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LUMBAR INTRATHECAL BACLOFEN FOR SUPRASPINAL SPASTICITY IN ADULTS.

Massager N, Voordecker P, Levivier M, Brotchi J and Pirotte B.

Purpose: Lumbar intrathecal Baclofen (LIB) infused by implantable programmable pump is very efficient for treating spinal spasticity. However, the benefit and indications of LIB therapy for spasticity of supraspinal origin remain poorly defined. The aim of this study was to evaluate the symptomatic improvement and the functional benefit from LIB in severe supraspinal spasticity in adults.

Method: We have tested 18 adult patients referred for severe spasticity following supraspinal lesions: 7 traumatic (5 limited trauma of the motor cortex, 2 diffuse brain injury), 5 cortical stroke, 4 multiple sclerosis, 1 cerebral palsy, 1 degenerative. Three patients were hemiplegic, 6 hemiparetic, 4 paraparetic and 5 tetraparetic. In all patients a L2-subarachnoid catheter was implanted with the tip at the D1O-level, and connected to a subcutaneous access-port. Patients were tested with increasing bolus doses of LIB. We assessed spastic symptoms (hypertonia, spasms, clonus) separately in upper and lower limbs, and the functional level (dressing, wheelchair, transfers, walking, pain) using appropriate scales. The nature, location and extent of the underlying brain lesion were assessed on magnetic resonance.

Result: Spastic symptoms were significantly improved by LIB injections, particularly in lower limbs, as compared to NaCl injections in 15 patients. A significant functional benefit was observed in 12 of them Patients with a lesion limited to the motor cortex showed better results than others.

Conclusion: LIB therapy. may provide functional benefit to patients with severe supraspinal spasticity, especially with lesion limited to the cortex.