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Clin Neurophysiol. 2012 Nov;123(11):2200-4. doi: 10.1016/j.clinph.2012.04.007. Epub 2012 May 16.

Effect of concentration and mode of intrathecal baclofen administration on soleus H-reflex in patients with muscle hypertonia.

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  • 1Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA. dstokic@mmrcrehab.org

Abstract

OBJECTIVES:

Assess spinal reflex excitability after increasing intrathecal baclofen (ITB) flow by manipulation of drug concentration and mode of administration.

METHODS:

The effect of concentration was assessed by comparing changes in H-reflex (H/M ratio) 1-6h after a 50μg ITB bolus at 50μg/ml concentration administered manually via lumbar puncture (LP, duration 1-2min, n=27) to a 50μg bolus at 500μg/ml concentration programmed through the pump and delivered via intrathecal catheter (IC, duration 10min) above simple continuous dose (25-100μg/day, n=16). The effect of mode of administration was assessed by comparing peak changes in H/M ratio after 50μg IC bolus above simple continuous dose (complex continuous mode, n=27) to simple continuous mode only (n=22) at equivalent daily doses (75-150μg/day).

RESULTS:

H/M decrease was faster and overall greater after LP than IC bolus (mean 1-h 77% vs. 63%, p=0.012; 1-6h 91% vs. 82%, p<0.001, respectively). H/M ratio also decreased significantly more with complex (91%) than simple continuous mode of administration (78%, p=0.025).

CONCLUSIONS:

Lower ITB concentration and complex continuous mode of administration lead to greater decrease in H/M ratio.

SIGNIFICANCE:

Decreased spinal reflex excitability after adjustment of drug and pump parameters to increase ITB flow may result in better clinical response.

Copyright © 2012 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

PMID:
22595326
[PubMed - indexed for MEDLINE]
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