Continuous intrathecal baclofen infusion alleviates autonomic dysfunction in patients with severe supraspinal spasticity

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Abstract
Continuous intrathecal baclofen infusion (CIBI) is a widely accepted therapy for the treatment of severe spinal spasticity. There is increasing evidence that CIBI has similar effects on patients with supraspinal spasticity resulting from either hypoxic or traumatic brain injury.1 A proportion of patients with supraspinal spasticity present with additional autonomic dysfunction. These dysfunctions are often unresponsive to conventional antiadrenergic medication. Patients may present with severe arterial hypertension, tachycardia, hyperhidrosis, hypersalivation, and bronchial hypersecretion. Mortality is mainly influenced by these symptoms. In addition to antiadrenergic medication sedatives and analgesics are often required. During intensive care treatment such medication often leads to a prolongation of artificial ventilation and delayed rehabilitation. During rehabilitation autonomic instability additionally interferes with physiotherapeutic activity. In the follow up of patients with severe supraspinal spasticity we noted the positive influence of intrathecal baclofen infusion on autonomic instability.1 Study of the literature did not disclose similar findings. So far, it had not yet been pointed out that CIBI has a positive influence on symptoms originating from severe hypoxic or traumatic brain damage. Eighteen patients with severe tetraspasticity from either hypoxic or traumatic brain injury were …

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