Outcomes of Intrathecal Baclofen Therapy Compared With Deep Brain Stimulation in a Patient With Dystonic Cerebral Palsy: A Case Report

Deep brain stimulation (DBS) in internal globus pallidus is considered to be a good option for controlling generalized dystonia in patients with this condition. In this relation, it is known that DBS has already been shown to have significant effects on primary dystonia, but is seen as controversial in secondary dystonia including cerebral palsy (CP). On the other hand, intrathecal baclofen (ITB) has been known to reduce spasticity and dystonia in patients who did not respond to oral medications or botulinum toxin treatment. Here, we report a patient with dystonic CP, who received the ITB pump implantation long after the DBS and who noted remarkable improvement in the 36-Item Short Form Health Survey, Dystonia Rating Scale, Modified Barthel Index, and visual analog scale scores for pain after an ITB pump implantation was used as compared with DBS. To our knowledge, the present case report is the first to demonstrate the effects of an ITB pump on reducing pain and dystonia and improving quality of life and satisfaction, compared with DBS in a patient with CP.

Bomba intratecal de baclofeno, ¿una intervención terapéutica útil y segura en pacientes con espasticidad? Presentación de casos / Intrathecal baclofen pump, useful and safe therapeutic intervention in spasticity? Report of four cases / Bomba intratecal de baclofeno, uma intervenção terapêutica útil e segura em doentes com espasti-cidade? Apresentação de casos

La espasticidad puede causar inmovilidad, postración, dolor crónico, úlceras, infecciones, trombosis y neumonías; los objetivos del tratamiento son controlar el dolor, mejorar la movilidad y la calidad de vida y reincorporar al paciente a sus actividades cotidianas por medio de medicamentos antiespásticos orales; sin embargo, los pacientes con espasticidad severa pueden requerir altas dosis orales de estos medicamentos y presentar efectos adversos, por lo que se ha planteado el uso del baclofeno por vía intratecal; en Colombia no se ha usado ampliamente esta intervención y no existen protocolos sobre las indicaciones para llevarla a cabo. El objetivo de esta serie de casos es presentar la experiencia de la Fundación Cardiovascular de Colombia en el tratamiento con bombas intratecales de baclofeno de cuatro pacientes con espasticidad severa, que no habían evolucionado favorablemente con antiespásticos orales, incluyendo altas dosis de baclofeno. Tres de ellos presentaron mejoría importante del dolor, la espasticidad y la calidad de vida, mientras que el otro cursó con síndrome de tolerancia a este medicamento. La bomba intratecal de baclofeno es una intervención útil y segura para pacientes con espasticidad severa que presentan mala respuesta al tratamiento oral o efectos adversos del mismo.

Spasticity may cause immobility, prostration, chronic pain, bedsores, infections, thrombosis and pneumonia; the purposes of its treatment are to control pain, improve mobility and quality of life, and reincorporate the patient to its daily activities by means of oral anti-spastic drugs; however, patients suffering from severe spasticity may require high oral doses of these medications, which may lead to adverse effects. In such cases, intrathecal baclofen has been proposed as a solution. This procedure has not been widely used in Colombia, so that protocols to perform it have not been established. We report the results obtained with the intrathecal administration of baclofen in four severely spastic patients, who had not previously responded to oral anti-spastic drugs, including high doses of baclofen. Pain, spasticity and quality of life significantly improved in three of them. The remaining one presented tolerance to the medication. Intrathecal baclofen pump is a useful and safe procedure for patients with severe spasticity and poorresponse to oral treatment.

A espasticidade pode causar imobilidade, prostração, dor crônico, úlceras, infeções, trombose e pneumonias; os objetivos do tratamento são controlar ador, melhorar a mobilidade e a qualidade de vida e reincorporar ao doente a suas atividades cotidianas por meio de medicamentos anti-espásticos orais; embora, os pacientes com espasticidade severa podem requerer altas doses orais destes medicamentos eapresentar efeitos adversos, pelo que se há planteado o uso do baclofeno por via intratecal; na Colômbia não se há usado amplamente esta intervenção e não existem protocolos sobre as indicações para levá-la a cabo. O objetivo desta série de casos é apresentar a experiência da Fundação Cardiovascular de Colômbia no tratamento com bombas intratecais de baclofeno de quatro doentes com espasticidade severa, que não haviam evolucionado favoravelmente com anti-espásticos orais, incluindo altas dose de baclofeno. Três deles apresentaram melhoria importante da dor, a espasticidade e a qualidade de vida, enquanto que o outro cursou com síndrome de tolerância a este medicamento. a bomba intratecal de baclofeno é uma intervenção útil e segura para doentes com espasticidade severa que apresentam má resposta aotratamento oral ou efeitos adversos do mesmo.

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

<p><b>INTRODUCTION</b>Intrathecal baclofen (ITB) therapy is a proven, effective treatment for disabling cortical spasticity. We describe the first local series of five patients with acquired brain injury (ABI) who received ITB and were followed up for 63.8 months.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>From 2006 to 2010, a total of five patients received ITB therapy via implanted pumps about 39.4 months after ABI. Four out of five patients experienced significant 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.</p><p><b>CONCLUSION</b>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 efficacy of ITB therapy for chronic disabling spasticity.</p>