Spasticity management via intrathecal baclofen pump

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Article reports on the use and effectiveness of intrathecal baclofen (Lioresal --registered trademark) for the treatment of spinal spasticity. First-line treatment for spasticity usually includes therapeutic stretching, positioning, and physical modalities (heat,cold). Oral spasticity medications represent the next line of treatment and include baclofen, diazepam, dantrolene sodium, and clonidine. For individuals in whom these treatments are ineffective, intrathecal delivery of baclofen via a subcutaneous pump and catheter system is an option approved by the FDA in 1992. Potential candidates are first assessed in the office setting and later scheduled for a "test dose" of intrathecal baclofen (50-100 micrograms) via lumbar puncture. Clinical response can be seen in hours and "responders" can receive the surgical implant as early as the next day. Bypassing the blood-brain barrier by the implantation allows low overall daily doses which are well tolerated with little or no side effects. Regulation and dosage adjustment can be managed by the physician with a laptop computer and a radiotelemetry wand. Pumps need refilling every 1-3 months, may need to be replaced every 4-5 years, and intermittent follow-up with patients should be maintained.

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