2010
DOI: 10.2176/nmc.50.386
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Consciousness Recovery Induced by Intrathecal Baclofen Administration After Subarachnoid Hemorrhage -Two Case Reports-

Abstract: Two patients with subarachnoid hemorrhage recovered consciousness after intrathecal baclofen administration using an implanted intrathecal baclofen pump delivering 50 mg per day using a simple infusion mode. Intrathecal baclofen resulted in significant reduction of spasticity 3 months after the implantation. Case 1 was reduced to a completely bedridden state with spasticity and could slightly move her fingers following commands. However, the patient could eat food and wash her face with minimal assistance at 3… Show more

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Cited by 10 publications
(11 citation statements)
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“…After receiving ITB therapy for a few months they both emerged from the MCS and showed a drastic reduction of spasticity (MAS score diminished from at least 2 points). The second one described two older patients (43 and 67 years) with subarachnoid hemorrhage who were candidates for ITB therapy as well [ 31 ]. The first patient showed a decrease of 1.5 points on average on the MAS scores after 8 months of treatment in addition to the clinical recovery (the patient was able to eat, brush his teeth, stand and speak).…”
Section: Resultsmentioning
confidence: 99%
See 1 more Smart Citation
“…After receiving ITB therapy for a few months they both emerged from the MCS and showed a drastic reduction of spasticity (MAS score diminished from at least 2 points). The second one described two older patients (43 and 67 years) with subarachnoid hemorrhage who were candidates for ITB therapy as well [ 31 ]. The first patient showed a decrease of 1.5 points on average on the MAS scores after 8 months of treatment in addition to the clinical recovery (the patient was able to eat, brush his teeth, stand and speak).…”
Section: Resultsmentioning
confidence: 99%
“…Regarding therapeutic options for spasticity, several treatments were reviewed by Leong (physical, pharmacological and surgical) for spastic children [ 23 ]. None of the reviewed treatments seemed to present great benefits in the management of spasticity, with an exception for ITB therapy [ 21 , 22 , 29 , 30 , 31 , 32 , 33 ]. This could be partly explained by the paucity of randomized clinical trials assessing the effects of physical therapy.…”
Section: Discussionmentioning
confidence: 99%
“…[4] Our patient had both spasticity as well as very low consciousness and was in a vegetative state due to severe head injury. Both of these problems seemed to be markedly helped by ITB.…”
Section: Discussionmentioning
confidence: 99%
“…184 Hypothermia results in attenuated stress response within particularly temperaturesensitive areas, including portions of the cortex, thalamus, and hippocampus-all structures involved in the generation and maintenance of arousal. 185 Global, but especially temperaturesensitive areas, including parts of the cortex, thalamus, and hippocampus [180][181][182][183][184][185] Medications Amantadine Inhibits NMDA receptors, dopamine agonist Nigrostriatal, mesolimbic, and frontostriatal pathways 197,198 Methylphenidate Cortical activation via dopamine and NE Prefrontal, frontal, posterior cingulate; retrosplenial, inferior parietal, temporal, and occipital cortices; precuneus 201,203 Modafinil/armodafinil Inhibits dopamine and NE transport; activates dopamine, glutamate, serotonin, and histamine release; GABA and orexin effects; thalamocortical coupling Hypothalamus, TMN, thalamocortical connections [197][198][199][200] Zolpidem Sedative hypnotic, GABA agonist Damaged neural tissue [201][202][203][204] IT Baclofen GABA agonist Spinal cord-cortical vs. thalamocortical circuitry [208][209][210][211] Electrical stimulation…”
Section: Emerging Therapies For Disorders Of Consciousnessmentioning
confidence: 99%
“…Case reports of improvement in levels of consciousness after intrathecal baclofen in patients with persistent vegetative state reveal a range of improvement from return of spontaneous eye opening (improvement to minimally conscious state) to spontaneous motor movement, following commands, and spontaneous speech. [208][209][210][211] The authors of a five-patient case series postulated that intrathecal baclofen improves levels of arousal by one of two possible mechanisms: (1) the GABAergic action of baclofen modulates gating of signals from the spinal cord to the cortex, resulting in increased cortical awareness of self and stimuli perhaps by blocking sensory overload; or (2) beneficial effects within the brain, including improved stability and coherence of thalamocortical circuits, improving circadian rhythms and sleep-wakecycle regularity through GABAergic action on glutamate receptors, and increased alertness through serotoninergic actions. 208 No randomized placebo-controlled studies have been published at this time on the use of intrathecal baclofen in patients with disorders of consciousness.…”
Section: Deep Brain Stimulation Increases Cortical Desynchronizationmentioning
confidence: 99%