title: Intrathecal baclofen in multiple sclerosis: too little, too late?
abstract: The majority of patients with multiple sclerosis (MS) have symptoms of spasticity that increasingly impair function as the disease progresses. With appropriate treatment, however, quality of life can be improved. Oral antispasticity medications are useful in managing mild spasticity but are frequently ineffective in controlling moderate to severe spasticity, because patients often cannot tolerate the adverse effects of increasing doses. Intrathecal baclofen (ITB) therapy can be an effective alternative to oral medications in patients who have a suboptimal response to oral medications or who cannot tolerate dose escalation or multidrug oral regimens. ITB therapy may be underutilized in the MS population because clinicians (a) are more focused on disease-modifying therapies rather than symptom control, (b) underestimate the impact of spasticity on quality of life, and (c) have concerns about the cost and safety of ITB therapy. Delivery of ITB therapy requires expertly trained staff and proper facilities for pump management. This article summarizes the findings and recommendations of an expert panel on the use of ITB therapy in the MS population and the role of the physician and comprehensive care team in patient selection, screening, and management.
authors.affiliation: Georgetown University Hospital, Washington, DC, USA.
authors.forename: April
authors.initials: A
authors.lastname: Erwin
authors.forename: Mark
authors.initials: M
authors.lastname: Gudesblatt
authors.forename: Francois
authors.initials: F
authors.lastname: Bethoux
authors.forename: Susan E
authors.initials: SE
authors.lastname: Bennett
authors.forename: Stephen
authors.initials: S
authors.lastname: Koelbel
authors.forename: Robert
authors.initials: R
authors.lastname: Plunkett
authors.forename: Saud
authors.initials: S
authors.lastname: Sadiq
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Stevenson
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Thomas
authors.forename: Carlo
authors.initials: C
authors.lastname: Tornatore
authors.forename: Mauro
authors.initials: M
authors.lastname: Zaffaroni
authors.forename: Mary
authors.initials: M
authors.lastname: Hughes
mesh_terms: D001418:Baclofen / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D015918:Infusion Pumps, Implantable; D007263:Infusions, Parenteral; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen