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NEUROLOGY 1995;45:1893-1897
© 1995 American Academy of Neurology

Intrathecal baclofen therapy in stiff-man syndrome

A double-blind, placebo-controlled trial

P.L. Silbert, MBBS, FRACP, J. Y. Matsumoto, MD, P.G. McManis, MBBS, FRACP, K.A. Stolp-Smith, MD, B. A. Elliott, MD and K.M. McEvoy, MD, PhD

From the Departments of Neurology (Drs. Silbert, Matsumoto, McManis, and McEvoy), Physical Medicine and Rehabilitation (Dr. Stolp-Smith), and Anesthesiology (Dr. Elliott), Mayo Clinic and Mayo Foundation, Rochester, MN.
Presented in part at the annual meetings of the American Academy of Electrodiagnostic Medicine, San Francisco, CA, September 1994, and the American Neurological Association, San Francisco, CA, October 1994.
Received August 22, 1994. Accepted in final form March 3, 1995.
Address correspondence and reprint requests to Dr McEvoy, Department of Neurology, Mayo Clinic, Rochester, MN 55904.

We performed a double-blind, placebo-controlled trial of intrathecal baclofen (ITB) in stiff-man syndrome. Three patients, unresponsive to current therapy, received 50 mu g of ITB or placebo on sequential days. Following ITB, all patients demonstrated improvement in reflex EMG activity. The mean reduction in total EMG activity (from all muscles) following stimulation of the medial plantar nerve (cutaneous flexor reflex) was 72% following 50 mu g of ITB compared with 18% following placebo (ANOVA: significance of F, p less than 0.0001). The mean latency to onset of the response was also significantly prolonged for all muscles following ITB (ANOVA: significance of F, p less than 0.05). Although reflex EMG activity was reduced in all patients, clinical improvement was evident in only one patient, who differed from the others studied by a longer duration of disease, greater severity of stiffness, less fear of falling, and greater electrophysiologic improvement.

NEUROLOGY 1995;45: 1893-1897




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