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Coma Recovery Association, Inc.
The brain is an amazing organ. Its remarkable and vast capacity allows us to be the people that we are. Traumatic brain injury can cause damage that interferes with our ability to function to our optimum capacity. Spasticity can occur as a result of brain Injury. Spasticity is a syndrome associated with an increase in the involuntary reflex activity of muscles to stretch. The consequences of spasticity are numerous and may include stiffness, spasms, contractures as well as pain. Spasticity can negatively impact on quality of life factors such as mobility and independence, hygiene, self-care and self-esteem, mood, sleep, and sexual function. In general, goals of spasticity treatment are relief of subjective discomfort, facilitation of patient care, improvement of functional capacity and prevention of long-term consequences of excessive and unevenly distributed muscle tone. Unfortunately, the treatment of moderate to severe spasticity by medication, physical therapy and local injections often provide less than satisfying or gratifying results. Baclofen is a medication that works directly in the areas of the brain and spinal cord that are important in controlling muscle tone and spasticity. Baclofen by mouth can be an effective treatment for spasticity. Oral Baclofen, however, is often ineffective in treating severe spasticity, because to achieve effective therapeutic concentrations to the spinal cord, unacceptable systemic side effects are often produced. These side effects can include lethargy, confusion, drowsiness and muscle weakness. This medication can be delivered directly to the spinal cord and brain by an implanted catheter. This technique has been shown not only to be safe but to have dramatic clinical effectiveness. This technique is called Intrathecal Baclofen Therapy. Intrathecal Baclofen is much more effective than when given by mouth because the medication is delivered directly into the cerebral spinal fluid surrounding the spinal cord which is the intended site of action. The effective doses intrathecally are only a fraction of those doses given orally. Intrathecal Baclofen Therapy is a non-destructive end-reversal treatment that reduces spasticity without impairing underlying voluntary movement. A test dose can be given by a spinal tap to allow the patient and family to judge for themselves the remarkable effectiveness and safety of this treatment before making a commitment to a permanent implantation of a pump and catheter system that is required for a long-term commitment to treatment. This delivery system is called the SynchroMed Infusion System. The dosage given can be adjusted to meet the needs of each patient with minimal side effects. In reducing spasticity at both upper and lower extremities, this treatment can enhance mobility, independence, urinary management, as well as quality of life, among tetraplegic and diplegic patient ITB therapy may reduce the incidence of contractures and other painful and costly medical complications associated with spasticity and immobility as well as to facilitate rehabilitation and reduce physical, logistic and financial burdens of caregiving. Careful patient selection optimizes the benefits of ITB therapy. Goal setting is important to define reasonable and realistic expectations to assess whether this treatment is appropriate for the persons affected with severe spasticity. This treatment is not only appropriate for those ambulatory or wheelchair bound that spasms and/or spasticity interfere with some function that has not responded to other treatment attempts. Even if the person is home or bed-bound and intellectually impaired, this treatment can be appropriate and utilized if the focused goal is for hygiene or improved transferring, improved sleep or reduction of pain related to the spasticity. Even in this instance with generalized severe spasticity, this treatment can be effective. The explicit criteria includes severe spasticity, clinical stability, age greater than 4 and patient size sufficient to support the implanted device. The inclusion criteria must include realistic treatment goals as well as motivation and commitment of patients, families and caregivers. The few explicit contra-indications to this treatment include active infection, allergy to oral Baclofen or pregnancy. The treatment team will determine whether the indications for this therapy are present without any exclusion criteria also being present. The team will also consider clinical, functional, as well as psychosocial parameters that bear on a particular patient’s suitability for this treatment. I have been involved in treatment of spasticity by Intrathecal Baclofen therapy over the past several years and have found this to be an extremely affective and rewarding treatment. I have also been impressed by the first gains that patients have achieved as a result of this therapy. This treatment is extremely safe with appropriate clinical expertise, allows individualized fine-tuning of clinical response. The treatment is reversible and does not involve destruction of neural tissue. This treatment offers a marked consistently superior clinical response in the difficult spasticity management situation. If you, a family member, or someone you take care of have spasticity that interferes with function and have not been satisfied with the results of other treatment options, additional information about the use of Intrathecal Baclofen Therapy should be obtained. This information can be obtained directly from Medtronic, Inc., the world wide web @ southshoreneurologic.com or Contact someone who is involved with or knowledgeable about this therapy.
Written by: Mark Gudesblatt, M.D. Copyright © 1999, 2000, * SOUTH SHORE NEUROLOGIC ASSOCIATES, P.C.
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