Intrathecal baclofen therapy in brain injury and recovery of persistent vegetative state. Apropos of a case

• Published in: Rehabilitacion Vol. 54; no. 2; p. 137
• Main Authors: Espigares Correa, G, Benito-Penalva, J
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.04.2020
• Subjects: Intrathecal baclofen therapy; Permanent vegetative state; Terapia baclofeno intratecal; Minimal conscious state; Estado vegetativo persistente; Alteración nivel consciencia; Daño cerebral; Brain injury; Disorder of consciousness; Estado mínima consciencia
• ISSN: 1578-3278
• DOI: 10.1016/j.rh.2019.12.004

Patients with brain injury and spasticity are candidates for intrathecal baclofen therapy (ITB) when maximal doses of oral antispastic drugs fail. Some authors have described an improvement in the level of consciousness in patients with brain injury and disorder of consciousness treated with ITB for spasticity. We present the case of a 43-year-old patient with brain injury, spasticity, and permanent vegetative state (PVS) who showed an improvement in the level of consciousness after ITB for spasticity. We performed an ITB infusion test, assessing the spasticity with the Modified Ashworth Scale (MAS) and level of consciousness with the Coma Recovery Scale-Revised (CRS-R) and observed an improvement in the spasticity and the level of consciousness. Consequently, the ITB pump was implanted and the patient recovered from PVS to minimal conscious state (MCS). We conclude that ITB is indicated in patients with brain injury and spasticity. We suggest the improvement in the level of consciousness as a possible additional benefit. There is a lack of evidence to recommend ITB in patients with altered level of consciousness.