Spasticity management, part 3: Surgery and the use of intrathecal baclofen

Abstract

Spasticity is a common symptom of neurological conditions such as cerebral palsy, multiple sclerosis, traumatic brain injury, stroke and spinal cord injury. It occurs when there is an imbalance between inhibitory and excitatory signals from the spinal cord and brain. Spasticity is complex and requires careful evaluation within a multidisciplinary team so that treatment options can be tailored uniquely to the individual's needs. Many patients with spasticity try a combination of anti-spasmodic medications over a period. Unfortunately high doses of anti-spasmodic medication can be hard to tolerate as significant side effects can impair quality of life, causing fatigue and cognitive side effects. Intrathecal baclofen is often recommended if all other management strategies are failing. Other more invasive neurosurgical and orthopaedic interventions are considered occasionally; however, these are used infrequently in the adult population and are beyond the scope of this paper.