AI Article Synopsis
- The study evaluated the long-term effectiveness and safety of intrathecal baclofen (ITB) for treating spasticity related to multiple sclerosis (MS) over approximately 20 years.
- A total of 106 subjects were involved, and results showed significant improvements in spasticity and pain scores post-treatment, with many patients able to stop oral antispasticity medications.
- Complication rates were low, mostly mechanical, and a notable percentage of those who could walk before the treatment maintained their ability to do so after one year, suggesting ITB may be a beneficial early intervention.
Article Abstract
Objective: Evaluate long-term efficacy and safety of ITB in treating MS-related spasticity over ∼ 20 years of service provision in a single centre.
Methods: A single centre prospective observational cohort study was performed. Eligible subjects underwent ITB trial by bolus dose via lumbar puncture and responders proceeded to pump implantation. Demographics, spasticity scores (Ashworth), spasm score (Penn), stiffness, pain and discomfort (Visual Analogue Scale), mobility (10 M walk), spasticity treatment, and ITB doses were analysed longitudinally.
Results: 106 people were included with 568 patient years of data. Ashworth, Penn and VAS/NRS mean scores improved post-trial compared with baseline (p < 0.001). Sustained efficacy was reported on Ashworth, Penn and VAS scores over time. After 1 year, 73 (69%) discontinued all oral antispasticity medications. Complication rates were low at 0.05 complications per pump year and mostly mechanical (usually catheter) related. In 8 ambulatory subjects, 7 (87%) continued to walk one year after pump insertion, 5 (62%) were still walking at time of analysis (mean follow up 3.4 years).
Conclusions: ITB is an effective and safe long term treatment for refractory MS related spasticity. Efficacy was sustained over time and the majority of subjects subsequently discontinued systemic medications. In a small cohort, ability to walk was preserved, indicating ITB should be considered earlier in this cohort.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.msard.2018.10.009 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Does a delay of surgery due to a multidisciplinary screening process result in neuromuscular scoliosis curve progression in complex Cerebral Palsy?
Int Orthop
December 2024
Baylor College of Medicine, Department of Orthopedics, Houston, TX, USA.
Purpose: While surgical intervention of scoliosis in cerebral palsy (CP) patients has shown notable improvements in quality of life, the high risk of post-operative complications in CP patients necessitates careful preoperative optimization. A preoperative multidisciplinary (Multi-D) pathway at our tertiary pediatric hospital in effect since 2014 led to a significant reduction in mortality at one year. However, such a strategy delays surgery, potentially increasing the risk of curve progression.
View Article and Find Full Text PDFIntrathecal baclofen pump for severe hypertonia in a patient with juvenile Huntington's disease: illustrative case.
J Neurosurg Case Lessons
December 2024
Physical Medicine and Rehabilitation, Weill-Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York.
Background: While the symptoms of Huntington's disease (HD) typically first appear around the age of 40 years, 5%-10% of patients experience symptoms before the age of 21 years, in which case it is classified as juvenile Huntington's disease (JHD). JHD poses a unique clinical problem, as affected patients experience rapid deterioration in their quality of life as the motor manifestations of the disease become overwhelming. Medical treatment options for HD are sparse, and the only Food and Drug Administration-approved medication for the treatment of HD is the VMAT-2 inhibitor tetrabenazine.
View Article and Find Full Text PDFMultimodal surgical strategy for mixed refractory hypertonia in a patient with cerebral palsy: C1-2 puncture and pectoral pocket for baclofen pump implantation following lumbosacral ventral-dorsal rhizotomy. Illustrative case.
J Neurosurg Case Lessons
December 2024
Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
Background: Intrathecal baclofen pump (ITBP) therapy has been successfully used to treat hypertonia in children with cerebral palsy (CP) since its Food and Drug Administration approval in 1984. CP affects multiple organ systems, leading to the accumulation of medical access and implantable devices, increasing the medical complexity of these children. The authors present the case of a patient with extreme surgical complexity and review the medical decision-making and surgical details.
View Article and Find Full Text PDFIntrathecal Baclofen Pump Refill-Related Cardiac Arrest: A Case Report.
J Pain Palliat Care Pharmacother
November 2024
Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA.
We present the case of a 45-year-old male with a history of multiple sclerosis complicated by spasticity and paraplegia, who developed altered mental status and type II respiratory failure requiring intubation on the same day his intrathecal baclofen pump was refilled by his pain physician. Shortly after admission, the patient experienced cardiac arrest four times within two hours until the pump contents were aspirated, and the patient was stabilized. This case report emphasizes the significance of vigilance and prompt recognition of intrathecal baclofen poisoning, which can lead to life-threatening toxicities and withdrawals.
View Article and Find Full Text PDFBaclofen is a common muscle relaxant agent used in a number of neurological disorders acting at central level and potentially causing adverse respiratory events, still largely unknown at therapeutic doses. We present the case of a young woman with spastic tetraparesis secondary to perinatal asphyxia treated with a standard dose of intrathecal baclofen who developed nocturnal symptoms, somnolence and memory loss during the day. Nocturnal cardio-respiratory sleep monitoring showed a high number of central sleep apneas (CSA).
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!