Intrathecal Baclofen for Spasticity Management: A Comparative Analysis of Spasticity of Spinal vs Cortical Origin

Abstract

Background/Objective: To examine the differences in intrathecal baclofen management of individuals with spasticity of cortical vs spinal etiologies. Design: Retrospective chart review of 57 individuals with the diagnoses of severe cortical and spinal spasticity requiring an intrathecal baclofen pump. Methods: Parameters evaluated included daily dosage of medication required, flex vs simple continuous delivery modes, dosing changes, need for other local spasticity treatment, and catheter complications. Results: There were no statistically significant differences between individuals with cortical spasticity and spinal spasticity when comparing daily dosage, number of contacts, and mode of delivery. At 6 months, there was a statistically significant difference in dosing between individuals with multiple sclerosis and those without. Within groups, there was a significant difference in average daily dosing over 3 years. A significant difference was found comparing the use of botulinum toxin type A for upper extremity spasticity within the cortical group. Nine individuals had catheter complications. Conclusions: Cortical and spinal spasticity appear to parallel each other with no significant differences in daily dosing, dosing changes, and mode of delivery of intrathecal baclofen. This did not hold true at all time points for the multiple sclerosis subgroup. The significant difference noted within groups for daily dosing over the first 3 years challenges the notion of stable dosing over time. Focal injections of Botox/phenol in the upper extremities are an important adjunct therapy for patients with cortical spasticity, even after the placement of an intrathecal baclofen pump. Our complication rate was slightly lower than that reported in the literature.

Cost-effectiveness of Intrathecal Baclofen Therapy in severe refractory non-focal disabling spasticity: a Spanish hospital perspective

“…An explantation occurred once in the EPICE data set; considering the rates reported in the literature [18,20,22,27], the corresponding probability was accepted as a conservative estimate for the present cost-effectiveness analysis. Other adverse events implying health-care resource use occurred in the EPICE study on average 0.014 times per month, which is consistent with recent data reported in the literature [20,22,29].…”

“…This is essentially consistent with the review by McIntyre et al [7] who found that baclofen dosage increases typically occur up to 6-months postpump implantation, then rise more slowly over time, and finally reach a plateau after approximately 12 months. Saval et al [29], however, challenge the notion of stable dosing over time and maintain that focal injections remain important adjunct therapy for patients with cortical spasticity. While this discussion is clinically relevant, probably it has little consequences for the cost-effectiveness of ITB Therapy, since our sensitivity analysis suggests that the ICER is not particularly affected by changes in drug costs.…”

Toll-like receptors in central nervous system injury and disease: A focus on the spinal cord

“…Osmotic pumps for the i.t. delivery of various agents have been used in the clinical setting (Saval and Chiodo, 2010) and could be adapted for the administration of TLR ligands, even though this approach is more invasive, requires surgery, and has the risk of late mechanical failures or infections related to the device which delivers the medication (the pump system).…”

Travmatik Spinal Kord Yaralanmalı Hastalarda İntratekal Baklofen Tedavisi

“…Önceki çalışmalarda baklofen gereksinimi zamanla artmıştır ve sabit dozlara 6-18. aylarda ulaşılmıştır. Başlangıç dozları genellikle 100-170 µg/gün arasında iken, bir yıl sonunda 175-475 µg/gün aralığındadır (8,11,13,(15)(16)(17)(18)(19)(20). Literatürle uyumlu olarak hastalarımızda zamanla baklofen gereksinimi arttı ve 6-12. aylar arasında sabit İTB dozları elde edildi.…”

“…Baklofen (beta-p-chlorophenyl-GABA) yapı olarak inhibitör nörotransmitter olan gama aminobütürik asit analoğudur. Santral sinir sisteminde pre-postsinaptik GABA-B reseptörlerine bağlanır ve etkisini mono-polisinaptik spinal refleksleri inhibe ederek gösterir (6)(7)(8)(9). Yan etki insidansı %10 ila %75 arasında değişir ve ciddi yan etkileri genellikle dozla ilişkilidir (10).…”