Improved gait performance
Baclofen was used via an implanted (intrathecal) pump to treat mild spasticity associated with HSP that was causing walking difficulty. Oral medications to treat the spasticity had been unsuccessful. The dosage of baclofen from the pump was closely monitored and regulated, and a point found where spasticity was decreased, but muscle strength was maintained, leading the patient to be able to walk at double the speed he could previously.
To show the benefits of a continuous ITB test-infusion in a patient with HSP with an improved gait performance after ITB pump-implantation DESIGN: Case report SETTING: Clinical setting PARTICIPANT: A 49-year old male, with hereditary spastic paraplegia (HSP), experiencing progressive walking difficulties due to spasticity of the lower extremities, which did not respond to oral spasmolytics.
Prolonged continuous ITB test-infusion, which started low and was increased gradually, to provide a stable dose of ITB over a prolonged period of time, providing the patient enough time to experience the effects of ITB, because he feared functional loss due to the ITB-therapy.
MAIN OUTCOME MEASURES:
Modified Ashworth Scale (MAS), EMG, muscle strength, Timed Up and Go tests and a Patient Global Impression of Change were performed as outcome measures. Gait performance before and after ITB pump-implantation was assessed in a motion lab.
During the test-infusion ITB dose was gradually increased to a continuous dose of 108 μg/day. This dose caused a decreased spasticity, with maintenance of the muscle strength. After pump-implantation gait performance was improved resulting in an increased knee flexion during the loading response and a doubled walking speed as compared to baseline.
HSP patients suffering from mild spasticity, not responding to oral spasmolytics should receive a continuous ITB test-infusion, to provide the patient with enough time to experience the delicate balance between spasmolysis and muscle strength. ITB-therapy has shown to be a suitable therapy to improve gait performance in HSP patients.
Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
SOURCE: Arch Phys Med Rehabil. 2015 Jan 24. pii: S0003-9993(15)00043-X. doi: 10.1016/j.apmr.2015.01.012. [Epub ahead of print]
Improved gait performance in a patient with hereditary spastic paraplegia after a continuous intrathecal baclofen test-infusion and subsequent pump-implantation; a case report.
- 1,3Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: [email protected].
- 2Department of Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- 4Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.