Disclosures: Rachel E. Wilson, MD: Nothing to disclose

Case Description: Patient was transferred from outside institution 6 weeks after SCI for comprehensive rehabilitation program. He had no voluntary muscle activation below the level of injury. Generalized spasticity and chronic pain were severe in the context of current and previous neurologic insults, including traumatic brain injury and central cord syndrome. Despite titration of multiple oral medications to maximum dose, his progress was limited; therefore, intrathecal baclofen (ITB) test was arranged. After procedure was explained, patient consented and received a 100mcg ITB bolus.

Setting: Inpatient rehabilitation unit

Patient: 36-year-old male with acute traumatic C3 incomplete spinal cord injury (SCI).

Assessment/Results: Patient’s spasticity dramatically decreased post-trial, however, the absence of tone revealed his major motor deficits. He became dysphoric, with the perception that the ITB caused his paralysis without addressing his pain. The patient was clearly not prepared in terms of understanding the underlying injury, nor did his expectations align with the intended outcome. After multiple sessions with a rehabilitation psychologist, patient is considering ITB pump placement for the future.

Discussion: Spasticity is a common complication after SCI, affecting one-third of all patients, often diminishing function and quality of life. ITB has been successful in those with difficult to treat spasticity. Patients dissatisfied with ITB therapy typically had a lower percentage of personal goals met. This case highlights the importance of understanding patients’ goals, helping set realistic expectations, and involving rehabilitation psychology to assist in the informed process prior to such procedures.

Conclusion: ITB screening tests can have dramatic effects on both the physical and psychological well-being of patients, especially if trialed in post-acute care rehabilitation settings. Prior to ITB screening, patients’ understanding of the underlying injury and purpose of the procedure should be ensured, while also establishing appropriate goals and expectations. Early rehabilitation psychology inclusion may assist in more successful trials and prevent expectation mismatch.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/intrathecal-baclofen-caused-my-paralysis-a-case-report/