Continuously infused intrathecal baclofen for spastic dystonic hemiplegia - A preliminary report

The objective of this study was to determine whether the continuous intrath ecal delivery of baclofen will control spastic hypertonia associated with l ong-standing hemiplegia from acquired brain injury. Six hemiparetic patient s (average age, 50 (range, 42-66) yr) with more than 6 mo of disabling lowe r limb spastic hypertonia on one side caused by either a unilateral traumat ic brain injury or a stroke were recruited in a consecutive manner. The set ting was a tertiary care outpatient and inpatient rehabilitation center dir ectly attached to a university hospital. Patients were screened via a rando mized, double-blind, placebo-controlled, crossover design to receive either an intrathecally administered bolus injection of normal saline or 50 mu g of baclofen. Data for Ashworth rigidity scores, spasm scores, and deep tend on reflex scores were collected on the affected upper limb and lower limb s ide. Those who dropped an average of two points on their affected lower lim b side Ashworth scores were then offered computer-controlled pump implantat ion for continuous intrathecal administration of baclofen. Differences over time were assessed via descriptive statistics and Wilcoxon's signed-rank t est. After 3 mo of treatment, the average lower limb Ashworth score on the affected side decreased from 3.7 +/- 1.0 to 1.9 +/- 0.6 standard deviation (SD) (P < 0.0001), the reflex score from 1.8 +/- 1.3 to 0.5 +/- 0.8 SD (P = 0.0208), and the spasm score from 1.3 +/- 1.2 to 0.8 +/- 1.3 SD (P > 0.05) . The average upper limb Ashworth score on the affected side decreased from 3.4 +/- 0.9 to 2.1 +/- 0.9 SD (P = 0.0002), the reflex score from 2.3 +/- 0.5 to 1.7 +/- 0.5 SD (P > 0.050, and the spasm score from 0.8 +/- 1.3 to 0 +/- 0 SD (P > 0.05). The average intrathecally administered dose of baclof en that was required to attain these effects was 205.3 mu g, which was cont inuously infused for 24 h. Continuous intrathecal infusion of baclofen is c apable of maintaining a reduction in the dystonia on the hemiparetic side w ithout significantly affecting motor strength on the normal side.