Prospective study on the use of bolus intrathecal baclofen for spastic hypertonia due to acquired brain injury.
OBJECTIVE
To determine if the intrathecal delivery of baclofen will decrease spastic hypertonia caused by brain injury.


METHODS
Eleven patients more than 1 year after their brain injury with disabling lower extremity spastic hypertonia.


METHODS
University tertiary care outpatient rehabilitation clinic.


METHODS
Patients were a consecutive sample randomized in a double blind, placebo-controlled crossover study.


METHODS
Bolus intrathecal injection of either normal saline or 50 micrograms baclofen.


METHODS
Data for Ashworth rigidity scores, spasm scores, and deep tendon reflex scores were collected for both the upper extremities (UE) and lower extremities (LE). Changes over time were assessed via Friedman's test. Differences between the placebo and active drug at any given time were assessed via Wilcoxon signed-rank.


RESULTS
Four hours after injection with the active drug (maximum effect) the average LE Ashworth score decreased from 4.2 +/- 0.8 (SD) to 2.2 +/- 0.6 (p = .0033), spasm score from 3.1 +/- 1.0 to 1.0 +/- 0.7 (p = .0032), and reflex score from 3.3 +/- 0.5 to 1.0 +/- 1.3 (p = .0033). The average UE Ashworth score decreased from 3.3 +/- 1.3 to 1.9 +/- 0.8 (p = .0033), spasm score from 1.8 +/- 1.3 to 0.6 +/- 1.0 (p = .007), and reflex score from 2.7 +/- 0.5 to 1.7 +/- 0.6 (p = .0111). No trend was observed over time with placebo administration. There were significant reductions in the average for LE Ashworth (p < .0001), spasm (p < .0001), and reflex (p < .0001) scores and for UE Ashworth (p < .0001) and spasm (p < .0004) scores observed over 4 hours (maximum effect) with active drug administration. No significant differences were noted between the active drug and placebo groups before administration in LE and UE Ashworth, spasm, or reflex scores. There were significant differences between the active drug and placebo groups at 4 hours after administration for LE and UE Ashworth, spasm, and reflex scores (p < or = .0272).


CONCLUSIONS
Intrathecal injection of baclofen is capable of reducing the spastic hypertonia associated with brain injury.
Meythaler
J M
JM
Department of Rehabilitation Medicine, University of Alabama-Birmingham School of Medicine 35233-7330, USA.
DeVivo
M J
MJ
Hadley
M
M
D000328:Adult; D001418:Baclofen / Q000008:administration & dosage*; D001930:Brain Injuries / Q000150:complications*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D009222:Myotonia / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D013035:Spasm / Q000188:drug therapy / Q000209:etiology
D001418:Baclofen