Post-stroke ambulation improves with baclofen therapy


By Joene Hendry

WESTPORT, CT (Reuters Health) – A small group of patients with post-stroke spastic hemiplegia showed improvement in ambulation and mobility following intrathecal baclofen pump implantation, according to preliminary findings released on Friday at the North American Stroke meeting in San Diego, California.

Dr. Gerard E. Francisco and colleagues at the Institute for Rehabilitation and Research in Houston, Texas implanted baclofen pumps in the abdominal walls of four male and four female post-stroke patients. The pumps deliver from less than 100 mcg to over 1000 mcg baclofen, according to the patient's need, Dr. Francisco noted.

The patients ranged from 42 to 69 years of age and underwent pump implantation from 14 months to 55 months post-stroke. Patients were ambulatory prior to implantation, but experienced inadequate control of their muscle spasticity.

After a mean of 9.4 months of treatment the researchers analyzed pre- and post-implantation comfortable walking speed, Ashworth Scale muscle scores in the patients' lower limbs, and Functional Independence Measure mobility.

"Seven of the eight patients showed clinically significant improvement in the speed of walking." Dr. Francisco told Reuters Health. All patients improved in function, he added.

The patients' mean timed ambulation over a distance of 50 feet improved from an average of 132 seconds pre-implantation to 63.6 seconds post-implantation. The patients also showed improvement in lower limb muscle scores and in mobility domains, while their normal limbs were unaffected by the baclofen therapy.

Dr. Francisco added that standard measures of spasticity do not capture the patients' perceptions of their therapy. "Individual reports from patients and caregivers show there was a significant improvement in the patients' quality of living." Dr. Francisco also noted that after implantation, "the patients say they feel looser and are walking better."

Most side effects are minor, and related to the surgical implantation technique, he told Reuters Health. Medication side effects may include minor drowsiness and light-headedness, and may occur with either overdose or withdrawal of baclofen.

Dr. Francisco's group is conducting a multicenter study in a larger population to determine the safety and efficacy of baclofen therapy. They expect to release preliminary results from this study later this year.

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