LONG-TERM INTRATHECAL BACLOFEN THERAPY IN PATIENTS WITH INTRACTABLE SPASTICITY

Background: Severe spasticity unresponsive to oral drugs may respond s atisfactorily to baclofen delivered intrathecally. Methods: Intratheca l baclofen (IB) therapy delivered by means of implanted infusion pumps was used for nine patients with severe spasticity. Six patients had m ultiple sclerosis, two cervical spinal cord injury, and one head injur y. All were non-ambulatory. Results: Patients showed improvement in ma ny areas, including ability to transfer, seating, pain control, person al care, and liability to skin breakdown. Before IB therapy, only thre e of the nine patients were able to live at home in the community and six were institutionalized. At the end of our follow-up period, only o ne patient remained institutionalized, three lived in group homes and five lived at home in the community. In the year preceding pump implan tation, the nine patients spent a total of 755 days in acute care hosp itals. In the year following onset of IB therapy, they spent only 259 days in hospital. Conclusions: IB therapy can improve patient quality of life and can be cost-effective in carefully selected patients with severe spasticity and disability. The drug delivery catheter is that p art of the therapeutic system most vulnerable to failure. Because of t he varied expertise required to manage these patients effective ly, an d the potential for a variety of complications, it is essential that a n IB program is supported by a well-organized multi-disciplinary medic al team.