Intrathecal baclofen for the treatment of spasticity. Case report with thematic review
Keywords:
Baclofen, Pain, Central Nervous System Paresis, Gamma-Aminobutyric Acid
Abstract
Introduction: Spasticity is triggered by a central nervous system disorder and may be local or generalized. The severity of symptoms, including functional limitation, deformity, pain, sleep disorders, depression and multiple disabilities, depends on the areas involved. The treatment of the disease is based on physical therapy and complemented with posture correcting devices, a few surgical interventions and drug therapy. Baclofen is a useful drug for this pathology and is usually administered orally; however, due to its low bioavailability or poor tolerance some patients require intrathecal administration.
Objective: The purpose of this article is to present a literature review based on a case report of a patient with a diagnosis of spastic tetraparesis, receiving intrathecal baclofen treatment through an implantable intrathecal therapy pump (ITP).
Methods and materials: A database search was conducted in EBSCO, MEDLINE and OVID that included systematic review articles, clinical trials, narrative reviews and case series between 1995 and 2012, for a non-systematic narrative review and a case report.
Results: 35 articles were considered in total for an update on the topic suggested.
Conclusions: Baclofen use through an implanted ITP is an effective and safe option for treating patients with severe spasticity refractory to conventional oral therapy.
References
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6. Strommen JA. Management of spasticity from spinal cord dysfunction. Neurol Clin. 2013;31:269-86.
7. Rekand T, Gronning M. Treatment of spasticity related to multiple sclerosis with intrathecal baclofen: A long-term follow-up. J Rehabil Med. 2011;43:511-4
8. Bakheit AM. The pharmacological management of post-stroke muscle spasticity. Drugs Aging. 2012;29:941-7.
9. Zafonte R, Lombard L, Elovic E. Antispasticity medications: Uses and limitations of enteral therapy. Am J Phys Med Rehabil. 2004;83:50-8.
10. Nandi PR. Pain in neurological conditions. Curr Opin Support Palliat Care. 2012;6:194-200.
11. Meythaler JM, Roper JF, Brunner RC. Cyproheptadine for intrathecal baclofen withdrawal. Arch Phys Med Rehabil. 2003;84:638-42.
12. Dones I, Nazzi V, Broggi G. The guidelines for the diagnosis and treatment of spasticity. J Neurosurg Sci. 2006;50:101-5.
13. Oreja-Guevara C. Treatment of spasticity in multiple sclerosis: New perspectives regarding the use of cannabinoids. Rev Neurol. 2012;55:421-30.
14. Leussink VI, Husseini L, Warnke C, Broussalis E, Hartung HP, Kieseier BC. Symptomatic therapy in multiple sclerosis: The role of cannabinoids in treating spasticity. Ther Adv Neurol Disord. 2012;5:255-66.
15. Kheder A, Nair KP. Spasticity: Pathophysiology, evaluation and management. Pract Neurol. 2012;12:289-98.
16. Tullman M. Symptomatic therapy in multiple sclerosis. Continuum: lifelong learning in neurology. Mult Scler. 2004;10:142-72.
17. Shaw LC, Price CI, van Wijck FM, Shackley P, Steen N, Barnes MP, et al. Botulinum Toxin for the Upper Limb after Stroke (BoTULS) Trial: Effect on impairment, activity limitation and pain. Stroke. 2011;42:1371-9.
18. Esquenazi A, Albanese A, Chancellor MB, Elovic E, Segal KR, Simpson DM, et al. Evidence-based review and assessment of botulinum neurotoxin for the treatment of adult spasticity in the upper motor neuron syndrome. Toxicon. 2012:41-101.
19. Lee DG, Jang SH. Ultrasound guided alcohol neurolysis of musculocutaneous nerve to relieve elbow spasticity in hemiparetic stroke patients. NeuroRehabilitation. 2012;31:373-7.
20. Botte MJ, Abrams RA, Bodine-Fowler SC. Treatment of acquired muscle spasticity using phenol peripheral nerve blocks. Orthopedic. 1995;18:151-9.
21. Sconfienza LM, Lacelli F, Bruno A, Serafini G. Ultrasound guidance can improve the outcome of botulinum toxin A injection. Eur J Phys Rehabil Med. 2009;45:153.
22. Py AG, Zein Addeen G, Perrier Y, Carlier RY, Picard A. Evaluation of the effectiveness of botulinum toxin injections in the lower limb muscles of children with cerebral palsy. Preliminary prospective study of the advantages of ultrasound guidance. Ann Phys Rehabil Med. 2009;52:215-23.
23. Karst M, Wippermann S, Ahrens J. Role of cannabinoids in the treatment of pain and (painful) spasticity. Drugs. 2010;70:2409-38.
24. Gevirtz C. Pain management of the patient with multiple sclerosis. Topics in Pain Management. 2008;23:1-5.
25. Bhidayasiri R. Dystonia Genetics and Treatment Update. Neurologist. 2006;12:74-85.
26. Francisco GE, Latorre JM, Ivanhoe CB. Intrathecal baclofen therapy for spastic hypertonia in chronic traumatic brain injury. Brain Injury. 2007;21:335-8.
27. Brochard S, Remy-Neris O, Filipetti P, Bussel B. Intrathecal baclofen infusion for ambulant children with cerebral palsy. Pediatr Neurol. 2009;40:265-70.
28. Brennan PM, Whittle IR. Intrathecal baclofen therapy for neurological disorders: A sound knowledge base but many challenges remain. Br J Neurosurg. 2008;22:508-19.
29. Dario A, Tomei G. A benefit-risk assessment of baclofen in severe spinal spasticity. Drug Saf. 2004;27:799-818.
30. Taricco M, Adone R, Pagliacci C, Telaro E. Pharmacological interventions for spasticity following spinal cord injury. Cochrane Database of Systematic Reviews. 2000. Issue 2.
31. Perez MR, Pulley SC. Intrathecal analgesia in cancer pain. Techniques in Regional Anesthesia and Pain Management. 2010;14:10-8.
32. Awaad Y, Rizk T, Siddiqui I, Roosen N, McIntosh K, Waines GM. Complications of intrathecal baclofen pump: Prevention and cure. ISRN Neurol. 2012;2012:575168.
33. Magro E, Remy-Neris O, Seizeur R, Allano V, Quinio B, Dam-Hieu P. Bilateral subdural hematoma following implantation of intrathecal drug delivery device. Neuromodulation. 2011;4:179-81.
34. Castaüo B, Benito J, Pires F, Ferreira S, Lopez R, Vida J. Delirium secondary to intrathecal baclofen. Spinal Cord. 2009;47:477-80.
35. Heetla HW, Staal MJ, Kliphuis C, van Laar T. The incidence and management of tolerance in intrathecal baclofen therapy. Spinal Cord. 2009;47:751-6.
2. Mullarkey T. Considerations in the treatment of spasticity with intrathecal baclofen. Am J Health Syst Pharm. 2009;66 Suppl 5:14-22.
3. Habek M, Kami A, Balash Y, Gurevich T. The place of botulinum toxin in the management of multiple sclerosis. Clin Neurol Neurosurg. 2010;112:592-6.
4. Abolhasani H, Ansari NN, Naghdi S, Mansouri K, Ghotbi N, Hasson S. Comparing the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS) in the assessment of wrist flexor spasticity in patients with stroke: Protocol for a neurophysiological study. BMJ Open. 2012;2, pii: e001394.
5. Park EY, Kim WH, Choi YI. Factor analysis of the WeeFIM in children with spastic cerebral palsy. Disabil Rehabil. 2012 (Epub ahead of print).
6. Strommen JA. Management of spasticity from spinal cord dysfunction. Neurol Clin. 2013;31:269-86.
7. Rekand T, Gronning M. Treatment of spasticity related to multiple sclerosis with intrathecal baclofen: A long-term follow-up. J Rehabil Med. 2011;43:511-4
8. Bakheit AM. The pharmacological management of post-stroke muscle spasticity. Drugs Aging. 2012;29:941-7.
9. Zafonte R, Lombard L, Elovic E. Antispasticity medications: Uses and limitations of enteral therapy. Am J Phys Med Rehabil. 2004;83:50-8.
10. Nandi PR. Pain in neurological conditions. Curr Opin Support Palliat Care. 2012;6:194-200.
11. Meythaler JM, Roper JF, Brunner RC. Cyproheptadine for intrathecal baclofen withdrawal. Arch Phys Med Rehabil. 2003;84:638-42.
12. Dones I, Nazzi V, Broggi G. The guidelines for the diagnosis and treatment of spasticity. J Neurosurg Sci. 2006;50:101-5.
13. Oreja-Guevara C. Treatment of spasticity in multiple sclerosis: New perspectives regarding the use of cannabinoids. Rev Neurol. 2012;55:421-30.
14. Leussink VI, Husseini L, Warnke C, Broussalis E, Hartung HP, Kieseier BC. Symptomatic therapy in multiple sclerosis: The role of cannabinoids in treating spasticity. Ther Adv Neurol Disord. 2012;5:255-66.
15. Kheder A, Nair KP. Spasticity: Pathophysiology, evaluation and management. Pract Neurol. 2012;12:289-98.
16. Tullman M. Symptomatic therapy in multiple sclerosis. Continuum: lifelong learning in neurology. Mult Scler. 2004;10:142-72.
17. Shaw LC, Price CI, van Wijck FM, Shackley P, Steen N, Barnes MP, et al. Botulinum Toxin for the Upper Limb after Stroke (BoTULS) Trial: Effect on impairment, activity limitation and pain. Stroke. 2011;42:1371-9.
18. Esquenazi A, Albanese A, Chancellor MB, Elovic E, Segal KR, Simpson DM, et al. Evidence-based review and assessment of botulinum neurotoxin for the treatment of adult spasticity in the upper motor neuron syndrome. Toxicon. 2012:41-101.
19. Lee DG, Jang SH. Ultrasound guided alcohol neurolysis of musculocutaneous nerve to relieve elbow spasticity in hemiparetic stroke patients. NeuroRehabilitation. 2012;31:373-7.
20. Botte MJ, Abrams RA, Bodine-Fowler SC. Treatment of acquired muscle spasticity using phenol peripheral nerve blocks. Orthopedic. 1995;18:151-9.
21. Sconfienza LM, Lacelli F, Bruno A, Serafini G. Ultrasound guidance can improve the outcome of botulinum toxin A injection. Eur J Phys Rehabil Med. 2009;45:153.
22. Py AG, Zein Addeen G, Perrier Y, Carlier RY, Picard A. Evaluation of the effectiveness of botulinum toxin injections in the lower limb muscles of children with cerebral palsy. Preliminary prospective study of the advantages of ultrasound guidance. Ann Phys Rehabil Med. 2009;52:215-23.
23. Karst M, Wippermann S, Ahrens J. Role of cannabinoids in the treatment of pain and (painful) spasticity. Drugs. 2010;70:2409-38.
24. Gevirtz C. Pain management of the patient with multiple sclerosis. Topics in Pain Management. 2008;23:1-5.
25. Bhidayasiri R. Dystonia Genetics and Treatment Update. Neurologist. 2006;12:74-85.
26. Francisco GE, Latorre JM, Ivanhoe CB. Intrathecal baclofen therapy for spastic hypertonia in chronic traumatic brain injury. Brain Injury. 2007;21:335-8.
27. Brochard S, Remy-Neris O, Filipetti P, Bussel B. Intrathecal baclofen infusion for ambulant children with cerebral palsy. Pediatr Neurol. 2009;40:265-70.
28. Brennan PM, Whittle IR. Intrathecal baclofen therapy for neurological disorders: A sound knowledge base but many challenges remain. Br J Neurosurg. 2008;22:508-19.
29. Dario A, Tomei G. A benefit-risk assessment of baclofen in severe spinal spasticity. Drug Saf. 2004;27:799-818.
30. Taricco M, Adone R, Pagliacci C, Telaro E. Pharmacological interventions for spasticity following spinal cord injury. Cochrane Database of Systematic Reviews. 2000. Issue 2.
31. Perez MR, Pulley SC. Intrathecal analgesia in cancer pain. Techniques in Regional Anesthesia and Pain Management. 2010;14:10-8.
32. Awaad Y, Rizk T, Siddiqui I, Roosen N, McIntosh K, Waines GM. Complications of intrathecal baclofen pump: Prevention and cure. ISRN Neurol. 2012;2012:575168.
33. Magro E, Remy-Neris O, Seizeur R, Allano V, Quinio B, Dam-Hieu P. Bilateral subdural hematoma following implantation of intrathecal drug delivery device. Neuromodulation. 2011;4:179-81.
34. Castaüo B, Benito J, Pires F, Ferreira S, Lopez R, Vida J. Delirium secondary to intrathecal baclofen. Spinal Cord. 2009;47:477-80.
35. Heetla HW, Staal MJ, Kliphuis C, van Laar T. The incidence and management of tolerance in intrathecal baclofen therapy. Spinal Cord. 2009;47:751-6.
How to Cite
1.
Rivera Diaz RC, Arcila Lotero MA, Campuzano Escobar D. Intrathecal baclofen for the treatment of spasticity. Case report with thematic review. Colomb. J. Anesthesiol. [Internet]. 2013 Jul. 1 [cited 2024 Apr. 25];41(3):229–235. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/698
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Published
2013-07-01
How to Cite
1.
Rivera Diaz RC, Arcila Lotero MA, Campuzano Escobar D. Intrathecal baclofen for the treatment of spasticity. Case report with thematic review. Colomb. J. Anesthesiol. [Internet]. 2013 Jul. 1 [cited 2024 Apr. 25];41(3):229–235. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/698
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Case Report / Case Series
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