Long-term continuously infused intrathecal baclofen for spastic-dystonic hypertonia in traumatic brain injury: 1-year experience

Objective: To determine if the long-term use of continuously infused intrathecal baclofen (ITB) over a 1-year period will control spastic-dystonic hypertonia in patients with traumatic brain injury (TBI). Setting: Tertiary care outpatient and inpatient rehabilitation center directly attached to a university hospital. Subjects: Persons with TBI and intractable spasticity and dystonia for more than 6 months' duration recruited in a consecutive manner. Design: TBI patients were admitted to the study after screening via a bolus injection of either intrathecal normal saline or 50 mu g of baclofen. Data for Ashworth rigidity scores, spasm scores, and deep tendon reflex scores were collected for both the upper extremities (UE) and lower extremities (LE). Patients whose LE Ashworth scores decreased an average of 2 points were then offered implantation of a computer-controlled pump for continuous ITB. Changes over time were assessed statistically via Friedman's analysis for ordinal data and ANOVA for linear data. Differences between set points in time were also assessed via Wilcoxon signed rank. Data Set: Seventeen patients (average age 29 +/- 11yrs) with spasticity and/or dystonia treated over 1 year via a computer-controllable intrathecal delivery system for the delivery of ITB. Results: After 1 year of continuous ITB treatment the average LE Ashworth score decreased from 3.5 +/- 1.3 (SD) to 1.7 +/- 0.9 (p < .0001), spasm score from 1.8 +/- 1.3 to 0.2 +/- 0.5 (p < .0001), and reflex score from 2.5 +/- 1.1 to 0.1 +/- 0.3 (p < .0001). The average UE Ashworth score decreased from 2.9 +/- 1.5 to 1.6 +/- 1.0 (p < .0001), spasm score from 1.2 +/- 1.5 to 0.2 +/- 0.6 (p < 0.0001), and reflex score from 2.2 +/- 0.5 to 1.0 +/- 0.8 (p < .0001). The average ITB dose required to attain these effects at 1 year was 302 mu g continuously infused per day. Conclusion: Continuous intrathecal infusion of baclofen is capable of maintaining a reduction in spasticity and dystonia in both the upper and lower extremities of TBI patients. (C) 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.