Intrathecal Baclofen Therapy for Spasticity Management
Summary
Intrathecal baclofen therapy employs a surgically implanted pump and catheter system to deliver baclofen directly into the cerebrospinal fluid, achieving high local drug concentrations with reduced systemic side effects. Originally developed for severe spasticity in cerebral palsy and spinal cord injury, its indications have expanded to include hereditary spastic paraparesis, post-stroke spastic dystonia and other refractory hypertonic disorders. The programmable pump allows precise dose titration and bolus trials to predict individual response, while recent improvements in catheter materials and anchoring techniques have lowered mechanical failure rates. Clinical benefits include marked reduction in muscle tone, improved mobility and enhanced quality of life, although care must be taken to monitor for complications such as infection, cerebrospinal fluid leak and life-threatening withdrawal. Multidisciplinary protocols for patient selection, imaging surveillance and long-term maintenance have been established, and evolving models of community-based delivery are broadening access worldwide.
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Intrathecal Baclofen Therapy for Spasticity Management publication trend
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Technical terms
Intrathecal administration: Direct delivery of medication into the cerebrospinal fluid within the spinal canal.
Baclofen: A gamma-aminobutyric acid (GABA) B-receptor agonist used to inhibit spinal reflexes.
Spasticity: Velocity-dependent increase in muscle tone resulting from upper motor neuron lesions.
Modified Ashworth Scale: A clinical tool for grading the resistance encountered during passive muscle stretch.
Gross Motor Function Measure: A standardised instrument for assessing changes in motor function in individuals with cerebral palsy.
Catheter: A flexible tube that conveys baclofen from the pump into the intrathecal space.
Pump: An implantable, programmable device that stores and delivers precise doses of baclofen.
References
- Eleven years’ experience with Intrathecal Baclofen – Complications, risk factors. Brain and Behavior (2018).
- Imaging Evaluation of Intrathecal Baclofen Pump-Catheter Systems. American Journal of Neuroradiology (2010).
- Intrathecal Baclofen in Hereditary Spastic Paraparesis. Frontiers in Neurology (2019).
- Blessing or burden? Long‐term maintenance, complications and clinical outcome of intrathecal baclofen pumps. Surgical Practice (2018).
- Intrathecal baclofen efficacy for managing motor function and spasticity severity in patients with cerebral palsy: a systematic review and meta-analysis. BMC Neurology (2024).
- Case report: Intrathecal baclofen therapy improved gait pattern in a stroke patient with spastic dystonia. Frontiers in Neurology (2024).
- Evaluating Community-Based Intrathecal Baclofen Therapy: Effectiveness, Safety, and Feasibility. Journal of Clinical Medicine (2024).
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