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

Restricted access

✓ 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poor long-term responders, four deaths due to underlying disease, and three whose participation has been voluntarily withdrawn.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.

Article Information

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.
Headings
References
  • 1.

    Frost FNanninga JPenn Ret al: Intrathecal baclofen infusion: effect on bladder management programs in patients with myelopathy. Am J Phys Med Rehabil 68:1121151989Frost 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 GJStewart-Wynne EGPerlman D: Intrathecal baclofen for severe spasticity. Med J Aust 147:2611987 (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 JSPenn 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 Press1989 pp 601616Kroin 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 MLPenn RDCorcos DMet al: Effects of intrathecal baclofen on voluntary motor control in spastic paresis. J Neurosurg 72:3883921990Latash 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 MLPenn RDCorcos DMet al: Short-term effects of intrathecal baclofen in spasticity. Exp Neurol 103:1651721989Latash 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 YSallerin-Caute BVerdie JCet al: Chronic intrathecal baclofen administration for control of severe spasticity. J Neurosurg 72:3934021990Lazorthes 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 PGNarayan RKSandin KJet al: Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury. Paraplegia 29:48641991Loubser 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 13:1841861991Müller 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 HZierski JPenn RD: Local-Spinal Therapy of Spasticity. Berlin: Springer-Verlag1988Müller H Zierski J Penn RD: Local-Spinal Therapy of Spasticity. Berlin: Springer-Verlag 1988

    • Search Google Scholar
    • Export Citation
  • 10.

    Müller-Schwefe GPenn RD: Physostigmine in the treatment of intrathecal baclofen overdose. Report of three cases. J Neurosurg 71:2732751989Müller-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 JBFrost FPenn R: Effect of intrathecal baclofen on bladder and sphincter function. J Urol 142:1011051989Nanninga 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 GStruppler AMeyerson BAet al: Intrathecal baclofen for long-term treatment of spasticity: a multicentre study. J Neurol Neurosurg Psychiatry 52:9339391989Ochs 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 BPenn RDSavoy SMet al: Functional outcome after delivery of intrathecal baclofen. Arch Phys Med Rehabil 70:30321989Parke 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 Sciences1988 pp 157166Penn 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 RDKroin JS: Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1:10781984 (Letter)Penn RD Kroin JS: Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1:1078 1984 (Letter)

    • Search Google Scholar
    • Export Citation
  • 16.

    Penn RDKroin JS: Long-term intrathecal baclofen infusion for treatment of spasticity. J Neurosurg 66:1811851987Penn 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 RDSavoy SMCorcos Det al: Intrathecal baclofen for severe spinal spasticity. N Engl J Med 320:151715211989Penn 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 TKShapiro SA: Efficacy of dorsal longitudinal myelotomy in treating spinal spasticity: a review of 20 cases. J Neurosurg 75:3974011991Putty 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 ASAli AFordham EWet al: Indium-111 DTPA flow study to evaluate surgically implanted drug pump delivery system. Clin Nucl Med 15:1541561990Rosenson 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 MMertens P: Indications for surgery to treat adults with harmful spasticity in Sindou MAbbott RKeravel Y (eds): Neurosurgery for Spasticity. Wien: Springer-Verlag1991 pp 211214Sindou 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 AGrundy DMacdonell R: The effect of intrathecal baclofen on the lower urinary tract in paraplegia. Paraplegia 28:4204271990Talalla 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
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 266 246 8
Full Text Views 217 92 4
PDF Downloads 126 44 2
EPUB Downloads 0 0 0
PubMed
Google Scholar