[Intrathecal baclofen for severe spasticity].

Spasticity is often observed in patients with brain or spinal cord injuries. Patients with severe spasticity experience considerable difficulty in performing the activities of daily living (ADLs). Baclofen is an agonisit at gamma-aminobutyric acid (GABA) receptors, and is, therefore, a neuroinhibitor, and decreases spasticity. However, because of blood-brain-barrier (BBB) sufficient concentrations of baclofen do not reach the spinal cord. Intrathecal administration of baclofen enables its direct infiltration into the spinal cord, and drastically reduce spasticity. In Japan, the government approved intrathecal baclofen (ITB) treatment in April, 2006. Thus far we have 40 patients administered ITB treatment. Further, we have implanted a pump that delivers baclofen in 22 patients who nevertheless require baclofen administration. All patients implanted with the pump are satisfied with the reduction in spasticity which has improved the performance of activities among wheelchair users and facilitates locomotion. In 2 patients, the implants were removed; in 1, the reason for the removal infection, and in the other was disruption of catheter. Re-implantation surgery was performed on both patients and baclofen treatment was continued.