Objective: The authors present their experience in the treatment of spasticity with intrathecal baclofen (ITB) by continuous pump infusion system. The features, advantages and complications of this treatment modality are discussed, demonstrated by the clinical results of 25 consecutive cases together with literature review on this topic.

Materials and Methods: Twenty-five patients suffering from spasticity secondary to cranial and spinal pathologies were treated by ITB and pump implantation between 2006 and 2010. Of these patients, 18 were male (72%) and 7 were female (28%), with a mean age of 34.4±11.2 years (range: 12-52 years). The mean preoperative Ashworth score was 3.8±0.49. The average follow-up period was 20.3±10.2 months (range:3-52 months).

Results: The mean postoperative Ashworth score was 2.44±0.86. The final evaluation of the patients revealed decrease in Ashworth score by 3 points in 2 patients (8%), 2 points in 9 patients (36%), 1 point in 10 patients (40%) and no change in 4 patients (16%). Excluding the patients whose pumps were removed, the final infusion rates ranged between 55 and 250 μg/day (mean: 134.6±62.8). Complications were seen in 6 patients (24%). The most common complication was catheter dysfunction, which was seen in 3 patients (12%). Pump infection requiring removal of the pump and antibiotic therapy occurred in 2 patients (8%).

Conclusion: Intrathecal baclofen delivered through an implanted catheter and pump system represents a significant advancement in the management of adult and pediatric spasticity. The procedure is generally safe and well-tolerated. Most important, intrathecal delivery maximizes spinal effect while minimizing cerebral side effects. Indeed, ITB offers perhaps the best option in many patients with severe spasticity refractory to medical management.