Effectiveness and safety of cervical catheter tip placement in intrathecal baclofen treatment of spasticity: A systematic review
DOI:
https://doi.org/10.2340/16501977-2857Keywords:
intrathecal baclofen, tip placement, cervical, upper extremity, spasticityAbstract
Objective: To evaluate the effectiveness and safety of intrathecal baclofen treatment of spasticity, ad-ministered via a cervical catheter tip.
Design: A review of PubMed and the Cochrane Library up to September 2020. No restriction in study design. Two reviewers independently evaluated eligibility, extracted data and evaluated risk of bias. Studies were included in which patients were treat-ed with intrathecal baclofen for spasticity, with the catheter tip at or above the first thoracic level, independent of diagnosis and age.
Results: Thirteen studies were eligible, with a mod-erate to critical risk of bias. Improvement in spastic-ity was seen only in the upper extremity in 6% of subjects, only in the lower extremity in 2%, in both upper and lower extremities in 50% and without specification of location in 41%. Upper extremity function improved in 88% of cases. Neither drug-related (1%) nor technical (21%) complications occurred more often than in lower placement of the tip. Effects on respiratory function and sleep apnoea were not investigated.
Conclusion: Cervically administered intrathecal baclofen seems to improve upper extremity spasticity and function, without causing more complications than thoracolumbar intrathecal baclofen. However, the mainly drug-related complications have not been thoroughly investigated and the available literature is of poor methodological quality. Further research is needed to confirm the efficacy and safety of this procedure.
Lay abstract
Spasticity is a common complication in central neurological disorders. It can lead to discomfort and func-tional limitations. To reduce spasticity, administration of baclofen via a catheter into the spinal canal has been used successfully for several years. However, this treat-ment often has limited effects on the upper limbs. The catheter tip is often situated in the thoracolumbar region. This review suggests that baclofen treatment via a cervically located catheter tip reduces spasticity of both arms and legs. Also, arm function improved in patients with a cervical catheter tip. Neither drug-related nor technical complications occurred more often than in lower placement of the cervical catheter tip. Few studies were found on this subject, and the available literature is of poor quality. Therefore, more research is needed to confirm the positive effect of this procedure on spasticity of the arms and to monitor for complications.
Downloads
References
Schinwelski MJ, Sitek EJ, Waz P, Slawek JW. Prevalence and predictors of post-stroke spasticity and its impact on daily living and quality of life. Neurol Neurochir Pol 2019; 53: 449–457.
Holtz KA, Lipson R, Noonan VK, Kwon BK, Mills PB. Prevalence and effect of problematic spasticity after traumatic spinal cord injury. Arch Phys Med Rehabil 2017; 98: 1132–1138.
Patejdl R, Zettl UK. Spasticity in multiple sclerosis: contribution of inflammation, autoimmune mediated neuronal damage and therapeutic interventions. Autoimmun Rev 2017; 16: 925–936.
Lance JW. Symposium synopsis. In: Feldman RG, Young RR, Koella WP, editors. Spasticity: disordered motor control. Chicago: Year Book Medical Publishers; 1980, p. 485–494.
Pandyan AD, Gregoric M, Barnes MP, Wood D, Van Wijck F, Burridge J, et al. Spasticity: clinical perceptions, neurological realities and meaningful measurement. Disabil Rehabil 2005; 27: 2–6.
Brennan PM, Whittle IR. Intrathecal baclofen therapy for neurological disorders: a sound knowledge base but many challenges remain. Br J Neurosurg 2008; 22: 508–519.
Federatie Medisch Specialisten. Cerebrale en/of spinale spasticiteit. 2016. [cited 2020 Sep 24] Available from: https://richtlijnendatabase.nl/richtlijn/cerebrale_en_of_spinale_spasticiteit/cerebrale_en_of_spinale_spasticiteit_-_startpagina.html.
Balsara K, Jea A, Raskin JS. Neurosurgical management of spastic conditions of the upper extremity. Hand Clin 2018; 34: 547–554.
Dykstra D, Stuckey M, DesLauriers L, Chappuis D, Krach L. Intrathecal baclofen in the treatment of spasticity. Acta Neurochir Suppl 2007; 97: 163–171.
Rekand T, Grønning M. Treatment of spasticity related to multiple sclerosis with intrathecal baclofen: a long-term follow-up. J Rehabil Med 2011; 43: 511–514.
Kroin JS, Ali A, York M, Penn RD. The distribution of medication along the spinal canal after chronic intrathecal administration. Neurosurgery 1993; 33: 226–230.
Heetla HW, Proost JH, Mol mans BH, Staal MJ, van Laar T. A pharmacokinetic-pharmacodynamic model for intrathecal baclofen in patients with severe spasticity. Br J Clin Pharmacol 2016; 81: 101–112.
Albright AL, Turner M, Pattisapu JV. Best-practice surgical techniques for intrathecal baclofen therapy. J Neurosurg 2006; 104: 233–239.
Sivakumar G, Yap Y, Tsegaye M, Vloeberghs M. Intrathecal baclofen therapy for spasticity of cerebral origin – does the position of the intrathecal catheter matter? Childs Nerv Syst 2010; 26: 1097–1102.
McCall TD, MacDonald JD. Cervical catheter tip placement for intrathecal baclofen administration. Neurosurgery 2006; 59: 634–640.
Barbara-Bataller E, Mendez-Suarez JL, Aleman-Sanchez C, Sanchez-Enriquez J, Sosa-Henriquez M. Change in the profile of traumatic spinal cord injury over 15 years in Spain. Scand J Trauma Resusc Emerg Med 2018; 26: 27.
McKinley W, Santos K, Meade M, Brooke K. Incidence and outcomes of spinal cord injury clinical syndromes. J Spinal Cord Med 2007; 30: 215–224.
Hentz VR, Leclercq C. The management of the upper limb in incomplete lesions of the cervical spinal cord. Hand Clin. 2008; 24: 175–184.
Bensmail D, Quera Salva MA, Roche N, Benyahia S, Bohic M, Denys P, et al. Effect of intrathecal baclofen on sleep and respiratory function in patients with spasticity. Neurology 2006; 67: 1432–1436.
Bensmail D, Marquer A, Roche N, Godard AL, Lofaso F, Quera-Salva MA. Pilot study assessing the impact of intrathecal baclofen administration mode on sleep-related respiratory parameters. Arch Phys Med Rehabil 2012; 93: 96–99.
Kishima H, Yanagisawa T, Goto Y, Oshino S, Maruo T, Tani N, et al. Respiratory function under intrathecal baclofen therapy in patients with spastic tetraplegia. Neuromodulation 2016; 19: 650–654.
Overgard TM, Kjaersgaard-Hansen L, Soe M, Illum NO. Positive experience with intrathecal baclofen treatment in children with severe cerebral palsy. Dan Med J 2015; 62: 4999.
Motta F, Stignani C, Antonello CE. Effect of intrathecal baclofen on dystonia in children with cerebral palsy and the use of functional scales. J Pediatr Ortho 2008; 28: 213–217.
Chappuis D, Boortz-Marx R, Stuckey M, Baxter T, DesLauriers L. Safety and efficacy of intrathecal baclofen infused in the cervical and high thoracic area: a preliminary report [abstract]. Am J Phys Med Rehabil 2001; 80: 314.
Broseta J, Garcia-March G, Sanchez-Ledesma MJ, Anaya J, Silva I. Chronic intrathecal baclofen administration in severe spasticity. Stereotact Funct Neurosurg 1990; 54–55: 147–153.
Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: 4919.
Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 2018; 23: 60–63.
Pandyan AD, Johnson GR, Price CI, Curless RH, Barnes MP, Rodgers H. A review of the properties and limitations of the Ashworth and modified Ashworth scales as measures of spasticity. Clin Rehabil 1999; 13: 373–383.
Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67: 206–207.
Penn RD, Savoy SM, Corcos D, Latash M, Gottlieb G, Parke B, et al. Intrathecal baclofen for severe spinal spasticity. N Engl J Med 1989; 320: 1517–1521.
Concalves J, Garcia-March G, Sanchez-Ledesma MJ, Onzain I, Broseta J. Management of intractable spasticity of supraspinal origin by chronic cervical intrathecal infusion of baclofen. Stereotact Funct Neurosurg 1994; 62: 108–112.
Randall M, Carlin JB, Chondros P, Reddihough D. Reliability of the Melbourne assessment of unilateral upper limb function. Dev Med Child Neurol 2001; 43: 761–767.
Barry MJ, VanSwearingen JM, Albright AL. Reliability and responsiveness of the Barry-Albright dystonia scale. Dev Med Child Neurol 1999; 41: 404–411.
Krystkowiak P, du Montcel ST, Vercueil L, Houeto JL, Lagrange C, Cornu P, et al. Reliability of the Burke-Fahn-Marsden scale in a multicenter trial for dystonia. Mov Disord 2007; 22: 685–689.
Boyce MJ, Canning CG, Mahant N, Morris J, Latimer J, Fung VS. The Toronto western spasmodic torticollis rating scale: reliability in neurologists and physiotherapists. Parkinsonism Relat Disord 2012; 18: 635–637.
Chang EV, Ehsan A. Placement of baclofen pump catheter tip for upper extremity spasticity management. Neuromodulation 2018; 21: 714–716.
Aljuboori Z, Archer J, Huff W, Moreno A, Jea A. Placement of baclofen pump catheter through a C1-2 puncture: technical note. J Neurosurg Pediatr 2018; 21: 389–394.
Ughratdar I, Muquit S, Ingale H, Moussa A, Ammar A, Vloeberghs M. Cervical implantation of intrathecal baclofen pump catheter in children with severe scoliosis. J Neurosurg Pediatr 2012; 10: 34–38.
Muquit S, Ughratdar I, Ingale H, Vloeberghs M. Cervical catheter placement for intrathecal baclofen test dose: is it safe? Childs Nerv Syst 2012; 28: 919–922.
Harned ME, Salles SS, Grider JS. An introduction to trialing intrathecal baclofen in patients with hemiparetic spasticity: a description of 3 cases. Pain Physician 2011; 14: 483–489.
Motta F, Antonello CE, Stignani C. Upper limbs function after intrathecal baclofen therapy in children with secondary dystonia. J Pediatr Orthop 2009; 29: 817–821.
Dykstra DD, Mendez A, Chappuis D, Baxter T, DesLauriers L, Stuckey M. Treatment of cervical dystonia and focal hand dystonia by high cervical continuously infused intrathecal baclofen: a report of 2 cases. Arch Phys Med Rehabil 2005; 86: 830–833.
Roscher M, Munin MC. Poster 291: Improved upper extremity spasticity during continuous intrathecal baclofen trial with high cervical catheter placement: a case report. PMR 2016; 8: 255.
Korenkov Al, Niendorf WR, Darwish N, Glaeser E, Gaab MR. Continuous intrathecal infusion of baclofen in patients with spasticity caused by spinal cord injuries. Neurosurg Rev 2002; 25: 228–230.
Meythaler JM, Guin-Renfroe S, Brunner RC, Hadley MN. Intrathecal baclofen for spastic hypertonia from stroke. Stroke 2001; 32: 2099–2109.
Meythaler JM, DeVivo MJ, Hadley M. Prospective study on the use of bolus intrathecal baclofen for spastic hypertonia due to acquired brain injury. Arch Phys Med Rehabil 1996; 77: 461–466.
Heetla HW, Staal MJ, Proost JH, van Laar T. Clinical relevance of pharmacological and physiological data in intrathecal baclofen therapy. Arch Phys Med Rehabil 2014; 95: 2199–2206.
Skalsky AJ, Fournier CM. Intrathecal baclofen bolus dosing and catheter tip placement in pediatric tone management. Phys Med Rehabil Clin N Am 2015; 26: 89–93.
Enzmann DR, Pelc NJ. Normal flow patterns of intracranial and spinal cerebrospinal fluid defined with phase–contrast cine MR imaging. Radiology 1991; 178: 467–474.
Ertzgaard P, Campo C, Calabrese A. Efficacy and safety of oral baclofen in the management of spasticity: a rationale for intrathecal baclofen. J Rehabil Med 2017; 49: 193–203.
Hsieh JC, Penn RD. Intrathecal baclofen in the treatment of adult spasticity. Neurosurg Focus 2006; 21: 5.
Published
How to Cite
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
