A clinical study of intrathecal baclofen using a programmable pump for intractable spasticity.
OBJECTIVE
To determine the impact of intrathecal baclofen (ITB) therapy on outcomes of functional independence, pain, subjective improvement, performance, and standard measures of spasticity.


METHODS
A noncomparative, multicenter, prospective cohort trial of patients with implanted pumps followed up over a 12-month period for the assessment of spasticity, pain, and function.


METHODS
Twenty-four European centers of neurology or rehabilitation familiar with implantable pump technique participated.


METHODS
Patients with intractable spasticity (N=138) who responded positively to a trial dose of baclofen (n=133) and who began ITB therapy (n=129) were enrolled.


METHODS
Implantation of a Medtronic SynchroMed Infusion System with the administration of ITB therapy.


METHODS
Ashworth Scale assessment, Penn Spasm Frequency Scale scores, pain assessment, FIM instrument scores or WeeFIM scores for children, Canadian Occupational Performance Measure (COPM), and subjective ratings of overall relief were the tools administered.


RESULTS
Muscle tone, spasm scores, and pain intensity reductions were observed. Overall FIM scores increased significantly in cognitive and motor function. COPM scores for both performance and satisfaction also improved significantly. Patients reported increased relief from pain and spasticity, supported by physician reports. Forty-three percent of patients reported adverse events, mostly related to patients' underlying conditions (20%), the device implant surgery (10%), or complications with the catheter (9%).


CONCLUSIONS
ITB therapy using a programmable pump is clinically effective and well tolerated, despite a seemingly high level of adverse events, in patients with intractable spasticity of spinal or cerebral origin and may offer improvements in pain relief and function.
Guillaume
Daniel
D
Centre Neurologique et de Réadaptation Fonctionnelle, Fraiture-en-Condroz, Belgium.
Van Havenbergh
Anthony
A
Vloeberghs
Michael
M
Vidal
Joan
J
Roeste
Geir
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D001418:Baclofen / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D009128:Muscle Spasticity / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D017060:Patient Satisfaction; D016896:Treatment Outcome
D009125:Muscle Relaxants, Central; D001418:Baclofen