The experience of the Geneva University Hospitals in the treatment of spasticity by intrathecal Baclofen for adults

Abstract

After 30 years of use of intrathecal baclofen for the treatment of generalized spasticity, no other treatment has demonstrated superior efficiency. This long duration allows us to study the real use of this treatment and its complications. Retrospective study based on patient records. The medical records of 45 patients were analysed: 27 are still followed, 10 died, 4 stopped their treatment (9%), 4 were lost to follow-up. The follow-up time was 7.3 ± 4.9 years (0.6–23.6 years), with an accumulated duration of 323 years. The causes of spasticity included: spinal cord injury (15), multiple sclerosis (12), cerebral palsy (4), stroke (4) traumatic brain injury (4) other (6). Six could walk without assistance (FAC ≥ 4). In 24 the test trial was realised by lumbar puncture and by external pump in 18. Fifty percent had at least one significant complication (between 1 and 10 events/patient). On average, one significant complication occurred every 7 years of follow-up. Sixty-seven percent of complications (31/46) were related to the catheter: break (8), fissure (6), disjunction (2), kinking (1), migration (7), malposition (3) or unspecified dysfunction of catheter (4). The remainder were related to infections (4), to skin problems (3), rotation of the pump (3) and the problems of Baclofen dosage (3). Few complications were related to pump dysfunction (1), leaving aside cases of battery fading. The diagnosis of catheter fissures may be difficult; it sometimes requires a scintigraphy and sometimes a comparison test of the effect of a bolus by pump vs by lumbar puncture. Despite a high rate of complications, treatment discontinuation is rare, indicating good efficiency. The catheter is much more frequently the cause of complications than the pump. A detailed analysis of the surgical technique and a prospective multicenter assessment of new catheters are needed.