Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study

Abstract

A total of 93 patients with intractable spasticity due to either spinal cord injury (59 cases), multiple sclerosis (31 cases), or other spinal pathology (three cases) were entered into a randomized double-blind placebo-controlled screening protocol of intrathecal baclofen test injections. Of the 88 patients who responded to an intrathecal bolus of 50, 75, or 100 micrograms of baclofen, 75 underwent implantation of a programmable pump system for chronic therapy. Patients were followed for 5 to 41 months after surgery (mean 19 months). No deaths or new permanent neurological deficits occurred as a result of surgery or chronic intrathecal baclofen administration. Rigidity was reduced from a mean preoperative Ashworth scale score of 3.9 to a mean postoperative score of 1.7. Muscle spasms were reduced from a mean preoperative score of 3.1 (on a four-point scale) to a mean postoperative score of 1.0. Although the dose of intrathecal baclofen required to control spasticity increased with time, drug tolerance was not a limiting factor in this study. Only one patient withdrew from the study because of a late surgical complication (pump pocket infection). Another patient received an intrathecal baclofen overdose because of a human error in programming the pump. The results of this study indicate that intrathecal baclofen infusion can be safe and effective for the long-term treatment of intractable spasticity in patients with spinal cord injury or multiple sclerosis.

Subdural catheter migration may lead to baclofen pump dysfunction

“…3 The decision to implant a drug delivery system is usually taken after a positive test (two points diminution in Ashworth or Spasm frequency scale) obtained after a single injection of 50-100 mg of intrathecal baclofen. 3,4 The effect on the spasticity is spectacular in most cases with a quick diminution of the muscle tonus. [4][5][6] Quality of life usually improves due to decrease of nocturnal spasms and a better level of independence.…”

“…3,4 The effect on the spasticity is spectacular in most cases with a quick diminution of the muscle tonus. [4][5][6] Quality of life usually improves due to decrease of nocturnal spasms and a better level of independence. 6,7 As therapeutic doses are low, the treatment is usually well tolerated.…”

“…These complications are rare and are seen mostly with programming errors. 3,4 The most frequent secondary effects are drowsiness, dizziness, blurred vision and slurred speech. 3 The fragile component of the drug delivery system is the intrathecal catheter, subjected to the body movements and prone to kink or shear.…”

Intrathecal baclofen in tetraplegia of spinal origin: efficacy for upper extremity hypertonia

“…Prior studies with intrathecal baclofen have also noted increasing dosage requirements with the passage of time. 1,5,8,33 This has been attributed to the downregulation of GABA-B receptors at the spinal level. 1,33 In our study, the slight increase in tone at 12 months is also suggestive of emerging tolerance.…”

Radioisotopic control for baclofen pump catheter failure

“…Previous studies have found catheter malfunction occurring at rates varying from 10% to 40%. 2,3 Kink and perforation represent 50% of the causes of catheter malfunction. A plain X-ray is usually enough to show a dislodgement or a kink.…”