gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Long-term intrathecal baclofen in patients with severe cerebral spasticity

Intrathecale Baclofen-Langzeittherapie bei Patienten mit schwerer zerebraler Spastik

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  • corresponding author J. Koy - Klinik für Neurochirurgie, Universitätsklinikum Dresden
  • T. Pardula - Klinik für Neurochirurgie, Universitätsklinikum Dresden
  • M. Pohl - Klinik Bavaria, Kreischa
  • G. Schackert - Klinik für Neurochirurgie, Universitätsklinikum Dresden

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 02.17

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc234.shtml

Published: May 8, 2006

© 2006 Koy et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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 antispastic 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).

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 antispastic medication with accompanying physical therapy is found to be insufficient.