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On the recovery of disorders of consciousness under intrathecal baclofen administration for severe spasticity—An observational study

BACKGROUND: Occasionally, patients show dramatic recovery from disorders of consciousness (DOC) under intrathecal baclofen (ITB), an established treatment option for severe supraspinal spasticity. Anecdotal explanations for ITB‐related recovery of cognition include modulation of afferent impulses at...

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Autores principales: Halbmayer, Lucas‐Michael, Kofler, Markus, Hitzenberger, Gabriel, Matzak, Heinrich, Fava, Elena, Genelin, Eleonora, Werkmann, Mario, Saltuari, Leopold, Versace, Viviana, Dobesberger, Judith, Pucks‐Faes, Elke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120732/
https://www.ncbi.nlm.nih.gov/pubmed/35398998
http://dx.doi.org/10.1002/brb3.2566
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author Halbmayer, Lucas‐Michael
Kofler, Markus
Hitzenberger, Gabriel
Matzak, Heinrich
Fava, Elena
Genelin, Eleonora
Werkmann, Mario
Saltuari, Leopold
Versace, Viviana
Dobesberger, Judith
Pucks‐Faes, Elke
author_facet Halbmayer, Lucas‐Michael
Kofler, Markus
Hitzenberger, Gabriel
Matzak, Heinrich
Fava, Elena
Genelin, Eleonora
Werkmann, Mario
Saltuari, Leopold
Versace, Viviana
Dobesberger, Judith
Pucks‐Faes, Elke
author_sort Halbmayer, Lucas‐Michael
collection PubMed
description BACKGROUND: Occasionally, patients show dramatic recovery from disorders of consciousness (DOC) under intrathecal baclofen (ITB), an established treatment option for severe supraspinal spasticity. Anecdotal explanations for ITB‐related recovery of cognition include modulation of afferent impulses at the spinal level, thereby reducing spasticity‐related proprioceptive information overload within cortico–thalamo–cortical connections. OBJECTIVE: In this retrospective patient chart analysis, we assessed whether a reduction in spasticity would be associated with an increase in Coma Recovery Scale revised (CRS‐R) scores in a larger sample of patients than previously published. METHODS: From a hospital‐based ITB treatment register, we extracted data from 26 patients with DOC and severe supraspinal spasticity who improved by >2 points on the Coma Recovery Scale revised (CRS‐R) within 6 months after ITB treatment initiation. We assessed Modified Ashworth scale (MAS) scores and CRS‐R scores on admission (PRE) and 3 and 6 months after initiation of ITB treatment (3M, 6M). We performed correlation analysis of the scores and their respective changes (PRE to 3M, 3M to 6M). We also correlated the time from acute event until ITB initiation to CRS‐R scores at 3M and 6M. RESULTS: ITB led to significant improvement in spasticity based on MAS scores, which did not correlate to the improvements seen in CRS‐R total and subscale scores. Daily ITB dose did neither correlate to MAS scores nor to CRS‐total scores in the whole patient group, but after 3 months, ITB dose correlated to some CRS‐R subscale scores in some patient subgroups. Time until ITB treatment did not correlate to CRS‐R scores later on. CONCLUSIONS: Our data confirm that ITB may exert beneficial effects in selected DOC patients with respect to improved cognitive functions, which, however, do not correlate to its antispastic effect. The lack of correlation between time to ITB and CRS‐R outcome, but significant CRS‐R improvements following pump implantation, renders spontaneous remissions unlikely and leaves room for alternative pharmacological mechanisms.
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spelling pubmed-91207322022-05-21 On the recovery of disorders of consciousness under intrathecal baclofen administration for severe spasticity—An observational study Halbmayer, Lucas‐Michael Kofler, Markus Hitzenberger, Gabriel Matzak, Heinrich Fava, Elena Genelin, Eleonora Werkmann, Mario Saltuari, Leopold Versace, Viviana Dobesberger, Judith Pucks‐Faes, Elke Brain Behav Original Articles BACKGROUND: Occasionally, patients show dramatic recovery from disorders of consciousness (DOC) under intrathecal baclofen (ITB), an established treatment option for severe supraspinal spasticity. Anecdotal explanations for ITB‐related recovery of cognition include modulation of afferent impulses at the spinal level, thereby reducing spasticity‐related proprioceptive information overload within cortico–thalamo–cortical connections. OBJECTIVE: In this retrospective patient chart analysis, we assessed whether a reduction in spasticity would be associated with an increase in Coma Recovery Scale revised (CRS‐R) scores in a larger sample of patients than previously published. METHODS: From a hospital‐based ITB treatment register, we extracted data from 26 patients with DOC and severe supraspinal spasticity who improved by >2 points on the Coma Recovery Scale revised (CRS‐R) within 6 months after ITB treatment initiation. We assessed Modified Ashworth scale (MAS) scores and CRS‐R scores on admission (PRE) and 3 and 6 months after initiation of ITB treatment (3M, 6M). We performed correlation analysis of the scores and their respective changes (PRE to 3M, 3M to 6M). We also correlated the time from acute event until ITB initiation to CRS‐R scores at 3M and 6M. RESULTS: ITB led to significant improvement in spasticity based on MAS scores, which did not correlate to the improvements seen in CRS‐R total and subscale scores. Daily ITB dose did neither correlate to MAS scores nor to CRS‐total scores in the whole patient group, but after 3 months, ITB dose correlated to some CRS‐R subscale scores in some patient subgroups. Time until ITB treatment did not correlate to CRS‐R scores later on. CONCLUSIONS: Our data confirm that ITB may exert beneficial effects in selected DOC patients with respect to improved cognitive functions, which, however, do not correlate to its antispastic effect. The lack of correlation between time to ITB and CRS‐R outcome, but significant CRS‐R improvements following pump implantation, renders spontaneous remissions unlikely and leaves room for alternative pharmacological mechanisms. John Wiley and Sons Inc. 2022-04-10 /pmc/articles/PMC9120732/ /pubmed/35398998 http://dx.doi.org/10.1002/brb3.2566 Text en © 2022 The Authors. Brain and Behavior published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Halbmayer, Lucas‐Michael
Kofler, Markus
Hitzenberger, Gabriel
Matzak, Heinrich
Fava, Elena
Genelin, Eleonora
Werkmann, Mario
Saltuari, Leopold
Versace, Viviana
Dobesberger, Judith
Pucks‐Faes, Elke
On the recovery of disorders of consciousness under intrathecal baclofen administration for severe spasticity—An observational study
title On the recovery of disorders of consciousness under intrathecal baclofen administration for severe spasticity—An observational study
title_full On the recovery of disorders of consciousness under intrathecal baclofen administration for severe spasticity—An observational study
title_fullStr On the recovery of disorders of consciousness under intrathecal baclofen administration for severe spasticity—An observational study
title_full_unstemmed On the recovery of disorders of consciousness under intrathecal baclofen administration for severe spasticity—An observational study
title_short On the recovery of disorders of consciousness under intrathecal baclofen administration for severe spasticity—An observational study
title_sort on the recovery of disorders of consciousness under intrathecal baclofen administration for severe spasticity—an observational study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120732/
https://www.ncbi.nlm.nih.gov/pubmed/35398998
http://dx.doi.org/10.1002/brb3.2566
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