Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-25T01:14:57.428Z Has data issue: false hasContentIssue false

10 - Intrathecal baclofen for the control of spinal and supraspinal spasticity

Published online by Cambridge University Press:  22 August 2009

By
David N. Rushton
Edited by
Michael P. Barnes  and
Garth R. Johnson
David N. Rushton
Affiliation:
Consultant in Neurological Rehabilitation Frank Cooksey Rehabilitation Unit, Kings College Hospital, London, UK
Michael P. Barnes
Affiliation:
University of Newcastle upon Tyne
Garth R. Johnson
Affiliation:
University of Newcastle upon Tyne
Get access

Summary

Introduction

Intrathecal baclofen (ITB)

Penn and Kroin (1985) first described the benefits that could be obtained by long-term infusion of baclofen into the spinal subarachnoid space, reporting the treatment of six patients with severe continuing spasticity and spasms resulting from spinal injury or multiple sclerosis. They found a dramatic dose-related benefit which was highly valued by patients. Patients reported functional improvements in their activities of daily living (ADLs), reduced discomfort, improvement in sleep patterns, continence and nocturia. Voluntary power did not necessarily improve, but one patient in the initial series was enabled to walk provided that the dose was carefully titrated. Control of her spasticity and spasms was needed, but some lower limb tone had to be retained.

Penn and Kroin found that the optimum dose varied widely and that the effects were strongly dose-related. There was some evidence of drug tolerance: during the first few months, the average daily dose rose from 100 to 150 μg to something approaching 500 μg. Because they were so much improved, patients were unwilling to take part in controlled trials involving placebo infusions.

All of the significant findings put forward in this initial report have been amply confirmed during the following years, in subsequent larger and longer trials undertaken by the same authors and in many other centres. The initial and many subsequent trials were open; but double-blind, randomized, placebo-controlled trials of ITB have more recently been conducted in spinal spasticity and have reported a similar magnitude of benefit (Ordia et al., 1996).

Keywords

Ashworth scaleintrathecal baclofensclerosisspasmsspinal intrathecal administrationspasticity
Type
Chapter
Information
Upper Motor Neurone Syndrome and Spasticity
Clinical Management and Neurophysiology
 , pp. 181 - 192
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albright, A. L. (1996). Baclofen in the treatment of cerebral palsy. J Child Neurol, 11: 77–83.Google Scholar
Albright, A. L., Barron, W. B., Fasick, M. P., Polinko, P. & Janosky, J. (1993). Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA 270: 2475–7.Google Scholar
Albright, A. L., Barry, M. J., Fasick, M. P. & Janosky, J. (1995). Effects of continuous intrathecal baclofen infusion and selective posterior rhizotomy on upper extremity spasticity. Pediatr Neurosurg, 23: 82–5.Google Scholar
Armstrong, R. W., Steinbok, P., Cochrane, D. D.et al. (1997). Intrathecally administered baclofen for treatment of children with spasticity of cerebral origin. J Neurosurg, 87: 409–14.Google Scholar
Azouvy, P., Mane, M., Thiebaut, J. B.et al. (1996). Intrathecal baclofen administration for control of severe spinal spasticity: functional improvement and long-term follow-up. Arch Phys Med Rehabil, 77: 35–9.Google Scholar
Azouvy, P., Brami, Roby A., Biraben, A.et al. (1993). Effect of intrathecal baclofen on the monosynaptic reflex in humans: evidence for a postsynaptic action. J Neurol Neurosurg Psychiatry, 56: 515–19.Google Scholar
Bardutzky, J., Tronnier, V., Schwab, S. & Meinch, H.-M. (2003). Intrathecal baclofen for stiff-person syndrome: life-threatening intermittent catheter leakage. Neurology, 60: 1976–8.Google Scholar
Barolat, G., Singh-Sahni, K., , Staas, W. E. Jr. et al. (1995). Epidural spinal cord stimulation in the management of spasms in spinal cord injury: a prospective study. Stereotact Func Neurosurg, 64: 153–64.Google Scholar
Becker, R., Alberti, O. & Bauer, B. L. (1997). Continuous intrathecal baclofen infusion in severe spasticity after traumatic or hypoxic brain injury. J Neurol, 244: 160–6.Google Scholar
Becker, W. J., Harris, C. J., Long, M. L.et al. (1995). Long term intrathecal baclofen therapy in patients with intractable spasticity. Can J Neurol Sci, 22: 208–17.Google Scholar
Bohannon, R. W. & Smith, M. B. (1987). Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther, 67: 206–7.Google Scholar
Brindley, G. S., Polkey, C. E., Rushton, D. N. & Cardozo, L. (1986). Sacral anterior root stimulators for bladder control in paraplegia: the first 50 cases. J Neurol Neurosurg Psychiatry, 49: 1104–14.Google Scholar
Bushman, W., Steers, W. D. & Meythaler, J. M. (1993). Voiding dysfunction in patients with spastic paraplegia: urodynamic evaluation and response to continuous intrathecal baclofen. Neurourol Urodyn, 12: 163–70.Google Scholar
Campbell, S. K., Almeida, G. L., Penn, R. D. & Corcos, D. M. (1995). The effects of intrathecally administered baclofen on function in patients with spasticity. Phys Ther, 75: 352–62.Google Scholar
Coffey, R. J., Edgar, T. S., Francisco, G. E.et al. (2002). Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome. Arch Phys Med Rehabil, 83: 735–41.Google Scholar
Davis, R. (2000). Cerebellar stimulation for cerebral palsy spasticity, function and seizures. Arch Med Res, 31: 290–9.Google Scholar
Denys, P., Mane, M., Azouvi, P.et al. (1998). Side effects of chronic intrathecal baclofen on erection and ejaculation in patients with spinal cord lesions. Arch Phys Med Rehabil, 79: 494–96.Google Scholar
Dressandt, J., Auer, C. & Conrad, B. (1995). Influence of baclofen upon the alpha-motoneuron in spasticity by means of F-wave analysis. Muscle Nerve, 18: 103–7.Google Scholar
Fromm, G. H., Terrence, C. F. & Chatta, A. S. (1992). Baclofen in the treatment of trigeminal neuralgia: double blind study and long-term follow-up. Ann Neurol, 15: 240–4.Google Scholar
Gaffen, A., Nesic, M. & Coleman, G. (2005). Intrathecal baclofen (Lioresal): suspected adverse incidents associated with implantable drug pump system. Can Adv React Newsl, 15(4): 1–2.Google Scholar
Gardner, B., Jamous, A., Teddy, P.et al. (1995). Intrathecal baclofen – a multicentre clinical comparison of the Medtronics Programmable, Cordis Secor and Constant Infusion Infusaid drug delivery systems. Paraplegia, 33: 551–4.Google Scholar
Kofler, M., Kronenberg, M. F., Rifici, C., Saltuari, L. & Bauer, G. (1994). Epileptic seizures associated with intrathecal baclofen application. Neurology, 44: 25–7.Google Scholar
Kroin, J. S. & Penn, R. D. (1992). Cerebrospinal fluid pharmacokinetics of lumbar intrathecal baclofen. In: Lakke, J. P. W. F. , J. P. W. F., Delhaas, E. M. & Rutgers, A. W. F. (eds.), Parenteral Drug Therapy in Spasticity and Parkinson's Disease. Parthenon, pp. 67–77.
Lance, J. W. (1980). Symposium synopsis. In: Feldman, R. G., Young, R. R. & Koella, W. P. (eds.), Spasticity: Disordered Motor Control. Chicago: Year Book Medical Publishers, pp. 485–94.
Loubser, P. G. & Akmann, N. M. (1996). Effects of intrathecal baclofen on chronic spinal cord injury pain. J Pain Symptom Manage, 12: 241–7.Google Scholar
Meythaler, J. M., DeVivo, M. J. & Hadley, M. (1996). Prospective study on the use of bolus intrathecal baclofen for spastic hypertonia due to acquired brain injury. Arch Phys Med Rehabil, 77: 461–6.Google Scholar
Meythaler, J. M., McCary, A. & Hadley, M. N. (1997). Prospective assessment of continuous intrathecal infusion of baclofen for spasticity caused by acquired brain injury: a preliminary report. J Neurosurg, 87: 415–9.Google Scholar
Middel, B., Kuipers-Upmeijer, H., , Bouma, L.et al. (1997). Effect of intrathecal baclofen delivered by an implanted programmable pump on health related quality of life in patients with severe spasticity. J Neurol Neurosurg Psychiatry, 63: 204–9.Google Scholar
Mohammed, I. & Hussain, A. (2004). Intrathecal baclofen withdrawal syndrome – a life-threatening complication of baclofen pump: a case report. BMC Clin Pharmacol, 4: 6.Google Scholar
Muller, H. (1992). Treatment of severe spasticity: results of a multicentre trial conducted in Germany involving the intrathecal infusion of baclofen by an implantable drug delivery system. Dev Med Child Neurol, 34: 739–45.Google Scholar
Muller, H., Zierski, J., Dralle, D., Krauss, D. & Mutschler, E. (1988). Pharmacokinetics of intrathecal baclofen. In: Muller, H., Zierski, J. & Penn, R. D. (eds.), Local Spinal Therapy of Spasticity. Berlin: Springer-Verlag, pp. 223–6.
Muller-Schwefe, G., & Penn, R. D. (1989). Physostigmine in the treatment of intrathecal baclofen overdose: report of three cases. J Neurosurg, 71: 273–5.Google Scholar
Nance, P., Schryvers, O., Schmidt, B.et al. (1995). Intrathecal baclofen therapy for adults with spinal spasticity: therapeutic efficacy and effect on hospital admissions. Can J Neurol Sci, 22: 22–9.Google Scholar
Ordia, J. I., Fischer, E., Adamski, E. & Spatz, E. L. (1996). Chronic intrathecal delivery of baclofen by a programmable pump for the treatment of severe spasticity. J Neurosurg, 85: 452–7.Google Scholar
Parise, M., Garcia-Larrea, L., , Mertens, P., Sindou, M. & Mauguiere, F. (1997). Clinical use of polysynaptic flexion reflexes in the management of spasticity with intrathecal baclofen. EEG Clin Neurophysiol, 105: 141–8.Google Scholar
Patterson, V., Watt, M., Byrnes, D., Crowe, E. & Lee, A. (1994). Management of severe spasticity with intrathecal baclofen delivered by a manually operated pump. J Neurol Neurosurg Psychiatry, 57: 582–5.Google Scholar
Penn, R. D. (1992). Intrathecal baclofen for spasticity of spinal origin: seven years of experience. J Neurosurg, 77: 236–40.Google Scholar
Penn, R. D. & Kroin, J. S. (1985). Continuous intrathecal baclofen for severe spasticity. Lancet, 2: 125–7.Google Scholar
Penn, R. D., Savoy, S. M., Corcos, D. C.et al. (1989). Intrathecal baclofen for severe spinal spasticity. N Engl J Med, 320: 1517–18.Google Scholar
Reeves, R. K., Stolp-Smith, K. A. & Christopherson, M. W. (1998). Hyperthermia, rhabdomyolysis and disseminated intravascular coagulation associated with baclofen pump catheter failure. Arch Phys Med Rehabil, 201: 353–6.Google Scholar
Rifici, C., Kofler, M., Kronenberg, M.et al. (1994). Intrathecal baclofen application in patients with supraspinal spasticity secondary to severe traumatic brain injury. Funct Neurol, 9: 29–34.Google Scholar
Rivas, D. A., Chancellor, M. B., Hill, K.et al. (1993). Neurological manifestations of baclofen withdrawal. J Urol, 150: 1903–5.Google Scholar
Rushton, D. N., Brindley, G. S., Polkey, C. E. & Browning, G. V. (1989). Implant infections and antibiotic-impregnated silicone rubber coating. J Neurol Neurosurg Psychiatry, 52: 223–9.Google Scholar
Saltuari, L., Baumgartner, H., Kefler, M.et al. (1990). Failure of physostigmine in treatment of acute severe intrathecal baclofen intoxication. N Engl J Med, 322: 1535.Google Scholar
Saltuari, L., Kronenberg, M., Marosi, M. J.et al. (1992). Long-term intrathecal baclofen treatment in supraspinal spasticity. Acta Neurol Napoli, 14: 195–207.Google Scholar
Sampson, F. C., Hayward, A., Evans, G.et al. (2002). Functional benefits and cost/benefit analysis of continuous intrathecal baclofen infusion for the management of severe spasticity. J Neurosurg, 96: 1052–7.Google Scholar
Teddy, P. (1997). Intrathecal drug delivery systems. In: Neuroprostheses, Neuromodulators and Rehabilitation. London: British Society of Rehabilitation Medicine, pp. 47–9.
Zahavi, A., Geertzen, J. H. B., Middel, B., Staal, M. & Rietman, J. S. (2004). Long term effect (more than five years) of intrathecal baclofen on impairment, disability and quality of life in patients with severe spasticity of spinal origin. J Neurol Neurosurg Psychiatry, 75: 1553–7.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×