gms | German Medical Science

Objective: The aim of the study was to ascertain the long term effectiveness of intrathecal baclofen therapy with adults suffering from severe cerebral spasticity. Up to now, there are only a few systematic investigations on spasmolytic treatment in apallic patients with cerebral spasticity.

Methods: 24 patients with severe spasticity due to traumatic, hypoxic or haemorrhagic brain injury were treated with intrathecal baclofen via a subcutaneously implanted pump system (Synchromed^®). Their average age was 43 years. Follow-up was obtained after 2 years (range: 12 months to 4 years). The therapeutic effect was assessed by the Modified Ashworth Scale (MAS) and the Functional Independence Measure (FIM) were used to assess the therapeutic effect.

Results: The MAS score decreased from 3.4 ± 0.98 to 2.4 ± 0.83 showing a statistically significant improvement (p=0,008). The FIM scale showed no marked changes within the observation period. The dosage of intrathecal baclofen increased from a mean of 314 ± 154µg/d at one month after pump insertion to 583 ± 275 µg/d at 2 years post implantation. The seriousness of contractures remained constant in comparison to the initial state. The alleviation of arm spasticity showed no statistically significant correlation to the level of the tip of the spinal catheter (range: Th 3 to Th 12). The complication rate was 8.3% (one infection and one occlusion of a spinal catheter).

Conclusions: Intrathecal application of baclofen was shown to be an effective treatment in apallic patients with cerebral spasticity. To avoid the development of contractures intrathecal application should be initiated as soon as oral spasmolytic medication with accompanying physical therapy is found to be insufficient.