Introduction: Intrathecal administration of baclofen via a continuous programmable buttery based pump is a recognized option in the treatment of medically refractory spasticity. Objective outcome evaluation is usually based on clinical evaluation of the spastic muscles groups. Such evaluations my not indicate functional improvement in this heterogeneous group of patients. In this study, patient's compliance after two years of implanting the pump device was set as an indication of effectiveness of the treatment as appreciated by the patients themselves or their caregivers.
Methods: A cohort group of 35 patients were admitted to the hospital for an intrathecal baclofen trial. A total of 27 patients were implanted with battery based programmable baclofen pump. All patients were referred to a specialized outpatient clinic for medication refilling and adjustment of rate of infusion. All follow-up visits were supported by national health services and free of any charges including transportation. All patients had either minimum of two years follow-up or discontinuation of therapy for different reasons. All patients' medical data were collected prospectively and reviewed at the time of the study.
Results: Twenty seven patients (15 males and 12 females) were included in the study. Patient`s age ranged from 7 to 69 years (mean of 29 year). Documented etiologies of spasticity included trauma, cerebral palsy, familial spasticity, multiple sclerosis, tumors and others. All patients were operated by the same surgeon (senior author) following the same operative and post operative protocol. At the 2 years post implantation set point, 20 patients continue to comply with the treatment. All of them reported at least moderate improvement in the symptoms that deserve compliance with the therapy. The other 7 patients had the pump removed as decided by the patients themselves or the caregivers (5 patients), recurrent infection(1patient) and death secondary to the primary disease (1 patient).
Conclusions: At 2 years follow-up after implantation of programmable intrathecal baclofen pump therapy for intractable spasticity, 74% of patients continue to comply with the treatment.
Patient Care: A new approach to evaluate the effectiveness of this treatment modality.
Learning Objectives: effectiveness of intrathecal Baclofen therapy for spasticity