Use of Intrathecal Baclofen for Treatment of Severe Spasticity in Selected Patients With Motor Neuron Disease. (November 2013)

• Record Type: Journal Article
• Authors: Bethoux, Francois; Boulis, Nicholas; McClelland, Shearwood; Willis, Mary Alissa; Hussain, Mariam; Machado, Andre; Mychkovsky, Lydia; Stough, Darlene; Sutliff, Matt; Pioro, Erik P.
• Is Part Of: Neurorehabilitation & neural repair. Volume 27:Number 9(2013)
• Page Start: 828
• Page End: 833
• Publication Date: 2013-11
• Subjects: motor neuron disease -- intrathecal baclofen -- spasticity; Nervous system -- Diseases -- Patients -- Rehabilitation -- Periodicals; Brain damage -- Patients -- Rehabilitation -- Periodicals; Spinal cord -- Wounds and injuries -- Patients -- Rehabilitation -- Periodicals; Nervous system -- Regeneration -- Periodicals; Neuroplasticity -- Periodicals; 616.804305
• DOI: 10.1177/1545968313496325
• Languages: English
• ISSNs: 1545-9683

Abstract

Objective . To assess the safety and efficacy of intrathecal baclofen (ITB) therapy for severe spasticity in patients with upper–motor neuron predominant motor neuron disease (U-MND). Methods . A total of 44 patients with U-MND were referred for discussion of ITB therapy. Baseline and outcomes data were extracted on 35 patients from a clinical spasticity registry at a tertiary referral center. Patients choosing to initiate ITB (n = 20) were compared with those choosing conservative therapy (n = 15). Results . At baseline, lower average pain score in the non-ITB group was the only significant difference between the 2 groups. A significant reduction in pain scores, Modified Ashworth Scale (MAS), Spasm Frequency Scale, and requirement for oral spasticity medications was observed within the ITB group at early and late follow-up. Within the non-ITB group, there was a significant increase in MAS scores between baseline and late follow-up. A statistically significant difference favoring the ITB group was observed for change in MAS score ( P < .0001), Numerical Rating Scale pain score ( P = .04), dose of oral baclofen ( P = .002) and tizanidine ( P = .003), and number of oral medications for spasticity ( P = .002). There was no difference between the 2 groups in the progression of hip flexor weakness or in the proportion of patients who became nonambulatory. Conclusions . Our findings suggest that ITB can effectively reduce spasticity and related symptoms without compromising function in selected patients with U-MND.