Research Reports - Influence of intrathecal baclofen on the level of consciousness and mental functions after severe traumatic brain injury

Brain Inj. 2014 Dec 1:1-6

Al-Khodairy AT(1), Wicky G, Nicolo D, Vuadens P

Abstract Background: Whenever oral treatment or botulinum toxin injections fail
to control severe spasticity, a trial with intrathecal baclofen is recommended no
earlier than 1 year after brain injury. When irreversible contractures are to be
avoided, such a trial might be done earlier. Some have briefly reported cognitive
modifications with this treatment. Methods: During the trial period, intrathecal
baclofen is continuously infused by a portable external pump through an
intrathecal catheter. The daily dose is adjusted according to the clinical
response. If the expected response is obtained by reduction of spasticity, a
programmable pump is then implanted. Throughout the procedure, close
neuropsychological follow-up is pursued. Results: Two persons with extremely
severe brain injury and spasticity received a programmable pump less than 10
months after trauma. Unexpectedly, one emerged from the minimally conscious state
and the other from post-traumatic amnesia. Conclusions: Intrathecal baclofen
should be considered within the first year after brain injury whenever spasticity
does not respond to medication. ITB lessens the degree of spasticity which in
turn facilitates care and, thus, has the potential to limit contractures. After
severe brain injury, this treatment might trigger recovery from altered states of
consciousness, improve cognition and facilitate rehabilitation.

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