Stereotactic endoscopic placement of third ventricle catheter for long-term infusion of baclofen in patients with secondary generalized dystonia

Abstract

<jats:p>Continuous infusion of baclofen is a treatment option for severe generalized dystonia. Catheter insertion within the third ventricle has been described as an alternative to standard intrathecal placement to maximize intracranial concentrations of baclofen. The authors describe their experience with a novel technique for stereotactic endoscopic insertion of baclofen infusion catheters in the third ventricle in 3 patients with severe secondary generalized dystonia. Insertion was successful in all 3 patients, and all of them experienced significant improvement in dystonia scores on the Barry-Albright Dystonia Scale. Follow-up ranged from 5.5 to 7 months (mean 6 months), and no mechanical complications or CSF leaks were observed. The stereotactic endoscopic insertion of a baclofen infusion catheter into the third ventricle appears to be a safe method for continuous intraventricular baclofen infusion in patients with generalized secondary dystonia.</jats:p>

Effect of continuous intrathecal baclofen therapy in children: a systematic review

“…[28][29][30][31] Two articles reported Barry-Albright Dystonia Scale outcomes after IVB treatment. 30,32 These results were similarly positive. Various other spasticity or dystonia measures, such as spasm and clonus scale and the Burke-Fahn-Marsden scale, all showed moderate-to-large effect sizes for improvement in CP.…”

“…Large‐to‐very‐large effect sizes were found for improvement of dystonia measured with the Barry‐Albright Dystonia Scale in children with dyskinetic CP . Two articles reported Barry‐Albright Dystonia Scale outcomes after IVB treatment . These results were similarly positive.…”

“…One study reported on two children with Lesch–Nyhan syndrome, one child with amyotrophic lateral sclerosis, and one with Dandy–Walker syndrome but as part of a bigger (mainly CP) group, and MAS results were not separately reported for these patients . Dystonia (measured with the Barry‐Albright Dystonia Scale) improved after intervention in case studies of patients with traumatic brain injury, anoxic brain injury, methylmalonic aciduria, panthothenate kinase deficiency, and adrenoleukodystrophy . A case study of a patient with striatal lesions showed no improvement of dystonia …”

“…35 Dystonia (measured with the Barry-Albright Dystonia Scale) improved after intervention in case studies of patients with traumatic brain injury, anoxic brain injury, methylmalonic aciduria, panthothenate kinase deficiency, and adrenoleukodystrophy. 30,32 A case study of a patient with striatal lesions showed no improvement of dystonia. 30 Activities Small effect sizes were found for improvement of gross motor function measured with the Gross Motor Function Measure when comparing results before and after intervention in children with CP in the level II study and three level IV to V studies.…”

Prepontine placement of an intrathecal baclofen pump catheter for treatment of dystonia

“…Cerebral palsy is a disorder arising from a non-progressive lesion in the developing brain commonly associated with increased muscle tone leading to dystonia in up to 25% of patients, often refractory to medical therapy. [ 2 , 4 ] In these cases, baclofen is effectively used to treat patients with spastic cerebral palsy and dystonic cerebral palsy. [ 5 ] In addition, baclofen has become widely used for its antispastic effects in patients with spinal cord injury, multiple sclerosis, and traumatic brain injuries.…”