Management of Intractable Spasticity of Supraspinal Origin by Chronic Cervical Intrathecal Infusion of Baclofen

Conçalves, J.; García-March, G.; Sánchez-Ledesma, M.J.; Onzain, I.; Broseta, J.

doi:10.1159/000098605

Cited by 25 publications

(34 citation statements)

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“…Only six (46.2%) described a consecutive series of patients [9,50,51,52,53,54], the other seven (53.8%) described a group of selected patients which had been treated by the authors. Five (38.5%) referred to diagnostic criteria .…”

Section: Resultsmentioning

confidence: 99%

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Management of Factitious Disorders: A Systematic Review

Eastwood

Bisson

2008

Psychother Psychosom

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Background: The literature regarding the management of factitious disorder (FD) is diverse and generally of case reports or case series. To date there has been no systematic review of the effectiveness of management techniques. Methods: Systematic review of all evidence reporting the management and subsequent outcome in FD. Data were extracted and outcomes were assessed using an adaptation of the Global Improvement Scale. Results were analysed by parametric statistical tests; a meta-analysis was not possible. Results: Thirty-two case reports and 13 case series were eligible for inclusion. Analysis of the case reports found no significant difference in outcomes between confrontational and non-confrontational approaches [t(29) = 0.72, p = 0.48], between treatment with psychotherapy compared to no psychotherapy [t(30) = 0.69, p = 0.48], and when psychiatric medication had been prescribed compared with not [t(30) = 0.35, p = 0.73]. A trend was observed that a longer length of treatment lead to better outcomes, but this was not significant [F(5, 26) = 1.17, p = 0.35]. The consecutive case series demonstrated that many FD sufferers were not engaged in treatment and were lost to follow-up but did not provide any strong evidence regarding the effectiveness of different management approaches. Conclusions: There is an absence of sufficient robust research to determine the effectiveness of any management technique for FD. The establishment of a central reporting register to facilitate the development of evidence-based guidelines is recommended.

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Section: Resultsmentioning

confidence: 99%

“…Confrontation techniques were not always reported and were generally poorly described but included non-punitive approaches [51, 58, 59], a mixture of confrontational and non-confrontational strategies [53, 60], and a double-binded face-saving technique [54, 61]. …”

Section: Resultsmentioning

confidence: 99%

Management of Factitious Disorders: A Systematic Review

Eastwood

Bisson

2008

Psychother Psychosom

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“…Autodestructive syndromes are at times striking for the direct, indirect or combined methods of patient self-manipulation they involve [1,2,3,4,5] and examples have been reported from numerous fields of medicine [6,7,8,9]. …”

Section: Methodsmentioning

confidence: 99%

“…The term ‘direct’ autodestructive behaviour refers to direct, external injuries to the skin [6], including e.g. self-induced scratches, cuts or burns [10,11,12,13,14].…”

Section: Methodsmentioning

confidence: 99%

Autodestructive Syndromes

Kocalevent

Fliege

Rose

et al. 2005

Psychother Psychosom

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Background: The phenomenon ‘autodestructive behaviour’ is becoming an increasingly serious disease and cost factor in a wide range of medical fields. The present paper presents a survey of the literature on autodestructive behaviour, excluding psychotic, substance-induced or organic brain disorders. Starting out with a conceptual overview, the paper goes on to look into the epidemiology of autodestructive behaviour and the forms in which it manifests itself. Method: A literature search was conducted in Medline, Psycinfo and Psyndex using the search terms ‘artifact’, ‘artificially induced’, ‘autodestructive’, ‘self-mutilation’, ‘factitious’, ‘self-harm’, ‘self-induced’, ‘self-inflicted’, ‘self-injuring’ and ‘self-mutilation’ for the period from 1977 to 2003. Results: Five of a total of 18 empirical studies describe the simultaneous occurrence of direct and indirect forms of autodestructive behaviour. Reported prevalence rates range from 0.032% to 9.36%. The ratio of females to males was found to be 2:1 (average age: 31.5 years; SD: 9.3 years); in contrast, the gender ratio was reversed for Munchausen’s syndrome. The case history data presented are patchy and differ in terms of their priorities. We found a large number of codiagnoses, which seems to indicate that personality and dependence disorders, or substance misuse, are characteristic of both direct and indirect forms of autodestructive behaviour. Conclusions: The task at hand is to use a yet-to-be-developed nomenclature and adequately operational diagnostic criteria to work out standardised survey instruments that do justice to the heterogeneity of this disorder complex.

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“…31,32 The cervical positioning is questioned because of the potential risk of central side effects. 33 Thus, the choice for the treatment of upper limb spasticity depends on the function of lower limbs. If there is no remaining lower limb function, the safest choice is to increase the doses and keep to a lumbar position.…”

Section: Implantation Proceduresmentioning

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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Management of Intractable Spasticity of Supraspinal Origin by Chronic Cervical Intrathecal Infusion of Baclofen

Cited by 25 publications

References 0 publications

Management of Factitious Disorders: A Systematic Review

Management of Factitious Disorders: A Systematic Review

Autodestructive Syndromes

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

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