Intrathecal baclofen for spasticity of spinal origin: seven years of experience

View More View Less
  • 1 Department of Neurosurgery, Rush Medical College, Chicago, Illinois
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ A total of 66 consecutive patients with severe spasticity of spinal cord origin were screened with intrathecal baclofen, and all but two responded with a two-point decrease in their Ashworth spasticity scale and/or spasm scale score. Of these, 62 elected to receive chronic intrathecal baclofen administration by means of an implanted delivery system. These patients have been followed for an average of 30 months (the first three for 81 months). Intrathecal baclofen has been well tolerated and all serious side effects were transient and have been managed by dose adjustments. The pump presently available has worked safely; the only problem has been stalling in 7% of these devices. The catheter system has had to be repaired in just over one-half of the patients and is the main cause of interruption of drug delivery. Of the 62 patients implanted, 52 (84%) continue to be treated adequately for spasticity; there are three poor long-term responders, four deaths due to underlying disease, and three whose participation has been voluntarily withdrawn. It is suggested that long-term control of spinal spasticity by intrathecal baclofen can be achieved in most patients.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Richard D. Penn, M.D., Department of Neurosurgery, Rush-Presbyterian-St. Luke's Medical Center, 1653 West Congress Parkway, Chicago, Illinois 60612.
  • 1.

    Frost F, , Nanninga J, & Penn R, et al: Intrathecal baclofen infusion: effect on bladder management programs in patients with myelopathy. Am J Phys Med Rehabil 68:112115, 1989 Frost F, Nanninga J, Penn R, et al: Intrathecal baclofen infusion: effect on bladder management programs in patients with myelopathy. Am J Phys Med Rehabil 68:112–115, 1989

    • Search Google Scholar
    • Export Citation
  • 2.

    Hankey GJ, , Stewart-Wynne EG, & Perlman D: Intrathecal baclofen for severe spasticity. Med J Aust 147:261, 1987 (Letter) Hankey GJ, Stewart-Wynne EG, Perlman D: Intrathecal baclofen for severe spasticity. Med J Aust 147:261, 1987 (Letter)

    • Search Google Scholar
    • Export Citation
  • 3.

    Kroin JS, & Penn RD: Implantable pumps to deliver drugs directly into the CNS, in Neuwelt EA (eds): Implications of the Blood-Brain Barrier and Its Manipulation. Vol 2: Clinical Aspects. New York: Plenum Press, 1989, pp 601616 Kroin JS, Penn RD: Implantable pumps to deliver drugs directly into the CNS, in Neuwelt EA (eds): Implications of the Blood-Brain Barrier and Its Manipulation. Vol 2: Clinical Aspects. New York: Plenum Press, 1989, pp 601–616

    • Search Google Scholar
    • Export Citation
  • 4.

    Latash ML, , Penn RD, & Corcos DM, et al: Effects of intrathecal baclofen on voluntary motor control in spastic paresis. J Neurosurg 72:388392, 1990 Latash ML, Penn RD, Corcos DM, et al: Effects of intrathecal baclofen on voluntary motor control in spastic paresis. J Neurosurg 72:388–392, 1990

    • Search Google Scholar
    • Export Citation
  • 5.

    Latash ML, , Penn RD, & Corcos DM, et al: Short-term effects of intrathecal baclofen in spasticity. Exp Neurol 103:165172, 1989 Latash ML, Penn RD, Corcos DM, et al: Short-term effects of intrathecal baclofen in spasticity. Exp Neurol 103:165–172, 1989

    • Search Google Scholar
    • Export Citation
  • 6.

    Lazorthes Y, , Sallerin-Caute B, & Verdie JC, et al: Chronic intrathecal baclofen administration for control of severe spasticity. J Neurosurg 72:393402, 1990 Lazorthes Y, Sallerin-Caute B, Verdie JC, et al: Chronic intrathecal baclofen administration for control of severe spasticity. J Neurosurg 72:393–402, 1990

    • Search Google Scholar
    • Export Citation
  • 7.

    Loubser PG, , Narayan RK, & Sandin KJ, et al: Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury. Paraplegia 29:4864, 1991 Loubser PG, Narayan RK, Sandin KJ, et al: Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury. Paraplegia 29:48–64, 1991

    • Search Google Scholar
    • Export Citation
  • 8.

    Müller H: Treatment of severe spasticity: results of a multicenter trial conducted in Germany involving the intrathecal infusion of baclofen by an implantable drug delivery system. Rev Eur Tech Biomed 13:184186, 1991 Müller H: Treatment of severe spasticity: results of a multicenter trial conducted in Germany involving the intrathecal infusion of baclofen by an implantable drug delivery system. Rev Eur Tech Biomed 13:184–186, 1991

    • Search Google Scholar
    • Export Citation
  • 9.

    Müller H, , Zierski J, & Penn RD: Local-Spinal Therapy of Spasticity. Berlin: Springer-Verlag, 1988 Müller H, Zierski J, Penn RD: Local-Spinal Therapy of Spasticity. Berlin: Springer-Verlag, 1988

    • Search Google Scholar
    • Export Citation
  • 10.

    Müller-Schwefe G, & Penn RD: Physostigmine in the treatment of intrathecal baclofen overdose. Report of three cases. J Neurosurg 71:273275, 1989 Müller-Schwefe G, Penn RD: Physostigmine in the treatment of intrathecal baclofen overdose. Report of three cases. J Neurosurg 71:273–275, 1989

    • Search Google Scholar
    • Export Citation
  • 11.

    Nanninga JB, , Frost F, & Penn R: Effect of intrathecal baclofen on bladder and sphincter function. J Urol 142:101105, 1989 Nanninga JB, Frost F, Penn R: Effect of intrathecal baclofen on bladder and sphincter function. J Urol 142:101–105, 1989

    • Search Google Scholar
    • Export Citation
  • 12.

    Ochs G, , Struppler A, & Meyerson BA, et al: Intrathecal baclofen for long-term treatment of spasticity: a multicentre study. J Neurol Neurosurg Psychiatry 52:933939, 1989 Ochs G, Struppler A, Meyerson BA, et al: Intrathecal baclofen for long-term treatment of spasticity: a multicentre study. J Neurol Neurosurg Psychiatry 52:933–939, 1989

    • Search Google Scholar
    • Export Citation
  • 13.

    Parke B, , Penn RD, & Savoy SM, et al: Functional outcome after delivery of intrathecal baclofen. Arch Phys Med Rehabil 70:3032, 1989 Parke B, Penn RD, Savoy SM, et al: Functional outcome after delivery of intrathecal baclofen. Arch Phys Med Rehabil 70:30–32, 1989

    • Search Google Scholar
    • Export Citation
  • 14.

    Penn RD: Intrathecal baclofen for severe spasticity, in Penn RD (eds): Neurological Applications of Implanted Drug Pumps. New York: New York Academy of Sciences, 1988, pp 157166 Penn RD: Intrathecal baclofen for severe spasticity, in Penn RD (eds): Neurological Applications of Implanted Drug Pumps. New York: New York Academy of Sciences, 1988, pp 157–166

    • Search Google Scholar
    • Export Citation
  • 15.

    Penn RD, & Kroin JS: Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1:1078, 1984 (Letter) Penn RD, Kroin JS: Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1:1078, 1984 (Letter)

    • Search Google Scholar
    • Export Citation
  • 16.

    Penn RD, & Kroin JS: Long-term intrathecal baclofen infusion for treatment of spasticity. J Neurosurg 66:181185, 1987 Penn RD, Kroin JS: Long-term intrathecal baclofen infusion for treatment of spasticity. J Neurosurg 66:181–185, 1987

    • Search Google Scholar
    • Export Citation
  • 17.

    Penn RD, , Savoy SM, & Corcos D, et al: Intrathecal baclofen for severe spinal spasticity. N Engl J Med 320:15171521, 1989 Penn RD, Savoy SM, Corcos D, et al: Intrathecal baclofen for severe spinal spasticity. N Engl J Med 320:1517–1521, 1989

    • Search Google Scholar
    • Export Citation
  • 18.

    Putty TK, & Shapiro SA: Efficacy of dorsal longitudinal myelotomy in treating spinal spasticity: a review of 20 cases. J Neurosurg 75:397401, 1991 Putty TK, Shapiro SA: Efficacy of dorsal longitudinal myelotomy in treating spinal spasticity: a review of 20 cases. J Neurosurg 75:397–401, 1991

    • Search Google Scholar
    • Export Citation
  • 19.

    Rosenson AS, , Ali A, & Fordham EW, et al: Indium-111 DTPA flow study to evaluate surgically implanted drug pump delivery system. Clin Nucl Med 15:154156, 1990 Rosenson AS, Ali A, Fordham EW, et al: Indium-111 DTPA flow study to evaluate surgically implanted drug pump delivery system. Clin Nucl Med 15:154–156, 1990

    • Search Google Scholar
    • Export Citation
  • 20.

    Sindou M, & Mertens P: Indications for surgery to treat adults with harmful spasticity, in Sindou M, , Abbott R, & Keravel Y (eds): Neurosurgery for Spasticity. Wien: Springer-Verlag, 1991, pp 211214 Sindou M, Mertens P: Indications for surgery to treat adults with harmful spasticity, in Sindou M, Abbott R, Keravel Y (eds): Neurosurgery for Spasticity. Wien: Springer-Verlag, 1991, pp 211–214

    • Search Google Scholar
    • Export Citation
  • 21.

    Talalla A, , Grundy D, & Macdonell R: The effect of intrathecal baclofen on the lower urinary tract in paraplegia. Paraplegia 28:420427, 1990 Talalla A, Grundy D, Macdonell R: The effect of intrathecal baclofen on the lower urinary tract in paraplegia. Paraplegia 28:420–427, 1990

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 461 196 25
Full Text Views 232 15 0
PDF Downloads 136 10 1
EPUB Downloads 0 0 0