Consciousness recovery induced by intrathecal baclofen administration after subarachnoid hemorrhage -two case reports-.
Two patients with subarachnoid hemorrhage recovered consciousness after intrathecal baclofen administration using an implanted intrathecal baclofen pump delivering 50 microg per day using a simple infusion mode. Intrathecal baclofen resulted in significant reduction of spasticity 3 months after the implantation. Case 1 was reduced to a completely bedridden state with spasticity and could slightly move her fingers following commands. However, the patient could eat food and wash her face with minimal assistance at 3 months after the implantation, and could stand up in the parallel bars with assistance and speak several words at 8 months. Case 2 was in a completely bedridden state at 10 months after onset and could neither drink water nor follow instructions. However, the patient became oriented and could eat by herself within 3 to 4 weeks of implantation. She could walk with a cane and use the stairs with minimal assistance at 2 and 3 months after implantation. The patient could speak fluently within 6 months of implantation. Flatulence and dysuria happened during the screening test, but these symptoms were not repeated after implantation of a pump-catheter-system and continuous intrathecal baclofen infusion. Continuous intrathecal baclofen infusion caused both improvement in muscle tone and spasms and consciousness recovery from the vegetative state. This therapy is a strong candidate treatment for patients with spasticity and consciousness disturbance.
Oyama
Hirofumi
H
Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Gifu, Japan. oya3776@arrow.ocn.ne.jp
Kito
Akira
A
Maki
Hideki
H
Hattori
Kenichi
K
Tanahashi
Kuniaki
K
D000328:Adult; D000368:Aged; D001418:Baclofen / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D018755:GABA Agonists / Q000008:administration & dosage*; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome; D014474:Unconsciousness / Q000188:drug therapy* / Q000209:etiology
D018755:GABA Agonists; D001418:Baclofen