Akademik Veri Yönetim Sistemi
Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi, cilt.60, sa.4, ss.295-301, 2014 (SCI-Expanded)
© 2014 by Turkish Society of Physical Medicine and Rehabilitation.Objective: To evaluate the effects of intrathecal baclofen therapy (ITB) in patients with severe spasticity.Material and Methods: Patients who had a baclofen pump implanted between 2004-2012 were included in the study. The inclusion criteria were severe spasticity with nonresponse to medical oral therapy and physiotherapy, modified Ashworth scale (MAS) score 3-4, and Penn’s spasm scale (PSS) score 3-4. The ITB assessment criteria were MAS, PSS, visual analog scale (VAS), functional independence measurement (FIM), and short form-36 (SF-36) Tests were given before ITB and 3 months after implantation.Results: Twenty-one patients were given the test dose, and the ITB pump was implanted for 16. There were 11 men (68.75%) and 5 women (31.25%). Mean age was 33±10.34, ranging between 12-53 years. Eleven (68.75%) had spinal cord injury, 2 (12.50%) had multiple sclerosis, 2 (12.50%) had cerebral palsy, and 1 (6.25%) had a hypoxic brain. Eleven (68.75%) of these patients were paraplegic, 4 were (25%) tetraplegic, and 1 had (6.25%) dystonic cerebral palsy. Mean follow-up was 52.25±33.10 months, ranging between 3-100 months. Daily baclofen dose was between 70-475 µg (average 220±110.58 µg). Modified Ashworth scale decreased from 3.43±0.53 to 1.00±0.73 (p=0.00); PSS decreased from 3.50±1.03 to 1.12±1.02 (p=0.001); global pain decreased from 44.37±36.14 to 18.75±19.95, (p=0.003); FIM increased from 71.18±20.88 to 76.31±28.25 (p=0.023); SF-36 physical function increased from 2.06±8.25 to 18.25±26.06 (p=0.006); physical role difficulty increased from 1.56±6.25 to 40.31±29.74 (p=0.002); general health increased from 29.37±17.68 to 47.62±27.35 (p=0.005); pain increased from 26.31±30.49 to 53.37±26.45 (p=0.005); vitality increased from 38.93±20.94 to 61.25±19.70 (p=0.001); social function increased from 19.31±14.59 to 70.56±82.74 (p=0.001); emotional role difficulty increased from 10.37±26.40 to 56.31±38.08 (p=0.004); and mental health increased from 46.25±18.12 to 61.12±19.81 (p=0.004). During the follow-up period, pump-related complications were seen in 2 patients.Conclusion: ITB is an effective and safe treatment option in severe spasticity.