[Intrathecal baclofen and traumatic brain injury. A review]

Severe head injury can induce hypertonia. There are two kinds of hypertonia related to severe injury. The most common one is a spasticity that occurs a long time after the head injury; the second is hypertonia that occurs during the early stage of the post-trauma recovery. Hypertonia is associated with other symptoms and defines post-trauma dysautonomia. Intrathecal baclofen can alleviate spasticity in severe head injury with improvement of the Ashworth score, spasm score or reflex score. But it also improves the number of paroxymal dysautonomic episodes. Real functional improvement is more difficult to show. To be effective, intrathecal baclofen therapy in brain injured patients needs high doses per day, through a spinal catheter in the mediothoracic region, and delivered at least continuously for a few hours to achieve a functional improvement.