title: Intrathecal baclofen therapy for severe spasticity: analysis on a series of 112 consecutive patients and future prospectives.
abstract: OBJECTIVE
  Intrathecal baclofen therapy (ITB) is a well-known treatment for spasticity. Despite this fact, several topics have to be still discussed: new indications and screening tools, appropriate surgical timing and complicance avoidance.
  
  
  METHODS
  A total of 112 consecutive patients all with a severe, progressive and refractory to medical therapy spasticity from different causes were treated using ITB, after a bolus test. Every patient was assessed by means of Modified Ashworth Scale (MAS), Penn spasm frequency scale (SFS) and Visual Analog Scale for pain. Since available, a Gait analysis was also performed.
  
  
  RESULTS
  There were 63 males (56%) and 49 females (44%). Seventy-four (66%) had a quadriparesis, 34 (30.4%) had a paraparesis and 4 (3.6%) were hemiplegic. Among these patients 77 (68.7%) were non ambulatory, while 35 (31.3%) were ambulatory. These patients suffered from spasticity due to many different diseases. Mean follow-up was 55 months. The mean Modified Ashworth score decreased from 4.5±0.5 preoperatively to 1.2±0.4 on chronic intrathecal baclofen. Daily baclofen dose varied between 23 and 500 mcg. Drug-induced complications and catheter related problems occurred, respectively in 7 (6.3%) and 10 patients (8.9%).
  
  
  CONCLUSIONS
  Although ITB is a well known and good treatment option in the management of severe spasticity, because of the different goals and subgroups of patients treated, a variety of techniques are needed to evaluate the benefits of this therapy. New indications, effects of ITB on central nervous system and cognitive functions needs yet to be fully clarified.
authors: Department of Neurosurgery, Second University of Naples SUN, Naples, Italy. massimo.natale@unina2.it
authors: M
authors: M
authors: Natale
authors: G
authors: G
authors: Mirone
authors: M
authors: M
authors: Rotondo
authors: A
authors: A
authors: Moraci
mesh_terms: D000293:Adolescent; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003244:Consciousness Disorders / Q000139:chemically induced; D006233:Persons with Disabilities; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D009127:Muscle Rigidity / Q000503:physiopathology; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D012883:Skin Ulcer / Q000209:etiology; D013129:Spinal Puncture; D055815:Young Adult
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen