Intrathecal Baclofen Therapy Applications: Assessment of Our Cases Between 2004-2012

Abstract

Objective: To evaluate the effects of intrathecal baclofen therapy (ITB) in patients with severe spasticity. Material and Methods: Patients who had a baclofen pump implanted between 2004-2012 were included in the study. The inclusion criteria were severe spasticity with nonresponse to medical oral therapy and physiotherapy, modified Ashworth scale (MAS) score 3-4, and Penn's spasm scale (PSS) score 3-4. The ITB assessment criteria were MAS, PSS, visual analog scale (VAS), functional independence measurement (FIM), and short form-36 (SF-36) Tests were given before ITB and 3 months after implantation. Results: Twenty-one patients were given the test dose, and the ITB pump was implanted for 16. There were 11 men (68.75%) and 5 women (31.25%). Mean age was 33 +/- 10.34, ranging between 12-53 years. Eleven (68.75%) had spinal cord injury, 2 (12.50%) had multiple sclerosis, 2 (12.50%) had cerebral palsy, and 1 (6.25%) had a hypoxic brain. Eleven (68.75%) of these patients were paraplegic, 4 were (25%) tetraplegic, and 1 had (6.25%) dystonic cerebral palsy. Mean follow-up was 52.25 +/- 33.10 months, ranging between 3-100 months. Daily baclofen dose was between 70-475 mu g (average 220 +/- 110.58 mu g). Modified Ashworth scale decreased from 3.43 +/- 0.53 to 1.00 +/- 0.73 (p=0.00); PSS decreased from 3.50 +/- 1.03 to 1.12 +/- 1.02 (p=0.001); global pain decreased from 44.37 +/- 36.14 to 18.75 +/- 19.95, (p=0.003); FIM increased from 71.18 +/- 20.88 to 76.31 +/- 28.25 (p=0.023); SF-36 physical function increased from 2.06 +/- 8.25 to 18.25 +/- 26.06 (p=0.006); physical role difficulty increased from 1.56 +/- 6.25 to 40.31 +/- 29.74 (p=0.002); general health increased from 29.37 +/- 17.68 to 47.62 +/- 27.35 (p=0.005); pain increased from 26.31 +/- 30.49 to 53.37 +/- 26.45 (p=0.005); vitality increased from 38.93 +/- 20.94 to 61.25 +/- 19.70 (p=0.001); social function increased from 19.31 +/- 14.59 to 70.56 +/- 82.74 (p=0.001); emotional role difficulty increased from 10.37 +/- 26.40 to 56.31 +/- 38.08 (p=0.004); and mental health increased from 46.25 +/- 18.12 to 61.12 +/- 19.81 (p=0.004). During the follow-up period, pump-related complications were seen in 2 patients. Conclusion: ITB is an effective and safe treatment option in severe spasticity.