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10 - Intrathecal baclofen for the control of spinal and supraspinal spasticity

Published online by Cambridge University Press:  22 August 2009

By
David N. Rushton
Edited by
Michael P. Barnes  and
Garth R. Johnson
David N. Rushton
Affiliation:
Consultant in Neurological Rehabilitation Frank Cooksey Rehabilitation Unit, Kings College Hospital, London, UK
Michael P. Barnes
Affiliation:
University of Newcastle upon Tyne
Garth R. Johnson
Affiliation:
University of Newcastle upon Tyne
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Summary

Introduction

Intrathecal baclofen (ITB)

Penn and Kroin (1985) first described the benefits that could be obtained by long-term infusion of baclofen into the spinal subarachnoid space, reporting the treatment of six patients with severe continuing spasticity and spasms resulting from spinal injury or multiple sclerosis. They found a dramatic dose-related benefit which was highly valued by patients. Patients reported functional improvements in their activities of daily living (ADLs), reduced discomfort, improvement in sleep patterns, continence and nocturia. Voluntary power did not necessarily improve, but one patient in the initial series was enabled to walk provided that the dose was carefully titrated. Control of her spasticity and spasms was needed, but some lower limb tone had to be retained.

Penn and Kroin found that the optimum dose varied widely and that the effects were strongly dose-related. There was some evidence of drug tolerance: during the first few months, the average daily dose rose from 100 to 150 μg to something approaching 500 μg. Because they were so much improved, patients were unwilling to take part in controlled trials involving placebo infusions.

All of the significant findings put forward in this initial report have been amply confirmed during the following years, in subsequent larger and longer trials undertaken by the same authors and in many other centres. The initial and many subsequent trials were open; but double-blind, randomized, placebo-controlled trials of ITB have more recently been conducted in spinal spasticity and have reported a similar magnitude of benefit (Ordia et al., 1996).

Keywords

Ashworth scaleintrathecal baclofensclerosisspasmsspinal intrathecal administrationspasticity
Type
Chapter
Information
Upper Motor Neurone Syndrome and Spasticity
Clinical Management and Neurophysiology
 , pp. 181 - 192
Publisher: Cambridge University Press
Print publication year: 2008

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