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Arch Phys Med Rehabil. 2019 May;100(5):837-843. doi: 10.1016/j.apmr.2018.09.124. Epub 2018 Oct 26.

Intrathecal Baclofen Trial Before Device Implantation: 12-Year Experience With Continuous Administration.

Author information

1
Department of Neurology, Hochzirl Hospital, Zirl, Austria. Electronic address: elke.pucks-faes@tirol-kliniken.at.
2
Department of Neurology, Hochzirl Hospital, Zirl, Austria.
3
Department for Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria.
4
Department of Neurology, Hochzirl Hospital, Zirl, Austria; Research Unit for Neurorehabilitation, South Tyrol, Bolzano, Italy.

Abstract

OBJECTIVE:

To report our experience using continuous intrathecal baclofen (ITB) administration prior to a possible ITB device implantation.

DESIGN:

Retrospective open label study. Mean duration of follow-up 64 months.

SETTING:

Primary-care and referral center, ambulatory and hospitalized care.

PARTICIPANTS:

Patients (N=116) undergoing continuous ITB trials between 2006 and 2017.

INTERVENTIONS:

Continuous application of baclofen via a temporary intrathecal catheter connected to an external pump.

MAIN OUTCOME MEASURES:

Assessment of the modified Ashworth Scale and range of movement prior versus end of ITB trial. According to the Barthel Index, definition of high-level patients (60-100 scoring points) and low-level patients (0-55 scoring points). Calculation of the Rivermead Mobility Index in high-level patients prior versus end of ITB trial. Evaluation of occurring adverse events.

RESULTS:

A total of 119 ITB trials were performed in 116 patients (78 men, mean age 41±16), 113 patients completed the trials (31 of 113 high level, 82 of 113 low level). The median modified Ashworth scale improved from 4 (interquartile range [IQR] 3-4) to 2 (IQR 1-2; P≤.001), the range of movement from 2 (IQR 1-3) to 3 (IQR 3-3; P≤.001). The Rivermead Mobility Index increased from 9 (IQR 6-12) to 10 (IQR 7-12.5; P=.004) in high-level patients. Eighty-eight out of 113 patients (78%) were appropriate candidates for ITB device surgery, 75 of 88 (85%) proceeded to an implantation. A total of 69 adverse events occurred in 57 of 119 trials (48%), 37 of 69 (54%) were drug related, 32 of 69 (46%) were procedure related, and 42 of 69 (61%) were minor. The ITB device was implanted in 69 of 75 patients (92%) at last follow-up.

CONCLUSIONS:

Continuous administration of ITB is an effective and useful alternative to ITB bolus application during ITB screening period. Half of the patients experienced adverse events; the majority were minor events.

KEYWORDS:

Baclofen; Catheters; Muscle spasticity; Rehabilitation

PMID:
31030729
DOI:
10.1016/j.apmr.2018.09.124

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