A to Z of MS Intrathecal baclofen

Baclofen is a widely used as a treatment for spasticity in multiple sclerosis and is normally taken as tablets. In high doses oral baclofen can be hard to tolerate because of side effects such as fatigue. Where this and other management strategies have failed, intrathecal baclofen may be considered.

The intrathecal space is the fluid filled cavity that surrounds the spinal cord within the spine. Drugs delivered intrathecally are passed directly into this cavity. This is a much more efficient delivery method that bypasses some of the side-effects of oral tablets, and provides a higher dose of the drug more consistently.

Intrathecal baclofen involves surgically implanting a pump under the skin of the abdomen near the waistline. The pump is about two and a half centimetres thick and about seven and a half centimetres wide. The pump is linked to the spinal cavity by a tube that is inserted by a lumbar puncture.

The pump stores and releases prescribed doses of baclofen. An external programmer can be used to adjust the dose, rate and timing of the baclofen. The pump is refilled by an injection roughly every three months and does not need further surgery. Pumps last for around five to seven years, at which time they will need to be replaced.

Because of the surgical procedure, the need to refill pumps and potentially replace pumps, together with the obvious risk of infection, intrathecal baclofen is only available in the UK in a few specialist centres.

Reference

Dario A, Tomei G.
Management of spasticity in multiple sclerosis by intrathecal baclofen.
Acta Neurochirurgica Supplement 2007;97(Pt 1):189-192.
abstract

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