Intrathecal baclofen in paroxysmal sympathetic hyperactivity: Impact on oral treatment. Issue 11 (28th September 2018)

• Record Type: Journal Article
• Authors: Pucks‐Faes, Elke; Hitzenberger, Gabriel; Matzak, Heinrich; Verrienti, Giulio; Schauer, Robert; Saltuari, Leopold
• Is Part Of: Brain and behavior. Volume 8:Issue 11(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-09-28
• Subjects: autonomic nervous system diseases -- baclofen -- brain injuries -- sympathetic nervous system -- traumatic; Neurology -- Periodicals; Neurosciences -- Periodicals; Psychology -- Periodicals; Psychiatry -- Periodicals; 616.8005
• DOI: 10.1002/brb3.1124
• Languages: English
• ISSNs: 2162-3279

Abstract

Abstract: Introduction: Intrathecal baclofen (ITB) is a commonly used treatment in severe spasticity. The main objective of this study was to assess the impact of ITB on reduction or withdrawal of oral drugs in patients with paroxysmal sympathetic hyperactivity (PSH) after severe traumatic brain injury. Methods: We retrospectively evaluated 20 patients with PSH due to severe traumatic brain injury who were treated with ITB in a primary care and referral center of neurology. Rates of and time until complete withdrawal or possible reduction in oral baclofen and oral propranolol after ITB treatment were calculated. Moreover, vegetative parameters (heart rate and blood pressure) as well as hypertonic attacks were assessed. Results: The median time of complete oral baclofen disposal was 5 ± 3.7 (CI 95% [2.9–7.1], range 0–14) days after ITB pump implantation in 20 of 20 patients, and the median time of complete oral propranolol disposal was 24 ± 62.97 (CI 95% [−7.87–55.87], range 5–191) in 15 of 20 patients. With ITB treatment, PSH improved promptly in all patients with alleviation of heart rate and blood pressure as well as reduction in attacks with motor phenomena. ITB treatment was safe and without complications. Conclusions: ITB might facilitate cutting back or dispensing with other conventional oral drugs, such as oral baclofen and oral propranolol. Our study provides further evidence that ITB treatment should be considered in patients with otherwise medically refractory PSH in severe traumatic brain injury. Further prospective multicenter studies are needed to confirm the findings of this study. Abstract : This study investigates the impact of intrathecal baclofen (ITB) on reduction or withdrawal of oral drugs in 20 patients with paroxysmal sympathetic hyperactivity (PSH) after severe traumatic brain injury. After ITB pump implantation, the median time of complete oral baclofen disposal was 5 days, and the median time of complete oral propranolol disposal was 24 days. ITB treatment was safe and effective with prompt improvement of PSH in all patients (alleviation of heart rate and blood pressure as well as reduction of attacks with motor phenomena).