Long-term continuously infused intrathecal baclofen for spastic-dystonic hypertonia in traumatic brain injury: 1-year experience

Meythaler, Jay M.; Guin-Renfroe, Sharon; Grabb, Paul A.; Hadley, Mark N.

doi:10.1016/s0003-9993(99)90301-5

Cited by 108 publications

(48 citation statements)

References 33 publications

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“…Similar ®ndings have been noted in the traumatic brain injury and pediatric cerebral palsy populations. 1,18 There was not, however, a signi®cant decline in spasm frequency with the relatively rigorous Friedman's test. Friedman's test takes into account the shape of the curve during the entire follow-up period, while the Wilcoxon signed rank test examines the magnitude of di erence between two de®ned timepoints on the curve.…”

Section: E Ects On Hypertoniamentioning

confidence: 91%

“…5 ± 7,11 ± 13,16 This is important because intrathecal baclofen di uses rapidly from the intrathecal space into the spinal cord, resulting in a lumbar-to-brain gradient. 1,6,16 Since intrathecal delivered baclofen crosses from the Figure 7 Intrathecal baclofen dosage (mg/day) requirements with one standard deviation bar intrathecal space to the spinal cord quickly, it intuitively makes sense to move the catheter cephalid toward the cervical region for improved upper extremity e ects.…”

Section: E Ects On Hypertoniamentioning

confidence: 99%

“…1,5,8,33 This has been attributed to the downregulation of GABA-B receptors at the spinal level. 1,33 In our study, the slight increase in tone at 12 months is also suggestive of emerging tolerance. Akman found a signi®cant increase in dosage requirements up until 12 months followed by a leveling o from 12 to 24 months.…”

Section: Dosage Requirementsmentioning

confidence: 99%

“…5 ± 14 Baclofen, 4-amino-3 (p-chlorophenyl) butyric acid, is felt to work by binding to inhibitory presynaptic GABA-B receptors in the spinal cord. 1 Intrathecal delivery of the drug facilitates achievement of therapeutic levels in the cerebrospinal¯uid (CSF) while minimizing systemic side e ects (ie, drowsiness or confusion). 1,5 ± 8 Prior studies examining the e cacy of intrathecal baclofen (ITB) for hypertonia of spinal origin have presented results solely on e cacy in the lower extremities.…”

Section: Introductionmentioning

confidence: 99%

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Intrathecal baclofen in tetraplegia of spinal origin: efficacy for upper extremity hypertonia

Burns

Meythaler

2001

Spinal Cord

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Study design: Retrospective analysis. Objectives: To evaluate the e cacy of intrathecal baclofen (ITB) for upper extremity spastic hypertonia in tetraplegia of spinal origin. Setting: University of Alabama at Birmingham hospital. Methods: The medical records of 14 individuals with tetraplegia of spinal origin who underwent intrathecal baclofen pump placement were reviewed. The e ects of intrathecal baclofen on spasm frequency, deep tendon re¯exes, and tone (Ashworth scale) were assessed for the upper and lower extremities for a 1-year follow-up period.Results: There were statistically signi®cant declines in upper extremity spasm scores (1.8 points, P=0.012), re¯ex scores (1.4 points, P50.0001) and Ashworth scores (0.6 points, P50.0001) for the 1-year follow-up period. For the lower extremities, all decreases were signi®cant (P50.0001). There was also a statistically signi®cant (P50.0001) increase in intrathecal baclofen dosage requirements during the 1-year follow-up period to maintain the reductions in spasm frequency, re¯exes and tone. Conclusions: Intrathecal baclofen is a safe and e ective intervention for treating upper extremity hypertonia of spinal origin. In addition, the level of intrathecal catheter placement is felt to be of importance. Spinal Cord (2001) 39, 413 ± 419

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Section: E Ects On Hypertoniamentioning

confidence: 91%

Section: E Ects On Hypertoniamentioning

confidence: 99%

Section: Dosage Requirementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intrathecal baclofen in tetraplegia of spinal origin: efficacy for upper extremity hypertonia

Burns

Meythaler

2001

Spinal Cord

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“…5 The first indications for intrathecal baclofen consisted of spasticity secondary to spinal cord lesions (SCI and MS) 5,6 and were subsequently extended to include spasticity secondary to supraspinal lesions (cerebral palsy, traumatic brain injury and stroke). [7][8][9] Before implanting an intrathecal baclofen infusion pump, test injections are performed to ensure the efficacy of baclofen and to confirm the indication for an implanted pump.…”

Section: Introductionmentioning

confidence: 99%

Aseptic meningitis after intrathecal baclofen injection

Bensmaïl¹,

Peskine²,

Denys³

et al. 2005

Spinal Cord

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Study design: Two case reports of aseptic meningitis after intrathecal baclofen injection. Objectives: To report an unusual complication of intrathecal baclofen injection during test injections. Setting: Department of Neurological Rehabilitation, R Poincare´Hoˆpital (Paris-Ile de FranceOuest University). Case reports: We present two cases of chemical meningitis after intrathecal baclofen injections by lumbar puncture. These cases presented with febrile meningeal syndromes during the 24 h following intrathecal baclofen injection. Direct cerebrospinal fluid (CSF) examination and CSF cultures were negative. An intense cellular reaction was observed with a marked predominance of neutrophils. Meningitis resolved spontaneously over 3-4 days. Conclusions: Chemical meningitis is a rare complication of intrathecal baclofen injections that must be recognized. It is a diagnosis of exclusion and its pathophysiological mechanism remains unclear.

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The surgical treatment of spasticity

Smyth

Peacock

2000

Muscle Nerve

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Many neurosurgical procedures have been designed for or applied to the treatment of spasticity arising from different disorders, including cerebral palsy; traumatic, ischemic, or hypoxic brain injury, multiple sclerosis, and spinal cord injury. Neurosurgical procedures are primarily aimed at reducing spasticity by interrupting the stretch reflex at various sites along the spinal reflex arc or attempting to increase the centrally mediated inhibitory influence on the pool of motor neurons in the anterior horn. Surgical interventions for spasticity can be classified into peripheral ablative procedures, such as rhizotomy or peripheral neurectomy, and central ablative procedures, such as cordectomy, myelotomy, or stereotactic procedures. Non‐ablative procedures include peripheral nerve or motor point blocks, the implantation of cerebellar or spinal stimulators, and the implantation of subdural catheters for infusion of pharmacologic agents to increase inhibitory activity. Several proposed mechanisms for spasticity are reviewed so that the rationale for the various surgical interventions for spasticity described may be better understood. © 2000 John Wiley & Sons, Inc. Muscle Nerve 23: 153–163, 2000.

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Long-term continuously infused intrathecal baclofen for spastic-dystonic hypertonia in traumatic brain injury: 1-year experience

Cited by 108 publications

References 33 publications

Intrathecal baclofen in tetraplegia of spinal origin: efficacy for upper extremity hypertonia

Intrathecal baclofen in tetraplegia of spinal origin: efficacy for upper extremity hypertonia

Aseptic meningitis after intrathecal baclofen injection

The surgical treatment of spasticity

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