The objectives of intrathecal baclofen are to administer the lowest dose for optimal effect on spasticity without systemic toxicity and to improve comfort, function, and ease of care of patients with spasticity. In case of spasticity of cerebral origin, intrathecal baclofen treatments should be started as soon as the condition of the patient is stabilized and prior to the development of contractures due to spasticity.
The use of botulinum toxin type A may be an important adjunctive therapy to increase the therapeutic effect of baclofen and the effectiveness of rehabilitation programs in patients after spinal cord injury (24).
Long-term continuous infusion of intrathecal baclofen delivered via an implantable pump can be effective for controlling spasticity resistant to other treatments. In patients with multiple sclerosis, spasm frequency is the single most common variable positively affected by intrathecal baclofen therapy. Continuous intrathecal baclofen can now be used in ambulatory patients with spasticity without causing weakness or interference with other aspects of ambulation. Intrathecal baclofen remains effective for the long-term treatment of spasticity of multiple sclerosis and increases the quality of life and functional independence in these patients (19).
Intrathecal baclofen therapy effectively reduces spasticity in children with cerebral palsy but complications necessitating removal of the baclofen pump can occur. Further research is needed to identify criteria describing the ideal candidate for intrathecal baclofen.
Long term administration of intrathecal baclofen by an implanted pump improves clinical efficacy in controlling spasticity but does not reduce the neurologic disability. The benefit and risk assessment, however, is favorable because the adverse effects do not exceed the benefits of oral and intrathecal baclofen for patients with spinal spasticity.
A review of records of all persons with cerebral palsy who received long-term treatment with intrathecal baclofen for spasticity showed that the treatment did not increase mortality and, rather, contributed to an increase in life expectancy as compared to matched cohorts (17).
Significant improvement in global intense pain, sharp pain, dull pain, and deep pain occurs during the first 6 months following intrathecal baclofen treatment of complex regional pain syndrome, but after this period, the scores level off despite further improvement of dystonia and continued intrathecal baclofen dose escalation (28).
A retrospective study has shown that intrathecal baclofen reduces dystonia and spasticity in dyskinetic cerebral palsy with improvement in sitting, communication, and fine motor function (Eek et al 2018).
Intrathecal baclofen therapy is effective in reducing spasticity in patients with cerebral palsy due to acquired brain injury, traumatic or hypoxic, but an intrathecal bolus injection should be performed to verify beneficial as well as adverse effects prior to implantation of the pump (30).
A single center prospective observational cohort study has concluded that intrathecal baclofen is an effective and safe long-term treatment for refractory spasticity related to multiple sclerosis, and most of patients subsequently discontinued systemic medications (23). A retrospective review of records from patients with spasticity of spinal origin showed that use of the Ashworth scale as a guide for dose adjustment of intrathecal baclofen therapy enabled effective management of patients with a relatively low dose of baclofen and a low rate of drug-related complications (Kawano et al 2018).
