Abstract
Intrathecal baclofen therapy has been used in the treatment of generalized spasticity in children since 1996. It has also been noted to help decrease dystonia in this population. It is very important to understand the pathophysiology of these conditions and the range of treatments available. Careful assessment is needed to determine whether someone is a good candidate for intrathecal baclofen therapy. Ideally a multidisciplinary team including the patient and family should work together to create realistic goals for treatment including improving function, comfort, and ease of care. All medical issues need to be understood and followed closely before and after intrathecal pump implantation. A screening trial can be performed but is not necessary prior to pump implantation. Optimizing dose titration and catheter tip positioning can help to maximize treatment effects. Medical and surgical complications have been recognized and need to be worked up and managed efficiently. The benefits of intrathecal baclofen therapy have been widely published and include improvement in comfort and function but most importantly in quality of life.
Similar content being viewed by others
References
Abbott R (1996) Selective rhizotomy for treatment of childhood spasticity. J Child Neurol 11:S36–S42
Abousamra O, Rogers KG, McManus M et al (2016) Evaluation of intrathecal baclofen delivery system malfunction by computed tomography scan. Dev Med Child Neurol 58:409–415
Albright AL, Cervi A, Singletary J (1991) Intrathecal baclofen for spasticity in cerebral palsy. JAMA 265:1418–1422
Albright AL, Barron WB, Fasick MP et al (1993) Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA 270:2475–2477
Albright AL, Barry MJ, Fasick MP et al (1995) Effects of continuous intrathecal baclofen infusion and selective dorsal rhizotomy on upper extremity spasticity. Pediatr Neurosurg 23:82–85
Albright AL, Barry MJ, Fasick MP et al (1996) Continuous intrathecal baclofen for symptomatic generalized dystonia. Neurosurgery 38:934–939
Albright AL, Thompson CS, Minnigh MB (2007) Cerebrospinal fluid baclofen concentrations in patient undergoing continuous intrathecal baclofen therapy. Dev Med Child Neurol 49:423–425
Armstrong RW (1992) Intrathecal baclofen and spasticity: what do we know and what do we need to know? Dev Med Child Neurol 34:739–745
Armstrong RW, Steinbok P, Cochrane DD et al (1997) Intrathecally administered baclofen for the treatment of children with spasticity of cerebral palsy. J Neurosurg 87:409–414
Bayhan I, Sees JP, Nishnianidze T (2016) Infection as a complication of intrathecal baclofen treatment in children with cerebral palsy. J Pediatr Orthop 36:305–309
Boster AL, Bennett S, Bilsky G et al (2016a) Best practices for intrathecal baclofen therapy: screening test. Neuromodulation 19:616–622
Boster AL, Adair R, Gooch JL et al (2016b) Best practices for intrathecal baclofen therapy: dosing and long term management. Neuromodulation 19:623–631
Butler C, Campbell S (2000) Evidence of the effects of intrathecal baclofen for spastic and dystonic cerebral palsy. AACPDM Treatment Outcomes Committee review Panel. Dev Med Child Neurol 42:634–645
Campbell SK, Almeida GL, Penn RD et al (1995) The effects of intrathecally administered baclofen on function in patients with spasticity. Phys Ther 75:352–362
Frost F, Nanninga J, Penn R (1989) Intrathecal baclofen infusion: effects on bladder management programs in patients with myelopathy. Am J Phys Med Rehabil 68:112–115
Gans B, Glenn M (1990) In: Glenn M, Whyte J (eds) The practical management of spasticity in children and adults. Lea & Febiger, Philadelphia, pp 1–7
Gerszten PC, Albright AL, Barry MJ (1997) Effect on ambulation of continuous intrathecal baclofen infusion. Pediatr Neurosurg 27:40–44
Gerszten PC, Albright AL, Johnstone GF (1998) Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with cerebral palsy. J Neurosurg 88:1009–1013
Gormley ME Jr (1999) Management of spasticity in children. Part 2: oral and intrathecal baclofen. J Head Trauma Rehabil 2:207–209
Grabb PA, Guin-Renfroe S, Meythaler JM (1999) Midthoracic catheter placement for intrathecal baclofen administration in children with quadriplegic spasticity. Neurosurgery 45:833–837
Katz RT, Campagnolo DI (1994) Pharmacologic management of spasticity. Phys Med Rehabil State Art Rev 8:473–480
Keenan C, Alexander M, Sung I et al (2000) Intrathecal baclofen for treatment of spasticity in children. Phys Med Rehabil State Art Rev 12:275–283
Keisswetter H, Schober W (1975) Lioresal in the treatment of neurogenic bladder dysfunction. Urol Int 30:63–71
Krach LE (2001) Pharmacotherapy of spasticity: oral medications and intrathecal baclofen. J Child Neurol 16:31–36
Kroin JS (1992) Intrathecal drug administration, present use and future trends. Clin Pharmacokinet 22:319–326
Kroin JS, Ali A, York M et al (1993) The distribution of medication along the spinal cord after chronic intrathecal administration. Neurosurgery 33:226–230
Lance JW (1980) Symposium synopsis. In: Young RR, Feldman RG, Koella WP (eds) Spasticity: disordered motor control. Symposia Specialists, Miami, pp 485–495
Massagli TL (1991) Spasticity and its management in children. Phys Med Rehabil Clin N Am 2:867–889
Mathur SN, Chu SK, McCormick Z et al (2014) Long-term intrathecal baclofen:outcomes after more than 10 years of treatment. PM & R 6:506–513
McCormick ZL, Chu SK, Binler D et al (2016) Intrathecal versus oral baclofen: a matched cohort study of spasticity, pain, sleep, fatigue, and quality of life. PM & R 8:551–562
McMahon M, Pruitt D et al (2015) Cerebral palsy. In: Alexander MA, Matthews D (eds) Pediatric rehabilitation principles and practice. Demos Medical, New York, pp 336–364
Medtronic ITB (2017a) The effects of magnetic resonance imaging (MRI) on SyncroMed II drug infusion systems, Therapy product monograph. Medtronic Inc., Minneapolis
Medtronic ITB (2017b) The effects of magnetic resonance imaging (MRI) on SyncroMed II drug infusion systems, Therapy technical note. Medtronic Inc., Minneapolis
Meythaler JM, Guin-Renfroe S, Grabb P et al (1999) Long-term continuously infused intrathecal baclofen for spastic-dystonic hypertonia in traumatic brain injury: 1-year experience. Arch Phys Med Rehabil 80:13–19
Meythaler JM, Guin-Renfroe S, Law C et al (2001) Continuously infused intrathecal baclofen over 12 months for spastic hypertonia in adolescents and adults with cerebral palsy. Arch Phys Med Rehabil 82:155–161
Miller F (1998) Gait analysis in cerebral palsy. In: Dormans JP, Pellegrino L (eds) Caring for the child with cerebral palsy. Brookes, Baltimore, pp 169–191
Muller H, Zierski J, Dralle D (1988) Pharmacokinetics of intrathecal baclofen in spasticity. In: Muller X, Zierski J, Penn RD (eds) Local-spinal therapy of spasticity. Springer, Berlin, pp 223–226
Muller-Schwefe G, Penn RD (1989) Physostigmine in the treatment of intrathecal baclofen overdose. Report of three cases. J Neurosurg 71:273–275
Nanninga JB, Frost F, Penn R (1989) Effect of intrathecal baclofen on bladder and sphincter control. J Urol 142:101–105
Peacock W, Straudt L (1991) Functional outcomes following selective posterior rhizotomy in children with cerebral palsy. J Neurosurg 74:380–385
Penn RD, Kroin JS (1984) Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1:1078
Penn RD, Savoy SM, Corcos D et al (1989) Intrathecal baclofen for severe spinal spasticity. N Engl J Med 320:1517–1521
Pin TM, McCartney L, Lewis J et al (2011) Use of intrathecal baclofen therapy in ambulant children and adolescents with spasticity and dystonia of cerebral origin: a systematic review. Dev Med Child Neurol 53:885–895
Price GW, Wilkins GP, Turnbull MJ et al (1984) Are baclofen-sensitive GABAb receptors present on primary afferent terminals of the spinal cord? Nature 307:71–74
Ried S, Pellegrino L, Albinson-Scull S et al (1998) The management of spasticity. In: Dormans JP, Pellegrino L (eds) Caring for the child with cerebral palsy. Brookes, Baltimore, pp 99–123
Rosenson AS, Ali A, Fordham EW (1990) Indium-111 DTPA flow study to evaluate surgically implanted drug pump delivery system. Clin Nucl Med 15:154–156
Sampathkumar P, Scanlon PD, Plevak DJ (1998) Baclofen withdrawal presenting as multi-organ system failure. J Neurosurg 88:562–563
Saulino M, Ivanho C, McGuire JR et al (2016a) Best practices for intrathecal baclofen therapy: patient selection. Neuromodulation 19:607–615
Saulino M, Anderson DJ, Doble J (2016b) Best practices for intrathecal baclofen therapy:troubleshooting. Neuromodulation 19:632–641
Yoon YK, Lee KC, Cho HE et al (2017) Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury. Medicine 96(34):e7472
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this entry
Cite this entry
McManus, M. (2018). Intrathecal Baclofen Therapy: Assessment and Medical Management. In: Miller, F., Bachrach, S., Lennon, N., O'Neil, M. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-50592-3_44-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-50592-3_44-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-50592-3
Online ISBN: 978-3-319-50592-3
eBook Packages: Springer Reference MedicineReference Module Medicine