Abstract
Intrathecal baclofen (ITB) delivered by programmable pump devices represents an important treatment modality for severe spasticity when other treatment modalities have an insufficient effect. In this paper, we report excellent clinical outcomes after ten years of ITB treatment in a multiple sclerosis patient.
Material and methods: A 58-year-old female with clinically definite multiple sclerosis in secondary progression was referred to our neurological department for treatment of severe spasticity of the lower extremities. The final diagnosis was based on the typical clinical status, magnetic resonance (MRI) findings and oligoclonal antibodies in the cerebrospinal fluid.
At the time of ITB testing, the MS patient had EDSS of 7. She was treated with a high-dose antispasmodic medication.
After positive clinical response to ITB bolus, she underwent pump implantation (Synchromed EL, Medtronic) in 2004 with very good effect on spasticity and decreased frequency of muscle spasms. After four years of implantation, she experienced catheter malfunction resulting in its reimplantation.
At the end of battery life after five years from the first implantation, the patient underwent pump reimplantation (Synchromed II, Medtronic). The patient is satisfied and tolerates the total daily dose of 125 μg of baclofen well.
Her current EDSS is 7.5. Conclusion: Intrathecal baclofen delivery is a good treatment option in patients with severe generalized spasticity that limits activities of daily living as shown in our MS patient who has been stable for 10 years of ITB treatment.
Complications of ITB are less important and usually well treatable