Contributions
Abstract: EP1693
Type: Poster Sessions
Abstract Category: Therapy - Symptomatic treatment
Introduction: Spasticity is a common symptom in Multiple Sclerosis. Anecdotally patients report improved concentration/cognitive performance when switching to intrathecal baclofen (ITB).
Aim: To explore whether subjects who proceed with ITB pump implantation and reduce oral anti-spasticity agents will improved on measures of cognitive function.
Methods: Thirty subjects admitted for trial of ITB via lumbar puncture and pump implantation. Measures performed pre ITB trial and at 3 months: Ashworth, Penn spasm scale, VAS: pain, stiffness, spasm, EDSS and medications. Neuropsychological tests: Sustained Attention to Response Test, Symbol Digit Modalities Test, California Verbal Learning Test-2nd Edition, WAIS-III Digit Span, VOSP Incomplete Letters and Position Discrimination subtests, Delis-Kaplan Executive Function System tests. Hospital Anxiety and Depression scale and Fatigue Severity Scale.
Paired t test for within subject change and effect sizes (Cohen's d) were calculated. Subgroup analysis of those on ≥2 or ≤ 1 spasticity medications at baseline. Re-analysis excluding 2 non-MS patients.
Results: 29 subjects completed per protocol. Mean age 46 years [30 - 56], disease duration 15 years [6 - 23], RRMS = 3, SPMS = 17 and PPMS=7. 24 were on multiple spasticity medications. Ashworth, Penn, VAS scores significantly improved with ITB. Mean ITB dose at 3 months was 144.5 mcg/day, 19 discontinued all other treatments. There was no deterioration on any cognitive or mood measure. An improvement of moderate effect size was found in Backwards Digit Span (d=0.45, p=0.038) and HADS - anxiety (d=0.47, p=0.018). FSS score decreased (d=0.52, p=0.014). This effect increased excluding 2 non-MS subjects, effect size d=0.59, p=0.008. Small improvement in SDMT score (d=0.26) and SART response time (d=0.25) were nonsignificant. Performance on other measures did not change.
A trend for improvement in depression scores was noted, (d=0.36, p=0.067).
Effect sizes were larger in subgroup on ≥2 oral spasticity medications at baseline, compared to the group on ≤1 medication (SDMT, d=0.46 vs d=0.02; Backwards digit span 0.47 vs 0.37; HADS-anxiety 0.50 vs 0.39; HADS-depression d=0.45 vs 0.20 and FSS, d=0.57 vs 0.42).
Conclusions: Switching to ITB resulted in improved spasticity scores and improvement on some measures of fatigue, anxiety, auditory attention/verbal working memory. Improvement of speed of processing was noted in those withdrawing higher doses of oral medication.
Disclosure: R Farrell has received honoraria and consulting fees from Biogen Idec, Merck, Teva, GW Pharma, Canbex Pharmaceuticals Ltd, Allergan PLC.
M Summers: nothing to disclose
E Keenan: nothing to disclose
K Buchanan: nothing to disclose
H Lee: nothing to disclose
V Stevenson: nothing to disclose
Research was supported by internal funding University College London Hospitals.
R Farrell research activity is supported by the NIHR Biomedical Research Centre.
Abstract: EP1693
Type: Poster Sessions
Abstract Category: Therapy - Symptomatic treatment
Introduction: Spasticity is a common symptom in Multiple Sclerosis. Anecdotally patients report improved concentration/cognitive performance when switching to intrathecal baclofen (ITB).
Aim: To explore whether subjects who proceed with ITB pump implantation and reduce oral anti-spasticity agents will improved on measures of cognitive function.
Methods: Thirty subjects admitted for trial of ITB via lumbar puncture and pump implantation. Measures performed pre ITB trial and at 3 months: Ashworth, Penn spasm scale, VAS: pain, stiffness, spasm, EDSS and medications. Neuropsychological tests: Sustained Attention to Response Test, Symbol Digit Modalities Test, California Verbal Learning Test-2nd Edition, WAIS-III Digit Span, VOSP Incomplete Letters and Position Discrimination subtests, Delis-Kaplan Executive Function System tests. Hospital Anxiety and Depression scale and Fatigue Severity Scale.
Paired t test for within subject change and effect sizes (Cohen's d) were calculated. Subgroup analysis of those on ≥2 or ≤ 1 spasticity medications at baseline. Re-analysis excluding 2 non-MS patients.
Results: 29 subjects completed per protocol. Mean age 46 years [30 - 56], disease duration 15 years [6 - 23], RRMS = 3, SPMS = 17 and PPMS=7. 24 were on multiple spasticity medications. Ashworth, Penn, VAS scores significantly improved with ITB. Mean ITB dose at 3 months was 144.5 mcg/day, 19 discontinued all other treatments. There was no deterioration on any cognitive or mood measure. An improvement of moderate effect size was found in Backwards Digit Span (d=0.45, p=0.038) and HADS - anxiety (d=0.47, p=0.018). FSS score decreased (d=0.52, p=0.014). This effect increased excluding 2 non-MS subjects, effect size d=0.59, p=0.008. Small improvement in SDMT score (d=0.26) and SART response time (d=0.25) were nonsignificant. Performance on other measures did not change.
A trend for improvement in depression scores was noted, (d=0.36, p=0.067).
Effect sizes were larger in subgroup on ≥2 oral spasticity medications at baseline, compared to the group on ≤1 medication (SDMT, d=0.46 vs d=0.02; Backwards digit span 0.47 vs 0.37; HADS-anxiety 0.50 vs 0.39; HADS-depression d=0.45 vs 0.20 and FSS, d=0.57 vs 0.42).
Conclusions: Switching to ITB resulted in improved spasticity scores and improvement on some measures of fatigue, anxiety, auditory attention/verbal working memory. Improvement of speed of processing was noted in those withdrawing higher doses of oral medication.
Disclosure: R Farrell has received honoraria and consulting fees from Biogen Idec, Merck, Teva, GW Pharma, Canbex Pharmaceuticals Ltd, Allergan PLC.
M Summers: nothing to disclose
E Keenan: nothing to disclose
K Buchanan: nothing to disclose
H Lee: nothing to disclose
V Stevenson: nothing to disclose
Research was supported by internal funding University College London Hospitals.
R Farrell research activity is supported by the NIHR Biomedical Research Centre.