Intraventricular baclofen as an alternative to intrathecal baclofen for intractable spasticity or dystonia: outcomes and technical considerations

Clinical article

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Object

The aim of this study was to identify the benefits of intraventricular baclofen (IVB) therapy for the treatment of intractable spasticity or dystonia in a subset of patients who had experienced multiple revisions while receiving intrathecal baclofen (ITB) therapy.

Methods

The authors reviewed the charts of 22 consecutive patients with intractable spasticity or dystonia who initially underwent ITB therapy, subsequently suffered multiple revisions during ITB therapy, and ultimately received IVB therapy, all during a 12-year period from November 1998 to October 2010. The intraventricular catheters were positioned in the lateral ventricle, aided by stereonavigation.

Results

The surgical revision rate (the average number of surgical revisions per average number of follow-up years) during ITB therapy was 0.84, and was 0.50 during IVB therapy. The most frequent complication requiring surgical revision during ITB therapy was catheter occlusion, followed by pump malfunction/pump pocket issues, and infection. The most frequent complication requiring surgical revision during IVB therapy was infection, followed by catheter misplacement/migration. Four patients suffered infection that required removal of their intraventricular catheter, and currently have no baclofen system.

Conclusions

Some of these patients had a history of increasing revisions with increasing frequency during ITB therapy. Such a history puts them at risk for spinal arachnoiditis, a condition that complicates further ITB therapy. For such patients, the authors believe that IVB therapy may be a beneficial therapeutic option, given that the surgical revision rate was lower for IVB than for ITB. Intraventricular baclofen may be a cost-effective option for patients with mounting revisions during ITB therapy.

Abbreviations used in this paper:ITB = intrathecal baclofen; IVB = intraventricular baclofen.
Article Information

Contributor Notes

Address correspondence to: Aaron A. Cohen-Gadol, M.D., M.Sc., Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, 1801 North Senate Boulevard #610, Indianapolis, Indiana 46202. email: acohenmd@gmail.com.Please include this information when citing this paper: published online August 3, 2012; DOI: 10.3171/2012.6.PEDS11456.
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References
  • 1

    Albright AL: Intraventricular baclofen infusion for dystonia. Report of two cases. J Neurosurg 105:1 Suppl71742006

  • 2

    Albright AL: Long-term intraventricular baclofen infusion in beagles. J Neurosurg 107:3 Suppl2252272007

  • 3

    Albright ALBarry MJFasick PBarron WShultz B: Continuous intrathecal baclofen infusion for symptomatic generalized dystonia. Neurosurgery 38:9349391996

    • Search Google Scholar
    • Export Citation
  • 4

    Albright ALBarry MJPainter MJShultz B: Infusion of intrathecal baclofen for generalized dystonia in cerebral palsy. J Neurosurg 88:73761998

    • Search Google Scholar
    • Export Citation
  • 5

    Albright ALBarry MJShafton DHFerson SS: Intrathecal baclofen for generalized dystonia. Dev Med Child Neurol 43:6526572001

  • 6

    Albright ALCervi ASingletary J: Intrathecal baclofen for spasticity in cerebral palsy. JAMA 265:141814221991

  • 7

    Albright ALFerson SS: Intraventricular baclofen for dystonia: techniques and outcomes. Clinical article. J Neurosurg Pediatr 3:11142009

    • Search Google Scholar
    • Export Citation
  • 8

    Albright ALThompson KCarlos SMinnigh MB: Cerebrospinal fluid baclofen concentrations in patients undergoing continuous intrathecal baclofen therapy. Dev Med Child Neurol 49:4234252007

    • Search Google Scholar
    • Export Citation
  • 9

    Aldrete JA: Neurologic deficits and arachnoiditis following neuroaxial anesthesia. Acta Anaesthesiol Scand 47:3122003

  • 10

    Becker RAlberti OBauer BL: Continuous intrathecal baclofen infusion in severe spasticity after traumatic or hypoxic brain injury. J Neurol 244:1601661997

    • Search Google Scholar
    • Export Citation
  • 11

    Borowski ALittleton AGBorkhuu BPresedo AShah SDabney KW: Complications of intrathecal baclofen pump therapy in pediatric patients. J Pediatr Orthop 30:76812010

    • Search Google Scholar
    • Export Citation
  • 12

    Collins PHockley ADWoollam DH: Surface ultrastructure of tissues occluding ventricular catheters. J Neurosurg 48:6096131978

  • 13

    de Lissovoy GMatza LSGreen HWerner MEdgar T: Cost-effectiveness of intrathecal baclofen therapy for the treatment of severe spasticity associated with cerebral palsy. J Child Neurol 22:49592007

    • Search Google Scholar
    • Export Citation
  • 14

    Deer TRRaso LJCoffey RJAllen JW: Intrathecal baclofen and catheter tip inflammatory mass lesions (granulomas): a reevaluation of case reports and imaging findings in light of experimental, clinicopathological, and radiological evidence. Pain Med 9:3913952008

    • Search Google Scholar
    • Export Citation
  • 15

    Diederich NJComella CLMatge GBecker GSchiltz FMetz H: Sustained effect of high-dose intrathecal baclofen in primary generalized dystonia: a 2-year follow-up study. Mov Disord 12:110011021997

    • Search Google Scholar
    • Export Citation
  • 16

    Ford BGreene PLouis EDPetzinger GBressman SBGoodman R: Use of intrathecal baclofen in the treatment of patients with dystonia. Arch Neurol 53:124112461996

    • Search Google Scholar
    • Export Citation
  • 17

    François BVacher PRoustan JSalle JYVidal JMoreau JJ: Intrathecal baclofen after traumatic brain injury: early treatment using a new technique to prevent spasticity. J Trauma 50:1581612001

    • Search Google Scholar
    • Export Citation
  • 18

    Guevara JALa Torre JDenoya CZúccaro G: Microscopic studies in shunts for hydrocephalus. Childs Brain 8:2842931981

  • 19

    Haranhalli NAnand DWisoff JHHarter DHWeiner HLBlate M: Intrathecal baclofen therapy: complication avoidance and management. Childs Nerv Syst 27:4214272011

    • Search Google Scholar
    • Export Citation
  • 20

    Jones LLTuszynski MH: Chronic intrathecal infusions after spinal cord injury cause scarring and compression. Microsc Res Tech 54:3173242001

    • Search Google Scholar
    • Export Citation
  • 21

    Kaufman BAPark TS: Ventricular anatomy and shunt catheters. Pediatr Neurosurg 31:161999

  • 22

    Motta FBuonaguro VStignani C: The use of intrathecal baclofen pump implants in children and adolescents: safety and complications in 200 consecutive cases. J Neurosurg 107:1 Suppl32352007

    • Search Google Scholar
    • Export Citation
  • 23

    Park TS: Editorial. Intraventricular baclofen. J Neurosurg 107:3 Suppl2242007

  • 24

    Penn RD: Drug pumps for treatment of neurologic diseases and pain. Neurol Clin 3:4394511985

  • 25

    Penn RDKroin JS: Continuous intrathecal baclofen for severe spasticity. Lancet 2:1251271985

  • 26

    Penn RDKroin JS: Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1:10781984. (Letter)

  • 27

    Penn RDSavoy SMCorcos DLatash MGottlieb GParke B: Intrathecal baclofen for severe spinal spasticity. N Engl J Med 320:151715211989

    • Search Google Scholar
    • Export Citation
  • 28

    Postma TJOenema DTerpstra SBouma JKuipers-Upmeijer HStaal MJ: Cost analysis of the treatment of severe spinal spasticity with a continuous intrathecal baclofen infusion system. Pharmacoeconomics 15:3954041999

    • Search Google Scholar
    • Export Citation
  • 29

    Sampson FCHayward AEvans GMorton RCollett B: Functional benefits and cost/benefit analysis of continuous intrathecal baclofen infusion for the management of severe spasticity. J Neurosurg 96:105210572002

    • Search Google Scholar
    • Export Citation
  • 30

    Siebner HRDressnandt JAuer CConrad B: Continuous intrathecal baclofen infusions induced a marked increase of the transcranially evoked silent period in a patient with generalized dystonia. Muscle Nerve 21:120912121998

    • Search Google Scholar
    • Export Citation
  • 31

    Turner MS: Assessing syndromes of catheter malfunction with SynchroMed infusion systems: the value of spiral computed tomography with contrast injection. PM R 2:7577662010

    • Search Google Scholar
    • Export Citation
  • 32

    Vender JRHester SWaller JLRekito ALee MR: Identification and management of intrathecal baclofen pump complications: a comparison of pediatric and adult patients. J Neurosurg 104:1 Suppl9152006

    • Search Google Scholar
    • Export Citation
  • 33

    Ward AHayden SDexter MScheinberg A: Continuous intrathecal baclofen for children with spasticity and/or dystonia: goal attainment and complications associated with treatment. J Paediatr Child Health 45:7207262009

    • Search Google Scholar
    • Export Citation
  • 34

    Zhang SXHuang FGates MWhite JHolmberg EG: Extensive scarring induced by chronic intrathecal tubing augmented cord tissue damage and worsened functional recovery after rat spinal cord injury. J Neurosci Methods 191:2012072010

    • Search Google Scholar
    • Export Citation
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