Article

Intrathecal baclofen infusion is an established method for the
treatment of generalized and disabling spasticity.
The most frequent technical
problems are due to catheter /pump disconnections, but diagnosis of dysfunction
may be difficult. Case report:
We report here the case of a 53-year-old woman
with spastic paraplegia treated with intrathecal baclofen. Spasticity remained
uncontrolled despite a gradual increase in baclofen dosage. On plain radiographs
the distal end of the catheter was found to be pointing downwards with the
catheter tip at level L5 and no apparent disconnection or failure. Indium111
diethylenetriamine penta-acetic acid (DTPA) scintigraphy combined with computed
tomography revealed that the activity of the radioisotope was highest next to the
first sacral vertebra and that there was no leakage. Radioisotope activity above
the lumbar level was very low. The catheter tip was therefore repositioned to
level T7. One month later, spasticity was well controlled and a second
scintigraphy confirmed high activity of intrathecal radioisotope up to the basal
cisterns. Discussion: The combination of Indium111 DTPA scinti-graphy with
computed tomography allows anatomical and functional investigation of intrathecal
drug administration. In this case report this approach showed that the inefficiency of intrathecal baclofen was due to the caudal orientation of the
catheter.

Langue : ANGLAIS