Intrathecal baclofen for treatment of generalised dystonia and spasticity in non progressive disorders

Varaprasad; Purohit, A. K.; Bhattacharjee, Suchanda; Panigrahi, Manas
July 2007
Journal of Pediatric Neurosciences;Jul-Dec2007, Vol. 2 Issue 2, p100
Academic Journal
OBJECTIVE: To study, improvement in dystonia and spasticity in non progressive disorders with continuous infusion of baclofen intrathecally. MATERIALS AND METHODS: Study was conducted from September 2004 to July 2007. Study included 14 patients, age ranging from 4 t o 40 years with generalized dystonia (n=8), spasticity (n=6) due to various causes[cerebral palsy (n=8), post trauma (n=4), post spinal tumor excision (n=1)]. The patients were selected after a positive result from a trial dose with 50mcg or 100 mcg of. baclofen intrathecally. A synchromed type 1 or 2 type of pump was placed with the catheter tip passed upto T3 level. Doses required were in the range of 100 to 700 mcg in the spasticity group and in the range of 140 to 1000 mcg in the dystonia group. Doses were regulated by telemetry using a programmer along with regular refilling of the drug. Response to the treatment was observed based on improvement in Ashworth Spasticity scale and modified Marsden dystonia scale. The follow up period ranged from 10 days to 21 months. RESULTS: Spasticity improved in all patients. Seven of the-eight patients with dystonia improved. Dystonia patients required higher dose compared to the spasticity group. Side effects like wound infection and skin necrosis were seen in three patients where pump was removed. In one patient it was replaced on the opposite side of the abdomen and the other two patients are waiting for replacement. One patient has a paradoxical increase in dystonic spasms upto particular dose. Poor compliance was also noticed in a few and one patient got the pump removed, as he was not able to get it refilled. CONCLUSION: Continuous intrathecal baclofen pump offers a better alternative treatment modality for generalized dystonia and some well selected cases of spasticity with a relatively simple technique. Most of the complications can be managed conservatively. However, socioeconomic and geographic factors were important hindrances with this minimally invasive non ablative method.


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