Intrathecal baclofen pump use for spasticity - A clinical survey

Objective: To obtain information from continuous intrathecal baclofen infus ion (CIBI) pump centers regarding specific clinical practices and experienc es. Methods: A total of 115 centers were surveyed by mail. Results: Forty centers (35%) responded with information about 1002 test dos es and 936 pump placements. Patient diagnoses included cerebral palsy, spin al cord injury, traumatic brain injury, and others. The average test dose w as 50 mug. A total of 87% of trials were successful. The most common test d ose complications were nausea/vomiting (2.6%) and sedation (2.2%). Pump pla cement complications included cerebrospinal fluid (CSF) collection (3.3%), constipation (2.9%), headache (2.4%), and CSF leak (2.2%). The most common long-term complications were catheter kink or migration (4%) and infection (1.2%). Improved daily activities including easier diapering, dressing, tra nsfers, orthotic wear and comfort, and sitting tolerance were reported in t he majority (>90%) of patients. Mixed results were reported for oral motor function and head, bladder, and bowel control. Conclusions: CIBI is an effective treatment for severe spasticity, with dra matic quality-of-life improvements and a small number of significant compli cations. Long-term benefits and complications need to be monitored in this complex population.