title: Intrathecal Baclofen therapy in Germany: Proceedings of the IAB-Interdisciplinary Working Group for Movement Disorders Consensus Meeting.
abstract: Continuous intrathecal Baclofen application (ITB) through an intracorporeal pump system is widely used in adults and children with spasticity of spinal and supraspinal origin. Currently, about 1200 new ITB pump systems are implanted in Germany each year. ITB is based on an interdisciplinary approach with neurologists, rehabilitation specialists, paediatricians and neurosurgeons. We are presenting the proceedings of a consensus meeting organised by IAB-Interdisciplinary Working Group for Movement Disorders. The ITB pump system consists of the implantable pump with its drug reservoir, the refill port, an additional side port and a flexible catheter. Non-programmable pumps drive the Baclofen flow by the reservoir pressure. Programmable pumps additionally contain a radiofrequency control unit, an electrical pump and a battery. They have major advantages during the dose-finding phase. ITB doses vary widely between 10 and 2000 μg/day. For spinal spasticity, they are typically in the order of 100-300 μg/day. Hereditary spastic paraplegia seems to require particularly low doses, while dystonia and brain injury require particularly high ones. Best effects are documented for tonic paraspasticity of spinal origin and the least effects for phasic muscle hyperactivity disorders of supraspinal origin. Oral antispastics are mainly effective in mild spasticity. Botulinum toxin is most effective in focal spasticity. Myotomies and denervation operations are restricted to selected cases of focal spasticity. Due to its wide-spread distribution within the cerebrospinal fluid, ITB can tackle wide-spread and severe spasticity.
authors.affiliation: Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. dressler.dirk@mh-hannover.de.
authors.forename: D
authors.initials: D
authors.lastname: Dressler
authors.affiliation: Neuropädiatrie, Schön Klinik Vogtareuth, Vogtareuth, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Berweck
authors.affiliation: Klinik für Stereotaxie und Funktionelle Neurochirurgie, Uniklinik Köln, Cologne, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Chatzikalfas
authors.affiliation: Neurologie, Dr. Becker Rhein-Sieg-Klinik, Nümbrecht, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Ebke
authors.affiliation: HELIOS Klinik Leezen, Leezen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Frank
authors.affiliation: Neurologie, Medical Park Humboldtmühle, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Hesse
authors.affiliation: Therapiezentrum Burgau, Burgau, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Huber
authors.affiliation: Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
authors.forename: J K
authors.initials: JK
authors.lastname: Krauss
authors.affiliation: Abteilung für Anästhesiologie, Pädiatrische Intensivmedizin und Notfallmedizin, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany.
authors.forename: K-H
authors.initials: KH
authors.lastname: Mücke
authors.affiliation: HELIOS Klinik Geesthacht, Geesthacht, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Nolte
authors.affiliation: Neurologie, St.-Barbara-Hospital, Gladbeck, Germany.
authors.forename: H-D
authors.initials: HD
authors.lastname: Oelmann
authors.affiliation: Neurologie, MATERNUS-Klinik für Rehabilitation, Bad Oeynhausen, Germany.
authors.forename: P W
authors.initials: PW
authors.lastname: Schönle
authors.affiliation: Department of Neurosurgery, Klinikum Ingolstadt, Ingolstadt, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schmutzler
authors.affiliation: Movement Disorders Section, Department of Neurology, Hannover Medical School, Hannover, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Pickenbrock
authors.affiliation: Neurologisches Rehazentrum Godeshöhe, Bonn, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Van der Ven
authors.affiliation: Pädiatrie, Asklepios Klinik Nord, Hamburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Veelken
authors.affiliation: Zentrum für Rückenmarkverletzte, Berufsgenossenschaftliche Unfallklinik, Murnau, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Vogel
authors.affiliation: , Mainz, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Vogt
authors.affiliation: IAB-Interdisciplinary Working Group for Movement Disorders, Hamburg, Germany.
authors.forename: F Adib
authors.initials: FA
authors.lastname: Saberi
mesh_terms: D001418:Baclofen / Q000008:administration & dosage*; D005858:Germany; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects; D007278:Injections, Spinal; D009069:Movement Disorders / Q000188:drug therapy*; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D009128:Muscle Spasticity / Q000188:drug therapy*
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: Consensus; Continuous application; Intrathecal Baclofen; Pump; Spasticity