Optimising therapy for spastic syndrome by combining baclofen with botulinumtoxin

Intrathecal administration of baclofen has proved to be an effective treatm ent of spasticity related to CNS damage. Especially patients with spinal sp asticity due to traumatic spinal cord injury or transverse myelitis showed a dramatic reduction of spasticity and improvement of their Ashworth scores . The results are, however, often disappointing in patients with muscular h ypertension of the extensor muscles, which is frequently found in patients with multiple sclerosis or cerebral hypoxia. In the latter, using intrathec al baclofen may be restricted by serious side effects. Batulinumtoxin A is widely used in patients with various forms of dystonia. It has also been studied in spastic disorders, where local injections were valuable in relieving focal spasticity in hemiparetic patients and in infa ntile cerebral palsy. It is used only cautiously in severe paraspasticity. The case reports of 4 patients with incomplete and complete paraparesis due to spinal cord injury, neuradegenerative pyramidal disorder, a nd cerebral hypoxia demonstrate that a combination of intrathecal baclofen and botulin umtoxin A can improve clinical benefits and reduce side effects.