Intrathecal Drugs for Spasticity

Abstract

Intrathecal Baclofen has proved to be extremely effective in the treatment of severe spasticity. The idea of using medication intrathecally came from the observation that patients who had significant side effects from oral morphine could be treated effectively via the spinal route. The high cerebral spinal fluid (CSF) concentration at the cord level produces excellent analgesia and avoids drowsiness and nausea because little morphine gets to the supraspinal levels. In an analogous way, oral baclofen therapy often is limited by central side effects before a significant reduction in spasticity occurs. However, if the drug is introduced into the lumbar space, a complete reversal of spasticity is achieved without central side effects [1]. If one uses an implantable drug pump and catheter system to deliver baclofen continuously, the therapeutic effect can then be maintained [2]. This technique has been used for over 25 years and has proved to be successful in treating many type of spasticity.