Long term effect (more than five years) of intrathecal baclofen on impairment, disability, and quality of life in patients with severe spasticity of spinal origin

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 75; no. 11; pp. 1553 - 1557
• Main Authors: Zahavi, A, Geertzen, J H B, Middel, B, Staal, M, Rietman, J S
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01-11-2004; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Activities of Daily Living - classification; Activities of Daily Living - psychology; Adult; Aged; ambulation index; baclofen; Baclofen - administration & dosage; Baclofen - adverse effects; Biological and medical sciences; Disability Evaluation; Dose-Response Relationship, Drug; EDSS; effect size; expanded disability status scale; Female; FIM; Follow-Up Studies; functional independence measure; Hopkins symptom checklist; HSCL; Humans; incapacity status scale; Infusion Pumps, Implantable; Injections, Spinal; Injuries of the nervous system and the skull. Diseases due to physical agents; intrathecal administration; ISS; Male; Medical sciences; Middle Aged; Multiple sclerosis; Multiple Sclerosis - complications; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Muscle Relaxants, Central - administration & dosage; Muscle Relaxants, Central - adverse effects; Muscle Spasticity - diagnosis; Muscle Spasticity - drug therapy; Muscle Spasticity - psychology; Neurology; Patients; QLI; Quality of life; Quality of Life - psychology; quality of life index; Questionnaires; Sick Role; Sickness Impact Profile; SIP; Spasticity; Spinal cord injuries; Spinal Cord Injuries - complications; Traumas. Diseases due to physical agents; Treatment Outcome; Human; Disability; Striated muscle disease; Nervous system diseases; Baclofen; Spasticity; Muscle tonus alteration; Neurological disorder; Long term; Intrathecal; Quality of life
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2003.014282

Objectives: To evaluate long term change in impairment, disability, and health related functional status in patients with severe spasticity who received intrathecal baclofen. Methods: A long term (more than five years) observational longitudinal follow up study assessing 21 patients who received intrathecal baclofen given by programmable pump. Patients had chronic disabling spasticity which did not respond to oral antispasmolytic agents. Clinical efficacy was assessed by the Ashworth scale and spasm score; disability by the expanded disability status scale (EDSS), ambulation index (AI), and incapacity status scale (ISS); and health related quality of life by the sickness impact profile (SIP) and the Hopkins symptom checklist (HSCL). Results: Compared with pretreatment values, there was a significant improvement in clinical efficacy (Ashworth scale and spasm score, p<0.05) but a small but significant worsening of disability (EDSS, AI, and ISS, p<0.05). Comparing pretreatment with 26 weeks after pump implantation, a worsening was observed in disability (EDSS and ISS, p<0.05) and perceived health status (SIP, psychosocial dimension, p<0.05). Conclusions: Long term administration of intrathecal baclofen delivered by an implanted programmable pump resulted in improved clinical efficacy but not in improvement in disability or perceived health status.