Effective management of spasticity and impacts on weight change and resting energy expenditure in a female with spinal cord injury: a case report

Nevin, Amy N; Nguyen, Khanh; Atresh, Sridhar; Vivanti, Angela; Hickman, Ingrid

doi:10.1038/scsandc.2017.57

Cited by 6 publications

(8 citation statements)

References 16 publications

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“…Several studies reported that the resting metabolic rate in SCI individuals is overestimated by 5-35% when the standard value is used [14][15][16]. Therefore, most studies use the participant's own resting VO 2 to calculate EE in METs during daily activities in the SCI population [15][16][17][18][19]. However, these studies mainly focused on individuals with motor-complete SCI and EE values during non-sedentary activities.…”

Section: Introductionmentioning

confidence: 99%

Energy expenditure and muscle activity during lying, sitting, standing, and walking in people with motor-incomplete spinal cord injury

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Energy expenditure and muscle activity during lying, sitting, standing, and walking in people with motor-incomplete spinal cord injury

et al. 2018

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“…Nevin et al . recommend appropriate dietary counseling [22]. That should add to already known measures to lower the incidence of skin complications, such as regular checking of skin, relieving the constant pressure and shearing, repositioning of the body, keeping skin clean and dry [23].…”

Section: Discussionmentioning

confidence: 99%

“…None of the other authors, by our knowledge, systematically evaluated the possible correlation of skin-related complications with BM, BMI or risk evaluation for pressure ulcer in patients with ITB. Nevin et al recommend appropriate dietary counseling [22]. That should add to already known measures to lower the incidence of skin complications, such as regular checking of skin, relieving the constant pressure and shearing, repositioning of the body, keeping skin clean and dry [23].…”

Section: Discussionmentioning

confidence: 99%

Twenty years of intrathecal baclofen therapy in Slovenia: a retrospective single-center analysis of complications

Benedičič

Sršen

Grabljevec

et al. 2023

International Journal of Rehabilitation Research

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Since the first implantation in July 2001, the intrathecal baclofen (ITB) therapy for patients with generalized spasticity has been used in Slovenia for 20 years. The aim of this retrospective study was to evaluate the rates of different complications, especially if catheter-related complications were less frequent after the introduction of the coated catheter type in February 2013, and the potential correlation between higher baclofen doses and the incidence of complications. We retrospectively collected data from all patients in the registry during the period from 3 July 2001 to 31 December 2021. Among 138 patients (48 females), 120 patients had the first ITB system implanted at the University Medical Centre Ljubljana. Forty-three complications were reported in 38 patients (27%), with a total complication rate of 0.203/1000 days or 0.074/pump year. The most frequent was catheter-related (0.083/1000 days or 0.030/pump year), followed by skin-related (0.063/1000 days or 0.023/pump year) and pump-related complication (0.026/1000 days or 0.009/pump year). The incidence of catheter-related complications decreased significantly since the use of Ascenda type catheter: 14/7 complications per 88/147 implantations (P = 0.008). Patients with complications had a statistically significantly higher dose of baclofen: median 400 µg/24h vs. median 300 µg/24h (P = 0.016). Our retrospective analysis confirmed a significant decrease of catheter-related complications after the implementation of Ascenda type catheter in February 2013. Patients with a higher ITB dose had a statistically significantly higher incidence of complications. The total complication rate was a bit higher as previously reported in other studies, which is consistent with a long follow-up time.

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“…To mitigate these side effects, use of intrathecal baclofen treatment (IBT) has steadily improved over the last four decades and has become a preferred method of managing severe spasticity that is refractory to oral spasmolytic agents. IBT has been associated with fewer side effects compared to oral baclofen, especially when only a small concentrated dose is pumped into the intrathecal space to effectively manage spasticity[ 10 , 11 ]. Intrathecal baclofen treatment requires surgical implantation of a metallic disc (pump) and a catheter under the skin of the abdomen near the waistline.…”

Section: Introductionmentioning

confidence: 99%

“…In one prospective longitudinal trial, participants experienced increases in fat mass after 12 mo of IBT[ 8 ]. In a case report, Nevin et al [ 11 ] noted that a 36-year-old woman, who previously lost weight, gained an additional 6 kg within 27 mo of commencement of IBT. This suggests that IBT may predispose an individual to changes in body composition[ 13 ], cardiovascular disease and metabolic syndrome, even as early as 12 mo into treatment.…”

Section: Introductionmentioning

confidence: 99%

Long-term effect of intrathecal baclofen treatment on bone health and body composition after spinal cord injury: A case matched report

Ifon¹,

Ghatas²,

Davis³

et al. 2020

WJO

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BACKGROUND Severe spasticity may negatively impact functionality and quality of life after spinal cord injury (SCI). Intrathecal baclofen treatment (IBT) is effectively used to manage severe spasticity and reduce comorbidities. However, long-term IBT may have a negative effect on bone mineral content (BMC), bone mineral density (BMD) and body composition (such as percentage fat mass and lean body mass). We demonstrated the negative effects of long-term IBT use in a single case compared with two non-IBT users. CASE SUMMARY A 46-year old Caucasian male Veteran (case) with a 21 year history of complete tetraplegia (complete C6 SCI) was implanted with IBT for 20 years. The case was matched to two participants with different time since injuries [2 (match 1) and 13 (match 2) years] without IBT. Knee BMC and BMD at the epiphysis and metaphysis of the distal femur and proximal tibia were evaluated using dual knee and the dual femur modules of GE Lunar iDXA software. Total and leg body composition assessments were also conducted for the three participants. Potential effect of long-term IBT was demonstrated by changes in BMD, consistent with bone demineralization, at the distal femur and proximal tibia and changes in percentage fat mass and lean mass of legs. The case showed 113% lower BMD at the distal femur, and 78.1% lower at the proximal tibia compared to match 1, moreover the case showed 45% lower BMD at the distal femur, and no observed changes at the proximal tibia compared to match 2. The case had 27.1% and 16.5% greater leg %fat mass compared to match 1 and match 2, respectively. Furthermore, the case had 17.4% and 11.8% lower % leg lean mass compared to match 1 and match 2, respectively. CONCLUSION Long-term IBT may impact bone health and body composition parameters in persons with complete SCI. It may be prudent to encourage regular screening of individuals on long-term IBT considering the prevalence of osteoporosis related fractures, cardiovascular diseases, and metabolic disorders in this population.

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Effective management of spasticity and impacts on weight change and resting energy expenditure in a female with spinal cord injury: a case report

Cited by 6 publications

References 16 publications

Energy expenditure and muscle activity during lying, sitting, standing, and walking in people with motor-incomplete spinal cord injury

Energy expenditure and muscle activity during lying, sitting, standing, and walking in people with motor-incomplete spinal cord injury

Twenty years of intrathecal baclofen therapy in Slovenia: a retrospective single-center analysis of complications

Long-term effect of intrathecal baclofen treatment on bone health and body composition after spinal cord injury: A case matched report

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