Management ofseverespasticity withintrathecal baclofen delivered byamanually operated pump

Intrathecal baclofen abolishes spasticity in many patients with neurological diseases buttherearefewstudies onits long-termeffectiveness. Since1986a manuallyoperated subcutaneous pump has been used to deliverbaclofen intrathecally in21patients with afollow upofatleast oneyear.Mostpatients had multiple sclerosis andallwerewheelchair-bound. Sixteenpatients had a complete andsustained benefit. Infour otherpatients thetreatment waseffective intheshorttermbutnotinthelong term.Intheremaining patient thepump neverworked.Complications included meningitis, pump failure,erosion through theskin, andbaclofen overdose. Nevertheless, onlythreepatients have askedtodiscontinue thetreatment. We conclude thatintrathecal baclofen, deliveredbya manually operated implanted pump,isaneffective treatment forsevere spasticity inmostpatients.