Intrathecal Baclofen Associated With Improvement of Consciousness Disorders in Spasticity Patients

Margetis, Konstantinos; Korfias, Stefanos; Gatzonis, Stylianos; Boutos, N.; Stranjalis, George; Boviatsis, Efstathios; Sakas, Damianos E.

doi:10.1111/ner.12147

Cited by 48 publications

(39 citation statements)

References 48 publications

(49 reference statements)

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“…While it is uncertain if this was directly due to the effects of ITB therapy or delayed spontaneous recovery, Margetis et al postulate movement recovery, sleep-wake cycle, restoration of cortical inhibition and reduction in thalamocortical excitability as possible reasons for cognitive improvement. (25) According to previous reports, doses of ITB in cortical spasticity in the fi rst 1-2 years of follow-up can range from 263 mcg/day to 591 mcg/day, with wide variations from 93 mcg/day to 2,000 mcg/day. (26,27) Our preliminary experience concurs with this fi nding.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Law

King

et al. 2016

smedj

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INTRODUCTIONIntrathecal baclofen (ITB) therapy is a proven, effective treatment for disabling cortical spasticity. We describe the fi rst local series of fi ve patients with acquired brain injury (ABI) who received ITB and were followed up for 63.8 months.METHODS A retrospective review of medical and rehabilitation records of patients who received ITB therapy was carried out. Data studied included baseline demographic and injury variables, implantation data, spasticity and function, ITB dosage over time and complications.RESULTS From 2006 to 2010, a total of fi ve patients received ITB therapy via implanted pumps about 39.4 months after ABI. Four out of fi ve patients experienced signifi cant reductions in their lower limb spasticity scores and improvements in global function and dependency. One patient had minor adverse events associated with baclofen-related sedation. The mean ITB dose at one year was 182.7 ± 65.6 mcg/day. CONCLUSION Our preliminary study showed encouraging long-term outcomes and safety for ITB therapy after ABI-related intractable spasticity. Individual ITB responses over time were variable, with gender differences. The outcomes experienced by our centre were comparable to those in the general ABI population, supporting the effi cacy of ITB therapy for chronic disabling spasticity.

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Section: Discussionmentioning

confidence: 99%

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

Wang

Law

King

et al. 2016

smedj

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“…Although the CRS-R total score (TS) has been used for prognostic purposes [6], its diagnostic utility has not been investigated. This represents an important evidentiary gap given that prior studies have relied on the CRS-R TS when tracking functional recovery [7], investigating the relationship between behavioral and physiological markers of consciousness [8], and determining the effectiveness of treatment interventions [9]. The primary aim of this report is to investigate the sensitivity and specificity of CRS-R TS in detecting conscious awareness.…”

Section: Introductionmentioning

confidence: 99%

Sensitivity and Specificity of the Coma Recovery Scale–Revised Total Score in Detection of Conscious Awareness

Bodien

Carlowicz

Chatelle

et al. 2016

Archives of Physical Medicine and Rehabilitation

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Objective The aim of this report is to describe the sensitivity and specificity of Coma Recovery Scale-Revised (CRS-R) total scores in detecting conscious awareness. Design Data were retrospectively extracted from the medical records of patients enrolled in a specialized Disorders of Consciousness (DoC) program. Sensitivity and specificity analyses were completed using CRS-R-derived diagnoses of Minimally Conscious State (MCS) or Emerged from Minimal Conscious State (EMCS) as the reference standard for conscious awareness and the total CRS-R score as the “test criterion”. A receiver operating curve (ROC) was constructed to demonstrate the optimal CRS-R total cut-off score for maximizing sensitivity and specificity. Setting Specialized DoC program Participants 252 patients enrolled in the DoC program (157 male; mean age = 49 years; mean time from injury =48 days; traumatic etiology=127, non-traumatic etiology=125; diagnosis of coma or VS=72, diagnosis of MCS or EMCS=182) Interventions Not applicable. Main Outcome Measure(s) Sensitivity and specificity of CRS-R total scores in detecting conscious awareness Results A CRS-R total score of 10 or higher yielded a sensitivity of 0.78 for correct identification of patients in MCS or EMCS, and specificity of 1.00 for correct identification of patients who did not meet criteria for either of these diagnoses (i.e., were diagnosed with VS or coma). The area under the curve (AUC) in the ROC analysis is 0.98. Conclusion(s) A total CRS-R score of 10 or higher provides strong evidence of conscious awareness but resulted in a false negative diagnostic error in 22% of patients who demonstrated conscious awareness based on CRS-R diagnostic criteria . A cut-off score of 8 provides the best balance between sensitivity and specificity, accurately classifying 93% of cases. The “optimal” total score cut-off will vary depending on the user's objective.

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“…Patients after stroke may have spastic hemiplegia and first trial nonsurgical management, such as oral medications and chemodenervation with botulinum toxin, before considering ITB therapy, whereas patients with TBI or HIE may have severe generalized spasticity earlier that interferes with rehabilitation programs, nursing care, personal care, and positioning, which may necessitate early consideration of ITB therapy [21,22]. In addition, ITB therapy has been reported to reduce symptoms of autonomic dysfunction [23], and some authors suggests that it may be associated with improvement in disorders of consciousness [24,25]. Furthermore, early initiation of ITB therapy has not been associated with negative global outcomes as measured by the Disability Rating Scale and Level of Cognitive Functioning [26].…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Dosing of Intrathecal Baclofen in the Treatment of Spasticity After Acquired Brain Injury

Maneyapanda

McCormick

Marciniak

et al. 2017

PM&R

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Intrathecal Baclofen Associated With Improvement of Consciousness Disorders in Spasticity Patients

Cited by 48 publications

References 48 publications

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

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

Sensitivity and Specificity of the Coma Recovery Scale–Revised Total Score in Detection of Conscious Awareness

Long‐Term Dosing of Intrathecal Baclofen in the Treatment of Spasticity After Acquired Brain Injury

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