An estimated 5,600 people in the United States are diagnosed every year with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, and as many as 30,000 Americans have the disease at any given time.
Unfortunately, there is no cure for ALS, and it leads to death most typically two to five years after diagnosis. One of the side effects of ALS is spasticity, a condition resulting from excess motor neuron excitation due to lesions in the upper motor neuron pathway that lead to the absence of inhibition of alpha and/or gamma motor neurons. Spasticity can cause uncontrollable and often painful muscle contractions. Although the pain associated with spasticity can usually be controlled with medication and physical therapy, some patients are unresponsive to this treatment.
Researchers at the University of Minnesota Medical School and the Cleveland Clinic explored the efficacy of treating ALS patients with intractable spasm-related pain with an intrathecal baclofen (ITB) pump. Eight patients were implanted with the ITB pump between January 2003 and December 2005 at the Cleveland Clinic.
The results of this study, Intrathecal Baclofen for Spasticity-Related Pain in Amyotrophic Lateral Sclerosis: Efficacy and Factors Associated with Pain Relief, will be presented by Shearwood McClelland III, MD, 3:57 to 4:09 p.m. on Tuesday, April 17, 2007, during the 75th Annual Meeting of the American Association of Neurological Surgeons in Washington, D.C. Co-authors are Francois A. Bethoux MD, Matthew H. Sutliff, PT, Darlene K. Stough RN, Kathleen M. Schwetz, RN, Danuta M. Gogol, RN, Michelle Harrison, PT, Erik P. Pioro, MD, PhD, and Nicholas M. Boulis, MD.
Patients were selected by the operating surgeon and neurologists specializing in the treatment of ALS on the basis of a history of longstanding ALS-associated spasticity, despite optimal medication management. Following successful test injection, patients were referred to the Cleveland Clinic Center for Neurological Restoration for programmable ITB implantation.
- The eight patients ranged in age from 33 to 77, with a mean age of 43.8 at surgery.
- The duration of the patients' ALS symptoms ranged from 14 to 108 months, with an average of 47.4 months at surgery.
- Both pre- and postoperative pain was quantified using a 0-10 scale, with 0 representing no pain and 10 representing maximum pain.
- The mean modified preoperative pain score was 7.69, ranging from 6 to 10.
Following surgery, patients were transferred to an inpatient rehabilitation unit before eventually returning home with continuing outpatient or in-home rehabilitation. Patients were subsequently followed by the ALS and related disorders team at the Cleveland Clinic for ITB pump adjustments and refills. Mean follow-up was 9.8 months.
The following outcomes were noted: