Intrathecal Baclofen Therapy for Spasticity in Post-stroke Patients

Abstract

Stroke is a cause of disability, which results from tetraparesis or hemiparesis in the extremities. Spastic hypertonia can have a profound effect on stroke recovery. In addition to its negative effects on gait, spastic hypertonia is often accompanied by other troubling upper motor neuron signs, such as painful spasm, weakness, and incoordination.Intrathecal baclofen therapy (ITB) is effective and safe for treating spastic hypertonia resulting from cerebral palsy, spinal cord injury, brain injury, and multiple sclerosis. By circumventing the bloodbrain barrier, only a small dose of baclofen is required via the intrathecal route of administration to exert its effects on spinal neurons. Baclofen, 4-amino-3 (p-chlorophenyl) butyric acid, is structurally similar to gamma aminobutyric acid (GABA) and binds to presynaptic GABA-B receptors within the brain stem, dorsal horn of the spinal cord, and other central nervous system (CNS) regions. The delivery system consists of a subcutaneously placed pump with a reservoir attached to an intraspinal catheter. The pump can be programmed to deliver medication at various flow rates through a catheter that enters at the lumbar spinal level into the subarachnoid space of the spinal canal. The central side effects of oral baclofen, such as drowsiness or confusion appear to be minimized with intrathecal administration.Recently, ITB therapy is also being used for poststroke spastic hypertonia. We evaluated the usefulness of ITB therapy for spasticity in post-stroke patients.

Corticospinal tract: a new hope for the treatment of post-stroke spasticity

“…Many surgical, pharmacological, and therapeutic interventions are used to manage spasticity in clinical settings, individually or in combination [ 151 – 154 ]. Pharmacological interventions [ 154 ], such as muscle relaxants (e.g., baclofen [ 155 ]) or anti-spasmodic drugs (e.g., botulinum toxin injections [ 156 – 158 ]), may be used to relieve muscle spasms. These drugs act directly on the spinal cord or muscle fibers to reduce muscle hyperexcitability and promote relaxation.…”