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Intrathecal Baclofen therapy in Germany: Proceedings of the IAB—Interdisciplinary Working Group for Movement Disorders Consensus Meeting

  • Neurology and Preclinical Neurological Studies - Original Article
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Abstract

Continuous intrathecal Baclofen application (ITB) through an intracorporeal pump system is widely used in adults and children with spasticity of spinal and supraspinal origin. Currently, about 1200 new ITB pump systems are implanted in Germany each year. ITB is based on an interdisciplinary approach with neurologists, rehabilitation specialists, paediatricians and neurosurgeons. We are presenting the proceedings of a consensus meeting organised by IAB—Interdisciplinary Working Group for Movement Disorders. The ITB pump system consists of the implantable pump with its drug reservoir, the refill port, an additional side port and a flexible catheter. Non-programmable pumps drive the Baclofen flow by the reservoir pressure. Programmable pumps additionally contain a radiofrequency control unit, an electrical pump and a battery. They have major advantages during the dose-finding phase. ITB doses vary widely between 10 and 2000 μg/day. For spinal spasticity, they are typically in the order of 100–300 μg/day. Hereditary spastic paraplegia seems to require particularly low doses, while dystonia and brain injury require particularly high ones. Best effects are documented for tonic paraspasticity of spinal origin and the least effects for phasic muscle hyperactivity disorders of supraspinal origin. Oral antispastics are mainly effective in mild spasticity. Botulinum toxin is most effective in focal spasticity. Myotomies and denervation operations are restricted to selected cases of focal spasticity. Due to its wide-spread distribution within the cerebrospinal fluid, ITB can tackle wide-spread and severe spasticity.

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Acknowledgments

DD received honoraria for consultations from Allergan, Eisai/Solstice, Ipsen, Merz and Syntaxin. He is a shareholder in Allergan. He holds patents in botulinum toxin research.

Author information

Authors and Affiliations

  1. Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    D. Dressler

  2. Neuropädiatrie, Schön Klinik Vogtareuth, Vogtareuth, Germany

    S. Berweck

  3. Klinik für Stereotaxie und Funktionelle Neurochirurgie, Uniklinik Köln, Cologne, Germany

    A. Chatzikalfas

  4. Neurologie, Dr. Becker Rhein-Sieg-Klinik, Nümbrecht, Germany

    M. Ebke

  5. HELIOS Klinik Leezen, Leezen, Germany

    B. Frank

  6. Neurologie, Medical Park Humboldtmühle, Berlin, Germany

    S. Hesse

  7. Therapiezentrum Burgau, Burgau, Germany

    M. Huber

  8. Department of Neurosurgery, Hannover Medical School, Hannover, Germany

    J. K. Krauss

  9. Abteilung für Anästhesiologie, Pädiatrische Intensivmedizin und Notfallmedizin, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany

    K.-H. Mücke

  10. HELIOS Klinik Geesthacht, Geesthacht, Germany

    A. Nolte

  11. Neurologie, St.-Barbara-Hospital, Gladbeck, Germany

    H.-D. Oelmann

  12. Neurologie, MATERNUS-Klinik für Rehabilitation, Bad Oeynhausen, Germany

    P. W. Schönle

  13. Department of Neurosurgery, Klinikum Ingolstadt, Ingolstadt, Germany

    M. Schmutzler

  14. Movement Disorders Section, Department of Neurology, Hannover Medical School, Hannover, Germany

    H. Pickenbrock

  15. Neurologisches Rehazentrum Godeshöhe, Bonn, Germany

    C. Van der Ven

  16. Pädiatrie, Asklepios Klinik Nord, Hamburg, Germany

    N. Veelken

  17. Zentrum für Rückenmarkverletzte, Berufsgenossenschaftliche Unfallklinik, Murnau, Germany

    M. Vogel

  18. Mainz, Germany

    T. Vogt

  19. IAB-Interdisciplinary Working Group for Movement Disorders, Hamburg, Germany

    F. Adib Saberi

Authors
  1. D. Dressler
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  2. S. Berweck
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  3. A. Chatzikalfas
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  4. M. Ebke
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  5. B. Frank
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  6. S. Hesse
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  7. M. Huber
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  8. J. K. Krauss
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  9. K.-H. Mücke
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  10. A. Nolte
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  11. H.-D. Oelmann
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  12. P. W. Schönle
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  13. M. Schmutzler
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  14. H. Pickenbrock
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  15. C. Van der Ven
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  16. N. Veelken
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  17. M. Vogel
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  18. T. Vogt
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  19. F. Adib Saberi
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Corresponding author

Correspondence to D. Dressler.

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Dressler, D., Berweck, S., Chatzikalfas, A. et al. Intrathecal Baclofen therapy in Germany: Proceedings of the IAB—Interdisciplinary Working Group for Movement Disorders Consensus Meeting. J Neural Transm 122, 1573–1579 (2015). https://doi.org/10.1007/s00702-015-1425-1

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  • DOI: https://doi.org/10.1007/s00702-015-1425-1

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