Functional Outcome and Clinical Significance of Long-term Intrathecal Baclofen Therapy for Severe Spasticity

Abstract

Continuous delivery of intrathecal baclofen via an implantable pump was first used to treat severe intractable spasticity in 1985. We report the results of 70 patients followed for up to five years and the effects that reduction of spasticity has had on mobility status, daily living activities, and satisfaction with treatment. Practical considerations resulting from this experience and implications for patient selection and management are reported.Over the time span studied, muscle tone and spontaneous painful muscle spasms were markedly reduced and remained stable at two steps lower than prior to treatment when assessed by the Ashworth spasticity and clinical spasms scale. After six months, more than 90% of both the physicians and the patients assessed the benefit of the procedure as excellent or good. Patients with spasticity in lower limbs caused by spinal lesions had the best long-term success with regard to their mobility status and their daily living activities, e.g., dressing. Increased dose requirements were observed in about 5% of patients during several months of continuous treatment. The spinal catheter was the most vulnerable part of the implanted system. Malfunction of the catheter was the reason for operative revision in more than one third of our patients over several years of treatment.

Intrathecal Baclofen Therapy in Adults and Guideline for Clinical Nursing Care

“…A retrospective analysis of ADLs and mobility outcome variables in patients receiving ITB therapy was reported by Ochs and Tonn (1996). Mobility was improved: 58% of bedridden patients were able to use wheelchairs, 14% of patients using wheelchairs were able to stand, and 10% of these patients were able to ambulate with crutches.…”

A History of Intraspinal Analgesia, a Small and Personal Journey

“…Since this initial report, there have been many reports on both the clinical efficacy and side-effects of the therapy (91)(92)(93)(94)(95)(96)(97)(98)(99)(100)(101)(102)(103).…”