Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury

Abstract

Intrathecal baclofen (ITB) has been known to reduce spasticity which did not respond to oral medications and botulinum toxin treatment. However, few results have been reported comparing the effects of ITB therapy in patients with cerebral palsy (CP) and acquired brain injury. This study aimed to investigate beneficial and adverse effects of ITB bolus injection and pump therapy in patients with CP and to compare outcomes to patients with acquired brain injury such as traumatic brain injury and hypoxic brain injury. ITB test trials were performed in 37 patients (19 CP and 18 acquired brain injury). Based on ambulatory function, CP patients were divided into 2 groups: 11 patients with nonambulatory CP and 8 patients with ambulatory CP. Change of spasticity was evaluated using the Modified Ashworth Scale. Additional positive or negative effects were also evaluated after ITB bolus injection. In patients who received ITB pump implantation, outcomes of spasticity, subjective satisfaction and adverse events were evaluated until 12 months post-treatment. After ITB bolus injection, 32 patients (86.5%) (CP 84.2% versus acquired brain injury 88.9%) showed a positive response of reducing spasticity. However, 8 patients with CP had negative adverse effects. Particularly, 3 ambulatory CP patients showed standing impairment and 1 ambulatory CP patient showed impaired gait pattern such as foot drop because of excessive reduction of lower extremity muscle tone. Ambulatory CP patients received ITB pump implantation less than patients with acquired brain injury after ITB test trials (P = .003 by a chi-squared test). After the pump implantation, spasticity was significantly reduced within 1 month and the effect maintained for 12 months. Seventeen patients or their caregivers (73.9%) were very satisfied, whereas 5 patients (21.7%) suffered from adverse events showed no subjective satisfaction. In conclusion, ITB therapy was effective in reducing spasticity in patients with CP and acquired brain injury. Before ITB pump implantation, it seems necessary to perform the ITB bolus injection to verify beneficial effects and adverse effects especially in ambulatory CP.

Combination of acamprosate and baclofen (PXT864) as a potential new therapy for amyotrophic lateral sclerosis

“…Its precise mechanism of action is still unknown, but it is thought to modulate glutamate receptors and inhibitory glycine-gated ion channels. BCL is a GABA B agonist currently used to treat spasticity in ALS (Yoon et al, 2017 and GABAergic imbalance. Based on these rational observations, we assessed PXT864 activity in models of ALS.…”

“…Its precise mechanism of action is still unknown, but it is thought to modulate glutamate receptors and inhibitory glycine‐gated ion channels. BCL is a GABA B agonist currently used to treat spasticity in ALS (Yoon et al, 2017). Importantly, PXT864 efficacy was already demonstrated in AD and PD models (Chumakov et al., 2015; Hajj et al., 2015) which share molecular and cellular pathogenic mechanisms with ALS, particularly glutamatergic and GABAergic imbalance.…”

Baclofen therapeutics, toxicity, and withdrawal: A narrative review

“…2 Compared with oral administration, intrathecal baclofen (ITB) can more effectively treat spasticity directly at the level of the spinal cord with less associated systemic side effects. 10 In a cross-sectional matched cohort survey study comparing the two routes of administration, patients who received ITB experienced significantly fewer and less severe spasms compared with those who received oral baclofen. 11 In this study, there were no significant differences between the two groups in regards to pain, sleep, fatigue, or quality of life.…”

Outcomes of Intrathecal Baclofen Therapy Compared With Deep Brain Stimulation in a Patient With Dystonic Cerebral Palsy: A Case Report

“…On the other hand, an ITB treatment has been known as a treatment to reduce spasticity that is not effective in the case of using oral medications or botulinum toxin treatment. Many studies of ITB treatment have also reported significant decreases in dystonia as seen in some affected patients [2,3].…”