Comparison of long-term outcomes of patients with severe traumatic or hypoxic brain injuries treated with intrathecal baclofen therapy for dysautonomia.
OBJECTIVE
To compare the long-term outcome of patients with severe traumatic brain injury and patients with hypoxic brain injury with dysautonomia and hypertonia treated with intrathecal baclofen therapy.


METHODS
Fifty-three patients with severe traumatic (n = 43/53) or hypoxic (n = 10/53) brain injuries treated by intrathecal baclofen therapy were included to be evaluated with the Coma Recovery Scale-Revised, the Barthel Index, the Glasgow Outcome Scale, the Ashworth scale, the scores of hypertonic attacks, of sweating episode and of voluntary motor responses. A retrospective analysis highlighted patients' characteristics at admission and before surgery and their complications.


RESULTS
After a mean follow-up time of 9.6 years, 13/53 (24.5%) patients had died. Alive patients with traumatic brain injury had a higher level of consciousness recovery (p < 0.02) and more abilities in activities of daily living (p < 0.008) in the long-term. Their dysautonomia and limb hypertonia also significantly improved, contrary to patients with hypoxic brain injury who needed higher doses of baclofen (p < 0.03).


CONCLUSIONS
At long-term follow-up, patients with hypoxic brain injury had a poorer functional outcome than patients with traumatic brain injury with persistent symptoms of dysautonomia associated with uncontrolled hypertonia, despite the use of intrathecal baclofen.
Service de Neurochirurgie, Hôpital Pellegrin, Bordeaux, France.
Xavier
X
Hoarau
Edwidge
E
Richer
Patrick
P
Dehail
Emmanuel
E
Cuny
D000293:Adolescent; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage*; D001930:Brain Injuries / Q000188:drug therapy / Q000503:physiopathology* / Q000534:rehabilitation; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005602:France; D023261:Glasgow Outcome Scale; D006801:Humans; D002534:Hypoxia, Brain / Q000188:drug therapy / Q000503:physiopathology* / Q000534:rehabilitation; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009122:Muscle Hypertonia / Q000188:drug therapy / Q000503:physiopathology* / Q000534:rehabilitation; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D054969:Primary Dysautonomias / Q000188:drug therapy / Q000503:physiopathology* / Q000534:rehabilitation; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D009125:Muscle Relaxants, Central; D001418:Baclofen