Managing Spasticity in People With Multiple Sclerosis: A Goal-Oriented Approach to Intrathecal Baclofen Therapy

The effectiveness of intrathecal baclofen therapy (ITB) in the management of severe spasticity in people with multiple sclerosis (MS) was reviewed retrospectively. The multidisciplinary team reviewed the medical, therapy, and nursing notes of 19 people with MS who were treated with ITB. The audited information included surgical procedures, postoperative complications, medical side effects, dose requirements, and multidisciplinary input. Seventeen people were included in the audit. A total of 23 problems and 34 functional goals as objects for ITB treatment were recorded. Eighty-seven percent of the patients had sustained improvement in at least one problem, and 79% in at least one goal. Only two patients had no sustained improvement in any problem or goal. These results suggest that ITB can be an effective intervention in people with severe spasticity in MS. However, this approach requires careful patient selection, a dynamic goal-oriented approach, expert implantation, and ongoing evaluation of individual responses to treatment over time. (Int J MS Care. 2001; 3(4): 10–21)