Intrathecal baclofen after traumatic brain injury: Early treatment using anew technique to prevent spasticity

Background: In the early course of severe head trauma, the clinical value o f intrathecal administration of baclofen to reduce autonomic disorders and spasticity has not been established. Methods: We studied four patients (Glasgow Coma Scale score 3 or 4) with au tonomic disorders and spasticity who failed to respond to conventional trea tment during the early course of head injury, Baclofen (25 mug/mL) was infu sed continuously through an intrathecal catheter inserted at patient bedsid e and subcutaneously tunneled. When this treatment was successful, the spin al catheter was removed and surgically replaced by another catheter connect ed to a subcutaneous pump. Clinical follow-up was obtained at 6 months afte r the head injury, Results: Mean delay for the initiation of intrathecal baclofen was 25 days (range, 21 to 31 days), and optimal dose was 385 +/- 185 mug/day. In all pa tients, the Ashworth score was consistently reduced (3.5 +/- 0.5. vs. 4.5 /- 0.5 for upper limbs and 2 +/- 0.5 vs. 4.5 +/- 0.5 for lower limbs), as w ere both the frequency and intensity of autonomic disorders. The spinal cat heters were used during a mean period of 9.5 +/- 1.7 days without complicat ions. All three survivors were equipped with a programmable pump and had a lower Ashworth score at 6 months. Autonomic disorders had disappeared in tw o patients and remained modest in the remaining patient. Conclusion: Continuous administration of baclofen via the intrathecal route using this new technique seems to reduce autonomic disorders and spasticit y during the early course of severe traumatic head injury.