Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin

Albright, A. Leland; Gilmartin, Richard; Swift, Dale M.; Krach, Linda E.; Ivanhoe, Cindy B.; McLaughlin, John F.

doi:10.3171/jns.2003.98.2.0291

Cited by 190 publications

(119 citation statements)

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“…[1][2][3] The dose of ITB therapy has shown to increase during the first 12-18 months of therapy, very likely due to optimization of the individual needed dose, after which it stabilizes. 2,4,5 However, unexplained dose increases may still occur in up to 20% of ITB patients after these first 18 months.…”

Section: Introductionmentioning

confidence: 99%

Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion

2009

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Study design: Pilot study. Objective: To study the effect of pulsatile bolus infusion of intrathecal baclofen (ITB) on daily ITB dose, in patients showing dose increases, probably due to tolerance. Setting: Department of neurology and neurosurgery, University Medical Center Groningen, the Netherlands. Methods: Data on dosages and clinical efficacy were gathered from four patients who were switched from continuous to pulsatile bolus infusion of ITB, because of the probable diagnosis of tolerance to ITB. Results: Switching from continuous to pulsatile bolus infusion resulted in a decrease of the daily ITB dose, while the clinical effect could be kept stable, without introducing adverse events. Conclusion: Pulsatile bolus infusion of ITB seems to be an effective and safe treatment strategy to reverse the need for increasing ITB dosages in patients with the probable diagnosis of tolerance to ITB.

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Section: Introductionmentioning

confidence: 99%

Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion

2009

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“…The stroke consensus panel reported that a reasonable time to achieve optimal dosing was 3 months, with longer periods required in some individuals (16,23). Albright et al (24) observed decreased tone up to 5 years out, with stable dosing occurring after the first 2 years.…”

Section: Introductionmentioning

confidence: 99%

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

Saval

Chiodo

2010

The Journal of Spinal Cord Medicine

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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.

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“…17 The only outcome addressed in our study is survival; other benefits of ITB therapy have been previously reported and include tone reduction, comfort, ease of care, and decrease in number of anticipated orthopedic procedures. 3,5,[24][25][26][27] The most obvious limitation of the present study was that the cohorts were not prospectively randomly assigned. However, blinding of observation would not be relevant with the outcome measure of survival, and implementation of a randomly assigned study would be impossible in current practice.…”

Section: Discussionmentioning

confidence: 99%

“…Intrathecal baclofen (ITB), which was approved by the US Food and Drug Administration in 1996 for use in individuals with CP, is effective in the reduction of spasticity as well as dystonia and is frequently used to treat hypertonicity associated with CP. [2][3][4] In addition to the long-term reduction of hypertonicity, authors have reported improvement in comfort, positioning, ease of care provision, and motor function in select groups of individuals, and a reduction in the anticipated need for orthopedic surgery. 2,5,6 Progression of hip dislocation may be reduced with ITB, although the effect of ITB on the progression of scoliosis is controversial.…”

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confidence: 99%

Survival of individuals with cerebral palsy receiving continuous intrathecal baclofen treatment: a matched‐cohort study

Krach

Kriel

Day³

et al. 2010

Develop Med Child Neuro

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AIM To determine whether intrathecal baclofen (ITB) changes mortality risk in persons with cerebral palsy (CP).METHOD Records were reviewed for all persons with CP who were managed with ITB for hypertonicity at a specialty hospital in Minnesota between May 1993 and August 2007. A comparison cohort was randomly selected from clients of the California Department of Developmental Services who were initially evaluated between 1987 and 1990 and were matched to those with ITB for age, sex, Gross Motor Function Classification System (GMFCS) level, presence or absence of epilepsy, and feeding-tube use. Survival probabilities were estimated using the Kaplan-Meier method, and differences were tested via log-rank.RESULTS Three hundred and fifty-nine persons with CP (202 males, 157 females) receiving ITB for hypertonicity (mean age 12y 8mo, SD 7y 9mo, range 3y 1mo to 39y 9mo) were matched to 349 persons without ITB pumps (195 males, 154 females; mean age 12y 7mo, SD 8y 4mo, range 2y 7mo to 40y). The proportion of patients at different GMFCS levels in the ITB and in the non-ITB cohorts, respectively, was as follows: level II 3% and 3%, level III 16% and 16%, level IV 38% and 37%, and level V 43% and 44%. Survival at 8 years of follow-up was 92% (SD 1.9%) in the ITB cohort and 82% (SD 2.4%) in the non-ITB cohort (p<0.001). After adjustment to account for recent trends in improved survival in CP, 8-year survival in the non-ITB cohort was 88%, which was not significantly different from the ITB cohort (p=0.073).INTERPRETATION ITB therapy does not increase mortality in individuals with CP and may suggest an increase in life expectancy.Cerebral palsy (CP) is the most common congenital cause of disability in children, affecting approximately 2 to 3 per 1000 live births. 1 Spasticity is reported in approximately 70% of those with CP and is thought to interfere with function and comfort. Baclofen is a derivative of gamma-aminobutyric acid that is used to treat spasticity. The effectiveness of oral baclofen is limited by its sedating side effects, so the drug is often administered intrathecally by continuous infusion to deliver it to the site of action, the spinal cord. Intrathecal baclofen (ITB), which was approved by the US Food and Drug Administration in 1996 for use in individuals with CP, is effective in the reduction of spasticity as well as dystonia and is frequently used to treat hypertonicity associated with CP. [2][3][4] In addition to the long-term reduction of hypertonicity, authors have reported improvement in comfort, positioning, ease of care provision, and motor function in select groups of individuals, and a reduction in the anticipated need for orthopedic surgery. 2,5,6 Progression of hip dislocation may be reduced with ITB, although the effect of ITB on the progression of scoliosis is controversial. [7][8][9][10] ITB therapy involves the surgical implantation of a programmable pump with a reservoir for the continuous delivery of baclofen to the intrathecal space. As such, it is associated with risks related to surge...

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Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin

Abstract: Intrathecal baclofen provides effective long-term treatment of spasticity of cerebral origin and its effects do not appear to diminish with time. This therapy is frequently associated with adverse side effects that usually can be alleviated by adjustments in dosage.

Cited by 190 publications

References 12 publications

Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion

Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion

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

Survival of individuals with cerebral palsy receiving continuous intrathecal baclofen treatment: a matched‐cohort study

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