Improved gait performance in a patient with hereditary spastic paraplegia after a continuous intrathecal baclofen test infusion and subsequent pump implantation: a case report.

Abstract

OBJECTIVE:

To show the benefits of a continuous intrathecal baclofen (ITB) test infusion in a patient with hereditary spastic paraplegia (HSP), with an improved gait performance after ITB pump implantation.

DESIGN:

Case report.

SETTING:

University hospital.

PARTICIPANT:

A 49-year old man with HSP experiencing progressive walking difficulties because of lower extremity spasticity, which did not respond to oral spasmolytics.

INTERVENTIONS:

A prolonged, continuous ITB test infusion was started at a low dose and increased gradually, to provide a stable dose of ITB over a prolonged period. The gradual dose increase provided the patient enough time to experience the effects of ITB, because he feared that ITB therapy might cause functional loss.

MAIN OUTCOME MEASURES:

Modified Ashworth Scale, electromyography, muscle strength, timed Up and Go tests, and the Patient Global Impression of Change. Gait performance before and after ITB pump implantation was assessed in a motion laboratory.

RESULTS:

During the test infusion, the ITB dose was gradually increased to a continuous dose of 108μg/d. This dose caused the spasticity to decrease, with maintenance of muscle strength. After pump implantation, gait performance was improved, resulting in increased knee flexion during the loading response and a doubled walking speed as compared with baseline.

CONCLUSIONS:

Patients with HSP who have mild spasticity that does not respond to oral spasmolytics should receive a continuous ITB test infusion, to provide them with enough time to experience the delicate balance between spasmolysis and muscle strength. ITB administration is a suitable therapy to improve gait performance in patients with HSP.

• Authors: Herre W Heetla, Jan P Halbertsma, Rienk Dekker, Michiel J Staal, Teus van Laar
• Journal: Archives of physical medicine and rehabilitation (Arch Phys Med Rehabil) Vol. 96 Issue 6 Pg. 1166-9 (Jun 2015) ISSN: 1532-821X [Electronic] United States
• PMID: 25626112 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Chemical References

• GABA-B Receptor Agonists
• Baclofen

Topics

• Baclofen (administration & dosage)
• Electromyography
• GABA-B Receptor Agonists (administration & dosage)
• Gait Disorders, Neurologic (drug therapy)
• Humans
• Infusion Pumps, Implantable
• Infusions, Spinal
• Male
• Middle Aged
• Muscle Strength
• Spastic Paraplegia, Hereditary (drug therapy)