Intraventricular vs Intrathecal Baclofen for Secondary Dystonia: A Comparison of Complications

BACKGROUND: Intrathecal baclofen (ITB) is an effective treatment for secondary dystonia. However, in many patients with dystonia, placement of an intrathecal catheter is difficult because of anatomic anomalies or spinal fusion. Intraventricular baclofen (IVB) has been shown to be an effective alternate route for drug delivery in a small series of patients. OBJECTIVE: To present the largest series of IVB cases to date and to compare the complication rate with that of a concurrent cohort of ITB cases. METHODS: The senior author's series of IVB cases were reviewed. All contemporaneous cases of ITB for dystonia were reviewed as a control group. Data were collected by retrospective medical records review. RESULTS: Thirty IVB patients and 33 ITB patients were identified. Mean follow-up was 15 and 16 months, respectively. IVB patients were younger, were more commonly underweight, and had more severe dystonia, although no difference between groups was significant. Eleven patients (37%) in the IVB group and 16 patients (48%) in the ITB group experienced complications. Kaplan-Meier survival analysis showed an odds ratio of 0.67 (95% confidence interval, 0.30-1.48; P = .31) in favor of IVB. Adjusting for age and underweight status yielded an odds ratio of 0.64 (95% confidence interval, 0.29-1.42; P = .27) in favor of IVB. There were 7 catheter or leak-related complications in the ITB group and 2 in the IVB group (P = .15). CONCLUSION: This study shows that IVB is as safe as ITB. There may be a lower risk of catheter or leak-related complications with IVB, although this study was too small to show significance. ABBREVIATIONS: BAD, Barry-Albright dystonia ITB, intrathecal baclofen IVB, intraventricular baclofen