Summary
This chapter will review the application of intrathecal baclofen (ITB) in the management of post-stroke hypertonia, a major complication that results in deformity and discomfort, and limits mobility and performance of activities of daily living (ADL). Initially, ITB was considered only in conditions characterized by severe multi-limb spastic hypertonia in non-ambulatory individuals. Lately, ITB is used in persons with stroke who can ambulate, with the intent of further improving walking ability. Early clinical experience and evidence suggest that when used in the appropriate patient, ITB is efficacious and safe in managing post-stroke hypertonia in individuals of various functional levels. This chapter will also review clinical situations that are common in the stroke population, which may influence treatment decision choices. There are still ample opportunities to conduct research on this treatment modality, especially in the areas of patient selection and outcomes in the stroke population.
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References
Ashworth B (1964) Preliminary trial of carisoprodol in multiple sclerosis. Practitioner 192: 540–542
Bohannon RW, Smith MB (1986) Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67: 206–207
Boyd RN, Graham HK (1996) Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy. Eur J Neurol Suppl 4: S23–S33
Brailowsky S, Knight RT, Blood K, Scabini D (1986) Gamma amino butyric acid-induced potentiation of cortical hemiplegia. Brain Res 362: 322–330
Brunnstrom S (1970) Recovery stages and evaluation procedures. In: Brunnstrom S (ed) Movement therapy in hemiplegia: a neurophysiological approach, Harper & Row Publishers Inc., Maryland, pp 34–55
Coffey RJ, Edgar TE, Francisco GE et al (2002) Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome. Arch Phys Med Rehabil 83: 735–741
Chapuis DM, Boortz-Marx RL, Stuckey MW et al (2002) Safety of continuously infused intrathecal baclofen in the cervical and high thoracic areas for patients with spasticity, dystonia, and movement disorders: a prospective case series. Arch Phys Med Rehabil 83:1676 (abs)
Denys P, Mane M, Azouvi P et al (1998) Side effects of chronic intrathecal baclofen on erection and ejaculation in patients with spinal cord lesions. Arch Phys Med Rehabil 79: 494–496
Francisco GE, Ivanhoe CB, Grissom SP et al (2001) Prospective evaluation of the efficacy and safety of intrathecal baclofen therapy for spastic hypertonia due to stroke. Arch Phys Med Rehabil 82: 1341(abs)
Francisco GE, Boake C (2003) Improvement in walking speed in post-stroke spastic hemiplegia after intrathecal baclofen therapy: a preliminary study. Arch Phys Med Rehabil 84(8): 1194–1199
Goldstein LB (1998) Potential effects of common drugs on stroke recovery. Arch Neurol 55(4): 454–456
Gracies JM, Weisz DJ, Yang BY et al (2002) Spastic co-contraction and movement speed: effects of botulinum toxin type A injection into an agonist. Ann Neurol Suppl 1: S89
Hill DR, Bowery NG (1982) [3H]Baclofen and [3H]GABA bind to bicuculline-insensitive GABAB sites in rat brain. Nature 290: 149–152
Knuttson E, Lindblom U, Martensson A (1974) Plasma and cerebrospinal fluid levels of baclofen (Lioresal) at optimal therapeutic responses in spastic paresis. J Neurol Sci 23: 473–484
Kofler M, Kronenberg M, Rifici C, Saltuari L, Bauer G (1994) Epileptic seizures associated with intrathecal baclofen application. Neurology 94: 25–27
Kofler M, Matak H, Saltuari L (2002) The impact of intrathecal baclofen on gastrointestinal function. Brain Inj 16(9): 825–836
Kroin JS, Penn RD (1991) Cerebrospinal fluid pharmacokinetics of lumbar intrathecal baclofen. In: Lakke JPWF (ed) Parenteral drug therapy in spasticity and Parkinson’s disease. Parthenon Pub. Group Inc., Park Ridge, NJ, pp 67–77
Kroin J (1992) Intrathecal drug administration: present use and future trends. Clinical Pharmacokinet 22: 319–326
Meythaler JM, Guin-Renfroe S, Hadley MN (1999) Continuously infused intrathecal baclofen for spastic/dystonic hemiplegia: a preliminary report. Am J Phys Med Rehabil 78: 247–254
Meythaler JM, Guin-Renfroe S, Brunner RC, Hadley MN (2001) Intrathecal baclofen for spastic hypertonia from stroke. Stroke 32: 2099–2109
Muller H, Zierski J, Dralle D, Krauss D, Mutschler E (1998) Pharmacokinetics of intrathecal baclofen. In: Muller et al (eds) Local-spinal therapy of spasticity. Springer, Berlin, pp 223–226
Perry J, Garrett M, Gronley JK, Mulroy SJ (1995) Classification of walking handicap in the stroke population. Stroke 26: 982–989
Remy-Neris O, Tiffrau V, Bouilland S (2003) Intrathecal baclofen in subjects with spastic hamiplegia: assessment of the antispastic effect during gait. Arch Phys Med Rehabil 84: 643–650
Schallert T, Hernandez TD, Barth TM (1986) Recovery of function after brain damage: severe and chronic disruption by diazepam. Brain Res 379: 104–111
Schuele SU, Kellinghaus C, Shook SJ et al (2005) Incidence of seizures in patients with multiple sclerosis treated with intrathecal baclofen. Neurology (United States) 64(6): 1086–1087
Tardieu G, Shentoub S, Delarue R (1967) A la recherché d’une technique de mesure de la spasticite. Rev Neurol 1954 91: 143–144
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Francisco, G.E. (2007). Intrathecal baclofen in the management of post-stroke hypertonia: current applications and future directions. In: Sakas, D.E., Simpson, B.A., Krames, E.S. (eds) Operative Neuromodulation. Acta Neurochirurgica Supplements, vol 97/1. Springer, Vienna. https://doi.org/10.1007/978-3-211-33079-1_30
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DOI: https://doi.org/10.1007/978-3-211-33079-1_30
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