Summary
Baclofen, a derivative of g-aminobutyric acid (GABA) has been known for many years to be a useful drug in the treatment of spinal spasticity. However, when the spasticity is severe, the systemic administration has to be increased, often without therapeutic effects but frequently with central side-effects. Baclofen given intrathecally however, in microgram doses has been previously reported to be effective and safe.
A personal experience is reported of 9 severely spastic patients residing in chronic care facilities who were treated from July 1984 to March 1986 with intrathecal baclofen. The spasticity was causing significant nursing care problems, and 6 patients were reduced to a completely bedridden state. Each patient initially received a percutaneous intrathecal drug injection of 0.2–0.7 mg of baclofen to test its efficacy. A subcutaneous intrathecal system for further injections was placed in 6 patients. In 3 patients a decreased level of consciousness was observed. In the 3 cases of multiple sclerosis, intrathecal baclofen resulted in significant reduction of spasticity for 24 to 48 hours after each injection. The spasticity was improved in only one of the 2 cases of posttraumatic paraplegia. The effect was not convincing in the 2 cases of spinal cord tumour, and in the case of cerebral palsy the effect was improvement in spasticity, but also significant drowsiness.
Baclofen, in comparison with some other drugs such as morphine or midazolam, also tried intrathecally by the authors, is the most effective in reducing spasticity. Its use however warrants caution, for it can cause decreased consciousness, and there is currently no antagonist.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Ault B, Evans RE (1981) The depressant action of baclofen on the isolated spinal cord of the neonatal rat. Eur J Pharmacol 71: 357–364
Bowery NG, Hill DR, Hudson AL et al (1980) Baclofen decreases neurotransmitter release at a novel GABA receptor. Nature 283: 92–92
Fukada H, Kudo Y, Oho H (1977) Effects of GABA on spinal synaptic activity. Eur J Pharmacol 44: 17–24
Gilman AG, Goodman LS, Gilman A (1980) The pharmacological basis of therapeutics. Macmillan Publishing, New York
Grahame-Smith DG, Aronson JK (1984) Oxford textbook of clinical pharmacology and drug therapy. Oxford University Press
Knutsson E, Lindblom U, Martensson A (1974) Plasma and cerebrospinal fluid levels of baclofen ( Lioresal) at optimal therapeutic responses in spastic paresis. J Neurol Sei 23: 473–484
Kroin JS, Penn RD, Beissinger RL etal (1984) Reduced spinal reflexes following intrathecal baclofen in the rabbit. Exp Brain Res 54: 191–194
Pederson S, Arlien-Soborg P, Mai J (1974) The mode of action of the GABA derivative baclofen in human spasticity. Acta Neurol Scand 50: 665–680
Penn RD, Kroin JS ( 1984 ) Intrathecal baclofen alleviates spinal cord spasticity. Lancet (i ): (1078)
Penn RD, Kroin JS (1985) Continuous intrathecal baclofen for severe spasticity. Lancet (ii): 125–127
Price GW, Wilkin GP, Turnbull MJ etal (1984) Are baclofen sensitive GABA-B receptors present on primary afferent terminals of the spinal cord. Nature 307: 71–74
Regan JW, Roeske WP, Yamamura HI (1980) The benzodiazepine receptor and its development and modulation by GABA. J Pharm Exp Ther 212: 137–143
Reynold JEF (1982) The extra pharmacopeia. The Pharmaceutical Press, London
Siegfried J, Lazorthes Y (eds) (1985) Neurochirurgie de l’infirmité motrice cérébrale. Neurochirurgie 31: 95–101
Siegfried J, Rea GL (1986) Intrathecal application of drugs for muscle hypertonia. Scand J Rehab Med, in press
Yaksh TL, Reddy SVR (1981) Studies in the primate on the analgetic effects associated with intrathecal actions of opiates, adrenerigc agonists, and baclofen. Anesthesiology 54: 451–467
Young RR, Delwaide PJ (1981) Spasticity, Parts I and II. NEJM 304: 28–33, 96–99
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1987 Springer-Verlag
About this paper
Cite this paper
Siegfried, J., Rea, G.L. (1987). Intrathecal Application of Baclofen in the Treatment of Spasticity. In: Gybels, J., Hitchcock, E.R., Meyerson, B., Ostertag, C., Rossi, G.F. (eds) Advances in Stereotactic and Functional Neurosurgery 7. Acta Neurochirurgica Supplementum, vol 39. Springer, Vienna. https://doi.org/10.1007/978-3-7091-8909-2_31
Download citation
DOI: https://doi.org/10.1007/978-3-7091-8909-2_31
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-8911-5
Online ISBN: 978-3-7091-8909-2
eBook Packages: Springer Book Archive