Midthoracic Catheter Tip Placement for Intrathecal Baclofen Administration in Children with Quadriparetic Spasticity

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

doi:10.1097/00006123-199910000-00020

Cited by 78 publications

(41 citation statements)

References 6 publications

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“…24 Because intrathecally delivered baclofen crosses to the spinal cord quite quickly, it makes sense to move the delivery catheter more cephalad in patients with spasticity/dystonia involvement of the upper extremities. 7,8,17 In patients with considerable spasticity and/or dystonia in the upper extremities, we have experienced considerable success placing the catheter tip up to the midthoracic area. [7][8][9]17 Still, the effect of ITB in the upper extremities was not as dramatic as in the lower extremities.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] Baclofen, 4-amino-3 (p-chlorophenyl) butyric acid, is structurally similar to gamma aminobutyric acid (GABA) and binds to presynaptic GABA-B receptors within the brain stem, dorsal horn of the spinal cord, and other central nervous system (CNS) sites. [3][4][5]10,11,[15][16][17][18][19][20][21][22] The intrathecal infusion of baclofen through chronically placed catheters has been reported to be useful in treating spastic hypertonia in adults with spinal cord injury, multiple sclerosis, cerebral palsy and acquired brain injury. 7,8,10,[12][13][14] The delivery system consists of a subcutaneously placed pump with a reservoir attached to an intraspinal catheter.…”

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confidence: 99%

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Intrathecal Baclofen for Spastic Hypertonia From Stroke

Meythaler

Guin-Renfroe

Brunner

et al. 2001

Stroke

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169

104

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Background and Purpose-We sought to determine whether continuous intrathecal delivery of baclofen can effectively decrease spastic hypertonia due to stroke. Methods-Stroke patients with Ͼ6 months of intractable spasticity were screened via a randomized, double-blind, placebo-controlled crossover design of either intrathecal normal saline or 50 g baclofen. Those who dropped an average of 2 points in either their affected lower extremity side Ashworth or Penn spasm frequency scores were then offered computer-controlled pump implantation for continuous ITB and followed prospectively for up to 12 months.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Intrathecal Baclofen for Spastic Hypertonia From Stroke

Meythaler

Guin-Renfroe

Brunner

et al. 2001

Stroke

Self Cite

169

104

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show abstract

“…30 Some studies have evaluated the effect of ITB on upper limb spasticity: midthoracic catheter placement seems to offer better control than the rostral position on upper limb spasticity of both spinal and cerebral origin. 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.…”

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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“…(5) Intrathecal baclofen (ITB) therapy has now become a widely recognised treatment for severe, disabling spasticity in individuals with cerebral palsy, stroke, and spinal cord and brain injuries. (6)(7)(8)(9)(10)(11)(12)(13)(14) Other benefi ts of ITB therapy include reduction of central pain, improvement in cerebral dysautonomia and improvements in disorders of consciousness. (15,16) Despite the established therapeutic value of ITB therapy, there is a paucity of local literature.…”

Section: Introductionmentioning

confidence: 99%

Treatment of severe, disabling spasticity with continuous intrathecal baclofen therapy following acquired brain injury: the experience of a tertiary institution in Singapore

Wang

Law

King

et al. 2016

smedj

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INTRODUCTIONIntrathecal baclofen (ITB) therapy is a proven, effective treatment for disabling cortical spasticity. We describe the fi rst local series of fi ve patients with acquired brain injury (ABI) who received ITB and were followed up for 63.8 months.METHODS A retrospective review of medical and rehabilitation records of patients who received ITB therapy was carried out. Data studied included baseline demographic and injury variables, implantation data, spasticity and function, ITB dosage over time and complications.RESULTS From 2006 to 2010, a total of fi ve patients received ITB therapy via implanted pumps about 39.4 months after ABI. Four out of fi ve patients experienced signifi cant reductions in their lower limb spasticity scores and improvements in global function and dependency. One patient had minor adverse events associated with baclofen-related sedation. The mean ITB dose at one year was 182.7 ± 65.6 mcg/day. CONCLUSION Our preliminary study showed encouraging long-term outcomes and safety for ITB therapy after ABI-related intractable spasticity. Individual ITB responses over time were variable, with gender differences. The outcomes experienced by our centre were comparable to those in the general ABI population, supporting the effi cacy of ITB therapy for chronic disabling spasticity.

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Midthoracic Catheter Tip Placement for Intrathecal Baclofen Administration in Children with Quadriparetic Spasticity

Cited by 78 publications

References 6 publications

Intrathecal Baclofen for Spastic Hypertonia From Stroke

Intrathecal Baclofen for Spastic Hypertonia From Stroke

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

Treatment of severe, disabling spasticity with continuous intrathecal baclofen therapy following acquired brain injury: the experience of a tertiary institution in Singapore

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