Intrathecal baclofen for multiple sclerosis related spasticity: A twenty year experience

Objective: Evaluate long-term efficacy and safety of ITB in treating MS-related spasticity over ∼ 20 years of service provision in a single centre.

Methods: A single centre prospective observational cohort study was performed. Eligible subjects underwent ITB trial by bolus dose via lumbar puncture and responders proceeded to pump implantation. Demographics, spasticity scores (Ashworth), spasm score (Penn), stiffness, pain and discomfort (Visual Analogue Scale), mobility (10 M walk), spasticity treatment, and ITB doses were analysed longitudinally.

Results: 106 people were included with 568 patient years of data. Ashworth, Penn and VAS/NRS mean scores improved post-trial compared with baseline (p < 0.001). Sustained efficacy was reported on Ashworth, Penn and VAS scores over time. After 1 year, 73 (69%) discontinued all oral antispasticity medications. Complication rates were low at 0.05 complications per pump year and mostly mechanical (usually catheter) related. In 8 ambulatory subjects, 7 (87%) continued to walk one year after pump insertion, 5 (62%) were still walking at time of analysis (mean follow up 3.4 years).

Conclusions: ITB is an effective and safe long term treatment for refractory MS related spasticity. Efficacy was sustained over time and the majority of subjects subsequently discontinued systemic medications. In a small cohort, ability to walk was preserved, indicating ITB should be considered earlier in this cohort.