Baclofen bridging, weaning protocol and pain management of a person with T6 paraplegia who required removal of intrathecal baclofen pump due to wound infection

Intrathecal baclofen is recognised as an effective treatment option for severe symptoms of segmental spasticity after spinal cord injury. We present our experience of a case of a patient who was admitted to our centre for elective intrathecal baclofen pump revision surgery, but postsurgical complications of a blocked catheter and subsequent wound infections meant the pump had to be removed. In this case, treatment of severe spasticity and nociceptive pain was required while avoiding potentially lethal side effects of sudden baclofen withdrawal. We suggest an effective bridging and weaning protocol for oral drug titration to treat spasticity and pain as a blended syndrome in this challenging situation.

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INTRATHECAL BACLOFEN PUMP FOR SPASTIC HYPERTONIA FOLLOWING PENETRATING BRAIN INJURY

10.36106/gjra/4102645 ◽

2021 ◽

pp. 76-78

Author(s):

Anand Sharma ◽

Yashbir Dewan

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Brain Injury ◽

Intrathecal Baclofen ◽

Gunshot Injury ◽

Review Of Literature ◽

Penetrating Brain Injury ◽

Severe Spasticity ◽

Cord Injury

Management of severe spasticity following penetrating brain injury is often a difcult problem. Orally administered medications generally offer limited benets. Intrathecally administered baclofen has been shown to be effective in patients with spasticity caused by spinal cord injury and stroke, however, the effectiveness of ITB for spasticity related to penetrating brain injury is not well established. We reported two cases of spastic hypertonia following gunshot injury to brain with brief review of literature upon role of intrathecal baclofen pump (ITB) in cortical spastic hypertonia

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Spinal cord stimulation and intrathecal baclofen therapy for patients with severe spasticity after spinal cord injury

Neuropharmacology of Neuroprotection - Progress in Brain Research ◽

10.1016/bs.pbr.2020.09.007 ◽

2020 ◽

pp. 79-99

Author(s):

Artur Biktimirov ◽

Igor Bryukhovetskiy ◽

Aruna Sharma ◽

Hari Shanker Sharma

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Cord Stimulation ◽

Intrathecal Baclofen ◽

Intrathecal Baclofen Therapy ◽

Severe Spasticity ◽

Cord Injury

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Effects of Intrathecal Baclofen on Perceived Sexual Functioning in Men With Spinal Cord Injury

Journal of Spinal Cord Medicine ◽

10.1080/10790268.2008.11753988 ◽

2008 ◽

Vol 31 (1) ◽

pp. 97-102 ◽

Cited By ~ 10

Author(s):

Michael L. Jones ◽

Donald P. Leslie ◽

Gerald Bilsky ◽

Brock Bowman

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Sexual Functioning ◽

Intrathecal Baclofen ◽

Cord Injury

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37. H-reflex and F-wave of the patients of spinal cord injury before and after intrathecal baclofen injection

Clinical Neurophysiology ◽

10.1016/j.clinph.2010.02.118 ◽

2010 ◽

Vol 121 (7) ◽

pp. e27

Author(s):

Katsuhiro Mizuno ◽

Kazushige Hasegawa ◽

Osamu Uemura ◽

Daisuke Matsuura ◽

Masako Katahira ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Intrathecal Baclofen ◽

H Reflex ◽

Cord Injury ◽

Before And After ◽

F Wave

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Normalization of Central Cord Syndrome Spinal Cord Injury Urodynamics After Intrathecal Baclofen Therapy: A Case Report

Neuromodulation Technology at the Neural Interface ◽

10.1111/j.1525-1403.2009.00227.x ◽

2009 ◽

Vol 12 (4) ◽

pp. 310-314 ◽

Cited By ~ 1

Author(s):

Adam L. Schreiber ◽

Guy W. Fried ◽

Christopher S. Formal

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Case Report ◽

Intrathecal Baclofen ◽

Intrathecal Baclofen Therapy ◽

Cord Injury ◽

Central Cord Syndrome

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Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study

Journal of Neurosurgery ◽

10.3171/jns.1993.78.2.0226 ◽

1993 ◽

Vol 78 (2) ◽

pp. 226-232 ◽

Cited By ~ 292

Author(s):

Robert J. Coffey ◽

David Cahill ◽

William Steers ◽

T. S. Park ◽

Joe Ordia ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Intrathecal Baclofen ◽

Neurological Deficits ◽

Pump System ◽

Postoperative Score ◽

Long Term Treatment ◽

Cord Injury

✓ A total of 93 patients with intractable spasticity due to either spinal cord injury (59 cases), multiple sclerosis (31 cases), or other spinal pathology (three cases) were entered into a randomized double-blind placebocontrolled screening protocol of intrathecal baclofen test injections. Of the 88 patients who responded to an intrathecal bolus of 50, 75, or 100 µg of baclofen, 75 underwent implantation of a programmable pump system for chronic therapy. Patients were followed for 5 to 41 months after surgery (mean 19 months). No deaths or new permanent neurological deficits occurred as a result of surgery or chronic intrathecal baclofen administration. Rigidity was reduced from a mean preoperative Ashworth scale score of 3.9 to a mean postoperative score of 1.7. Muscle spasms were reduced from a mean preoperative score of 3.1 (on a fourpoint scale) to a mean postoperative score of 1.0. Although the dose of intrathecal baclofen required to control spasticity increased with time, drug tolerance was not a limiting factor in this study. Only one patient withdrew from the study because of a late surgical complication (pump pocket infection). Another patient received an intrathecal baclofen overdose because of a human error in programming the pump. The results of this study indicate that intrathecal baclofen infusion can be safe and effective for the long-term treatment of intractable spasticity in patients with spinal cord injury or multiple sclerosis.

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