Intrathecal baclofen for intractable spasticity of spinal origin: Results of a long-term multicenter study

R. J. Coffey, D. Cahill, W. Steers, T. S. Park, J. Ordia, J. Meythaler, R. Herman, A. G. Shetter, R. Levy, B. Gill, R. Smith, J. Wilberger, J. D. Loeser, C. Chabal, C. Feler, J. T. Robertson, R. D. Penn, A. Clarke, K. J. Burchiel

Research output: Contribution to journalArticle

344 Scopus citations

Abstract

A total of 93 patients with intractable spasticity due to either spinal cord injury (59 cases), multiple sclerosis (31 cases), or other spinal pathology (three cases) were entered into a randomized double-blind placebo- controlled screening protocol of intrathecal baclofen test injections. Of the 88 patients who responded to an intrathecal bolus of 50, 75, or 100 μg of baclofen, 75 underwent implantation of a programmable pump system for chronic therapy. Patients were followed for 5 to 41 months after surgery (mean 19 months). No deaths or new permanent neurological deficits occurred as a result of surgery or chronic intrathecal baclofen administration. Rigidity was reduced from a mean preoperative Ashworth scale score of 3.9 to a mean postoperative score of 1.7. Muscle spasms were reduced from a mean preoperative score of 3.1 (on a four-point scale) to a mean postoperative score of 1.0. Although the dose of intrathecal baclofen required to control spasticity increased with time, drug tolerance was not a limiting factor in this study. Only one patient withdrew from the study because of a late surgical complication (pump pocket infection). Another patient received an intrathecal baclofen overdose because of a human error in programming the pump. The results of this study indicate that intrathecal baclofen infusion can be safe and effective for the long-term treatment of intractable spasticity in patients with spinal cord injury or multiple sclerosis.

Original languageEnglish (US)
Pages (from-to)226-232
Number of pages7
JournalJournal of neurosurgery
Volume78
Issue number2
DOIs
StatePublished - 1993

Keywords

  • baclofen
  • intrathecal drug infusion
  • multiple sclerosis
  • spasticity
  • spinal cord injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Coffey, R. J., Cahill, D., Steers, W., Park, T. S., Ordia, J., Meythaler, J., Herman, R., Shetter, A. G., Levy, R., Gill, B., Smith, R., Wilberger, J., Loeser, J. D., Chabal, C., Feler, C., Robertson, J. T., Penn, R. D., Clarke, A., & Burchiel, K. J. (1993). Intrathecal baclofen for intractable spasticity of spinal origin: Results of a long-term multicenter study. Journal of neurosurgery, 78(2), 226-232. https://doi.org/10.3171/jns.1993.78.2.0226