Long-Term Continuously Infused Intrathecal Baclofen for Spastic-Dystonic Hypertonia in Traumatic Brain Injury: 1-Year Experience.Meythaler JM, Guin-Renfroe S, Grabb P, Hadley MN (Department of Physical Medicine and Rehabilitation physical medicine and rehabilitation or physiatry or physical therapy or rehabilitation medicine Medical specialty treating chronic disabilities through physical means to help patients return to a comfortable, productive life despite a medical , University of Alabama School of Medicine The University of Alabama School of Medicine (also known as the UAB School of Medicine) is a medical school located in Birmingham, Alabama. The main campus of the medical school is located at the University of Alabama at Birmingham (also known as UAB , Birmingham, Ala), Arch Phys Med Rehabil. 1999;80:13-19. This study determined if the long-term use of continuously infused intrathecal intrathecal /in·tra·the·cal/ (-the´k'l) within a sheath; through the theca of the spinal cord into the subarachnoid space. Intrathecal baclofen over a 1-year period would control spastic-dystonic hypertonia hypertonia /hy·per·to·nia/ (-to´ne-ah) a condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching. hy·per·to·ni·a n. in patients with traumatic brain injury (TBI). Persons with TBI and intractable spasticity and dystonia dystonia /dys·to·nia/ (-to´ne-ah) dyskinetic movements due to disordered tonicity of muscle.dyston´ic dystonia musculo´rum defor´mans of more than 6 months' duration were recruited for the study. Seventeen patients (average age = 29 [+ or -] 11 years) were included after screening via a bolus injection of either intrathecal saline or 50 [micro]g of baclofen; the screening was done to test for an efficacious response to baclofen. Data for Ashworth rigidity scores (ie, spacticity), the number of muscle spasms, and deep tendon reflex deep tendon reflex n. Abbr. DTR Tonic contraction of the muscles in response to a stretching force, due to stimulation of muscle proprioceptors. Also called myotatic reflex. scores were collected for both the upper and lower extremities. Patients whose lower-extremity Ashworth scores decreased an average of 2 points were then offered implantation of a computer-controlled pump for continuously infused intrathecal baclofen. Changes over time were assessed over a 1-year time period using the following statistical methods: Friedman's analysis for ordinal data, an ANOVA anova see analysis of variance. ANOVA Analysis of variance, see there for linear data, and Wilcoxon signed ranks for differences between set points in time. After 1 year of continuous treatment, the average upper- and lower-extremity Ashworth scores decreased significantly as did the spasm and reflex scores. The decrease in the scores was greater for the lower extremities than upper extremities. The average dose required to attain these effects at 1 year was 302 [micro]g continuously infused per day. According to the authors, continuous intrathecal infusion of baclofen is capable of maintaining a reduction in spasticity and dystonia in both the upper and lower extremities of patients with TBI. However, the authors stressed that considerable therapy may be needed to deal with contractures or so that patients can learn how to function with greatly reduced muscle tone. Daniel M Corcos, PhD University of Illinois at Chicago Chicago, Ill |
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