IT baclofen for spasticity in MS

Intrathecal baclofen effectively reduces spasticity in MS patients, but does not appear to improve walking abilities, according a retrospective study.The French study involved retrospective analysis of case files of MS patients receiving IT baclofen as test injections in a rehabilitation unit. The objective of treatment in non-walking patients was to improve comfort by reducing flexor spasms, whereas the objective in patients still able to walk was to obtain an improvement in the quality of gait. If test boluses achieved the primary objective, as well as reducing overall spasm scores and did not cause troublesome adverse effects, patients received chronic intrathecal baclofen therapy via a pump. Sixty-four MS patients (51 non-walking, 13 walking) received IT baclofen test injections during the study period, of which 44 (43 non-walking, 1 walking) subsequently received chronic baclofen therapy via the pump. Pump placement was not undertaken in six of eight non-walking patients due to their poor general health, and in the other two non-walking patients due to no obvious improvement in comfort, despite significant reduction of spasticity. All but one of the walking patients showed no improvement in walking after the IT baclofen test injections, and therefore did not receive chronic baclofen therapy via the pump. The authors note, "We always observed a reduction of spasticity and spasms. However, patients never described any improvement in their walking. They described either greater difficulty to remain standing or an abnormal fatigue on walking... These patients seem to 'rely on' their spasticity to walk."The authors conclude that the objective of treatment is usually patient comfort rather than a functional objective, and walking subjects may not be the best candidates for therapy. However, the retrospective nature of the study may limit the power of the results, and conclusions should be interpreted cautiously.Reference...