Article

Baclofen commonly is used to manage spasticity caused by central
nervous system lesions or dysfunction. Although both intrathecal and oral
delivery routes are possible, no study has directly compared clinical outcomes
associated with these 2 routes of treatment. OBJECTIVE: To compare spasticity
levels, pain, sleep, fatigue, and quality of life between individuals receiving
treatment with intrathecal versus oral baclofen. DESIGN:
Cross-sectional matched
cohort survey study. SETTING: Urban academic rehabilitation outpatient clinics.
PARTICIPANTS: Adult patients with spasticity, treated with intrathecal or oral
baclofen for at least 1 year, matched 1:1 for age, gender, and diagnosis.
METHODS: Standardized surveys were administered during clinic appointments or by
telephone. MAIN OUTCOME MEASURES: Surveys included the Penn Spasm Frequency
Scale, Brief Pain Inventory, Epworth Sleepiness Scale, Fatigue Severity Scale,
Life Satisfaction Questionnaire, and Diener Satisfaction with Life Scale.
RESULTS: A total of 62 matched subjects were enrolled. The mean (standard
deviation [SD]) age was 46 (11) years with a mean duration of intrathecal
baclofen or oral baclofen treatment of 11 (6) and 13 (11) years, respectively.
There were 40 (64%) male and 22 (36%) female subjects. Primary diagnoses included
spinal cord injury (n = 38), cerebral palsy (n = 10), stroke
(n = 10), and
multiple sclerosis (n = 4). The mean (SD) dose of intrathecal and oral baclofen
at the time of survey were 577 (1429) mug/day and 86 (50) mg/day, respectively.
Patients receiving intrathecal compared with oral baclofen experienced
significantly fewer (1.44 [0.92] versus 2.37 [1.12]) and less severe (1.44 [0.92]
versus 2.16 [0.83]) spasms, respectively as measured by the Penn Spasm Frequency
Scale (P < .01; P < .01). There were no significant differences in pain, sleep,
fatigue, and quality of life between groups. Subanalysis of patients with SCI
mirrored results of the entire study sample, with significant decreases in spasm
frequency and severity associated with intrathecal compared to oral baclofen
(P < .01; P < .01), but no other between group differences.
The mean (SD) percent
change in dose of oral (21% [33%]) compared with intrathecal (3% [28%]) baclofen
was significantly larger two years prior to the date of survey (P = .02).
CONCLUSIONS: Long-term treatment with intrathecal compared with oral baclofen is
associated with reduced spasm frequency and severity as well as greater dose
stability. These benefits must be weighed against the risks of internal pump and
catheter placement in patients considering intrathecal baclofen therapy.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS