Intraventricular versus Intrathecal Baclofen for SecondaryDystonia: A Comparison of Complications.

Abstract

BACKGROUND: Intrathecal baclofen (ITB) is an effective treatment for secondary dystonia.However, in many patients with dystonia, placement of an intrathecal catheter is difficult due to anatomic anomalies or spinal fusion.Intraventricular baclofen (IVB) has been shown to be an effective alternate route for drug delivery in a small series of patients. OBJECTIVE: To present the largest series of IVB cases to date, and compare the complication rateto that of a concurrent cohort of ITB cases. METHODS: The senior author's series of IVB cases were reviewed.All contemporaneous cases of ITB for dystonia were reviewed as a control group.Data were collected by retrospective medical records review. RESULTS: Thirty IVB patients and 33ITB patientswere identified.Mean follow up was 15 and 16 months, respectively.IVB patients were younger, more commonly underweight, and had more severe dystonia, though no difference between groups was significant.Eleven patients (37%) experienced complications in the IVB group, and 16 (48%) in the ITB group.Kaplan-Meier survival analysis showed an odds ratio of 0.67 (95% CI 0.30-1.48, p=0.31) in favor of IVB.Adjusting for age and underweight status yielded an odds ratio of 0.64 (95% CI 0.29-1.42, p=0.27) in favor of IVB.There were 7 catheter or leak-related complications in the ITB group and 2 in the IVB group(p=0.15). CONCLUSION: Intraventricular baclofen is as safe as intrathecal baclofen.There may be a lower risk of catheter or leak-related complications with IVB, though this study was too small to show significance.