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 fol lowed for up to five years and the effects that reduction of spasticity has had on mobil ity status, daily living activities, and satisfaction with treatment. Practical considera tions 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 pro cedure 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. Key Words: Intrathecal baclofen—Spasticity—Functional changes— Drug delivery systems.