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Intrathecal Baclofen Therapy

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Spasticity and Muscle Stiffness

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Abstract

Intrathecal baclofen (ITB) exerts its therapeutic effect by delivering baclofen directly into the cerebrospinal fluid with rapid distribution to GABA-B-rich neurons in lamina II of the spinal cord. It is indicated for poorly-controlled, generalized spasticity despite maximal therapy and/or limited tolerance of other treatment modalities in patients with spasticity of spinal (traumatic spinal cord injury and multiple sclerosis) and cerebral (acquired brain injury, cerebral palsy, and stroke) origin. ITB therapy is accomplished through the use of a surgically-implanted, programmable pump that delivers drug at precise flow rates via a catheter introduced into the spinal canal. This chapter reviews the components of ITB therapy, patient selection, trial dose, pump implantation and ITB therapy initiation, pump maintenance and chronic therapy, troubleshooting, management of ITB overdose and withdrawal, and pump explantation. Successful implementation of ITB therapy requires a robust team structure to manage the routine, urgent, and emergent needs of the patients receiving this treatment.

Medicine is a science of uncertainty and an art of probability.

– William Osler, The Principles and Practices of Medicine, 1892.

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Authors and Affiliations

  1. Cooper University Health Care, Camden, NJ, USA

    Michael Saulino

  2. Department of Physical Medicine and Rehabiliation, Cooper Medical School of Rowan University, Camden, NJ, USA

    Michael Saulino

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  1. Departments of Physical Medicine and Rehabilitation and Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Preeti Raghavan

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Saulino, M. (2022). Intrathecal Baclofen Therapy. In: Raghavan, P. (eds) Spasticity and Muscle Stiffness. Springer, Cham. https://doi.org/10.1007/978-3-030-96900-4_11

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