Abstract
Severe spastic tone and/or spastic hypertonia can be the most disabling consequences
of a neurologic insult, resulting from an excess of muscle tone. Baclofen, a GABA-B
agonist, is one of the most widely used drugs in treating abnormal or disabling spastic
tone. However, the effectiveness of baclofen taken orally is often limited by its
systemic side effects, including sedation, confusion, and lethargy. Intrathecal baclofen
(ITB) delivered by an implanted catheter can work directly at the spinal cord level
to reduce spastic tone through presynaptic inhibition. Several decades after Penn
and Kroin (1984) proved that continuous infusion of intrathecal baclofen reduced spinal
cord spasticity, numerous studies have demonstrated the benefits of ITB therapy and
proven its effectiveness in modulating and reducing spastic tone. In this article
the authors review current methods of management with ITB therapy; summarize the current
knowledge, controversies, and available scientific literature; illustrate through
different clinical cases treatment strategies and their outcomes; and lastly, provide
a synopsis of current clinical practice in ITB therapy with insights into new therapeutic
developments.
Keywords
intrathecal - baclofen - spastic tone - GABA - hypertonia - hyperreflexia - infusion
mode
