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Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury.

Abstract Intrathecal baclofen (ITB) has been known to reduce spasticity which did not respond to oral medications and botulinum toxin treatment. However, few results have been reported comparing the effects of ITB therapy in patients with cerebral palsy (CP) and acquired brain injury. This study aimed to investigate beneficial and adverse effects of ITB bolus injection and pump therapy in patients with CP and to compare outcomes to patients with acquired brain injury such as traumatic brain injury and hypoxic brain injury. ITB test trials were performed in 37 patients (19 CP and 18 acquired brain injury). Based on ambulatory function, CP patients were divided into 2 groups: 11 patients with nonambulatory CP and 8 patients with ambulatory CP. Change of spasticity was evaluated using the Modified Ashworth Scale. Additional positive or negative effects were also evaluated after ITB bolus injection. In patients who received ITB pump implantation, outcomes of spasticity, subjective satisfaction and adverse events were evaluated until 12 months post-treatment. After ITB bolus injection, 32 patients (86.5%) (CP 84.2% versus acquired brain injury 88.9%) showed a positive response of reducing spasticity. However, 8 patients with CP had negative adverse effects. Particularly, 3 ambulatory CP patients showed standing impairment and 1 ambulatory CP patient showed impaired gait pattern such as foot drop because of excessive reduction of lower extremity muscle tone. Ambulatory CP patients received ITB pump implantation less than patients with acquired brain injury after ITB test trials (Pā€Š=ā€Š.003 by a chi-squared test). After the pump implantation, spasticity was significantly reduced within 1 month and the effect maintained for 12 months. Seventeen patients or their caregivers (73.9%) were very satisfied, whereas 5 patients (21.7%) suffered from adverse events showed no subjective satisfaction. In conclusion, ITB therapy was effective in reducing spasticity in patients with CP and acquired brain injury. Before ITB pump implantation, it seems necessary to perform the ITB bolus injection to verify beneficial effects and adverse effects especially in ambulatory CP.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28834868
OWN - NLM
STAT- MEDLINE
DA  - 20170823
DCOM- 20170911
LR  - 20170911
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 34
DP  - 2017 Aug
TI  - Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and
      acquired brain injury.
PG  - e7472
LID - 10.1097/MD.0000000000007472 [doi]
AB  - Intrathecal baclofen (ITB) has been known to reduce spasticity which did not
      respond to oral medications and botulinum toxin treatment. However, few results
      have been reported comparing the effects of ITB therapy in patients with cerebral
      palsy (CP) and acquired brain injury. This study aimed to investigate beneficial 
      and adverse effects of ITB bolus injection and pump therapy in patients with CP
      and to compare outcomes to patients with acquired brain injury such as traumatic 
      brain injury and hypoxic brain injury. ITB test trials were performed in 37
      patients (19 CP and 18 acquired brain injury). Based on ambulatory function, CP
      patients were divided into 2 groups: 11 patients with nonambulatory CP and 8
      patients with ambulatory CP. Change of spasticity was evaluated using the
      Modified Ashworth Scale. Additional positive or negative effects were also
      evaluated after ITB bolus injection. In patients who received ITB pump
      implantation, outcomes of spasticity, subjective satisfaction and adverse events 
      were evaluated until 12 months post-treatment. After ITB bolus injection, 32
      patients (86.5%) (CP 84.2% versus acquired brain injury 88.9%) showed a positive 
      response of reducing spasticity. However, 8 patients with CP had negative adverse
      effects. Particularly, 3 ambulatory CP patients showed standing impairment and 1 
      ambulatory CP patient showed impaired gait pattern such as foot drop because of
      excessive reduction of lower extremity muscle tone. Ambulatory CP patients
      received ITB pump implantation less than patients with acquired brain injury
      after ITB test trials (P = .003 by a chi-squared test). After the pump
      implantation, spasticity was significantly reduced within 1 month and the effect 
      maintained for 12 months. Seventeen patients or their caregivers (73.9%) were
      very satisfied, whereas 5 patients (21.7%) suffered from adverse events showed no
      subjective satisfaction. In conclusion, ITB therapy was effective in reducing
      spasticity in patients with CP and acquired brain injury. Before ITB pump
      implantation, it seems necessary to perform the ITB bolus injection to verify
      beneficial effects and adverse effects especially in ambulatory CP.
FAU - Yoon, Young Kwon
AU  - Yoon YK
AD  - aDepartment and Research Institute of Rehabilitation Medicine, Yonsei University 
      College of Medicine bDepartment of Medicine, The Graduate School of Yonsei
      University cRehabilitation Institute of Neuromuscular Disease dDepartment of
      Neurosurgery and Brain Research Institute, Yonsei University College of Medicine 
      eBrain Korea 21 PLUS Project for Medical Science, Yonsei University fYonsei Stem 
      Cell Research Center, Avison Biomedical Research Center, Seoul, Korea.
FAU - Lee, Kil Chan
AU  - Lee KC
FAU - Cho, Han Eol
AU  - Cho HE
FAU - Chae, Minji
AU  - Chae M
FAU - Chang, Jin Woo
AU  - Chang JW
FAU - Chang, Won Seok
AU  - Chang WS
FAU - Cho, Sung-Rae
AU  - Cho SR
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Muscle Relaxants, Central)
RN  - H789N3FKE8 (Baclofen)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Baclofen/administration & dosage/adverse effects/*therapeutic use
MH  - Brain Injuries/*drug therapy
MH  - Cerebral Palsy/*drug therapy
MH  - Female
MH  - Humans
MH  - Infusion Pumps, Implantable
MH  - Injections, Spinal
MH  - Male
MH  - Mobility Limitation
MH  - Muscle Relaxants, Central/administration & dosage/adverse effects/*therapeutic
      use
MH  - Muscle Spasticity/*drug therapy
MH  - Patient Satisfaction
PMC - PMC5571990
EDAT- 2017/08/24 06:00
MHDA- 2017/09/12 06:00
CRDT- 2017/08/24 06:00
AID - 10.1097/MD.0000000000007472 [doi]
AID - 00005792-201708250-00005 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Aug;96(34):e7472. doi: 10.1097/MD.0000000000007472.