Outcomes, complications, and dosing of intrathecal baclofen in the treatment of multiple sclerosis: a systematic review

• Published in: Neurosurgical focus Vol. 56; no. 6; p. E14
• Main Authors: Cozzi, Francesca M, Zuckerman, David, Sacknovitz, Ariel, Gozum, Nimrod, Syal, Arjun, Danisi, Fabio, Sukul, Vishad
• Format: Journal Article
• Language: English
• Published: United States 01.06.2024
• Subjects: Baclofen - administration & dosage; Humans; Injections, Spinal - methods; Multiple Sclerosis - complications; Multiple Sclerosis - drug therapy; Muscle Relaxants, Central - administration & dosage; Muscle Spasticity - drug therapy; Muscle Spasticity - etiology; Treatment Outcome; intrathecal baclofen; treatment; spasticity; quality of life; multiple sclerosis
• ISSN: 1092-0684; 1092-0684
• DOI: 10.3171/2024.3.FOCUS2464

The purpose of this systematic review was to evaluate empirical outcomes of studies in the literature that investigated effectiveness of intrathecal baclofen (ITB) in the treatment of multiple sclerosis (MS)-related spasticity (MSRS) based on various metrics. Since the first description of this route of baclofen delivery for MS patients by Penn and Kroin in 1984, numerous studies have contributed to the medical community's knowledge of this treatment modality. The authors sought to add to the literature a systematic review of studies over the last 2 decades that elucidates the clinical impact of ITB in treating MSRS with the following endpoints: impact on patient-centered outcomes, such as spasticity reduction (primary), complications (secondary), and dosing (secondary). The authors queried three databases (PubMed, Scopus, and Cochrane Library) using the following search terms: (intrathecal baclofen) AND (multiple sclerosis). The set inclusion criteria were as follows: 1) original, full-text article; 2) written in the English language; 3) published between and including the years 2000 and 2023; 4) discussion of pre- and post-ITB pump implantation outcomes (e.g., reduction in spasticity and improved comfort) in MSRS patients with long-term ITB treatment; and 5) contained a minimum of 5 MS patients. Data on study type, patient demographics, follow-up periods, primary outcomes, and secondary outcomes were extracted from the included studies. The authors' search yielded 465 studies, of which 17 met inclusion criteria. Overall, they found evidence for the effectiveness of ITB in treating MSRS patients whose condition was refractory to oral medications, with significant reported changes in spasm frequency from pre- to postimplantation. They also found evidence supporting the positive impact of ITB on MSRS patients' quality of life. Moreover, the authors found that most complications were surgical rather than pharmacological. In addition, the average 1-year dose of ITB (reported in 7 of the included studies) was 191.93 μg/day, which is substantially lower than ITB doses reported in the literature for patients with central (non-MS) or spinal origins of spasticity at 1-year follow-up. The evidence supports ITB as a clinically effective treatment for MSRS, particularly in patients in whom oral antispasmodics and physiotherapy have failed. This systematic review contributes a comprehensive synthesis of clinical benefits, complications, and dosing of ITB reported over the past 2 decades, which furthers an understanding of ITB's clinical utility in practice.