Spasticity Rigidity and Pain

Spasticity & Rigidity

Spasticity of spinal cord and cerebral origin, such as seen in spinal cord trauma, degenerative spinal disease, cerebral palsy and brain injury is a challenging disorder to control effectively. Traditional rehabilation therapies and oral antispastic drugs often fail to relieve severe spasticity in such patients with intractable spasticity. This therapy consists of long-term delivery of baclofen, a peripherally acting muscle relaxnt, directly into subarachnoid space using an implantable, programmable pump and aspinal catheter. The does of the drug is adjusted by an external programmer.

Case Studies For Spasticity and Rigidity

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Intrathecal Drug Delivery System For Spasticity

	Manika Bisht 14 years Female spasticity due to head injury
Manika Bisht 14yrs/F had severe head injury on 5th july2002. She was in coma for 36 days and remained hospitalized for four months. She recovered her consciousness gradually over a period of year. After recovery she developed severe spasticity (stiffness) on both upper and lower limbs, more on right side. She was given all oral medications to reduce the spasticity but there was not any significant improvement. She remained confined to bed and wheelchair. Later on she developed severe painful spasms in the limbs, which were resistant to all medications. Intrathecal trial bolus of 35ug baclofen was given and patient responded very well. Her stiffness and spasms were subsidized totally. She was advised by Dr Alok Gupta, Consultant Neurosurgeon, VIMHANS, New Delhi.to undergo implantation of Synchromed-II intrathecal baclofen pump. The implantation was done on 02/11/04.Patient responded remarkably to the therapy. Intrathecal baclofen infusion of 30ug/day resulted in relief of spasticity and painful spasms. She is now able to sit comfortably, stand with support, improvement in overall activities of daily living. Mr Sanjeet Sandhu 25 years Male resident of UK SPASTICITY PATIENT STORY
Mr. Sanjeet Sandhu met with a road side accident in summer of 2001.He noticed tremor in the left upper limb after 6 weeks of injury. Gradually his symptoms progressed. He became more lethargic and became fatigue easily. Patient developed stiffness, difficulty in walking and balance problem. The symptoms progressed very rapidly and for last 6 months he was on wheelchair and even on wheelchair he required assistance. He was put on all anti-Parkinson medication and on oral baclofen at highest dose without any significant improvement. His MRI was normal. He was diagnosed to have Parkinson plus syndrome. He was told that no therapy could benefit him. He was brought to India at VIMHANS, New Delhi in the month of Oct2004.After detailed evaluation it was decided that if his stiffness can be reduced he would be more manageable. Trial bolus of Intrathecal baclofen 50ug was given and he responded very well and rigidity (stiffness) reduced significantly. Dr Alok Gupta, Consultant Neurosurgeon, VIMHANS, and New Delhi operated him on 28/10/04. Implantation of Synchromed-II intrathecal programmable baclofen pump was done. He responded very well to therapy. At the time of his departure from INDIA patient was walking with minimal support. His family was happy. Intrathecal Baclofen therapy improved his quality of life and activities of daily living.
Mr. Raja Ram 58 years Male PATIENT STORY OF BRACHIAL PLEXUES INJURY
Mr Raja Ram 58yrs/M had an road accident in Oct 2003,followed by weakness of right upper limb. After one week of injury he reported excruciating pain in right upper limb. His NCV revealed right Pan brachial plexus injury. He was operated at VIMHANS, New Delhi. Microsurgical neurolysis was done on 13/08/04 which did not improve his pain He was lateron subjected to two successive stelliate ganglion block, which also could not improve his pain. The pain was so bad that patient wanted his right upper limb to be amputed as early as possible. On 1/09/04 he was given a trial bolus of intrathecal morphine. Patient gets immediately pain relief for a day. He was advised to undergo implantation of intrathecal morphine delivery pump. Dr Alok Gupta, Consultant Neurosurgeon, VIMHANS, and New Delhi operated him on 2/09/04. Patient responded very well and has complete pain relief till date. Patient is on only 1.9mg/day dose. Of morphine infusion.