title: Efficacy and safety of oral baclofen in the management of spasticity: A rationale for intrathecal baclofen.
abstract: Oral baclofen has long been a mainstay in the management of spasticity. This review looks at the clinical evidence for the efficacy and safety of oral baclofen in patients with spasticity of any origin or severity, to determine whether there is a rationale for the use of intrathecal baclofen. Results suggest that oral baclofen may be effective in many patients with spasticity, regardless of the underlying disease or severity, and that it is at least comparable with other antispasmodic agents. However, adverse effects, such as muscle weakness, nausea, somnolence and paraesthesia, are common with oral baclofen, affecting between 25% and 75% of patients, and limiting its usefulness. Intrathecal baclofen may be an effective alternative as the drug is delivered directly into the cerebrospinal fluid, thus bypassing the blood-brain barrier and thereby optimizing the efficacy of baclofen while minimizing drug-related side-effects. Intrathecal baclofen is a viable option in patients who experience intolerable side-effects or who fail to respond to the maximum recommended dose of oral baclofen.
authors.affiliation: Department of Rehabilitation Medicine, Linköping University Hospital , SE-581 85 Linköping, Sweden. per.ertzgaard@liu.se, Per.Ertzgaard@regionostergotland.se.
authors.forename: Per
authors.initials: P
authors.lastname: Ertzgaard
authors.forename: Claudia
authors.initials: C
authors.lastname: Campo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Calabrese
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage* / Q000009:adverse effects; D006970:Disorders of Excessive Somnolence / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000009:adverse effects; D009128:Muscle Spasticity / Q000188:drug therapy*; D018908:Muscle Weakness / Q000139:chemically induced; D009325:Nausea / Q000139:chemically induced; D010276:Parasympatholytics / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D009125:Muscle Relaxants, Central; D010276:Parasympatholytics; D001418:Baclofen