Clinical Experience With Continuous Intrathecal Baclofen Trials Prior to Pump Implantation

Phillips, Mary Viola; Miljković, Nataša; Ramos-Lamboy, Marlyn; Moossy, John; Horton, John A.; Buhari, Alhaji M.; Munin, Michael C.

doi:10.1016/j.pmrj.2015.03.020

Cited by 21 publications

(11 citation statements)

References 17 publications

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“…The next step for these patients remained dose adjustments following the implantation of the pump. Overall, continuous intrathecal administration of the baclofen to evaluate its systemic and functional effects could be considered as a helpful method as mentioned by some authors 16 , but we believe it would put extra burden, both on the patient and the hospital by hospitalizing and using another trial pump for several days. After coming to a consensus on the implantation of the baclofen pump, all the patients were operated and a catheter was placed in the intrathecal space either via percutaneous route or via partial hemi-laminectomy in the right decubitus position usually at the 2-3 or 3-4 interlaminar spaces.…”

Section: Discussionmentioning

confidence: 98%

Continuous intrathecal baclofen delivery in severely disabling spasticity

et al. 2018

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Background/Aim. Spasticity is the consequence of several clinical conditions including cerebral palsy, brain injury, spinal cord injury, multiple sclerosis, aneurysm bleeding, and some other neurological disorders. The aim of this study was to determine the efficacy of intrathecal baclofen (ITB) treatment in medically intractable severely disabling spasticity and present the challenges encountered during pump implantation surgery on these patients. Methods. The patients who underwent intrathecal baclofen pump implantation surgery between the years 2012 and 2015 with minimum follow-up of six months were recruited from the clinic archives. Twenty two patients with severe spasticity who had Modified Asworth Spasticity Scale (MASS) score of 3 or 4 were enrolled in our series. Eight of twenty-two patients were at pediatric age and they all were non-ambulant before surgery. Results. All of the patients underwent programmable intrathecal baclofen pump implantation surgery. Catheters were placed via percutaneous technique into to the subarachnoid space in 18 patients while, we had to perform partial hemi-laminectomy in order to place the catheters in 4 patients. All the patients improved significantly and 5 began using upper extremities and 3 adults became ambulant following physical therapy. Mean of the MASS scores improved from 3.59 to 1.32 (p < 0.001). Conclusion. The ITB therapy obviously increased quality of life and functional outcome in patients with disabling spasticity. As a result, physical treatment was more useful for these patients. Although some spinal abnormalities due to spasticity may necessitate partial hemilaminectomy to implant the pump, patients with intractable spasticity should be given the chance of intrathecal baclofen treatment at the earliest period of their lifetime disability. ApstraktUvod/Cilj. Spasticitet je posledica nekoliko kliničkih stanja kao što su cerebralna paraliza, povrede mozga, povrede kičmene moždine, multipla skleroza, ruptura neurizme sa krvarenjem, kao i neki drugi neurološki poremećaji. Cilj ove studije bio je da se utvrdi efikasnost primene intratekalnog baklofena (ITB) u lečenju upornog teškog onesposobljavajućeg spasticiteta, kao i izazovi sa kojima se susrećemo tokom hirurške ugradnje pumpe kod ovih bolesnika. Metode. Iz kliničkih protokola u periodu 2012-2015. godina izdvojili smo bolesnike kojima je ugrađena baklofenska pumpa intratekalno uz minimlno praćenje od šest meseci. Dvadeset dva bolesnika sa teškim spasticitetom koji su imali modifikovani Asworth skor spasticiteta (MASS) između 3 i 4 bili su uključena u studiju. Osam od 22 bolesnika bila su u dečjem uzrastu i svi su bili nepokretni pre hirurškog zahvata. Rezultati. Svi bolesnici bili su podvrgnuti hirurškoj implantaicji programabilne intratekalne baklofenske pumpe. Kateteri su postavljeni perkutano u subarahnoidni prostor kod 18 bolesnika, dok smo parcijalnu hemilaminektomiju primenili za ugradnju katetera kod četiri bolesnika. Kod svih bolesnika javilo se značajno poboljšanje, 5 bolesnika počelo je da korist...

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Section: Discussionmentioning

confidence: 98%

Continuous intrathecal baclofen delivery in severely disabling spasticity

et al. 2018

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“…One patient would have been missed with a single‐shot trial, as she required a higher baclofen dose to obtain efficacy. More recently, Phillips et al reported on 57 patients with refractory spasticity that underwent a continuous ITB trial . Spasticity significantly decreased during trial, with 34% of ambulatory patients progressing to a less restrictive assistive device by trial's end.…”

Section: Methodsmentioning

confidence: 99%

Best Practices for Intrathecal Baclofen Therapy: Screening Test

Boster

Bennett

Bilsky

et al. 2016

Neuromodulation: Technology at the Neural Interface

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“…Although intrathecal dosing can be titrated, many patients need to “feel” the decreased hypertonicity. And, occasionally, some patients decline implantation as a result of not liking being “too loose” [7]. Adversely effecting lower extremity function in these circumstances is unacceptable.…”

Section: Case Scenariomentioning

confidence: 99%

“…Although ITB trialing is considered a relatively safe procedure, it is not completely risk‐free undertaking. The rate of complications during ITB trialing has been reported to be as high as 30%‐40% [7,8]. Adverse events may include nausea and vomiting, dizziness, paresthesia, drowsiness and sedation, spinal headaches, hypotonia, dizziness, paresthesia, hypotension, respiratory depression, infection, nausea/vomiting, urinary retention, hypotension, seizures, drowsiness/sedation, and coma.…”

Section: Case Scenariomentioning

confidence: 99%