We thus report our experience of continuous ITB therapy in fi ve ABI survivors in Singapore who were followed up over 63.8 months.…”

Neuromodulation Using Intrathecal Baclofen Therapy for Spasticity and Dystonia

“…This finding shows that spastic hypertonia contributes greatly to hypermetabolism, a result that underlines the necessity of treatment, since untreated continuation of this hypermetabolic condition would influence future cardiopulmonary function, and potentially affect the survival of the patient. 5,8,10) Metabolic function also tended to correlate with improvements in Ashworth score, and we considered that metabolic function should be utilized in adjusting ITB treatment after the procedure.…”

Treatment Progress of Paroxysmal Sympathetic Hyperactivity after Acquired Brain Injury

“…In addition, the rate of complication ranges from 20 to 50% [31], and oral baclofen has been reported to be ineffective [27,32]. Early ITB therapy has not been assessed, and patients should be given other conventional therapy first (such as sedatives and α- and β-antagonists) under normal circumstances [33,34]. The main side effects of baclofen include muscle weakness, elevation of liver enzymes, sedation, bronchial hyperactivity, and adventitious movements.…”