Multidisciplinary Multiple Sclerosis Clinic Approach to Intrathecal Baclofen Therapy: From Patient Selection to Optimization of Therapy
Intrathecal Baclofen (ITB) is an FDA approved therapy for severe spasticity of both spinal and cerebral origin with documented positive clinical outcomes for patients with Multiple Sclerosis (MS), however, this therapy is underutilized in the MS patient population. The prevalence of spasticity in MS is high with clinical manifestations in an estimated 60% of MS patients; 40-70% of patients report impairments as a result of their spasticity.
To provide insight and spread awareness to MS care providers about the multidisciplinary approach to Spasticity Care in a large MS center.
The MS Center at OhioHealth utilizes a multidisciplinary team approach in the management of severe spasticity with ITB; including careful patient selection, providing patient/family/caregiver education, identifying individualized treatment goals, performing ITB test dose in our clinic setting with the family/caregiver present, arranging a follow up appointment to discuss test dose results, if appropriate arrange for surgical implantation, manage titration, optimization and maintenance phases of ITB therapy.
Seventeen patients have been evaluated using the MS Center multidisciplinary approach. A total of fifteen out of seventeen patients had an improvement in spasticity following ITB test dose. Thirteen patients were referred on for ITB implantation.
ITB is an option for management of moderate to severe spasticity in MS patients. Using a multidisciplinary approach to ITB patient selection and evaluation results in optimal care of MS patients with spasticity. ITB management requires long-term commitment of a dedicated MS multidisciplinary team and ongoing evaluation of the patient’s response while managing their complex health needs.