Intrathecal Baclofen Therapy: Assessment and Medical Management

Intrathecal baclofen therapy has been used in the treatment of generalized spasticity in children since 1996. It has also been noted to help decrease dystonia in this population. It is very important to understand the pathophysiology of these conditions and the range of treatments available. Careful assessment is needed to determine whether someone is a good candidate for intrathecal baclofen therapy. Ideally a multidisciplinary team including the patient and family should work together to create realistic goals for treatment including improving function, comfort, and ease of care. All medical issues need to be understood and followed closely before and after intrathecal pump implantation. A screening trial can be performed but is not necessary prior to pump implantation. Optimizing dose titration and catheter tip positioning can help to maximize treatment effects. Medical and surgical complications have been recognized and need to be worked up and managed efficiently. The benefits of intrathecal baclofen therapy have been widely published and include improvement in comfort and function but most importantly in quality of life.