title: Best Practices for Intrathecal Baclofen Therapy: Patient Selection.
abstract: BACKGROUND
  When spasticity interferes with comfort, function, activities of daily living, mobility, positioning, or caregiver assistance, patients should be considered for intrathecal baclofen (ITB) therapy.
  
  
  METHODS
  An expert panel consulted on best practices.
  
  
  RESULTS
  ITB can be considered for problematic spasticity involving muscles/muscle groups during all phases of diseases, including progressive neurologic diseases. ITB alone or with other treatments should not be exclusively reserved for individuals who have failed other approaches. ITB combined with rehabilitation can be effective in certain ambulatory patients. ITB is also highly effective in managing spasticity in children, who may suffer limb deformity, joint dislocation, and poor motor function from spasticity and muscle tightness on the growing musculoskeletal system. Spasticity management often allows individuals to achieve higher function. When cognition is impaired, ITB controls spasticity without the cognitive side effects of some oral medications. Goal setting addresses expectations and treatment in the framework of pathology, impairment, and disability. ITB is contraindicated in patients with hypersensitivity to baclofen, which is rare, or active infection. Some patients with an adverse reaction to oral baclofen may be mistakenly classified as having an allergic reaction and may benefit from ITB. Relative contraindications include unrealistic goals, unmanageable mental health issues, psychosocial factors affecting compliance, and financial burden. Vascular shunting for hydrocephalus is not a contraindication, but concurrent use may affect cerebrospinal fluid flow. Seizures or prior abdominal or pelvic surgery should be discussed before proceeding to an ITB screening test.
  
  
  CONCLUSIONS
  ITB should be considered when spasticity interferes with comfort or function.
authors.affiliation: Intrathecal Therapy Services, MossRehab, Elkins Park, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Saulino
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.|Mentis Neuro Health Brain Injury and Stroke Program at TIRR-Memorial Hermann, Houston, TX, USA.
authors.forename: Cindy B
authors.initials: CB
authors.lastname: Ivanhoe
authors.affiliation: Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: McGuire
authors.affiliation: Spasticity Management Program, Alta Bates Summit Medical Center, Berkeley, CA, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Ridley
authors.affiliation: Department of Orthopedic and Scoliosis Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Shilt
authors.affiliation: Systems Medical Chief, Neuroimmunology, OhioHealth Multiple Sclerosis Program, Columbus, OH, USA.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Boster
mesh_terms: D001418:Baclofen / Q000008:administration & dosage*; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D007278:Injections, Spinal; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D009128:Muscle Spasticity / Q000188:drug therapy*; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards*; D013997:Time Factors
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: Clinical protocols; consensus; implantable; infusion pumps; intrathecal baclofen; muscle spasticity