Intrathecal Baclofen Effective in Treating Spasticity

Abstract

Objective To provide an overview of the chemistry, adverse-effect profile, and risk-benefit issues of intrathecal administration of baclofen in treating spasticity. Data Sources Information was collected by conducting a MEDLINE search for clinical trials, reviews, and other articles pertaining to the use of intrathecal baclofen. Study Selection Studies, review articles, and editorials that addressed the chemistry, clinical use, and risk-benefit issues of intrathecal baclofen were reviewed. Data Extraction Data were extracted from clinical trials, reviews, and editorials when the information pertained to the purpose of the objective. Data Synthesis Baclofen is a GABAB-receptor agonist that has presynaptic and postsynaptic inhibitory action. Intrathecal administration of baclofen is a rational approach to delivering the drug directly to the GABAB receptors in the spinal cord. The literature demonstrates that long-term intrathecal baclofen administration via a programmable infusion pump is effective in the management of spasticity. Complications of delivering baclofen intrathecally via an infusion pump include pump failure, catheter dislocation, and infection related to the initial procedure or to pump refills. Dosage requirements increase over time as tolerance to baclofen develops. Tolerance is not a serious concern because the dosage requirement is maximized in about one year. Conclusions In treating intractable spasticity, intrathecal baclofen is a viable, safe alternative to destructive surgical neurectomy, which carries risks of serious neurologic complications. Long-term intrathecal baclofen treatment via an implanted programmable infusion pump not only is effective in treating spasticity, but also improves functional capacities in patients who are unresponsive to high-dose oral antispastic agents.