Research shows mixed results
A review of recent research on the effectiveness of intrathecal baclofen for HSP shows mixed results. Some of the findings include:
* some patients have good functional improvement.
* satisfaction was high for patients who received implantation early instead of waiting for the natural course of the disease.
* a possible compromise between decreased spasticity and muscular weakness.
* the baclofen dose needed for hereditary spastic paraplegia (HSP) is significantly smaller than that in other diseases.
* baclofen causes some clinically significant adverse reactions.
Satisfaction was high for patients who received implantation early instead of waiting for the natural course of the disease. Some patients with hereditary spastic paraparesis have good functional improvement with chronic intrathecal delivery of baclofen if walking is still possible. Despite the natural history of the disease, functional results are stable during the first 5 years of treatment. The data indicate a possible compromise between decreased spasticity and muscular strengthening with the treatment.
Intrathecal baclofen therapy has been used for several years, despite the fact that long-term gait modifications in ambulatory patients have not been thoroughly investigated. A 31-yr-old male patient affected by hereditary spastic paraparesis was evaluated clinically and by gait analysis. Evaluations were made before and at 6, 12, 16, and 24 mos after implantation. The patient showed a clear improvement in self-selected speed, step and stride length, knee and ankle kinematics, and ankle kinetics. Moreover, the response observed on self-selected speed is consistent with the intrathecal baclofen dose administered. To our knowledge, this is the first report of a long-term instrumental gait analysis assessment of a patient receiving intrathecal baclofen. Gait analysis could be a reliable and feasible assessment tool to evaluate ambulatory patients receiving intrathecal baclofen therapy over time and to help clinicians in determining exact dose requirements.
Compared with pretreatment values, there was an improvement in clinical efficacy, but the baclofen dose needed for hereditary spastic paraplegia (HSP) was significantly smaller than that in other diseases. The result shows the importance of knowledge of the adequate baclofen dose in each disease in that baclofen causes some clinically significant adverse reactions.