Intrathecal Baclofen Therapy to Reduce Spacticity in Two Patients with Traumatic Central Nervous System Injury

Spasticity is a common sequela in patients with spinal cord injury (SCI) or traumatic brain injury (TBI). Conventional oral baclofen therapy in large doses may induce gastrointestinal discomfort and neuropsychiatric symptoms. Intrathecal baclofen (ITB) is a relatively new modality for treating spasticity of spinal cord origin. Herein, we present our experience with ITB therapy for treatment of SCI- and TBI-related spasticity. Case 1 involves a 21-year-old man with SCI at the C3-C4 region accompanied by a traumatic herniated intervertebral disc, resulting in incomplete tetraplegia. Case 2 involves a 19-year-old man with a localized brain contusion and acute subdural hematoma in the left frontal-temporal-parietal lobe. Both patients underwent ITB implantation after preoperative and ITB screening 28 months and 29 months, respectively to treat severe spasticity. Functional independent measure scores and mean modified Ashworth scores were calculated preoperatively and postoperatively in both patients to evaluate outcome of ITB therapy. Overall, both patients exhibited a good response. Mean modified Ashworth scores decreased soon after ITB implantation and adequate dosage adjustment in both patients. Functional independent scores improved gradually during the follow-up periods. There were no complications, and no overdose or withdrawal symptoms at 3-month postoperative follow-up in case 1 and at 7-month postoperative follow-up in case 2. ITB therapy is effective in reducing spasticity in patients with SCI and in patients with TBI.