Contributions
Abstract: EP1701
Type: Poster Sessions
Abstract Category: Therapy - Symptomatic treatment
Introduction: Spasticity is a frequent and disabling symptom in people with Multiple Sclerosis. Intrathecal baclofen (ITB) is effective but rarely used in ambulant people with MS.
Objectives: To evaluate impact on ambulation of ITB in a cohort of people with MS-related spasticity.
Methods: A single centre prospective observational cohort study was performed between 2009 - 2018. Subjects were admitted for ITB trial and subsequent pump implantation. Data of ambulatory patients were collected at baseline, after intrathecal baclofen bolus via LP (4 - 8 hours monitored) and at 3 months and annually after pump implant. Data included: baseline demographics, EDSS, spasticity scores (Ashworth), spasm score (Penn), 10m timed walk (10MTW), mobility aids, other spasticity treatment, ITB dose. Data was analysed with paired t-tests, one way ANOVA and linear regression using SPSS v22.
Results: 31 people were included, 20 female, 11 male, mean age 59 years [26-69]. All EDSS 6.0 - 7.0. 19 were taking oral anti-spasticity drugs and 9 on disease modifying drugs. Improvement on Ashworth (mean pre 1.34, post 0.72, p< 0.01) and Penn (mean pre 3.14, post 1.08, p< 0.01). Baseline 10MTw mean 69.9s [20-186] and trial 67.3s [24-211] (p=0.8). 21 people (68%) proceeded with pump implantation and ten (32%) did not. Lower limb MRC power was higher in those who proceeded with pump: mean 3.16 (1.7-5.0) vs 2.54 (1.4-3.7) (p = 0.017). There was no statistically significant difference in 10mTW from baseline measurement up to 1 year as determined by one-way ANOVA (F(3,24) = 1.7, p = 0.19). At review, 17 patients (80%) were ambulatory (mean follow up 3.14 years, [range 1 - 8]). Two people have remained ambulatory with bilateral aid for 8 years (EDSS pre pump 6.5 and 7). 2 people were unable to mobilise at 1 year. 16 people (76%) discontinued all other spasticity treatments post-pump. A linear regression was performed to predict 10mTw at 3 months from baseline EDSS score. Baseline EDSS significantly predicted 10mtW following dose stabilisation at 3 months (p = 0.015).
Conclusions: In this cohort we have shown that ITB can preserve ambulation whilst effectively treating spasticity in a carefully selected cohort. Baseline EDSS is a predictor of 10mTw following dose stabilisation. A small number may experience prolonged improvement in mobility.
Disclosure: Y Sammaraiee, L Keenan, K Buchanan, V Stevenson have nothing to disclose. R. Farrell has received honoraria / consultant fees from GW Pharma, Canbex Pharmaceuticals Ltd, Biogen Idec, Merck, Allergan PLC. R Farrell is supported by the NIHR UCL Biomedical Research Centre.
Abstract: EP1701
Type: Poster Sessions
Abstract Category: Therapy - Symptomatic treatment
Introduction: Spasticity is a frequent and disabling symptom in people with Multiple Sclerosis. Intrathecal baclofen (ITB) is effective but rarely used in ambulant people with MS.
Objectives: To evaluate impact on ambulation of ITB in a cohort of people with MS-related spasticity.
Methods: A single centre prospective observational cohort study was performed between 2009 - 2018. Subjects were admitted for ITB trial and subsequent pump implantation. Data of ambulatory patients were collected at baseline, after intrathecal baclofen bolus via LP (4 - 8 hours monitored) and at 3 months and annually after pump implant. Data included: baseline demographics, EDSS, spasticity scores (Ashworth), spasm score (Penn), 10m timed walk (10MTW), mobility aids, other spasticity treatment, ITB dose. Data was analysed with paired t-tests, one way ANOVA and linear regression using SPSS v22.
Results: 31 people were included, 20 female, 11 male, mean age 59 years [26-69]. All EDSS 6.0 - 7.0. 19 were taking oral anti-spasticity drugs and 9 on disease modifying drugs. Improvement on Ashworth (mean pre 1.34, post 0.72, p< 0.01) and Penn (mean pre 3.14, post 1.08, p< 0.01). Baseline 10MTw mean 69.9s [20-186] and trial 67.3s [24-211] (p=0.8). 21 people (68%) proceeded with pump implantation and ten (32%) did not. Lower limb MRC power was higher in those who proceeded with pump: mean 3.16 (1.7-5.0) vs 2.54 (1.4-3.7) (p = 0.017). There was no statistically significant difference in 10mTW from baseline measurement up to 1 year as determined by one-way ANOVA (F(3,24) = 1.7, p = 0.19). At review, 17 patients (80%) were ambulatory (mean follow up 3.14 years, [range 1 - 8]). Two people have remained ambulatory with bilateral aid for 8 years (EDSS pre pump 6.5 and 7). 2 people were unable to mobilise at 1 year. 16 people (76%) discontinued all other spasticity treatments post-pump. A linear regression was performed to predict 10mTw at 3 months from baseline EDSS score. Baseline EDSS significantly predicted 10mtW following dose stabilisation at 3 months (p = 0.015).
Conclusions: In this cohort we have shown that ITB can preserve ambulation whilst effectively treating spasticity in a carefully selected cohort. Baseline EDSS is a predictor of 10mTw following dose stabilisation. A small number may experience prolonged improvement in mobility.
Disclosure: Y Sammaraiee, L Keenan, K Buchanan, V Stevenson have nothing to disclose. R. Farrell has received honoraria / consultant fees from GW Pharma, Canbex Pharmaceuticals Ltd, Biogen Idec, Merck, Allergan PLC. R Farrell is supported by the NIHR UCL Biomedical Research Centre.