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

Authors
 Young Kwon Yoon  ;  Kil Chan Lee  ;  Han Eol Cho  ;  Minji Chae  ;  Jin Woo Chang  ;  Won Seok Chang  ;  Sung-Rae Cho 
Citation
 MEDICINE, Vol.96(34) : e7472, 2017 
Journal Title
 MEDICINE 
ISSN
 0025-7974 
Issue Date
2017
MeSH
Adult ; Baclofen/administration & dosage ; Baclofen/adverse effects ; Baclofen/therapeutic use ; Brain Injuries/drug therapy ; Cerebral Palsy/drug therapy ; Female ; Humans ; Infusion Pumps, Implantable ; Injections, Spinal ; Male ; Mobility Limitation ; Muscle Relaxants, Central/administration & dosage ; Muscle Relaxants, Central/adverse effects ; Muscle Relaxants, Central/therapeutic use ; Muscle Spasticity/drug therapy ; Patient Satisfaction
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 (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.
Files in This Item:
T201702920.pdf Download
DOI
10.1097/MD.0000000000007472
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
Yonsei Authors
Chang, Won Seok(장원석) ORCID logo https://orcid.org/0000-0003-3145-4016
Cho, Sung-Rae(조성래) ORCID logo https://orcid.org/0000-0003-1429-2684
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160635
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