Intrathecal baclofen therapy treats severe spasticity by delivering medication directly into the cerebrospinal fluid through an implanted pump, rather than by mouth. Because the medication reaches the spinal cord directly, a very small dose achieves what oral treatment cannot, and the sedation and drowsiness that limit oral therapy are largely avoided. A test dose is always given before a pump is implanted.
At a glance
- Main indications
- Severe spasticity of spinal or cerebral origin: cerebral palsy, multiple sclerosis, spinal cord injury, after stroke or brain injury
- Test dose
- A single intrathecal test dose, with the response assessed over several hours, before any implant
- Implant
- A programmable pump in the abdominal wall with a catheter to the intrathecal space
- Refills
- Percutaneous refills at regular intervals in clinic; the pump is programmed telemetrically
- Key safety point
- Abrupt withdrawal is a medical emergency — refills must never be missed
- Managed with
- Physical medicine and rehabilitation, physiotherapy and, in children, paediatric neurology
Why deliver medication this way
Oral antispastic treatment must cross into the nervous system from the bloodstream, so the dose needed to relax the legs also reaches the brain, causing drowsiness, weakness and cognitive dulling. Many patients stop treatment for this reason. Delivering the medication directly into the cerebrospinal fluid concentrates its effect where it is needed, at roughly a hundredth of the oral dose, so spasticity can be controlled while the patient stays alert.
Defining the goal before deciding
Spasticity is not always the enemy. Some patients use their own stiffness to stand or transfer, and reducing it can make them less functional rather than more. The first step is therefore to agree an explicit goal with the patient, the family and the rehabilitation team: reducing pain and spasms; making dressing, seating and personal care possible; preventing contractures; improving gait; or improving comfort and dignity in a patient who is not mobile. Each goal is legitimate, but they call for different dosing.
Yilmaz A, Yıldızgören MT. A Preliminary Report: Which Patients May Be Candidates For Intrathecal Baclofen Pump? Scholars Journal of Applied Medical Sciences, 2018.
The test dose
A single dose is given into the intrathecal space by lumbar puncture and the effect on muscle tone, spasms and function is measured over the following hours by the surgeon and the rehabilitation team. This answers two questions directly: does this patient's spasticity respond, and does reducing it help or hinder them? Only patients who pass this test proceed to implantation.
Living with a pump
- The pump is refilled percutaneously in clinic at regular intervals; the interval depends on dose and reservoir size.
- Dosing is adjusted telemetrically, and complex schedules can be programmed for different times of day.
- Refill appointments must never be missed. Abrupt interruption of intrathecal baclofen can cause a severe withdrawal syndrome that is a medical emergency. Every patient and family is taught to recognise it.
- Catheter problems, infection and pump end-of-life are the main long-term issues; the pump is replaced at end of battery life.
Ask about intrathecal baclofen therapy
No medication dosing is given on this site. Dose selection, refill intervals and withdrawal management are individual clinical decisions.
Frequently asked questions
Who is a candidate for an intrathecal baclofen pump?
Patients with severe spasticity of cerebral or spinal origin that is not controlled by oral treatment and physiotherapy, or in whom oral treatment causes unacceptable drowsiness — and who respond to an intrathecal test dose.
Is the pump permanent?
The system can be removed, but it is intended as long-term therapy. The pump is replaced at the end of its battery life, typically after several years.