Serial Intraventricular Baclofen Bolus: A New Approach to Facilitate Implant Decisions

Abstract Background: Intrathecal test doses of baclofen do not provide patients with an impression of the long-term benefits of having a pump implanted. As a result, post-implant satisfaction may vary. The following is a method to address these concerns. Objective: The objective of the study was to analyse the outcomes of a feasibility study of intraventricular baclofen daily serial dosing via an Ommaya reservoir. Methodology: Prospectively, 12 patients who met indications underwent the treatment along with individualised rehabilitation programmes. Inclusion criteria were intractable spasticity not responsive to oral antispastics, dystonic CP or spastic dystonia under workup. Exclusion criteria were a history of major trauma with implants, and concomitant neurological diseases. The drug was given daily at the same time, and goals were revised weekly until the patient party decided. The Modified Ashworth score, Coma Recovery Scale-Revised, Barry Albright Dystonia Scale and Disability Rating Scales were used as outcome measures. Results: All patients had a reduction in tone, and some made gains in the Disability Rating Scale. There was minimal change in the Coma Recovery Score-Revised. Of the 12, five proceeded to pump implantation. One patient developed meningitis during the trial and received a pump regardless. Conclusion: In conclusion, this is a feasible method to help the patient party decide if this is a treatment option, they find useful.