A 10-year follow-up study of patients with severe traumatic brain injury and dysautonomia treated with intrathecal baclofen therapy.
OBJECTIVE
To describe the long-term disorders of consciousness in patients with dysautonomia and hypertonia treated with intrathecal baclofen therapy (IBT).


METHODS
Forty-three patients with severe traumatic brain injuries who were previously implanted with an intrathecal baclofen pump were included to be evaluated in the long-term with the Coma Recovery Scale-Revised. The Barthel Index, the Glasgow Outcome Scale, the Ashworth scale, the scores of hypertonic attacks, of sweating episodes and of voluntary motor responses were used to describe functional abilities and residual impairments. A retrospective analysis highlighted patients' characteristics at admission, before surgery and their complications.


RESULTS
After a mean follow-up of 10 years, nine of 43 (20.9%) patients had died, 13/43 (30.2%) patients were severely disabled or in an unresponsive wakefulness syndrome and 21/43 (48.8%) patients had good recovery of consciousness. The latter patients tended to receive IBT later, suggesting a later development of uncontrolled symptoms of dysautonomia and hypertonia. They needed lower doses of baclofen, suggesting that they had less severe symptoms. Their dysautonomia, limb hypertonia and voluntary motor responses improved significantly compared to patients with poor outcome.


CONCLUSIONS
Recovery of good long-term consciousness is possible. A low level of consciousness recovery and the early development of severe and persistent symptoms of dysautonomia associated with hypertonia could be linked to poor long-term outcome.
Service de Neurochirurgie, Hôpital Pellegrin, Bordeaux, France.
Xavier
X
Hoarau
Edwige
E
Richer
Patrick
P
Dehail
Emmanuel
E
Cuny
D000293:Adolescent; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage / Q000627:therapeutic use*; D001930:Brain Injuries / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000627:therapeutic use*; D054969:Primary Dysautonomias / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation; D011379:Prognosis; D020127:Recovery of Function / Q000187:drug effects; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D009125:Muscle Relaxants, Central; D001418:Baclofen