Long-term use of Continuously Delivered Baclofen Medication for Excessive Abnormal Muscle Tone

Past Studies

Past Studies using oral medications to treat spastic-dystonic hypertonia for persons with traumatic brain injuries have not been successful. Spastic-dystonic hypertonia can occur following traumatic brain injury or stroke. Spastic-dystonic hypertonia describes abnormal excessive muscle tone that can cause pain and loss of limb movement. It can also cause a limb to become “fixed” or “frozen” in an uncomfortable position. Because of movement limitations or fixed bending and positioning of limbs, persons with spastic-dystonic hypertonia can experience difficulty moving their bodies and taking care of themselves. This can cause problems with walking and activities of daily living, such as eating, dressing, bathing, and grooming.

Baclofen medication can be delivered continuously and directly to the fluid surrounding the spinal cord by using a small pump placed surgically under the skin. This is called “intrathecal baclofen therapy.” Because using this method allows the medication to be delivered directly to the spinal cord, a much lower dose of baclofen is required with much less distributed to the whole system. The negative side effects can be greatly lessened as a result. Intrathecal baclofen therapy can be very effective for persons with spasticity in large muscle groups or the type of spasticity that increases with movement. The long-term effects of intrathecal baclofen therapy for persons with traumatic brain injury had not been studied.

This Study

This Study included seventeen persons with traumatic brain injury who had spastic-dystonic hypertonia in their lower limbs for at least six months and had failed to respond to oral antispasticity medications. Participants were treated with intrathecal baclofen therapy for a year. During the first six months of treatment, participants experienced significant decreases in excessive abnormal muscle tone. During the last six months of the study, muscle improvements were maintained. Only a few people experienced minor side effects that were resolvable. As participants obtained increased movement skills, they worked continuously with occupational and physical therapists to achieve more independent lifestyles.

Who May Be Affected By These Findings

Persons with brain injury and spastic-dystonic hypertonia, their families and caregivers, healthcare professionals, researchers

Caveats

The side effects associated with oral dose baclofen appear to be minimized when the medication is delivered directly to the body via a pump system. This method of delivery can concentrate the medication at higher levels possible than with oral doses of baclofen. It appears to have less of an effect on the upper extremities than the lower extremities despite advancing the catheter to the T-6 level.

Bottom Line

Baclofen continuously delivered by a pump device surgically implanted in the body appears to relieve a condition of abnormal excessive muscle tone and deformities called spastic-dystonic hypertonia in selected persons with traumatic brain injury. The relief of this condition can enable persons with traumatic brain injury to work with occupational and physical therapists to achieve more independent lifestyles.

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