Sleep disturbance in the patients with severe spasticity and its improvement by intrathecal baclofen therapy

<p>Purpose: Patients with severe spasticity caused by cerebral palsy suffer from sleep disturbance. Intrathecal baclofen (ITB) therapy releases spasticity; thus, may result to a deep sleep. We measured the sleep pattern of patients with severe spasticity before and after ITB therapy induction.</p><p>Methods: Four patients with cerebral palsy (boys aged 10, 13, and 18 years and a woman aged19 years) and two adults with head trauma and stroke participated in the study. All patients presented persistent consciousness disturbance and spastic tetrapalsy with level V in gross motor function classification system. ITB system was implanted in all patients and degrees of pre - and postoperative modified Ashworth scale (mAS) was scored. Total and deep sleep durations were analyzed by motion, heart rate, and heart rate variability using a sports watch mounting acceleration meter and heart rate meter. The measurements were performed overnight 1 day before and 7 days after ITB therapy induction.</p><p>Results: Doses of baclofen were adjusted at 70-200 µg/day. Spasticity scored by mAS significantly decreased from 2.85 ± 0.12 to 2.31 ± 0.36 (p ＝ 0.014). Average total and deep sleep durations preoperatively were 7 h 26 m ± 3 h 3 m and 30 m ± 34 m, which were shorter than the sleep durations of the same age group of healthy individuals. Total and deep sleep durations under the ITB therapy significantly increased to 8 h 48 m ± 2 h 17 m (p ＝ 0.04) and 1 h 8 m ± 2 h 47 m (p ＝ 0.03).</p><p>Conclusion: In patients with severe spasticity, sleep was a disturbance that may be improved by ITB therapy. Sleep duration and depth, as well as mAS, could serve as good indicators for adjusting the optimal ITB dose.</p>