Intrathecal Baclofen in Multiple Sclerosis

lease of excitatory neurotransmitter and allowing the muscle to relax and change its length (stretch). As GABA receptors are concentrated at the dorsal horn of laminae 1–4, an intrathecal infusion method delivers baclofen directly to the site of action. Use of intrathecal baclofen requires a coordinated approach by an experienced multidisciplinary team including a neurologist or rehabilitation physician, neurosurgeon, physiotherapists, nurses, and occupational therapists. The process involves careful patient selection (spasticity assessment and measures), a trial of baclofen either through a lumbar puncture bolus or a temporary intrathecal catheter, the implant procedure, discharge planning and long-term follow-up (dose titration and pump refill, 24-hour help line). To be considered a candidate for intrathecal baclofen therapy, the patient and his/her family and healthcare team must establish and agree on realistic, appropriate and achievable therapeutic goals. In turn, the patient/caregiver must agree with the treatment goals and take responsibility for obtaining refills and other follow-up care on schedule. The advantages and disadvantages of intrathecal baclofen are summarized in table 1 . Some established treatment goals of intrathecal baclofen are to facilitate patient transfers, relieve pain, enable sitting, permit the use of standing equipment, improve perineal access and reduce sleep disturbances. More recent goals include improving patients’ cognitive function by reducing or discontinuing