Summary
Spasticity is a disorder of the sensorimotor system resulting in velocity-dependent increased muscle tone and tendon reflexes. Intrathecal baclofen is currently the most effective means of treating diffuse abnormal spasticity of both cerebral and spinal origin in the adult and pediatric patient. Careful patient assessment, selection and continued therapies are essential to a successful intrathecal baclofen management program.
Once a patient receives a baclofen pump, close monitoring is needed for dose adjustment and pump problems. Baclofen overdose and withdrawal by either system failure or human error can cause significant side effects and be life threatening. Excellent understanding of the baclofen delivery system, programming and dose effects are needed to evaluate any patient complaints.
Future uses of intrathecal pump therapy includes use of other intrathecal drugs besides baclofen (or in combination with baclofen) and the effects of placing the catheter tip at various spinal levels.
At the University of Minnesota, Sister Kenny Institute and Gillette Children’s Specialty Healthcare our experience has shown excellent results with this form of therapy over the last 12–16 years.
Keywords
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Albright AL (1996) Baclofen in the treatment of cerebral palsy. J Child Neurol 11(2): 77–83
Albright AL, Cervi A, et al (1991) Intrathecal baclofen for spasticity in cerebral palsy. J Am Med Association 265(11): 1418–1422
Albright LA, Barron WB, Fasick MP, Polinko P, Janosky J (1993) Continuous intrathecal baclofen infusion for infusion for spasticity of cerebral origin. JAMA 270: 2475–2478
Albright AL, Barry MJ, et al (1995) Effects of continuous intrathecal baclofen infusion and selective posterior rhizotomy on upper extremity spasticity. Pediatric Neurosurg 23: 82–85
Albright AL, Barry MJ, Painter MJ, Shultz B (1998) Infusion of intrathecal baclofen for generalized dystonia in cerebral palsy. J Neurosurg 88: 73–76
Albright AL, Gilmartin R, Swift D, Krach LE, Ivanhoe CB, McLaughlin JF (2003) Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin. J Neurosurg 98: 291–295
Albright L, Peacock WJ, et al (2004) Spasticity Reduction. In: Gage JR (ed) The treatment of gait problems in cerebral palsy. MacKeith, London pp 286–313
Alden TD, Lytle RA, Park TS, Noetzel MJ, Ojemann JG (2002) Intrathecal baclofen withdrawal: a case report and review of the literature. Childs Nerv Syst 18(9–10): 522–525
Al-Khodairy AT, Vuagnat H, Uebelhart D (1999) Symptoms of recurrent intrathecal baclofen withdrawal resulting from drug delivery failure: a case report. Am J Phys Med Rehabil 78(3): 272–277
Armstrong RW, Steinbok P, Cochrane DD, Kube SD, Fife SE, Farrell K (1997) Intrathecally administered baclofen for treatment of children with spasticity of cerebral origin. J Neurosurg 87: 409–414
Bardutsky J, Tronnier V, Schwab S, Meinck HM (2003) Intrathecal baclofen for stiff-person syndrome: life-threatening intermittent catheter leakage. Neurology 60(12): 1976–1978
Boviatsis EJ, Kouyialis AT, Boutsikakis I, Forfias S, Sakas DE (2004) Infected CNS infusion pumps. Is there a chance for treatment without removal? Acta Neurochir (Wien) 146(5): 463–467
Campbell WM, Ferrel A, McLaughlin JF, Grant GA, Loeser JD, Graubert C, Bjornson K (2002) Long-term safety and efficacy of continuous intrathecal baclofen. Developmental Med Child Neurol 44: 660–665
Chappuis D, Boortz-Marx R, Stuckey M, Baxter T, DesLaureis L (2000) Safety and efficacy of intrathecal bacolfen infused in the cervical and high thoracic area: a preliminary report. Am J Phys Med Rehabil 80: 314–317
Coffey RJ, et al (1993) Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study. J Neurosurg 78: 226–232
Coffey RJ, Edgar TS, Francisco GE, Graziani V, Meythaler JM, Ridgely PM, Sadiq SA, Turner MS (2002) Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome. Arch Phys Med Rehabil 83(6): 735–741
Conlalves J, Garcia-March G, Sanchez-Lidesma MJ, Onzsin J, Bronsita J (1994) Management of intractable spasticity of supraspinal origin by chronic cervical intrathecal infusion of baclofen. Stereotact Funct Neurosurg 62: 108–112
Dawes WJ, Drake JM, Fehlings D (2005) Microfracture of a baclofen pump catheter with intermittent under-and overdose. Pediatric Neurosurg 39(3): 144–148
Dykstra D, Mendez A, Chappuis D, Baxter T, DesLauries L, Stuckey M (2005) Treatment of cervical dystonia and focal hand dystonia by high cervical continuously infused intrathecal baclofen: a report of 2 cases. Arch Phys Med Rehabil 86: 830–833
Gerszten PC, Albright AL, Johnstone GF (1998) Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy. J Neurosurg 88: 1009–1013
Gilmartin R, Bruce D, et al (2000) Intrathecal baclofen for management of spastic cerebral palsy: multicenter trial. J Child Neurol 15: 71–77
Gooch JL, Oberg WA, Grams B, Ward LA, Walker ML (2003) Complications of intrathecal baclofen pumps in children. Pediatr Neurosurg 39(1): 1–6
Grabb PA, Guin-Renfroe S, Meythaler JM (1999) Midthoracic catheter tip placement for intrathecal baclofen administration in children with quadriparetic spasticity. Neurosurgery 45(4): 833–836
Gracies J-M, Nance P, et al (1997) Traditional pharmacological treatments for spasticity part II: general and regional treatments. Muscle Nerve 20Suppl 6: S92–S120
Gracies JM, Elovic E, McGuire JR, Nance P, Simpson DM (2002) Traditional pharmacologic treatments for spasticity part II: systemic treatments. In: Mayer NH, Simpson DM (eds) Spasticity: etiology, management and the role of botulinum toxin. We Move, New York, pp 65–93
Hammerstad JP (1999) Strength and reflexes. In: Goetz CG, Pappert EJ (eds) Textbook of clinical neurology. WB Saunders Company, Philadelphia, pp 225–266
Huch K, Kunz U, Kluger P, Puhl W (1999) Epidural blood patch under fluoroscopic control: non-surgical treatment of lumbar cerebrospinal fluid fistula following implantation of an intrathecal pump system. Spinal Cord 37(9): 648–652
Hugenholtz H, Nelson RF, Dehoux E (1993) Intrathecal baclofen — the importance of catheter position. Can J Neurol Sci 20(2): 165–167
Katz RT (1991) Management of spastic hypertonia after stroke. J Neurorehabil 5Suppl 1: S5–S12
Katz RT, Campagnolo DI (1994) Pharmacologic management of spasticity. Phys Med Rehabil. State of the Art Reviews 8(3): 473–480
Kawiecki J, Krach L, Quigley S, Gormley M, Petrinio J (2001) Effect of intrathecal baclofen infusion trial via an external pump system on spasticity and function observed at multiple catheter levels: a single case study. Arch Phys Med Rehabil 82: 1307 (abstract)
Kronin JS, Penn RD (1991) Cerebrospinal fluid pharmacokinetics of lumbar intrathecal baclofen. In: Lakke JPWF, Delhaas EM, Rutgers AWF (eds) Parenteral drug therapy in spasticity and Parkinson’s disease. Parthenon, New York, pp 73–83
Lazorthes Y, Sallerin-Caute B, Verdie J, Bastide R, Carillo J (1990) Chronic intrathecal baclofen administration for control of severe spasticity. J Neurosurg 72: 393–402
Le Breton F, Daviet JC, Monteil J, Vidal J, Munoz M, Dudognon P, Salle JY (2001) Radioisotopic control for baclofen pump catheter failure. Spinal Cord 39(5): 283–285
Little JW, Massagli TL (1998) Spaticity and associated abnormalities of muscle tone. In: DeLisa JA, Gans BG (eds) Rehabilitation medicine: principles and practice, 3rd edn. Lippincott-Raven Publishers, Philadelphia, pp 997–1013
Mayer NH (2002) Clinicophysiologic concepts of spasticity and motor dysfunction in adults with an upper motoneuron lesion. In: Mayer NH, Simpson DM (eds) Spasticity: etiology, management and the role of botulinum toxin. We Move, New York, pp 1–11
Meythaler JM, McCary A, Hadley M (1997) Prospective study on the use of continuously infused intrathecal baclofen for spasticity due to acquired brain injury: a preliminary report. J Neurosurg 87: 415–419
Meythaler JM (2001) Spastic hypertonia. Physical medicine and rehabilitation Clin North Am 12(4): 725–977
Meythaler JM, Roper JF, Brunner RC (2003) Cyproheptadine for intrathecal baclofen withdrawal. Arch Phys Med Rehabil 84(5): 638–642
Murphy NA, Irwin MCN, Hoff C (2002) Intrathecal baclofen therapy in children with cerebral palsy: efficacy and complications. Arch Phys Med Rehabil 83: 1721–1725
O’Connell M, Wong TZ, Forkheim KE, Jain M, Shipes SW, Fuchs HE (2004) Comparison of Tc99m-DTPA and indium-111 DPTA studies of baclofen pump function. Clin Nuclear Med 29(9): 578–580
Ordia JI, Fischer E, Adamski E, Chagnon KG, Spatz EL (2002) Continuous intrathecal baclofen infusion by a programmable pump in 131 consecutive patients with severe spasticity of cerebral origin. Neuromodulation 5(1): 16–24
Penn RD (1992) Intrathecal baclofen for spasticity of spinal origin: seven years of experience. J Neurosurg 77: 236–240
Rizzo MA, et al (2004) Prevalence and treatment of spasticity reported by multiple sclerosis patients. Multiple Sclerosis 10(5): 589–595
Robins B, Boggs DP (2001) Caudal epidural blood patch for treating intractable vomiting in a child after placement of a permanent intrathecal catheter. Anesthesia and Analgesia 92(5): 1169–1170
Steers WD, Meythaler JM, et al (1992) Effects of acute bolus and chronic continuous intrathecal baclofen on genitourinary dysfunction due to spinal cord pathology. J Urol 148: 1849–1855
Stempien L, Tsai T (2000) Intrathecal baclofen pump use for spasticity: a clinical survey. Am J Phys Med Rehabil 79(6): 536–541
Taha J, Favre J, Janszen M, Galarza M, Taha A (2004) Correlation between withdrawal symptoms and medication pump residual volume in patients with implantable Synchro Med pump. Neurosurgery 55(2): 390–394
The Medtronic ITB Therapy Clinical Reference Guide for Spasticity Management (2002) UC19961184cEN NP 2584c Medtronic, Inc
Yaksh TL, Ramana Reddy SV (1981) Studies in the primate on the analgetic effects associated with intrathecal actions of opiate, alpha-adrenergic agonists and baclofen. Anesthesiology 54: 451–467
Young RR (1994) Spasticity: a review. Neurology 44Suppl 9: S12–S20
Young RR, Emre M, et al (1997) Current issues in spasticity management. The Neurologist 3(4): 261–275
Zed PJ, Stiver HG, Devonshire V, Jewesson PJ, Marra F (2000) Continuous intrathecal pump infusion of baclofen with antibiotic drugs for treatment of pump-associated meningitis. Case report. J Neurosurg 92(2): 347–349
Zuniga RE, Perera S, Abram SE (2002) Intrathecal baclofen: a useful agent in the treatment of well-established complex regional pain syndrome. Regional Anesthesia Pain Med 27(1): 90–93
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Springer-Verlag
About this chapter
Cite this chapter
Dykstra, D., Stuckey, M., DesLauriers, L., Chappuis, D., Krach, L. (2007). Intrathecal baclofen in the treatment of spasticity. In: Sakas, D.E., Simpson, B.A., Krames, E.S. (eds) Operative Neuromodulation. Acta Neurochirurgica Supplements, vol 97/1. Springer, Vienna. https://doi.org/10.1007/978-3-211-33079-1_22
Download citation
DOI: https://doi.org/10.1007/978-3-211-33079-1_22
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-33078-4
Online ISBN: 978-3-211-33079-1
eBook Packages: MedicineMedicine (R0)