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Best Practices for Intrathecal Baclofen Therapy: Patient Selection. Neuromodulation 2016 Aug;19(6):607-15

Date

07/20/2016

Pubmed ID

27434197

DOI

10.1111/ner.12447

Scopus ID

2-s2.0-84981749596   27 Citations

Abstract

INTRODUCTION: When spasticity interferes with comfort, function, activities of daily living, mobility, positioning, or caregiver assistance, patients should be considered for intrathecal baclofen (ITB) therapy.

METHODS: An expert panel consulted on best practices.

RESULTS: ITB can be considered for problematic spasticity involving muscles/muscle groups during all phases of diseases, including progressive neurologic diseases. ITB alone or with other treatments should not be exclusively reserved for individuals who have failed other approaches. ITB combined with rehabilitation can be effective in certain ambulatory patients. ITB is also highly effective in managing spasticity in children, who may suffer limb deformity, joint dislocation, and poor motor function from spasticity and muscle tightness on the growing musculoskeletal system. Spasticity management often allows individuals to achieve higher function. When cognition is impaired, ITB controls spasticity without the cognitive side effects of some oral medications. Goal setting addresses expectations and treatment in the framework of pathology, impairment, and disability. ITB is contraindicated in patients with hypersensitivity to baclofen, which is rare, or active infection. Some patients with an adverse reaction to oral baclofen may be mistakenly classified as having an allergic reaction and may benefit from ITB. Relative contraindications include unrealistic goals, unmanageable mental health issues, psychosocial factors affecting compliance, and financial burden. Vascular shunting for hydrocephalus is not a contraindication, but concurrent use may affect cerebrospinal fluid flow. Seizures or prior abdominal or pelvic surgery should be discussed before proceeding to an ITB screening test.

CONCLUSIONS: ITB should be considered when spasticity interferes with comfort or function.

Author List

Saulino M, Ivanhoe CB, McGuire JR, Ridley B, Shilt JS, Boster AL

Author

John R. McGuire MD Professor in the Physical Medicine and Rehabilitation department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Baclofen
Databases, Bibliographic
Humans
Injections, Spinal
Muscle Relaxants, Central
Muscle Spasticity
Patient Selection
Practice Guidelines as Topic
Time Factors