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At least 1,081 records · Page 60Linked to original sources
PubMed2006

Intrathecal baclofen therapy improves functional intelligibility of speech in cerebral palsy.

OBJECTIVE: To assess the effect of intrathecal baclofen on spastic dysarthia in cerebral palsy. DESIGN: Single case study. METHODS: Functional outcome measures, including the Assessment of Intelligibility of Dysarthric Speech, were performed before and after a trial of intrathecal baclofen in an adult patient with spastic dysarthria due to cerebral palsy. The patient proceeded to intrathecal baclofen pump implantation and was reassessed after six months of continuous intrathecal baclofen therapy. RESULTS: Improvement in function including speech intelligibility was seen following the intrathecal baclofen trial. The improvement was sustained at six months post pump implantation. CONCLUSIONS: Intrathecal baclofen improved functional intelligibility of speech in a carefully selected subject. The Assessment of Intelligibility of Dysarthric Speech was found to be a useful quantitative tool to assess the effect of intrathecal baclofen on spastic dysarthria.

Adult↗
PubMed2004

Guided intrathecal baclofen administration by using soleus stretch reflex in moderate-severe spastic multiple sclerosis patients with implanted pump.

We tested the hypothesis that changes in soleus stretch reflex was correlated to changes in intrathecal baclofen dose in 12 multiple sclerosis patients with moderate-severe spasticity treated with intrathecal baclofen pump. Twice patients were evaluated clinically and biomechanically. The short-latency soleus stretch reflex was elicited by rotating the ankle joint 4 degrees with a velocity from 3.1 to 180 degrees/s. There was a strong correlation between changes in intrathecal baclofen dose and amplitude of the short-latency stretch reflex (r=-0.88, P<0.001), which means that with an increase in baclofen dose there is a decrease in the amplitude. In contrast, no correlation exists between changes in intrathecal baclofen dose and clinical assessment of spasticity by using the Ashworth scale. The amplitude of the stretch reflex was very small (5 microV) compared with previous findings (>50 microV), which indicates an effective antispastic effect of intrathecal baclofen. We suggest that clinical evaluation of spasticity using Ashworth scale is insensitive to detect minor changes in moderate-severe spasticity and consequently might not be very useful in evaluating spasticity in relation to ambulatory filling of baclofen pumps. The soleus stretch reflex might be useful in situations when there is doubt about the effect of intrathecally administered baclofen.

Adult↗
PubMed1992

Intrathecal thyrotropin-releasing hormone does not alter the progressive course of ALS: experience with an intrathecal drug delivery system.

Evidence that thyrotropin-releasing hormone (TRH) has prominent trophic effects on the motor system led to several negative therapeutic trials in amyotrophic lateral sclerosis, a disease of the motor system. Since TRH crosses the blood-brain barrier poorly, if at all, we postulated that the negative parenteral clinical trials could be a result of insufficient drug-receptor interaction. We thus carried out a blinded, placebo-controlled, crossover study of intrathecal TRH in 36 patients by delivery through an implanted, constant infusion pump achieving a steady-state CSF level comparable with that shown to be effective in tissue culture experiments. Utilizing a quantitative measurement technique to assess motor unit loss, we did not observe any alteration of the progressive course during 6 months on TRH and 6 months on saline placebo. However, the implanted pump delivery system proved to be safe, reliable, and well tolerated.

Adult↗
PubMed2003

Intrathecal baclofen for stiff-person syndrome: life-threatening intermittent catheter leakage.

Intrathecal baclofen (ITB) is used for unresponsiveness to other treatment for patients with stiff-person syndrome (SPS). The authors report a patient with SPS who developed acute and life-threatening baclofen withdrawal symptoms. Open surgery disclosed a small position-dependent leak in the catheter connector. This catheter failure was not detected by standard noninvasive checking methods.

Acute Disease↗
PubMed2006

Cervical catheter tip placement for intrathecal baclofen administration.

OBJECTIVE: Intrathecal baclofen can reduce congenital and posttraumatic spasticity. Traditionally, the catheter tip for baclofen delivery is placed in a low thoracic position, which can result in a lumbar-to-cisternal cerebrospinal fluid baclofen concentration gradient. We investigated whether more rostral catheter placement was technically feasible, safe, and able to control upper extremity spasticity. METHODS: The records of 48 patients with a baclofen pump were reviewed retrospectively to evaluate the safety and efficacy of cervically placed intrathecal catheters for baclofen administration. Twenty-three patients had a catheter located in a cervical position and 25 had a catheter in a thoracic position (control group). Complications, including baclofen overdose, mechanical failures, and infections, were noted. Pre- and postoperative Ashworth scores were determined by a physical therapist using a standardized protocol. RESULTS: The mean duration of the follow-up period was 10 months. The groups were not significantly different in patient age, baclofen dose, or duration of follow-up, but differed somewhat in the causes of spasticity. For patients with a cervical catheter tip position, upper extremity Ashworth scores decreased significantly from 4.0 +/- 0.8 (standard deviation) preoperatively to 3.0 +/- 0.9 postoperatively (P = 0.003). In both groups, lower extremity spasticity was significantly reduced. Postoperatively, one patient with a cervical catheter developed aspiration pneumonia, possibly because of sedation. Other complications included hardware infections, mechanical malfunctions, and pseudomeningoceles. CONCLUSION: In this series, placement of intrathecal baclofen catheters in the cervical region resulted in equal control of spasticity in the upper and lower extremities and did not increase complications related to the catheter position.

Adolescent↗
PubMed2004

Use of intrathecal morphine infusion for spasticity.

OBJECTIVE: To study the efficacy of intrathecal morphine infusion to treat spasticity. SETTING: Functional Neurosurgery Division of University of São Paulo, Brazil. METHOD: Twelve patients with clinical refractory spasticity were studied. Two females and 10 males, with median age of 34.4 years (20 to 61 ys.). The initial Ashworth scale was 4.6. They were submitted to pump implantation for intrathecal morphine infusion. RESULTS: The final Ashworth scale was 2.2. The median dose concentration of Intrathecal morphine was 0.95 mg, with a mean frequency of 1.8 times a day. Four patients developed pruritus, two patients nausea, two patients urinary retention, however all improved after morphine concentration was decreased. One patient was submitted to pump review after extrusion catheter. CONCLUSIONS: Intrathecal morphine infusion is very helpful in patients with spasticity refractory to clinical treatment, and we observed only minor complications.

Adult↗
PubMed1979

Continuous mini-infusion of bupivacaine into the epidural space during labor. Part I: Radiographic visualization of the epidural catheters.

Two groups, each consisting of 20 parturients, were given a continuous infusion of 0.25 per cent bupivacaine into the epidural space for pain relief, after test and loading doses. The analgesic effect was registered during labor. After delivery the course of the catheters in the epidural space was investigated radiologically. In the first group long catheters (mean 16.5 cm from the skin surface) and in the second group short catheters (mean 10.5 cm) were used. The medial approach in the epidural space was varied between the first and second lumbar interspaces. The relationship between the position of the catheter tip and the degree of analgesia was also studied. In two mothers with fetus mortuus ante partum, the spread of a radiopaque dye solution was followed during labor. Through the force of gravity and the mothers position, the spread of solution covered three segments within 30 minutes. It was concluded, that slow infusion of local anesthetic solution gives satisfactory pain relief if the catheter is inserted into the first lumbar interspace to a depth of 10--12 cm from the skin surface ending close to the Th12 level. Gradual raising of the mother from the supine to the semirecumbent position and regular change of sides during mini-infusion is important for an even spread of the analgesic solution and analgasia.

Anesthesia, Epidural↗
PubMed2006

Intrathecal baclofen therapy in children.

Since its introduction in the late 1980s, intrathecal baclofen (ITB) therapy has become the standard treatment for severe generalized spasticity and dystonia in children. Treatment with ITB decreases spasticity in the upper and lower extremities and has been associated with improved function and decreased musculoskeletal contractures. In addition, ITB decreases generalized secondary dystonia and has been associated with improved comfort and ease of care in approximately 85% and with improved function in approximately 33% of patients. Continued effectiveness of ITB in treating spasticity has been observed for up to 17 years, and its effectiveness in treating dystonia has been observed for up to 10 years. Although ITB therapy is frequently associated with complications such as infections, catheter malfunctions, and cerebrospinal fluid leaks, the benefits of therapy appear to outweigh the risks. Additional investigation is needed to determine the effects of ITB on other movement disorders such as athetosis and chorea.

Baclofen↗
PubMed2006

Intrathecal baclofen in the treatment of adult spasticity.

Medical management of adult spasticity, a condition of increased muscle tone and deep tendon reflexes, is often challenging and complex. Oral medications such as baclofen often have unacceptable supraspinal side effects at effective doses. Intrathecal baclofen delivered by an implanted catheter and pump system provides good relief of spasticity while overcoming these limitations. In this paper the authors survey the use of oral and intrathecal baclofen therapy, detail the surgical process, and explain the risks and benefits of the procedure.

Administration, Oral↗
PubMed2006

Intrathecal baclofen therapy and multiple sclerosis: outcomes and patient satisfaction.

OBJECT: In this study the authors provide an assessment of intrathecal baclofen (ITB) therapy and evaluate patient outcomes and satisfaction. METHODS: Records for patients with multiple sclerosis who were selected as candidates for ITB therapy were reviewed for their response to test dose, surgical technique, surgery- and pump-related complications, and short- and long-term response to therapy. Family and caregiver assessments of the value of ITB therapy were also reviewed. CONCLUSIONS: Intrathecal baclofen therapy is safe and effective. Most patients and caregivers express satisfaction with the therapy and would recommend it to other patients. Spasm frequency appears to be the single most common variable positively affected by therapy.

Baclofen↗
PubMed1995

Catheter systems for intrathecal drug delivery.

A prospective study of intrathecal catheter reliability was performed at Rush-Presbyterian-St. Luke's Medical Center. All 102 patients who had baclofen administered chronically for spasticity via an implanted drug pump were included. Sixty percent of the patients had no catheter complications; the remaining patients had one to five complications over their course of treatment. Survival analysis demonstrated a steady rate of malfunction up to 80 months, with the mean time to first failure recorded at 20 months. Kinks, holes, breaks, dislodgments, and disconnections were the most common complications. On the basis of their research the authors conclude that the thin-walled silastic catheter does not perform well and that larger, thick-walled catheters should be used.

Adolescent↗