BACKGROUND Intrathecal baclofen (ITB) is traditionally reserved for non-ambulatory patients. OBJECTIVE To investigate outcomes of ITB in ambulatory multiple sclerosis (MS) patients. METHODS Changes in outcome measures were estimated by a mixed effect model, while the complication rate was calculated using a logistic regression. Predictors of non-ambulatory status were identified by Cox model. RESULTS In all, 256 patients received an ITB test injection and 170 underwent ITB surgery. Aggregate Modified Ashworth Scale (MAS) scores for the ambulatory ITB cohort decreased from 13.5 ± 6.96 to 4.54 ± 4.18 at 5 years (p < 0.001). There was no significant change in walking speed 1 year post ITB surgery (0.45 m/second ± 0.30 vs 0.38 m/second ± 0.39, p = 0.80) with 77.8% of patients remaining ambulatory which decreased to 41.7% at year 5. Longer MS disease duration (hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.01-1.07; p = 0.018) and lower hip flexor strength (HR: 0.40; 95% CI: 0.27-0.57; p < 0.001) predicted non-ambulatory status after surgery. Complications were more likely in the ambulatory cohort (odds ratio (OR): 3.30, 95% CI: 2.17-5.02; p = 0.017). CONCLUSION ITB is effective for ambulatory MS patients without compromising short-term walking speed, although a higher complication rate was observed in this cohort.

中文翻译：

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非卧床多发性硬化症患者鞘内注射巴氯芬的长期结果：单中心经验

背景鞘内注射巴氯芬(ITB)传统上保留用于非走动患者。目的 调查 ITB 在非卧床多发性硬化 (MS) 患者中的结果。方法 通过混合效应模型估计结果指标的变化，而使用逻辑回归计算并发症发生率。非走动状态的预测因子由 Cox 模型确定。结果 总共有 256 名患者接受了 ITB 测试注射，170 名患者接受了 ITB 手术。5 年时，门诊 ITB 队列的综合改良 Ashworth 量表 (MAS) 评分从 13.5 ± 6.96 降至 4.54 ± 4.18 (p < 0.001)。ITB 手术后 1 年步行速度没有显着变化（0.45 m/s ± 0.30 vs 0.38 m/s ± 0.39，p = 0.80），77.8% 的患者保持行走，在第 5 年下降到 41.7%。MS 病程较长（风险比 (HR)：1.04；95% 置信区间 (CI)：1.01-1.07；p = 0.018）和较低的髋屈肌力量（HR：0.40；95% CI：0.27-0.57；p < 0.001 ) 预测手术后的非走动状态。门诊队列中更可能出现并发症（比值比 (OR)：3.30，95% CI：2.17-5.02；p = 0.017）。结论 ITB 对非卧床 MS 患者有效，且不会影响短期步行速度，尽管在该队列中观察到更高的并发症发生率。