title: An investigation of the relationship between autonomic dysreflexia and intrathecal baclofen in patients with spinal cord injury.
abstract: To study the relationship between autonomic dysreflexia and intrathecal baclofen in patients with spinal cord injury.
  
  
  
  Retrospective chart review.
  
  
  
  Inpatient and outpatient acute rehabilitation facility.
  
  
  
  Thirty-four subjects.
  
  
  
  We reviewed patients' medical records to ascertain the presence of symptomatic autonomic dysreflexia (AD) prior to and after implantation of an intrathecal baclofen (ITB) pump for spasticity in spinal cord injury patients. We recorded risk factors for autonomic dysreflexia including kidney and bladder stones, heterotopic ossification (HO), and ischial / sacral pressure ulcers.
  
  
  
  Presence of autonomic dysreflexia pre and post-intrathecal baclofen pump placement, presence of risk factors associated with autonomic dysreflexia including (1) kidney or bladder stones, (2) heterotopic ossification, and (3) pressure ulcers.
  
  
  
  Of the 34 subjects, 25 (73.5%) experienced AD prior to ITB pump placement and only 2 (5.9%) after placement. Four subjects (11.8%) had kidney or bladder stones, of which, all had AD prior to placement and none had AD afterwards. Twenty-six subjects (76.5%) had pressure ulcers, of which, all experienced AD prior to placement and only one (0.02%) afterwards. Six patients (17.6%) had HO, of which 5 (83%) had AD prior to placement and none afterwards. Additionally, three patients (8.8%) had at least 2 of the above risk factors, of which, all had AD prior to ITB placement and none afterwards.
  
  
  
  This study showed a significant reduction of symptomatic episodes of autonomic dysreflexia after spinal cord injury, even in those with additional risk factors for development of autonomic dysreflexia.
authors.affiliation: a MetroHealth Medical Center/MetroHealth Rehabilitation Institute of Ohio , Cleveland , OH , USA.
authors.forename: Anna Sophia
authors.initials: AS
authors.lastname: Del Fabro
authors.affiliation: a MetroHealth Medical Center/MetroHealth Rehabilitation Institute of Ohio , Cleveland , OH , USA.|b Department of Physical Medicine & Rehabilitation , Case Western Reserve University School of Medicine , Cleveland , OH , USA.
authors.forename: Melvin
authors.initials: M
authors.lastname: Mejia
authors.affiliation: a MetroHealth Medical Center/MetroHealth Rehabilitation Institute of Ohio , Cleveland , OH , USA.|b Department of Physical Medicine & Rehabilitation , Case Western Reserve University School of Medicine , Cleveland , OH , USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Nemunaitis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020211:Autonomic Dysreflexia / Q000453:epidemiology / Q000209:etiology*; D001418:Baclofen / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D060186:Infusions, Spinal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D013119:Spinal Cord Injuries / Q000188:drug therapy*; D014545:Urinary Calculi / Q000453:epidemiology*
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: Autonomic dysreflexia; Baclofen; Intrathecal