Abstract
Spasticity can be a serious problem for victims of cerebral and spinal injury. It can interfere with programs of rehabilitation and adequate self-care. Oral antispasticity drugs can only achieve slight modulating effects and side effects are common. An alternative to dorsal rhizotomy, tenotomy, and epidural neurostimulation is long-term intrathecal delivery of baclofen with a pump. Due to the proximity of the medica tion to the site of action, a better effect on spasticity can be achieved with extremely low doses (30 μgr). Many side effects are reduced, such as the gastrointestinal dis turbances of nausea and constipation, drowsiness, fatigue, weakness, tiredness, and/or, with an oral overdose, depression of the central nervous system with coma and res piratory depression. In the Department of Neurosurgery at the University Medical Center in Gottingen, intrathecal medicine pumps have been implanted in 70 patients with spasticity resulting from spinal or cerebral lesions, with baclofen doses of between 30 and 1200 μgr/day. From our experience, long-term intrathecal treatment with baclofen for most forms of spinal and cerebral spasticity is effective and helpful. The possibility of using the treatment for patients receiving ambulatory care in neurologic centers and the possible reduction of oral antispasticity agents are additional advan tages of the method.