Ann Rehabil Med.  2019 Oct;43(5):555-561. 10.5535/arm.2019.43.5.555.

Intrathecal Baclofen Dosage for Long-Term Treatment of Patients With Spasticity Due to Traumatic Spinal Cord Injuries or Multiple Sclerosis

• Skoog B
• Hedman B

• KMID: 2463703
• DOI: http://doi.org/10.5535/arm.2019.43.5.555

Abstract

OBJECTIVE
To investigate dosage changes in intrathecal baclofen during long-term treatment of patients with severe leg spasticity.
METHODS
We performed a retrospective chart review of 49 patients treated with an intrathecal baclofen pump (ITB) because of severe leg spasticity, for a minimum of 7 years. Eight patients were excluded due to catheter/pump failure or factors aggravating spasticity. Of the remaining 41 patients, 19 had spinal cord injury (SCI) and 22 were diagnosed with multiple sclerosis (MS). Among the SCI patients, 15 had cervical and 4 thoracic SCI, with 7 patients showing the American Spinal Injury Association impairment scale (AIS) A and 12 patients with AIS B-D. The dose was regulated by discussion among the patients and their physicians, usually 4-10 times annually, to reduce leg spasticity and also avoid leg/trunk weakness.
RESULTS
After 1 year patients on ITB needed a median dose of 168 mg/24 hr (range, 30-725 mg) for an optimal effect. After 7 to 10 years the dosage needed to reduce leg spasticity in the MS patients was significantly increased compared with the initial dose (mean 157%, n=22 and mean 194%, n=18). In contrast, the SCI patients needed only a modest increase (mean 113% and 121%). The difference between MS and SCI patients was significant (t-test p=0.006 and p=0.004).
CONCLUSION
The increased dosage in MS patients compared with patients diagnosed with SCI probably reflects the progressive disease course. The need for a large dosage increase in patients with SCI suggests possible pump failure, triggering factors for spasticity or progressive spinal disease.

Keyword

Muscle spasticity; Spinal infusion; Baclofen; Spinal cord injuries; Multiple sclerosis

MeSH Terms

Baclofen*
Humans
Infusions, Spinal
Leg
Multiple Sclerosis*
Muscle Spasticity*
Retrospective Studies
Spinal Cord Injuries*
Spinal Cord*
Spinal Diseases
Spinal Injuries
Baclofen

Figure

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  Fig. 1. Long-term changes in intrathecal baclofen dosage of patients with spinal cord injury (A) or multiple sclerosis (B). One patient with spinal cord injury had the pump system changed after 20 years (hatched line). AIS, American Spinal Cord Injury Association impairment score.

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  Fig. 2. Changes (%) in long-term intrathecal baclofen dosage of patients with spinal cord injury (A) and multiple sclerosis (B). AIS, American Spinal Cord Injury Association impairment score.

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  Fig. 3. Comparison of mean intrathecal baclofen dosages between patients with spinal cord injury and multiple sclerosis. The bars indicate 95% confidence interval.

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