Intrathecal baclofen for the treatment of spasticity

Abstract

Spasticity is a clinical condition characterized by a velocity-dependent increase of muscle tone due to "parapyramidal" disturbance of the inhibitory afferents to the second motor neuron. Intrathecal baclofen (ITB) is at present the most effective treatment for generalized spasticity provided that an accurate assessment of patients to be candidates for ITB is made. The most important patient selection criterion is lack of positive response to any oral antispastic drug or appearance of undesired side effects of such oral treatment. Spasticity should not be treated in patients in whom it may be helpful to maintain posture due to their very poor muscle strength. When assessing a spastic patient alternative treatments such as Botox and peripheral neurotomies must also be considered, particularly in cases of predominantly focal spasticity. According to our experience, it is advisable to divide spastic patients into two different groups: the first group including wheel-chaired and bed-ridden patients, the second group comprising spastic patients who are still able to move. In each of these two groups treatment goals vary and require different protocols for the patients' evaluation. Assessment of patients is completed with the functional index measurement (FIM) scale in order evaluate changes in patients' quality of life caused by variations in the motor performance. Currently, treatment of spasticity with ITB is the most effective way of reducing spasticity regardless of its cause. © 2007 Springer-Verlag.