Comparison of long-term outcomes of patients with severe traumatic or hypoxic brain injuries treated with intrathecal baclofen therapy for dysautonomia.

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    • Subject Terms:
      AUTONOMIC nervous system diseases; CEREBRAL anoxia; FISHER exact test; HEALTH status indicators; SPINAL injections; T-test (Statistics); U-statistics; ACTIVITIES of daily living; RETROSPECTIVE studies; DATA analysis software; BACLOFEN; DESCRIPTIVE statistics; DISEASE complications
    • Abstract:
      Primary objective: To compare the long-term outcome of patients with severe traumatic brain injury and patients with hypoxic brain injury with dysautonomia and hypertonia treated with intrathecal baclofen therapy. Methods and procedures: Fifty-three patients with severe traumatic ( n = 43/53) or hypoxic ( n = 10/53) brain injuries treated by intrathecal baclofen therapy were included to be evaluated with the Coma Recovery Scale-Revised, the Barthel Index, the Glasgow Outcome Scale, the Ashworth scale, the scores of hypertonic attacks, of sweating episode and of voluntary motor responses. A retrospective analysis highlighted patients' characteristics at admission and before surgery and their complications. Main outcomes and results: After a mean follow-up time of 9.6 years, 13/53 (24.5%) patients had died. Alive patients with traumatic brain injury had a higher level of consciousness recovery ( p < 0.02) and more abilities in activities of daily living ( p < 0.008) in the long-term. Their dysautonomia and limb hypertonia also significantly improved, contrary to patients with hypoxic brain injury who needed higher doses of baclofen ( p < 0.03). Conclusions: At long-term follow-up, patients with hypoxic brain injury had a poorer functional outcome than patients with traumatic brain injury with persistent symptoms of dysautonomia associated with uncontrolled hypertonia, despite the use of intrathecal baclofen. [ABSTRACT FROM AUTHOR]
    • Abstract:
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