Respiratory Function Under Intrathecal Baclofen Therapy in Patients With Spastic Tetraplegia

Kishima, Haruhiko; Yanagisawa, Takufumi; Goto, Yuko; Oshino, Satoru; Maruo, Takeshi; Tani, Naoki; Khoo, Hui Ming; Hosomi, Koichi; Hirata, Masayuki; Yoshimine, Toshiki

doi:10.1111/ner.12394

Cited by 8 publications

(5 citation statements)

References 16 publications

(29 reference statements)

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“…As we already reported, respiratory function improved due to a reduction in generalized spasticity in some patients. 27 - 29 ) Contrary to HSP, the baclofen dose was gradually increased, and it reached a constant level in the 11th year after introducing ITB despite increasing the Ashworth scale. Aspects aside spasticity, such as caregiving, or improved respiratory function, may be responsible for reaching a constant level of baclofen dosage without an increase after 11 years.…”

Section: Discussionmentioning

confidence: 97%

“…All patients were relieved of spasticity after ITB implantation and were discharged from the hospital. The median (range) Ashworth scales at discharge for patients with HSP, CP, and SCI were 20.5 (16-30), 30.5 , and 19 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), respectively, and those at final follow-up were 20 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), 36.5 , and 16 . Decreasing trends were observed in the HSP and SCI groups while an increasing trend was observed in the CP group (p-values were 0.648, 0.206, 0.423, respectively; Wilcoxon's signed rank sum test).…”

Section: Ashworth Scalementioning

confidence: 99%

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Characteristics of Changes in Intrathecal Baclofen Dosage over Time due to Causative Disease

KIMOTO,

OSHINO,

TANI

et al. 2023

Neurol. Med. Chir.(Tokyo)

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Intrathecal baclofen (ITB) therapy effectively treats spasticity caused by brain or spinal cord lesions. However, only a few studies compare the course of treatment for different diseases. We investigated the change in daily dose of baclofen per year and its associated adverse events in patients presenting with the three most common etiologies at our institute: hereditary spastic paraplegia, cerebral palsy, and spinal cord injury. The ITB pumps were implanted from July 2007 to August 2019, with a mean follow-up period of 70 months. In patients with hereditary spastic paraplegia, baclofen dosage was reduced after eight years following ITB introduction, and the treatment was terminated in one patient owing to disease progression. In patients with cerebral palsy, the dosage increased gradually, and became constant in the 11th year. Patients with spinal cord injury gradually increased their baclofen dosage throughout the entire observation period. Severity and adverse event rates were higher in patients with cerebral palsy than in others. The degree and progression of spasticity varied depending on the causative disease. Understanding the characteristics and natural history of each disease is important when continuing ITB treatment.

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Section: Discussionmentioning

confidence: 97%

Section: Ashworth Scalementioning

confidence: 99%

Characteristics of Changes in Intrathecal Baclofen Dosage over Time due to Causative Disease

KIMOTO,

OSHINO,

TANI

et al. 2023

Neurol. Med. Chir.(Tokyo)

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“…Regard ing respiratory function and sleep-related disorders, cervical ITB might influence either positively, due to reduced spasticity of thoracic muscles, or negatively, due to central side-effects or peripheral muscle weakness. Previous research demonstrated positive effects of continuous thoracic ITB on respiratory function ( 21 ); however, also a worsening of sleep apnoea syndrome on boluses ( 20 ). The current review found no reported effects on respiratory function and sleep apnoea syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…However, it might lead to an insufficient effect on LE spasticity. Cervical ITB could also influence respiratory function and sleep-related disorders, either positively or negatively ( 19 – 21 ). Furthermore, a high cervical concentration of baclofen could increase cerebral side-effects and thereby influence cognitive and emotional functions.…”

mentioning

confidence: 99%

Effectiveness and safety of cervical catheter tip placement in intrathecal baclofen treatment of spasticity: A systematic review

Jacobs¹,

Maas²,

Brusse-Keizer³

et al. 2021

J Rehabil Med

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Objective To evaluate the effectiveness and safety of intrathecal baclofen treatment of spasticity, administered via a cervical catheter tip. Design A review of PubMed and the Cochrane Library up to September 2020. No restriction in study design. Two reviewers independently evaluated eligibility, extracted data and evaluated risk of bias. Studies were included in which patients were treated with intrathecal baclofen for spasticity, with the catheter tip at or above the first thoracic level, independent of diagnosis and age. Results Thirteen studies were eligible, with a moderate to critical risk of bias. Improvement in spasticity was seen only in the upper extremity in 6% of subjects, only in the lower extremity in 2%, in both upper and lower extremities in 50% and without specification of location in 41%. Upper extremity function improved in 88% of cases. Neither drug-related (1%) nor technical (21%) complications occurred more often than in lower placement of the tip. Effects on respiratory function and sleep apnoea were not investigated. Conclusion Cervically administered intrathecal baclofen seems to improve upper extremity spasticity and function, without causing more complications than thoracolumbar intrathecal baclofen. However, the mainly drug-related complications have not been thoroughly investigated and the available literature is of poor methodological quality. Further research is needed to confirm the efficacy and safety of this procedure. LAY ABSTRACT Spasticity is a common complication in central neurological disorders. It can lead to discomfort and functional limitations. To reduce spasticity, administration of baclofen via a catheter into the spinal canal has been used successfully for several years. However, this treatment often has limited effects on the upper limbs. The catheter tip is often situated in the thoracolumbar region. This review suggests that baclofen treatment via a cervically located catheter tip reduces spasticity of both arms and legs. Also, arm function improved in patients with a cervical catheter tip. Neither drug-related nor technical complications occurred more often than in lower placement of the cervical catheter tip. Few studies were found on this subject, and the available literature is of poor quality. Therefore, more research is needed to confirm the positive effect of this procedure on spasticity of the arms and to monitor for complications.

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“…Recent studies have also reported its therapeutic benefit for both stable and progressive neurological diseases, particularly with regards to ADL (activities of daily life) [16] and the improvement of respiratory function in spastic neurological diseases [17] .…”

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confidence: 99%

Intrathecal Baclofen Pump Implantation for Type 2 Gaucher Disease

Hori

Fukuhara²,

Aoi³

et al. 2017

Pediatr Neurosurg

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Gaucher disease (GD) is the most common type of lysosomal storage disease, with type 2 being the most severe subtype. Type 2 GD patients suffer significant progressive neurological impairment, including spasticity, opisthotonus, seizure, and apnea. The recently developed enzyme replacement therapy (ERT) has shown therapeutic benefit for GD. However, as the enzymes do not cross the blood-brain barrier, ERT does not ameliorate neurological impairment in GD. Intrathecal baclofen therapy (IBT) is indicated for spastic neurological diseases, such as cerebral palsy, and studies have shown its therapeutic benefit in improving several manifestations of GD, such as scoliosis caused by muscle spasticity and respiratory function. To date, the potential benefits of IBT for treating lysosomal storage diseases such as GD have not been examined. Here we provide the first report of a patient with type 2 GD treated with IBT, and demonstrate its therapeutic benefit in ameliorating the neurological aspects of this disease.

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Respiratory Function Under Intrathecal Baclofen Therapy in Patients With Spastic Tetraplegia

Cited by 8 publications

References 16 publications

Characteristics of Changes in Intrathecal Baclofen Dosage over Time due to Causative Disease

Characteristics of Changes in Intrathecal Baclofen Dosage over Time due to Causative Disease

Effectiveness and safety of cervical catheter tip placement in intrathecal baclofen treatment of spasticity: A systematic review

Intrathecal Baclofen Pump Implantation for Type 2 Gaucher Disease

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