title: Improved gait performance in a patient with hereditary spastic paraplegia after a continuous intrathecal baclofen test infusion and subsequent pump implantation: a case report.
abstract: OBJECTIVE
  To show the benefits of a continuous intrathecal baclofen (ITB) test infusion in a patient with hereditary spastic paraplegia (HSP), with an improved gait performance after ITB pump implantation.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A 49-year old man with HSP experiencing progressive walking difficulties because of lower extremity spasticity, which did not respond to oral spasmolytics.
  
  
  METHODS
  A prolonged, continuous ITB test infusion was started at a low dose and increased gradually, to provide a stable dose of ITB over a prolonged period. The gradual dose increase provided the patient enough time to experience the effects of ITB, because he feared that ITB therapy might cause functional loss.
  
  
  METHODS
  Modified Ashworth Scale, electromyography, muscle strength, timed Up and Go tests, and the Patient Global Impression of Change. Gait performance before and after ITB pump implantation was assessed in a motion laboratory.
  
  
  RESULTS
  During the test infusion, the ITB dose was gradually increased to a continuous dose of 108μg/d. This dose caused the spasticity to decrease, with maintenance of muscle strength. After pump implantation, gait performance was improved, resulting in increased knee flexion during the loading response and a doubled walking speed as compared with baseline.
  
  
  CONCLUSIONS
  Patients with HSP who have mild spasticity that does not respond to oral spasmolytics should receive a continuous ITB test infusion, to provide them with enough time to experience the delicate balance between spasmolysis and muscle strength. ITB administration is a suitable therapy to improve gait performance in patients with HSP.
authors.affiliation: Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: h.w.heetla@umcg.nl.
authors.forename: Herre W
authors.initials: HW
authors.lastname: Heetla
authors.affiliation: Department of Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Jan P
authors.initials: JP
authors.lastname: Halbertsma
authors.affiliation: Department of Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Rienk
authors.initials: R
authors.lastname: Dekker
authors.affiliation: Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Michiel J
authors.initials: MJ
authors.lastname: Staal
authors.affiliation: Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Teus
authors.initials: T
authors.lastname: van Laar
mesh_terms: D001418:Baclofen / Q000008:administration & dosage*; D004576:Electromyography; D058786:GABA-B Receptor Agonists / Q000008:administration & dosage*; D020233:Gait Disorders, Neurologic / Q000188:drug therapy*; D006801:Humans; D015918:Infusion Pumps, Implantable; D060186:Infusions, Spinal; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D015419:Spastic Paraplegia, Hereditary / Q000188:drug therapy*
chemical_list: D058786:GABA-B Receptor Agonists; D001418:Baclofen
keywords: Baclofen; Case reports; Injections, spinal; Muscle spasticity; Rehabilitation; Spastic paraplegia, hereditary