Türk Nöroşirürji Dergisi 2016 , Vol 26 , Num 2
Intraventricular Baclofen for Dystonia and Spasticity: Case Report and Review of the Literature
Aydın AYDOSELİ1, Pulat Akın SABANCI1, Müge DOLGUN1, Yavuz ARAS1, Emre ALTUNRENDE1, Ahmet ALİ2, Güntülü ŞIK3, Ali Nail İZGİ1
1İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı, İstanbul, Türkiye
2İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, İstanbul, Türkiye
3İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Çocuk Yoğun Bakım Bilim Dalı, İstanbul, Türkiye
Intrathecal baclofen treatment for dystonia is first administered by Narayan et al. in 1991. Intraventricular baclofen pump implantation for cerebral dystonia was reported by Albright et al. for the first time in 2006. Our aim is to discuss the first intraventricular baclofen pump implantation reported in Turkey in a case of secondary dystonia due to cernicterus with the review of the literature. Intraventricular baclofen pump implantation was planned in a 10 year-old, term-born boy with intractable progressive dystonia due to a history of jaundice that started on the 3rd day after birth. With the aid of neuronavigation and cranial endoscopy, an intraventricular catheter was placed. The system was completed with the implantation of the pump in the right subcostal area. Patient response was evaluated. A low dose, 50 mcg/day baclofen infusion was administered to the patient. On postoperative day 3, the patient’s complaints of dystonia started to decline. After this progress, the dosage of baclofen infusion was augmented to 350 mcg/day at various day intervals. With the dosage of 350 mcg/day infusion, the patient’s modified Ashworth Scale and Albright Dystonia Scale parameters were degraded to 2 in the upper and lower extremities. He was tracheostomized on room air and discharged from the intensive care unit with the resolution of his opisthotonic posture and dyspnea complaints. The first-line treatment for the secondary dystonia and spasticity patients is oral medication. Trihexyphenidyl HCL, levodopa and oral baclofen are frequently used as oral medication. In cases that are non responsive to treatment or receive inadequate oral treatment due to the side-effects, intraventricular baclofen or intratechal baclofen can be administered in accordance with the indication. Although little is known about the long-term efficacy of the procedure, Intraventricular baclofen treatment is an alternative method for dystonia patients. In our case, there were no adverse effects of intraventricular baclofen treatment, and there was a dramatic recovery 2 months after the implantation of the pump. Anahtar Kelimeler : Baclofen, Dystonia, Infusion, Intraventricular, Muscle spasticity