Effect of Bolus Dose of Intrathecal Baclofen Followed by Pump Implantation in Severe Spasticity in Multiple Sclerosis Patients


Authors: I. Štětkářová 1;  J. Šroubek 2;  I. Vrba 3;  J. Peregrin 1;  E. Havrdová 4
Authors‘ workplace: Neurologické oddělení 1;  neurochirurgické oddělení a 2;  Anesteziologicko-resuscitační oddělení, Nemocnice Na Homolce, Praha 3;  Neurologická klinika VFN a 1. LF UK, Praha 4
Published in: Cesk Slov Neurol N 2007; 70/103(2): 190-195
Category: Short Communication

Overview

Aim:
In chronic-progressive stages of MS, patients often suffer from severe spasticity and therefore have difficulties with daily self-care; their quality of life is significantly worsened. High doses of oral antispastic drugs lead to excessive general adverse effects. In this study we have demonstrated our experience with intrathecal baclofen delivery by a programmable pump device. The appropriate selection of patients is very important. Positive effects of the bolus administration have to be proved before the pump implantation.

Material and Methods:
Nine MS patients in chronic progressive stage (EDSS 6.5-8.5) were enrolled in this study. Various clinical scales were used for the muscle tone assessment (Ashworth scale), frequency of spasms and pain. H reflex after the tibial nerve stimulation at the fossa poplitea was performed before and 6 hours after the intrathecal baclofen administration in 5 patients.

Results:
Positive effects of the baclofen bolus administration were noted in 8 subjects. In one subject the test was not completed due to technical problems. The decrease of H/M amplitude ratio was observed after the baclofen administration in all 5 subjects, by 28 % on the average. To date, six MS patients have successfully implanted the baclofen drug delivery system.

Conclusions:
Decreased spasticity and better quality of life is obvious in all 6 patients with the baclofen pump. H/M amplitude ratio served as an objective measurement of the spinal motoneuron excitability in the intrathecal baclofen delivery. It is useful for verifying the baclofen administration.

Key words:
spasticity, multiple sclerosis, oral drug antispastic therapy, intrathecal baclofen, H reflex – H/M amplitude ratio


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Paediatric neurology Neurosurgery Neurology

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