Neurorehabilitation and neural repair · 2013
Use of intrathecal baclofen for treatment of severe spasticity in selected patients with motor neuron disease.
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Bethoux Francois, Boulis Nicholas, McClelland Shearwood, Willis Mary Alissa, Hussain Mariam, Machado Andre, Mychkovsky Lydia, Stough Darlene, Sutliff Matt, Pioro Erik P
Аннотация
OBJECTIVE: To assess the safety and efficacy of intrathecal baclofen (ITB) therapy for severe spasticity in patients with upper-motor neuron predominant motor neuron disease (U-MND).
METHODS: A total of 44 patients with U-MND were referred for discussion of ITB therapy. Baseline and outcomes data were extracted on 35 patients from a clinical spasticity registry at a tertiary referral center. Patients choosing to initiate ITB (n = 20) were compared with those choosing conservative therapy (n = 15).
RESULTS: At baseline, lower average pain score in the non-ITB group was the only significant difference between the 2 groups. A significant reduction in pain scores, Modified Ashworth Scale (MAS), Spasm Frequency Scale, and requirement for oral spasticity medications was observed within the ITB group at early and late follow-up. Within the non-ITB group, there was a significant increase in MAS scores between baseline and late follow-up. A statistically significant difference favoring the ITB group was observed for change in MAS score (P < .0001), Numerical Rating Scale pain score (P = .04), dose of oral baclofen (P = .002) and tizanidine (P = .003), and number of oral medications for spasticity (P = .002). There was no difference between the 2 groups in the progression of hip flexor weakness or in the proportion of patients who became nonambulatory.
CONCLUSIONS: Our findings suggest that ITB can effectively reduce spasticity and related symptoms without compromising function in selected patients with U-MND.
METHODS: A total of 44 patients with U-MND were referred for discussion of ITB therapy. Baseline and outcomes data were extracted on 35 patients from a clinical spasticity registry at a tertiary referral center. Patients choosing to initiate ITB (n = 20) were compared with those choosing conservative therapy (n = 15).
RESULTS: At baseline, lower average pain score in the non-ITB group was the only significant difference between the 2 groups. A significant reduction in pain scores, Modified Ashworth Scale (MAS), Spasm Frequency Scale, and requirement for oral spasticity medications was observed within the ITB group at early and late follow-up. Within the non-ITB group, there was a significant increase in MAS scores between baseline and late follow-up. A statistically significant difference favoring the ITB group was observed for change in MAS score (P < .0001), Numerical Rating Scale pain score (P = .04), dose of oral baclofen (P = .002) and tizanidine (P = .003), and number of oral medications for spasticity (P = .002). There was no difference between the 2 groups in the progression of hip flexor weakness or in the proportion of patients who became nonambulatory.
CONCLUSIONS: Our findings suggest that ITB can effectively reduce spasticity and related symptoms without compromising function in selected patients with U-MND.