Effect of Intrathecal Baclofen Concentration on Spasticity Control: Case Series

Abstract

Background/Objective: Intrathecal baclofen (ITB) has been shown to be an effective treatment for severe spasticity of spinal or cerebral origin. Although most patients respond well to an ITB trial, there are often difficulties in achieving and/or maintaining such effectiveness with ITB pump treatment. There are few published guidelines for dosing efficacy and no studies looking at the effect of concentration of ITB on spasticity management. Methods: Case series of 3 adults with severe spasticity treated with ITB pump: a 44-year-old man with C7 tetraplegia using a 40-mL Medtronic SynchroMed II pump with 500-lg/mL concentration; a 35-year-old woman with traumatic brain injury with right spastic hemiplegia using a 18-mL Medtronic SynchroMed EL pump with 2,000-lg/mL concentration; and a 43-year-old woman with spastic diplegic cerebral palsy using a 40-mL Medtronic SynchroMed II pump with 2,000-lg/mL concentration. Results: After reducing ITB concentrations in the pump, either as part of a standard protocol for dye study to assess the integrity of pump and catheter system or secondary to plateau in therapeutic efficacy, patients experienced temporary, significant reduction in spasticity based on range of motion, Modified Ashworth scores, and verbal feedback. Conclusions: Decreasing the concentration of ITB seems to affect spasticity control. Further research in this area is needed for those patients with refractory spasticity to optimize efficacy of ITB therapy.

Continuous intrathecal orexin delivery inhibits cataplexy in a murine model of narcolepsy

“…In 1984, Penn and Kroin introduced intrathecal administration of baclofen in humans to alleviate spasticity in severe cases (25). Since then, intrathecal drug delivery has become an important treatment option for individuals with severe spasticity, dyskinetic cerebral palsy, stiff-man syndrome, and chronic pain (20,22,26). Because the GABA analog baclofen has relatively low BBB penetrability (27), a high dose is needed orally, imparting unwanted side effects.…”

Polyanalgesic Consensus Conference 2012: Recommendations for the Management of Pain by Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel

“…The use of IT baclofen in patients with spasticity of cerebral origin was evaluated in one study, results of which revealed no correlation between IT catheter tip position and clinical response of the patient (204). Results from a small case series of patients with spasticity of various etiologies suggest that spasticity control can be improved in some cases with the use of a decreased concentration of IT baclofen at the same dose rate (205).…”

Three-Day Continuous Oxytocin Infusion Attenuates Thermal and Mechanical Nociception by Rescuing Neuronal Chloride Homeostasis via Upregulation KCC2 Expression and Function

“…In 1984, Penn and Kroin introduced intrathecal administration of baclofen in humans to alleviate spasticity in severe cases ( Penn and Kroin, 1984 ). Since then, intrathecal drug delivery has become an important treatment option for individuals with severe spasticity, dyskinetic cerebral palsy, stiff-man syndrome, and chronic pain ( Penn and Mangieri, 1993 ; Saval and Chiodo, 2008 ; Eek et al, 2018 ). Drugs can be administered via an intrathecal route that allows for the placement of the medication in close proximity to the target receptors so that a much lower dose is needed.…”