Intrathecal baclofen therapy: challenges in patients with multiple sclerosis.
Intrathecal baclofen (ITB) is a recognized therapy for severe spasticity of both spinal and cerebral origin, with documented positive clinical outcomes for many patients with multiple sclerosis (MS). This article reviews some specific considerations concerning the use of ITB in the MS population, based on the author's 10 years of clinical experience. The unpredictable and progressive nature of the disease affects the identification of appropriate goals, the patient's decision-making process, and the evaluation of the response to the treatment over time. Patients with MS may be more sensitive to intrathecal baclofen than patients with other diagnoses, and may need a lower dose for both the screening test and maintenance therapy. Subtle cognitive changes may affect the patient's ability to understand the education needed for successful management of ITB. Some practical strategies are offered for the nurse involved in the care of these patients in each stage of the therapy.
Ridley
Barbara
B
Spasticity Management Clinic, Alta Bates Summit Medical Center, Berkeley, CA 96704, USA. ridleyb@sutterhealth.org
D000203:Activities of Daily Living; D001294:Attitude to Health; D001418:Baclofen / Q000009:adverse effects / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control; D003657:Decision Making; D018450:Disease Progression; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D006301:Health Services Needs and Demand; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008403:Mass Screening; D016743:Mental Competency; D009103:Multiple Sclerosis / Q000150:complications / Q000523:psychology / Q000628:therapy*; D009125:Muscle Relaxants, Central / Q000009:adverse effects / Q000627:therapeutic use*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009730:Nursing Assessment; D010347:Patient Care Planning; D018579:Patient Selection; D019990:Perioperative Care / Q000379:methods / Q000451:nursing; D019145:Rehabilitation Nursing; D016896:Treatment Outcome
D009125:Muscle Relaxants, Central; D001418:Baclofen