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.