CHRONIC INTRATHECAL BACLOFEN IN SEVERELY DISABLING SPASTICITY - SELECTION, CLINICAL-ASSESSMENT AND LONG-TERM BENEFIT

Flexor and extensor spasm associated with severe spasticity frequently cause pain and suffering in neurologically impaired patients, and gre atly, interfere with comfort and activities. When high doses of oral m edications are necessary to keep the symptoms under control and are po ol ly tolerated, the long-term spinal-selective intrathecal infusion o f baclofen by means of implanted drug pump and catheter is a safe, eff icient and reversible alternative to destructive surgical procedures. Between September 1991 and March 1995, intrathecal baclofen was infuse d in 18 selected patients out of a series of 42 severely disabled spas tic cases. We report here our preliminary experience with the criteria of selection, the initial intrathecal bolus test and the longterm ben efit of the selected patients. Our results confirm the dramatic immedi ate and long-term benefit reported in other series. After a period of treatment of 1 to 42 months, 13 patients had a complete disappearance of their spastic symptoms without any oral treatment, one patient kept unchanged clonus despite the use of low-dose oral treatment and anoth er one a severe, not improved dysuria although in both of them hyperto nia and spasms were abolished. Finally, 2 patients had important joint stiffness slightly impairing the benefit from the treatment. None of the 18 patients had central side-effects related to baclofen. With tim e, a slight increase in daily dose (inferior to 10%) was necessary in most patients.