Intrathecal baclofen administration for control of severe spinal spasticity: functional improvement and long-term follow-up.
OBJECTIVE
To assess long-term efficacy and functional benefits of intrathecal baclofen for severe spinal spasticity.


METHODS
A prospective before-after trial.


METHODS
A neurological rehabilitation department of a university hospital. Pump implantation was realized in neurosurgery; follow-up was carried out mostly on an outpatient basis.


METHODS
Eighteen patients with severe and disabling spinal spasticity received intrathecal baclofen by an implantable pump; average follow-up was 37.4 months (range, 9 to 72).


METHODS
Spasticity (Ashworth and spasms frequency scores); disability (Functional Independence Measure [FIM]).


RESULTS
A significant decrease in tone and spasms was observed in all patients. Tolerance appeared during the first 6 to 9 months. Later on, efficacy remained stable, except in cases of mechanical problems of the pump or catheter. Functional assessment found a highly significant (p < .001) increase of FIM score (particularly for bathing, dressing lower body, transfers, and in some cases, locomotion). This was particularly marked in patients with thoracic spinal cord lesion. In cases of severe upper limb dysfunction, FIM was only improved for wheelchair displacements, due to a better sitting position, but nursing became easier and life comfort was enhanced. Severe side effects (overdose) were observed in two cases.


CONCLUSIONS
Efficacy remained stable after 6 to 9 months. Marked improvement of functional independence was observed in paraplegic patients. Improvement was less spectacular in patients with severe upper limb dysfunction, but nevertheless appreciable in terms of life comfort and use of attendants.
Azouvi
P
P
Department of Neurological Rehabilitation, Raymond Poincaré Hospital, Garches, France.
Mane
M
M
Thiebaut
J B
JB
Denys
P
P
Remy-Neris
O
O
Bussel
B
B
D000203:Activities of Daily Living; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage* / Q000009:adverse effects; D062787:Drug Overdose; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000534:rehabilitation; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000009:adverse effects; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D012648:Self Care; D013119:Spinal Cord Injuries / Q000150:complications / Q000534:rehabilitation*; D018709:Statistics, Nonparametric; D013595:Syringomyelia / Q000150:complications / Q000534:rehabilitation
D009125:Muscle Relaxants, Central; D001418:Baclofen