Intrathecal baclofen in subjects with spastic hemiplegia: assessment of the antispastic effect during gait.
OBJECTIVE
To determine whether leg muscle stiffness is measurably reduced after intrathecal baclofen (ITB) in subjects with spastic hemiplegia.


METHODS
Nonrandomized trial.


METHODS
Inpatient multidisciplinary rehabilitation unit in France.


METHODS
Seven consecutive subjects with spastic hemiplegia having Ashworth Scale scores for their quadriceps and triceps greater than 2.


METHODS
Subjects were given ITB by lumbar puncture after a dose-selecting test period.


METHODS
Triceps and quadriceps Ashworth scores, gait analysis at preferred and maximal speed measured by a motion analysis system with 2 forceplates, and electromyographic recording of leg muscles before and 4 hours after ITB. The slopes of the moment-angle curves were measured on the hemiplegic side at the onset of ankle and knee flexion to assess muscle stiffness during walking. Pre- and post-ITB spatiotemporal, kinetic, and kinematic data were compared by using a nonparametric test (Wilcoxon signed-rank test).


RESULTS
Ashworth scores of the quadriceps and triceps of all subjects decreased significantly after ITB. Maximal walking speed increased significantly, with a significant increase in stride length, but the preferred walking speed was unchanged. Minimal knee extension and maximal ankle flexion were the only kinematic data significantly different (increased) after ITB. The slope of the ankle moment-angle curve decreased significantly after ITB at preferred gait speed; it also decreased at maximal gait speed in all but 1 subject. Of the 4 available moment-angle curves, 3 showed decreased knee extensor muscle stiffness. The duration of the bursts of spastic muscles decreased after ITB.


CONCLUSIONS
Acute ITB improved walking and reduced muscle stiffness at both the ankles and knees on the spastic hemiplegic side of our subjects. Electromyographic findings suggest that some of the post-ITB reduction in muscle stiffness might be attributed to decreased spasticity.
Rémy-Néris
Olivier
O
Groupe Hopale, Motion Analysis Laboratory, and Department of Physical Medicine, Berck sur Mer, France. Oremyneris@hopale.com
Tiffreau
Vincent
V
Bouilland
Stéphane
S
Bussel
Bernard
B
D000328:Adult; D000842:Ankle / Q000503:physiopathology; D001418:Baclofen / Q000008:administration & dosage* / Q000494:pharmacology; D001696:Biomechanical Phenomena; D001835:Body Weight; D001930:Brain Injuries / Q000150:complications; D002547:Cerebral Palsy / Q000150:complications; D004576:Electromyography; D005260:Female; D005684:Gait / Q000187:drug effects*; D006429:Hemiplegia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007278:Injections, Spinal / Q000379:methods; D007717:Knee / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000494:pharmacology; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000187:drug effects; D012720:Severity of Illness Index; D013129:Spinal Puncture; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome; D016138:Walking
D009125:Muscle Relaxants, Central; D001418:Baclofen