Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study.
A total of 93 patients with intractable spasticity due to either spinal cord injury (59 cases), multiple sclerosis (31 cases), or other spinal pathology (three cases) were entered into a randomized double-blind placebo-controlled screening protocol of intrathecal baclofen test injections. Of the 88 patients who responded to an intrathecal bolus of 50, 75, or 100 micrograms of baclofen, 75 underwent implantation of a programmable pump system for chronic therapy. Patients were followed for 5 to 41 months after surgery (mean 19 months). No deaths or new permanent neurological deficits occurred as a result of surgery or chronic intrathecal baclofen administration. Rigidity was reduced from a mean preoperative Ashworth scale score of 3.9 to a mean postoperative score of 1.7. Muscle spasms were reduced from a mean preoperative score of 3.1 (on a four-point scale) to a mean postoperative score of 1.0. Although the dose of intrathecal baclofen required to control spasticity increased with time, drug tolerance was not a limiting factor in this study. Only one patient withdrew from the study because of a late surgical complication (pump pocket infection). Another patient received an intrathecal baclofen overdose because of a human error in programming the pump. The results of this study indicate that intrathecal baclofen infusion can be safe and effective for the long-term treatment of intractable spasticity in patients with spinal cord injury or multiple sclerosis.
Coffey
J R
JR
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
Cahill
D
D
Steers
W
W
Park
T S
TS
Ordia
J
J
Meythaler
J
J
Herman
R
R
Shetter
A G
AG
Levy
R
R
Gill
B
B
D000328:Adult; D000368:Aged; D001418:Baclofen / Q000008:administration & dosage*; D004311:Double-Blind Method; D004361:Drug Tolerance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D013118:Spinal Cord Diseases / Q000150:complications*; D013119:Spinal Cord Injuries / Q000150:complications*
D001418:Baclofen