title: Intrathecal baclofen: effects on spasticity, pain, and consciousness in disorders of consciousness and locked-in syndrome.
abstract: Disorders of consciousness (DOCs) include coma, vegetative state (VS), and minimally conscious state (MCS). Coma is characterized by impaired wakefulness and consciousness, while VS and MCS are defined by lacking or discontinuous consciousness despite recovered wakefulness. Conversely, locked-in syndrome (LIS) is characterized by quadriplegia and lower cranial nerve paralysis with preserved consciousness. Intrathecal baclofen (ITB) is a useful treatment to improve spasticity both in patients with DOCs and LIS. Moreover, it supports the recovery of consciousness in some patients with VS or MCS. The precise mechanism underlying this recovery has not yet been elucidated. It has been hypothesized that ITB may act by reducing the overload of dysfunctional sensory stimuli reaching the injured brain or by stabilizing the imbalanced circadian rhythms. Although the current indication of ITB is the management of severe spasticity, its potential use in speeding the recovery of consciousness merits further investigation.
authors.affiliation: Neurological Institute, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy, francesca.pistoia@univaq.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pistoia
authors.forename: Simona
authors.initials: S
authors.lastname: Sacco
authors.forename: Marco
authors.initials: M
authors.lastname: Sarà
authors.forename: Marco
authors.initials: M
authors.lastname: Franceschini
authors.forename: Antonio
authors.initials: A
authors.lastname: Carolei
mesh_terms: D001418:Baclofen / Q000008:administration & dosage*; D003243:Consciousness / Q000187:drug effects*; D003244:Consciousness Disorders / Q000188:drug therapy* / Q000503:physiopathology; D004334:Drug Administration Schedule; D006801:Humans; D007278:Injections, Spinal; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy*; D011379:Prognosis; D011782:Quadriplegia / Q000188:drug therapy* / Q000503:physiopathology; D011788:Quality of Life; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen