Pharmacology References

317 Pages·2006·0.93 MB·English

Pharmacology References
(1970) Diazepam in spasticity. Lancet 1, 1161-1162.
(1973) Baclofen for spasticity. Drug Ther. Bull. 11, 63-64.
(1974) Dantrolene sodium for treatment of spasticity. Med. Lett. Drugs Ther. 16,
61-62.
(1974) A comparative trial of dimethothiazine in spastic conditions. Practitioner
213, 101-105.
(1977) Oestrogens, calcium transport, and coronary spasm. Lancet 1, 229-230.
(1983) Drugs to relieve spasticity. Drug Ther. Bull. 21, 1-3.
(1984) Mantakassa: an epidemic of spastic paraparesis associated with chronic
cyanide intoxication in a cassava staple area of Mozambique. 1. Epidemiology
and clinical and laboratory findings in patients. Ministry of Health, Mozambique.
Bull. World Health Organ 62, 477-484.
(1984) Mantakassa: an epidemic of spastic paraparesis associated with chronic
cyanide intoxication in a cassava staple area of Mozambique. 2. Nutritional
factors and hydrocyanic acid content of cassava products. Ministry of Health,
Mozambique. Bull. World Health Organ 62, 485-492.
(1989) Spasticity. Lancet 2, 1488-1490.
(1991) Consensus conference. Clinical use of botulinum toxin. National Institutes
of Health. Conn. Med. 55, 471-477.
(1994) Intrathecal baclofen for spasticity. Med. Lett. Drugs Ther. 36, 21-22.
(1994) A double-blind, placebo-controlled trial of tizanidine in the treatment of
spasticity caused by multiple sclerosis. United Kingdom Tizanidine Trial Group.
Neurology 44, S70-S78.
Abstract: Tizanidine was evaluated in a prospective, double-blind, randomized,
placebo-controlled trial in 187 patients with MS. Taken orally for 9 weeks and
preceded by a titration phase for a period of 3 weeks starting at 2 mg daily,
tizanidine produced a significant reduction in spastic muscle tone compared with
placebo treatment. Within the effective dose range of 24 to 36 mg given daily in
three doses, tizanidine achieved a 20% mean reduction in muscle tone.
Approximately 75% of patients, with all degrees of spasticity, reported subjective
improvement without an increase in muscle weakness, but there was no
improvement in activities of daily living depending on movement. Tizanidine
achieved its maximum effect on spasticity within 1 week of the start of treatment;
the benefit was maintained for at least 1 week after discontinuation of therapy. A
variety of adverse events was recorded by patients taking tizanidine, but these
were minor and reversible, and rarely limited treatment. Tizanidine is a well-
tolerated and effective drug for symptomatic treatment of spasticity
(1997) Marijuana as medicine: how strong is the science? Consum. Rep. 62, 62-
63.
(1997) Tizanidine for spasticity. Med. Lett. Drugs Ther. 39, 62-63.
(1998) Spasticity: current and future management. Royal College of Physicians,
November 13, 1997. Hosp. Med. 59, 61-69.
Abstract: Tizanidine hydrochloride (Zanaflex), an alpha 2-adrenoreceptor agonist,
is the first new antispasticity agent to become available in the UK for more than
20 years. It provides effective reduction of spasticity without affecting muscle
strength. The mechanisms of spasticity, its measurement and management,
together with the place of tizanidine in its treatment, were discussed at a
symposium held at the Royal College of Physicians on November 13 1997
Aarli J.A. (1992) [Treatment with botulinum toxin--a new and effective therapy].
Tidsskr. Nor Laegeforen. 112, 2624.
Abbott R. (1996) Sensory rhizotomy for the treatment of childhood spasticity. J.
Child Neurol. 11 Suppl 1, S36-S42.
Abstract: Sensory rhizotomy in the treatment of spasticity has been evolving over
the past century since its first use in 1888. This paper reviews its historical
evolution, current physiologic basis, range in current surgical technique, and the
outcome, along with complications seen over the past decade since its
repopularization
Abdel-Salam A., Eyres K.S., and Cleary J. (1992) A new paradiscal injection
technique for the relief of back spasm after chemonucleolysis. Br. J. Rheumatol.
31, 491-493.
Abstract: Back spasm, or spasm of the back muscles, is the commonest adverse
reaction encountered after chemonucleolysis. In order to overcome this
troublesome complication, the authors present a new 'paradiscal injection
technique'. After the injection of chymopapain into the affected disc, the needle is
withdrawn to just outside the annulus. Bupivacaine is injected into the paradiscal
'space' which acts upon the paravertebral muscles. Eighty consecutive patients
have been treated by chemonucleolysis with paradiscal injection for pain relief.
All patients were discharged the same day or the following day and no immediate
complications occurred. When reviewed 3 weeks later, only three (3.8%) patients
complained of back pain (which was different in character to that present before
the injection or was exacerbated by the injection). Pain persisted in the same
patients until 6 months after the injection but was negligible. None of the
remaining patients had developed back pain as a result of chymopapain. The
authors suggest that the addition of paradiscal injection of bupivicaine after
cymopapain injection can reduce the incidence of spasm of the back muscles.
This technique is a major contribution to increasing the efficacy of
chemonucleolysis for the treatment of herniated lumbar disc
Abel N.A. and Smith R.A. (1994) Intrathecal baclofen for treatment of intractable
spinal spasticity. Arch. Phys. Med. Rehabil. 75, 54-58.
Abstract: This study assessed the safety and efficacy of intrathecal baclofen in
the treatment of intractable spasticity caused by spinal cord injury or multiple
sclerosis. Twenty-three patients with severe chronic spasticity underwent bolus
test dosing with 50, 75, or 100 micrograms of intrathecal baclofen administered
by lumbar puncture. All patients were either refractory to oral baclofen at a dose
of 120 mg/d or side effects were unacceptable at a lower dose. There was a
significant decrease in tone and spasticity in all 23 patients. Nineteen patients
underwent implantation of a programmable pump and intrathecal catheter
designed to deliver baclofen directly to the spinal cord. Rigidity (tone) was
decreased from a mean prebolus Ashworth score of 3.8 to a mean postbolus
Ashworth score of 1.5 and spasms from a mean prebolus score of 3.5 to a mean
postbolus score of 1.2 for a minimum of 4 hours. Patients have been observed
for a mean of 16 months (range 2 to 34 months). Ashworth scores have
remained reduced to an acceptable level (< or = 2 with periodic adjustment in
dosage in all but three patients. There has been one pump malfunction and four
catheter malfunctions; few serious medication and postoperative complications
have occurred. There was one death caused by underlying disease, one patient
voluntarily withdrew, and three patients developed tolerance to the extent that
optimal control of spasticity tone could not be maintained. Although intrathecal
baclofen is safe and effective in the majority of patients, three patients required >
1,000 micrograms/d with increasingly higher doses over time and exhibited a
poor response
Abramson A.S. (1967) Modern concepts of management of the patient with
spinal cord injury. Arch. Phys. Med. Rehabil. 48, 113-121.
Acland R.H. (1993) Intrathecal baclofen for the management of severe spasticity.
N. Z. Med. J. 106, 129-130.
Adachi H., Riku S., Fujishiro K., and Kuru S. (1998) [A case of Satoyoshi
syndrome with symptoms resembling neuroleptic malignant syndrome]. Rinsho
Shinkeigaku 38, 637-640.
Abstract: Satoyoshi syndrome is a rare neurological disorder of unknown etiology
characterized by progressive muscle spasms, alopecia, diarrhea and skeletal
abnormalities. We here describe a 25-year-old man who developed symptoms
similar to neuroleptic malignant syndrome (NMS). He began to have the clinical
characteristics of Satoyoshi syndrome at the age of 12 years. He was admitted to
hospitals many times with painful muscle spasms and pyrexia in the early stage
of the disease. He received steroid pulse therapy and oral prednisone at the age
of 19, the extent and frequency of the spells being reduced thereafter. He was
admitted to our hospital due to recurrence of his usual muscle spasms. He was
treated with midazolam intravenously to relieve severe muscle ache, pain in the
left shoulder, and insomnia. About 90 minutes later, he became comatose, with
the following manifestations: hyperthermia, low blood pressure, tachycardia,
profuse perspiration, acute respiratory failure, and ensuing cardiac arrest. He
developed rhabdomyolysis, acute renal failure, hepatic damage, and diffuse
intravascular coagulation. Serum creatine kinase level was elevated to 306,910
IU. He died of multiple organ failure 13 days after admission. His symptoms
resembled NMS and malignant hyperthermia (MH). None of patients with
Satoyoshi syndrome accompanied by NMS or MH have been reported. It
remains to be clarified whether midazolam administration induces NMS in
Satoyoshi syndrome. Nevertheless, careful attention should be paid when one
administers midazolam to patients with this syndrome
Adamcho N.I., Bondar' V.P., and Rusavskii I.V. (1978) [Prevention and treatment
of the complications of peridurography]. Vopr. Neirokhir. 43-47.
Abstract: In lumbar peridurography conducted in 117 patients with discogenic
radiculitis complications occurred both in the stage of peridural anesthesia and
after introduction of the radiocontrast medium. During anesthesia the dura mater
was punctured in 4 patients, in another 2 patients dicaine penetrated into the
subarachnoid space and caused spinal anesthesia with a high upper level.
Peridural anesthesia with paralysis of the respiratory musculature developed in 1
patient. After the injection of the radiocontrast medium, spasm in the lower
extremities and trunk of the type of spinal epilepsy developed in 4 patients. The
clinical picture, prevention, and treatment of these complications are discussed
Advokat C., Mosser H., and Hutchinson K. (1997) Morphine and dextrorphan
lose antinociceptive activity but exhibit an antispastic action in chronic spinal rats.
Physiol Behav. 62, 799-804.
Abstract: Within 3-4 weeks after spinal transection, morphine-induced
antinociception, assessed with the tail flick reflex in rats, is profoundly reduced.
The cause of this decrement is unknown. The present studies were conducted to
determine whether this phenomenon reflects a general loss in opiate activity or a
selective decline in opiate antinociception. This was accomplished by assessing
the effect of morphine on two different responses, the tail flick reflex and the
hindlimb spasticity that develops in chronic spinal rats. Because excitatory amino
acid antagonists are also antinociceptive in acute spinal rats, the effect of one
such drug, dextrorphan, on these two behaviors was also evaluated in chronic
spinal animals. The antinociceptive and antispastic effect of subcutaneous (6
mg/kg) and intrathecal (5 micrograms) morphine injections were assessed in
intact and chronic (21-28 days) spinal rats, whereas the effect of subcutaneous
(25 and 40 mg/kg) and intrathecal (350 micrograms) dextrorphan was assessed
in acute (1 day) and chronic spinal rats. The antinociceptive effect of both drugs
was significantly reduced in chronic spinal animals, relative to saline controls.
However, each drug treatment produced a significant antispastic effect in the
same animals, indicating a selective decline in opiate action. This outcome also
suggests that excitatory amino acid antagonists may be useful as adjunct
antispastic agents
Agar N.S., Irvine S., Davis J.R., and Harley J.D. (1972) Enzymopenic
methaemoglobinaemia and spastic diplegia in an Italian- Yugoslavian child. Med.
J. Aust. 2, 429-430.
Ahmadi-Abhari S.A., Akhondzadeh S., Assadi S.M., Shabestari O.L.,
Farzanehgan Z.M., and Kamlipour A. (2001) Baclofen versus clonidine in the
treatment of opiates withdrawal, side- effects aspect: a double-blind randomized
controlled trial. J. Clin. Pharm. Ther. 26, 67-71.
Abstract: OBJECTIVE: Baclofen is known for the alleviation of signs and
symptoms of spasticity. Reports from our previous study have suggested that it
may be at least as effective as clonidine in the management of physical
symptoms of opiate withdrawal syndromes and superior to clonidine in the
management of mental symptoms. We now report on a randomized double- blind
comparison of baclofen vs. clonidine in view of side-effects profile. METHODS: A
total of 62 opiates addicts were randomly assigned to treatment with baclofen or
clonidine during a 14-day, double-blind clinical trial. All patients met the DSM IV
criteria for opioid dependence. Maximum daily doses were 40 mg for baclofen
and 0.8 mg for clonidine. This trial medication was given three times per day in
divided doses. The severity of side-effects was measured in days 0, 1, 2, 3, 4, 7
and 14. RESULTS: There was no significant difference between two treat7ments
in terms of retention in treatment (dropout) and overall side-effect. Nevertheless,
significantly more problems relating to hypotension were encountered with
subjects on clonidine. CONCLUSION: We conclude that, the low incidence of
hypotension with baclofen suggests that the drug may be suitable for outpatient
ambulatory treatment of withdrawal from opiates
Aicardi J. and Chevrie J.J. (1975) [Neurologic manifestations following pertussis
vaccination]. Arch. Fr. Pediatr. 32, 309-317.
Abstract: Twenty cases of acute neurological complications occuring within 7
days of pertussis immunization are reported. Convulsions were present in every
case and status epilepticus was observed in five infants. In only 4 cases were
neurological or epileptic sequelae lacking. The clustering of neurological
complications in the 24 hours following immunization is not consistent with the
hypothesis of a mere temporal coincidence. However, the mechanism and
incidence of post-immunization encephalopathies remains obscure and
epidemiological studies are in order
Aisen M.L., Dietz M.A., Rossi P., Cedarbaum J.M., and Kutt H. (1992) Clinical
and pharmacokinetic aspects of high dose oral baclofen therapy. J. Am.
Paraplegia Soc. 15, 211-216.
Abstract: Baclofen is a centrally acting muscle relaxant used for treatment of
spasticity. Some patients, to experience adequate symptomatic relief, require
dosages of baclofen that significantly exceed the conventional 80 mg daily
maximum advocated by the 1992 Physicians' Desk Reference. In this pilot study
of baclofen kinetics and dynamics in eleven patients, the safety and efficacy of
high dose baclofen was confirmed. The data suggest that the pharmacokinetics
of high dose baclofen may vary from those described previously. Time-to-peak
plasma levels and plasma half-lives were noted to be substantially longer than
prior reports indicate. Baclofen blood levels were observed to rise gradually over
time in some patients on a stable dosing regimen, probably a result of impaired
renal clearance. These findings may indicate that a change in pattern of
prescription is warranted and that a reliable and practical measurement of
systemic baclofen levels has a useful role in clinical practice, particularly for the
patient with neurogenic bladder and potential renal insufficiency
Aisen M.L., Dietz M., McDowell F., and Kutt H. (1994) Baclofen toxicity in a
patient with subclinical renal insufficiency. Arch. Phys. Med. Rehabil. 75, 109-
111.
Abstract: Baclofen, a centrally acting gamma-aminobutyric acid agonist is a
commonly used pharmacotherapy for spasticity of spinal origin. It is primarily
excreted by glomerular filtration with a clearance proportional to creatinine
clearance. We describe a 39-year-old quadriplegic women who, over a 16-week
period, developed clinical signs of baclofen toxicity confirmed by progressively
rising serum baclofen levels while on a conventional stable dosing regimen.
During this period blood urea nitrogen and creatinine concentrations were normal
and stable (9mg/dL and 0.8mg/dL, respectively). However, creatinine clearance
values were consistently low (55 to 60m/min), suggesting renal insufficiency as
the underlying cause. After a decrease in baclofen dosage, evidence of baclofen
toxicity resolved. Clinicians should be alert to signs of evolving baclofen toxicity
even in patients on an apparently stable regimen. Baclofen dosage adjustments
based on systemic baclofen level may play a role in optimizing the clinical
management of spasticity
Akinfieva T.A. and Gerasimova I.L. (1984) [Comparative toxicity of various
barium compounds]. Gig. Tr. Prof. Zabol. 45-46.
Akiyama T., Maeda K., and Yamada W. (1971) [Electromyographic studies on
muscle tone of the lower extremities in spastic paralysis]. Iryo. 25, 74-90.
Akman M.N., Loubser P.G., Donovan W.H., O'Neill M.E., and Rossi C.D. (1993)
Intrathecal baclofen: does tolerance occur? Paraplegia 31, 516-520.
Abstract: Concern over the development of tolerance in patients on continuous
intrathecal baclofen therapy has arisen as this new form of treatment for
spasticity has gained wider use. We have studied time-dose relationships in 18
spinal cord injured patients who have undergone intrathecal baclofen infusion
pump implantation since February 1988 in our facility. Our data show that there
was a significant increase in baclofen dosage needed to control spasticity during
the first 12 months post implantation. After 12 months, however, no significant
changes in dosage requirement was detected. In addition, there was no
significant difference between completely and incompletely spinal cord injured
patients with regard to both the initial dose and the tolerance trend
Akman M.N., Loubser P.G., Fife C.E., and Donovan W.H. (1994) Hyperbaric
oxygen therapy: implications for spinal cord injury patients with intrathecal
baclofen infusion pumps. Case report. Paraplegia 32, 281-284.
Abstract: A patient with a cervical spinal cord injury receiving intrathecal baclofen
for spasticity control underwent a 7 week course of hyperbaric oxygen therapy to
induce healing of an ischial decubitus ulcer. After completion of this treatment
and during a routine baclofen infusion pump refill, the actual pump reservoir
volume exceeded computer measurements obtained with telemetry. Examination
of the physiology of hyperbaric oxygen therapy in relation to infusion pump
function revealed that the intraspinal pressures attained during hyperbaric
oxygen therapy produced retrograde leakage of cerebrospinal fluid into the
infusion pump reservoir
Al Essa M.A., Bakheet S.M., Patay Z.J., Nounou R.M., and Ozand P.T. (1999)
Cerebral fluorine-18 labeled 2-fluoro-2-deoxyglucose positron emission
tomography (FDG PET), MRI, and clinical observations in a patient with infantile
G(M1) gangliosidosis. Brain Dev. 21, 559-562.
Abstract: The clinical, biochemical, pathological and neuroradiological findings of
a 2-year-old Saudi boy with infantile G(M1) gangliosidosis are reported. The
patient had a progressive neurologic deterioration, manifesting with
developmental regression, sensorimotor and psychointellectual dysfunction and
generalized spasticity that started at 4 months of age. Cherry-red macula, facial
dysmorphia, hepatomegaly, exaggerated startle response to sounds, skeletal
dysplasia, and vacuolated foamy lymphocytes that contain finely fibrillar material
in addition to lamellar membranes and electron-dense rounded bodies were
seen. MRI of the brain demonstrated mild diffuse brain atrophy and features of
delayed dysmyelination and demyelination. Brain FDG PET scan revealed a mild
decrease in the basal ganglia uptake, and moderate to severe decrease in
thalamic and visual cortex uptake, and an area of increased glucose uptake in
the left frontal lobe, probably representing an active seizure focus. The functional
changes indicated by FDG PET scan and the structural abnormalities shown on
MRI were found to be complementary in the imaging evaluation of infantile G(M1)
gangliosidosis
Al Khodairy A.T., Gobelet C., and Rossier A.B. (1998) Has botulinum toxin type A
a place in the treatment of spasticity in spinal cord injury patients? Spinal Cord.
36, 854-858.
Abstract: OBJECTIVE: To present and discuss treatment of severe spasms
related to spinal cord injury with botulinum toxin type A. DESIGN: A 2-year
follow- up study of an incomplete T12 paraplegic patient, who was reluctant to
undergo intrathecal baclofen therapy, presenting severe painful spasms in his
lower limbs treated with intramuscular injections of botulinum toxin type A.
SETTING: Department of Physical Medicine and Rehabilitation, Hopital de
Gravelone, Sion, Switzerland. SUBJECT: Single patient case report. MAIN
OUTCOME MEASURE: Spasticity, spasms and pain measured with the modified
Ashworth scale, spasm frequency score and visual analogue scale. RESULTS:
Treatment of spasticity with selective intramuscular injections of botulinum toxin
type A resulted in subjective and objective improvement. CONCLUSION:
Botulinum toxin type A has its place in the treatment of spasticity in spinal cord
injury patients. This treatment is expensive and its effect is reversible. It can
complement intrathecal baclofen in treating upper limb spasticity in tetraplegic
patients. Tolerance does occur to the toxin. Although high doses of the product
are well tolerated, the quantity should be tailored to the patient's need. The
minimal amount necessary to reach clinical effects should be adhered to and
booster doses at short period intervals should be avoided
Al Khodairy A.T., Vuagnat H., and Uebelhart D. (1999) Symptoms of recurrent
intrathecal baclofen withdrawal resulting from drug delivery failure: a case report.
Am. J. Phys. Med. Rehabil. 78, 272-277.
Abstract: A 24-yr-old, completely (T8) paraplegic male patient presenting with
severe spasticity had a drug administration device implanted in April 1991 for
continuous intrathecal administration of baclofen. After a period of remarkable
improvement in both the spasticity level and his quality of life, the patient
experienced several short-lasting episodes of increased spasticity, with severe
spasms. Among the possible causes of these deleterious episodes were
microcrystalluria, obstipation, a decubitus ulcer, a foreign body in the buttocks,
drug tolerance to baclofen, electromagnetic interference, and erroneous filling
and programing of the pump. The catheter was the most common source of
intrathecal baclofen withdrawal symptoms and had to be changed four times in 5
yr. Intrathecal baclofen administered through an implantable drug administration
device is a highly effective but complex and expensive procedure that requires
careful patient selection and close monitoring by highly qualified and well-trained
health professional. Withdrawal symptoms may be related to noncompliance on
the part of the patient, erroneous filling or programing of the pump, depletion of
the battery, random component failure, concomitant illness, drug tolerance, or
advancement of the disease itself. When failure of the device is suspected,
substitution with oral baclofen is recommended until a full work-up is performed
to determine the defect
Albany K. (1997) Physical and occupational therapy considerations in adult
patients receiving botulinum toxin injections for spasticity. Muscle Nerve Suppl 6,
S221-S231.
Abstract: Physical and occupational therapists play important roles in the
evaluation and management of patients receiving botulinum toxin injections for
spasticity. Baseline evaluation includes areas beyond the muscles being injected,
since local spasticity reduction may lead to more widespread functional changes.
Because the evaluation itself influences tone, a consistent order of muscle
evaluation is recommended. The range of preinjection assessments includes
evaluation of tone, mobility, strength, balance, endurance, assistive devices, and
others. After injection, therapeutic interventions have multiple aims, including
strengthening and facilitation, increasing range of motion, retraining of
ambulation and gait, improving the fit and tolerance of orthoses, and improved
functioning in ADLs
Albright A.L., Cervi A., and Singletary J. (1991) Intrathecal baclofen for spasticity
in cerebral palsy. JAMA 265, 1418-1422.
Abstract: Seventeen patients with congenital spastic cerebral palsy and six
patients with other forms of spasticity were injected intrathecally with doses of
placebo or baclofen, 25 micrograms, 50 micrograms, or 100 micrograms, in a
randomized, double-blind manner. Muscle tone in the upper and lower
extremities was assessed by Ashworth scores both before the injections and
every 2 hours afterward for 8 hours. Function of the upper extremities was
evaluated before the injections and 4 hours afterward. Muscle tone in the lower
extremities was significantly decreased within 2 hours after baclofen injection and
remained lower than baseline 8 hours afterward. Upper extremity tone and
function were not significantly affected by these single doses. Confusion and
drowsiness occurred in two of the youngest children in the study after the 50-
micrograms dose, but cleared within 2 hours. Our findings indicate that
intrathecal baclofen reduces spasticity in children with cerebral palsy, as it does
in adults with spasticity of spinal origin
Albright A.L. (1992) Neurosurgical treatment of spasticity: selective posterior
rhizotomy and intrathecal baclofen. Stereotact. Funct. Neurosurg. 58, 3-13.
Abstract: The pathophysiology of spasticity and the history of posterior
rhizotomies are reviewed. The rationale for selective posterior rhizotomies is that
electrical stimulation identifies afferent posterior rootlets that terminate on
relatively uninhibited alpha motoneurons; if these uninhibited rootlets are divided,
spasticity can be alleviated without loss of other posterior root functions.
Indications, technique, and results of selective posterior rhizotomies are
presented. The use of continuous intrathecal baclofen (CITB) is summarized.
CITB at doses of approximately 300 micrograms/day consistently reduces lower
extremity spasticity and diminishes or alleviates muscle spasms in adults with
spasticity of spinal origin. Single doses of intrathecal baclofen significantly
decrease lower extremity muscle tone in children with cerebral palsy, and the
effects can be maintained in these patients by CITB infusions which diminish
muscle tone not only in the lower extremities, but in the upper extremities as well.
CITB is best accomplished via an externally programmable pump that allows
titration of the daily dose to attain the desired reduction in spasticity. Factors
influencing the decision for rhizotomy or CITB are presented
Albright A.L., Barron W.B., Fasick M.P., Polinko P., and Janosky J. (1993)
Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA
270, 2475-2477.
Abstract: OBJECTIVE--To determine if continuous intrathecal baclofen infusion
(CIBI) would provide continuous relief of spasticity in patients with spasticity of
cerebral origin, especially children with cerebral palsy. DESIGN--Prospective,
unblinded trial, before and after CIBI. SETTING-- Children's Hospital of
Pittsburgh (Pa). PATIENTS--Thirty-seven patients, 5 to 27 years of age, with
spasticity of cerebral origin. INTERVENTION--Continuous intrathecal baclofen
infusion for 3 to 48 months. MAIN OUTCOME MEASURES--Muscle tone, range
of motion, upper extremity timed tasks, activities of daily living (ADLs).
RESULTS--Six and 12 months after CIBI, muscle tone was significantly
decreased in the upper (P = .04) and lower (P = .001) extremities. There was a
significant relationship between baclofen dosage and muscle tone in the upper (P
= .02) and lower (P = .001) extremities. Hamstring motion, upper extremity
function, and ADLs were significantly improved in 25 patients who were capable
of self-care. CONCLUSION--Spasticity of cerebral origin can be effectively
treated with CIBI. Because baclofen dosages can be titrated for the desired
clinical response, CIBI is particularly useful for patients who need some spasticity
to stand and ambulate
Albright A.L., Barry M.J., and Hoffmann P. (1995) Intrathecal L-baclofen for
cerebral spasticity: case report. Neurology 45, 2110-2111.
Albright A.L., Barry M.J., Fasick M.P., and Janosky J. (1995) Effects of
continuous intrathecal baclofen infusion and selective posterior rhizotomy on
upper extremity spasticity. Pediatr. Neurosurg. 23, 82-85.
Abstract: This study was performed to compare the effects of continuous
intrathecal baclofen infusion (CIBI) and selective posterior rhizotomy (SPR) on
upper extremity (UE) spasticity and range of motion in children with cerebral
palsy. Spasticity was assessed with the Ashworth scale of muscle tone and
range of motion was evaluated. Thirty-eight patients who had been treated with
CIBI for at least 6 months were paired, according to pretreatment UE muscle
tone and functional status, with 38 patients who had undergone SPR. The CIBI
dosage had been titrated to reduce over lower extremity spasticity and improve
lower extremity function, rather than to improve UE tone. The pretreatment
muscle tone in the two groups was virtually identical. The UE tone of children
treated with CIBI decreased from 2.07 prior to treatment to 1.66 after 1 year (p <
0.01). The tone of children treated with SPR decreased from 2.03 to 1.70 after 1
year (p = 0.005). In that group, the likelihood of a clinically significant reduction in
muscle tone (one point or greater) was greater in children with a higher
pretreatment UE muscle tone. There was no correlation between the percentage
of posterior lumbar roots divided in SPR and the subsequent reduction in UE
tone. There were no significant changes in the range of motion in any UE joint, at
either 6 or 12 months, after either CIBI or SPR. We conclude that both CIBI and
SPR significantly reduce UE spasticity, in addition to the previously documented
reduction in lower extremity spasticity
Albright A.L. (1996) Intrathecal baclofen in cerebral palsy movement disorders. J.
Child Neurol. 11 Suppl 1, S29-S35.