Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion

Abstract

Study design: Pilot study. Objective: To study the effect of pulsatile bolus infusion of intrathecal baclofen (ITB) on daily ITB dose, in patients showing dose increases, probably due to tolerance. Setting: Department of neurology and neurosurgery, University Medical Center Groningen, the Netherlands. Methods: Data on dosages and clinical efficacy were gathered from four patients who were switched from continuous to pulsatile bolus infusion of ITB, because of the probable diagnosis of tolerance to ITB. Results: Switching from continuous to pulsatile bolus infusion resulted in a decrease of the daily ITB dose, while the clinical effect could be kept stable, without introducing adverse events. Conclusion: Pulsatile bolus infusion of ITB seems to be an effective and safe treatment strategy to reverse the need for increasing ITB dosages in patients with the probable diagnosis of tolerance to ITB.

Best Practices for Intrathecal Baclofen Therapy: Troubleshooting

“…). Assuming the previously described steps have been undertaken without detection of system abnormalities, interventions for tolerance include decreasing the concentration of baclofen solution with a concomitant increase in flow rate, utilization of periodic bolus/flexible dosing, serial decrements in dosing followed by a retitration, or a drug holiday .…”

Efficacy of a Targeted Drug Delivery on‐Demand Bolus Option for Chronic Pain

“…The versatility of TDD hardware and software has evolved from devices capable of simple continuous nonprogrammable flow, to TDD systems with time and daily‐programmable variable modes . Optimizing programming algorithms received attention after physicians treating spasticity demonstrated that baclofen tolerance can be reversed when the agent is administered by daily timed bolus rather than continuous infusion . TDD patients may now use a wireless device to administer physician‐prescribed boluses of intrathecal analgesics to treat incident pain or unpredictable fluctuations in daily pain .…”

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

“…Different treatment options can be considered such as a drug holiday (i.e. a period without intrathecal baclofen) or a change in the drug administration to complex continuous or to pulsative administration instead of simple continuous [27,30]. Draulans [7], on the other hand, believes that long-term dosage stabilization of ITB may indicate that tolerance does not exist and that the need for dose increase may instead represent an unrecognized catheter malfunction.…”