Treatment of severe, disabling spasticity with continuous intrathecal baclofen therapy following acquired brain injury: the experience of a tertiary institution in Singapore

• Published in: Singapore medical journal Vol. 57; no. 1; pp. 8 - 12
• Main Authors: Wang, Zhe Min, Law, Jia Hao, King, Nicolas Kon Kam, Rajeswaran, Deshan Kumar, Soh, Samantha, Rao, Jai Prashanth, Ng, Wai Hoe, Chua, Karen Sui Geok
• Format: Journal Article
• Language: English
• Published: Singapore Singapore Medical Association 01-01-2016
• Subjects: Baclofen - administration & dosage; Brain Injuries - complications; Brain Injuries - drug therapy; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Infusion Pumps, Implantable; Injections, Spinal; Male; Muscle Relaxants, Central - administration & dosage; Muscle Spasticity - diagnosis; Muscle Spasticity - drug therapy; Muscle Spasticity - etiology; Original; Retrospective Studies; Severity of Illness Index; Singapore - epidemiology; Tertiary Care Centers; Treatment Outcome; traumatic brain injury; hypertonia; spasticity; dystonia; intrathecal baclofen pump
• ISSN: 0037-5675
• DOI: 10.11622/smedj.2016005

Intrathecal baclofen (ITB) therapy is a proven, effective treatment for disabling cortical spasticity. We describe the first local series of five patients with acquired brain injury (ABI) who received ITB and were followed up for 63.8 months.
A retrospective review of medical and rehabilitation records of patients who received ITB therapy was carried out. Data studied included baseline demographic and injury variables, implantation data, spasticity and function, ITB dosage over time and complications.
From 2006 to 2010, a total of five patients received ITB therapy via implanted pumps about 39.4 months after ABI. Four out of five patients experienced significant reductions in their lower limb spasticity scores and improvements in global function and dependency. One patient had minor adverse events associated with baclofen-related sedation. The mean ITB dose at one year was 182.7 ± 65.6 mcg/day.
Our preliminary study showed encouraging long-term outcomes and safety for ITB therapy after ABI-related intractable spasticity. Individual ITB responses over time were variable, with gender differences. The outcomes experienced by our centre were comparable to those in the general ABI population, supporting the efficacy of ITB therapy for chronic disabling spasticity.