Chronic Intrathecal Baclofen Infusion for Spasticity: Relationship between Pump and Host.
ABSTRACT Twenty patients with chronic intractable spinal spasticity were implanted with a totally implantable programmable pump for intrathecal administration of baclofen. The objective of this study was to evaluate the relationship between pump and the host. Clinical efficacy of the therapy was evaluated by the Ashworth Scale, the Spasms Frequency Scale, and the Functional Independence Measure (FIM) motor scores. All patients were asked to reply to 10 questions regarding discomfort of their refills, the ease of rehabilitation after therapy, their fear of pump failure and onset of alarm signals, their discomfort due to a metallic foreign body (the pump), the attitude of their relatives and other persons regarding their pump system, whether they would undergo this therapy again, and whether, in the absence of public health insurance, whether they would be willing to pay for their pump and therapy. The Ashworth scale, the Spasms Frequency Scale, and the FIM motor score showed a significant improvement in all patients after the onset of therapy with baclofen. The refill procedure was not a problem in all patients while four patients (20%) considered the number of refills "uncomfortable." Rehabilitation was no problem after the pump was implanted in all patients, 10 patients (50%) feared pump failure, while six patients (30%) feared their alarm signals. Three patients (15%) had some discomfort from their pumps rubbing against their belts; two patients (10%) stated that other people were aware of their pumps; all but two patients (10%) were ready to have their implants again; three patients (15%) would pay for the pump in case of absence of public health insurance for the therapy. We conclude that the implant of pumps for chronic intrathecal baclofen infusion is, today, a known effective procedure. Refill of the pump system was not a problem in our patient population, while the number of refills did cause some discomfort in some patients. It was shown by our study that the pump did facilitate rehabilitation in our patients, and a certain degree of dependence on the pump did exist. Fifty percent of the patients were afraid of pump failure and 30% were afraid of their alarm signals going off. The fact that most patients would undergo this therapy again and some would even pay for it directly in the absence of public insurance for the therapy were indices of patient satisfaction with the procedure. Because this was a small study, we believe that larger studies are necessary to corroborate our findings.
- [Show abstract] [Hide abstract]
ABSTRACT: Dans le cadre des procédures d’accréditation, l’implantation de pompes à baclofène a été retenue en 2006 par le centre de rééducation et de réadaptation fonctionnelles de Kerpape, au titre de l’évaluation des pratiques professionnelles (référence 44b), et cela en regard du coût et de la complexité potentielle de ce traitement. L’analyse de cette pratique a bénéficié d’une validation institutionnelle. La méthode utilisée repose sur une revue exhaustive de la littérature et une étude rétrospective de 76 dossiers sur une période de 6 ans, complétée par une enquête de satisfaction des personnes traitées. Les résultats ont été communiqués aux expertsvisiteurs avec l’obtention d’une cotation B. Des actions d’amélioration sont enfin préconisées. Within the context of accreditation procedures, baclofen pump implantation was chosen in 2006 by the Kerpape functional rehabilitation centre as the subject of an evaluation of professional practices (reference 44b), with regard to the cost and potential complexity of this method of treatment. Analysis of this practice was validated institutionally. The method of analysis used was an exhaustive review of the literature, together with a retrospective study of 76 cases over a period of six years and a survey on the satisfaction of the treated patients. The results were communicated to visiting experts and received a grade B. Finally, recommendations for improvement are noted.La Lettre de médecine physique et de réadaptation 01/2007; 23(4):214-230.
- [Show abstract] [Hide abstract]
ABSTRACT: Successful treatment of severe spasticity represents an imperative of symptomatic therapy of multiple sclerosis (MS) due to a significant improvement of physical, psychic and social rehabilitation of MS patients, as well as a long-term cost savings for the additional treatments of conditions arising from uncontrolled severe spasticity. Continuous intrathecal administration of baclofen (ITB), using a subcutaneously implanted programmable infusion pump, is a minimally invasive, reversible method for the treatment of severe diffuse spasticity of the spinal origin. The first two cases in our country, treated by ITB due to severe spasticity caused by MS, were reported. Despite the local complications of surgical wound healing above the implanted components of the ITB-system in one patient, the optimal reduction of spasticity the with complete elimination of spastic pain was obtained in both patients. Our initial experiences confirmed ITB as a safe and effective therapeutical option for the treatment of intractable spasticity in patients with MS. Major prerequisites for this were adequate patient selection and good control of the basic disease. The use of the minimal invasive implantation technique and the experience in choosing of the adequate ITB-system components, could successfully prevent the occurrence of local complications related to the impaired healing of the ITB-system implantation site.Vojnosanitetski pregled. Military-medical and pharmaceutical review 03/2006; 63(2):187-91. · 0.21 Impact Factor