The Cerebrovascular Disease research paper evaluates the use of intrathecal baclofen therapy versus conventional medical management for severe poststroke spasticity: results from a multicentre, randomised, controlled, open-label trial (SISTERS).
Poststroke spasticity (PSS) is a common cause of disability in stroke survivors, reportedly occurring in 17%–43% of patients during the first year. Without effective treatment, the excessive muscle tone can cause pain and stiffness, deformity and reduced range of movement, significantly impairing the patient’s quality of life.
Management of severe PSS typically requires a multifaceted approach involving physical therapy and rehabilitation techniques and/or pharmacological treatments. Oral antispastics, particularly baclofen, have long been the cornerstone of treatment, although they often lead to sub-optimal results or cause adverse effects at therapeutic doses.
Intrathecal baclofen (ITB) therapy is indicated for use in severe, chronic spasticity of cerebral or spinal origin, including generalised spastic hypertonia following stroke. Evidence for its effectiveness in treatment of spasticity mainly comes from controlled studies in cerebral palsy and multiple sclerosis, and no randomised trial to date has evaluated ITB therapy for PSS.
In previous non-randomised studies in patients with stroke, ITB therapy was effective in:
- reducing spastic tone in the extremities
- increasing motor strength
- reducing pain
- improving gait and walking speed in ambulatory patients
- increasing functional independence
- improving the patient’s quality of life
Despite this potential therapeutic value, less then 1% of patients with stroke with severe spasticity are currently treated with ITB therapy.
The ‘Spasticity In Stroke–Randomised Study’ (SISTERS) aimed to demonstrate the superior effect of ITB therapy over oral medication (conventional medical management (CMM)) on severe spasticity in patients with stroke after 6-month active treatment and to generate safety data for ITB therapy and CMM.
About Dr. Creamer
Michael Creamer, D.O. is board certified by the American Board of Physical Medicine and Rehabilitation with a subspecialty certification in spinal cord injury medicine and pain medicine. In 1983, he earned his Doctor of Osteopathy from the Chicago College of Osteopathic Medicine and completed his residency in physical medicine and rehabilitation at Northwestern University.
Dr. Creamer has received “Top Doctor” recognition in the December editions of Orlando Magazine 2002-2016.
Skilled in a multidisciplinary approach to the treatment of pain, Dr. Creamer takes pride in providing his patients with the highest quality of care at our Pain Relief Centers Central Florida location in downtown Orlando.
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