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Best Practices for Intrathecal Baclofen Therapy: Patient Selection
Michael Saulino1, Cindy B Ivanhoe2,3, John R McGuire4
1Intrathecal Therapy Services, MossRehab, Elkins Park, PA, USA.
Summary
Intrathecal baclofen (ITB) therapy is recommended when spasticity impacts daily comfort and function. This treatment is effective across various diseases and patient groups, including children, and offers benefits without cognitive side effects.
Area of Science:
- Neurology
- Physical Medicine and Rehabilitation
Background:
- Spasticity significantly impacts patient comfort, daily function, mobility, and overall quality of life.
- Intrathecal baclofen (ITB) therapy is a treatment option for managing severe spasticity.
Purpose of the Study:
- To outline best practices for considering and implementing intrathecal baclofen (ITB) therapy for spasticity management.
- To define patient populations and clinical scenarios where ITB is indicated.
Main Methods:
- An expert panel convened to discuss and establish best practices for ITB therapy.
- Review of clinical evidence and guidelines for spasticity management.
Main Results:
- ITB is effective for problematic spasticity in all disease phases, including progressive neurological conditions.
- ITB is beneficial for children with spasticity-related musculoskeletal issues and can improve function in ambulatory patients when combined with rehabilitation.
- ITB manages spasticity without cognitive side effects, making it suitable for patients with cognitive impairment. Contraindications include hypersensitivity, active infection, and certain psychosocial factors.
Conclusions:
- Intrathecal baclofen (ITB) therapy should be considered when spasticity interferes with a patient's comfort or functional abilities.
- ITB is a versatile treatment option not limited to patients who have failed other therapies.
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