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Object: In this study the authors provide an assessment of intrathecal baclofen (ITB) therapy and evaluate patient outcomes and satisfaction.
Methods: Records for patients with multiple sclerosis who were selected as candidates for ITB therapy were reviewed for their response to test dose, surgical technique, surgery- and pump-related complications, and short- and long-term response to therapy. Family and caregiver assessments of the value of ITB therapy were also reviewed.
Conclusions: Intrathecal baclofen therapy is safe and effective. Most patients and caregivers express satisfaction with the therapy and would recommend it to other patients. Spasm frequency appears to be the single most common variable positively affected by therapy.
Multiple sclerosis is a common neurodegenerative disorder that affects more than 400,000 people in the US per year. One of the most common complicating factors in patient function as well as a primary cause of morbidity is the development of spasticity. Some degree of spasticity will develop in more than 70% of patients throughout the course of their disease. In many cases the spasticity progresses until the patient's function is significantly impaired. In cases in which patients reach the point where they require full care, spasticity and contracture may limit their ability to obtain care outside of a professional setting. In addition, in many patients painful spontaneous or sensory-evoked muscle spasms develop, which are often unpredictable and are a significant cause of discomfort and disability. When patients can't be adequately treated medically, either due to ineffectiveness of oral drug therapy or to side effects limiting the ability to titrate medications, ITB therapy is a potential treatment option. In many cases, patients are enthusiastic about pursuing this treatment option. Nevertheless, patient satisfaction and the long-term efficacy of therapy are less clear.
We have evaluated 35 consecutively treated patients who were prospectively identified as potential candidates for ITB therapy. We have reviewed these patients with regard to their response to their screening dose, surgical technique, perioperative/pump complications, short-and long-term outcomes, and patient and caregiver satisfaction. Outcome and satisfaction were assessed in a multipoint questionnaire.
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