Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study

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✓ A total of 93 patients with intractable spasticity due to either spinal cord injury (59 cases), multiple sclerosis (31 cases), or other spinal pathology (three cases) were entered into a randomized double-blind placebocontrolled screening protocol of intrathecal baclofen test injections. Of the 88 patients who responded to an intrathecal bolus of 50, 75, or 100 µg of baclofen, 75 underwent implantation of a programmable pump system for chronic therapy. Patients were followed for 5 to 41 months after surgery (mean 19 months). No deaths or new permanent neurological deficits occurred as a result of surgery or chronic intrathecal baclofen administration. Rigidity was reduced from a mean preoperative Ashworth scale score of 3.9 to a mean postoperative score of 1.7. Muscle spasms were reduced from a mean preoperative score of 3.1 (on a fourpoint scale) to a mean postoperative score of 1.0. Although the dose of intrathecal baclofen required to control spasticity increased with time, drug tolerance was not a limiting factor in this study. Only one patient withdrew from the study because of a late surgical complication (pump pocket infection). Another patient received an intrathecal baclofen overdose because of a human error in programming the pump. The results of this study indicate that intrathecal baclofen infusion can be safe and effective for the long-term treatment of intractable spasticity in patients with spinal cord injury or multiple sclerosis.

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Address reprint requests to: Robert J. Coffey, M.D., Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
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References
  • 1.

    Albright ALCervi ASingletary J: Intrathecal baclofen for spasticity in cerebral palsy. JAMA 265:141814221991Albright AL Cervi A Singletary J: Intrathecal baclofen for spasticity in cerebral palsy. JAMA 265:1418–1422 1991

    • Search Google Scholar
    • Export Citation
  • 2.

    Coffey RJPenn RDHirsch R: Intrathecal baclofen for intractable spasticity of spinal origin: preliminary results of a multicenter study. Stereotact Funct Neurosurg 54/55:2172181990Coffey RJ Penn RD Hirsch R: Intrathecal baclofen for intractable spasticity of spinal origin: preliminary results of a multicenter study. Stereotact Funct Neurosurg 54/55:217–218 1990

    • Search Google Scholar
    • Export Citation
  • 3.

    DaSilva AT: Intrathecal baclofen. N Engl J Med 321:141414151989 (Letter)DaSilva AT: Intrathecal baclofen. N Engl J Med 321:1414–1415 1989 (Letter)

    • Search Google Scholar
    • Export Citation
  • 4.

    Dralle DMuller HZierski Jet al: Intrathecal baclofen for spasticity. Lancet 2:10031985 (Letter)Dralle D Muller H Zierski J et al: Intrathecal baclofen for spasticity. Lancet 2:1003 1985 (Letter)

    • Search Google Scholar
    • Export Citation
  • 5.

    Frost FNanninga JPenn Ret al: Intrathecal baclofen infusion. Effect of 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 of bladder management programs in patients with myelopathy. Am J Phys Med Rehabil 68:112–115 1989

    • Search Google Scholar
    • Export Citation
  • 6.

    Kroin JSPenn RDBeissinger RLet al: Reduced spinal reflexes following intrathecal baclofen in the rabbit. Exp Brain Res 54:1911941984Kroin JS Penn RD Beissinger RL et al: Reduced spinal reflexes following intrathecal baclofen in the rabbit. Exp Brain Res 54:191–194 1984

    • Search Google Scholar
    • Export Citation
  • 7.

    Kums JJMDelhaas EM: Intrathecal baclofen infusion in patients with spasticity and neurogenic bladder disease. Preliminary results. World J Urol 9:991041991Kums JJM Delhaas EM: Intrathecal baclofen infusion in patients with spasticity and neurogenic bladder disease. Preliminary results. World J Urol 9:99–104 1991

    • Search Google Scholar
    • Export Citation
  • 8.

    Latash MLPenn RDCorcos DMet al: Effects of intrathecal baclofen on voluntary motor control inparesis. J Neurosurg 72:3883921990Latash ML Penn RD Corcos DM et al: Effects of intrathecal baclofen on voluntary motor control inparesis. J Neurosurg 72:388–392 1990

    • Search Google Scholar
    • Export Citation
  • 9.

    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
  • 10.

    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
  • 11.

    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
  • 12.

    MacDonell RATalalla ASwash Met al: Intrathecal baclofen and the H-reflex. J Neurol Neurosurg Psychiatry 52:111011121989MacDonell RA Talalla A Swash M et al: Intrathecal baclofen and the H-reflex. J Neurol Neurosurg Psychiatry 52:1110–1112 1989

    • Search Google Scholar
    • Export Citation
  • 13.

    Muller HZierski JDralle Det al: The effect of intrathecal baclofen on electrical muscle activity in spasticity. J Neurol 234:3483521987Muller H Zierski J Dralle D et al: The effect of intrathecal baclofen on electrical muscle activity in spasticity. J Neurol 234:348–352 1987

    • Search Google Scholar
    • Export Citation
  • 14.

    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
  • 15.

    Narayan RKLoubser PGJankovic Jet al: Intrathecal baclofen for intractable axial dystonia. Neurology 41:114111421991Narayan RK Loubser PG Jankovic J et al: Intrathecal baclofen for intractable axial dystonia. Neurology 41:1141–1142 1991

    • Search Google Scholar
    • Export Citation
  • 16.

    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
  • 17.

    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
  • 18.

    Penn RDKroin JS: Continuous intrathecal baclofen for severe spasticity. Lancet 2:1251211985Penn RD Kroin JS: Continuous intrathecal baclofen for severe spasticity. Lancet 2:125–121 1985

    • Search Google Scholar
    • Export Citation
  • 19.

    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
  • 20.

    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
  • 21.

    Penn RDSavoy SMCorcos Det al: Intrathecal baclofen for severe spinal spasticity. N Engl J Med 230:151715211989Penn RD Savoy SM Corcos D et al: Intrathecal baclofen for severe spinal spasticity. N Engl J Med 230:1517–1521 1989

    • Search Google Scholar
    • Export Citation
  • 22.

    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
  • 23.

    Saltuari LBaumgartner HKofler Met al: Failure of physostigmine in treatment of acute severe intrathecal baclofen intoxication. N Engl J Med 322:153315341990 (Letter)Saltuari L Baumgartner H Kofler M et al: Failure of physostigmine in treatment of acute severe intrathecal baclofen intoxication. N Engl J Med 322:1533–1534 1990 (Letter)

    • Search Google Scholar
    • Export Citation
  • 24.

    Terrence CFFromm GH: Complications of baclofen withdrawal. Arch Neurol 38:5885891981Terrence CF Fromm GH: Complications of baclofen withdrawal. Arch Neurol 38:588–589 1981

    • Search Google Scholar
    • Export Citation
  • 25.

    Wilson PRYaksh TL: Baclofen is antinociceptive in the spinal intrathecal space of animals. Eur J Pharmacol 51:3233301978Wilson PR Yaksh TL: Baclofen is antinociceptive in the spinal intrathecal space of animals. Eur J Pharmacol 51:323–330 1978

    • Search Google Scholar
    • Export Citation
  • 26.

    Yaksh TLReddy SVR: Studies in the primate on the analgetic effects associated with intrathecal actions of opiates, α-adrenergic agonists and baclofen. Anesthesiology 54:4514671981Yaksh TL Reddy SVR: Studies in the primate on the analgetic effects associated with intrathecal actions of opiates α-adrenergic agonists and baclofen. Anesthesiology 54:451–467 1981

    • Search Google Scholar
    • Export Citation
  • 27.

    Young RR: Treatment of spastic paresis. N Engl J Med 320:155315551989 (Editorial)Young RR: Treatment of spastic paresis. N Engl J Med 320:1553–1555 1989 (Editorial)

    • Search Google Scholar
    • Export Citation
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