[Intrathecal baclofen in hereditary spastic paraparesis: benefits and limitations].
BACKGROUND
Chronic intrathecal delivery of baclofen has been introduced for treatment of severe spinal spasticity. Very little is known about this treatment in hereditary spastic paraparesis. Here we review the benefits and limitations of pump implantation for baclofen delivery in this population.


METHODS
Consecutive patients presenting with hereditary spastic paraparesis were assessed for spasticity (Ashworth and Penn scores), muscular strength and walking (speed, comfort and perimeter length). The effect of intrathecal delivery of baclofen was judged after progressive bolus injections or chronic administration by electrical syringe. The pump implantation was proposed when spasticity scores decreased by 2 or more points, with muscular strength preserved and walking area increased.


RESULTS
We investigated 6 patients (3 males; mean age 48 years) with hereditary spastic paraparesis. The mean follow-up was 19 years; for 4 patients who received pump implantation, the mean follow-up was 6.2 years. The mean baclofen daily dose was 75 mug. Satisfaction was high for patients who received implantation early instead of waiting for the natural course of the disease.


CONCLUSIONS
Some patients with hereditary spastic paraparesis have good functional improvement with chronic intrathecal delivery of baclofen if walking is still possible. Despite the natural history of the disease, functional results are stable during the first 5 years of treatment. The data indicate a possible compromise between decreased spasticity and muscular strengthening with the treatment.
Lambrecq
V
V
Département de neurologie, CHU de Bordeaux, pôle neurosciences cliniques, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
Muller
F
F
Joseph
P-A
PA
Cuny
E
E
Mazaux
J-M
JM
Barat
M
M
D001418:Baclofen / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use*; D020336:Paraparesis, Spastic / Q000188:drug therapy*
D009125:Muscle Relaxants, Central; D001418:Baclofen