Intrathecal baclofen in multiple sclerosis: Too little, too late?

Abstract

The majority of patients with multiple sclerosis (MS) have symptoms of spasticity that increasingly impair function as the disease progresses. With appropriate treatment, however, quality of life can be improved. Oral antispasticity medications are useful in managing mild spasticity but are frequently ineffective in controlling moderate to severe spasticity, because patients often cannot tolerate the adverse effects of increasing doses. Intrathecal baclofen (ITB) therapy can be an effective alternative to oral medications in patients who have a suboptimal response to oral medications or who cannot tolerate dose escalation or multidrug oral regimens. ITB therapy may be underutilized in the MS population because clinicians (a) are more focused on disease-modifying therapies rather than symptom control, (b) underestimate the impact of spasticity on quality of life, and (c) have concerns about the cost and safety of ITB therapy. Delivery of ITB therapy requires expertly trained staff and proper facilities for pump management. This article summarizes the findings and recommendations of an expert panel on the use of ITB therapy in the MS population and the role of the physician and comprehensive care team in patient selection, screening, and management.

Patient experiences with intrathecal baclofen as a treatment for spasticity – a pilot study

“…In addition, some patients noted that health care providers need more knowledge about ITB and who could benefit from ITB. Erwin et al [31] points out that ITB is underused and that ITB should be a treatment option even in the early stages of MS.…”

Travmatik Spinal Kord Yaralanmalı Hastalarda İntratekal Baklofen Tedavisi

“…Hastanın pozisyonlanmasını, oturmasını, hemşirelik bakımını, hijyen faaliyetlerini, kontinansı ve günlük yaşam aktivitelerini bozabilir, kontraktür ve skolyoz gelişimine sebep olabilir, bası yarası oluşumuna zemin hazırlayabilir ve inkomplet hastalarda ambulasyonu olumsuz etkileyebilir. Aynı zamanda ani ve durdurulamayan spazmlar, ağrıya ve uyku düzeninin bozulmasına sebep olabilir (1)(2)(3)(4)(5).…”

Intrathecal Baclofen in Multiple Sclerosis

“…At the time of referral to specialist services, however, many patients will have suffered with severe spasticity for years, can no longer use their legs and may have developed contractures. As the focus of modern medicine shifts more towards prevention, a case is building for the use of intrathecal baclofen in ambulatory patients [2]. …”