title: Treatment of severe, disabling spasticity with continuous intrathecal baclofen therapy following acquired brain injury: the experience of a tertiary institution in Singapore.
abstract: BACKGROUND
  Intrathecal baclofen (ITB) therapy is a proven, effective treatment for disabling cortical spasticity. We describe the first local series of five patients with acquired brain injury (ABI) who received ITB and were followed up for 63.8 months.
  
  
  METHODS
  A retrospective review of medical and rehabilitation records of patients who received ITB therapy was carried out. Data studied included baseline demographic and injury variables, implantation data, spasticity and function, ITB dosage over time and complications.
  
  
  RESULTS
  From 2006 to 2010, a total of five patients received ITB therapy via implanted pumps about 39.4 months after ABI. Four out of five patients experienced significant reductions in their lower limb spasticity scores and improvements in global function and dependency. One patient had minor adverse events associated with baclofen-related sedation. The mean ITB dose at one year was 182.7 ± 65.6 mcg/day.
  
  
  CONCLUSIONS
  Our preliminary study showed encouraging long-term outcomes and safety for ITB therapy after ABI-related intractable spasticity. Individual ITB responses over time were variable, with gender differences. The outcomes experienced by our centre were comparable to those in the general ABI population, supporting the efficacy of ITB therapy for chronic disabling spasticity.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Zhe Min
authors.initials: ZM
authors.lastname: Wang
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Jia Hao
authors.initials: JH
authors.lastname: Law
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore.
authors.forename: Nicolas Kon Kam
authors.initials: NK
authors.lastname: King
authors.affiliation: Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Deshan Kumar
authors.initials: DK
authors.lastname: Rajeswaran
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore.
authors.forename: Samantha
authors.initials: S
authors.lastname: Soh
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore.
authors.forename: Jai Prashanth
authors.initials: JP
authors.lastname: Rao
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore.
authors.forename: Wai Hoe
authors.initials: WH
authors.lastname: Ng
authors.affiliation: Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Karen Sui Geok
authors.initials: KS
authors.lastname: Chua
mesh_terms: D001418:Baclofen / Q000008:administration & dosage*; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D009128:Muscle Spasticity / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: dystonia; hypertonia; intrathecal baclofen pump; spasticity; traumatic brain injury
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