Fatma Gul

Best Practices for Intrathecal Baclofen Therapy: Troubleshooting.

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

Efficacy and Safety of AbobotulinumtoxinA (Dysport) for the Treatment of Hemiparesis in Adults With Upper Limb Spasticity Previously Treated With Botulinum Toxin: Subanalysis From a Phase 3 Randomized Controlled Trial

To assess the efficacy and safety of abobotulinumtoxinA in adults with upper limb spasticity previously treated with botulinum toxin A (BoNT‐A).

Poster 292 Improvement of Spasticity Following AbobotulinumtoxinA (Dysport®) Injections in Shoulder Muscles in Hemiparetic Patients with Upper Limb Spasticity–Sub-Analysis of a Prospective, Long-Term, Open-Label Study with Single and Repeated Injection Cycles

Participants: A total of 134 patients (abobotulinumtoxinA, n1⁄489; placebo, n1⁄445) were randomized and 129 (abobotulinumtoxinA, n1⁄484; placebo, n1⁄445) completed the W4 primary endpoint evaluation. Interventions: CD patients were randomized (2:1) to abobotulinumtoxinA or placebo. Toxin-naı̈ve abobotulinumtoxinA patients received 500 units/2 mL in 2 affected neck muscles. AbobotulinumtoxinA CD subjects who had previously received botulinum treatment (non-naı̈ve) received 250-500 units/2 mL (2.5:1 abobotulinumtoxinA: previous onabotulinumtoxinA [Botox ] dose) into muscles injected during prior treatments. Main Outcome Measures: The primary endpoint was change from baseline to Week 4 (W4) in Toronto Western Spasmodic Torticollis Rating Oasis, The Online Abstract Submission System Scale (TWSTRS) total score. Safety was assessed over the 12-week study period. Results: Versus placebo, abobotulinumtoxinA patients experienced significantly greater changes from baseline in TWSTRS score at W4 (-2.5 versus -10.8, P<.001; based upon the modified intent-to-treat population). Adverse events (AEs) occurred in 41% and 22% of abobotulinumtoxinA and placebo patients, respectively. Dysphagia was reported in 9% of treated patients. Other AEs in treated patients were muscle weakness, neck pain, and headache, none of which were reported with placebo. Conclusions: Data from this study indicate a 2 mL dilution of abobotulinumtoxinA was significantly more effective than placebo in CD patients. No unexpected AEs were observed relative to previous studies that used the 1 mL dilution volume in this patient population. Level of Evidence: Level II

Poster 308 Improvement of Spasticity, Active Movements and Active Function after Repeated Injections of AbobotulinumtoxinA (Dysport) in Adults with Spastic Paresis in the Upper Limb: Results of a Phase III Open-Label Extension Study

Disclosures: George Francis: I Have No Relevant Financial Relationships To Disclose Case/Program Description: Sacral neoplasms often present as large masses refractory to chemotherapy and radiation, requiring a sacrectomy. Multiple sacral nerve roots and vessels may be compromised, resulting in immobility, pressure ulcers, orthostasis, and neurogenic bowel and bladder. Our goal is to review the rehabilitative needs and outcomes post-sacrectomy via two inpatient case presentations. A 58-year-old woman with a solitary fibrous tumor underwent an en bloc resection involving a subtotal sacrectomy from S2 to coccyx, an L5-S1 laminectomy, ligation of her bilateral S2-5 nerve roots, neurolysis of bilateral S1 and sciatic nerve roots, and bilateral gluteal flap closures. Post-operatively, activity precautions included no walking initially and no hip flexion for two weeks. She required tilt table treatments and was ambulating at post-op Day 8. The rehabilitation challenges included: training on the management of her neurogenic bowel and bladder, controlling her neuropathic and somatic pain, and mobilizing her despite the hip restrictions. The second case includes a 67-year-old male with a sacral chordoma who underwent a two-stage surgery. Stage one involved preparation for the en bloc resection of the sacral tumor. One day later, stage two involved an L5-S1 laminectomy, ligation of the S2-5 nerve roots, en bloc resection of the sacral, bilateral S1 root and sciatic neurolysis, and bilateral gluteus muscle flaps for closure. His rehabilitation challenges included: severe protein malnutrition, orthostatic hypotension, delayed wound healing, fluid collection, uncontrolled pain, and neurogenic bowel and bladder. Setting: Tertiary cancer center. Results: Highly functional outcomes are seen in these patients, including independent bowel and bladder management and return to pre-operative ambulatory status. Discussion: Rehabilitation interventions for these patients include: medical stabilization, pain management, wound healing, transfers, mobility, and neurogenic bowel and bladder management. Conclusions: These are highly complex surgical patients with extensive rehabilitation needs that require the management by a physiatrist. Level of Evidence: Level V

Complications Related to Intrathecal Baclofen Therapy: A Review of 10 Years of Experience From a Children's Hospital Pediatric Rehabilitation Medicine Clinic

features include detrusor instability leading to nocturia, urinary frequency, incontinence, and minor sensory changes, especially paresthesias and loss of vibration sense. Cognitive function is unaffected and there is no upper limb involvement usually. Conclusions: Spasticity is one of the manifestations of tropical spastic paraparesis. If not properly addressed and treated it may hinder the rehabilitation course and prevent the patient from being optimized for therapy.