We studied the effect of the intrathecal infusion of baclofen, an agonist of gamma-aminobutyric acid, on abnormal muscle tone and spasms associated with spinal spasticity, in a randomized double-blind crossover study. Twenty patients with spinal spasticity caused by multiple sclerosis or spinal-cord injury who had had no response to treatment with oral baclofen received an intrathecal infusion of baclofen or saline for three days. The infusions were administered by means of a programmable pump implanted in the lumbar subarachnoid space. Muscle tone decreased in all 20 patients (mean [+/- SD] Ashworth score for rigidity, from 4.0 +/- 1.0 to 1.2 +/- 0.4; P less than 0.0001), and spasms were decreased in 18 of the 19 patients who had spasms (mean [+/- SD] score for spasm frequency, from 3.3 +/- 1.2 to 0.4 +/- 0.8; P less than 0.0005). Tests for motor function, neurologic examination, and assessments by the patients correctly indicated when baclofen was being infused in all cases. All patients were then entered in an open long-term trial of continuous infusion of intrathecal baclofen. During a mean follow-up period of 19.2 months (range, 10 to 33), muscle tone has been maintained within the normal range (mean Ashworth score, 1.0 +/- 0.1) and spasms have been reduced to a level that does not interfere with activities of daily living (mean spasm score, 0.3 +/- 0.6). No drowsiness or confusion occurred, one pump failed, and two catheters became dislodged and had to be replaced. No infections were observed. Our observations suggest that intrathecal baclofen is an effective long-term treatment for spinal spasticity that has not responded to oral baclofen.
Source Information
Department of Neurosurgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612.
This article has been cited by other articles:
Que, J. C., Siddall, P. J., Cousins, M. J.
(2007). Pain Management in a Patient With Intractable Spinal Cord Injury Pain: A Case Report and Literature Review. Anesth. Analg.
105: 1462-1473
[Abstract][Full Text]
Miller, L., Mattison, P., Paul, L., Wood, L.
(2007). The effects of transcutaneous electrical nerve stimulation (TENS) on spasticity in multiple sclerosis. Mult Scler
13: 527-533
[Abstract]
Bensmail, D., Salva, M. A. Q., Roche, N., Benyahia, S., Bohic, M., Denys, P., Bussel, B., Lofaso, F.
(2006). Effect of intrathecal baclofen on sleep and respiratory function in patients with spasticity. Neurology
67: 1432-1436
[Abstract][Full Text]
Leary, S M, Gilpin, P, Lockley, L, Rodriguez, L, Jarrett, L, Stevenson, V L
(2006). Intrathecal baclofen therapy improves functional intelligibility of speech in cerebral palsy. Clin Rehabil
20: 228-231
[Abstract]
Murphy, P. M., Skouvaklis, D. E., Amadeo, R. J.J., Haberman, C., Brazier, D. H., Cousins, M. J.
(2006). Intrathecal catheter granuloma associated with isolated baclofen infusion.. Anesth. Analg.
102: 848-852
[Abstract][Full Text]
Kesiktas, N., Paker, N., Erdogan, N., Gulsen, G., Bicki, D., Yilmaz, H.
(2004). The Use of Hydrotherapy for the Management of Spasticity. Neurorehabil Neural Repair
18: 268-273
[Abstract]
Zahavi, A, Geertzen, J H B, Middel, B, Staal, M, Rietman, J S
(2004). Long term effect (more than five years) of intrathecal baclofen on impairment, disability, and quality of life in patients with severe spasticity of spinal origin. J. Neurol. Neurosurg. Psychiatry
75: 1553-1557
[Abstract][Full Text]
Vaney, C, Heinzel-Gutenbrunner, M, Jobin, P, Tschopp, F, Gattlen, B, Hagen, U, Schnelle, M, Reif, M
(2004). Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Mult Scler
10: 417-424
[Abstract]
Jarrett, L, Nandi, P, Thompson, A J
(2002). Managing severe lower limb spasticity in multiple sclerosis: does intrathecal phenol have a role?. J. Neurol. Neurosurg. Psychiatry
73: 705-709
[Abstract][Full Text]
Kalita, J, Shah, S, Kapoor, R, Misra, U K
(2002). Bladder dysfunction in acute transverse myelitis: magnetic resonance imaging and neurophysiological and urodynamic correlations. J. Neurol. Neurosurg. Psychiatry
73: 154-159
[Abstract][Full Text]
Paisley, S, Beard, S, Hunn, A, Wight, J
(2002). Clinical effectiveness of oral treatments for spasticity in multiple sclerosis: a systematic review. Mult Scler
8: 319-329
[Abstract]
Bowery, N. G., Bettler, B., Froestl, W., Gallagher, J. P., Marshall, F., Raiteri, M., Bonner, T. I., Enna, S. J.
(2002). International Union of Pharmacology. XXXIII. Mammalian gamma -Aminobutyric AcidB Receptors: Structure and Function. Pharmacol. Rev.
54: 247-264
[Abstract][Full Text]
Meythaler, J. M., Guin-Renfroe, S., Brunner, R. C., Hadley, M. N., Francisco, G. E.
(2001). Intrathecal Baclofen for Spastic Hypertonia From Stroke Editorial Comment. Stroke
32: 2099-2109
[Abstract][Full Text]
Brosamle, C., Huber, A. B., Fiedler, M., Skerra, A., Schwab, M. E.
(2000). Regeneration of Lesioned Corticospinal Tract Fibers in the Adult Rat Induced by a Recombinant, Humanized IN-1 Antibody Fragment. J. Neurosci.
20: 8061-8068
[Abstract][Full Text]
van Hilten, B. J., van de Beek, W.-J. T., Hoff, J. I., Voormolen, J. H.C., Delhaas, E. M.
(2000). Intrathecal Baclofen for the Treatment of Dystonia in Patients with Reflex Sympathetic Dystrophy. NEJM
343: 625-630
[Abstract][Full Text]
Gilmartin, R., Bruce, D., Storrs, B. B., Abbott, R., Krach, L., Ward, J., Bloom, K., Brooks, W. H., Johnson, D. L., Madsen, J. R., McLaughlin, J. F., Nadell, J.
(2000). Intrathecal Baclofen for Management of Spastic Cerebral Palsy: Multicenter Trial. J Child Neurol
15: 71-77
[Abstract]
Ko, C. K.
(1999). Effectiveness of rehabilitation for multiple sclerosis. Clin Rehabil
13: 33-41
[Abstract]
Kent-Braun, J. A., Ng, A. V., Castro, M., Weiner, M. W., Gelinas, D., Dudley, G. A., Miller, R. G.
(1997). Strength, skeletal muscle composition, and enzyme activity in multiple sclerosis. J. Appl. Physiol.
83: 1998-2004
[Abstract][Full Text]
Albright, A. L.
(1996). Intrathecal Baclofen in Cerebral Palsy Movement Disorders. J Child Neurol
11: S29-S35
[Abstract]
Kent-Braun, J. A., Sharma, K. R., Miller, R. G., Weiner, M. W.
(1996). Effects of Electrically Stimulated Exercise Training on Muscle Function in Multiple Sclerosis. Neurorehabil Neural Repair
10: 143-151
[Abstract]
Dimitrijevic, M. R.
(1995). Evaluation and Treatment of Spasticity. Neurorehabil Neural Repair
9: 97-110
Mattison, P.
(1993). Transcutaneous electrical nerve stimulation in the management of painful muscle spasm in patients with multiple sclerosis. Clin Rehabil
7: 45-48
[Abstract]
Herman, R., D'Luzansky, S. C.
(1991). Pharmacologic Management of Spinal Spasticity. Neurorehabil Neural Repair
5: S15-S20
[Abstract]
Previous
