Intrathecal Baclofen: Delivery Makes the Difference

• Baclofen acts as GABA analog in the spinal cord. The specific receptor site is GABA-b located in the dorsal horn of the spinal cord.
• Oral baclofen has a wide volume of distribution, only a small portion reaches target receptors in the spinal cord. It does not easily corss the blood-brain barrier to penetrate the cerebrospinal fluid (CSF).
• Oral baclofen is often ineffective in treating severe spasticity because to achieve effective therapeutic concentrations in the spinal cord produces unacceptable systemic side effects. (lethargy, confusion, drowsiness, and muscle weakness).
• Intrathecal baclofen is effective because medication is delivered directly into the cerebrospinal fluid (CSF) surrounding the spinal cord - the intended site of action. Effective doses intrathecally are a fraction of those doses given orally.

• Decreased spasticity results in decreased pain, increased comfort, increased independence and self-esteem, improvement in activities of daily living (ADL), advancement in the performance of bowel and bladder programs, improved self-care, improved cognition and improved quality of sleep.
• Compared to oral therapies, ITB markedly reduces intolerable side effects and in a vast majority eliminates needs for other spasticity medications or interventions.
• ITB can be used in conjunction with other therapies.
  

• Surgery
• Initial expense
• Cosmetic issues
• Refilling intervals may be frequent
• Potential Pump, Medication & Catheter problems
• Lack of awareness among physicians, therapists, case managers, and patients
• Fear of unknown and "new technology"

• Extremely safe with appropriate clinical expertise.
• Allows individualized fine tuning of clinical response.
• Reversibility, does not involve destruction of neural tissue.
• Marked Consistently Superior Clinical Response in the Difficult Spasticity Management Situation.

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