Intrathecal Baclofen Therapy for Spinal Origin Spasticity: Spinal Cord Injury, Spinal Cord Disease, and Multiple Sclerosis

Ochs, G.; Naumann, Claus; Dimitrijevic, Meta M.; Sindou, Marc

doi:10.1046/j.1525-1403.1999.00108.x

Cited by 39 publications

(47 citation statements)

References 32 publications

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“…Its first indication was chronic, medically intractable spasticity of spinal origin. 1,2 Indications have been extended to spasticity of other origins, 3,4 to dystonia, 5 and more recently to the treatment of early vegetative dysfunction in traumatic brain injury. 6,7 Spasticity is defined by Lance as a velocity-dependent increase in muscle tone with exaggerated tendon jerk resulting from hyperexcitability of the stretch reflex.…”

Section: Introductionmentioning

confidence: 99%

Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients

et al. 2004

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Study design: Case series of a consecutive sample. Retrospective audit. Objective: To analyze the long-term safety and efficacy of intrathecal baclofen (ITB), and technical incidents. Setting: Neurosurgical and Physical Medicine Departments of two university hospitals in western France. Methods: The medical records of 40 patients who underwent ITB pump placement for the treatment of severe chronic spasticity were reviewed. Patients were eligible independently of the origin of the spasticity (spinal cord origin 33, brain damage 8). They underwent a final assessment with clinical examination and questionnaire in 2001. Ashworth scale scores were assessed, patient satisfaction was rated on a visual analog scale (VAS), functional independence before and after treatment was classified as bed-ridden, wheelchair dependant or ambulant, and the frequency and nature of complications were noted. Results: The average follow-up period was of 4 years. The average Ashworth score at the final assessment was 1.870.6. Average patients satisfaction was 7.4/1072.21 on VAS. In all, 85% would have undergone the procedure again if they had to make the decision. In 85% of the cases the ambulation status was unchanged. Technical incidents occured at least once in 37% of the patients (due to the catheter in 58% and to the pump in 42%). They included catheter disconnections (4), migration (4), kinks (3), obstruction (3), development of fibrosis (3), disconnection of pump reservoir (2), porosity of pump membrane (2), unexplained pump dysfunction (4) leakage, and subcutaneous collection (5). Severe pharmacological side effects requiring transfer to intensive care unit occured in 12% of cases, 80% of which were directly related to pump refill procedures. Conclusion: ITB remained effective in the long term and patients were satisfied. Nevertheless, complications were frequent, involving mainly the catheters, which would require further technical improvements.

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Section: Introductionmentioning

confidence: 99%

Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients

et al. 2004

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“…Pharmaka, die weiterhin zum Einsatz kommen, sind Opioide, Lokalanästhetika, α 2 -und GABA-Agonisten [30,33,63,84,86].Weitere Pharmaka befinden sich in der Entwicklung [33]. …”

Section: Intrathekale Pharmakotherapie Zur Behandlung Chronischer Schunclassified

Standardisierung invasiver neuromodulativer Verfahren

Harke

Rosenow²,

Tronnier³

et al. 2003

Der Schmerz

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The Working Group on Neuromodulation of the German Association for the Study of Pain, composed of representatives from various scientific specialty societies, met on December 9, 2000, March 24, 2001, October 5, 2001, and December 8, 2001. As a result of these discussions grounded in current knowledge, the following guidelines were formulated for the standardization of invasive techniques of neuromodulation intended to serve as a systematic aid in decision-making and to provide recommendations for practice-oriented methods. The guidelines were based on both the clinical and practical experience of the group participants (see information box on the next page) as well as on the current scientific literature and guidance from the consensus report of the European Federation of IASP Chapters (EFIC) [23]. The guidelines serve the purpose of orientation and have no effect on either assumption of liability or discharge from liability. The guidelines were conceived for use by physicians in private practice,doctors in hospitals,and nonmedical personnel concerned with the care of chronic pain patients. The Working Group consists of unsalaried volunteers. The participants received no honorarium and were only reimbursed for normal travel expenses in accordance with customary directives. The guidelines will be revised should new scientific results become available, at the latest in 2 years. The plan exists to further develop the guidelines to stages II and III (AWMF). The Steering Committee of the DGSS appraised the guidelines and authorized the guidelines before publication.

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“…However, it is recognized that bolus trials may have limitations given the 4-to 8-hour time window to (1) assess effects on function in patients who rely on a baseline level of spasticity and (2) monitor for potential adverse effects. Some patients, such as those with spastic dystonia, require very high doses to yield a good outcome, and such doses could be difficult to attain during a bolus trial [7][8][9][10]. In addition, data are conflicting about whether ITB improves or worsens ambulation; because patients PM R XXX (2015) [1][2][3][4][5][6][7] www.pmrjournal.org can use spasticity for stance stability, reducing hypertonia may cause them to be unstable while walking [8,11].…”

Section: Introductionmentioning

confidence: 99%

Clinical Experience With Continuous Intrathecal Baclofen Trials Prior to Pump Implantation

Phillips

Miljković

Ramos-Lamboy

et al. 2015

PM&R

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Intrathecal Baclofen Therapy for Spinal Origin Spasticity: Spinal Cord Injury, Spinal Cord Disease, and Multiple Sclerosis

Cited by 39 publications

References 32 publications

Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients

Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients

Standardisierung invasiver neuromodulativer Verfahren

Clinical Experience With Continuous Intrathecal Baclofen Trials Prior to Pump Implantation

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