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Objectives: Intrathecal baclofen (ITB) pumps are an effective treatment for spasticity; however infection rates have been reported in 3-26% of patients in the literature. The multidisciplinary ITB service has been established at The National Hospital for Neurology and Neurosurgery, UCLH, Queen Square, London for over 20 years. Our study was designed to clarify the rate of infection in our ITB patient cohort and secondly, to formulate and implement best practice guidelines and to determine prospectively, whether they effectively reduced infection rates.

There are many roles within the nursing workforce that extend beyond caring for patients. Liz Keenan, a previously published author with this journal, discuss her new position as staff governor.

ObjectiveEvaluate the efficacy of THC:CBD (Nabiximols) for resistant MS-related spasticity (MS-rs).BackgroundSpasticity is a problematic symptom in MS. THC:CBD is a second line agent for MS-rs in people presenting side effects (SEs) or inadequate response to other treatments.Design/MethodsPatients failing ≥2 treatments for spasticity were offered THC:CBD. Outcomes were measured at baseline. At 2 weeks telephone review was conducted and at 4 weeks face to face review.Responders continued medication for 3 months and were reviewed at 6 monthly intervals therafter. Spasticity Numerical Rating-Scale (NRS), Multiple Sclerosis Spasticity Scale-88 (MSSS-88), walking ability, concomitant medications and side effects (SE) were recorded. Clinical Responders (CR) were defined as having a≥20% reduction in NRS score, Non Responders (NR) were offered alternative options including Intrathecal Baclofen (ITB).Results102 subjects were treated, 24 discontinued THC:CBD within 2 weeks, 78 attended 4 week review. 32%were CRs with improvement in NRS (p<0.001) and MSSS-88 score (p<0.001). Mean time to discontinuation was 3.8 months. Other benefits included improvement in spasms, pain, bladder control and sleep. SEs were reported and mild in 48% and serious in 7%. ITB was pursued in 24 patients.ConclusionsTHC:CBD provided symptomatic relief in a significant number of patients and can serve as alternative to ITB.