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Late recovery of responsiveness after intra-thecal baclofen pump implantation and the role of diffuse pain and severe spasticity: a case report

  • Case Report - Brain trauma
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Abstract

Patients with a prolonged disorder of consciousness (DoC) may present with severe spasticity and diffuse pain, which might impair motor output, thus preventing any possible behavioral responsiveness. A 26-year-old man affected by frontoparietal hemorrhage was operated by hematoma evacuation and decompressive craniectomy; coma persisted for 1 month; cranioplasty and ventriculo-peritoneal shunting was performed after 4 months. At admission in rehabilitation, he was diagnosed as vegetative state/unresponsive wakefulness syndrome (VS/UWS). The implantation of intrathecal baclofen (ITB) pump (Medtronic SynchroMed™ II), 14 months after, (60 μg/daily), dramatically improved behavioral responsiveness according to Coma Recovery Scale-Revised (CRS-R) from 6 to 12 (1 month after ITB). Nociception Coma Scale-Revised (NCS-R) also changed from 4 to 8 at the same time points. This case report may be an example of covert cognition that should have been diagnosed as a functional locked-in syndrome or motor-cognitive dissociation, rather than as VS/UWS.

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Funding

This work has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement no. 778234.

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Authors and Affiliations

  1. IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179, Rome, Italy

    Rita Formisano, Marta Aloisi, Marianna Contrada, Francesca Spanedda, Sara Schiattone, Sylwia Niedbala & Maria Gabriella Buzzi

  2. Pain Therapy Unit S, Giovanni-Addolorata Hospital, Rome, Italy

    Maria Rosaria Cobianchi

  3. Pain Therapy Unit, Salvator Mundi International Hospital, Rome, Italy

    Gianni Colini Baldeschi

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  1. Rita Formisano
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  2. Marta Aloisi
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  3. Marianna Contrada
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  4. Francesca Spanedda
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  5. Sara Schiattone
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  6. Sylwia Niedbala
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  7. Maria Rosaria Cobianchi
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  8. Gianni Colini Baldeschi
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  9. Maria Gabriella Buzzi
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Correspondence to Rita Formisano.

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This article is part of the Topical Collection on Brain trauma

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Video Legend: cognitive motor dissociation between the extreme motor disability and a covert residual cognitive functioning, which was imprisoned before ITB pump implantation. (MP4 35,274 kb)

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Formisano, R., Aloisi, M., Contrada, M. et al. Late recovery of responsiveness after intra-thecal baclofen pump implantation and the role of diffuse pain and severe spasticity: a case report. Acta Neurochir 161, 1965–1967 (2019). https://doi.org/10.1007/s00701-019-03994-2

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  • DOI: https://doi.org/10.1007/s00701-019-03994-2

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