| Autor: |
Abbatemarco, Justin, Griffin, Austin C., Jones, Noble, Hartman, Jennifer, McKee, Keith, Zhini Wang, Nagel, Sean, Machado, Andre, Bethoux, Francois |
| Předmět: |
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| Zdroj: |
International Journal of MS Care; 2020, Vol. 22 Issue S2, p80-80, 1/3p |
| Abstrakt: |
Background: Spasticity is a common cause of disability and diminished quality of life in patients with multiple sclerosis (MS). Intrathecal baclofen therapy (ITB) is an effective treatment option for patients with MS with severe spasticity that is refractory to oral drug administration, but there is limited evidence of its long-term efficacy and safety in ambulatory patients with MS. Objectives: This single-center, retrospective case series investigates the outcomes of ITB in ambulatory and nonambulatory patients with MS with medically intractable spasticity over a 5-year follow-up period. Methods: Data from the Mellen Center Intrathecal Baclofen Registry were analyzed retrospectively. All patients were diagnosed with MS and underwent an ITB test injection. Baseline demographics were collected along with outcome measures including Spasm Frequency Scale, Modi- fied Ashworth scale (MAS), hip flexor strength, and walking speed on the Timed 25 Foot Walk. Group comparisons were done using 2-sample t test or Wilcoxon rank sum test, and logistic regression was used to assess the occurrence of complications. Results: 170 patients with MS underwent ITB infusion system implantation. The aggregate MAS score for the ambulatory cohort (n = 87) was significantly reduced from 13.5 ± 6.96 to 4.54 ± 4.18 at 5 years (P < .001) post ITB implantation. Similarly, spasm frequency (0-4 scale) was significantly reduced in ambulatory patients, from 1.71 ± 0.78 at baseline, to 0.77 ± 0.94 at 5 years (P < .001). The average ITB dose was lower for the ambulatory cohort compared to the nonambulatory cohort except at the 5-year follow-up visit. Among ambulatory patients at baseline, 56 (77.8%) were ambulatory at 1 year with no significant change in walking speed (baseline 0.45 m/s ± 0.30 vs 1 year 0.38 m/s ± 0.39 at 1 year, P = .80). At the 5-year follow-up point, 20 (41.7%) patients remained ambulatory with a walking speed of 0.21 m/s ± 0.37 (P < .001). Longer disease duration (hazard ratio [HR] 1.04; 95% CI 1.01-1.07; P = .018), and lower hip flexor strength at baseline (HR 0.40; 95% CI 0.27-0.57; P < .001) were predictors for transition to nonambulatory status after ITB implantation. Complications were more common in the ambulatory ITB group (n = 29, 22.1%) compared to the nonambulatory group (n = 10, 8.0%) with an odds ratio of 3.30 (95% CI 2.17-5.02; P = .017). Conclusions: ITB is an effective therapy for reducing spasticity in ambulatory patients with MS without compromising walking speed in the short term, although we did observe a higher complication rate in this cohort. This study supports the use of ITB in carefully selected ambulatory patients with MS. Randomized, prospective studies are needed to provide more information on this important subject. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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