A review of intrathecal baclofen in the management of spasticity

Spasticity is associated with damage to the corticospinal tract and is a common complication of neurological disease. Patients with spasticity complain of stiffness, involuntary spasm and pain. The majority of patients are managed conservatively with physiotherapy and/or oral medication. However, 25-35% of patients will develop unacceptable side-effects or fail to respond to oral doses of antispasmodics. Surgical procedures such as myelotomy, rhizotomy and neurotomy have not been universally successful. More recently, intrathecal baclofen has become established as an important adjunct in the management of spasticity. This article describes the mechanism of action of baclofen, the delivery systems available and the criteria for patient selection. The screening phase, surgical procedure and specific postoperative observations are also described.