Skip to main content

Intrathecal baclofen in the management of post-stroke hypertonia: current applications and future directions

  • Chapter
Operative Neuromodulation

Part of the book series: Acta Neurochirurgica Supplements ((NEUROCHIRURGICA,volume 97/1))

Summary

This chapter will review the application of intrathecal baclofen (ITB) in the management of post-stroke hypertonia, a major complication that results in deformity and discomfort, and limits mobility and performance of activities of daily living (ADL). Initially, ITB was considered only in conditions characterized by severe multi-limb spastic hypertonia in non-ambulatory individuals. Lately, ITB is used in persons with stroke who can ambulate, with the intent of further improving walking ability. Early clinical experience and evidence suggest that when used in the appropriate patient, ITB is efficacious and safe in managing post-stroke hypertonia in individuals of various functional levels. This chapter will also review clinical situations that are common in the stroke population, which may influence treatment decision choices. There are still ample opportunities to conduct research on this treatment modality, especially in the areas of patient selection and outcomes in the stroke population.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Ashworth B (1964) Preliminary trial of carisoprodol in multiple sclerosis. Practitioner 192: 540–542

    PubMed  CAS  Google Scholar 

  2. Bohannon RW, Smith MB (1986) Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67: 206–207

    Google Scholar 

  3. Boyd RN, Graham HK (1996) Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy. Eur J Neurol Suppl 4: S23–S33

    Google Scholar 

  4. Brailowsky S, Knight RT, Blood K, Scabini D (1986) Gamma amino butyric acid-induced potentiation of cortical hemiplegia. Brain Res 362: 322–330

    Article  PubMed  CAS  Google Scholar 

  5. Brunnstrom S (1970) Recovery stages and evaluation procedures. In: Brunnstrom S (ed) Movement therapy in hemiplegia: a neurophysiological approach, Harper & Row Publishers Inc., Maryland, pp 34–55

    Google Scholar 

  6. Coffey RJ, Edgar TE, Francisco GE et al (2002) Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome. Arch Phys Med Rehabil 83: 735–741

    Article  PubMed  Google Scholar 

  7. Chapuis DM, Boortz-Marx RL, Stuckey MW et al (2002) Safety of continuously infused intrathecal baclofen in the cervical and high thoracic areas for patients with spasticity, dystonia, and movement disorders: a prospective case series. Arch Phys Med Rehabil 83:1676 (abs)

    Google Scholar 

  8. Denys P, Mane M, Azouvi P et al (1998) Side effects of chronic intrathecal baclofen on erection and ejaculation in patients with spinal cord lesions. Arch Phys Med Rehabil 79: 494–496

    Article  PubMed  CAS  Google Scholar 

  9. Francisco GE, Ivanhoe CB, Grissom SP et al (2001) Prospective evaluation of the efficacy and safety of intrathecal baclofen therapy for spastic hypertonia due to stroke. Arch Phys Med Rehabil 82: 1341(abs)

    Google Scholar 

  10. Francisco GE, Boake C (2003) Improvement in walking speed in post-stroke spastic hemiplegia after intrathecal baclofen therapy: a preliminary study. Arch Phys Med Rehabil 84(8): 1194–1199

    Article  PubMed  Google Scholar 

  11. Goldstein LB (1998) Potential effects of common drugs on stroke recovery. Arch Neurol 55(4): 454–456

    Article  PubMed  CAS  Google Scholar 

  12. Gracies JM, Weisz DJ, Yang BY et al (2002) Spastic co-contraction and movement speed: effects of botulinum toxin type A injection into an agonist. Ann Neurol Suppl 1: S89

    Google Scholar 

  13. Hill DR, Bowery NG (1982) [3H]Baclofen and [3H]GABA bind to bicuculline-insensitive GABAB sites in rat brain. Nature 290: 149–152

    Article  Google Scholar 

  14. Knuttson E, Lindblom U, Martensson A (1974) Plasma and cerebrospinal fluid levels of baclofen (Lioresal) at optimal therapeutic responses in spastic paresis. J Neurol Sci 23: 473–484

    Article  Google Scholar 

  15. Kofler M, Kronenberg M, Rifici C, Saltuari L, Bauer G (1994) Epileptic seizures associated with intrathecal baclofen application. Neurology 94: 25–27

    Google Scholar 

  16. Kofler M, Matak H, Saltuari L (2002) The impact of intrathecal baclofen on gastrointestinal function. Brain Inj 16(9): 825–836

    Article  PubMed  Google Scholar 

  17. Kroin JS, Penn RD (1991) Cerebrospinal fluid pharmacokinetics of lumbar intrathecal baclofen. In: Lakke JPWF (ed) Parenteral drug therapy in spasticity and Parkinson’s disease. Parthenon Pub. Group Inc., Park Ridge, NJ, pp 67–77

    Google Scholar 

  18. Kroin J (1992) Intrathecal drug administration: present use and future trends. Clinical Pharmacokinet 22: 319–326

    Article  CAS  Google Scholar 

  19. Meythaler JM, Guin-Renfroe S, Hadley MN (1999) Continuously infused intrathecal baclofen for spastic/dystonic hemiplegia: a preliminary report. Am J Phys Med Rehabil 78: 247–254

    Article  PubMed  CAS  Google Scholar 

  20. Meythaler JM, Guin-Renfroe S, Brunner RC, Hadley MN (2001) Intrathecal baclofen for spastic hypertonia from stroke. Stroke 32: 2099–2109

    PubMed  CAS  Google Scholar 

  21. Muller H, Zierski J, Dralle D, Krauss D, Mutschler E (1998) Pharmacokinetics of intrathecal baclofen. In: Muller et al (eds) Local-spinal therapy of spasticity. Springer, Berlin, pp 223–226

    Google Scholar 

  22. Perry J, Garrett M, Gronley JK, Mulroy SJ (1995) Classification of walking handicap in the stroke population. Stroke 26: 982–989

    PubMed  CAS  Google Scholar 

  23. Remy-Neris O, Tiffrau V, Bouilland S (2003) Intrathecal baclofen in subjects with spastic hamiplegia: assessment of the antispastic effect during gait. Arch Phys Med Rehabil 84: 643–650

    Article  PubMed  Google Scholar 

  24. Schallert T, Hernandez TD, Barth TM (1986) Recovery of function after brain damage: severe and chronic disruption by diazepam. Brain Res 379: 104–111

    Article  PubMed  CAS  Google Scholar 

  25. Schuele SU, Kellinghaus C, Shook SJ et al (2005) Incidence of seizures in patients with multiple sclerosis treated with intrathecal baclofen. Neurology (United States) 64(6): 1086–1087

    CAS  Google Scholar 

  26. Tardieu G, Shentoub S, Delarue R (1967) A la recherché d’une technique de mesure de la spasticite. Rev Neurol 1954 91: 143–144

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gerard E. Francisco .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer-Verlag

About this chapter

Cite this chapter

Francisco, G.E. (2007). Intrathecal baclofen in the management of post-stroke hypertonia: current applications and future directions. In: Sakas, D.E., Simpson, B.A., Krames, E.S. (eds) Operative Neuromodulation. Acta Neurochirurgica Supplements, vol 97/1. Springer, Vienna. https://doi.org/10.1007/978-3-211-33079-1_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-211-33079-1_30

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-33078-4

  • Online ISBN: 978-3-211-33079-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics