AI Summary & Key Takeaways
AI InsightDuring the follow-up period, pump-related complications were seen in 2 patients.Conclusion: ITB is an effective and safe treatment option in severe spasticity.
📌 3 Key Takeaways
Abstract
Objective: To evaluate the effects of intrathecal baclofen therapy (ITB) in patients with severe spasticity.Material and Methods: Patients who had a baclofen pump implanted between 2004-2012 were included in the study. The inclusion criteria were severe spasticity with nonresponse to medical oral therapy and physiotherapy, modified Ashworth scale (MAS) score 3-4, and Penn's spasm scale (PSS) score 3-4. The ITB assessment criteria were MAS, PSS, visual analog scale (VAS), functional independence measurement (FIM), and short form-36 (SF-36) Tests were given before ITB and 3 months after implantation. Results: Twenty-one patients were given the test dose, and the ITB pump was implanted for 16. There were 11 men (68.75%) and 5 women (31.25%). Mean age was 33±10.34, ranging between 12-53 years. Eleven (68.75%) had spinal cord injury, 2 (12.50%) had multiple sclerosis, 2 (12.50%) had cerebral palsy, and 1 (6.25%) had a hypoxic brain. Eleven (68.75%) of these patients were paraplegic, 4 were (25%) tetraplegic, and 1 had (6.25%) dystonic cerebral palsy. Mean follow-up was 52.25±33.10 months, ranging between 3-100 months. Daily baclofen dose was between 70-475 µg (average 220±110.58 µg). Modified Ashworth scale decreased from 3.43±0.53 to 1.00±0.73 (p=0.00); PSS decreased from 3.50±1.03 to 1.12±1.02 (p=0.001); global pain decreased from 44.37±36.14 to 18.75±19.95, (p=0.003); FIM increased from 71.18±20.88 to 76.31±28.25 (p=0.023); SF-36 physical function increased from 2.06±8.25 to 18.25±26.06 (p=0.006); physical role difficulty increased from 1.56±6.25 to 40.31±29.74 (p=0.002); general health increased from 29.37±17.68 to 47.62±27.35 (p=0.005); pain increased from 26.31±30.49 to 53.37±26.45 (p=0.005); vitality increased from 38.93±20.94 to 61.25±19.70 (p=0.001); social function increased from 19.31±14.59 to 70.56±82.74 (p=0.001); emotional role difficulty increased from 10.37±26.40 to 56.31±38.08 (p=0.004); and mental health increased from 46.25±18.12 to 61.12±19.81 (p=0.004). During the follow-up period, pump-related complications were seen in 2 patients.Conclusion: ITB is an effective and safe treatment option in severe spasticity.
Özet
Amaç: Ciddi spastisitesi olan hastalarda intratekal baklofen (İTB) tedavisininetkilerini değerlendirmek.Gereç ve Yöntemler: Çalışmamızda 2004-2012 yılları arasında İTBtedavisi için pompa takılan hastalar incelemeye alınmıştır. Çalışmayaalınma kriterleri; oral medikal tedavi ve fizyoterapiye cevap vermeyenciddi spastisite ile modifiye Ashworth skalası (MAS) ve Penn spazm frekansı(PSF) skorlarının da 3-4 arasında olması idi. İntratekal baklofen etkinliğinindeğerlendirilmesi MAS, PSF, vizüel analog skala (VAS), fonksiyonelbağımsızlık ölçeği (FIM), kısa form-36 (SF-36) ile yapılmıştır. Testler, İTBöncesinde ve pompa takıldıktan sonraki 3. ayda verilmiştir.Bulgular: Yirmi bir hastaya test dozu verilmiş ve 16 hastaya pompatakılmıştır. Hastaların 11'i (%68,75) erkek, 5'i (%31,25) ise kadındı.Yaş aralığı 12-53 yıl arasında değişmekte olup, ortalama 33±10,34 yılolarak bulundu. On bir (%68,75) spinal kord yaralanması, 2 (%12,50)multipl skleroz, 2 (%12,50) serebral palsi, 1 (%6,25) hipoksik beyinsendromu olan hasta çalışmaya alındı. Bunların 11'i (%68,75) paraplejik,4'ü (%25) tetraplejik, 1'i (%6,25) ise distonik serebral palsi idi. Hastaizlem süremiz 2-100 ay arasında olup, ortalama 52,25±33,10 aydı.Ortalama günlük baklofen dozu 220±110,58 µg olup, 70-475 µgarasında değişmekte idi. Modifiye Ashworth skalası 3,43±0,53'den1,00±0,73'e (p=0,00); PSF 3,50±1,03'den 1,12±1,02'ye (p=0,001); VAS44,37±36,14'den 18,75±19,95'e (p=0,003) düştü; FIM 71,18±20,88'den76,31±28,25'e (p=0,023); SF-36 fiziksel fonksiyon 2,06±8,25'den18,25±26,06'ya (p=0,006); fiziksel rol güçlüğü 1,56±6,25'den40,31±29,74'e (p=0,002); sağlığın genel algılanması 29,37±17,68'den47,62±27,35'e (p=0,005); ağrı 26,31±30,49'dan 53,37±26,45'e(p=0,005); vitalite 38,93±20,94'den 61,25±19,70'e (p=0,001); sosyalfonksiyon 19,31±14,59'dan 70,56±82,74'e (p=0,001); emosyonel rol güçlüğü 10,37±26,40'dan 56,31±38,08'e (p=0,004); mental sağlık46,25±18,12'den 61,12±19,81'e yükseldi (p=0,004). Takip sırasında 2hastada pompa ile ilgili komplikasyon gelişti.Sonuç: Ciddi spastisitede İTB etkin ve güvenilir bir tedavi seçeneğidir.