Evaluation of the impact of intrathecal baclofen on the walking ability of people with Multiple Sclerosis related spasticity.

Sammaraiee, Yezen; Stevenson, VL; Keenan, Elizabeth; Buchanan, Katrina; Lee, Hyeong-su; Padilla, H; Farrell, Rachel

doi:10.1016/j.msard.2020.102503

Cited by 9 publications

(22 citation statements)

References 15 publications

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“…ITB is traditionally reserved for non-ambulatory patients ( 35 ), based on the assumption that improvement in walking function should not be expected with ITB therapy ( 36 ). However, there is a growing body of evidence that this is not the case and early ITB treatment may keep people walking for longer, particularly in progressive disorders, such as multiple sclerosis ( 29 , 35 ), although a higher rate of catheter-related complications has been observed in this cohort ( 35 , 37 ).…”

Section: Discussionmentioning

confidence: 86%

“…2 ). Patients considered for ITB tend to have predominantly lower limb spasticity ( 8 ); however, ITB is known to have some impact in the upper limbs and trunk (often considered to be approximately one-third of the effect in lower limbs), particularly at higher doses and perhaps depending on the placement of the tip of the catheter ( 7 , 27 – 29 ).…”

Section: Discussionmentioning

confidence: 99%

“…In the same way, there is consensus on the parameter “patient compliance with treatment”, which is highly likely to be dependent on the parameter “patient goal/expectation”. It is therefore of paramount importance that, before embarking on ITB treatment, patients/relatives and care-givers must be engaged, suitable and willing to undergo a trial with a test dose of ITB to assess efficacy, a surgical procedure for implantation and commit to regular follow-up for pump refills ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

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European expert consensus on improving patient selection for the management of disabling spasticity with intrathecal baclofen and/or botulinum toxin type A

Biering-Sørensen

Stevenson²,

Bensmaïl³

et al. 2021

J Rehabil Med

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Objective To develop an algorithm for the selection of adults with disabling spasticity for treatment with intrathecal baclofen (ITB) and/or botulinum toxin type A (BoNT A). Methods A European Advisory Board of 4 neurologists and 4 rehabilitation specialists performed a literature review on ITB and BoNT A treatment for disabling spasticity. An online survey was sent to 125 physicians and 13 non-physician spasticity experts. Information on their current clinical practice and level of agreement on proposed selection criteria was used to inform algorithm design. Consensus was considered reached when ≥75% of respondents agreed or were neutral. Results A total of 79 experts from 17 countries completed the on-line survey (57%). Agreement was reached that patients with multi-segmental or generalized disabling spasticity refractory to oral drugs are the best candidates for ITB (96.1% consensus), while those with focal/segmental disabling spasticity are ideal candidates for BoNT A (98.7% consensus). In addition the following are good candidates for ITB (% consensus): bilateral disabling spasticity affecting lower limbs only (97.4%), bilateral (100%) or unilateral (90.9%) disabling spasticity affecting lower limbs and trunk, and unilateral or bilateral disabling spasticity affecting upper and lower extremities (96.1%). Conclusion This algorithm will support the management of adult patients with disabling spasticity by aiding patient selection for ITB and/or BoNT A treatments. LAY ABSTRACT Involuntary muscle overactivity or spasticity is the increase in muscle tone caused as a consequence of a brain or spine lesion. The muscle overactivity can become disabling spasticity and adequate treatment or combination of treatments are essential to reduce or eliminate the problems and disability caused by the involuntary muscle overactivity. An European expert consensus on the treatment of disabling spasticity, with Intrathecal Baclofen (an implanted pump that delivers baclofen directly near the spinal cord) or injection of Botulinum Toxin into muscles, was made using an online survey with 79 experts completing the survey. This algorithm supports the future management of adult patients with disabling muscle overactivity by aiding patient selection for Intrathecal Baclofen and/or Botulinum Toxin treatment.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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European expert consensus on improving patient selection for the management of disabling spasticity with intrathecal baclofen and/or botulinum toxin type A

Biering-Sørensen

Stevenson²,

Bensmaïl³

et al. 2021

J Rehabil Med

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show abstract

“…This review evaluated 17 papers 5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] (n = 534 patients), including one randomised controlled trial, 14 five nonrandomised trials, 5,8,9,13,15 one retrospective observational cohort study, 10 five case series, 11,[18][19][20][21] four case reports 12,16,17,22 and one letter to the editor. 23 The patient demographics are listed in Table 1.…”

Section: Resultsmentioning

confidence: 99%

The impact of intrathecal baclofen on the ability to walk: A systematic review

2022

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Objective Intrathecal baclofen (ITB) is an effective treatment for lower limb spasticity. In ambulatory patients with spasticity, there is a justifiable concern that ITB treatment may compromise ambulatory function by reducing the heightened muscle tone, thereby unmasking underlying muscle weakness. ITB is hence offered with reservation in ambulant patients. In this article, we review the literature surrounding the effect of ITB therapy on ambulatory function in patients with concurrent spasticity and discuss the key findings. Data sources A literature search of ProQuest Medline and EBSCO CINAHL databases was performed. Review method Inclusion criteria included (a) studies reporting the effect of ITB in adult ambulatory patients; (b) studies with an intervention of screening test trial via either bolus injections or continuous infusion tests; and (c) studies with an intervention of ITB pump implantation. Seventeen eligible studies were identified and two authors independently assessed the study quality using the risk of bias in nonrandomised studies of interventions tool (ROBINS-I). Results Seventeen studies were included, with a total of 534 participants. Most of the patients remain ambulatory after ITB treatment, accompanied by improvements in gait speed and reduction in spasticity. Conclusion ITB therapy when administered in carefully selected ambulatory patients with spasticity is not associated with loss of ambulatory function.

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“…[ 32 , 33 ]. In the same way, ITB in ambulatory patients with multiple sclerosis was shown to reduce spasticity, spasm frequency, and self-reported pain up to 1 year post-pump insertion without negative impact on walking and transfers [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Reasons and Determinants of BoNT-A Treatment Discontinuation in Patients Living with Spasticity: A 10-Year Retrospective Analysis

Cinone

Santoro

Spina

et al. 2022

Toxins

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Background: The present study aimed to evaluate the reasons and determinants of BoNT-A discontinuation in patients with stroke, multiple sclerosis, spinal cord injury, and traumatic brain injury. Methods: It is a retrospective study of 56 discontinuer patients treated with botulinum toxin between January 2011 and December 2021. Discontinuation rates and their predictors were estimated using Kaplan–Meier, Log rank test, and Cox’s regression method of analyses.Results: The mean age was 56.54 years, 53.57% were affected by post-stroke spasticity, 17.86% by spinal cord injury, 12.5% and 16.07% by traumatic brain injury and multiple sclerosis, respectively. The median discontinuation time was 5 months. The main reason for discontinuation were logistic problems (37%) and orthopedic surgeries or intrathecal baclofen (27%). Discontinuers were more likely to have severe spasticity (R = 1.785), have no pain (HR = 1.320), no access to rehabilitation services (HR = 1.402), and have cognitive impairment (HR = 1.403). Conclusions: The main reasons for discontinuation are related to logistic issues (due to distance or the absence of an adequate caregiver) and surgical interventions for spasticity, including intrathecal baclofen. It is crucial to identify possible predictors of discontinuation to improve the effectiveness of a multidisciplinary management. The study confirms the crucial role of rehabilitation and caregivers in achieving better long-term outcomes.

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Evaluation of the impact of intrathecal baclofen on the walking ability of people with Multiple Sclerosis related spasticity.

Cited by 9 publications

References 15 publications

European expert consensus on improving patient selection for the management of disabling spasticity with intrathecal baclofen and/or botulinum toxin type A

European expert consensus on improving patient selection for the management of disabling spasticity with intrathecal baclofen and/or botulinum toxin type A

The impact of intrathecal baclofen on the ability to walk: A systematic review

Reasons and Determinants of BoNT-A Treatment Discontinuation in Patients Living with Spasticity: A 10-Year Retrospective Analysis

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