Aaron Boster

Best Practices for Intrathecal Baclofen Therapy: Patient Selection.

When spasticity interferes with comfort, function, activities of daily living, mobility, positioning, or caregiver assistance, patients should be considered for intrathecal baclofen (ITB) therapy.

Best Practices for Intrathecal Baclofen Therapy: Troubleshooting.

Troubleshooting helps optimize intrathecal baclofen (ITB) therapy in cases of underdose, overdose, and infection.

Best Practices for Intrathecal Baclofen Therapy: Dosing and Long‐Term Management

Intrathecal baclofen (ITB) therapy aims to reduce spasticity and provide functional control.

Best Practices for Intrathecal Baclofen Therapy: Screening Test

Intrathecal baclofen (ITB) screening assesses response to a test dose of ITB on spasticity and function and identifies adverse reactions.

Poster 67 Best Practices in Intrathecal Baclofen Therapy: Dosing and Long-Term Management

an MRI of the cervical and thoracic spine, EMG/NCS and PM&R evaluation. Setting: Outpatient rehabilitation clinic. Results or Clinical Course: Patient evaluated in PM&R clinic after MRI was performed, with results noting T2 hyperintense signal from C1 until at least T12, conistent with spinal cord syrinx. Physical examination notable for atrophy of the FDI, thenar, and hypothenar eminences and weakness at the elbow, wrist and hand; lower extremity examination with trace contraction of the dorsi/plantarflexors. MRI L spine was ordered to evaluate extent of syrinx, which was found as caudal as the conus (L1-L2). Neurosurgical plan was to proceed with placement of a syringosubarachnoid shunt. Further rehabilitation needs would be addressed postoperatively. Discussion: Syringomyelia is a serious condition in which the usual cerebrospinal fluid (CSF) mechanics are disturbed, and can be seen in as many as 3-4% of patients after traumatic spinal cord injury, with an interval of occurrence from several months to many years. Normally, this is a benign prognosis, likely representing an area of liquefaction necrosis of cord tissue, but may progress to worsened or new neurological symptoms, as seen in this case. Holocord involvement had been noted in 1 recent case report, and other studies identified patients with as many as 19 segments involved, though this was in the significant minority (1-3). This study noted that patients appeared to have more desirable outcomes when opting for duraplasty and arachnolysis vs shunting. Conclusion: Spinal cord injury can cause a myriad of consequential conditions that affect a patient’s functional mobility and ADLs. Syringomyelia can be a potentially serious sequela in SCI patients and it is important to be aware of in that patient population as the dysfunctional CSF mechanics may continue to expand the syrinx, both proximally and distally, to a level distant from the original injury.